Brief Solution Models in Family Therapy

 

Major Concepts in Solution-Oriented Therapy

 

1.      Clients have within them or their social systems the resources to make the changes they need to make. The therapist’s job is to access these resources and help clients put them to use in appropriate areas of their lives.

 

2.      The role of positive expectations: Having positive expectations of client’s success is more conducive to tasks of exploration, discovery, and healing than a psychopathological perspective.

 

3.      Indirect communication: Stresses the importance of the therapist’s communication in his/her role as a passive inquirer who asks questions solely to receive an answer regardless of its content.

 

Basic Principles:

 

Clients have resources and strengths to resolve complaints — It is therapist’s task to access these abilities and help clients put them to use.

 

Change is constant — Therapists can do a great deal to influence client’s perceptions regarding the inevitability of change and what is supposed to happen during the therapy session.

 

The therapist’s job is to identify and amplify change — He/She accomplishes this through choice of questions, topics focused on or ignored. “Focus on what seems to be working however small, to label it as worthwhile, and to work toward amplifying it.” If [the change] is in a crucial area, it can change the whole system.

 

It is usually unnecessary to know a great deal about the complaint in order to resolve it — What is significant is what the clients are doing that is working. Learn from clients’ identifying when the problem is not troublesome. Clients can learn to function that way again to solve the problem.

 

It is not necessary to know the cause or function of a complaint to resolve it — Even the most creative hypotheses about the possible function of a symptom will not offer therapists a clue about how people can change. It simply suggests how people’s lives have become static. Ask those who want to know why they have a symptom: “Would it be enough if the problem were to disappear and you never understood why had it?”

 

A small change is all that is necessary: A change in one part of the system can affect change in another part of the system — “We have the sense that positive changes will at least continue and may expand and have beneficial effects in other areas of the person’s life.

 

Clients define the goal — Do not assume that therapists are better equipped to decide how their clients should live their lives; ask people to establish their own goals for treatment.

 

Rapid change or resolution of problems is possible — “We believe that, as a result of our interaction during the first session, our clients will gain a more productive and optimistic view of their situations.” Therapists expect them to go home and do what is necessary to make their lives more satisfying (p. 45). Average length of treatment is less than 10 sessions, usually 4 to 5, occasionally only 1.

 

There is no one “right” way to view things; Different views may be just as valid and may fit the facts just as well — Views that keep people stuck are simply not useful. Sometimes all that is necessary to initiate significant change is a shift in the person’s perception of the situation.”

 

Focus on what is possible and changeable rather than what is impossible and intractable — Focus on aspects of a person’s situation that seem most changeable. This imparts a sense of hope and power.

 

Specific Techniques Employed in Solution Oriented Therapy

 

INTRODUCING UNCERTAINTY

The therapist can introduce some uncertainty into the problem definition by asking “What gives you the impression that things seem difficult to handle?”  Or he/she can imply that there are days when the problem is nonexistent by asking “What is different about the days when things seem manageable?”

 

FRAMING QUESTIONS

Questions asked can elicit information about strengths, abilities, and resources.  Perceptions of problems then change significantly in this context.

 

1.  The Miracle Question:  Suppose that one night, while you were asleep, there was a miracle and this problem was solved.  How would you know?  What would be different?

This type of question seems to make a problem-free future more real and therefore more likely to occur.

The therapist is given guidelines and information to help the client go directly to a more satisfactory future.

 

2.  The Exception Question:  Asks the client to focus on times when problem does not occur or has not occurred when they expected it would.  They may discover solutions they had forgotten or not noticed.  The therapist might find clues on which to build future solutions.

 

Example:  “What is different about those times when things are working?”

 

REFRAMING PROBLEM DEFINITIONS

S-O therapists offer new, more workable problem definitions that are within the power of the client and therapist to solve.  They usually help the client reframe the problem definition to a more positive one or listen for a hint of something in the client’s complaint that can be solved.  This co-creates the experience that the problem is solvable and the client has some ability to solve it.

 

PROBLEM SOLVING TECHNIQUES

1.  Dissolve the idea that there is a problem:

Help people see their situations in new ways.

2.  Negotiate a solvable problem:

Reduce the size of the problem in the client’s eyes.  (Get specific about the problem; focus on when it is not so serious a problem).

3.  Frame towards the idea that clients have all the abilities and resources to solve the problem:

Create an atmosphere that facilitates the realization of strengths and abilities.

 

MATCHING THE CLIENT’S LANGUAGE

Example:  Use the exact words the client uses to describe the problem in asking questions about what they have done before, when it is not so serious a problem, etc.

Also, attend to client’s metaphors and utilize them also to extend observations, learn about their interests or hobbies to use metaphors that involve them.

 

MATCHING SENSORY MODALITIESUse words pertaining to “seeing” or “hearing” how things are and use words in the same vein.

 

CHANNELING THE CLIENT’S LANGUAGE

Channel away from jargon into action descriptions used in every day language.  This has the effect of depathologizing or normalizing clients’ situations.  Gradually change your terminology to less serious, more positive words.  (Example:  Use the words “transitional period” as this give the client the opportunity to take solace in hearing that a problem is temporary, helps shape their expectations for the future).

 

Use of verb forms:  Create a reality where the problem is in the past and possibilities exist for the present and in the future.  “When you had this problem before, you used to . . . you were having difficulty . . . how did the old you . . .”

 

Help clients make distinctions that are helpful (feeling like or thinking about . . . rather than doing it).

 

NORMALIZING AND DEPATHOLOGIZING

Tell clients that their problems are “understandable” and put the situation in an everyday frame of reference.  Say such things as “naturally,” “of course,” “welcome to the club,” “so what else is new,” “that sounds familiar,” or “yeah, me too.”

 

GOAL SETTING

Start small — “What will be the first sign that things are moving in the right direction?”  Goals must be concrete.

 

FAST-FORWARDING QUESTIONS

For use when clients can’t identify exceptions or past solutions.  Clients are asked to envision a future without the problem and describe what that looks like.  (The miracle question or a magic wand question).  “What will not would be different?”

 

FIRST SESSION PROTOCOL

The Consultation Break:  (from Brief Therapy article)

After 30-40 minutes, therapist excuses himself to consult with the team, or when working alone to think about things (p. 216).  Talk focuses on:  things the clients are doing that are good for them; any exception to the complaint pattern; and what the team imagines the clients will be like once the complaint is part of the past.

 

Compliments are then given based on what the client is already doing that is useful or good or right in some way, regardless of the specific content and context.  Compliments are designed to help the client “see through” their frame of the situation in such a way that a more flexible view of the situation is possible.  The purpose is to support the orientation toward solution while continuing the development of a “yes set” begun during the interview but now will be pursued in a more intense and focused manner.  [It] is designed to let clients know that the therapist sees things their way and agrees with them . . . Then the clients are in a proper frame of mind to accept clues about solutions (p. 216).

 

Clues are focused therapeutic suggestions, tasks, or directives about other sorts of things that the clients might do that will likely be good for them and will lead in the direction of solution (p. 216).

 

Message Delivery:  After intermission of 10 minutes or less, therapist returns and gives the formal intervention.  This takes 5 minutes or less, a new appointment is set, and the session ends.

 

 

Solution-Based Psychotherapy Techniques

 

Strong belief that client possesses solution to the problem. Never ending search for exceptions to the problem. Use of positive lines of questioning, stories, and expansion of client’s possessed solutions.

1.   Clients present 3 options:

      a.      Want to stop doing something

      b.      Want to start doing something

      c.      Want to do something differently

2.   Close examination of pretherapy change

3.   Emphasis is on strengths and solutions NOT problem or pathology.

4.   Hunt for exceptions

5.   Look for difference that makes a difference

6.   Do not give up with vagueness

7.   Close attention to language used by client AND therapist

8.   Future orientation

 

Assessment as Intervention

Pay attention to the client’s:

      1.      language

      2.      interests/motivations

      3.      frames of reference

      4.      behavior

      5.      symptoms

      6.      beliefs

 

1.   Pay close attention to their theories/beliefs/explanations

      — Where do they come from?

 

2.   Create fit of realities regarding therapy

      — what do clients believe therapy is about?

      — ethnographic interview

 

3.   Introduce:

      — confusion

      — disbelief

      — doubt

      — normalization

 

4.   Give close examination to their language and yours.

      A.     Vague statements

      B.      Unspecified verbs

               “He ruined the relationship” (how, what way?). “I am scared” (of what)

      C.     Specify comparison

               “He is lazy” (compared to whom)

      D.     Empty nouns

               respect, love, anger, depression

      E.      Generalization (all, non)

      F.      Cannot/will not vs. does/did not

      G.     Characterizations (lazy, aggressive)

      H.     Challenge claims

               “How do you know you feel depressed”

 

5.   What are your presuppositions

      — try to examine from another theory

 

6.   Reformulate the problem

      — do at end of session


 

Pretherapy Assessment

    1.  What makes you think your family needs our services?

    2.  What do you expect to happen here that will be helpful to your family?

    3.  What will convince you that your family does not need to come here?

    4.  How many days per week does the problem occur? (please circle)

               1       2          3          4          5          6          7

    5.  How many hours per day in the problem present?

    6.  Please place an X indicating the severity of the problem.

               1<----------------------------------5---------------------------------->10

          very mild                                                                                    very severe

    7.  Who will be the first person to notice an improvement in the problem?

    8.  What is one of the first things your family will be doing differently when they notice improvement?

    9.  When does your family NOT have the problem?

  10.  How do you explain when the problem does not happen?

  11.  How will you know when the problem is really solved?

  12.  What are you doing to keep things from getting worse?

  13.  What would tell you that things are getting a little better?

 

Todd, T. Pretherapy assessment. Unpublished measure. The Brief Therapy Institute of Denver, 8120 Sheridan Blvd., Ste. C-112, Westminster, CO, 80030.


 

Conducting the First Session of Solution-Focused Therapy

 

1)  FINDING OUT ABOUT THE CLIENT’S LIFE with a special attention to interests, motivations, competencies, and beliefs. This is accomplished in a social, conversational manner by “chatting” with the client about their work, hobbies, vocations, interests, and commitments. Special attention is given to metaphors and the use of language for the purpose of using such processes of communication to access the client’s beliefs and to assist the client in changing existing beliefs and behaviors. This sequence is on-going in that the therapist is always learning about the client, but a short time, usually 5-10 minutes, in given in the first session to get the sequence started. At the end of this sequence the therapist should be able to answer questions such as:

a)  What does the client like to do? Such as what subjects in school do they do like.

b)  What are some major hobbies or interests of the client?

c)  How do they use language to describe themselves and others?

d)  Are there any important key words or metaphors that can be used to communicate to the client?

e)  What is known so far about their worldview or beliefs?

2)  GATHERING A BRIEF DESCRIPTION OF THE PROBLEM BEHAVIORS. After the solution-focused therapist is acquainted with the client he or she proceeds to gather a problem description from the client by asking questions such as “What would have to happen for you to know that it was worth your time to come and see me today may be asked? Or, “If we were successful in making progress in solving the problem that brought you here today, what would need to be different?” The client will usually begin to volunteer information about the presenting problem. The therapist asks follow-up questions to gain a sense of the problem and context of the problem. However, the questions may be phrased in different ways to accommodate to individual clients. The therapist should come out of this sequence having asked and been provided answers to the following questions.

a)  What is the problem?

b)  How long is the problem been going on?

c)  How often does the problem occur?

d)  Where or in what situations does the problem occur?

e)  Who is there when the problem happens or who is involved in the problem?

f)  What does each person do in a sequence (What does your teacher do?, Your classmates?  When the principle comes what does he do? etc.)?

g)  Whose idea was it for you to come for help with the problem?

h)  Why did you come or get sent for help now and not before?

i)  What is your explanation for why this problem is happening?

j)  What have you tried so far to solve the problem?

3)  ASKING RELATIONSHIP QUESTIONS TO HELP THE CLIENT DEFINE THE SOCIALLY CONSTRUCTED NATURE OF THE PROBLEM. The therapist asks relationship questions such as What would your teacher say about your grades? What would your mother say? If you were to do something that made your teacher very happy what would that be? Who would be most surprised that you did really well on the test? What would that person say about the fact that you are doing so well ? Relationship questions are used throughout the sessions at different points to help the client gain a meta-perspective about the problem, and to assess the individual cognitive constructions and social constructions concerning the problem definition and resolution. Relationship questions can be used to help clients discuss their problems from a third person’s perspective, making the problems less threatening to discuss. After asking relationship sequence questions a therapist should know the following:

a)  How the client perceives the problem as well as their perceptions about others’ perspectives about the problem or problem resolution.

b)  How the problem is being socially constructed and who and how they are involved with those social constructions.

c)  Who from the client’s perspective makes the problem worse and who makes it better?

d)  What social supports and resources are available to the client and how these resources may be used to solve the problem.

4)  TRACKING SOLUTION BEHAVIORS OR EXCEPTIONS TO THE PROBLEM. The therapist proceeds to identify times when the problem does not occur, effective coping responses, and the contexts for the absence of the problem. The therapist says something such as, “Even though this is a very bad problem, in my experience people’s lives do not always stay the same. I bet that there are times when the problem of being sent to the principal’s office is not happening or at least it is better. Describe those times. What is different? How did you get that to happen?” The therapist gathers as many exceptions to the problem pattern as possible by repeatedly asking the client what else... what other times...? The therapist must be patient and give the client time to construct the exceptions from episodic memory. Since the client is often focused on the problem situations the exceptions may not be on the “tip of their tongue”. Once an exception has been identified by the client, the therapist uses “prompts,” such as “tell me more about that,” to help the client describe in detail the exceptions. The therapist also uses his or her own affects, tone and intense attention to the client’s story to communicate to the client that they are very interested in those exceptions. Such non-verbal gestures as nodding, smiling, leaning forward, looking surprised are used. They also may say something such as “how about that,” “I am amazed,” “Wow!” as social reinforcement to the client. This encourages the client to talk on and to develop in more detail the exceptions story. The therapist should come out of this sequence knowing the following:

a)  What exceptions to the problem exist?

b)  How often have exceptions occurred?

b)  When was the last time an exception happened?

c)  What was different in the situation where the exception occurred than in situations where the problem happens?

d)  Who was involved in making the exception happen?

5)  SCALING THE PROBLEM. Using Scaling questions to anchor the problem and to track progress toward problem resolutions. The therapist says, using the prior descriptions of the client concerning the problem descriptions and exceptions, “On a scale of 1-10 with 1 being that you are getting in trouble everyday in the class, picking on Johnny and Susi, getting out of your seat and being scolded by your teacher, and 10 being that instead of fighting with Johnny and Susi you are doing your work, and that you ask permission to get out of your seat, and your teacher says something nice to you, where would you be on that scale now?” With children, often smiley and sad faces are also used to anchor the two ends of the scale. Several other uses of the scaling technique in the therapy process include the following: 1) asking questions about where the client is on the scale in relationship to solving the problem; 2) using the scaling experience to find exceptions to the problems, such as saying “How did you get to the 3?” “What are you doing so you are not a 1?” 3) employing scales to construct “miracles” or to identify solution behaviors. For example, the therapist inquires as to where on the scale (with 1 representing low and 10 representing high) the client is, and proceeds to ask the client how that they will get from 1 to a 3. Or, the therapist inquires as to how clients managed to move from 4 rating to 5 a rating. How did they get that to happen? What new behaviors did they implement or what was different in their lives that made the changes? Solution-focused therapists may also express surprise that the problem is not worse on the scale as a way of complimenting the client’s coping behavior or as a way to use language to change the client’s perception of the intractable nature of their problem. Or, the therapist may use the scale, along with the “miracle question”(described below), by asking the client, “If there was an overnight miracle and you could get to a 9 or 10 on the scale, what would be the first thing that you would notice that is different?” Solution behaviors described by the client, through the use of the scaling technique, are often used in constructing specific tasks or homework assignments that are prescribed and discussed in future sessions. The therapist should finish the scaling sequence having accomplished the following:

a)  Developing a scale from 1-10 with the client which can be referred back to in future sessions.

b)  Having developed two concrete behavioral descriptions or self- anchors that describe the problem and its solutions. One (1) should be anchored as the problem behaviors and ten (10) the presence of solution behaviors. Therapist uses the client’s own words, descriptions, and images to develop the anchors.

c)  Having obtained a rating from the client on where they perceive they are on the scale today.

6)  USING COPING AND MOTIVATION QUESTIONS TO ASSESS HOW THE CLIENT PERCEIVES THEY ARE COPING AND TO DETERMINE THEIR MOTIVATION FOR CHANGE. This is a variation on the scaling question that helps the therapist assess the client’s motivation for solving the problem as well as how well the client perceives that they are coping with the problem. The therapist says something like:  “On a scale of 1-10 with 10 being you would do anything to solve this problem and 1 being that you do not care so much for solving it, where would you say you are right now?” Or the therapist may say: “On a scale of 1-10 with 1 being that you are ready to throw in the towel, and give up ever doing well in school and 10 being that you are ready to keep on trying, where would you rate yourself right now”? After asking coping and motivation questions the therapist should be able to determine the following:

a)  If the problem that has been defined is too overwhelming to the client. If the problem is too overwhelming then the problem needs to be broken down into smaller steps and re-defined for the client.

b)  How much self-efficacy and hope the client possesses toward the problem resolution. If the client does not believe the problem can be solved, steps must be taken to change this belief. The exception questions are empowering in this regard.

c)  What is the degree of commitment to work on the problem? If clients not interested in committing themselves to working on the problem, then the problem must be re-defined to muster some degree of commitment.

d)  If the problem that has been defined is the one that really interests and is the priority for the client.

7)  ASKING THE MIRACLE QUESTION TO DEVELOP SOLUTIONS. The therapist says, “Let’s suppose that a overnight miracle happened and the problem you are having with your teacher disappeared. But you were sleeping and did not know it. When you came to school the next day what would be the first thing that you would notice?” The therapist proceeds to help the client envision a new way of behaving and how things could be different. An extreme amount of detail is elicited to help develop a set of solution behaviors that are concrete and behaviorally specific. The therapist should come out of this sequence knowing the following:

a)  A detailed description of what life would be like without the problem.

b)  Having helped the client develop a specific set of behaviors, thoughts, and feelings that can be substituted for problem patterns.

c)  Obtaining from the client an idea of what is most important to the client and others concerning which changes that they will perceive as being a solution to the problem. Asking relationship questions along with the miracle question helps confirm this information.

8)  NEGOTIATING THE GOAL FOR CHANGE. From the problem descriptions and the miracle question the therapist negotiates with the client small, concrete and behavioral goals that the client would like to work towards. The goals should comprise the miracle picture of the client. The therapist should come out of this sequence having helped the client to set goals in the following manner.

a)  A goal should be important to the client. Something that they are motivated to accomplish. The client should say they are committed to working toward the goal. Clients should have clearly stated that this is something that they want for their lives.

b)  Goals should be small and obtainable. Movement should possible towards the goal immediately and before the next session.

c)  Goals should be concrete, specific, and behaviorally defined. The therapist and client should be able to describe specifically what the client is to do. The frequency and duration, and context of goal directed behaviors should be easily described. What, when, how and with whom is the behavior to happen?

d)  Goals should include the presence rather than absence of a behavior. A goal should describe what a client is to do instead of the problem behavior.

e)  Goals should be represented to the client as a beginning to behavior change rather than an end to the process. The therapist may use phrases like, “this is a step” or “this is a beginning.”

f)  Goals should be realistic and achievable within the context of client’s life. The goal must be a set of behaviors that a client can practice in everyday life. It cannot depend on other people to accomplish unless those people have agreed to work on the goal too. The goal should involve something the client is capable of doing on their own.

g)  Goals should be understood by the client, as communicated by the therapist, as being hard work, something you have to constantly work at to achieve. Action must be taken and tasks must be completed if the goal is to be reached. The therapist may say things like, “I know that this may not be easy but you have done it before.” “Are you willing to work to get this going?” “This will take a lot of effort but is something you can do.”

9)  TAKING A SESSION BREAK FOR REFLECTION, DEVELOPMENT OF COMPLIMENTS, AND FORMULATION OF A SET OF BEHAVIORAL TASKS. Near the end of the session the therapist takes a 5-10 minute break for reflection and to have time to construct the information gained into a behavioral task or homework assignment. It is not absolutely necessary for the therapist to give a homework assignment. He or she may simply offer a set of reflections for the client to think about, but in most instances such an assignment is given. Part of the work of the therapist is to formulate as many genuine compliments as possible to deliver to the client when they return to the session. The therapist should come out of the break with this information:

a)  A list of compliments to give to the client. Compliments should be based on the exceptions generated from the client, the miracle picture and the client’s strengths and capacities that are assessed in the session.

b)  A behavioral task or a set of reflections to be given to the client that requires the client to engage in behavioral exercises, recording behaviors, or reflections aimed at changing behavior, thoughts or feelings.

c)  A bridging statement that ties together the content of the session with a rationale for the homework assignment. A bridging statement is a statement that serves as a transitional sentence or two that moves the therapist from the compliments sequence back to the session content to the homework assignment. For example, “Since you do so well finishing your homework on the days that you ride the bus, but problem is essentially solved during those times when your mom picks you up, I am wondering if you can play a pretend game with me that asks you to do something different on the days you have to ride the bus. You do really well when you get home earlier and you start your homework right away before you watch TV. I am wondering if on the days you ride the bus that you could pretend that it is an hour earlier when you get home. In fact, I want you set your watch and clock in your room an hour backwards. Prepare the VCR to tape the show you usually watch and spend that hour on your homework.”

10) DELIVERING COMPLIMENTS AND TASKS.  The therapist delivers the compliments and behavioral tasks. The session is ended by setting another appointment. To complete this sequence in a successful manner the therapist should have:

a)  Given 4-5 genuine compliments to the client.

b)  Developed a set of meaningful reflections or a concrete behavioral task for the client to work on in-between sessions.

c)  Obtain a commitment from the client to do the task.

d)  Communicate that they will follow-up on their successes in the next session.

e)  Set another appointment.


 

Qualities of Well-formed Goals

 

1.  Saliency to the client

      — important to the client

 

2.  Small

 

3.  Concrete, specific, behavioral

 

4.  Presence rather than absence of something

 

5.  A beginning rather than an end

      — concentrate on starting

 

6.  Realistic and achievable within the context of client’s life

 

7.  Perceived as “Hard Work”

 

 

Berg, I., & Miller, S. (1992). Working with the problem drinker. New York: W. W. Norton.

 


 

 Solution-Focused Questions

1.   Scale

               1---------------------------------------------------10

         great                                                                    bad

2.   Introduction of doubt

      — reframe

      — multiple choice questions

      “Are you really co-dependent, or is it possible you are __________

               a) very empathetic

               b) conscientious

               c) sensitive

3.   Tasks

      A.     First session

               “Go home and examine what you do not want to change about __________.”

      B.      Surprise

               “Do something as a surprise but don’t tell when you do it. (To other) Record it secretly so we can discuss it.”

      C.     Generic

               “Keep a record of things you do this week when you are not ___________.”

      D.     Crystal Ball Technique

               — miracle questions

4.   Maintaining Change

      A.     Everything goes well

               “What do you need to do to keep it going?”

               “What may challenge you?”

      B.      If they focus on negative

               — redirect to solutions

      C.     Is same or worse

               — challenge, but show empathy

Solution-Oriented Therapy with Children

 

INTERVIEWING FOR CHANGE WITH CHILDREN

Imagination Questions: If you were Barney, how would you make Lisa happy? How will that help? What would you tell Mom and Dad to do to make Lisa happier? Let’s say you were a great magician, how would you change your parents? If you were a rap singer, what would you tell other boys just like you in your songs?

Imaginary Wand Questions: Let’s say I gave you an imaginary wand and you could wave it and make any of your wishes come true, what would those wishes be? If you pointed the wand at your parents, how will they have changed? How about if you pointed the wand at you, how will you have changed? When these chages happen, how will that make things better in your family?

Reversal Questions: Do you have any advice for your parents about how they can get you to [clean up your bedroom/empty the garbage/yell less]? What ideas do you have for your parents to help you do better in school? What advice do you have for me when I work alone with your parents? What should I work on changing with them?

Externalizing Questions: When ADD is trying to get you into trouble with your parents, what does it make you do? Does ADD make your (parents) relationship cave in or are you able to stand your ground as a team and not let it divide you? When the fears are trying to scare you, what do they whisper into your ears? Has there been anything lately that you have done to stand up to the fears to not let them push your son around? Billy, what do you do sometimes to chase away the fears?

 

FAMILY PLAY AND ART THERAPY TASKS

Family Squiggle Wiggle Game: Have the child pick a family member to draw a squiggly line on a sheet of construction paper. The child is then instructed to draw a picture out of the squiggly line and then tell a story about his or her picture. Family members, the child, and the therapist will then process the drawing. Once the discussion is completed, the child will then be instructed to draw a squiggly line on another sheet of paper and pick a family member or the therapist to create a picture out of his or her squiggly line and tell a story about it.

The Imaginary Time Machine: The child is given the following directive: Let’s say I have sitting over here an imaginary time machine and once you enter it, you can take it anywhere in time, in the past or into the future, where would you go? What would you see there? Whom would you meet and talk with? What would you talk about? If you and [the famous person from the past] hopped into the time machine and came back to 1997, how would [famous person] help you out today? What advice would he or she give you at school? How would he or she help out with your parents? (With future time trips) What would you bring back from [Mars/the year 3000/the child’s name of the place] to help you out today?

 

SOLUTION-ORIENTED TASKS

The Secret Surprise: Meet alone with the child and have him or her pick two nice surprises that he or she could perform in one week’s time to shock the parents in a positive way. The child is not to tell the parents what the surprises were until the next scheduled appointment. The parents will be asked to play detectives and try and guess what the surprises were.

Do Something Different Task: Explain to the parents that their child has got their number because they are too predictable. Instruct the parents as an experiment to do something off-the-wall wacky, or different than their usual course of action when the child pushes their buttons and engages in the problematic behavior they wished to see changed with their son or daughter.

 

Source: Matthew Selekman

 

WHAT TO DO IN THE FIRST SESSION

 

STRATEGIES FOR INTEGRATIVE SFT

1.         Problem-defining to family storytelling.

2.         Need to know where family is to get to their ideal outcome.

3.         Problems are not static things but are in a constant flux.

4.         What is the parents’ key question?

5.         What is your theory about why this problem exists?

6.         Explore family’s attempted solutions.

7.         Problem families = Have you thought of all the ways I could screw up? Ideal therapist? What would that person look like?

8.         Family Play/Art Strategies  A) put parents in charge of play and art tasks.

9.         Use developmental theory.

10.       Use resiliency literature. A) social skills. B) inspirational other.

11.       Winnicott’s Squiggle Game — (A) Choose a family member. (B) Draw the squiggle and draw a picture. (C) Each family member adds to the picture.

12.       Externalizing the problem. Map the influence of the problem. How long has the temper been pushing you around? Map the influence of people over problem. Competencies — Exceptions.

13.       Use of an audience to witness child’s competence.

14.       Problems are an ecology of ideas. Generate new ideas.

15.       (1) Relfection in Action, (meta postion). (2) Reflection on action.

16.       Follow-up miracle question with relationship questions. What will your Mom and Dad notice? What will your teacher notice? I am curious, are any pieces of this miracle happening now? When this piece happens, what happens?

16.       Use percentage questions. Percentage questions provide double descriptions. What percentage of time is the temper pushing you around versus you being in control?

17.       Use cognitive skills training.

18.       Unique description — How has your view of yourself changed?

19.       How did you take the big step? What did you tell yourself? If I popped in the video four weeks down the line, what further positive changes would I see?

20.       Miracle question and scaling questions for goals. How come this problem isn’t worse? What are you doing to keep this problem from getting worse? How come you have not thrown in the towel?

 

 


 

Positive Reframes

 

Negative

Positive

 

Angry

In touch

Bossy

Natural leader

Clingy

Affectionate

Conceited

Confident

Dependent

Connected

Distant

Independent

Goofy

Creative

Lies

Good storyteller

Loud

Expressive

Plain

Natural

Quiet

Thoughtful

Shy

Self directed

Sneaky

Inventive

Stubborn

Persistent

Talks back

Courageous

Teases

Can have fun

 

Partially adapted from DARE to by you.


 

SEQUENCES OF SOLUTION-FOCUSED QUESTIONS

1.        GOAL DEFINITION

(Clients usually start out by describing their problems and goals in broad terms and it takes some listening and clarifying before a clear goal can be determined. If client specifies several goals ask the client which one to start with.)

 

·        What brings you here today?

·        How will you know coming here is worthwhile?

·        What will you be doing differently?

·        What will other people notice?

·        How will you know you don’t have to come here anymore?

 

2.        PROBLEM DEFINITION

(Solution-construction is easiest when the goal is focused down to a problem that can be described in specific behavioral terms. (Example: The goal may be to be less depressed. The focused problem description could be to have more energy to study, or to call up friends and go out more.)

 

·        How is (example: depression) a problem for you?

·        Is that a problem for anyone else? How is it a problem for others?

·        What effect does that have on you?

·        How will things be different when the problem is solved? . . . for you? . . . for others?

 

3.        EXCEPTION QUESTIONS

(Don’t ask for exceptions until you and the client are clear about what the problem and the goal is.)

 

·        When don’t you, or didn’t you have this problem? . . . even a little bit?

·        What is different at those times?

·        What will make it possible for more of that to happen?

·        What small changes will you notice?

·        How will the small changes make a difference for you? For others?

·        What will you notice about yourself? . . . others? What will they notice about you?

 

4.        EXISTING RESOURCE QUESTIONS

 

·        What have you tried to do to solve the problem? What helped even a little bit?

·        How have you dealt with similar problems in the past?

·        What have you learned from previous experiences like this that might be useful in this situation?

 

5.        MIRACLE QUESTION

(This question or any question asking about a hypothetical solution is usually asked when the client cannot think of any exceptions or when he/she is having difficulties defining a goal).

 

·        If a miracle happened tonight and you woke up tomorrow morning and your problem was solved, how would things be different? Describe the differences from your point of view and what others would be doing and experiencing.

 

In response to clients’ answers ask:

 

·        Does some of that happen already at times? . . . even a little bit?

·        What will allow more of that to happen?

·        What will you have to do? . . . others?

 

6.        SCALING QUESTIONS

(Usually asked to help client get a better perspective about how severe a problem is. This question is also asked to track progress from session to session.)

 

·        On a scale from 0 to 10, with 0 being totally unacceptable and 10 as good as you can imagine, where would you put your relationship at this point?

 

Or

 

·        On a scale from 0 to 100, with 0 being never and 100 being always, what percentage of the time would you say you feel those anxious feelings that make you afraid to leave the house?

 

In response to answers ask:

 

·        How many degrees would it have to change for you to feel better?

·        What would a small step (from 3 to 3.5) look like? What will you be doing differently? What will others be doing differently?

 

7.        ADVANTAGE QUESTION

(Asked when clients keep giving negative answers.)

 

·        This may seem like a strange question, and I don’t want you to think I am not hearing how serious this problem is for you, but is there an advantage to your having this problem? . . . Is there anything positive about this negative situation?

 

In response to answers ask:

 

·        How can you have the advantage without having to maintain this problem? What can you do instead?

 

8.        COPING QUESTION

 

·        How come things aren’t worse? What have you done to keep them from being worse?

 

If the client still does not answer with exceptions or positives ask:

 

·        Do you think things can get worse? What will that be like for you? For others?

·        What is the smallest thing you can imagine will make a difference?


 

SUMMATION MESSAGE

 

 

1.        WHAT I HEARD YOU SAY TODAY:

 

This statement should include:

 

1.        the complaint

2.      the goals

3.      any progress that has already been made

4.      what the client said about how the situation is affecting him or her (including emotionally).

 

2.        MY RESPONSE IS:

 

This statement should include:

 

1.        the therapist’s reaction to the situation

2.      reinforcement of positives and changes

3.      normalizations, reframes, or new information

4.      acknowledgement of clients’ feelings.

 

3.        TASK

 

This should always be stated as a suggestion which clients can choose to do, rather than as an assignment.


 

SOME DOS AND DON’TS OF SOLUTION-FOCUSED THERAPY WITH COUPLES

 

DO

 

STAY joined with both partners at all times and agree with both their points of view in the summation message;

 

FREQUENTLY ask each partner for his or her point of view about what the other said to keep them both involved, and to keep yourself from becoming partial to one side;

 

MAKE use of circular questions;

 

TRY to find common agreement, no matter how small;

 

INQUIRE about their sexual relationship; they expect you to!

 

HAVE them define goals in small steps and in behavioral terms;

 

BE sure to get agreement from both partners about the treatment plan.

 

DON’T

 

EVER believe a relationship is hopeless by the way the couple presents itself or their situation at first;

 

REPLICATE their dysfunctional interactional pattern while working with them;

 

SEE them together if they mutually exclusive goals;

 

SEE them together if they fight continually;

 

LET one partner tell you secrets about the other over the phone;

 

HAVE a separate session with one partner without inviting the other in for a separate session as well;

 

WORK with a couple if one partner has confided in you about an ongoing affair that he/she does not want to end.

 

Readings for Week 2

Videos for Week 2

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