'I think the stroke doctors are wrong, on the ward they told me I would get better for 2 years then stop, but here I am 2 ½ years on and since these sessions I'm better, I'm making changes, I can see the ‘sign’ (where I need to go) and it's me doing it’.
Stroke Survivor aged 38
I remember feeling fascinated at University, whilst training to be a Speech and Language Therapist. How we humans have an innate urge and ability to communicate. Years were spent delving in minute detail into everything that can go wrong as we learn to communicate or everything that we can lose should we develop an acquired condition (Stroke, Progressive conditions, cancer etc…). I use the term ‘Communication’ as this is in what we as Speech and Language Therapists are expert (that and swallowing conditions). There is a common misconception that we just ‘teach someone to talk proper’! It is only when you or your family needs us, do people see what it means to struggle in some way to communicate or to eat and drink. Communication is so much more than just speech. Communication is understanding, expression, social, emotive and psychological. As a newly qualified therapist, I would thrive from the investigative process, the assessment - what had gone wrong and how could I fix it. Months would be spent seeing both adults and children, increasing vocabulary, correcting sounds, teaching strategies. I’d be proud of my little thank you cards - telling me how much I had helped someone. Some clients did really well, others made very few changes and some just seemed to disappear after a time.
Then in 2006 Solution Focus appeared in my life - I was hooked, but did it fit with S&L therapy? Could I do both? Over the following decade I would start to knit Solution Focus and S&L together. I didn’t realise back then when I suggested my best hopes, what difference it would make to me as an S&L therapist - or perhaps I did- if someone had asked me the question?
So why do Solution Focus and S&L Therapy fit together and what difference has it made to my practice as a S&L Therapist?
Exceptions
Both Solution Focus and S< look for exceptions.
Steve de Shazer noticed in his sessions that there were exceptions, times the problem wasn’t happening. This made sense to me. There were times for instance when a client who stammers was able to say what they wanted to say confidently. Times a person with aphasia was able to communicate their needs. To be able to support someone who is struggling with communication we have to look for exceptions to be able to move forward. Solution Focus enhanced my view of exceptions even more - allowing me to spend less time focusing on the problem and assessment process, to more time spent tapping into those exceptions and a person’s strengths. Often with creativity - resources are found that enable a client to communicate in a way that is right for them.
Invitational
It all seemed so simple - I actually need to ask this person/ family sat in front of me what they want. What are your best hopes from our talking together? Don’t get me wrong I did ask patients what their goals were, always setting some Speech and Language Related SMART target, but what did the goal of ‘To be able to say 50 more words in 3 months’ really mean or matter - until you ask ‘What difference would that make?
In my practice there has been a shift from advice to suggestions rather than ‘here are some strategies that I think would help’ it might sound like ‘Here are some ideas other people who stammer…. (insert other condition) have found useful, you may wish to try some and see what works for you’. Interestingly in Stammering most of what we know helps in S&L therapy has originated from people who stammer, they show us what works and if it works- let’s do more of that.
Productive
Chronic underfunding and staff shortages mean waiting lists for Speech and Language Therapy can be long. Solution Focus has helped reduce wait times and I feel made my work more productive and less stressful. My clients are seen for as long as they need to. I no longer work to 6 week blocks of therapy- just what they say they require. Sessions are guided by the clients’ best hopes, so I know we are on track and working towards meaningful ‘goals’. I use this term loosely as I don’t set goals anymore. My patients set us on a direction. In S&L therapy we use something called TOMS (Therapy Outcome Measures) to measure change and outcomes for therapy. Solution Focus conversations help provide the detail for change in a client’s activity, social participation and wellbeing.
‘Very productive sessions - I’ve given you a lot of information, maybe more than what I would have done to somebody else, and that’s down to your approach and how you approach it, if I’d of come into the room and you’d have just been taking it as a job rather than trying to help somebody, I’d have walked straight out again, but I can see what you are trying to do and that makes a whole difference to me, that relaxes me and in effect helps my stress and anxiety’
Patient with Functional Neurological Disorder aged 59
Collaborative
SF has allowed me a more positive relationship with my clients, noticing strengths in the person as opposed to the problem and a shift from being the only expert in the room to two. The expert in S< and asking questions and the expert in their best hopes and life. I feel privileged to see individual’s every day with such unique qualities and strength.
‘I feel listened to and taken seriously, that helps a whole lot’
Patient aged 17 with a stammer
Blended
I have found much if not all of my assessment can be completed during the Solution Focus process. Conversation gives me the wealth of interaction and language to inform my requirements for Speech and Language Therapy. Any further assessments will only be required if it fits with a client’s best hopes. Treatment can also be blended into sessions. Giving a client time to have a conversation with an expert facilitator is speech therapy at it’s best.
Strength based
Solution Focus plays to our strengths and our clients - As a whole Speech and Language Therapists tend to have strengths and resources that help us to use Solution Focus effectively. Speech and Language Therapists are often flexible and creative - I think the question ‘How do I use Solution Focus with someone who can’t communicate/ doesn’t speak English well/ is a child?’ comes up in nearly every Solution Focus training course I have attended. But interestingly not when training S&L therapists. This is because we know everyone can access these ideas and questions in some way - you just need to get creative. The Solution Focused session may look very different for instance for a group of teens who stammer vs an adult presenting with severe aphasia after a stroke. The SF process is the same, the person just has different needs. Whether there is more silence, more use of pictures/ objects, gesture, writing or playing, it all works. S< are also able to listen - really listen, to tolerate silence - just to wait. Our clients often need more time to say what they want to say, so we wait. I will never under-estimate the power of silence and all that it provides.
Aspires to invisibility
Insoo Kim Berg’s ‘leaving no footprints’ mantra struck me. When Evan George said ‘we do not have the right to waste our clients time’ it made me reflect. My clients wanted to be living a life that was right for them. Given that no-one has ever said to me ‘my best hopes are to be sat in this very tiny clinic room talking to you for years’. Something needed to shift. I no longer have the need to feel like I’ve rescued a client - have them tell me how much I’ve helped them (or get those nice cards). The joy now comes from hearing the statement ‘I did this’, in whichever time frame suits them, (which by the way is hardly ever years).
‘These sessions have really helped, I’ve changed the way I think about stammering, I’m not worried about it, I’m talking, living my life and accepting it. Even my son doesn’t need therapy now. It’s ok to stammer’.
Mum who stammers.
For me, the ‘Two Mountains’ metaphor (Harris 2009, P59) sums up how Solution Focus and S&L Therapy fit together. Solution Focus and S&L Therapy are like individual mountains. Both strong and complete in themselves. Together though, they create an entirely new landscape, valleys teeming with new possibilities and hope.
References
Burns, Kidge (2nd edition, 2016) Focus on Solutions: a health professional's guide London: SolutionsBooks.
de Shazer, Steve, Dolan, Yvonne, Korman, Harry, Trepper, Terry, MacCollum, Eric and Berg, Insoo Kim (2007) More Then Miracles: the state of the art of solution focused therapy. New York: Haworth.
Enderby, P., John. A., Petheram, B. (2013) Therapy Outcome Measures for Rehabilitation Professionals: Speech and Language Therapy, Physiotherapy, Occupational Therapy. Wiley: Chichester.
Harris, R. (2009) ACT with Love: Stop Struggling, Reconcile Differences, and Strengthen Your Relationship with Acceptance and Commitment Therapy. New Harbinger Publications.
Ratner, H., Yusuf, D. (2015) Brief Coaching with Children and Young People: a Solution Focused approach. London: Routledge Ratner, H., George, E., Iveson, C. (2012) Solution Focused Brief Therapy: 100 Key Ideas and Techniques. London: Routledge
Shennan, Guy (2014) Solution-Focused Practice: Effective communication to facilitate change. Basingstoke, Hampshire: Palgrave Macmillan.
Alex Ford
Highly Specialist Speech and Language Therapist
