E is for Exceptions

It may be that de Shazer’s first published reference to ‘Exceptions’ was in his book ‘Keys to Solution in Brief Therapy’ (1985). There he refers to ‘exceptions to the rule (of the problem)’ and he goes on to describe exceptions as ‘an important concept developed jointly by the author, Wallace Gingerich and Michele Wiener-Davis to describe what the therapist is after during the first session’ (ibid, p 34). However despite describing ‘exceptions’ as ‘an important concept’ de Shazer does not define exceptions particularly clearly in Keys, nor does he have a great deal to say about them beyond stating ‘it seems overly simple-minded to say that nothing is ever exactly like anything else’ (ibid, p 34) and then using the example of dry-bed nights when a child is regarded by his parents ‘as always wetting the bed’ (ibid, p 34). The centrality of the concept which is stated but perhaps not developed in Keys is clearer in the Milwaukee team’s 1986 paper ‘Brief Therapy: Focused Solution Development’. Here the team sets out a first session ‘format’ with 7 elements, the first three of which are as follows:

1. Introduction to our set-up and procedures.

2. Statement of the complaint.

3. Exploration of exceptions to the rules of the complaint.

As regards this third element the paper states ‘This phase of the interview is designed to find out what happens when the complaint does not happen and how the family gets this exception to happen. What happens when the couple's fights do not become violent? What happens when Johnnie's bed is dry? What happens when Susie does what she's told? What happens when mother is there and not father? What happens when they do communicate?’ (de Shazer et al., 1986 p 211). The authors elaborate stating ‘Our view is that both therapist and clients need to know what the clients do that works or is effective. Not only can this discussion lead to some models for intervention design and solution, but it implicitly lets the client know that the therapist believes that they not only can do - already are doing - things that are good for them’ (p 211). The authors conclude this section by stating ‘This phase naturally leads to goal setting because the client may just want more of what happens when the complaint does not happen. The simple fact that sometimes the complaint happens and sometimes it does not, helps to create the expectation that a future is possible which does not include the complaint’ (p 212). Returning to Keys de Shazer argues ‘… any intervention into a (problem) pattern based on the (client’s) . . . exceptions to that pattern will have the benefit of fitting, since it is part of the (client’s) reality (it is after all, their solution)’ (de Shazer, 1985, p 34). Let’s look at this in practice.

In 1990 Chris Iveson, Harvey Ratner and I first invited Steve de Shazer to London to spend 3 days with us, 1 day with our team and two days presenting to a much bigger audience. During the clinical day Steve demonstrated his approach with a live session with a new referral, a husband and wife and their two children, a boy and a girl. This short piece of transcript starts 2.27 minutes into the session after a very short period of social talk/problem-free talk.

1.  Therapist: Hmm. OK. So…what brings you guys here today?
2.  Husband: Well, it’s my money problems actually.
3.  Therapist: How so?
4.  Husband: Well, I do spend a lot of money.
5.  Therapist: A-ha
6.  Husband: But, mainly what I do is I sneak the money out as well, for our rent, food money and things like that.
7.  Therapist: OK. And what, er (thinking pause) what do you do when you resist the urge to take the money? (3.05)
8.  Husband: I do try.
9.  Therapist: Yeah. When was the most recent time you’ve overcome the urge to take, when you’ve resisted the urge to go out and spend it? . . . . When’s the most recent time?
10.  Husband: Well, I must admit it’s been this week.
11.  Therapist: This week sometime?
12.  Husband: Because I’ve been without . . . not much money really, so…forcing myself not to do anything like that.
13.  Therapist: Sometime this week? Today, yesterday?
14.  Husband: Today.
15. Therapist: Yeah? . . . Hmm. How did you do it?
16.  Husband: Just planned it out “no won’t do it”.
This example fits well with the ‘format’ outlined in the de Shazer et al. paper of 1986 just that he seems to have substituted a brief period of social talk for the ‘Introduction to our set-up and procedures’. So 1 to 6 are focused on the ‘statement of the complaint’ and at 7, three minutes and 5 seconds into the session, de Shazer asks an exception question ‘OK. And what, er (thinking pause) what do you do when you resist the urge to take the money?’ As the Milwaukee team state ‘In short, our view holds that clients already know what to do to solve the complaints they bring to therapy; they just do not know that they know’ (de Shazer et al., 1986 p 220).

At BRIEF, over a period of time, our definition of ‘exception’ became more inclusive. Of course we would enquire about those times when all the conditions for the problem to happen were in place and yet the problem did not happen, but over time we came to  include in our definition times when the problem happened less, lasted less long, was less intense, was experienced as less limiting or restricting. And naturally once the client had brought to mind any of these exception times we would enquire, as de Shazer does at 15 in the transcript, ‘how did you do it?’. So in 1985 de Shazer described exceptions as ‘what the therapist is after during the first session’; they are viewed as central, key to both goal-setting and to the construction of expectation and of fit. In BRIEF’s first book Problem to Solution (George et al.,1990) we followed de Shazer closely and exceptions are at the heart of our thinking but by 2012 when the BRIEF team published ‘Solution Focused Brief Therapy: 100 Key Ideas and Techniques’ (Ratner et al., 2012) exceptions have receded into the back-ground of our practice and now find themselves of secondary significance. The reason for this change is BRIEF’s focus on ‘straightening the line’ (George, 2016). In order to construct an exception we require a statement of problem; after all exceptions are defined as exceptions to the rule of the problem but by 1999 BRIEF is already opening first sessions with the ‘best hopes question’ (George et al., 1999) and following that with a detailed description of the preferred future. Why would we then elicit a complaint statement merely in order to construct exceptions with the client? Surely it would make more sense to follow the preferred future description by enquiring about ‘instances’ (George et al., 1999: p 27, Ratner et al., 2012, p 107)) of the preferred future already in place? Why loop back, as it were, through the problem if that is not necessary? So when are exceptions still useful?

Some clients come to therapy in a state of problem-domination, firmly focused on the problem that is troubling them and finding it difficult to make the shift into ‘solution talk’. The therapist’s invitation to focus on a preferred future might represent a step too far for the client, too large a leap. In these circumstances asking about exceptions allows us to work in a more problem-proximate way, asking about the times the problem does not occur means that the conversation stays closer to the problem than asking about the preferred future and thus may make more sense to the client. The rationale for asking exception questions is therefore related to the necessity to ‘fit’ sufficiently with the client, they represent a requirement rather than a preference, in a similar way perhaps to ‘coping questions’.

Finally in Clues de Shazer writes ‘Exceptions are not discovered, they are invented during the conversation between client and therapist. They are an element of a description, not a fact of real life’ (de Shazer, 1988, p 188). So what does he mean here? Well perhaps there are two thoughts to which de Shazer is pointing us. Clients typically come to therapy with problems. There are also times when the problem does not happen and so on. Often the client does not notice these ‘not-happening’ times and if they do sees these times as insignificant. Through asking about them and focusing on them the ‘not-happening’ times are transformed into exceptions, and when the client is aware of exceptions, the presence of exceptions changes the meaning of problem and changes the client’s idea of their relationship with the problem and thence of themselves. In addition whilst here de Shazer refers to exceptions the point that he is making is a broader point rather than a point specific to exceptions. In therapy ‘the therapist participates in inventing the therapeutic reality’ (ibid, p 188) he states since after all ‘the therapist never actually deals with “problems”, rather she deals with her clients’ reports or depictions of the “problems”’ (ibid, p 11). The relationship between ‘therapy talk’ and ‘real life’ is uncertain and even when we might like to believe that the client has changed all that we can know for certain is that the client is ‘depicting things differently’ (ibid, p 188). Yes indeed – ‘therapy is nothing but a bunch of talk’ (de Shazer, 1989)!

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, S. (1989) Therapy is nothing but a bunch of talk. Paper presented at Social Work Symposium, Poughkeesie, New York.
de Shazer, S., Kim Berg, I., Lipchik, E., Nunnally, E., Molnar, A., Gingerich, W., Weiner Davis, M. (1986) Brief Therapy: Focused Solution Development. Family Process 25:207-221.
George, E., Iveson, C. and Ratner, H. (1990) Problem to Solution: Brief Therapy with Individuals and Families. London: BT Press   
George, E., Iveson, C. and Ratner, H. (Revised and expanded Edition 1999) Problem to Solution: Brief Therapy with Individuals and Families. London: BT Press
George, E. (2016) Straightening the line. https://www.brief.org.uk/blog/2016/02/02/straightening-the-line/
Ratner, H., George, E., Iveson, C.  (2012) Solution Focused Brief Therapy: 100 Key Ideas and Techniques.  London: Routledge   

Evan George
London
03 November 2024