Couple's Counseling-Solution Focused Brief Therapy

Abstract

This Model Description and Application Outline will attempt to explain Solution-Focused Brief Therapy (SFBT), including its founders, and philosophy. Essential interventions of this family psychotherapeutic approach will be described. Specifically, this paper will answer the following: role of the counselor, theory of change, target of intervention, how to assess utilizing SFBT, and SFBT definitions of normalcy, health and pathology. It will also provide an outline of how to apply this theory to the case of a married couple.

    Solution-Focused Brief Therapy (SFBT) as applied to the family focuses on the inter-personal relationships of the family members rather than the intrapsychic domain which psychoanalysis focuses upon (Becvar & Becvar, 2013, p. 129). Considered a cybernetics/postmodern perspective, founders Stave de Shazer and his wife and co-founder Insoo Kim Berg founded the Brief Family Therapy Center in Milwaukee, Wisconsin (1985, 1988, and 1994). Similar in ways to O’Hanlon’s Solution-Oriented Therapy, de Shazer’s therapy emphasizes finding solutions rather than solving problems (Becvar & Becvar, 2013, p. 264), and is future-focused rather than discussing symptoms of the past (Gehart, 2014, p. 331). In 1991 de Shazer claimed, “The problem or complaint is not necessarily related to the problem.” In essence, de Shazer was saying that the presenting problem is not always the cause; the presenting problem is only the symptom and not the true etiology of the problem. According to this approach, instead of utilizing structured assessment tests with which to diagnose, the clinical interview should be structured as a client self-report in which the client describes her symptoms. Asking, “What are the reasons you think might be depressed?” invites the client to elaborate on her understanding of the word, “depressed.” Another question would be, “Tell me about the times when you feel ok or good, when you do accomplish things, enjoy your friends, and so on” (Becvar & Becvar, 2013, p. 265). According to de Shazer, the times when the client is not depressed are important for the purpose of “deconstructing the problem and constructing a solution” (p. 265). Solution-based therapies are increasingly popular with both clients, insurance companies and mental health organizations alike, as this therapeutic approach seeks to define and develop solutions leading to client goal-attainment (Gehart, 2014, p. 332).

    

    The role of the therapist in SFBT is that of an investigator rather than the traditional role as clinical expert and diagnostician. With an eye on solutions rather than problems, the SFBT therapist will identify and encourage the client to maintain those behaviors which will help her to achieve her goals. Further, de Shazer conceptualized conversations between clients and counselor as narratives, and in 1991 de Shazer noted 3 types of narratives:

1.     Progressive narratives-Explains how things are improving, vs. complaint-centered narratives

2.     Stability narratives-Explains how things are remaining the same

3.     Digressive narratives-Explains how life is moving away from or towards their intended goals.

Thus, assessing client’s strengths (Gehart, 2014, p. 332) and “setting goals becomes an important part of the process of shifting the context from complaint narratives to solution narratives” (Becvar & Becvar, 2013, p. 266).

   

    In SFBT, “setting goals thus becomes an important part of the process of shifting the context from complaint narratives to solution narratives” (Becvar & Becvar, 201, p. 266). De Shazer frequently used the Miracle Question to assist clients in understanding what the solution will look like. In addition to exception questions and the Miracle Question, de Shazer used scaling questions to measure client symptoms (Becvar and Becvar, 201, p. 267). According to SFBT, therapy would terminate when the client’s goals have been realized. “In broad strokes, solution-based therapists help clients identify their preferred solution (by talking about the problem, exceptions, and desired outcomes) and work with the clients to take small, active steps in this general direction each week” (O’Hanlon & Weiner-Davis, 1989). Most cases are time-limited to 1 to 10 sessions. However, in complex cases such as: sexual abuse or addiction, therapy may take years (O’Hanlon & Bertolino, 2002). Given this therapy’s cybernetics/postmodern philosophy, SFBT might define psychological or relational “normalcy” as a state of homeostasis, while defining psychopathology as when clients are not moving towards their goals. Psychological health might be defined as optimism and hope are restored and when therapy has achieved positive outcomes (Gehart, 2014, p. 336-337).    

    “Solution-oriented couples therapy is popular because the emphasis on strength and hope is well-suited for working with negative, interpersonal conflict, especially with couples who are in crisis or considering divorce” (Hudson & O’Hanlon, 1991; Weiner-Davis, 1992). When applying SFBT to the case of a married couple who I will describe, using the following solution-oriented couple’s therapy interventions will be most effective:

1.     Videotalk-The therapist distinguishes between facts (behaviors), stories (narrative) and experience (internal perceptions such as feelings) (Hudson & O’Hanlon, 1991)

2.     Complaints vs. requests-SFBT asks clients to learn to make requests vs. complain

3.     Constructive Questions-Designed to identify client’s possible solutions (Dolan, 1991, Gehart, 2014, p. 349).

   

    In the case of a married couple who has presented in counseling due to the husbands second affair, I would implement the following treatment plan:

1.     Develop a collaborative working relationship with all clients, inspiring hope and optimism

2.     Use the Miracle Question to identify future intended outcomes

3.     Identify exceptions to conflict, highlighting client’s strengths and resources

4.     Obtain agreement on treatment goals

5.     Use scaling questions to measure severity of symptoms, and to identify shorter-term goals

6.     Use solution-generating questions to identify long-term goals

7.     Identify needed referrals-connect family to community resources as needed

8.     Coping questions-Establish how the clients will cope with future problems/setbacks.

    

    In summary, Solution Focused Brief Therapy is a popular psychotherapeutic approach due to its solution-oriented interventions and philosophy, and can be utilized with individuals or families to develop a strength-based approach to resolving problems.

References:

Becvar, D.S., Becvar, R.J. (2013). Family Therapy: A Systematic Integration. Eighth Edition. PEARSON

De Shazer, S. (1985, 1988, 1994). Brief Family Center, Milwaukee, WI.

Gehart, D. (2014). Mastering Competencies in Family Therapy. BROOKS/COLE CENGAGE Learning.

O’Hanlon, B., Bertolino, B. (2002). Even from a broken web: Brief and respectful solution-oriented therapy for resolving sexual abuse. New York: Norton.

Hudson, P.O., O’Hanlon, W.H. (1991). Rewriting love stories: Brief Marital Therapy. New York: Norton.

Weiner-Davis, M. (1992). Divorce busting. New York: Summit Books.