Solution-Focused Brief Therapy

Solution-focused brief therapy (SFBT), also called solution-focused therapy or solution-building practice therapy, was developed by Steven de Shazer, Insoo Kim Berg, and their colleagues. As the name suggests, SFBT is future-focused and goal-directed, and focuses on solutions rather than on the problems that brought clients to seek therapy.

De Shazar, Berg, and their collaborators established the Brief Family Therapy Center (BFTC) in 1978 in Milwaukee, Wisconsin, as a training and research institution.

The entire solution-focused approach was developed inductively in the inner-city outpatient mental health service setting associated with the BFTC, in which clients were accepted without previous screening. The developers of SFBT spent hundreds of hours observing therapy sessions over the course of several years, carefully noting the therapists’ questions, behaviors, and emotions that occurred during the session and how the various activities of the therapists affected the clients and the therapeutic outcome of the sessions. Questions and activities related to clients’ report of progress were preserved and incorporated into the SFBT approach. The developers of SFBT were also strongly influenced by Milton Erickson’s use of language and metaphor and the work at the

Mental Research Institute in California focusing on communication patterns in families of people diagnosed with schizophrenia.

Since that early development, SFBT has become an important school of brief therapy. It has become a major influence in such diverse fields as business, social policy, education, criminal justice services, child welfare, and domestic violence offenders treatment. Described as a practical, goal-driven model, a hallmark of SFBT is its emphasis on clear, concise, realistic goal negotiations. The SFBT approach assumes that all clients have some knowledge of what would make their life better, even though they may need some (at times, considerable) help in describing the details of their better life. SFBT also assumes that everyone who seeks help already possesses at least the minimal skills necessary to create solutions.

Key Concepts and Tools of Solution-Focused Brief Therapy

All therapy is a form of specialized conversations. With SFBT, the conversations are directed toward developing and achieving the client’s vision of solutions. The following techniques and questions help clarify those solutions and the means of achieving them.

Looking for Previous Solutions

Solution-focused (SF) therapists have learned that most people have previously solved many problems and probably have some ideas of how to solve the current problem. To help clients see these potential solutions they may ask, “Are there times when this has been less of a problem?” or “What did you (or others) do that was helpful?”

Looking for Exceptions

Even when a client does not have a previous solution that can be repeated, most have recent examples of exceptions to their problem. These are times when a problem could occur, but does not. The difference between a previous solution and an exception is small, but significant. A previous solution is something that the clients have tried on their own that has worked, but that they later discontinued. An exception is something that happens instead of the problem, often spontaneously and without conscious intention. SF therapists may help clients identify these exceptions by asking, “What is different about the times when this is less of a problem?”

Focusing on Present and Future Rather Than the Past

The questions asked by SF therapists are usually focused on the present or on the future. This reflects the basic belief that problems are best solved by focusing on what is already working, and how clients would like their life to be, rather than focusing on the past and the origin of problems. For example, they may ask, “What will you be doing in the next week that would indicate to you that you are continuing to make progress?”

Giving Compliments

Compliments are another essential part of SFBT. Validating what clients are already doing well, and acknowledging how difficult their problems are encourages clients to change while giving the message that the therapist has been listening (i.e., understands) and cares. Compliments in therapy sessions can help to punctuate what the client is doing that is working. In SF therapy, compliments are often conveyed in the form of appreciatively toned questions of “How did you do that?” that invite the client to self-compliment by virtue of answering the question.

Inviting the Clients to Do More of What Is Working

Once SF therapists have created a positive frame via compliments and then discovered some previous solutions and exceptions to the problem, they gently invite the client to do more of what has previously worked, or to try changes they have brought up which they would like to try—frequently called “an experiment.”

Asking the Miracle Question

This unusual sounding tool is powerful in generating the first small steps of “solution states” by helping clients to describe small, realistic, and doable steps they can take as soon as the next day. The miracle question developed out of desperation with a suicidal woman with an alcoholic husband and four “wild” children who gave her nothing but grief. She was desperate for a solution, but thought that she might need a “miracle” to get her life in order. Since the development of this technique, the miracle question (MQ) has been tested numerous times in many different cultures. The most recent version is as follows:

Therapist: I am going to ask you a rather strange question… that requires some imagination on your part…do you have a good imagination?
Client: I think so, I will try my best.
Therapist: Good. The strange question is this: After we talk, you go home (go back to work), and you still have lots of work to do yet for the rest of today (list usual tasks here). And it is time to go to bed… and everybody in your household is sound asleep and the house is very quiet… and in the middle of the night, there is a miracle and the problem that brought you to talk to me about is all solved. But because this happens when you are sleeping, you have no idea that there was a miracle and the problems is solved…so when you are slowly coming out of your sound sleep… what would be the first small sign that will make you wonder… there must’ve been a miracle… the problem is all gone! How would you discover this?
Client: I suppose I will feel like getting up and facing the day, instead of wanting to cover my head under the blanket and just hide there.
Therapist: Suppose you do, get up and face the day, what would be the small thing you would do that you didn’t do this morning?
Client: I suppose I will say good morning to my kids in a cheerful voice, instead of screaming at them like I do now.
Therapist: What would your children do in response to your cheerful “good morning”?
Client: They will be surprised at first to hear me talk to them in a cheerful voice, and then they will calm down, be relaxed. God, it’s been a long time since that happened.
Therapist: So, what would you do then that you did not do this morning?
Client: I will crack a joke and put them in a better mood.

These small steps become the building block of an entirely different kind of day as clients may begin to implement some of the behavioral changes they just envisioned. This is the longest question asked in SFBT and it has a hypnotic quality to it. Most clients visibly change in their demeanor and some even break out in smiles as they describe their solutions. The next step is to identify the most recent times when the client has had small pieces of miracles (called exceptions) and get them to repeat these forgotten experiences.

Asking Scaling Questions

Scaling questions (SQ) can be used when there is not enough time to use the MQ. Scaling questions are useful in helping clients assess their situations, track their progress, or evaluate how others might rate them on a scale of 0 to 10. It is used in many ways, including with children and clients who are not verbal or who have impaired verbal skills. One can ask about clients’ motivation, hopefulness, depression, and confidence, and the progress they made, or a host of other topics that can be used to track their performance and what might be the next small steps.

The couple in the following example sought help to decide whether their marriage could survive or they should get divorced. They reported they have fought for 10 years of their 20 years of marriage and they could not fight anymore.

Therapist: Since you two know your marriage better than anybody does, suppose I ask you this way. On a scale of 1 to 10, where 10 stands for you have every confidence that this marriage will make it and 1 stands for the opposite, that we might just as well walk away right now and it’s not going to work. What number would you give your marriage? (After a pause, the husband speaks first.)
Husband: I would give it a 7. (The wife flinches as she hears this.)
Therapist: (To the wife) What about you? What number would you give it?
Wife: (She thinks about it a long time) I would say I am at 1.1.
Therapist: (Surprised) So, what makes it a 1.1?
Wife: I guess it’s because we are both here tonight.

Asking Coping Questions

These questions are a powerful reminder that all clients engage in many useful things even in times of overwhelming difficulties. Even in the midst of despair, many clients do manage to get out of bed, get dressed, feed their children, and do many other things that require major effort. The question “How do you do it?” is an empowering question that opens up a different way of looking at client’s resiliency and determination.

Research Findings

Even though it is an inductively developed model, from its earliest beginnings, there has been consistent interest in assessing SFBT’s effectiveness. Given the clinical philosophy behind the SFBT approach, it is not surprising that the initial research efforts relied primarily on client self-reports. Since then, an increasing number of studies have been generated, many with randomized comparison groups, such as that of Lotta Lindforss and Dan Magnusson who studied the effects of SFBT on the prison recidivism in Hageby Prison in Stockholm, Sweden. Their randomized study compared clients who received an average of five SFBT sessions and those who received their usual available services. Clients were followed at 12 and 16 months after discharge from prison. The SFBT group consistently did better than the control group.

A number of researchers have reviewed studies conducted in a variety of settings and geographical locations, with a range of clients. Based on the reviews of these outcome studies, Wallace J. Gingerich and Sheri Eisengrat concluded that the studies offered preliminary support that the SFBT approach could be beneficial to clients. However, more microanalysis research into the co-construction process in solution-focused conversation is needed to develop additional understanding of how clients change through participating in these conversations.

References:

Berg, I. K., & de Shazer, S. (1993). Making numbers talk: Language in therapy. In S. Friedman (Ed.), The new language of change: Constructive collaboration in psychotherapy. New York: Guilford Press.
Berg, I. K., & Dolan, Y. (2001). Tales of solution: A collection of hope inspiring stories. New York: Norton.
De Jong, P., & Berg, I. K. (2007). Interviewing for solutions (3rd ed.). Pacific Grove, CA: Brooks/Cole.
De Shazer, S. (1984). The death of resistance. Family Process, 23, 79-93.
De Shazer, S., Dolan, Y., Korman, H., Trepper, T. S., McCollom, E., & Berg, I. K. (2007). More than miracles: The state of the art of solution-focused brief therapy. Binghamtom, NY: Haworth Press.
Gingerich, W., & Eisengrat, S. (2000). Solution-focused brief therapy: A review of the outcome research. Family Process, 39, 477-198.
Lindforss, L., & Magnusson, D. (1997). Solution-focused therapy in prison. Contemporary Family Therapy: An International Journal, 19, 89-103.
McGee, D., Del Vinto, A., & Bavelas, J. (2005). An interactional model of questions as therapeutic interventions. Journal of Marital and Family Therapy, 31, 371-384.