Solution Focused Brief Therapy

In the 2000s, hypnotherapists began to combine the best of Solution Focused Brief Therapy (SFBT) with Ericksonian hypnotherapy to produce therapy that was goal focused (what the client wanted to achieve) rather than the more traditional problem focused approach (spending time discussing the issues that brought the client to seek help). A solution-focused hypnotherapy session may well also include techniques from NLP. But what is SFBT?

Early in the 20th century, following the work of people like Freud, a client could be in therapy for a very long time. The thinking was that until you could understand the cause of a problem, there was no way that it could be resolved. It was very problem-focused. As the 20th century moved into its second half, people were beginning to wonder whether this approach was the best one to use.

Milton Erickson is one of the originators of brief therapy. Erickson used the analogy of a person who wants to change the course of a river – if he opposes the river by trying to block it, the river will merely go over and around him. But if he accepts the force of the river and diverts it in a new direction, the force of the river will cut a new channel. Erickson also introduced a forerunner to the Miracle Question in which he would ask his client to look into the future and see themselves as they wanted to be, problems solved, and then to explain what had happened to cause this change to come about. A second technique he used was to ask them to think of a date in the future, then work backwards, asking them what had happened at various points on the way.

Similarly, Bill O’Hanlon (who worked closely with Erickson) came up with other ways of getting a client to look to a future without their problem, eg a time machine, crystal ball, rainbow bridge, and a letter from a future self. In one version he would say, “let’s say that a few weeks or months of time have elapsed, and your problem has been resolved. If you and I were to watch a videotape of your life in the future, what would you be doing on the tape that would show that things were better?” O’Hanlon called his less structured approach Solution-Oriented Therapy and Possibility Therapy.
There was also the Mental Research Institute (MRI) in Palo Alto, California, which used a form of brief therapy that was based on ‘the interactional view’. With this approach, problems were thought to happen ‘between’ rather than ‘within’ people. Problems would appear when people responded to everyday difficulties in ways that made them worse. The way that a therapist worked was to identify what the ‘attempted solutions’ were that had caused rather than solved the problems, and then help their clients to do something else instead.

And then, in the late 1970s and early 1980s, at the Brief Family Therapy Center in Milwaukee, Steve de Shazer, Insoo Kim Berg, and their colleagues created the radical new approach of Solution Focused Brief Therapy (SFBT). In addition to the people already mentioned, their ideas built on the work of people such as Gregory Bateson, Don Jackson, Paul Watzlawick, John Weakland, Virginia Satir, Jay Haley, and others. Their core idea was that whatever problem a client had come to therapy with, there always seemed to be an exception to the problem, a time when it didn’t happen, or happened less or with less intensity. And this led them to believe that the client already had the seeds of a solution and didn’t need the therapist to get them to do something different – all they needed was to do more of what they were doing during these exceptional times. The therapist’s job was simply to find out what people were doing that was working, then help them to do more of it.

So, let’s look in more detail at SFBT’s key assumptions:

  • Understanding the cause of the problem is not necessary to resolve it. Attempting to do so may, unwittingly, lengthen or complicate therapy.
  • The client’s attempted solution (eg avoidance in the case of anxiety) eventually becomes part of the problem. Therefore, changing patterns of response – doing something different – is fundamental to the approach.
  • Change happens anyway. However severe the problem, there are times when it is absent, less severe or intense. The therapist must help identify and amplify this change.
  • Clients have resources and strengths that can be brought to bear in resolving the complaint. These are often overlooked in problem-focused approaches.
  • Clear, salient, and realistic goals are a vital factor in eliciting successful outcomes.
  • Poorly-defined or absent goals can prolong or complicate therapy.
  • A small change is all that is necessary. Clients are frequently able to manage alone if the therapist can ‘start the ball rolling’.
  • The client defines the goals and decides when therapy should end.
  • Rapid change is possible, even where there is a history of persistent symptoms.
  • The relationship between therapist and client is critical; collaboration and a ‘robust’ working relationship are more important than theory and expertise.
  • Each client is unique in their skills, resources, and the way they view their problem. There is therefore no ‘one size fits all’ solution.
  • The focus is on the present and the future, on where the client wants to go rather than where they have come from.
  • SFBT sees ‘resistance’ or hostility as a function of the relationship rather than the permanent disposition of the client.

In the UK, Solution-Focused Therapy was pioneered by Harvey Ratner, Evan George, and Chris Iveson. They established the Brief Therapy Practice, which later became BRIEF. In 2003 this group established the United Kingdom Association for Solution Focused Practice (UKASFP).

The Association for Solution Focused Hypnotherapy (AFSFH) adds hypnotherapy to this approach to help speed up the process of positive change with clients.

An SFBT session starts with the client being asked for their best hopes for the session. That way the client decides what they want to get out of the session.

Problem-free talk allows clients to talk about what is going well, what areas of their life are problem-free. It can be useful for uncovering hidden resources, and often uncovers client values, beliefs, and strengths. From this, a strength from one part of their life can be transferred-generalized to another area where a new behaviour is required.

SFBT principally uses questions and compliments to identify a client’s goals, and help the client create a detailed description of what life will be like when the goal is accomplished and the problem is either gone or coped with satisfactorily. By identifying ‘exceptions’, (ie times when some aspect of the client’s goal was already happening to some degree), the therapist can help the client come up with appropriate and effective solutions.

SFBT identifies client competencies, ie any behaviours by the client that contribute to moving in the direction of the client’s goal. How did they manage to achieve or maintain their current level of progress, are there any recent positive changes, and how did the client develop new and existing strengths, resources, and positive traits?

SFBT uses the acronym MECSTAT, which stands for Miracle questions, Exception questions, Coping questions, Scaling questions, Time-out, Accolades, and Task. The miracle question asks the client to imagine waking up in the morning and the issue that brought them to the clinic has gone. It then asks them to visualize what he would be doing, how they would be feeling, and who would notice. Exception questions look for times when the problem doesn’t occur or is less prevalent. Coping questions identify strengths that a person has to help them cope with their problems.

SFBT uses a time-out to reflect on the developments of the current session. It’s preceded by the therapist asking the client if there is anything that the therapist has not asked that the client feels would be important for the therapist to know.
During this break, the client is complimented for their efforts during the session (ie accolades).

The task comes from a brainstorming session where the client suggests behaviours that will help them move towards their goal. The therapist can then ask the client to try this new behaviour – that’s their task (what we might call their homework).

Solution-focused hypnotherapists use all these proven techniques and add the power of trance work to enable clients to make positive changes to their lives quickly.

Trevor Eddolls
iTech-Ed Hypnotherapy
Wilts SN14 0TL
01249 443256