Tell me what to do

Introduction

Steve de Shazer, the key originator of solution focused brief therapy, was much influenced in his therapeutic development by the work of the Brief Therapy Project at the Mental Research Institute in Palo Alto, California. Indeed John Weakland of that team was both a mentor and friend to Steve de Shazer right up until John Weakland’s death in 1995 and until Steve’s own death in 2005 he always referred to John as ‘my mentor’. The work of the Mental Research Institute (MRI) was, in turn, greatly influenced by the work of Milton Erikson, the American hypnotherapist. Members of that team visited Erikson regularly over a period of some years and Erikson took on almost ‘guru’ status for some of them, influencing without a doubt the later development of their work. One of the outstanding features of Erikson’s work was the way in which he developed the idea of the therapeutic task and indeed the extraordinary nature of the tasks that Erikson prescribed for his patients. The emphasis on tasks, telling people what to do, has indeed been a key feature of the work that followed on from this tradition. Look for example at the work of Peggy Papp of the Ackerman Brief Therapy Project in New York in her book The Process of Change, drawing a distinction, as she does, between compliance and defiance based tasks. Look again at Haley’s development of Erikson’s ideas through his Ordeal Therapy. Now whether these tasks would fit with the client’s idea of being ‘told what to do’ is sometimes doubtful but nonetheless the tradition from which solution focused brief therapy springs had no difficulty in telling people to do things and at times to do quite strange things. de Shazer in early solution focus carried on with the creative tradition of task development. Note for example his ‘skeleton tasks’. What he noticed here was that some tasks seemed to be useful to the client irrespective of the nature of the problem, (previously the task had always been shaped with great care to the specific problem that the client was presenting), and it was noticing this that helped de Shazer to formulate the idea that there is no necessary connection between the problem and the solution. The long tradition within systemic therapy of paying careful attention to the shaping of the task has faded in significance in the work of the BRIEF, to the extent that over 85% of the suggestions offered to clients involve minimally intrusive, noticing type suggestions. Indeed very often no suggestion of any sort is deemed necessary. The change of language here is in itself significant since referring to suggestions rather than to tasks itself signals a shift of position. Tasks are meant to be carried out whilst any suggestion in which the client sees no value will in all probability quietly be ignored or subtly changed by the client into something that could be of more use. The reason for this shift, moving away from prescribing actions to suggesting that the client notice more of what is right, fits with the BRIEF focus on working from a de-centred position where the client experiences himself at the centre of his therapy rather than the therapist with her clever suggestions. So how can we respond when the client says ‘Tell me what to do. You’re the expert aren’t you?’

Useful in past?

Before responding to the client’s request it can be useful first of all to check out with the client ‘has it ever been useful to you in the past when people have told you what to do?’ When the client answers ‘no, it’s never really helped before, the worker can get right back on with asking questions that might make a difference from the preferred, de-centred position.’

Before doing that could I just ask some questions

In these circumstances it is often possible to respond to the client by stating that before offering any suggestion the worker has some more questions to ask. Focusing these questions on instances and exceptions, on what’s worked for the client in the past, what has helped the client to cope, to get through or to get by, will elicit evidence from the client of what he is doing right. The client can then safely be advised to ‘Do more of it’.

3 + 1

If the worker is going to offer advice then it is possible to do this from a position within which the client is still framed as the expert chooser. ‘In this sort of situation in the past I’ve known people who have done x, people who’ve done y and people who’ve done z. All of those have seemed to work for them. You know yourselves much better than I know you so which of those do you think would be most useful for you and your family or do you think that you will find your own and different way of moving forward?’

Experiment

Offering the client a task with which to experiment fits the bill of offering a firm suggestion, implicitly fits the invitation from the client to take on an expert position, but leaves the solution with the client. ‘Until we meet again I’d like you to experiment with something and to watch out carefully for what difference it makes. Each day for one hour in the morning I’d like you to pretend that the miracle has happened and to see how other people respond differently to you. Would that be OK?’ This experimenting was a favourite suggestion of Steve de Shazer’s, used by him for example in the teaching tape ‘the Right Path’. Naturally the worker will follow this up in the next session by asking about the difference that the experiment made and focusing in particular on ‘how did you do that?’ when positive changes are reported.

Worker overwhelmed with certainty

There are times, and all of us might recognise these, whether at the end of a session or during the course of it, that we are overwhelmed with certainly as to what we believe that the client should do to resolve his problem. The certainty can become such that we are incapable of continuing to listen to the client, incapable of continuing to be curious about the client’s life in the face of the whispering that we hear in our ears ‘if only he just did that’, ‘if only he would just do that’. In order to discharge this burden of certainty with a view to getting on with the work the worker can say to the client ‘do you mind me interrupting you for a second? While you’ve been talking I’ve been overwhelmed by an idea of what you could do to sort this out. You’ve probably tried it before and it probably did not work but have you ever tried to …?’ Since the client probably has tried it before and it probably did not work framing the suggestion in this way allows the client not to have to be polite. The client will not feel obliged to protect the worker’s feelings by pretending that this is the first time she has ever heard this (in fact the last 4 workers all said the same thing and it never did work), he will therefore be able to agree with the worker that this does not help. The worker will then be able to get back to work, listening to the client, hearing clues, building possibilities. Of course occasionally the client will reach out to the worker and hold on to the suggestion before she puts it away. Just every now and again our obsessive ideas really are useful. Some workers take the view that it is unethical to withhold a good suggestion. This framing can offer an answer to their dilemma: how do I share the idea in a way that is not overly impositional in the client’s life.

Evan George