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Transcript of Sfbt us pt
Solution Focused Brief TherapySolution Focused Brief Therapy
Steve de Shazer Steve de Shazer & Insoo Kim Berg& Insoo Kim BergO'Hanlon O'Hanlon
"Solution Behaviour" not "Problem Behaviour""Solution Behaviour" not "Problem Behaviour"
Social ConstructionistSocial Constructionist
Focus on what clients want to achieve Focus on what clients want to achieve
Doesn't focus on problemsDoesn't focus on problems
Doesn't focus on pastDoesn't focus on past
How Brief a Therapy?How Brief a Therapy?
Aim for 5 sessionsAim for 5 sessions
45 mins each session45 mins each session
Rarely beyond 8 sessions Rarely beyond 8 sessions
Sometimes 1 session enoughSometimes 1 session enough
Any improvements after 3 sessions?Increase Any improvements after 3 sessions?Increase gap between sessions as time goes ongap between sessions as time goes on
Solution Focused Brief TherapySolution Focused Brief Therapy
Principle 1Principle 1
Nobody's perfect all the time - even in their Nobody's perfect all the time - even in their problemsproblems
What can these "exceptions" tell usWhat can these "exceptions" tell us
Things people ordinarily do can contribute to Things people ordinarily do can contribute to solution solution
Solution Focused Brief TherapySolution Focused Brief Therapy
Principle 2Principle 2
Knowing where you wish to be makes getting there Knowing where you wish to be makes getting there easiereasier
Problems cloud our view of futureProblems cloud our view of future
Lose sight of what we want apart from ending Lose sight of what we want apart from ending problemproblem
Clearer it becomes, greater chance of making Clearer it becomes, greater chance of making solutionsolution
Basic Assumptions Clients have resources and strengths to
resolve complaints Change is constant The therapist’s job is to identify and amplify
change It is usually unnecessary to know much
about the complaint in order to resolve it. It’s not necessary to know the cause or
function of a complaint to resolve it.
Basic Assumptions continued
A small change is all that is necessary. A change in one part of the system can affect
change in another. Clients define goals There is no one right way to view things.
Different views may be valid. Focus on what is possible and changeable,
rather than what is impossible and intractable.
3 types of Clients Visitors: no complaints, along for the
ride; complimented and given no tasks Complainants: going along to placate
and appease; complain, distant, observant, and expectant - given observational and thinking tasks
Customers: Do Something – want to change; given behavioural tasks
Solution Focused Brief TherapySolution Focused Brief Therapy
Ask questions about. . . Ask questions about. . .
Client's storyClient's story
Client's strengthsClient's strengths
Client's resourcesClient's resources
Client's exceptionsClient's exceptions
RelationshipsRelationships
Self-esteem issuesSelf-esteem issues
Resources & Resources & ToolsTools
Miracle QuestionMiracle Question
ScalingScaling
Exception-seeking questionsException-seeking questions
Coping questionsCoping questions
Problem-free talkProblem-free talk
Typical First Session Opening: Social introductions,
structure session Collect Complaints - Problem Rank Complaints
(What’s 1st, 2nd, 3rd) Discuss Exceptions
"Best hopes of our work together?"Best hopes of our work together?"
Miracle questionMiracle question
"Tell me about when the problem is not there""Tell me about when the problem is not there"
"What would others notice about you?"What would others notice about you?
Typical First SessionTypical First Sessioncontinued...continued...
Find out what client wants from sessionsFind out what client wants from sessions
Find out small details of life if problems Find out small details of life if problems solvedsolved
What do they already do that is successful What do they already do that is successful
What might change by taking a small step What might change by taking a small step towards hopetowards hope
Session Structure Miracle question process Exceptions / pre-session changes Identify Goals Scales: situation now, willingness,
confidence Anything else/ Break Message
Subsequent Sessions Less Time on Complaint(s) More Time on Exceptions & Solutions
Opening: What’s different this week from last Exceptions: elicit, recognise, discuss, amplify Scaling: Accentuate any improvements
Therapeutic Break – time for reflection & consider task for next week
Compliments & Summary Tasks & Homework
Five Useful Questions The Miracle (Magic Wand) Question Has anything been better since the last
appointment? What’s changed? What’s better?
Can you think of a time in the past (month / year / ever) that you did not have this problem? What would have to happen for that to
occur more often? Scaling Questions 1 – 10 With all of that going on, how do you manage
to cope?
Coping QuestionCoping Question
Identify clent resources they dont even acknowledgeIdentify clent resources they dont even acknowledge
Can be used even in most pessimistic situationsCan be used even in most pessimistic situations
Genuine curiosity helpsGenuine curiosity helps
Genuine admiration for client helpsGenuine admiration for client helps
Helps identify referred futureHelps identify referred future
Ensure client doesn't feel you're contradicting themEnsure client doesn't feel you're contradicting them
"Despite all the problems you still work. How you do it?""Despite all the problems you still work. How you do it?"
De Shazer’s MiracleSuppose that one night, while you are
asleep, there is a miracle and the problem that brought you here is solved. However, because you are asleep you don't know that the miracle has already happened. When you wake up in the morning, what will be different that will tell you that the miracle has taken place? What else?
(1988)
O’Hanlon’s Videotape Question Let’s say that a few weeks or
months of time had elapsed, and your problem had been resolved. If you and I were to watch a videotape of your life in the future, what would you be doing on the tape that would show that things were better? (1987)
Scaling
Scale of 1 – 10 1 is the worst it’s ever been 10 is after the miracle has happened
Where are you now? Where do you need to be? What will help you move up one point? How can you keep yourself at that point?
Exception Questions Tell me about the times when (the
complaint) does not occur, or occurs less than at other times.
When does your partner listen to you? Tell me about the days when you wake up
more full of life. When are the times you manage to get
everything done at work?
Comparing PCT and SFBT
1. PCT because historically it is a fundamental therapuetic approach has influencedmost approaches that have followed. Even CBT is now delivered from anempathetic relationship, albeit asymetric. SFBT is no different it draws on empathyand the relationship too.2. Most therapists now integrate different elements into their practice thereforecomparisons are based on unrealistic ideal types.
Similarities
1. Both are client centred and value the client as the author of their own lives.
2. Both emphasise client talk and see therapist utterances as having locutionary force e,g. metaphor paraphrasing and the miracle question, What and how something is said is important for both.
3. Both are minimally directive especially compared to behavioural oriented therapies e.g. CBT and DBT.
4. Both value the here and now in contast to psychoanalytic approaches.
5. Both rely on tentative dialogue as opposed to direct challenge.
6. Both focus on the clients frame of reference.
Differences
1. In later Rogerian therapy there was/is an ultimate counselling/existential goal ie to become a fully self actualised being. SFBT is more concerned with short medium term goals focused on more effective adaption or coping.
2. The above is based on philosophical differences related to the nature of reality. For SFBT it is socially constructed and relative. For Rogers scientific truth was possible and differences of world view were temporary not eternal.
3. PCT therapists tend to reflect and paraphrase whereas SFBT therapists would use questioning more to draw out the clients thoughts and emphasise positives.
Differences
4. SFBT will use reinforcing techniques for behaviours and attitudes it sees as positive (within the frame reference) e.g. the therapist compliments the alcoholic for drinking less.
5. SFBT is short 5-8 45min sessions. In theory PCT can be for as long as the client wishes with the proviso that the therapist can end if they believe it unproductive.
6. Possibly, PCT can “allow” acceptance of immutables such as death and inequality whereas SFBT is about amplifying hope in order to better cope.
Useful ReferencesUseful ReferencesBerg, I. K. (1991) Family Preservation: A Brief Therapy Workbook. Berg, I. K. (1991) Family Preservation: A Brief Therapy Workbook. London: BT Press.London: BT Press.
Berg, I.K. & Miller, S. (1992) Working with the Problem Drinker: A Solution Berg, I.K. & Miller, S. (1992) Working with the Problem Drinker: A Solution Focused Approach. New York: Norton.Focused Approach. New York: Norton.
de Shazer, S. (1985) Keys to Solution in Brief Therapy. New York: Norton.de Shazer, S. (1985) Keys to Solution in Brief Therapy. New York: Norton.
George, E., Iveson, C. & Ratner, H. (1999) Problem to Solution: Brief George, E., Iveson, C. & Ratner, H. (1999) Problem to Solution: Brief Therapy with Individuals and Families. London: BT Press.Therapy with Individuals and Families. London: BT Press.
Hawkes, D., Marsh, T. & Wilgosh, R. (1998) Solution-Focused Therapy: A Hawkes, D., Marsh, T. & Wilgosh, R. (1998) Solution-Focused Therapy: A Handbook for Health Care Professionals. Oxford: Butterworth–Handbook for Health Care Professionals. Oxford: Butterworth–Heinemann.Heinemann.
Hoyt, M. F. (1984) Single session solutions. In Constructive Hoyt, M. F. (1984) Single session solutions. In Constructive
Therapies (ed. M. F. Hoyt). New York: GuilfordTherapies (ed. M. F. Hoyt). New York: Guilford..
Useful ReferencesUseful ReferencesJacob, F. (2001) Solution-Focused Recovery from Eating Distress. London: Jacob, F. (2001) Solution-Focused Recovery from Eating Distress. London: BT Press.BT Press.
Lethem, J. (1994) Moved to Tears, Moved to Action: Brief Therapy with Lethem, J. (1994) Moved to Tears, Moved to Action: Brief Therapy with Women and Children.London: BT Press.Women and Children.London: BT Press.
MacDonald, A. J. (1994) Brief therapy in adult psychiatry. Journal of Family MacDonald, A. J. (1994) Brief therapy in adult psychiatry. Journal of Family Therapy, 16, 415–426.Therapy, 16, 415–426.
O'Connell, B. (1998) Solution-Focused Therapy.London: Sage.O'Connell, B. (1998) Solution-Focused Therapy.London: Sage.
Rhodes, J. & Ajmal, Y. (1995) Solution-Focused Thinking in Rhodes, J. & Ajmal, Y. (1995) Solution-Focused Thinking in Schools. London: BT Press.Schools. London: BT Press.
Sharry, J. (2001) Solution Focused Groupwork. London: Sage.Sharry, J. (2001) Solution Focused Groupwork. London: Sage.
Talmon, M. (1993) Single Session Solutions. New York: Addison-Werlely.Talmon, M. (1993) Single Session Solutions. New York: Addison-Werlely.