R is for Relationship

In both the introductory and the final chapter of their weighty (literally) text The Heart and Soul of Change (Hubble, Duncan and Miller. 1995) the authors draw our attention to the findings of Lambert (1992), citing his conclusions regarding the effective factors in therapy. Lambert’s proposition, often referred to as the Common Factors argument, is that 40% of the change effect in therapy can be ascribed to ‘Client/Extratherapeutic Factors’, 30% to variables relating to the client-therapist relationship, 20% to ‘Placebo, Hope and Expectancy’ and just 10% to ‘Model/Technique factors’. Expanding on the Client-Therapist relationship element Hubble, Duncan and Miller point to ‘a wide range of relationship-mediated variables found among therapies no matter the therapist’s theoretical persuasion. Caring, empathy, warmth, acceptance, mutual affirmation, and encouragement of risk taking and mastery are but a few’ (p 9). Given that in Solution Focused Practice and training there is little overt emphasis on the ‘therapeutic relationship’, indeed the term is not much used in Solution Focused texts other than in the work of Eve Lipchik ( 2002), this raises a question about how the approach manages to achieve such good outcomes, indeed how the approach manages to achieve such good outcomes in relatively few sessions if 30% of the change effect is relationship dependent. One answer to this seeming possible contradiction may be that relationship-enhancing activities lie at the very heart of all that we do in Solution Focused Practice. If a therapy could be thought to have a soul we could argue that the very soul of the approach is ‘relationship-positive’. So what are the practice characteristics in the model that could be thought to foster a strong and positive client-therapist relationship?

1. Centering the client. Since the Solution Focused approach is non-normative every SF practitioner will start by inviting the client to define their own ‘Best Hopes’ (George et al, 1990). The therapist has no view on what the focus should be. As Harry Korman has stated ‘until we know what the client wants we can have no questions to ask’. The client will perforce experience themselves therefore at the centre of the work. There is no assessment to determine what is wrong and what therefore the focus should be. There is no distinction made between ‘want’ and ‘need’, since the worker has no concept of ‘should’. There is no idea of ‘presenting problem’ and ‘underlying problem’, a framework common in mental health settings which invariably relegates the client’s knowing to second-class knowing. The client is the expert on their life. Only the client can answer the question ‘what are your best hopes from our talking together?’ The worker’s success or failure is assessed by the client ‘has this worker supported me in moving my life in my preferred direction?’. The worker is, in this sense, the servant of the client.

2. Appreciating. The Solution Focused worker adopts a position of ‘radical trust’. We choose to hold the assumption from our very first point of contact that the client is competent, that the client has the capacities necessary to make the changes that they specify, that the client is motivated towards change, and that the client is giving of their best. The Solution Focused worker is never critical of their client. Indeed if the work is showing no evidence of progress the Solution Focused worker, rather than choosing to blame their client’s ‘failure’, will turn their gaze onto themselves and ask the question ‘what am I doing that is not working here?’. The Solution Focused worker takes responsibility. Solution Focused workers will even take care in how they are talking about their clients in their clients’ absence, choosing only ever to talk as if the client was hearing every word that they are saying.

3. Co-constructing. Solution Focused Therapy is not a process that is done on or at or to our clients. It is a collaboration. We ask a question and the client answers and the worker’s subsequent response should both take account of the client’s statement and build on it. In Solution Focus we build our questions on the client’s last response, typically using their own words rather than our own. The client’s experience therefore should be, when the process is going well, an experience of exquisite attention, an experience of a worker listening hard, altering their tone to fit the client’s last response, concentrating on the client’s responses, working really hard to frame the next useful question. Experiencing a professional working so hard in this detailed way naturally gives the client the message ‘you are worth it’. And of course every answer that the client gives us is the right answer. There are no wrong answers in our approach. We choose to work with whatever the client says rather than challenging.

4. Partnership monitoring. At the beginning of my work with clients I will often say something along the lines of ‘there is no need for you to answer any question that you would prefer not to answer and if for any reason you begin to think that we are going in the wrong direction or that something important is being missed out could you please tell me – I really want this to be of use to you’. This framing invites the client into an active partnership – the client is not a passive recipient of the process. In addition we might well check as we progress through the conversation ‘is this making sense?’ or ‘are we talking about the right things?’ or indeed, as the client describes their preferred future, just checking ‘and if that were to happen would you be pleased’ or ‘would that be a shift in a good direction?’. These sort of questions repeatedly ensure that the therapist has not got disconnected from the client, that therapist and client are indeed still in partnership. And of course at the end of most sessions I will ask the client, prior to the final ending sequence, ‘and is there anything that you had in mind to say today that I have not given you the opportunity to say?’.

So here are four practices client-centering, appreciating, co-constructing and partnership monitoring that are embedded in Solution Focused conversations, that are foundational in our practice, and if, it seems to me, we honour these principles of practice in our work then the outcome will inevitably be to enhance the therapist-client relationship. As it happens the Solution Focused approach is also rather effective in relation to the ‘client/extratherapeutic’ factors and ‘placebo, hope and expectancy’. Everything that we do in the approach tends to enhance expectancy and inviting the client to watch out for pre-session change is just one amongst many ways of celebrating the extratherapeutic in our conversations. If Lambert is right in his Common Factor theory then no wonder Solution Focus works!

George, E., Iveson, C. and Ratner, H. (1990; Revised and expanded Edition 1999)

Problem to Solution: Brief Therapy with Individuals and Families. London: BT Press

Lambert, M. (1992) Implications of Outcome Research for Psychotherapy Integration. In J. C. Norcross & M. R. Goldfried (Eds.), Handbook of Psychotherapy Integration (pp 94 – 129). New York: Basic Books.

Lipchik, Eve (2002) Beyond Technique in Solution-Focused Therapy. New York: Guildford.

Hubble,M., Duncan, B., Miller, S. (1999). The Heart and Soul of Change. Washington, D.C. : American Psychological Association.

Evan George

London

09 March 2025.