Underlying beliefs, key aspects and limitations; practice approach including scaling question, miracle question, using exceptions, and coping questions
This page has three sections:
Background Material that provides the context for the topic
A suggested Practice Approach
A list of Supporting Material / References
Beliefs That Underlie the Model
The client is the expert.
If something is working, do more of it.
If something is found not to be working, then do something different.
Small steps can lead to big changes. Give people small tasks that are very achievable and completing them increases their confidence.
The solution is not necessarily related to the problem. What one thinks is an obvious solution might not be right for the person. Work with the person without preconceived ideas.
Reframe the problem into solution-focused language “I’m depressed” from the client may be reframed into “Sometimes you experience depression” by the practitioner. There is a focus on solution talk rather than problem talk.
When discussing the client’s desired future, use pre-suppositional language There is a big difference between saying “Has anything gotten better?” and “What has gotten better?”
No problem happens all of the time; there are always exceptions Explore these exceptions—when and why the problem is not around.
The future is creatable This can be used when someone is feeling trapped.
Key Aspects of the Model
Solution focused therapy assumes clients have the knowledge and solutions to solve their own problems and these can be uncovered by using certain questions. It is a strengths-based intervention. It uses the following approaches:
Pre-session change Early in the session ask what changes the client has noticed since the last session, or since they made the appointment. Improved: therapist asks questions about the changes that have started to emphasise client strengths—so if these changes were to continue in this direction, would this be what you would like?
Improved: therapist asks questions about the changes that have started to emphasise client strengths—so if these changes were to continue in this direction, would this be what you would like?
Same: therapist asks how client has managed to keep things from getting worse—may lead to information about previous solutions.
Solution-focused goals Elicit smaller goals rather than large ones, and frame them in positive language. Ask clients to describe their lives when things are “slightly” better instead of when the problem is completely solved. “When don’t you have this problem? When is the problem less bad? What is different about these times?”
Miracle question “If by some miracle things were how you wanted them to be, what would it look like?” This can generate the magnitude of the problem, but can also lead to client coming up with smaller, more manageable goals that can then be taken as the goals of therapy.
Coping questions Help clients notice times when they are coping with their problems and what it is they are doing at those times when they are successfully coping. “How have you been able to keep going despite all the difficulties you’ve encountered? How are you able to get around despite not being able to walk?”
Scaling questions Each goal should be scaled: Using a scale of 1-10, where things are now, and where they will be when therapy is “successful.” If the scale goes up between sessions, the therapist compliments the clients, then solicits extensive details describing how the clients were able to make such changes. This not only supports and solidifies the changes, but leads to the obvious nudge to “do more of the same.” If things “stay the same,” again, the clients can be complimented for maintaining their changes, or for not letting things get worse. “How did you keep it from going down?”
Relationship questions Ask clients to imagine how significant others in their environment might react to their problem/situation and any changes they make. “What would your mother (or spouse, sister, etc.) notice that is different about you if you are more comfortable with the new environment? How would your wife (or other significant others) rank your motivation to change on a one-to-ten scale?”
Constructing solutions and exceptions The therapist spends most of the session listening attentively for signs of previous solutions, exceptions, and goals. When these come out, the therapist punctuates them with enthusiasm and support. The therapist then works to keep the solution-talk in the forefront. Whereas the problem-focused therapist is concerned with missing signs of what has caused or is maintaining a problem, the SFBT therapist is concerned with missing signs of progress and solution.
“Is there anything I forgot to ask?” This question can be used before taking a break and reconvening
Take a break and reconvening Therapists are encouraged to take a break near the session end to collect his or her thoughts, and then come up with compliments and ideas for possible experiments. When the therapist returns to the session, he or she can offer the family compliments.
Experiments and homework assignments Therapists frequently end the session by suggesting a possible experiment for the client to try between sessions if they so choose. These experiments are based on something the client is already doing (exceptions), thinking, feeling, etc. that is heading them in the direction of their goal. Alternately, the client sometimes designs homework.
Limitations of solution-focused practice
May not be suitable for people who have difficulty responding to questions.
Focus on behaviour and perception rather than feelings may limit efficacy.
May not be effective with people in crisis or people with very low self-esteem who may not accept that they have strengths and skills.
There is an emphasis on the positive at the expense of understanding the despair and distress.
There is an absence of underpinning theories of human development and change.
The approach does not include a full understanding of the client’s life, e.g. through including a bio-psychosocial assessment.
A. The First Solution-Focused Session:
There are two functions that are accomplished simultaneously in the first solution- focused session: development of an initial goal and initiation of the solution building process. Solution-focused therapists use six questions that have been developed collaboratively with clients.
Pre-session change — “Between the time you called to set up this appointment and today (or since the last session), what is it that you’ve noticed that is already a little bit better?” This provides the therapist and client with clues of the goal and moves the conversation from the exploration of the problem to the building of a solution.
Vision for a better future (if clients are unable to delineate pre-session change) — “Suppose, your meeting with me today is helpful. What will be the first sign to you that things are different?”
Miracle question All the miracle question is designed to do is to allow clients to describe what it is they want out of therapy without having to concern themselves with the problem and the traditional assumptions that the solution is somehow connected with understanding and eliminating the problem.
Quite often the client will raise exceptions, times that the problem either is experienced as less significant or absent entirely. When the therapist hears this, it is usually helpful to expand on exceptions. “What part of the miracle is already happening?”
Scaling question Discuss what the particular number means to the client, “How is 3 different from 0,” or, “How did you go all the way up to 3?” Ask how the client will know when he or she is just one number higher on the scale.
Coping questions are useful when a client may have initial difficulty thinking beyond the problem situation and is unable to shift into a solution-building context. “Given everything you have told me about what’s going on in your life, how do just make it through each day?”
The therapist then takes a break and, on return, compliments the client by validating concerns, recognising competencies and suggests something to do between sessions.
B. Subsequent Solution-Focused Sessions
Clients make the decision when they want to return. Subsequent sessions begin with a scaling question and follow EARS:
Eliciting the exception,
Amplifying it (by asking the client to describe what is different between the exception time and the problem times and then exploring how the exception happened),
Reinforcing successes and strengths that the exception represents, and
Start again by asking “And what else is better?”
(available on request)
de Shazer, S., & Dolan, Y. (2012). More than miracles: The state of the art of solution-focused brief therapy. Florence: Taylor and Francis. Retrieved from http://ebookcentral.proquest.com/lib/une/detail.action?docID=668487
Fiona McAfrlane Lecture
Harms, L. (2007). Working with people: Communication skills for reflective practice. South Melbourne, Australia: Oxford University Press.
Lee, M Y. (2011). Solution-focused theory. In F. Turner (Ed.), Social work treatment: Interlocking theoretical approaches (5th ed.), (pp. 460-476). Oxford, England: Oxford University Press.