What do we do as Solution Focused Practitioners when our client says to us ‘I really need to know why I am (depressed, anxious, anorexic, bulimic, bi-polar . . . . )’. This question was asked again this week by a very engaged participant on our BRIEF Level 1 programme however interestingly it is a question that is asked on courses more often than the scenario that the question implies seems to actually happen in practice. I do remember a client saying this to me in 1999 and it must have happened since – but not that often. However if this were to happen tomorrow what might I think of doing? Here are 6 possibilities for practice.
Possibility 1. Wrong shop. Steve de Shazer liked to describe the Solution Focused approach as ‘just a bunch of talk’ (1989). He would state that The Solution Focused approach contains no explanatory theory; it neither seeks to explain why problems occur nor, in any elaborated way, why and how change happens. SFBT he explained is a description of a way of talking with people that is associated with clients reporting change and no more (and of course no less). Theory in the sense that he used the word was defined as follows “Theory as I use the term, is not meant as an explanation, but rather as a coherent description of specific sequences of events within a specific context” (de Shazer, 1988, pp 62 – 63). Were the client to ask for an explanation of why they have their problem the Solution Focused practitioner could, with justification, argue that the Solution Focused approach has no way of explaining, it has no theory of problem, it is merely, although rather usefully, a way of talking with people that leads most people to report changes relatively quickly. In other words if the client wants an explanation rather than life change they have come to the ‘wrong shop’, they have come to a change shop rather than an explanation shop.
Possibility 2. No way of knowing . . . for sure. A more radical although probably risky response would be to question the possibility of anyone truly being able to know for sure why people have problems. We could say to the client that if we had a panel of 20 mental health practitioners in a room all coming from different ‘therapeutic’ persuasions that they would be likely to come up with 20 different explanations. A psychiatrist might come up with an organic explanation, a CBT therapist might propose a cognitive explanation in terms of the way that the client is constructing and making sense of their world, a systemic therapist might offer an explanation in terms of patterns of interaction, a therapist for whom attachment theory was central might look back to early bonds and attachments and so on and so on. Whilst the 20 therapists in the room might be tempted to argue for the correctness of their own (pet) explanation actually all of them might know in their heart (or their head or wherever we might know things) that truth claims in relation to explanations are not justifiable. These ‘explanations’ merely hold the status of hypotheses and the question is not whether they are true but whether they are useful in the sense of productively guiding the therapist’s intervention. And indeed even if the intervention based on a particular explanation works it does not mean that that explanation was the right explanation since after all there is no way of knowing that an intervention based on a competing explanation might not have worked. Knowing why a problem has happened is in fact unknowable – for sure! All that we can ever do is to have ideas, to generate possibilities, and given the inevitable uncertainty it behoves us to hold our hypotheses lightly. de Shazer in ‘Putting Difference to Work’ (1991) talks about an analogous problem ‘it has always seemed to me that rigorous descriptions of what works, including decision-making criteria for figuring out what to do in specific clinical situations, are sufficient. But the question “How does it work?” always seems to arise. My position has been that one cannot know how it works, one can only know that it does work. Answers to the question “How does it work?” always involve speculation.And to speculate, to conjecture, is a matter of storytelling; it is fiction. Therefore, until quite recently, my response to the question “How does it work?” has been “Make up your own explanation: It is as good or better than mine”.’ (pp xvii – xviii).
Possibility 3. Make up your own. Following the last point that de Shazer makes, and perhaps influenced in addition by the work of Plamen Panayotov and his Simple Therapy, we could ask our client “so how do you explain the difficulties that you have been having?’. The client is likely to have an explanation and we can merely endorse it “that makes sense to me too – sounds very possible – although obviously we can never know for sure”. If the client has no explanation then we could ask ‘I guess you have had other people explaining how come things have turned out this way – which explanation makes most sense to you?’. And again on hearing the client’s response we could endorse it whilst still holding on to a little uncertainty, the impossibility of knowing for sure.
Possibly 4. Normal difficulty. Again in ‘Putting Difference to work’ (1991) de Shazer writes “It is, of course, easier to develop a solution to a "normal difficulty" than it is to develop a solution to a "very pathological problem that has roots deep in my infancy” (p 66). So if we felt that an explanation was necessary we should offer an explanation that ‘empowers the client’ to take an active part in the change process. Were we to explain the problem in relation to early childhood experiences then the client might reasonably be led to doubt that they themselves can do anything effective in relation to it, that this sort of complicated difficulty is likely to require expert intervention. An alternative, non-pathologising, empowering sort of explanation might be ‘habit’ “very often people do something that seems a good idea at the time, seems useful at the time, but after a time they get stuck, it becomes a habit, and habits can catch us all out”. Framing the problem, whether it be self-harm, or compulsive behaviours, or substance use as a habit empowers the client. All of us can get stuck with a habit- it is normal. In the same way dissociation can be framed as an initial useful response to an impossible situation but we can get stuck; the solution can outlive its usefulness.
Possibly 5. What difference would it make? And of course we can respond to the request for an explanation in a more conventional Solution Focused conversational way. When the client asks we in our turn could ask “and if you had an explanation that made absolute sense to you what difference would that make?”. The client may respond, for example, with “well I guess that I would just be more confident about my future, less worried about falling back into the problems that I have been having”. We could then respond with “well if we were able to do some talking together and you found yourself more confident about your future and less concerned about the possibility of falling back into the problems of the past and maybe during our talking an explanation had emerged for you but maybe not would that be good enough?”. Most people at this point will agree that this would be ‘good enough’ even if they are initially a little hesitant, indeed a little sceptical about the possibility of feeling better about their life without the explanation that they have assumed to be necessary. In responding this way we are utilising the ‘route and destination distinction’ (George, 2020). The client does not want an explanation merely because they are curious, it is not an end in itself; what they typically want is the difference to their living that they assume that the explanation would make. So we can then offer them the difference that they want, whilst separating it from the route that they had assumed necessary. Now every now and again the client’s construction around the requirement for change has rigidified to the point where the route is as important to the client as the destination. Only the defined route will work for them. And this was indeed the case with my 1999 piece of work. We negotiated together the destination, rather than sticking with the route, and we had a first session which seemed to go well. The client came back and reported that life was better. We spent the session unpacking his account of better and I asked at the end whether he thought that is would be useful to come back for a further session or whether we had done enough. He responded by agreeing that things were better but said that he still wanted an explanation. After some discussion I referred him on to an ‘explanation shop’, a psychodynamically-oriented counselling service. Only at this point did he tell me that his partner was in long-term psychodynamic therapy. Perhaps he wanted some of the same! I hope that it worked for him.
Possibility 6. Change first and explanation afterwards. Finally, another possibility is to respond to the client wanting an explanation with this idea. “Solution Focused Therapy is not focused on explanations and so I could not guarantee that you would reach an explanation during our work. You might but you might not. What about if we do two or three sessions together. You are then likely to be feeling better and if you still want an explanation then I could refer your elsewhere but at least when you were searching for an explanation you would not have to be living with the problems and the difficulties that you have been struggling with. What do you think?” Very few people are likely to still be interested in the explanation when life is going well for them!
I would be really interested to hear what all of you do in these circumstances. Thank-you.
de Shazer, Steve (1985) Keys to Solution in Brief Therapy. New York: Norton.
de Shazer, Steve (1988) Clues: Investigating Solutions in Brief Therapy. New York: Norton.
de Shazer, Steve (1989) Therapy is nothing but a bunch of talk. Paper presented at Social Work symposium. Poughkeepsie: New York.
de Shazer, Steve (1991) Putting Difference to Work. New York: Norton.
George, Evan (2020) Route or destination: a small and very important distinction. https://www.brief.org.uk/.../route-or-destination-a-small...
Panayotov, Plamen (not known) https://www.ebta.eu/.../the_difficulties_and_benefits_of...
Evan George
London
21st April 2024
