Using the Solution Focused Therapy Approach
Lisa Thomas, LCSW, LMFT, DAACS
In this paper, I will talk about Solution Focused therapy; also know as Brief therapy and how this method constructs solutions to issues in couples and family therapy. I will discuss how the therapist becomes solution focused with his or her clients, and what treatment methods look like. Using the Solution Focused Model with couples and what couples are good candidates for the treatment process. Average number of sessions and training requirements the therapist should have to appropriately meet the needs of these participating couples. Finally, cultural sensitivity when using Solution Focused therapy will be examined and research into the history and treatment success rate will be covered.
Becoming Solution Focused
Solution Focused Brief therapy began to develop in 1978 and was given its name in 1982 when the model began being used more frequently. Brief Solution Focused therapy focuses on promoting change in the direction of the client's goals. When a client enters into a therapist's care, the Solution Focused model follows a set of questions that will dictate where a client is starting from. Where a client is staring from is simply defined as where a client is willing to begin in the therapy process, which includes the amount of disclosure the client may be willing to exhibit. The therapist using this model may first ask the clients a question of what is the problem. This should then lead into what is the main cause of this problem. Next, the client may be asked what maintains the problem. After these questions are answered or at least attempted by the client, the therapist should have an idea about the client's patterns of behavior and thinking around the problem. Having this knowledge will give the therapist a staring point from which to work from (Walter & Peller, 1992).
How Does the Therapist Construct Solutions?
By understanding where the client is at right now, the therapist is able to construct solutions using the Solution Focused model. To construct solutions, there remain some assumptions, these may include; that there is a solution to the problem or that multiple solutions exist. That the solutions are constructable, the therapist and the client are able to construct the solutions and that the therapist and the client construct and or invent solutions rather than discover them. Finally, after solutions have been constructed, the therapist would want this process to be modeled in order for it to be implemented by the client.
In short, step one; find out what the client wants. Step two, look for what is working and do more of that. Step three, do something different. Solution Focused therapy is the answer to the question of how do we construct solutions? It is a total model; it encompasses a way of thinking, a way of conversing with clients and a way of constructing solutions interactively. Solution Focused therapy is not a collaboration of techniques; rather it reflects fundamental notions about change, about interaction and about attaining goals. The focus in therapy is shifted from the past to present day, where we look for causes and map patterns of problem maintenance (Walter & Peller, 1992).
Using Solution Focused Therapy with Couples
In Western Culture, individuals are generally free to marry whomever they choose. Yet despite careful consideration in choosing a partner, the majority of marriages end in divorce. The causes of marital unhappiness and disequilibrium have been extensively examined. They vary extending from cultural differences to personality contrasts. To be helpful to couples, the therapist must be fully aware of the cultural, relational and individual complexities when treating this population. The task of couple's psychotherapy using the Solution Focused model is the development, enhancement and maintenance of optimally functioning individuals in the context of intimate relationships (Shapiro, Peltz & Shapiro, 1998).
One suggestion for the couple's psychotherapy format is the use of couple's group therapy. According to this theory, neurotic marital patterns played out in a group were not damaging to group dynamics. Instead, the group was observed as providing considerable reality testing for the couple's own personal distortions. To prepare the therapist for group therapy using the Solution Focused model with couples, a screening process must first take place.
A willingness to participate is key, since the Solution Focused model does not cater to clients unwilling to disclose material. Some additional screening considerations include that couples entering into groups have their relationships as their primary source of stress. Members for whom individual pathology is different from that of others may well not be appropriate. An example of this is an individual who desires to be in a couples group with their partner but is suffering from a severe psychotic disorder, such as schizophrenia or has a significant substance abuse problem, domestic violence issues or other issues non-related to relationship repair (Shapiro, Peltz & Shapiro, 1998).
Finally, certain participant and treatment variables have been shown to affect group treatment outcomes. The ideal group is closed, time limited, homogeneous and process focused. Groups with specific limited goals lead by trained professional leaders using interventions geared to increase cohesion and altruism among members are most productive. The treatment phases include preparation, transition, treatment and termination (Shapiro, Peltz & Shapiro, 1998).
What Types of Couples Are Likely to Respond to Group Solution Focused Therapy?
The types of couples likely to respond to group Solution Focused therapy include; Younger couples which include couples who have not yet reached homeostasis. Couples for whom a relationship pathology is chronic and ego dehabilitating, and finally couple in which there is a scapegoating and or role confusion will respond best to the confrontation available in a group of peers. Group intervention is also recommended for couples with a mutual blaming pattern since group interaction may shine a light on this and hopefully break old habits through education and understanding (Shapiro, Peltz & Shapiro, 1998).
How Many Sessions are advised For Treatment?
The total number of sessions and the extent to which groups are open or closed affect potential participation. Some members will choose a closed group with a predictable fixed number of sessions to attend. Other people prefer the flexibility of an open group, although this could pose a confidentiality hazard as well as problems surrounding disclosure based on a possible low level of trust between the group members.
Closed groups that have a commitment of 10-12 sessions may be too large of an initial commitment for some potential members. Some individuals will also be threatened by a group that appears too short to accomplish anything without overwhelming emotional intensity. In general, a guideline to be followed is closed outpatient groups are commonly 6-20 sessions in length with the vast majority in the 10-12 session range. The psychotherapists leading the group need to be aware of their own personal demeanor, which includes scheduling groups when energy levels are available as opposed to gone or fading.
Is Solution Focused Therapy Sensitive to Cultural and Ethnic Differences?
In addition to appropriate Solution focused training and education in the mental health field, therapists need training in diversity. The client groups will always be made up of individuals who will bring a personal history and culture to each meeting whether it is in individual therapy or in a group setting. In any setting, there may be members with different needs, backgrounds, religions, races, ethnicity and cultures. Effective leaders must be aware of all of these differences and accommodate the client's needs into the treatment process (Shapiro, Peltz & Shapiro, 1998).
Diversity training is something every therapist should be required to have knowledge of before jumping into client treatment. To be considered a culturally competent therapist, one should be encouraged to follow six simple steps; 1) Become informed of others cultures but not to try and be an expert. 2) Help members define how the group will fit and serve them personally. 3) To respect differences and break down stereotypes. 4) Focus on cultural issues and not act as if culture is invisible. 5) Focus more interpersonally as multiculturalism increases. 6) Finally, have a co-leader who is from a different ethnic group, especially when the group members come predominantly from a similar ethnic background that differs from that of the therapist.
In short, when working with a group, success cannot be defined by a group plan of action for all members. Each individual contributes something unique to the group process and each takes something personal away from the group (Shapiro, Peltz & Shapiro, 1998).
Research on Solution Focused Therapy; is it working?
More important than how does a therapist conduct Solution Focused therapy is the question of does this method work. According to one research study conducted by Peter De Jong of Calvin College in Grand Rapids , Michigan , the answer is yes. In 1990, this professor began asking his clients a scaling question that read as; On a scale of 1-10 where 10 is the problem(s) you came to therapy for are solved and 0 equals the worst they have been, where are they now on that scale? 50 Client answers were recorded, and the result concluded that 80% of De Jong's clients were making progress, that is scores for final sessions were higher than for the first sessions using the pre and post-test design ( www.brief-therapy.org) .
Another study conducted by Peter Dejong and Insoo Kim Berg details the success of Solution Focused therapy in families. In this study, 275 individuals were studies and were between the ages of 2-60. 57% were identified as African-American, 5% Latin, 3% Native-American and 36% White. The gender breakdown was 60% female and 40% male. The potential range was on a scale of 1-10 with 10 being the highest. The clients ranged from 3-8 on immediate outcomes. They ranged from -3-0 no progress, 1-3 moderate progress, 4-8 significant progress. Finally, the population studied disclosed the following. 26% reported no progress, 49% reported moderate progress and 25% reported significant progress. The average number of sessions was 3, median number of sessions was 2 ( www.brief-therapy.org) .
These examples only illustrate two out of hundreds of research studies conducted on Solution Focused therapy. The point is that this therapy method, when administered appropriately to appropriate clients works in a positive fashion for the client(s). Hopefully, future research will refine the therapy process to make it even more effective when working with clients and families.
In conclusion, Solution Focused therapy is an excellent method to use in treating clients who are interested in changing through the use of the "here and now" approach. Solution Focused therapy has the capacity to help individuals transform their patterns of unhealthy thinking and be exposed to new light and new directions. Group Brief Solution therapy is also exceptionally helpful for couples because it allows variation for possible solutions. Individuals interested in digging up the past are not appropriate for Solution Focused therapy, as this method caters to a greater understanding of dealing with present day problems.