What happens In Solution Focused Therapy

The three Basic Questions about Solution Focused Therapy

Solution focused brief therapy is a simple idea but not easy to put into practice. It consists of only three basic questions which, if they can be answered, often lead to dramatic change. The task of the therapist is to ask the questions in a way that leads the client to discover the answers and this requires considerable skill.

Three Questions about Solution focused brief therapy  (And Sometimes a Fourth)

Three basic questions underpin solution focused brief therapy:

• What are your best hopes from this therapy?
• What would your day-to-day-life look like if these hopes were realised?
• What are you already doing and have done in the past that might contribute to these hopes being realised

The task of the therapist is to trust that each client has the answer to these questions and to ask the questions in such a way that the client finds the answers.

Best Hopes – Negotiating the Contract

The basic rule of negotiation between professional and client (whatever the professional service being offered) is to put the client's agenda first. "How can I help you?" being one of the most common starting points. A solution focused negotiation will often begin with "What are your best hopes from this meeting?" Clients will respond across a continuum: "I would like to have a better relationship with my children" and "To get you lot out of my life!" representing different ends. Traditionally the former response would be seen as characterising motivation and the latter resistance. A solution focused response would see them as equally motivated. "So if this meeting helped towards getting us out of your life would that mean it had been useful?" is a response that accepts the client's starting point without closing down potential for agreement. "Let's imagine that this begins to happen – you begin to get on with your life as a person, as a parent in a way that is totally right for you and also okay for 'the authorities', what do you think you'll start to see that is different?" With this question the professional accepts the legitimacy of the client's wishes, makes no attempt to impose an agenda of 'the authority', and legitimately requires merely that the client acts within 'the law' (in its most general sense). If this outcome is achieved then the client will be doing things their way and because they are within what is permissible the authorities will no longer need to be involved. A win-win outcome.

A Preferred Future – What's The First Thing You Would Notice?

After negotiating an agreed goal eliciting a detailed description of its realisation is a key task. For the client above a detailed picture of a day going well is likely to be included in the first meeting. The more detailed and concrete this description the more likely is the client to do it. Such a description might be built up as follows:

"She'd get up when I called her in the morning"
"What effect would that have on you?"
"I'd be surprised – and pleased!"
"How would she know you were pleased?"
"Because I'd tell her"
"And if you told her how pleased you were how do you think she would react?"
"She'd be nicer to me"
"And then?"
"We could start getting on better"
"So now let's imagine things don't happen so fast and she doesn't get up straight away. But it doesn't stop you being the sort of parent you want to be what might you notice about your response?"
"I wouldn't fly straight off the handle and start shouting and screaming at her"
"What would you do instead?"
"I'd leave her a bit and just get on with my own stuff"
"How do you think she might respond to this approach"
"She's a stubborn thing so she might even get herself up – she certainly doesn't when I shout so I may as well not waste my breath!"
"And when she did get up what would she notice about you?"
"I wouldn't be in such a bad mood"
"Instead?"
"I might even say good morning to her – that would be a change!"

The point of these interviews is to keep the descriptions ordinary, mundane and small scale so no part of them is beyond the client's ability. In this instance two scenarios are explored. These are continued into the day. Many professionals are already adept at eliciting detailed descriptions of problem behaviour. Solution focused practitioners use the same skills to describe potential and sought after future behaviour rather than actual and unwanted past behaviour.

What Are You Already Doing? The History of the Preferred Future

The third skill involves discovering what is already working and the often hidden resources at the client's disposal. A useful 'rule-of-thumb here is the more problems a client's has had to face and survive the more hidden resources they are likely to have.

Take the case of an adolescent prone to outbursts of violence at school:

"Tell me about a time when you have been really angry but haven't exploded"
"Yesterday this kid tried to pick a fight with me but I just walked away"
"How did you do that?"
"Because I'll get permanently excluded if I get into another fight"
"I can see why you would want to avoid that but how did you do it?"
"I just thought why should I let him bother me and walked away"
"So even in the heat of provocation you made yourself think – how do you think you did that?"
"I just didn't want to get excluded"
"Does this mean that you are the sort of person who when you really decide something you get on and do it?"
"I suppose so sometimes"
"And when you walked away what would the other kids have noticed that told them you were walking away with strength rather than with your tail between your legs?"

In this sequence an exception to the normal problem behaviour is discovered and explored in a way that is likely to lead to more. When the young man says he walked away "with confidence" the description can continue with the after effects of this success. It then turns out that the rest of the day went very well thus reinforcing the value of the restrained behaviour.

Solution Focused Conversations: Using Scales

With solution focused therapy the conversations look (and are) very simple but they are not easy to conduct. Many of the assumptions that drive them are contrary to the usual assumptions that govern conversations with clients. To begin with there is no intrinsic need to know and understand the problem. Instead the assumption is that knowing what to do next is more helpful than knowing why what you did yesterday was wrong. Another assumption is that no one is perfect and therefore no one can do their problem perfectly. This means that whatever the problem there will always be exceptions and these exceptions contain the seeds of alternative ways forward.

One of the most useful frameworks for solution focused conversations and one that keeps professional and customer on track is the 0–10 scale where 10 represents the hoped for outcome (i.e. the presence of what is desired rather than the absence of what is not) and 0 its opposite. The client's position on the scale allows for questions about how they are at that point rather than lower, how they improved things if they are higher than they have been in the past and what might tell them they are moving up the scale towards their desired goals. These scales can be constructed verbally but they can also be drawn (as mountains, stairs, ladders etc.), built (with chairs, toys, bricks etc.) and so provide the simplest and most concrete of structures for conversations about future hopes, past achievements and current strengths.

The Fourth Question: What's Better

When (if) the client comes back for subsequent sessions they will usually begin with the question What's better? This leads on to a conversation noting all the improvements, what the client did to achieve them, what difference these improvements are making in other areas of their life and how will the client know that things are continuing to improve. At BRIEF every solution focused therapy session, including the first, is seen as potentially the last, the average number of sessions is between four and five, the most common number of sessions is one and 80% of clients report lasting improvement.