Solution Focused Brief Therapy

Solution-Focused Therapy

The author of this paper is about to offer a brief literature review of what has come to be known as solution-focused therapy. Included in that literature review will be several specific topics or examples that are within the solution-focused therapy paradigm. These include the history of the theory, the use of language to help create a solution-focused therapeutic environment, the role of family history when it comes to solution-focused therapy, the shift from a problems focus to a solutions focus in a way that benefits the client, the development of a short vignette that is based on a family situation, global goals of the treatment method using the language of theory, interventions that should be used at each stage of treatment (those being beginning, middle and end) and a succinct summary of all of the above. There are certainly other methodologies that can be used when treating a patient in a therapeutic environment. However, the solutions-focused therapy method definitely has its proponents and it can be effectively used when harnessed by the right facilitator in the right way.

History & Summary of SFBT

Solution-focused therapy is also commonly known as solution-focused brief therapy. The two terms are interchangeable. The method of solution focused brief therapy (SFBT) is an "evidence-based, collaborative, strengths-based model developed in the 1980's by Steve de Shazer and Insoo Kim Berg and is now in use as an organizing treatment approach all over the world (Trepper, 2012). One of the primary uses of solution focused brief therapy is in a family therapy setting (Trepper, 2012). Shazer himself is held up as a pioneer when it comes to the broader field of family therapy. In fact, he is often bestowed the title "Grand Old Man of Family Therapy." The terms "iconoclast" and "creative genius" are often attributed to what is often referred to as a "minimalist" philosophy when it comes to how his therapy strategies deal with family and other aspects of everyday life. He has written five books about solution-focused brief therapy and similar topics. Solution-focused brief therapy itself evolved from something similar known as Brief Family Therapy, as written about by Shazer himself in 1982 (Trepper, Dolan, McCollum & Nelson, 2006).

Solution-Focused Brief Therapy is a future-focused methodology that is heavily goal-directed. The overall pattern in the therapy is to identify exceptions and solutions. Exceptions are times when an identified problem occurs or that could occur less. Solutions are a description of what life would be like if the problem was gone an resolved. As the therapy progresses, there is the use of "scales" that help determine how far towards a resolution to the prior-mentioned exceptions the therapy has helped the people involve progress. While family therapy is often the main focus of solution-based brief therapy, it can also be used for couple's therapy, treatment of sexual abuse, treatment of substance abuse, sex therapy, treatment of schizophrenia and so forth. There have even been books written that help people self-treat or treat within the group of people that are having the problems rather than using an outside facilitator. However, this report will focus mostly on family therapy as that is the primary application of solution-focused brief therapy and that is also indeed the focus of this literature review in general (Trepper, Dolan, McCollum & Nelson, 2006).

As one could easily gather, the history of a family is absolutely important when it comes to solution-focused brief therapy that is used to deal with family issues. It is that family history that has created and fostered the negative patterns that the therapist and/or other facilitator is trying to break. Further, the family members that are actively interacting within a family obviously need to be involved for the therapy to take its full effect. However, a limited group or single person that is having family problems can benefit from the therapy as they can find their own solutions that can assist with the problems they have with family members even if one or more family members involved cannot or will not be participatory in the therapy environment. A linchpin of family-oriented solution-focused brief therapy is that even if the problems created, not to mention the people involved, are complex and intricate, this does not mean that the solutions have to be robust and expansive. There could indeed be a very simple answer that can help a therapy recipient deal with a problem that is occurring in their family. Even simple solutions can be hard to keep in practice and make effective. However, this does not change the fact that the solution itself is not hard to quantify or define (Trepper, Dolan, McCollum & Nelson, 2006).

One of the important parts of any therapy is the focus of the questions that are used upon intake of a patient. Indeed, questions that are used when doing intake can be focused on solutions or they can be focused on problems. Solution-based brief therapy is no different. Indeed, an identification and fleshing out of the problems has to be done so that the solutions can thus be identified. However, the tenor and tone of the questions can influence how things progress or do not progress as the therapy cycle winds on (Richmond, Jordan, Bischof & Sauer, 2014). Indeed, there have been many studies where there has been an analysis, sometimes a micro-analysis, of the positive and negative vibes that flow during the questions asked and answered in a therapy session, whether it be solution-based brief therapy or some other method. The key is to start at the somewhat negative point and shift forward towards a more positive and solution-based approach as the therapy moves along. Of course, the tone and tenor of the therapy will begin in a fairly dark and/or negative place for the person seeking therapy and this is to be expected. Otherwise, the person probably would not be seeking therapy. However, it is important that there be progress towards solutions so that the problems can be alleviated via the solutions that are revealed and discussed. These theories and ideas may seem simple but other therapy methods are quite different in the trends they take. For example, cognitive behavioral therapy (CBT) is often much more negative in nature when it comes to the questions being asked. As one might expect, negative questions often lead to negative answers just like positive questions lead to more positive answers. As such, this explains perfectly why solution-focused brief therapy may start with negative questions and answers but there is an intentional and methodical progression on the part of the facilitator to guide the therapy recipient from the negative feelings and conditions that they are experiencing to solutions and a better tomorrow when it comes to those problems (Jordan, Froerer & Bavelas, 2013).

Vignette & Analysis

Therapist: So…if you could state it shortly and simply, what problem are you facing that you would like assistance with Patient: My wife and I love each other a lot but she is so depressed and hard to be around because she is always so negative.

Therapist: So, if I hear you correctly, you really love your wife and you are concerned about her mental state but it would appear that her depressive mood is itself depressing you. Would that be accurate?

Patient: Absolutely. I want to see her happier but she resists my attempts to lighten her spirits or seek help. I'm not sure what to do

Therapist: Well…ultimately she will need to find her path on her own, but there are things you can do to help yourself.

(end)

The problem with this couple is multi-faceted in one respect but is single-faceted in another. The wife in the situation is depressed and despondent. The husband seems to be in better shape mentally but is obviously concerned about his wife. However, the wife is resisting the fact that she is obviously in need of mental health care and her depressive symptoms are having a negative effect on the mental state of her husband. Indeed, it makes sense that he himself would become despondent and depressed because his wife is already there. Being exposed to that depressive condition day in and day out would certainly wear down and influence the husband in negative ways. The ultimate solution that would help both the husband and the wife is that the wife finds her own mental health care and the husband is supportive in that process. However, the wife cannot be made to realize that this is necessary or actually engage in such solution. She will have to be guided in that direction or she will have to find her path on her own. Regardless, the husband needs to help himself. The first stage of any treatment would be to ask the questions about how the wife says she feels, what the husband feels as a result, what he's tried to do, what has changed due to the behavior patterns and so forth (Trepper, Dolan, McCollum & Nelson, 2006).

After that, there needs to be a focus on what the husband would want to see happen and then there needs to be a focus on how to get there. The solution would be multi-faceted because what happens in the long run will obviously hinge on what the wife decides to do about her own mental condition. However, the husband can obviously control what he feels and does so he needs to take care of himself first. This does not mean abandoning or shunning the wife. Instead, the husband can focus on doing things every day that make him happy including hobbies, watching funny movies and so forth. Of course, there will be times where the wife will resist these happier times or even lament the husband for enjoying himself. The husband will have to be trained to respond that he loves her and that he wants her to be happy as well. However, he himself is trying to enjoy life and he would love to have her join him in doing the same in the form of his current hobbies or things that they can do together. The idea would be that if the wife sees him improving and progressing while at the same time expressing empathy and concern for his wife, she will be more apt to want to join him in improving her mental state. In short, the three stages in this treatment are as follows:

1) The husband can only control himself and he needs to address his own mental health concerns. The wife will have to find her own solutions, ultimately.

2) The husband will engage in thoughts and behaviors that bring him more happiness while at the same time telling the wife that he wants her to be happy with him and/or they can do things together

3) Eventually, the wife will probably come around and see that she needs to get some help and that her husband really does care for her. However, there is also the possibility that she will feel abandoned and/or she will refuse to get treatment. This could very well end up with them separating. However, the husband has no burden to be around someone that is always negative and hurting his own mental state. It may sound heartless to some but being altruistic or a martyr for the marriage is no solution. However, so long as he expressed empathy and concern for the wife, she will likely come around eventually (Trepper, Dolan, McCollum & Nelson, 2006; Taylor & Simon, 2014).