Solution-Focused Therapy

Presented by Joe Enright

Outline
History Development Model/Description Example Session Structure Application Research Support

History
Origins
Originally termed Solution-Focused Brief Therapy Developed in the 1980s by social workers Steve de Shazer and Insoo Kim Berg (husband and wife) Developed from aspects of several brief therapies

Aim
To provide brief therapy without any unnecessary components. Distill therapy down to only the elements necessary for positive change.
MacDonald (2007)

Development
Psychodynamic
Behavior Therapy
Emphasis on and respect for clients words and views, and no pressure for the client to change or be different Goals and baseline measurement Highlights clients thoughts and perceptions Acting as if change has already occurred

CBT

Systems Theory

Brief/Strategic Therapy

Novel aspects of Solution-Focused Therapy

Non-expert stance, importance of clients language, minimal number of sessions, value of slow change, problem and solution not connected
Faith in peoples abilities, resources, and motivation for change Absence of formal theory of change - deemed unnecessary
MacDonald (2007)

Solution-Focused Therapy Model

All that is necessary is that the person involved in a troublesome situation does something different. Steve de Shazer (1985)

Description
Disciplined and pragmatic approach, not theoretical. Basic Assumption = People are capable of change on their own Major Tenets:
If it isnt broken, dont fix it If it works, do more of it If its not working, do something different Small steps can lead to big changes The solution is not necessarily directly related to the problem The language for solution development and that for problem description, are different The future is both created and negotiable
de Shazer, 1985; Shazer & Dolan, 2007; MacDonald, 2007

Therapists Role
Democratic approach to therapist-client hierarchy Never pass judgment and avoid interpretations Dont try to convince, influence, scold, or push Expand options and offer alternative directions Lead from one step behind
Berg & Dolan, 2001; Shazer & Dolan, 2007; Cantwell & Holmes, 1994

General Approach/Techniques
Positive, collaborative, solution-focused stance No such thing as client resistance Explore past solutions Explore exceptions to the problem Questions only, no directives or interpretations Focus on the present and future Compliments Encouragement and Experiments
de Shazer & Dolan, 2007

Components of the 1st (Only?) Therapy Session

Intro and "Problem-talk" Pre-session change Solution-focused goal setting Miracle Question Scaling Constructing solutions and exceptions Break time After break, compliments and homework
MacDonald, 2007; de Shazer & Dolan, 2007

Intro and Problem-Talk

Only one problem (brief therapy) Not interested in collecting a thorough history

MacDonald, 2007

Components of the 1st (Only?) Therapy Session

Intro and "Problem-talk" Pre-session change Solution-focused goal setting Miracle Question Scaling Constructing solutions and exceptions Break time After break, compliments and homework
MacDonald, 2007; de Shazer & Dolan, 2007

Pre-session Changes
Three possible answers:
1) Nothing has happened Begin session generally (How can I help you today?) 2) Things have gotten better Jump to solution-focused goal setting (Would you like these changes to continue?)

3) Things are about the same Jump to exploring previous solutions and/or exceptions (How have you kept things from getting worse?)
de Shazer & Dolan, 2007

Components of the 1st (Only?) Therapy Session

Intro and "Problem-talk" Pre-session change Solution-focused goal setting Miracle Question Scaling Constructing solutions and exceptions Break time After break, compliments and homework
MacDonald, 2007; de Shazer & Dolan, 2007

Solution-Focused Goal Setting

Small goals Worded as a solution, not absence of a problem

MacDonald, 2007; de Shazer & Dolon, 2007

Components of the 1st (Only?) Therapy Session

Intro and "Problem-talk" Pre-session change Solution-focused goal setting Miracle Question Scaling Constructing solutions and exceptions Break time After break, compliments and homework
MacDonald, 2007; de Shazer & Dolan, 2007

Miracle Question
Now I want to ask you a strange question. Suppose that while you are sleeping tonight and the entire house is quiet, a miracle happens. The miracle that the problem which brought you here is solved. However, because you are sleeping, you dont know that the miracle has happened. So, when you wake up tomorrow morning, what will be different that will tell you a miracle has happened and the problem which brought you here is solved?
de Shazer & Dolan, 2007

Scaling
Scale problems/goals from 1-10 at pre-therapy, current time, and end time Allows ongoing measurement of progress in subsequent sessions Evidence of positive change

de Shazer & Dolan, 2007

Components of the 1st (Only?) Therapy Session

Intro and "Problem-talk" Pre-session change Solution-focused goal setting Miracle Question Scaling Constructing solutions and exceptions Break time After break, compliments and homework
MacDonald, 2007; de Shazer & Dolan, 2007

Constructing Solutions and Exceptions

Overarching aim of the rest of the session. Find examples of solutions and exceptions to the problem

MacDonald, 2007; de Shazer & Dolon, 2007

Components of the 1st (Only?) Therapy Session

Intro and "Problem-talk" Pre-session change Solution-focused goal setting Miracle Question Scaling Constructing solutions and exceptions Break time After break, compliments and homework
MacDonald, 2007; de Shazer & Dolan, 2007

Break-time
Consult with team if available Think of compliments, and consider experiments for homework

After the break

Present compliments Suggest homework experiments
MacDonald, 2007; de Shazer & Dolon, 2007

Application
Reportedly, one of the most popular in the world; applicable to all problems Often used in family and couples therapy - viewed as highly compatible with a systems theory approach Has been used with clients with problems such as sexual abuse, substance abuse, and schizophrenia* Also utilized in social services, social work, educational, and business settings Walk-in settings
Corcoran & Pillai, 2009; de Shazer & Dolan 2007; Macdonald, 2007; McCollum & Trepper, 2001

Research Support

Very little research conducted on effectiveness Not currently recognized as evidence-based Most studies demonstrate small to moderate positive effects, usually in treating non-psychiatric problems. One study demonstrated an equivalent reduction in depressive symptoms compared to a interpersonal therapy control Relatively Recent meta-analysis looked at 22 studies:
-Small effect sizes for internalizing behavior (e.g. depression, anxiety, low self-esteem) -Small effect sizes for externalizing behaviors (e.g. conduct, youth offender recidivism) -Small effect sizes for Family and Relationship problems
Kim et al., 2010; de Shazer & Dolan, 2007; Sundstrom, 1993; Gingerich & Eisengart, 2000; Corcoran & Pillai, 2009; Kim, 2008

References
Berg, I. K., & Dolan, Y. (2001). Tales of solutions: A collection of hope-inspiring stories. WW Norton & Co. Cantwell, P., & Holmes, S. (1994). Social construction: A paradigm shift for systemic therapy and training. Australian and New Zealand Journal of Family Therapy.

Corcoran, J., & Pillai, V. (2009). A review of the research on solution-focused therapy. British Journal of Social Work, 39(2), 234-242.
De Shazer, S. (1985). Keys to solution in brief therapy (pp. 3-17). New York: Ww Norton. De Shazer, S., Dolan, Y. M., & Korman, H. (2007). More than miracles. Haworth Press.

De Shazer, S., & Berg, I. K. (1997). What works?Remarks on Research Aspects of SolutionFocused Brief Therapy. Journal of Family therapy, 19(2), 121-124.
Gingerich, W. J., & Eisengart, S. (2000). SolutionFocused Brief Therapy: A Review of the Outcome Research*. Family process, 39(4), 477-498. Kim, J. S. (2008). Examining the effectiveness of solution-focused brief therapy: A meta-analysis. Research on Social Work Practice, 18(2), 107-116.

Kim, J. S., Smock, S., Trepper, T. S., McCollum, E. E., & Franklin, C. (2010). Is Solution-Focused Brief Therapy Evidence-Based?. Families in Society: The Journal of Contemporary Social Services, 91(3), 300-306.
Macdonald, A. (2011). Solution-focused therapy: Theory, research & practice. Sage. Sundstrom, S. M. (1993). Single-session psychotherapy for depression: Is it better to be problem-focused or solution-focused. Unpublished Dissertation, Iowa State University.