Solution-Focused Brief Therapy Concepts

N321: Therapeutic Interventions for Individuals and Groups

• Course taught by Michelle Patterson, RN, BSN, MN, October 2024
• Focuses on therapeutic interventions for individuals and groups.

Postmodern Approaches

• Solutions Focused Brief Therapy
• Motivational Interviewing
• Narrative Therapy
• Collaborative Language Systems Approach
• Postmodern Approaches in Groups

Modernist vs. Postmodernist

• Modernist:
  • Objective reality can be accurately described and observed.
  • Objective reality can be systematically known through scientific methodology.
  • Reality exists independent of any attempt to observe it.
  • Clients seek therapy when faced with a problem caused by deviating from the norm.
• Postmodernist:
  • Social constructionism: values the client's reality without questioning its accuracy.
  • Clients are experts of their lives.
  • There is not one right or wrong way to live life.

History of Social Constructionism

• Focus on diversity, multiple frameworks, and integration.
• Seeks to provide a wider range of perspective in counselling practice.
• Change begins by deconstructing the power of cultural narratives, specifically the dominant cultural positions that exist in society.

Postmodern Therapies

• Solutions-focused brief therapy
• Motivational Interviewing
• Narrative therapy
• Collaborative language systems approach

Solution-Focused Brief Therapy

• Initially developed by Steve de Shazer and Insoo Kim Berg in the 1980s.
• Future-focused goal-oriented therapy approach to brief intervention.
• Focuses on strengths and resilience of people by focusing on exceptions to the problem and their conceptualized solutions.
• Emphasis is on constructing solutions rather than problem-solving.
• Therapists assist clients in finding exceptions to their problems.

Positive Orientation

• Based on the assumption that people are healthy and competent and have the ability to construct solutions that can enhance their lives.
• We already can resolve the challenges life brings us, but at times we lose our sense of direction or our awareness of our competencies.
• The therapist's role is to help clients recognize competencies.
• Therapists can assist clients in shifting from a fixed problem state to a world with new possibilities.

SFBT Basic Philosophy

• Change is constant and inevitable.
• Clients want change.
• Clients are the experts and define goals.
• Future orientation – history is not essential.
• Emphasis is on what's possible & changeable – do something differently.
• Short-term and only small amounts of change are needed.
• Problems are maintained by doing more of the same and expecting no change.

SFBT Basic Assumptions

• Clients have resources and strengths to resolve complaints.
• Since change is constant, therapists' job is to identify and amplify change.
• A small change in one part can affect change in another.
• There is no one right way to view things and different views may be valid.
• Focus on what is possible and changeable.

Five-Step Process

• Clients describe their problems and therapist asks, "How can I be useful to you?"
• Therapist works with clients in developing well-formed goals, asking "what will be different in your life when your problems are solved?"
• Therapist asks clients about those times when their problems were not present or less severe, and what they did to make these events happen.
• Therapist and clients evaluate the progress being made, clients are asked what needs to be done before they see their problem being solved and what their next step will be.
• At the end of each session the therapist offers clients summary feedback, encouragement, and suggests what clients might do before the next session to further solve their problem.

Therapeutic Goals

• Collaborative process where therapists create an encouraging climate.
• Concentrate on small, realistic, achievable changes that lead to positive outcomes.
• Three criteria for goals: Start-based, Specific, Social.

Therapist's Role

• Not-knowing position - therapists enter the conversation with curiosity and interest in discovery.
• Strive to create a climate of mutual respect, dialogue, and affirmation.
• Help client imagine a future life different from the past.

Client-Therapist Relationship

• Customer-type: Client and therapist jointly identify a problem and a solution.
• Complainant: Client describes a problem but unable/unwilling to participate in solution building.
• Visitors: Client comes to therapy due to others thinking they have a problem.

Therapeutic Techniques: Questions

• Skillful questions allow people to utilize their resources.
• Questions are part of conversation, not a list.
• "How questions" suggest change.
• Effective questions focus on solutions.
• Questions can help clients notice when things were better.

SFBT Techniques

• Pre-therapy Change: What have you done since your last appointment that has made a difference in your problem?
• Exception Questions: Direct clients to times in their lives when problems did not exist.
• Coping Questions: Assess how clients manage adversity.
• Reframing: Building a different frame of reference around problems to make them more solvable.
• Scaling Questions: Clients measure problems on a scale of zero to ten.
• Formula First Session Talk: Therapist gives clients homework to complete between sessions.
• Therapist Feedback: Therapist gives feedback on client strengths and progress.
• Terminating: Focusing on future change and what they can do to maintain progress.

Miracle Questions

• Imagine waking up tomorrow; how would life be different if problems disappeared?
• How will you know that better days are ahead?

Motivational Interviewing

• Co-founded by William R. Miller and Stephen Rollnick.
• Humanistic, client-centered, psychosocial approach, modestly directive.
• Brief and applicable across various problems.
• Assists clients in committing to therapeutic process.
• Stresses client self-responsibility.
• Shares common characteristics with PCT and SFBT.

MI Basic Philosophy

• Clients possess abilities, strengths, and competencies.
• Therapists evoke clients’ inner resources, like in PCT.
• Unlike PCT, MI is deliberatively directive within the client’s frame of reference.
• Goal is to reduce client ambivalence about change.

MI Basic Principles

• Therapists strive to see the world from the client’s perspective.
• Designed to evoke and explore discrepancies and ambivalence.
• Reluctance is viewed as an expected part of the process.
• Therapists support client self-efficacy.
• Once clients are ready for change, therapists focus on strengthening commitment to implementing a change plan.

Stages of Change

• Precontemplation: no intention of changing anytime soon.
• Contemplation: awareness of the problem.
• Preparation: planning to take action.
• Action: modifying behavior.
• Maintenance: consolidating gains and preventing relapse.

MI Techniques

• Share commonalities with SFBT, with non-pathological and health-promoting emphasis.
• Avoid labeling clients as resistant.
• Resistance helps counselors adjust methods to support the client.

Narrative Therapy

• Founded by Michael White and David Epston.
• Strengths-based approach, emphasizing collaboration between client and therapist.
• Goal: Help clients view themselves as empowered.

Narrative Therapy: Basic Philosophy

• Focus on respectfully listening to client’s stories and searching for times in client’s life that they were resourceful.
• Avoids labeling and diagnosing.
• Focus on dominant stories the client has internalized.
• Therapist assists with separating clients from those stories to allow space for new stories.

Narrative Therapy: Key Concepts

• Stories are manufactured in social, cultural, and political contexts.
• Stories shape reality.
• Therapists listen without judgment or blame and acknowledge and value client experiences.
• Normalizing judgments are avoided; ex: intelligence isn’t measured by average but instead how an individual thinks.
• Therapists avoid totalizing language, reducing complexity.
• Double listening: separating the person from the problem.

Narrative Therapy: Therapeutic Process and Goals

• Collaborate to name the problem.
• Personify the problem.
• Investigate how the problem has disrupted the client.
• Explore alternative meanings of events.
• Discover moments of strength and resilience.
• Speculate on a new future.
• Empower the client through a counter-story outside of therapy.

Therapist's Role in Narrative Therapy

• Active facilitators demonstrating care, openness, respect, empathy, and fascination.
• "Not-knowing" position.
• Assist clients in creating a preferred story arc.
• Avoid language of diagnosis, intervention, assessment.

Therapeutic Techniques in Narrative Therapy

• Questions: Not-knowing position, always asking from a position of respect, curiosity, and openness. Externalization and Deconstruction, the person is not the problem. Deconstructing and searching for unique outcomes. Alternative Stories and Reauthoring, inviting clients to author alternative stories, turning point. Documenting the evidence, gaining an audience to support the story e.g. letters, writing.
• Collaboration, group leader tone is solution focused and members are less problem saturated.
• Understanding group member problems.
• Externalizing, double listening, questioning, and miracle questions.

This quiz explores key principles and techniques in Solution-Focused Brief Therapy (SFBT), including the roles of group leaders, the Miracle Question, scaling questions, and externalizing techniques. Participants will also examine the importance of recognizing personal resiliency and cultural considerations in therapy.