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Salamanca Reflections When I came home from the EBTA conference in Salamanca, Spain in 1998, I offered to summarize my notes for the sft-listserv. But, soon other commitments got in the way and my journal ended up gathering dust in the back of a bookshelf. I came across it the other day--began reading over my notes--and thought again about putting something together for the list members. Better late than never. So here, two years after the conference, are some of my recollections of those three days. What follows is a blend of notes taken at the time, my personal reflections at the time, and ideas that occurred to me while reading my journal this past week. What follows is not in any sense a finished product—somewhat hastily written, it’s not intended for publication but is more like a long email message to the listserv. I also want to make clear, that comments attributed to a particular person are my personal constructions--what I thought I heard in terms meaningful to me. I haven’t quoted people exactly, but rather used what I heard speakers say as part of a kind of dialogue I carried on with them in my mind at the conference and now again reading over my notes. Also, I haven’t tried to describe the many interesting and often humorous conversations Tobey and I had with people like Frank Thomas, Peter De Jong, Gale Miller, Paul Koeck and Insoo Kim Berg; Harry Korman’s magnificent performance of surgery has been expurgated as well. For those wishing to get a sense of the excitement, fun and camaraderie that develops over three days together with an international gang of solution-oriented brief therapists—including many of the people who participate on the sft-listserv--you’ll have to go to the next EBTA conference yourself. So here goes, starting off with a philosophical discussion that took place in a plenary session with Gale Miller, Steve de Shazer and Mattias Vargas. The discussion begins with the question of whether there are meaningful or useful differences between constructivism and social constructionism.
Some Philosophy for Solution-Focused Therapists Gale Miller: These two epistemologies have certain commonalities but they arise from different philosophical roots. But, for practical purposes, with respect to therapy, both suggest that "reality" is invented, and is not something "out there" that we perceive through our senses. Constructivism assumes "reality" as invented within, rather than between persons; social constructionism emphasizes the social, interactional aspects of experience and meaning-making. So while both agree that conversation and language influence how people experience reality and that reality is therefore subjective, invented, perspectival and fluid—constructivism places the process of meaning-making within persons while social constructionism places it within the interpersonal space between people.
Steve: "Questions in therapy are not things—they are influencing gestures." (This idea of questions as interventions can be found in NLP, White and Epston’s narrative therapy, Milan strategic family therapy, Karl Tomm’s work, and Goolishian and Anderson’s collaborative language systems approach.) Gale Miller spoke about what he called the "gorgeous ordinary." The following are my reflections on Gale’s comments. In our conversations with clients we want to attend to the small, everyday happenings that have gone unnoticed—so ordinary they have been overlooked, not paid attention to. In solution-focused therapy we remain curious, interested, and excited about these little ordinary happenings—especially the everyday successes our clients have but overlook in the face of their troubles. It is in these small, unnoticed experiences that people display all sorts of remarkable skills, talents, and qualities --we want to bring these resources to their attention because they are all too often lost both on clients and the professionals who have tried to help them in the past. Gale says, "The miracle question makes the ordinary extraordinary." Most of the time the answers clients give to the miracle questions are pretty simple things—smiling, saying nice things, pouring coffee for one another, saying you’re glad to see each other at the end of the day, being more patient getting the kids ready for school, etc. In the therapy context, when we begin asking about times some of these "miracles" have happened and when we convey our delighted surprise, we communicate that these "ordinary" events have something special about them and tell us something important about our clients. And, that these everyday miracles are worth exploring and attending to. By starting with simple events and everyday skills used without much thought in people’s ordinary comings and going we co-create possibilities of extraordinary outcomes. Steve: Why stick to the miracle question, Steve asks rhetorically, when there are other ways to invite clients to imagine post-solution future pictures? The miracle question, he explains, always evokes good answers. There are other similar questions such as, how will you know therapy can end, we can stop meeting like this, you are on track to solving the problems bringing you here? These questions usually produce useful answers but since the miracle question "always" gets good answers it’s worth using. "If it ain’t broke why fix it?" On the other hand, he points out, we want to be careful in teaching SFBT that we do not suggest this approach is formulaic or that it can be done in recipe fashion. Matthias Vargas: The distinction between what is and what is imaginable is not always clear. Conversationally shifting from "as if" to "it is" makes it possible for people to begin immediately experiencing as happening now what they are imagining as possible in the future. Future and present collapse. Asking clients to act "as if a miracle has happened" and to "pay attention to what is different" also collapses the distinction between pretend and reality. When people pretend to do or be a certain way are they pretending or being when they carry out the suggestion? At what point does imagining oneself doing certain things have the same effect as doing those things "in fact?" (I remember years ago in an Ericksonian hypnosis training group when our teacher had us imagine holding one hand in a bucket of ice water. I was a pretty easy subject and my hand got pretty damned cold after a while. He chose me for a demonstration, in which he stuck a pin in the flesh between the base of my thumb and index finger. I was amazed that I felt no pain whatsoever. I looked down at the pin sticking out of the back of my hand and thought to myself, "This is a pretty neat trick. How is he doing it? Making it look like he put a real pin into my flesh? " But more was to come. When he removed the pin, he asked me to imagine holding my hands near a warm fire. In a few seconds, a drop of blood formed where the pin had been. It’s experiences like this that make one a social constructionist.) Differences between problem-solving and solution-building It is important to be clear about the differences between a problem-solving and solution-building stance. The following are examples of questions that clarify the differences. "Why did you kick the door?" is clearly not a solution-focused question. But, it might not be so obvious that this next question isn’t either: "How can you stop yourself from getting violent when you are angry?" (When I first encountered sft, I couldn’t understand what was problematic about questions like this one. What’s wrong with asking the client how "they think" they might solve their problems or change their behavior in the future? After all, we aren’t imposing a solution—we are asking the client to tap his or her own creativity in building solutions. Isn’t this an effective non-directive way to invite clients to develop solutions and to bring about desired changes? Eventually I got it: this question is a problem-solving question. While it does not presuppose the way to solve a problem is to analyze it, it does suggest the way to solve it is to do what the client has been doing, trying to see a way out of the problem box by figuring out what to do to get out. In the example of the angry man who kicks doors, since he gets violent when he is angry and this is causing him problems, problem-solving involves figuring out how to act differently—what he can do—so he doesn’t get so angry or what he might do so he doesn’t act on that feeling. MRI problem-solving brief therapy is based on the idea that whatever the original problem might have been, the problem to solve in therapy relates to what the client has been doing, unsuccessfully, to solve the original problem. MRI brief therapy tries to get the client to stop using the current solution and to try something different. Solution-focused brief therapy shifts the focus from the problem and what people are doing to solve it to looking at times the problem isn’t happening (exceptions) and what will be different when the problem is solved (day after the miracle.) Understanding this important distinction makes it easier for the therapist to know what are problem-solving or solution-building questions. Here are some solution-building questions: "How did you get yourself to stop kicking the door?" "How did you get the strength to stop when you were so angry?" (In training and teaching I notice that it takes a while for people new to sft to get this problem-solving vs. solution-building distinction. But, even after they start to understand the difference it’s often still hard for them when doing therapy not to fall back into a more familiar problem-solving stance. It can a long time to stop asking, "what do you suppose you could do differently to solve this problem?" (As opposed, say, to asking "what will your kids notice different about you when you have solved this problem?) Workshop on current research on SFT: Peter De Jong and Mark Beyebach. Peter: Follow-up studies at BFTC show continued progress over time after therapy ends. Their studies also suggest that diversity—race, sex, ethnicity, etc, does not call for unique treatment; staying solution focused makes it less important for the therapist to tailor treatment based on these factors. Their research also confirms that it’s not necessary to understand a problem in order to solve it—problems and solutions are discontinuous. They find that there’s no correlation between the type of presenting problem and therapeutic outcome. However, there seems to be some correlation between intermediate and long-term outcome—progress during therapy seems to be predictive of further progress at 6 and 9 months after end of therapy. How clients measure/scale success in therapy is a predictor of the long-term success of treatment. Mark: What factors in the therapy process (observing what happens during treatment sessions) are related to a positive therapeutic outcome:
Michael Durrant—Letting the Past into a Future-Focused Therapy. (The following is a blending of what Michael said, what I heard and my own reflections at the time and now. I think I captured the essence of Michael’s position but he might not have said things exactly as I have represented him.) When clients feel it’s important to talk about the past—to tell us about what’s happened and how they think what’s happened has affected them-- we can do so in a future-focused, solution-building way. While our ultimate therapeutic aim is to engage clients in conversations that highlight for them evidence that they are moving in a desired direction—toward a preferred future—we can accomplish this aim by respectfully accepting the invitation to begin in problem-saturated conversation about past experiences. (Here’s how I think about this—when clients tell us that they need to work through past trauma or need to talk about what happened they are telling us they have a theory about what will help, what will make a difference. They have a theory of change [Miller, Duncan and Hubble talk about the value of understanding and working as much as possible within the client’s theory of change] in which they believe that such talk will lead to desired changes. In other words, they’re telling us they believe talking about the past is a means to an end—an end which may not yet be entirely clear to them, but which includes some change in how they experience life. Therefore, when we accept the client’s invitation into these past and often problem-saturated conversations we are on the alert for and often initiate opportunities to help the client identify what changes he or she hopes will result from talking with us about these past experiences—these are the solutions and goals.) Michael points out that we can ask questions that cast some doubt on the client’s theory of change. This makes it possible for the client to develop a variety of ways to solve the problems or make the changes he’s come to therapy to make. We can ask: "How do you suppose talking about these experiences will be helpful to you in making the changes you want? Or, "How will you know (what will be the signs that tell you) when we’ve talked enough about these experiences so we can concentrate more on where you want to go rather than where you’ve been?" Or, "What will be different (the first signs) that will tell you that you’re putting the past behind you? The client might say when they have worked through these traumatic experiences, they will be able to do this or that—it’s these "this’s" and "that’s" that will be the goals of therapy. It is important to validate the client’s pain and experiences, but this may not require lengthy engagement—we can ask about exceptions, we can reflect feelings without asking about feelings. We can put the client in control but give him or her choices—"Some people I have worked with were able to make some of the changes you say you want without going back and trying to understand what happened in the past. Other people tell me it has been helpful to explore the past. Some have made changes they wanted first and then we looked at the possible roots of the trouble later. What do you suppose would be most helpful to you?"
In solution focused therapy we can make suggestions, give advice, offer information, etc. But we do so in a collaborative, negotiated way. For example, parents often feel guilty and confused about their children’s difficulties. They are often comforted by explanations and labels, and we can be helpful by providing non-pathologizing ones where we can. (I find that normalizing as much as possible is very comforting to people and once people come to feel the problems they have with their children are normal we can begin to work together to develop solutions that fit this particular family.) Also reframing traumatic events in terms of survivorship and heroism rather than victimization is often very helpful.) SFT Supervision—I am combining my notes from a workshop with Chris Iveson and a plenary session on supervision with Insoo Berg and Gale Miller. Chris: Supervision, like therapy, can be brief. He explained the 15 minute consultation method. And, pointed out that there’s a difference between teaching and training solution-focused therapists and using solution-focused principles and techniques in supervising clinicians who work in other modalties. He supervises even those who are not solution-focused by exploring two general areas: (1) When things are going better in the therapy (exception) what are you doing different or differently? (2) What do you suppose will be happening in the sessions and for the client that tells you that therapy is on track? Chris advises supervisees that if they intend to compliment clients at the end of the session they should be looking and listening and teasing out qualities, competencies, and successes they can then compliment. He suggests taking notes about client competences so they can be worked into end-of session comments—compliments and suggestions to do more of what people are already doing that seems to be helpful to them. Insoo and Gale: Insoo did a consultation demo in front of the large group—Gale observed and then offered process comments, followed by general discussion participated in by various members of the audience. Insoo asks the Presenting Therapist: "What do you suppose could come out of this discussion that would be useful to you? Presenting Therapist: I would like to be "more clear" about this case. IKB: What part of the case would you like to be "more clear" about? (Some discussion follows about the client being confused and the therapist being confused as well and about the possible adverse effects of the client’s medication. Frankly I was none too clear myself at this point. What stood out was Insoo’s efforts to help this PT clarify for himself what, exactly he wants to be clear about—this was a complicated case with many aspects and Insoo wants to help the PT break up what he wants into small chunks. But after awhile she shifts gears.) Insoo asks—What does the client say she wants from therapy? PT: She wants to talk about the voice in her head. IKB: How is this voice a problem for her? It doesn’t sound as though it’s causing problems for her with her family. (Doesn’t assume the voice in the client’s head is necessarily a problem or that we can know how it is a problem. This is the curious, not-knowing stance which keeps the therapist/consultant asking questions that get good answers.) PT: She says she wants to "be her old self." IKB: What did she tell you she used to be like? (Insoo asks for details—these can be the elements of the client’s solutions and goals.) PT: Lively, etc. IKB: Occasionally her old self comes out? (Exceptions?) PT: Not so much. IKB: She doesn’t talk about this but she shows it maybe. Others see her sometimes as her old self? Maybe others see her competent behavior but she doesn’t see herself this way? (Explores the relationship aspects of this client’s experience—how others might see her in a more positive light than she sees herself.) PT: I am not sure others see her as competent. IKB: Do you suppose if others could show her her competent side she could use that? (Was Insoo offering an embedded suggestion that the PT could be on the lookout for evidence of such competence and could highlight such evidence with questions and compliments so that the client might discover she is already "her old self.") PT shifting to another topic: She says the only way the voice will disappear is if she dies. The voice tells her to watch out and don’t say anything. (Note the PT is, like the client focused on a solution or goal that is not well-formed—the absence of the voice. Insoo has been trying to bring out and build solutions and goals that meet the criteria of well-formed, but the PT returns to problem talk. IKB: How does she present Simon (the voice) to you and what does she want you to do? Do you suppose she will let you talk to Simon? He’s coming to the sessions anyway. Something to think about. (Here Insoo at the end offers some suggestions of ways to work with the client and her voice. The theme of finding out what will tell this PT and the client that progress toward well—formed goals is happening has been lost. But Insoo also suggests helping the client clarify what changes will make a difference to her. She ends by asking if the PT can think of anything else that might help you with this case?) Gale Miller’s analysis of the supervision conversation: Supervision is re-arranging what is already happening in the therapy and might happen in this consultation to meet the supervisee’s goals. Consultant re-arranges, without adding, without fuss or bother. Insoo asks: "What do you suppose would be useful?" Insoo didn’t ask "What do you want? (My notes: What’s the difference between these two questions? The former invites the supervisee to reflect on and clarify what could happen in this meeting--what can be done together—rather than what can the supervisor do or say to solve a clinical problem. "What do you want from this consultation?" suggests there is a problem and that the supervisor has something he or she can offer to the supervisee—as though the goal is a thing. Asking "What do you suppose would be useful?" invites negotiation and collaboration with the supervisee imagining what could happen in the conversations that could make a difference—focuses on process—what interpersonal process could be helpful rather than what can the therapist do or give that would be helpful.) As the consultee begins defining what could happen–-process—what could make a difference in his work with his client--Insoo clarifies, restates, focuses in on what seems essential, cutting away the less relevant, at least for the moment. She uses familiar reflecting, acknowledging and validating conversational techniques "It sounds like…"; "what I hear you saying…"; "let me see if I understand what you are telling me…"; "am I getting this right?" So while she reflects problem-focused comments by the consultee, her responses are minimal—she doesn’t ask questions or make comments that invite the consultee to expand on this problem-centered content. She simply shows that she’s listening respectfully, and conveys with a gesture or silence that the consultee still has the floor. Gale points out that Insoo goes slowly, she doesn’t jump in; she takes time to organize her own thoughts and responses—rich silences. A lot of room is give in which the PT can also think, mull over things, come up with his own ideas. Gale points out how Insoo’s comments and questions reflect the fundamental assumptions of solution-focused therapy—that the person she is talking with has innate competencies, has already accomplished a great deal in his life, has solved many problems, has had many successes and has many strengths and resources. As helpers our job is to assist those seeking our help to identify and tap those strengths and resources in ways that are as un-intrusive as possible. Do only what is minimally necessary to promote changes meaningful to the person we are assisting. A few "rearrangements" are often enough. (Insoo often says, "lead from behind" and "leave no footprints.") Phillip Ziegler, co-author with Tobey Hiller, of Recreating Partnership: A Solution-Oriented, Collaborative Approach to Couples Therapy. (In Press, 2001, W. W. Norton) Email: Ziegler@igc.org 8 Wildwood Ave.Webpage: home.igc.org/~ziegler Oakland, CA 94610 |
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Solution Focused Therapy
