Solution Focused Brief Therapy

Article was found at the Brief Therapy Network website.
Uncovering MRI Roots in Solution-Focused Therapy

  Eve Lipchik, M.S.W.

"Ideally, clinicians should move beyond the traditional dichotomy between clinical theory and practice and come to grips with both realms of therapy. To develop a perspective that encompasses these apparent opposites requires that we attend to epistemology. Following Bateson, I use the term epistemology to indicate the basic premises underlying action and cognition. Examination of our epistemological assumptions will enable us to more fully understand how a clinician perceives, thinks, and acts in the course of therapy."   (Keeney, p.7).

These words were written by Brad Keeney in l983. They represent a good description of the message that I was trying to convey to readers in my recent book, "Beyond Technique in SFT. " Lest readers think "She's not really solution focused because solution-focused therapists have moved beyond theory!" or  "She hasn't changed her thinking in the last twenty years?" let me clarify my position. A quarter century of clinical practice and teaching SFT has culminated in my present belief that while the language of therapy is unique in each case there must be some basic premises that define a therapist's role in relationship to clients. I will try to explain how I arrived at this thinking and my theoretical concepts that integrate the work of MRI, BFTC and Maturana and Varela.

A personal historical perspective  

For almost a decade from the late 70's to the late 80's I was part of the Brief Family Therapy team that developed Brief Family Therapy, the approach that later became Solution Focused Therapy. The theoretical ideas of this group were rooted in the work of Milton H. Erickson, Gregory Bateson and the group at the Mental Research Institute that included Don Jackson, Jay Haley, John Weakland, Paul Watzlawick, Lynn Segal, Richard Fisch and others. Like our colleagues at MRI, we focused on observable behaviors, avoided looking for causes, utilized what clients brought, believed that problems were situational difficulties between people, and that a small systemic change can make a difference.  We also used a consulting team to study the therapy process and facilitate it. Unlike the MRI group, however, BFTC quickly differentiated itself by adopting an ecosystemic approach. Ecosystemic thinking was the recognition that therapists could not be objective in assessing and intervening in the family system. Rather, therapist and team are participants in a therapeutic system that develops new and more functional interactional patterns with the family. Thus we moved from seeing ourselves as experts who decide which of the clients'interactional patterns to interrupt to developing new patterns with them that were unpredictable results of our collaboration. However, in spite of this theoretical difference, Ericksonian thinking about circumventing resistance remained a major factor in Brief Family Therapy. What MRI  considered maneuvering or utilizing the clients' "position" ( Fisch, Weakland, & Segal, 1982) became the more collaborative concept of  "cooperate with how clients cooperate" (de Shazer, l985)  at BFTC.  In either language, this concept requires therapists to be aware of their stance in relation to clients at all times.

In 1982, something happened at BFTC that shifted the focus from problems to solutions. Someone behind the mirror - today there are various memories about who it was - said at the end of a session "Let's not ask the family what they want to change, let's ask them what they don't want to change." This led to the discovery that when  people are asked to notice what they don't want to change,  changes occur for the better that may have nothing to do with the problem at all. For example, clients may have come in complaining that they want to stop fighting and discover their solution to be more time spent together on week-day nights. Asking clients to notice what they do not want to change draws their attention to positives and exceptions. This different perspective changes their perception of the situation from one that is problematic to one that also had positive aspects. This in turn affects attitude and behavior.

 
For me, the new solution focus gradually created a dichotomy between theory and practice. One reason for this was the increased emphasis on pragmatics vs. aesthetics.  As the team at BFTC strove for increasing minimalism and scientific predictability,  theory was reduced to a decision tree about when to ask which question. Indeed, this was theoretically so, but in practice it did not quite work that way most of the time. There was much more to consider than questions. The unique qualities and perspectives clients brought to therapy with them and their process in relation to the therapist were important factors, as well.

At that time, the team at BFTC was also interested in the possibilities of computerizing the therapeutic process. An artificial intelligent program called BRIEFER was developed to determine which task to assign at the end of the first session. Each one of us was interviewed by the  computer programmer about how we make choices in relation to clients. For me these interviews resulted in a heightened awareness of the context in which our techniques are used. That context was difficult to articulate but it seemed to me to have a lot to do with what we did not pay attention to, namely emotions.  

Harry Stack Sullivan's interpersonal theory was helpful to me at the time. His work had influenced Don Jackson much earlier and therefore indirectly influenced MRI's theoretical development. Sullivan was an early constructivist. He denied objective reality and considered problems and solutions to be the result of interpersonal relationships. Sullivan also eschewed diagnostic categories and defined problems as  "anxiety" in the general sense, e.g. discomfort with self in relation to others.  He referred to a state of well-being (solutions) as "security," or comfort with self and in relation to others. Like Maturana and Varela much later, Sullivan considered human relationships from a biological perspective, and as basic for physical and mental survival.  What spoke to me even more than Sullivan's perspective that encompassed both the individual and  interpersonal dynamics, was the emphasis on emotions. This encouraged me to keep searching for a way of incorporating emotions into  Solution-Focused Therapy.

John Weakland´s secret world

Experiences I had as a trainer led to further feelings on my part about a dichotomy between theory and practice. Before we became solution-focused at the Brief Family Therapy Center we taught therapists in our training program some theory before putting them in front of the mirror with clients. Afterwards, we sent trainees into the room armed with solution focused questions as soon as they started the program. I noticed that this change caused many clients to drop out quickly. Therefore, I began  experimenting with a different approach. I told trainees to concentrate first on listening to the clients and to come to an agreement with them about what they think will be different when they do not have to come anymore. Only when they had accomplished this did we give them  instructions from behind the mirror about which solution focused question to ask. This had better results because the trainees focused on the clients rather than on the questions. 

I owe a great deal to John Weakland for giving me a better understanding about what it means to integrate theory and practice as a clinician and teacher. John was a mentor to Steve de Shazer and was a regular visitor at BFTC. Whenever he came to Milwaukee he conducted demonstration interviews in front of the mirror for our trainees. These interviews sometimes seemed cold and mechanical to many of us, but one day he offered us an experience that made me understand that these interviews were simply elegant demonstrations of pure theory. During one of his later visits John offered to show our staff a videotape of one of his private practice sessions. In retrospect I wonder whether there was a purpose to this offer because he showed us such a different side of his work. The case was a relationship problem of an elderly couple that had been married over thirty years. John was warm and social. He skillfully contextualized his questions with empathic comments that reflected their view. He segued from the interview into a message and task without taking a break, just by punctuating the passage with a deep breath and a slight pause. The message and task were delivered as though they were a casual afterthought. It is easy to dismiss this difference a matter of style. I believe it was a demonstration of how one blends theory with practice in a way fitted the use of technique to the clients. Surprisingly, John acknowledged and utilized emotions, as well. It was very encouraging. 

While I now felt more confident about how to blend theory and practice as a clinician and teacher, the postmodern influence on SFT soon created another dilemma for me. On one hand I fully agreed that each client is unique and the therapeutic process should reflect that, on the other hand I was uncomfortable with the repudiation of theory.

The content in process

As a consultant I was repeatedly working with therapists of all levels of experience who considered themselves stuck when clients did not answer solution focused questions. My efforts to understand this made me realize that solution-focused questions and "language" were often thought to be interchangeable. Consequently, the conversations were taking place much more on a content level than the process level.

Let us consider an example. Sylvia, a thirty-one year old single woman who works in a bank, says she sought therapy because she feels depressed. After talking a while with the therapist about the symptoms of her depression and what her goals are she concludes that she would know she does not have to come to therapy anymore when she has a man in her life who loves her. The therapist then asks whether she has ever experienced this and  Sylvia answers "never" because the men drop her after the first few dates. In answer to the miracle question Sylvia paints an unrealistic picture of a relationship in which she is loved blindly and the man has no faults. Questions about how Sylvia has been coping without such a relationship revealed that whatever she had tried made her feel more discouraged. Rather than feeling stuck at this point, a solution-focused therapist can broadens the picture to include an interactional perspective.  That means talking with Sylvia about her perception about why men ask her out in the first place, how she responds to the way they respond to her, and what other options there might be to that process.

 
Let us imagine that as a result of this type of exchange Sylvia and the therapist learn that  Sylvia distrusts men and actually feels ambivalent about having a relationship. Now the themes of distrust and/or ambivalence can become the focus of the solution-focused questions. This will address process at another level and allow Sylvia to imagine a future from a different perspective. In the event that Sylvia does not find this conversation useful either, the therapist would have to reconsider how to cooperate with how Sylvia cooperates. In other words, what will he/she have to do different in relation to Sylvia to address the distrust or ambivalence?  Perhaps to agree with both sides of her ambivalence or to suggest that the distrust is protecting her until she is ready for a relationship? Utilizing the clients' position in relation to the therapist, or cooperating with how clients cooperate, not only addresses the process between therapist and client, but can, in turn, affect clients' process with others outside of therapy.

The notion of using this type of strategy as part of a postmodern approach will obviously cause some readers to raise an eyebrow. But isn't the decision to utilize clients' strengths strategy? Isn't it strategic to ask clients about exceptions to when they don't have a problem, or how their life would look the next morning after a miracle? And is it not an obligation that we carefully choose our responses to clients if they are paying us for our services?  If those choices are about drawing clients out about their options, is this not a deliberate act?

Integrating Maturana and Varela's ideas

In l995, I attended a presentation by Humberto Maturana in Heidelberg, Germany and realized that the theory of cognition he had developed with Francisco Varela fit the conditions for a theory that is congruent with my ideas about solution-focused practice: it represents a constructivist point of view, it provides a biological context for language, and it includes emotions.  Both the MRI model and the solution-focused model had eschewed emotions. The belief was that emotions, as compared to behaviors, were subjective and difficult to quantify and would slow down the brief therapy process. Obviously, emotions have always been part of the brief therapy interactions since one cannot separate thinking, feeling and behavior. However, it was a dictum that it was best not to talk about them. This is actually strange, given the Ericksonian emphasis on meeting clients where they are and utilizing what they bring to therapy.

According to Maturana and Varela's theory, living systems are organized to survive and recreate themselves. Their survival depends on structure coupling, a state of interdependence with other living systems. These systems are closed in that they can not change each other, but they can perturbate each other, that is, trigger change in each other to the degree that their structure allows. Living systems are constantly perturbating each other and mutual survival depends on mutual adaptation. Thus adaptation or change depends on conserving the necessary elements of what both  systems need to survive.

How does this translate to Solution-Focused Therapy?  When clients come to therapy their language (interaction) with others is stuck in an unsatisfactory way. Therapy is an interaction with clients that is intended to get them unstuck. The purpose of the therapist's role in this interaction is to benefit clients. According to Maturana and Varela, humans are living systems that distinguish themselves from other living systems by language. Language is described as action, a phenomenon that takes place in the recursion of linguistic interactions. In other words, human beings have closed neural networks that generate their own information,  but language is the act of mutual adaptation, or consensus about meaning between people and social groups. Thus therapists cannot change clients, they can only perturbate them to help them achieve the changes they desire. Solution-focused questions are a manner of perturbating in that they focus clients on what works for them already. However, given the interactional nature of language it makes sense that clients can also be perturbated by questions about their interactions with others, or that therapists utilize the clients' unique way of languaging/acting with them to try to trigger change.  A crucial element of this theory is Maturana and Varela's position that emotion is the underpinning for life and its continuation. Emotion drives the choices we make, therefore motion drives language (action). Maturana and Varela go as far as to speak of a "biology of love." They see life as being perpetuated by the acceptance of another (system/person) in coexistence with oneself. Certainly mutually satisfying personal and therapeutic relationships are perpetuated this way.

Based on what I have described above I have developed the following theoretical statement and assumptions to guide solution-focused thinking.

Human beings are unique in their genetic heritage and social development. Their capacity to change is determined by these factors and their interactions with others. Problems are present life situations experienced as emotional discomfort with self, and in relation to others. Change occurs through language when recognition of exceptions and existing and potential strengths create new actions.

Assumptions:

1.Every client s unique.

2.Clients have the inherent strengths and resources to help themselves.

3.Nothing is all negative.

4.There is no such thing as resistance.

5.You cannot change clients, they can only change themselves.

6.Solution-Focused Therapy goes slowly.

7.There is no cause and effect.

8.Solutions do not necessarily have anything to do with the problem.

9.Emotions are part of every problem and every solution.

10.Change is constant and inevitable; a small change can lead to bigger changes.

11.One can't change the past so one should concentrate on the future.

Notice these assumptions reflect a combination of interactional, solution-focused

and constructivist thinking. It has been my experience that these assumptions guide therapists in their decisions about what to respond to and what to ignore, and when to ask which question. Thus when a client is very negative the assumption that  "nothing is all negative" helps us remain persistent about find even a very small exception or strength. When clients "yes but" everything we say "emotions are part of every problem and solution" can remind us that the client must feel frustrated and stuck. Conveying our understanding of how they feel can be looked at as conserving what works for clients, namely a positive connection with another human being and a sense of trust.

Conclusion

The work that emanated from MRI almost half a century ago represented a major theoretical shift in how change in human behavior was conceptualized. In time, various therapeutic approached sprang from these roots and eventually overshadowed them. Solution-Focused Therapy is one of these approaches. It is a highly effective, client friendly manner of helping people.  However, when postmodernism caused theory to be dismissed as unnecessary I experienced the dichotomy between theory and practice once again. This article describes my efforts to resolve that dichotomy. Ultimately, I discovered the importance of reviving the MRI roots for effective Solution-Focused Therapy in addition to cross-breeding the approach with Maturana and Varela's ideas. My intention was not to complicate Solution-Focused Therapy but to strengthen and enhanced it for both therapists and clients. It is my sincere hope that this will prove to be so. 

References:

Chapman, A.J. (l976). Harry Stack Sullivan: The man and his work. New York: Putnam's.

de Shazer, S. (l985) Keys to solution in brief therapy. New York:Norton.

Fisch, R., Weakland, J.H., & Segal, L. (l982) Tactics of change: Doing therapy briefly. San Francisco:Jossey-Bass.

Keeney, B.P. (l983). Aesthetics of change. New York: The Guilford Press.

Maturana, H.R. & Varela, F.J. (l987). The tree of knowledge? The biological roots of human understanding. (Rev.ed.). Boston: Shambhala.

 

In addition to her private practice in ICF Consultants, Milwaukee, Wisconsin, Eve Lipchik teaches, consults and lectures nationally and internationally. From 1980 until 1988, she was a core member of the Brief Family Therapy Center in Milwaukee where she participated in the development of Solution-Focused Therapy. She has published in numerous books and journals. Her book entitled "Beyond Technique in Solution-Focused Therapy: Working with emotions and the therapeutic relationship" was recently published by Guilford.