Solution-Focused Brief Therapy: Collaboration and Ethics

Origins and Collaborative Nature of SFBT

Solution-Focused Brief Therapy (SFBT) was developed by Steve de Shazer, Insoo Kim Berg, and their colleagues in 1982 at the Brief Family Therapy Center in Milwaukee, Wisconsin. Initially, they employed a problem-resolution approach that they had encountered at the Mental Research Institute in Palo Alto, California, during their work with psychotherapist John Weakland. However, while listening closely to clients describing the details of their problems, they began noticing that clients also revealed exceptions — times when their problem was minimal or even absent. At this point, therapy shifted its emphasis from problem description to the specifics of those exceptions. This change of focus facilitated a transition from resolving problems to developing solutions. As the therapy's focus was redefined, a corresponding shift occurred in the role expectations of both clients and therapists. Solution-focused psychotherapists came to view clients as the experts on their own lives and, notably, on what would prove helpful to them. SFBT can therefore be defined as a collaborative and client-centered approach (Simon & Berg, n.d.).

The medical literature has begun promoting solution-focused therapy as a collaborative counseling method well suited to a busy client-centered family practice. Supporters among family physicians have suggested that SFT's emphasis on client abilities, resources, and strengths cultivates a counseling environment characterized by optimism and hope. The approach holds patients responsible for change by using encouraging language and acknowledging patients as capable of self-care. It thus demonstrates deep regard for clients as individuals, adopting a more equalized method of seeking solutions to problems (Greenberg, Granshorn, & Danilkewich, 2001).

Steven, a forty-year-old male, has a documented history of psychiatric issues dating back to early childhood. He was first hospitalized at the age of seventeen at a state psychiatric facility. Since then, he has been hospitalized multiple times at the same facility and in the mental health wards of community hospitals, with stays typically lasting between three and eight weeks. Four psychiatric assessments were completed by different psychiatrists over his last six years of medical history, all of whom diagnosed him with chronic undifferentiated schizophrenia. Over the course of his treatment, Steven was administered various psychiatric medications, several of which he reported as producing adverse side effects. In May 1996, he was referred by an outpatient community mental health facility to a Community Counseling unit in Goshen.

Case Example: Long-Term Psychiatric Client

Throughout his therapy, the client experienced increasing self-empowerment. Therapy functioned primarily to affirm the improvement that became progressively more apparent. What often proves most valuable to clients in this model is collaboration with therapists who acknowledge the limits of their own knowledge and remain genuinely curious about their clients' lives. SFBT therapists demonstrate growing interest in their clients' resources and strengths, and attentive listening guided by this interest ultimately proves most useful to clients (Simon & Berg, n.d.).

An essential element of preparing Marriage and Family Therapy (MFT) students is ensuring that they receive from their educators the same degree of empathy, awareness, and affirmation they will be expected to demonstrate when delivering therapeutic services to their own clients. Modeling these qualities gives MFT students the opportunity to observe and internalize skills that will be fundamental to their effectiveness as practitioners. Conversely, the absence of such faculty modeling may leave students less competent in these critical areas of practice, increasing the anxiety they experience as they transition from the classroom to the treatment room (Klick, 2005).

Research Measurement and MFT Training

Research has identified several themes related to how clinicians and researchers are influenced by postmodern theories. A gap between clinicians and researchers is apparent in marriage and family therapy, yet postmodern qualitative inquiry can offer pathways to bridging that divide. Clinicians and researchers can learn from one another: both can offer new approaches to engaging clients while conveying empathy and sharing narratives. Students also reported that methodological pluralism has the potential to make family therapy research more relevant to practicing clinicians (Hertlein, Shute, & Benson, 2004).

At the start of each session following the first, the therapist typically inquires about progress and what has been notable in the intervening period. Many clients report recognizable improvements, and the therapist helps the client describe those changes in as much detail as possible. When clients report that things have stayed the same or worsened, the therapist explores how the client has maintained stability despite deterioration — or, if things have worsened, what the client did to prevent further decline. Whatever the client has done to keep things from deteriorating becomes a focal point for compliments and possibly for further inquiry, since continuing those behaviors is encouraged (Trepper et al., n.d.).

Later in the session, after a substantial discussion of improvements, the therapist typically asks the client to rate themselves on a progress scale toward their solution. When the rating is higher than in the previous session, the therapist compliments this progress and helps the client identify how to maintain the change. At some point during the session, the therapist also checks — often indirectly — on how assigned tasks went. If the client completed the task and found it helpful in moving toward their goals, the therapist offers positive reinforcement. If the client did not complete the task, the therapist generally either sets it aside or asks what the client found more useful instead (Trepper et al., n.d.).