Solution Focused Therapy Technique

Comprehensive Case Conceptualization
Presenting Problem
Don is a 25 year old male working on his MBA while living at home with his parents. Don is sensitive about sex and sexuality as a result of his religious upbringing, from which he learned that premarital sex is wrong. This presents problems for him whenever he begins dating a girl, as, not surprisingly, sex inevitably comes up and Don does not know how to deal with it in a manner that would allow him to be firm in his religious principles while at the same time maintaining a healthy relationship. His lack of a girlfriend is upsetting for his parents because they want to see him be in a serious relationship as this would undoubtedly signify that he is maturing and ready to enter into the next phase of life. To them, Don currently seems stuck in a type of extended adolescence. Even though he is excelling in school, he is not succeeding in the real world in the sense that he still lives with his parents, does not exhibit a great deal of independence, and has no steady girlfriend which means no prospects towards getting married and starting a family of his own.  Don’s parents are worried about him; meanwhile Don is worried about his own sexuality, as he also feels conflicted in the sense that he feels he could be attracted to men as well as women. He is thoroughly uncomfortable when it comes to sex and does not know how to reconcile his sexuality with his religious upbringing so just avoids the issue altogether by abandoning a relationship as soon as it gets serious—i.e., sexuality rears its head.
From a family counseling perspective, the problem as presented is two-fold: 1) Don needs to understand that he can have a meaningful relationship that is healthy and sexual while still maintaining religious dignity; the pressure he feels to engage in premarital sex is psychological: in reality, many people still wait till marriage to engage in sexual activity. Indeed, this is the traditional norm. Don needs to be able to feel more confident about his own beliefs, and for this to happen he needs to better understand how sexuality is part of life and is perfectly normal, and how one can even feel sexual feelings for men and women. Don must figure out if he wants to maintain his religious beliefs and if he wants to have a family of his own one day. These two decisions on his part will help to dictate a plan moving forward. For his parents’ part, they need to understand that Don is confused about sex and sexuality with regard to his religious teachings. They need to understand that what he is experiencing is perfectly normal and that the best thing they can do for him to help him transition into the next stage of the family life cycle is to be supportive and empathetic and to allow him the freedom to explore on his own the next path of life that he chooses to take (Hanline, 1991; Ballard, 2012; Settles, 2016). Through support, family members can help other family members to make important transitions in life.
Rationale for Using Solution-Focused Therapy
Two models of therapy that could be used for this case are solution-focused therapy and narrative therapy. However, solution-focused therapy applies best because for Don there is a need to identify goals and work towards them by altering his behavioral patterns, whereas narrative therapy focuses more on separating the problem from the person by allowing family members to explain where they are coming from and how they perceive things (Gonçalves, Ribeiro, Silva, Mendes & Sousa, 2016). While narrative therapy can be helpful, it would not provide Don in this case with the clearest indication of direction or of how he might like to behave were all his anxieties and stresses neutralized.
One of the best techniques of solution-focused therapy is the “miracle question,” which allows the client to imagine that he woke up one day to find that all his problems have been solved and then to answer the question of how he would communicate this fact to others (Franklin, Biever, Moore, Clemons & Scamardo, 2001). Other techniques and interventions that can be applied via the solution-focused therapy method include scaling and goal setting, both of which can help the client to rank the seriousness of issues they are having so as to more objectively see them and their impact and to figure out what goals are important to him: “in solution focused advising the advisor does not provide the goal but can facilitate a semi-structured conversation that leads the student toward a goal” (Burg & Mayhall, 2002, p. 80). Narrative interventions include telling one’s story, externalization, and deconstruction—but for Don, these interventions may not be as effective as the more direct approach that solution-focused therapy provides. Don’s meandering approach to life and his stalling in the life cycle in which he is in indicates that solutions are what’s needed. He has most likely already spent a great deal of time in introspective activities—now it is time for him to make decisions about moving forward into the next stage, and for that reason solution-focused therapy will be key.
Collaborative Treatment Plan
Goals
The goals of solution-focused therapy are to allow the client to identify and define objectives and goals on his own. The counselor may provide some guidance or may have a goal in mind, but the most important thing is for the client to decide what goals to achieve. This makes the intervention more meaningful as goals emanate organically from the client’s own mind and will. The way to reach this point where the client is able to identify goals is to use a variety of interventions, such as scaling and the miracle question. The ultimate aim of solution-focused therapy is to assist the client in identifying goals that would help the individual to overcome obstacles or challenges in his or her life by applying behavioral methods that can be applied. Helping the client to identify personal goals is the first step; identifying behavior patterns that would facilitate achieving those goals would be the next step.
Scaling
Scaling or rating an issue on a scale of 1 to 10 can be a way for the client to identify where problem areas are: for instance, the client might be asked to rate his confidence in communicating with a girlfriend issues of religion or sexuality. The client might be asked to rank his sexual feelings for men or for women to see if one is felt more strongly than the other. Don might be asked to rank his conviction in his religious beliefs, whether he is firm in them or whether he is fearful of what they mean. The idea behind scaling is to give Don a sense of what the real problem is and what issues require the most attention. By focusing on the issues that rank highest, some clarity of purpose can be provided to help remove obstacles that get in the way of the main issues. Scaling can help to rid Don of distractions. Don would be able to identify what activities are hardest for hiim by scaling, which can lead to the development of a better awareness of himself. The same can be applied to his parents, who would also benefit from the scaling intervention, as it would help them to see where their problem areas are. For example, they might be asked to rank their ability to communicate with their son; or they may be asked to rank their ability to show supportive feelings and empathy with his transition to the next cycle in life
Miracle Question
The miracle question intervention can be used to help Don better understand how he might like to behave were he to wake up one day and find that all his problems had been solved. The key to this question is to frame it in such a way that it is not important to know how problems have been solved but just that they are no longer felt. The question then is how Don might communicate this to someone else. By showing that he is problem-free, Don can visualize the patterns of behavior that he can implement within his own life to truly bring about that problem-free state. By imagining himself as problem free and seeing how he would act and how he would show it, he is able to visualize himself in a new light that is separate from his current state. Instead of focusing on the problems, this intervention encourages the client to focus on the solution—the type of behavior that would represent positivity and a stress-free life. The underlying point of the miracle question is that provides the client with an organic way to envision how he himself would like to behave were he more comfortable with himself and his environment.
This exercise helps to provide the framework for establishing the goals that the client can identify: if Don says that he would communicate the miracle of waking up and finding himself without problems by giving his parents a hug and calling up a girl that he likes, the counselor can maneuver the discussion by indicating that in reality nothing is preventing Don from acting in this way already--and in this manner Don can set short-term, medium-term, and long-term goals for himself, using these building blocks of patterned behavior to establish the solutions that would help him to work forward to making a positive transition in life.
It can also be used with Don’s parents to help them see how they provide more positive expressions of support and love for their son. By asking them to answer the miracle question, they can identify positive patterns of behavior that would allow them to act with affection and empathy as well as to identify goals that they can then set for themselves to help Don transition to the next stage in life.
Treatment Plan
The treatment plan for Don and his family, therefore, would be to meet once per week, all together, to allow for each individual to engage in the three intervention techniques of scaling, miracle question, and goal setting. The outline of the plan would be presented to the family in the first session with an explanation given of how it is intended to work and what the goals of the plan are for each individual (explaining, ultimately, that it is up to each individual to identify goals that they want to set for themselves—as opposed to goals that they would like to set for one another). The next section would focus on scaling and these sessions could be provided individually with each family member taking turns to meet privately with the counselor for 30 minutes, or all together as a family depending on how the family feels about it. If any one member objects to an all-together approach or shows that he or she would be more comfortable engaging in the exercises individually, then the sessions will be conducted individually, with each member coming in for 30 minutes, while the other two wait outside for their turn. A follow-up session of 15 minutes in which the family, all-together, can ask questions will conclude these weekly sessions, which will continue until all three interventions have successfully been implemented. The overall timeframe for this plan is two months.
Examples of How the Solution-Focused Therapy Model Will be Used
Don. For Don, questions for scaling will include:
1) On a of 1 to 10, with 1 being the lowest and ten being the highest, how would you rank your conviction in terms of what you believe is right and wrong with respect to premarital sex?
a. Could you define the purpose of sex or why it is part of our human nature?
b. Could you define what your religious beliefs say is an appropriate use of the sex instinct?
2) On a scale of 1 to 10, with 1 being the lowest and ten being the highest, how would you rank your confidence in communicating your religious beliefs about sex to a girlfriend?
a. If you had to find the words to explain this belief to another person, what would they be?
b. How would you know if something happened to make it easier to use these words and explain this belief? What would the change look like? How would you sense it?
3) On a scale of 1 to 10, with 1 being the lowest and ten being the highest, how would you rank the importance of getting married and starting a family?
a. How stressful is this idea to you on the same scale?
b. How would you know if something happened to make this issue seem less stressful?
4) [Show a picture of a staircase and indicate that the first step is the lowest level of motivation and the top step being maximum motivation] Where would you locate yourself on this staircase in terms of wanting to move forward with your life in order to be independent of Mom and Dad and on your way to establishing a new life with a wife and children?
5) On a scale of 1 to 10, with 1 being the lowest and ten being the highest, how important is it to you to settle the issue of feeling attracted to men and to women both?
a. Do you feel you have to choose one over the other?
b. Do you feel that you have to act on these feelings?
The miracle question would follow in a separate session, and would proceed in this manner: “Suppose that you awoke one morning to find that all your issues had been miraculously resolved. You don’t know how nor do you even care. All you know is that everything is okay—everything is just right. How would you communicate this fact to your mom and to your dad? How would you communicate it to other people?”
Goal setting would follow this session, with Don being asked to identify goals, based on the answers to the miracle question and the behaviorisms that he would engage in serving as goal posts for how he would like to live were he to feel that he was free of problems. The scaling session would serve as a path towards understanding what the biggest challenges are and what he would like to address first and foremost and what issues could wait and be addressed later if they are still found to be lingering. Short-term, medium-term, and long-term goals will be discussed.
Mom and Dad. For Mom and Dad, the scaling questions would include:
1) On a of 1 to 10, with 1 being the lowest and ten being the highest, how would you rank your ability to communicate with your son?
a. How would you rank your ability to show support?
b. How would you know if your ability to show support was effective or ineffective for your son’s confidence?
2) On a of 1 to 10, with 1 being the lowest and ten being the highest, how important is it to you that your son find a good girl to settle down with and start a new family?
a. How would you know if you were helping or hindering his process?
b. How would you identify if your son were confused about something related to this process?
For the miracle question, the parents would be asked: “Suppose that you awoke one morning to find that all your issues had been miraculously resolved. You don’t know how nor do you even care. All you know is that everything is okay—everything is just right. How would you communicate this fact to your son? How would you communicate it to your spouse?”
For goal setting, Mom and Dad would be asked to identify goals that they would like to set for themselves based on their answers to the miracle question and to the scaling intervention. As with Don, goals will be divided into shor-term, medium-term, and long-term, and by the end of two months’ worth of sessions, the family should be able to identify whether short-term goals have been met and whether they are on track for meeting medium-term goals and how confident they feel about meeting long-term goals that they have identified or whether they feel a need to change these based on initial results with respect to short-term goals.
Cultural Components of the Family’s System
The family has a deep religious aspect to it, which has provided Don with his sense of right and wrong sexuality. This cultural component will be necessary to reflect upon when engaging in the counseling sessions, as it provides an informative backdrop against which the family’s perspectives on how a good life should be led can be identified. Incorporating this culture into discussions with respect to the three interventions described herein can be helpful for Don, Mom and Dad as it will enable to think about themselves, their challenges and their goals while objectively considering them in the light of their own culture as opposed to other people’s cultures. Establishing how important culture and religion are for them will help the sessions to move forward and effective solutions to be found.
Ethical or Legal Issues Relevant to the Practice of Family Counseling
Ethical issues relevant to the practice of family counseling include preventing counselor bias from clouding a counselor’s view of how to allow the clients to develop the right goals for themselves. In terms of religion, sexuality, or identity, it is important that the framework of value be determined by the clients instead of by the counselor. Another ethical issue is the importance of maintaining client confidentiality so that in sessions, what is said in private is retained in private.
Legal issues that are relevant to family counseling include having one’s certification, licensing and registration requirements in order and filed with the state before engaging in practice, so that all compliance issues with the state are met and the counselor can engage in counseling lawfully.

References
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