Brief Interventions: Solution Focused

Melodie H. Frick PhD, LPC-S, NCC, ACSSchool and Community Counselors Conference

April 25, 2013

Ensuring Failure in Treatment

• Anticipating failure• Discrepancy between the counselor’s and the

client’s theory of change• Continuing with an approach that does not help;

chronicity sometimes caused by the ineffective way of solving the problem rather than the problem itself

• Failure to take the client’s motivation into account. The client’s goal differs from the counselor’s.

Solution Focused Brief Therapy (SFBT)

• Problems are unsuccessful attempts in resolving conflict• The counselor does not need a lot of information about the

problem• Previous solutions and exceptions v. what is underlying the

problem• Questions v. directives or interpretations• Present and future-focused questions v. past-oriented

questions• Notice and value small changes• Strengths-based• The client defines the goal(s)

SFBT Outcome Research• Found effective with many issues: substance abuse, personality

disorders, PTSD, sexual trauma, academic problems, parenting issues, couple’s issues, etc.

• Contraindicated with clients who are unable to formulate a goal, unable to establish dialogue, difficult to diagnose, and for counselors who use expert role

• Effectiveness data from more than 2800 cases with a success rate exceeding 60%; requiring an average of 3-5 sessions of therapy time

• Neurobiology: stimulates both left and right hemispheres• With Children:

– Children who received SFBT or routine interventions reported 68% improvement at 3 month follow-up; those receiving SFBT used fewer other clinic resources

Bannink, 2007; Macdonald, 2007; McKerGow & Korman, 2009

Outcome Research continued• With High school students:

– Students receiving 1 of 3 forms of brief therapy- 69% of all groups reported improvement at 6 week follow-up with SFBT approach; involved fewer sessions

• With Adults: – After 4.6 sessions, 86% positive outcome at 18-months (Higher for

those with more sessions)– SFBT groups reported higher than non-SFBT groups, having 81% goal

achievement– After 6 group sessions, parents of adolescents showed higher scores

than control group on Parenting Skills Inventory– After 6 group sessions, couples reported more improvement than

control group• For Counselors:

– At 1 year follow-up, found to have less exhaustion and depersonalization compared to non-SFBT counselors

De Shazer, 1991; LaFontain & Garner, 1996; Littrell, Malia, & Vanderwood, 1995; Wheeler, 1995; Zimmerman, Jacobsen, MacIntyre, & Watson, 1996; Zimmerman, Prest, & Wetsel, 1997

Questions for Referrers

• What would be the best possible outcome of our collaboration?

• What are the client’s strengths?• What is the smallest change you can accept

from the client at this time?

How Do You Open a Session?

• What is the problem? or What is the matter? (Problem-focused)

• What brings you here? (Neutral)• What can I do for you? (Counselor will do the

work)• What needs to be accomplished today? or How would you be able to tell that you do not need to come back? (Solution-focused)

Interventions Acknowledge Problem/Feelings/Referral Wishes and complaints set as goals.

Not why, but what, how, when, and where. Goal Setting

The presence of a desired behavior/future situation rather than the absence of the undesired behavior/situation, expressed in concrete, positive terms

Preferred future (use Miracle Question); start with smaller goals

Measurable goals (leads to scaling questions)

Interventions continuedScaling questions

• Measure Progress, Motivation, Confidence

• With children/adolescents

If scale goes up:• Compliment on progress (nudge to do more)

If scale stays the same:• Compliment on maintaining and/or not letting

things get worse (competency questions) If scale goes down:

• Acknowledge client’s emotions and look for exceptions• Use coping questions• Compliment that it did not go even lower• Re-focus on how to get to a higher number

Interventions continued• Exceptions

– If yes, look for differences between exceptions and the problem, and the extent to which client has control over occurrence of exception

– If no exceptions, build hypothetical solutions/miracle question• Feedback

– Compliments (Indirect are very effective) • Homework (Observational and Behavioral); Explain reason/ rationale

for task in client’s words– Notice what is different – Keep doing what works – Do something different– Pay attention to the positive things that happen

• Pre-Session Change. Not if, but when.

Subsequent Sessions

• What is better?• E.A.R.S.

– Eliciting: draw out stories about progress/ exception

– Amplify: highlight/emphasize the role the client took to make an exception happen

– Reinforce: compliment/reinforce successes and/or steps that led to exceptions

– Start again: And what else is going better?

Responses to Pre-Session Change • Nothing has changed (Limited, if any, effort taken)

*Counselor- be careful not to be overly positive/ optimistic

• Things are about the same (Effort taken)• Things have started to change/get better

– Focus on details of how the client made this happen (strengths and resiliencies)

– Emphasize the difference from how things were before– Pay compliments– Continue with building goal(s)

Homework Assignments• Use another word than ‘homework’: suggestions, experiment• Keep it simple! Doable and realistic• Direct clients’ attention to aspects of their situations that are

most useful in finding solutions in reaching their goals• Have client design the experiment• If by client design:

– It is a familiar behavior (when unfamiliar, clients take longer to accomplish/understand; known as resistance in other theories)

– Clients usually assign more of what has previously worked or what they want to do

– Reduces tendency to resist outside intervention

‘Homework’ For Children• Pretend miracle has happened- notice reactions• Flip a coin

– Heads- secret new activity– Tails- do nothing differently– Parents have to guess which way coin landed each day but child

keeps info secret– Next session- compare notes with each other and the child

• Surprise task– With the child, find out what child could do to surprise the

parents– Follow-through and pay attention to parents’/others’ reactions– Have the parents do the same

‘Homework’ For Children continued• General observation task

– Have child pay attention parents’ reactions (e.g., when you start your homework without having to be told)

– For parents: Pay attention to the times things are going well at home and make a note of it

• Marble jar– Make a list of things the other person does that

are agreeable/impressive and put a marble in a jar; – Each evening discuss what each marble signifies and what went well that

day; – When jar is full– child receives a reward (positive reinforcement)

• Wonder bag– Parents and child each write down five wishes on separate sheets of paper

and place in separate bags– Each week each family member pulls a wish and has a week to make it come

true

Additional Techniques• Flip charts and drawings• Mind maps of a good day• Three chairs technique• Role-play- act out problem, explore change/role reversal,

act out solution, review• ‘I don’t know’ responses

– ‘Take a guess’– ‘That’s a difficult question’ and wait– ‘Suppose you did know’ or ‘What would your life look like if

you did know’ or ‘What difference would it make if you did know’

– ‘Suppose there’s a person who knows you as well as you know yourself. What would that person say?’

– ‘What would your partner/parent/teacher/sister say?’

Clients’ Roles• Visitor (No complaint)

– Whose idea was it for you to come here?– What are your thoughts about why you are here

today?– What do you need to do to convince [the referrer] so

that you don’t have to come back?– At a minimum, what are you prepared to do to

appease the [referrer]? How do you know you can do that? When was the last time you did that?

– No homework because no problem/goal defined; encourage to come back

Clients’ Roles continued• Complainant (Complaint, not ready for action)

– How do you cope? – I can’t change the other person. How can I help you?– Suppose you did want to change something about yourself,

what might that be?– What have you done to ensure that things didn’t get worse but

stayed the same?– What would you like instead of the problem?– Homework: Observational tasks

• Pay attention to what happens in your life that you would like to continue to happen

• Observe the positive moments so that you can talk about them next time

• Observe when you are 1-point higher on the scale and what you are doing differently in that moment

Clients’ Roles continued

• Customer (Ready to work)– Homework: (Observational and Behavioral tasks) – Continue with what works and pay attention to what

else you are doing that is helpful– Do the easiest thing that works– Do a piece of the miracle (experiment)– Pretend you are one or two points higher on the scale

and pay attention to the differences it makes, and the reactions of people who are important to you

SFBT Groups• Short-term and topic-focused (4-8 sessions)

– Structured around solution-focused exercises • Goal-setting, solution-building, exception-finding, future

choices (maintenance after group)– Homogenous regarding problem area; clients will have

individual goals and group goal• Initial Goal form:

– Identify 1-2 goals and rate from 1-10 – Identify steps already taken toward goals – Identify strengths, skills, and resources that will help achieve

goals

SFBT School-Based Group Example 1• Session 1: Forming

– Introductions and establish ground rules– Get to know one another activity– Share what they want to change in their lives– Homework: ‘This week notice what happens to you that you

want to continue to happen.’• Session 2: Establish Goals

– Review last week’s task, ‘What was better’ or ‘What did you notice that you want to continue?’

– Miracle Question– Realistic goals: ‘Now that we have an idea of what you would

like to be different, what will you be doing to get that to happen?’

– Students establish concrete goal for following week

SFBT Group Example 1 continued• Session 3: Keys to Solutions

– Students share/review goal from previous week

– Introduce skeleton keys

• Notice what works and continue to do more of,

• Do something different,

• Pay attention to exceptions,

• Read/write/tear-up thoughts

– Students encouraged to identify skeleton keys (can make foil keys to pass to student when identifies having used one)

SFBT Group Example 1 continued

• Session 4: Progress Towards Solution– Students review goals and progress– ‘Obstacle course’ exercise- help students identify

and overcome obstacles to change– Letter from older/wiser self– Different tasks are suggested:

• Making progress: Do more of the same • Stuck: Do something different • Have members help each other create ideas

– Goal Review Form

SFBT Group Example 1 continued

• Subsequent sessions- help students maintain progress and/or assist those who are stuck, use E.A.R.S.

• Final session– Review goals and progress made toward them– Students encouraged to provide feedback to

one another– Goal review form– Achievement is celebrated (even the smallest

steps)deShazer, 1985; LaFontain & Garner, 1996; LaFontain, Garner, & Boldosser, 1995

• Teacher coaching intervention at the classroom level• Counselor observes classroom (20min. – 1hr), 1-3 wks• Create classroom goals with teacher and students (weeks 4-6)• Scale classroom success and amplify• Teacher debriefing time• Results:

– Increase in teachers’ perceptions of students as better behaved– Increase in teachers’ positive perceptions of themselves as

effective classroom managers– Increased students’ perceptions of themselves as better

behaved and more respectful

Working on What Works (WOWW)

Kelly, Kim, & Franklin (2008)

Integrative Approaches• With Person-Centered• With Narrative• With CBT: Uses behavioral process

– Behavioral analysis of exceptions (not problem behaviors), – Operant conditioning- positive reinforcement of desired

behaviors, undesired behaviors extinguished (minimum attention paid by therapist)

– Classical conditioning- homework assignments, do something different, pretend miracle happened (counter-conditioning)

– With REBT- after identifying maladaptive thoughts can use questions “How will you be thinking differently?”, “How will you replace the negative thinking with more helpful thinking?”, “How will you feel when you have less stinking-thinking?”

References• Bannink, F. (2006). 1001 Solution-focused questions: Handbook for solution-

focused interviewing (2nd ed.). New York, NY: W. W. Norton.• Bannink, F. P. (2007). Solution-focused brief therapy. Journal of Contemporary

Psychotherapy, 37(2), 87-94.• De Shazer, S. (1985). Keys to solution in brief therapy (1st ed.). New York, NY:

Norton.• De Shazer, S. (1991). Putting difference to work. New York: Norton.• Franklin, C., Biever, J., Moore, K., Clemons, D., & Scamardo, M. (2007). The

effectiveness of solution-focused therapy with children in a school setting. Research on Social Work Practice, 11(4), 411-434.

• Kelly, M. S., Kim, J. S., Franklin, C. (2008). WOWW: Coaching teachers to see the solutions in their classrooms. In M. S. Kelly, J. S. Kim, & C. Franklin (Eds.), Solution-focused brief therapy in schools: A 360-degree view of research and practice (pp. 61-72). New York, NY: Oxford University Press.

• LaFontain, R. M., & Garner, N. E. (1996). Solution focused counselling groups: The results are in. Journal for Specialists in Group Work, 21, 128–143.

• LaFontain, R., Garner, N., & Boldosser, S. (1995). Solution-focused counseling groups for children and adolescents. Journal of Systemic Therapies, 14(4), 39-51.

• LaFontain, R., Garner, N., & Eliason, G. (1996). Solution-focused counseling groups: A key for school counselors. School Counselor, 42, 256-267.

References• Littrell, J. M., Malia, J. A., & Vanderwood, M. (1995). Single session brief

counselling in a high school. Journal of Counselling and Development, 73, 451–458.

• Macdonald, A. (2007). Solution-focused Therapy: Theory, research and practice. London: Sage.

• McKergow, M., & Korman, H. (2009). Inbetween-neither inside nor outside: The radical simplicity of solution-focused brief therapy. Journal of Systemic Therapies, 28(2), 34-49.

• Newsome, W. S. (2005). The impact of solution-focused brief therapy with at-risk junior high school students. Children & Schools, 27(2), 83-90.

• Wheeler, J. (1995). Believing in miracles: The implications and possibilities of using solution focused therapy in a child mental health setting. ACPP Review and Newsletter, 17, 255–261.

• Zimmerman, T. S., Jacobsen, R. B., MacIntyre, M., & Watson, C. (1996). Solution focused parenting groups: an empirical study. Journal of Family Therapy, 19, 159–172.

• Zimmerman, T. S., Prest, L., & Wetzel, B. (1997). Solution focused couples therapy groups: An empirical study. Journal of Family Therapy, 19, 125–144.