Solution-focused brief therapy (SFBT)
As the name suggests, SFBT, which arose from the work of de Shazer and col- leagues at the Brief Family Therapy Centre in Milwaukee, USA (de Shazer et al., 1986), emphasizes the notion of solution building by looking at a person’s exist- ing resources and future hopes. A typical programme of SFBT lasts for around five sessions. De Shazer and colleagues found that when clients exhibited prob- lem behaviour, there were inconsistencies in this behaviour – what they called
exceptions, i.e. clients exhibiting healthy as well as unhealthy behaviours. It was within these exceptions that solutions to the behaviour were found.
In common with other solution-focused interventions, SFBT is also goal- orientated, i.e. the clearer a client’s goals are, the greater the chance of these goals being achieved. Within the identification of goals lie the client’s future hopes. SFBT may be used as a discrete intervention on its own, or with other interventions (Iveson, 2002). SFBT has been used with a range of client presen- tations including depression (Sundstrom, 1993), eating disorders (O’Connell, 1998), substance misuse (Dolan, 1991) and sexual abuse (Dolan, 1991).
In Box 10.1 we describe the characteristics of SFBT (de Shazer and Berg, 1997; Gingerich and Eisengart, 2000).
Box 10.1 The characteristics of SFBT
r The therapist’s use of the ‘miracle’ question (see Table 10.1 below) r Use of scaling questions, for example asking the client ‘On a scale of
1–10, can you rate your problem-solving skills in general’
r A consulting break, for example allowing time off for the client to work on set tasks
r Giving the client compliments, for example praising them when they are making progress
r Assignment of homework tasks to work on between sessions, for exam- ple client agrees to go for a ten-minute walk every day
r Exploring strengths and solutions, for example the client identifies ex- isting strengths and solutions they have used in the past to deal with a current problem
r Goal setting, for example agreeing with the client the objectives of the session
r Exploring exceptions to the problem, for example asking the client to identify occasions when the problem did not exist
The first session in an SFBT intervention appears crucial in understanding the client’s concerns, and setting goals (future hopes) to address these con- cerns. Table 10.1 outlines what Iveson (2002) calls the key tasks of the first session of SFBT. We have adapted this to show how you can use this approach in any therapeutic encounter, and we provide examples of questions that you may use in this encounter.
Iveson suggests a useful metric that you can use to help the person assess his/her current state, and their ideal state. This is shown in Figure 10.1.
0 = the worst-case scenario
3 = where the person is presently
7 = a good, but realistic outcome
10 = the perfect solution
Figure 10.1 The Scale Framework (Iveson, 2002)
Table 10.1 Key tasks during the first session of solution-focused interventions (adapted from Iveson, 2002)
Mental health nurse’s task
Questions that may help the mental health nurse achieve his/her task Explore what the person is hoping to
achieve from the encounter
‘What are you hoping to achieve from our session today?’
Explore what life would be like if the person realized their hopes
‘Imagine you wake up tomorrow and you have realized all your hopes; what do you think would be different?’ This is regarded as the
‘miracle’ question Explore what the person is doing now, or
has done before, to realize their hopes
‘Think of a time when you have realized your hopes in the past. What did you do then?’
Explore what might be different if the person took a small step towards realizing their hopes
‘What things would you, or those close to you, notice if you realized some of your hopes?’
To make use of the scale ask the client to identify where they are on it, i.e.
the point of sufficient satisfaction to them. The scale is used to define:
r the client’s goals
r what they are already doing to achieve these goals r what their next step might be.
Using the miracle question is likely to help the client describe the perfect solution. Therefore, for a client with incapacitating depression, the perfect solution might be a life completely free of depressive symptoms. A good and realistic outcome for the same client is managing the depressive symptoms so that they can get on with their lives. Where the client is now involves exploring with them what they have done that has helped them arrive at this point or what they have done to prevent a worsening of their problem.
It is best not to explore in too much detail the worst-case scenario, but it is worth bearing in mind that, for depressed person, this could be a life of overwhelming depression with little remission from their symptoms.
Practice exercise: using a solution-focused communication style You are working in a community mental health team and one of your clients is Mary.
Mary has been a long-standing client of the team, but has made little progress with a succession of colleagues. You have been asked to work with Mary as it is thought she may benefit from a solution-focused approach. All you know of Mary is that she has a long history of cutting her arms when distressed. From what you have read so far about solution-focused communication, describe how you might help Mary overcome her distress without cutting her arms. Pay particular attention to the aims and characteristics of solution-focused styles, where the emphasis lies when communicating using this approach, and the key tasks and questions in your initial assessment of Mary.