Solution Focused Therapy SOW6425 Professor Nan Van Den Bergh.

Solution Focused Therapy

SOW6425

Professor Nan Van Den Bergh

SOLUTION-FOCUSED THERAPY

A short-term approach to intervention in which the social worker and client attend to solutions or exceptions to problems more so than to problems themselves.

It helps clients identify and amplify their strengths and resources toward the goal of finding solutions to presenting problems.

Principles

If it ain’t broke, don’t fix it

If it works, keep doing it

If it’s not working, stop

Small change leads to larger change

Keep intervention as simple (concrete) as possible

UNIQUE ASSUMPTIONS OFSOLUTION FOCUSED THERAPY

• Language is powerful in shaping one’s sense of reality– Words people use to define themselves and situations are influential in

conclusions they draw about those situations

– Is a clients language destructive or constructive

– Ex: This critiques “buy in” to “disease model” of addiction

• There is no necessary connection between problems and solutions– Client decision to act differently in the future may emerge

independently of “problem talk”

• Social workers must de-emphasize “problem talk”– Shift away from search for causes of client difficulties

• Problems are real but not necessarily ubiquitous– Through selective attention clients become preoccupied with

negatives in their life

• Events in a person’s past and present are not necessarily causally connected

Assumptions of Solution-Focused Therapy

(cont.)

• One need not understand a problem in order to resolve it– Worker must de-emphasize problem talk

• Emphasis on “solution talk” represents an effective means of helping clients focus on solutions as a way to think or act differently – Strengths and resources are highlighted

– Solutions do not need to be directly related to a client’s problem area

OVERVIEW OFSOLUTION-FOCUSED THERAPY APPROACH

Two Primary Activities

•Development of well-formed goals within the client’s frame of reference

•Development of solutions based on exceptions

The Process

•Describe the problem

•Develop goals

•Explore for exceptions

•End of session feedback

•Evaluate client progress (each session)

OVERVIEW OF SOCIAL WORKER’S ACTIVITIES

Facilitate•Change talk (seeking differences)

•Solution talk (constructing preferred futures)

•Strategy talk (for managing the problem) via:– Coping questions– Present multiple options– Scaling (levels of confidence, motivation, and progress)

•If the client is comfortable, he or she will disclose all of what is important

Engagement

• Social worker builds an alliance by accepting, without interpreting or reformulating, the clients perspective on the representing problem in the clients own language.

• Worker promotes a collaborative approach by communicating s/he does not possess “special knowledge about problem solving– S/he is eager to work with client on desired solutions

• Practitioner builds positive feelings and hope within client with future oriented questions– “what will be different for you when out time has been

successful”

Assessment

• There is no major distinction between assessment and intervention states

• Presenting issue must be investigated but :– Questions are intended to initiate change process

• Assess client’s level of motivation: Scaling 1-10: – “On a 1-10 basis with 1=low and 10 equal high, what is your willingness to invest

effort into the problem’s solution?”

– If low:” hmmm, Is there some part of the problem you would like to look at…?”

Assessment Questions

• “How will you know if our time together has been helpful?”

• “Have we clarified the central issue that you want to address?”

• “What will the future look like without the problem?”

• “Can we discover exceptions to the problem?”

• “How can we utilize your skills and qualities”

• “How can we collaborate?”

SOLUTION-FOCUSED INTERVENTIONS

• Give Compliments (Direct and indirect)

• Ask Future- Oriented Open-Ended Questions

• The worker’s language should always imply the likelihood of change

• Emphasis is on the future when the problem no longer exists

• “What will you be doing when _____ “

• The Pessimistic Stance (gets clients to argue for their own change)

• “It sounds like the problem is serious. How come things are not worse?”

• “What are you (or your family) doing to keep things from getting worse?

• “How has that been helpful? Would _____ agree?”

Solution Focused Interventions

• Reframing: worker provides positive feedback for aspects of clients behavior relative to the presenting problem– “taking the initiative to write a letter to your boyfriend about your

feelings was courageous and healthy, regardless of his response”

– Worker identifies genuine qualities of client of which s/he may not be aware

• Coping: highlights strengths in functioning– “How have you been able to manage the problem thus far?”– “What have you done recently that has been helpful?”– “The problem is serious; how come it is not worse?”– “What have you done to done to be able to “stay afloat?”

Solution Focused Interventions (cont.)

• Externalize: discuss the problem as something external from the client rather than something intrinsic to the client’s nature:– “How long has chaos been following you around” vs. “My life is

completely chaotic” ”– “How closely does depression follow you around?”– Does depression stay with you all day long?”– “Does depression ever leave you alone?”

• Externnalizing gives the client a reduced sense of victimization or pathology and a greater sense of control

Solution Focused Interventions (cont.)• Exceptions: these questions initiative the intervention state as they

bring ideas for solutions to the client’s attention

• Exceptions can be past experiences in a client's life when the problem might reasonably have been expected but somehow did not occur

• Ask questions help clients identify their strengths and competencies

• Identify protective factors that could be mobilized

• Recent exceptions are more useful for interventions

• Worker can “prescribe” the client undertake more of what s/he does during these “exception periods

EXAMPLES OF EXCEPTIONS QUESTIONS

• “What was going on in the past when the problem wasn’t a problem?”

• “Tell me about a time recently when the problem did not exist (or was• less troublesome)“

• “How did you make that (the exception) happen?”

• “What were you thinking?”

• “Who was there?” “How did they have a part in creating the exception?”

• “When did it happen?” “Where did it happen?”

• “What did you think and feel as a result of doing that?”

FOCUS OF THE FIRST SESSION

• Engagement Topics• Solution-focused engagement: Build positive feelings and a

sense of hope: – “Tell me what will be different for you when our time here has been

successful.”

• Assessment Topics• Client’s perceptions of the problem

• Client’s beliefs about the sources of the problem

• How the problem affects the client

• How the client has coped with the problem thus far

• What the client has tried already

• What the client’s experiences have been with other helpers

CREATE A CLIMATE FOR CHANGE: Goal Setting Topics

• Inquire about Pre-Session Change:

– “Has anything changed relative to the presenting problem since you set up this appointment?”

– “Are these the kinds of changes you would like to continue see happen?”

• Do not minimize the significance of any efforts the client has made, or any changes that may have occurred prior to the first meeting

CLARIFY THE CLIENT’SGOALS FOR INTERVENTION

•Encourage clear problem definition:– Partialize problems into issues capable of being defined as discreet and

measurable goals– Prioritize (decide what the client wants to work on first; only one issue

at a time)•Client define her/his own goals

– Goals must be concrete and stated simply so as to know when they have been achieved

– Goals also need to be partialized into discrete units that can be actively and specifically addressed

– Each goal needs to be scaled as to its importance to the client : 1-10

•Worker engages as a collaborator to assist in selecting goals that are achievable

– S/he may present alternative perspectives or working that can free client from habitual patterns of thinking to more positive and proactive goals

– Ex: suggest that desire to be “less depressed” be reframed to “spend more time engaged within pleasurable activities”

•er

•Scaling questions (for goal setting and assessing motivation)

Clarify the Client’s Goals for Intervention (cont.)

• During goal setting worker asks what point on a 1-10 continuum would indicate that the clients goal has been successfully achieved

• This same question is asked at the end of every session– Client is queried as to what needs to happen for the

client to advance to higher points on the scale

CHARACTERISTICS OFWELL-FORMULATED GOALS

• Realistic

• Challenging

• Include the possibility of interpersonal interaction

• Situational (vs. broad) focus

• Concrete, measurable

• Focus on the presence of desirable behavior rather

than the absence of a behavior

• Enable a focus on “steps” rather than a final result

• Client recognizes a role for him or herself

Miracle Question

• After goals are developed and exceptions are identified, intervention tasks can be developed following responses to the miracle question

• Client asked to imagine that during the night while asleep the presenting problem went away, but s/he did not know that.

– When s/he got up, what would provide evidence of problem resolution?• The Miracle Question :

– “Imagine when you go to sleep one night a miracle happens……. but you don’t know it…… what would be the first signs for you that ……”

• Worker assists client to describe specific” observations of what would be different, not global comments such as “I would be happy”

– EX: specific: “Maria and I got through breakfast without arguing”

• In addition to client perspective on “miracle” ask what others perspectives of miracle might be

–

Miracle Question (cont.)

• Client answers to miracle question provide indicators of change that can be incorporated into tasks for goal accomplishment– Ex: Task: “Will engage Maria in talking about the good things

she expects to happen that day”– Ex: Task: “Will have breakfast prepared for Maria and let her

know how glad I am to start each day with her”

• Worker suggests that task assignments can sometimes not go as intended– Setbacks are part of life and should not be seen as failures

• “progress prior to perfection….”

EXPLORE TASK IDEAS

• The End-of-Session “Message” • Compliments• Summary statement of positive strategies• Tasks:

– Personal functioning– Interactions with others– Interactions with resource systems

• The Formula First Session Task• “Between now and the next time we talk, notice the things in

your life that you would like to continue”

Tasks for End of 1st Visit

• Formula first-session task: – Ex: “Between now and the next time we meet I’d like you to

observe things happening in your life that you would like to see continue and then tell me about them”

• This is an invitation to clients to act in a forward looking manner– It may also influence client's thinking about solutions

• Surprise task: client is asked to do something between this session and the next that will “surprise” another person connected with the problem in a positive way

– “Between now and the next time we meet, do something that will pleasantly surprise _____ (a significant other person)”

– Rationale: whatever the client does will “shake-up” the client routine and potentially initiate new, more positive behaviors

SUBSEQUENT SESSIONS

• Ask: “What’s better?”

• Client should be encouraged to report positive and negative developments

• Clients may be ambivalent about “positive” changes that involve loss

• Ask questions about:

• Maintenance strategies “What needs to happen for these changes to keep happening? What obstacles may get in your way, and how might you overcome those?”

• Learning strategies “What have you learned so far from what you’ve been doing? What have you learned not to do?”

REVIEW TASK PERFORMANCE

• All session-to-session tasks should be jointly designed by the social worker and client; the client should take the lead in devising them

• Practitioners vary in the importance they place on the specificity of tasks, their accomplishment, and “reporting in”

• The client’s lack of or inability to follow through with a task signals the need to renegotiate tasks or goals or to review motivation

• Each session must include a segment wherein practitioner and client review therapy developments and task outcomes

– Clients progress toward goal achievement is measured by scaling on a 1-10 continuum

– Use of a 1 - 10 scale promotes specificity of focus and concrete indicators of movement

DEVELOP OR REINFORCENEW STRATEGIES FOR CHANGE

• Build on what the client is already doing

• Don’t focus too much on setbacks, but ask:– Should you be doing something different?

– Are your goals realistic?

– Is your timetable realistic?

– What did you do to stop it from getting worse?

– How did you cope with the problem not improving?

• Possibly revisit the miracle question (clients may change their answers)

EVALUATE EACH SESSION

• Evaluation Questions• “Is our work together helpful to you? Are the changes along the lines

that you hoped? Have your goals changed? What should we be doing differently?”

• During each session ask the client (on a 0 to 10 scale) what number will signify “good-enough” problem resolution

• Remind the client at the end of each session how progress toward goal achievement is being demonstrated

• After a goal is achieved, set additional goals or end the intervention

SOLUTION-FOCUSED INTERVENTIONWITH “VISITORS”

• Maintain the position of “not knowing”

• Agree with the client’s perceptions of the presenting situation

• Assume that there are good reasons for the client’s negativity

• Ask the client to elaborate on feelings of anger and negativity

• Turn client complaints into beginning goals for the intervention

• Listen for other people who are important to the client

• Ask what previous professional helpers” (if any) could have done

• differently to be more helpful

• Ask for the client’s perceptions of “best interest” and what he or she

• wants

• Make sure non-negotiable requirements are clear

• Give the client as much control of the intervention process as possible

INTERVENTION WITH CLIENTS IN CRISIS

• “How can I help?”

• “What have you tried already?”

• “What do you want to be different?”

• Ask Coping Questions

– “How do you get out of bed in the morning?”

– “How did you survive long enough to get here today?”

– “How have you managed to cope this far?”

– “How come things are not worse?”

QUESTIONS TO ASK WHEN ENDING INTERVENTION

• “What do you need to remember if things get difficult for you again?”

• “What will be the benefits for you that will make the effort worth it?”

• “Who is going to be able to help you?

• “Who do you think will be more a part of the problem?”

• “How long do you think it will take before this is not a big problem

• anymore?”

• “How will you remind yourself about the things you know are helpful?”

• “What do you expect the hardest challenge will be?”

• “What do you think the possible obstacles might be, and how will you overcome them?”

SFT IDEAS THAT ARE “TRANSFERABLE”TO OTHER APPROACHES

• Considering the balance of time spent discussing the client’s past, present, and future

• Scaling and the miracle-question can be useful when the social worker feels “stuck” with a client

• Attention to the client’s coping strategies can correct against a deficits bias

• It is not always necessary to look for detailed explanations of client problems

• The danger of fostering client dependency on formal intervention

CRITICISMS OF SOLUTION-FOCUSED INTERVENTION

• The practice denies clients the opportunity to explore presenting• problems in greater depth

• Its encouragement of clients to "think positively" may induce denial or minimization of problems

• Clients may feel discouraged from sharing important details or negative

• feelings about the presenting issue

• SFT may create a false impression on young practitioners that• intervention is relatively “easy” or straightforward