Solution-Focused Brief Therapy Case Conceptualization

Among today’s most popular and influential family therapies, Solution-Focused Brief Therapy (SFBT) is a short-term approach, which takes a nonpathological view of clients and strives to help them find solutions to current, specified problems. (Goldenberg & Goldenberg, 2008).

This internationally recognized approach comes from the work of social worker Steve de Shazer and his associates, Insoo Berg, Eve Lipchik, Scott Miller and Michele Weiner-Davis at the Brief Family Therapy Center in Milwaukee. Heavily influenced by his work at the Mental Research Institute (MRI) in Palo Alto de Shazer and his wife Insoo Kim Berg co-founded The Brief Family Therapy Center in Milwaukee in 1978 (Goldenberg & Goldenberg, 2008).

In describing his approach, de Shazer (1985) uses the metaphor: The complaints clients bring to the therapist are like locks on doors that could open to a more satisfactory life, if only they could find the key. Families often waste time being frustrated when trying to discover why the lock is in the way or why the door will not open, when the family should be looking for the key.

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Rather than focusing on why or how the presenting problem initially arose, solution-focused therapists attempt to aid the family in discovering its own creative solutions for becoming unstuck (de Shazer, 1985). de Shazer et al., (1986) believe the key to brief therapy is utilizing what the clients bring with them to help them meet their needs in such a way that they can make satisfactory lives for themselves. The main principles of Brief Solution- Focused Therapy are as follows:

  1. Most complaints develop and are maintained in the context of human interaction.

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  2. The task of Brief Therapy is to help clients do something different, by changing their interactive behavior and/or their interpretation of behavior and situations so that solution (a resolution of their complaint) can be achieved.
  3. We had long been puzzled by the notion of resistance in therapy. Rather than seeing this as “resistance” we viewed it more as the clients’ way of letting us know how to help them.
  4. New and beneficial meaning(s) can be constructed for at least some aspect of the client’s complaint.
  5. Only a small change is necessary.
  6. Change in one part of a system leads to changes in the system-as-a-whole.
  7. Effective therapy can be done even when the therapist cannot describe what the client is complaining about (de Shazer et.al, 1986).

Relevant Theorists

Co-founders of the Milwaukee Brief Family Therapy Center Steve de Shazer and Insoo Kim Berg devoted nearly 30 years to developing and refining the approach that is known as Solution-Focused Brief Therapy. de Shazer began to develop his own model of brief therapy (without the knowledge of the Palo Alto group until 1972) when he began his tenure at the Mental Research Institute (MRI) (de Shazer, 1985). Stimulated by Milton Erickson’s Special Techniques of Brief Hypnotherapy de Shazer pointed to the idea that the process of solution, from one case to another is more similar than the problems each intervention is meant to solve (de Shazer, 1985). This concept would become the cornerstone of his development of the “skeleton keys” to solutions. Insoo Kim Berg is arguably best known for her interviewing skills and development of the miracle question, which invites clients to develop well-formed goals in their own frame of reference as well as exception questions which focus on clients’ past successes and strengths related to what they want to be different (de Shazer, 1985). Eve Lipchik was one of the original core members of the Brief Family Therapy Center in Milwaukee and made contributions in many areas including how to construct solutions during the initial interviewing process.

Distinguishing Premises of Solution-Focused Therapy

The distinguishing premise that sets SFBT apart from other post-modern therapy models is as the title suggests it de-emphasizes the problem and focus on the solution. The therapist supports the client’s solution building by asking them what they would like to see change in their lives; by listening to the directions in which clients want to go and inquiring about exceptions to problems (De Jong & Berg, 2002). This future-oriented model begins constructing solutions immediately beginning with the pre-session change question: Since you made your appointment what has improved? The SFBT Pre-session question helps clients to be positive about their progress and helps them to recognize all the work they have already done to find a solution to their problem (De Jong & Berg, 2002).

All of the post-modern models emphasize movement towards change however differ in theoretical approaches. Narrative Therapists believe that people face difficulties when they live with “dominant stories” that are “problem saturated.” These dominant stories are restricting; they do not include important parts of a person’s experience and may lead them to negative conclusions about their identity (White & Epston,1989). Collaborative Languages Systems therapists propose that human systems are language and meaning generating systems. The collaborative therapist believes that language shapes reality, and that reality is socially constructed (Anderson, 1987).

Cultural, Ethnic/Racial, Gender, and Lifestyle Factors

The cultural and ethnic factors in this case are Matthew is Caucasian and Kiara is African American. It is imperative that as a therapist I do not make the mistake of assuming because we have common backgrounds that we share similar issues. For one family, identity with an ethnic group may be essential to their lives; in another family, ethnic identity may be more in the background (Prout & Brown, 2007). Therefore, I would access the importance of ethnicity with Matthew, Jason, and Lindsay if I were to see them as a family. What makes Solution-Focused Brief Therapy culturally competent is the principle of using the “client’s” language and the assumption that the client is the expert on what they want and that it is not up to us to tell them what is wanted (Walter & Peller, 1992).

Ethical / Legal issues

Assuming I were to see Matthew, Jason, and Lindsay as a family there would be both an ethical and legal considerations. The first would both children are under the age of 18 and one of the custodial parents is incarcerated and not available to give written consent. I would have to have a signed and witnessed consent form from Kiara before I would see the children. Second, the Code of Ethics for the American Association for Marriage and Family Therapy (AAMFT) requires therapists to “seek an appropriate balance between competing needs in the family system” (AAMFT, 2015, p. 2), but offers no guidance on how to determine whose needs are primary. Matthew has stated he is overwhelmed and Jason has shut down and is behaving aggressively. As a therapist I will utilize the time equally unless there is a crisis.

Identified Problem(s)

Problems can be defined as those things clients complain about to therapists and about which the therapists and the clients can do something (de Shazer, 1985). After listening to Matthew’s description of his present difficulties the problems/difficulties addressed in this case are: 1) Matthew’s 12-year-old son Jason has been displaying aggressive behavior lately (i.e. yelling at his little sister, slamming doors, and throwing objects). 2) Matthew’s 10-year-old daughter Lindsay is doing poorly in school and he believes she is not doing well because Kiara took her off of her meds. 3) Matthew’s wife Kiara was arrested 2 days ago for possession of a controlled substance for the third time.

Problem Formation

Complaints involve behavior brought about by the client’s world view (de Shazer, et al., 1985). So, Matthew what is your goal for being here today? Matthew: I am at my wits end! My son and daughter are acting out. I have tried everything, but Jason is behaving worse by the minute and to top it off my wife got arrested again 2 days ago. After a brief discussion with Matthew a distinct pattern of sequences has been identified. In the case of Jason every time he displays aggressive behavior Matthew makes the decision of how to view this behavior. Matthew will view the behavior as either good or bad and when Matthew views the behavior as bad the decision to punish Jason is seen as the most logical choice.

In the case of Kiara being arrested again Matthew it is likely that Matthew views Kiara’s drug use and consequent arrest as a problem she is not doing her best to overcome. Finally, Matthews’ view of Lindsay being taken off of her meds by Kiara could be viewed as Kiara being a hypocrite since she herself is on drugs and irresponsible since Lindsay was improving in school after being put on the meds. Because of his view of how to manage the problem (which in Jason’s case is to punish him for acting in a manner he does not approve of) Matthew has not attempted to implement other interventions. For the next few minutes of the session I will direct the conversation towards as much concrete detail as possible including the following: Step-by-step, what exactly happens?; Who is involved in the complaint?; How does the complaint differ depending on who is and who is not involved at a particular point?; and With what frequency does the complaint happen? (de Shazer, et al., 1986 p. 215).

Problem Maintenance

Complaints are maintained by the clients’ idea that what they decided to do about the original difficulty was the only right and logical thing to do (de Shazer, et al., 1986). In the past Matthew has dealt with Jason’s aggressive behavior by taking away his privileges (i.e. after pushing Lindsay Matthew cancelled a camping trip he planned to take Jason on. When this did not work Matthew began taking Jason’s personal items (i.e. play his play station). de Shazer et.al, (1986) believe that clients behave as if trapped into doing more of the same because selecting an alternative behavior from the rejected and forbidden “or” half of the premise is excluded. In response to Kiara’s drug problem Matthew has restricted her access to the bank accounts, he has threatened to leave her and once took the kids and went to his mother’s house for a week. Complaints consist of a difficulty and a recurring, ineffective attempt to overcome that difficulty, and/or a difficulty plus the perception on the part of the client that the situation is static, and nothing is changing (de Shazer et al., 1986).

To facilitate Matthew’s change in perception and create new a new meaning of his world view I will invite him to envision how the future will be when the problem no longer exists by using the miracle question. Therapists: Matthew what if you went to bed tonight and a miracle happened but you were sleep so you don’t know the miracle happened what would be the first thing you would notice that would let you know that the miracle had happened? Matthew: Kiara would be home for one thing. Therapist: What would be the next thing? I would go to Jason’s room and all the things that I had taken would be back in his room.

Resolution

Solutions are the behavioral and /or perceptual changes that the therapist and client construct to alter the difficulty, the ineffective way of overcoming the difficulty, and/or the construction of an acceptable, alternative perspective that enables the client to experience the complaint situation differently (de Shazer et al., 1986). Using Matthew’s language, I will facilitate a positive focus on what is already working with the use of exceptions: So, Matthew when Kiara is not using drugs what will she be doing? Matthew: she will be helping Lindsay with her homework. Therapist: What will you be doing? Matthew: I will be relaxing and watching the Texans play. Therapist: Can you tell me what will Jason be doing when he is not being aggressive with his sister? Matthew: he would probably be playing on his play station with his friends. Compliments can let the client know that the problem is common and there is nothing wrong with them (Walter, J. & Peller, J. 1992).

Therapist: Matthew I am very impressed that given all the things that are going on you that you are handling things as well as you are. I would end the session with Matthew by assigning the task of observing 1 thing Jason did well each day and write that down and bring that list back the next session. Through subsequent sessions Matthew and I would continue down the path of constructing solutions and new meanings through the use of scaling and coping questions. Therapist: So, Matthew what has been different since I last saw you? How have you managed that? On a scale of 1-10, 1 being it totally sucked and 10 being like you won the lottery how would rate where you are today? When Matthew is convinced he is on track therapy will be terminated.

References

  • Anderson, H. (1997). Conversation, language, and Possibilities: A Postmodern Approach to Therapy. New York, N.Y.: Basic Books.
  • de Shazer, S. (1985). Keys to Solution in Brief Therapy. de Shazer, S., Berg, I., Lipchik, E., Nunnally, E., Molnar, A., Gingerich, W., Weiner-Davis, M.
  • (1986). Brief therapy: Focused Solution Development. Family Process, 25, 207-221.
  • De Jong, P., & Berg, I. K. (2002). Interviewing for Solutions. Pacific Grove, CA: Brooks/Cole.
  • Goldenberg, H., & Goldenberg, I., (2008). Family Therapy: An Overview.
  • Prout, H. T., & Brown, D. T. (2007). Counseling and Psychotherapy with Children and Adolescents: Theory and Practice for Clinical and School Settings. (4th Edition)
  • Walter, J.L., Peller, J.E., (1992). Becoming Solution-Focused in Brief Therapy.
  • White, M. & Epston, D. (1989). Literate Means to Therapeutic Ends. Adelaide: Dulwich Centre Publications

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Solution-Focused Brief Therapy Case Conceptualization. (2021, Sep 20). Retrieved from https://studymoose.com/solution-focused-brief-therapy-case-conceptualization-essay

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