What is Solution Focused Therapy? And how may you use Solution Focused Therapy (SFT) to empower your clients to get unstuck and achieve their goals?
Today, we have the honor of an interview with Denise J. Krause, MSSW, a Clinical Professor and Associate Dean for Community Engagement and Alumni Relations at the University at Buffalo School of Social Work. Professor Krause will introduce us to Solution Focused Therapy and provide a case example in which she is applying this approach with a client struggling to find a job.
Solution Focused Therapy is an evidence-based practice you may wish to add to your clinical toolkit. As per Professor Krause, it is “useful for the “resistant” client/system,” and is used in “every modality; in multiple settings; and with all presenting problems.” It is also equal in efficacy to motivational interviewing.
Now without further ado, Denise, Could you give us a bit of your background?
I am a Clinical Professor and Associate Dean for Community Engagement and Alumni Relations at the UBSSW. I began full time with UBSSW in 1998 and began as an adjunct in 1993. Before that I worked for CMG Health, a Behavioral Managed Care Company for 3 years and prior to CMG worked at Catholic Charities of Buffalo for 10 years where I supervised a community based services office and a Housing Improvement Program for Seniors. In addition, I was a consultant to the Tonawanda Indian Reservation providing individual and family counselling; a nursing home and rural hospital per diem social worker; and had a private practice.
My interest in social work came from my college experiences of volunteering at the Binghamton Rape Crisis Center. I developed an interest in crisis work and advocacy. My original exposure to Solution Focused Therapy (SFT) came when I was at Catholic Charities (CC). CC had an extensive family therapy training program and, as part of the program, I was sent to the University of Rochester Family Therapy Training Institute. It was here that I met Insoo Kim Berg and was introduced to Solution Focused Therapy. The Institute used a live supervision model and I was fortunate to have both coursework and live supervision in family therapy and SFT. After my training was complete; myself and four colleagues continued the live supervision and study of SFT at CC. A member of our group went to Milwaukee to study with Insoo and Steve deShazier and shared readings, notes, and experiences. Together these reinforced the model and helped me to develop skill in SFT.
In 2007 Insoo Kim Berg was scheduled to deliver a multiple year training at a local agency. In January of that year she died leaving the agency at a loss for the training. A colleague, Linda Dinger (who was in the group mentioned above) and myself were asked to step in and deliver SFT over a two-year period. We, again, immersed ourselves in readings, audio and visual recordings, and practice of the model. Training others was an opportunity to fine-tune our skills and to model the model.
Since 2007 I have trained and taught Solution Focused Therapy to several agencies and individuals. In recent years I have also combined SFT with Trauma Informed Care as SFT provides “the how” and TIC “the what”.
How would you describe Solution Focused Therapy?
Solution Focused Theory is as much a philosophy as a model. Most people know it by the famous skill sets: scaling questions, exceptions, and the miracle question. Really, it is grounded in the reality that problems only exist in the context of “better” so that whenever we talk about problems, we can also talk about “better.” So the worker focuses on what IS working rather than on the problem.
SFT assumes that the client knows themselves best and the therapist’s job is to help the client achieve what they want. The worker does this by asking the right questions versus having the right answers. The process is quite simple: understand what the goal is, describe the goal in detail behaviorally, scale how close to the goal the client is, elicit the times when they have been successful working toward the goal, and identify next steps.
While the steps are simple the therapeutic process requires tremendous discipline. Workers have the tendency to want to “fix,” give advice, and interject their egos. Generally doing these things is more about us than the client and tend to get us off track.
Could you explain what are the key SFT key tools and how they are used ?
Many therapists use skill sets from SFT, but are not solution focused. To be solution focused means believing the assumptions listed above and operating from a stance of client as expert. The backbone skill of SFT are the exception questions. Exception means exception to the problem which by default is a solution. Exceptions are the times when problem isn’t happening, is better, or could happen but didn’t. SF practitioners are curious about those and how they happened. Exceptions are either random or deliberate and provide the key for movement toward a goal.
The scaling questions provide the most flexibility of all the skill sets in that just about anything can be scaled. Generally scales are 1-10 with 10 being the desired anchor. The technique has been adapted for children and those who might have a hard time with numbers to include creative ways to scale. Scaling is about the dynamic nature of movement (change) in one direction or another. It allows the client and worker to talk about what it takes to change with objectivity. Questions related to scaling include asking the client to explain how they chose the number they did, how come their number is not one lower, and how they will know they are moving up the scale.
Probably the most famous question related to this model is the miracle question. The miracle question asks the client to consider life without the problem by setting up a scene where a miracle happens and the problem is gone. The client doesn’t know a miracle happened because they were sleeping. The idea is to have the client reflect on what would tell them that there was a miracle. The technique is less about the miracle per se and more about the details of the miracle picture. What would be different? How would they know? What would others notice? This one skill set could take 20 minutes of a session.
As important as the skills listed above are goal formation questions. Since the essence of SFT is to help people achieve their goals (even when the goal is to get us out of their life), asking questions related to goals are key to success in the model. Versions of goal formation questions comes as “best hope” questions, “difference questions” and “imagine our time together was useful” questions. Burrowing into the behavioral descriptions of the goal is necessary so that the worker understands exactly what the client means by their goals.
Finally, the are two skill sets that receive less attention yet are significant with any SF work: the relationship questions and coping questions. Relationship questions are imbedded with all the skill sets above and ask the client to consider their answers from the perspective of others in their life. An example might be “what would your probation officer say is most important to focus on right now”?. Coping questions are very helpful to deescalate tension and acknowledge the skills and resources someone is using in the moment to make it. “How are you managing to the extent that you are” is an example.
Also see Greg’s SFT Handout!
What kind of homework is typically given to clients in this modality?
There is some controversy over the use of homework in this model. Generally homework would be called “tasks” and tasks can be behavioral or observational. When clients are able to identify deliberate exceptions to their problems, tasks are behavioral in that the client is asked to do more of what works. When exceptions are random, clients are asked to pay attention to or notice when things are better. The emphasis of the task will always be on what works or what helps.
Could you give a case example of how you may apply SFT while trying to help a client who is struggling to find a job?
In SFT all work is centered around the client’s goal. Every session begins with a goal-oriented question such as:
“How do you think I could be useful to you today?”
“What do you hope is different as a result of the time we spend together today?”
Assuming the client states that her best hope is to figure out a way to find a job, the SFP (Solution focused practitioner) would seek to understand the details about this goal. To elicit details about the goal, the SFP might ask:
“Imagine you left here feeling more hopeful about finding a job, what would your partner notice is different about you”?
“What is the first thing that will tell you that you are making progress toward finding a job”?
During each phase of the SF interview, the SFP is acknowledging, validating and offering indirect compliments. In this case, the SFP might validating the hopelessness and discouragement the client feels. The SFP will also use indirect compliments by saying “with the discouragement you feel, how do you manage to keep at it?”
Instead of offering a direct compliment such as “ I am impressed with how you put your resume together”, a SFP might offer:
“What did you do to get motivated to put this together?”
The emphasis is on what the client HAS done in service of their goal and more importantly, asks them to identify the skill sets they have used.
In the SFT model, these questions are revisited and elaborated upon. Once the client answers, the SFP becomes more curious about the accomplishment.
“What else did you do to make this happen?” Because the belief in the model is that the client already possesses the skills (solutions) to her “problem,” the SFP is patient while the client “re”-discovers them.
Once an understanding of the details of the goal is clear the SFP might ask the Miracle Question and follow ups to the miracle question. The client will more than likely explain that in her miracle she wakes up and has to go to work.
The SFP’s job here is to break this down into the finite steps that this entails including what others (maybe even her pets) will notice about her. The SFP will ask:
“Who will be the first person to notice that you are getting ready for or on your way to work”?
“What will notice is different about you?”
“What will they say to you after the miracle that they didn’t say today?”
Often, the SFP follows the miracle questions with exceptions questions to discover when the last time a small part of the miracle has happened.
“When was the last time you felt a sense of purpose when you got up”? or
“When was the last time you were able to engage in a conversation with a friend and feel proud of yourself?”
“How did you make this happen?”
When clients have a difficult time identifying exception they had control over, the SFT stays the course and will be curious about other difficult times the client has made it through. The SFP will be very curious how the client made that happen and what she noticed about herself.
From this point, the SFP will scale hopefulness, confidence or progress toward finding a job.
“On a scale of 1-10 where 10 is you are very hopeful about finding a job and 1 is the opposite, where are you?
The SFP will learn about the current hopefulness and what needs to change to be a bit more hopeful. A helpful question for the worker at this point is to actually ask “how will this be helpful to your goal of finding a job?”
The idea is to anchor the questions around what is possible. Sometimes this means revisiting the exceptions or even the goal. The work ends with the client being able to identify the next small step toward what she wants. This step may be directly related to finding work or indirectly related.
For example, this client may need to have a conversation with her ex about certain things before she can concentrate on finding a job. The key is that she knows what she has to do and the SFP’s job is ask questions to help her to get to that step.
A task might be to do more of what is helpful or to pay attention to the times she feels more hopeful about finding a job. (The idea here is to presuppose change will happen).
When/if the client returns for subsequent sessions the worker is curious about what is better. (Again the focus is on what is working).
How would you apply the Scaling technique with a client who wants to find work?
Scaling is a useful SF technique to help someone move toward their goal. In the case of someone who wants to finds a job a scaling question might begin with:
(SFP = Solutions Focused Practitioner; CL = Client)
SFP: On a scale of 1-10 where 10 is you are very confident you will find a job and 1 is the opposite where are you?
CL: I’d say a “2”
SFP: a “2”? (with a nod of understanding that the client feels a “2” is low). So…can you tell me how come it is not a “1”?
CL: well, I have my resume together and I am making calls and filling out applications.
SFP: What else keeps it from being a “1”?
CL: I have found jobs before, even though they didn’t work out.
SFP: So, you have your resume done, you are making calls, filling out applications and you have found jobs before. What else?
CL: I don’t know, I have to get a job.
SFP: You seem pretty sure about that
CL: Well, yeah
SFP: If we were to ask (insert significant relationship) your partner that same scaling question, where would she put you on the scale?
CL: (Laughs), well, she would put me much higher
CL: Probably a “7”
SFP: wow, that is higher. What does she know about you that put her confidence in you at a “7”?
CL: Well, I don’t tell her everything I am feeling and what people really think of me
SFP: What does she see?
CL: She sees someone who is confident and has it all together
SFP: Help me get a picture of that, what do you look like in her “7”?
CL: I go out and talk to people and then I come home and tell her about the pros and cons and what I think happened.
SFP: And that helps her see confidence in you
CL: It helps her.
SFP: What about that is helpful to you?
CL: Well…….I’m not sure…..I suppose it keeps me motivated
SFP: What else?
CL: I feel that I AM doing something
SFP: and that is helpful to you?
CL: I suppose
SFP: Let’s go back to your scale, suppose you move from a “2” to a “2.5”, what will you be doing that you are not doing now to feel more confident?
CL: H’mmm…..I might be more hopeful
SFP: more hopeful? What do you do when you are more hopeful?
CL: I will complain less.
SFP: wow, what will you do instead of complain?
CL: I would pretend that I am interested in talking about my job search and people I meet
SFP: and that would be a “2.5”?
SFP: can you show me what pretending looks/sounds like?
Once the client does this, the SFP might end will a scaling question on how likely it is that the client would be able to pretend. The same line of questioning might follow. Notice that during the scaling, the therapist does not have an investment in the client’s answers. Moving from a “2” to a “2.5” might be all it takes for the client to feel more hopeful/motivated/etc… about their goal. The goal is not to be a “10”, but to move up the scale. In the SF model, small changes are catalysts to bigger change.
What are some modifications that you make to SFT to make it trauma informed care (TIC)?
So, SFT isn’t modified at all really. Being SF IS being trauma informed. All the principles and assumptions of SFT fit with the principles of TIC. What Sue and I realized in our work with agencies is that TIC is great for giving people concepts to anchor practice around (safety, choice, trust, collaboration, empowerment), but TIC doesn’t give people the actual skills to develop these. SFT (with its’ skill sets) is perfect for helping people operational TIC principles. (See below chart)
Are there particular situations and/or clients for whom Solution Focused Therapy is especially beneficial, as well as scenarios for which SFT may not be appropriate?
SFT is used in every modality; in multiple settings; and with all presenting problems. SFT has been adapted for education, medicine, corrections, organizational development, child welfare, addictions, mental health, and many other systems.
In particular, SFT is useful for the “resistant” client/system as it is so client-centered. Solution Focused Therapy can be applied to every interaction. A danger, as with any model, exists when the practitioner is not well versed on the model and either “gives up” or is incompetent with the practice.
Many of the features you mention about SFT sound similar to motivational interviewing such as: the client is the expert, validate the client’s point of view/feeling, be clear on the goal from the client’s point of view and rating of symptoms/confidence in ability to address task. In terms of its effectiveness, is SFT considered equal to or better than motivational interviewing?
Great question. There are many similarities and a big difference comes with directives or insertion of the worker. In SFT this is rarely done.
All of the comparison studies show MI and SFT as equally successful. (They are compared against cognitive behavioral therapy (CBT) too). As an aside, microanalysis of sessions using, SF, MI and CBT show the SF therapists using more affirming language (utterances, words, etc…) and using fewer interpretations or formulations. I think this is interesting. Much of the research on SF in the US has been published in the last 10 years although internationally there is a much longer track record of research.
How do you recommend mental health professionals obtain training in this modality?
www.sfbta.org-links to training sites around the world. Spend hours observing and practicing.
Are you familiar with any SFT simulation programs that one may practice with?
I am not. These links may be helpful.
These schools/institutes have VERY reputable training programs. (They all have trainers who worked with Insoo and Steve and maintain integrity to the original thinking.
What would you say are the key 10 principles for every clinician to consider when employing Solution Focused Therapy?
- Notice what IS working
- Build on what IS already present
- Validate the client’s point of view/feelings
- Remember is there is NO one right way
- Be clear as to the goal of the work from the client’s point of view
- Change happens with small steps
- Small change leads to greater change
- Be NEXT to the client (not pulling from ahead or pushing from behind)
- People are doing their best in any given moment
- Ask the right question and the right answer will follow
Thanks so much, Denise, for providing us with this valuable introduction to Solution Focused Therapy!
Like this post? Please share it!