Solution-Focused Therapy with a Dying Client: Berg Analysis
This paper examines Insoo Kim Berg's solution-focused therapy session with Tanya, a client living with AIDS who has approximately six months to live. The analysis covers Berg's pattern of questioning, her use of repetition and active listening, and the miracle question technique. It also evaluates how the client's wants and needs were addressed throughout the session and proposes a treatment plan grounded in Brief Therapy and Solution-Oriented Possibility Therapy. Drawing on Ericksonian concepts and Gehart's case conceptualization framework, the paper demonstrates how solution-focused approaches can empower terminally ill clients to resolve personal obstacles and move toward a meaningful death.
- Pattern of Questioning: Berg's questioning techniques and miracle question method
- Repetition and Active Listening: Therapist's use of repetition and affirmations
- Client's Wants, Needs, and Outcomes: How Tanya's goals were addressed and met
- Other Concepts and Lessons Learned: Ericksonian concepts and key takeaways
- Treatment Plan: Proposed plan using Brief and Possibility Therapy
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What makes this paper effective
- The paper stays tightly grounded in a specific observed session, consistently referencing Berg's actual interventions rather than making abstract claims about the therapy model.
- It moves logically from observation (questioning pattern, repetition) to evaluation (client outcomes) to application (treatment plan), giving the analysis a clear progressive structure.
- The treatment plan section demonstrates applied clinical thinking by translating observed techniques into a replicable step-by-step framework with attention to client autonomy and flexibility.
Key academic technique demonstrated
The paper uses direct session observation as primary evidence, anchoring each analytical claim to a specific moment or technique from the Berg (2012) video. This evidence-based approach, combined with citation of Gehart's case conceptualization model, shows how to bridge clinical observation with theoretical frameworks — a core skill in graduate-level counseling analysis.
Structure breakdown
The paper opens with a section-by-section breakdown of Berg's technique (questioning, repetition, client needs, outcomes), then pivots to a reflective "Lessons Learned" note before presenting an original treatment plan. The treatment plan mirrors the session's structure — brief therapy timeframe, Solution-Oriented Possibility Therapy, and the miracle question — creating a satisfying symmetry between the observed and proposed clinical work. Total length is moderate, appropriate for a graduate reflection or short case analysis assignment.
Pattern of Questioning
The pattern of questioning that Berg uses in "Dying Well" begins with an effective questioning technique. Berg asks Tanya what she hopes or wants to accomplish before her death. Tanya responds that she wants to confront her past so that she can go home and say goodbye to her mother. Her goal is to "get rid of" the past issues keeping her from going home — namely, the abuse she suffered at the hands of her brothers and father (Berg, 2012). She believes that by confronting this issue she can avoid a painful encounter with her family when she returns home.
Berg asks Tanya, "What difference will it make?" if she confronts this issue and "gets rid of" the problem she is having with her feelings of hatred toward her brothers and father. Tanya talks through the issue, trying to make sense of both her own feelings and the advice given to her by doctors at the clinic where she is treated. Their advice is that she confront her brothers so that she can have a good death; however, she does not see the point, because doing so would just "bring it all up again" and besides "they don't think they did anything wrong," as Tanya explains (Berg, 2012).
Berg's pattern of questioning is continuous and, in tone, mainly comforting. She seeks to support her client rather than judge her. Her method of effective questioning is geared toward helping Tanya work through her issues by prompting her to ask herself why they are issues in the first place and what she expects to happen by confronting them. In doing this, Berg is actually helping Tanya confront those issues by drawing them into the open through conversation. This approach reflects the core principles of solution-focused brief therapy, which prioritizes client-generated solutions over therapist-directed diagnoses.
Finally, Berg transitions to the miracle question method. She asks Tanya what she would do if she went home, went to sleep, and woke up to find that a miracle had happened — that the problem had mysteriously resolved itself and no longer existed. This method of questioning enables the client to imagine a new sense of self and the world, helping to clear the air and give the client a vision to move toward and embrace. In this way, Tanya is able to envision a life for herself that feels complete, one in which she has a supportive family and no longer needs to feel guilty about her past.
Repetition and Active Listening
The therapist is notably repetitious with the client: she repeats much of what Tanya says to demonstrate that she is listening and understanding everything being communicated. She also repeats affirmative expressions throughout — "Mm-hm," "Mm," "Uh-huh," "Yes, I see," and similar responses.
After every pause, the therapist recounts what the client has said while also continuing to pursue a line of inquiry. Within the first twelve minutes of the session, she asserts three times that she does not understand why the client wants or needs to go home to confront a family issue in order to say goodbye to her mother before she dies. This sustained, gentle probing is designed to move the client toward a deeper examination of her underlying issues. Active listening of this kind is well documented as a foundational skill in client-centered counseling approaches.
Client's Wants, Needs, and Outcomes
The client appears to have gotten what she wanted: the opportunity to bury the past. She accomplishes this first by confronting the issue directly and then by imagining a new reality and future for herself — one in which she can conduct herself according to how she actually wants to live. She maintains her sense of reality and her awareness of approaching death, but she does not allow herself to be crushed by her problems. She moves confidently toward her goal of being able to say goodbye.
This outcome was achieved through a combination of effective questioning and effective listening. The therapist remained engaged with Tanya throughout — never telling her what to think, do, say, or feel — but affirming her responses and reflecting them back to demonstrate sympathy and empathy. Berg was also able to steer Tanya toward a healthier self-concept and a clearer goal by using the miracle question approach, which enabled Tanya to project herself into a world where the issue was resolved and her goal was attainable. By envisioning this scenario, Tanya moved a step closer to making it a reality, essentially seeing herself in the role she wanted to inhabit.
References
Berg, I. K. (2012, October 4). Dying well. Milwaukee, WI [Video file]. http://www.viddler.com/v/c5249886?secret=64169979
Gehart, D. R. (2014). Mastering competencies in family therapy. Belmont, CA: Brooks-Cole, Cengage Learning.
Solution-Oriented Possibility Therapy. (n.d.). Retrieved from http://www.billohanlon.com/
Counselling Therapies, Session 5: Solutions Focused Therapy [Video file]. http://search.alexanderstreet.com.proxy1.ncu.edu/view/work/1779358
PowerPoint — Chapter 9 Solution-Based MCFT. Chapter 9 Solution-Based MCFT.pptx.
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