What if things get worse?

What if things gets worse?

Most people’s lives do not work in terms of smooth transitions, seamlessly building from difficulty through resolution to self-fulfillment. Would that it were so (or perhaps not)! Most people’s lives are more up and down. Solution focused brief therapy is centred on noticing and working with the ups. Indeed most follow-up sessions start with the questions

‘So what is better?’

But just because the worker asks the client about what is better does not guarantee that the client will answer along the same lines. Indeed the client might, for example, answer by saying

‘Better? You’ve got to be joking. It’s worse. Much worse.’

Or the client might indicate that she has slipped down the scale

‘Last week I was at 6 on the scale. I’d be surprised if I was at 4 this.’

So what  do you do as a brief solution focused practitioner when things deteriorate in the client’s life?

Where is the client now?

First it is important to remember that there is a difference between those clients who are still on the slide ’things are getting worse day by day’ and those clients who have stopped the slide. For example, working with someone who has come to the therapist in relation to his drinking, having made progress the client may well report relapse. At the time of seeing the client again that client may still be drinking or may have stopped again. If the client has stopped again the solution focused worker will want to focus on

‘So how did you stop?’ and

‘So what does that tell you about you and your resources that you managed to stop again?’

If on the other hand the client reports himself still to be drinking the worker might ask

‘Given that you’re drinking what will it take for you to say that this meeting today has been useful to you?’

If the client responds by saying

‘First of all I need to stop again’

that gives a clear direction to the session. The worker might well inquire about what’s been helpful in the past in stopping, use a confidence scale of stopping (0 representing no confidence at all and 10 totally confident) and be interested in what the client will be seeing himself doing differently to be one point higher on the scale. Only when the client has dealt with this might the worker go on to a confidence of stopping and stayingstopped scale, if, of course, this is what the client wants.

Taking the scale example, where the client has slipped from 8 to 4, it is open to the worker to ask the client

‘So how have you stopped the slide at 4? How come you didn’t slide all the way down to 0?’

As the worker develops with the client a focus on what the client has done to ‘stop the slide’ the client is invited to notice what he is doing that is right. This question is another form of ‘so what are you doing to stop things getting worse?’

Life events?

However there are of course times when the deterioration in the client’s situation is associated with a life event or crisis, perhaps the loss of housing or of a job, illness, a child being excluded from school, difficulties in a relationship in the client’s life. At these times there is a dilemma of focus for the worker, a dilemma that within solution focused brief therapy will be best resolved by asking the client

‘So for today to be useful. . ?’

It is important to remember that many of the examples given above often fall into the life situation category in the client’s life, things that can best be coped with or managed rather than things that can be changed. This might lead the worker to ask

‘So what will tell you that you have dealt well enough with Clem’s exclusion to know that you can get on with dealing with your . . .?’

Forgetting?

At times there seems to be no particular reason that the client can see for the deterioration in his circumstances, no crisis, no life situation, nothing but a relapse. At these times it can be useful for the worker to ask the client

‘So what do you think it is that you have forgotten to keep doing?’

The idea that the relapse might be down to something that the client has forgotten to keep doing, after all we all forget things, can help to de-toxify the deterioration. The client can then move out of an accusatory frame of mind, ‘I’m just hopeless. Things never go well in my life’ or ‘changes never last. I always fall back into my old ways’. Sometimes of course the accusations are other-directed ‘You always do that. As soon as I’m improving you can’t bear it and you start. . . ‘ Neither of these frames, with the common element of blaming, whether it be blaming oneself or blaming someone else, are usually associated with energy, creativity and possibility in client’s lives. The sooner most clients leave the blame behind the sooner the client can get on with just figuring out what he needs to do to get back on track.

Learning?

Once the relapse is over or the crisis past then might be the time to ask of the client

‘Having got life back on track what do you think that you can learn from this that could be helpful to you in the future?’

The client’s answer can be followed up by asking

‘And how will others know that you’re putting this new knowledge about yourself and your situation to work in your life?’

This is also the time, very often to use a scale that invites the client to reflect on his confidence of staying on track in future

‘On a scale of 0 to 10 with 0 representing you having no confidence at all of being able to stay on track in the future, and 10 representing you being absolutely confident of being able to do that, however difficult it might be, where do you see things now on that scale?’ 

Evan George August 2010