Solution-Focused Therapy

Overview: What is Solution-Focused Therapy?

http://www.meisa.biz/solutions-focused-therapy.php

   Solution-focused therapy is based on the assumption that the future can be changed and negotiated regardless of the problem. It is focused around strengths and positivity that can be seen in the following quote from our text book, "The future is not a slave of the past events in a person's life; therefore, in spite of past traumatic events, a person can negotiate and implement many useful steps that are likely to lead him/her to a more satisfying life" (Wormer & Davis, p.106). Solution focused therapy also has an unintended consequence of helping counselors feel less burned out, more optimistic, and less likely to be captured by despair (Berg, 2013).

Who Created This Approach?

http://www.sfbta.org/about_sfbt.html

   The origins are found in Milton Erickson's work which strongly believed that solving the problem was more important than finding and elaborating on the root cause of the problem, and that clients had the ability within themselves and/or their social system to bring about change. (Wormer & Davis, 2008)

   The approach actually began in 1978 with Insoo Kim Berg and Steve deShazer. They borrowed money and put up their house for collateral to open a small brief therapy office in Milwaukee. Since this time, solution-focused therapy was no longer a “different paradigm” and is practiced all over the world (Wormer & Davis, 2008).

Key Components/Several Techniques:

   The Miracle Question is a helpful technique in supporting hope that things can be different in spite of many past attempts and failures. It leads the client directly into imagining, describing, creating, and embellishing on a day in the future without the burden of the particular problem. Through persistent questioning about what the person would be doing differently on this new, problem-free day, you see a natural progression to find out what small step the person could take in reality to reach a little bit of the whole, new picture. Below is a great explanation of the miracle question and how it can be helpful in therapy (Wormer & Davis, 2008).

   Another example from our text book includes a young woman, who has anorexia, who wants to get taller. After learning from a dietitian that her low intake of calcium will impact bone growth, she began to add previously rejected foods to her diet. She was able to take more food in because the food became "medicine" rather than calories (Wormer & Davis, 2008).

   Scaling Questions can be used in a variety of ways to help the client assess level of hope, determination, confidence, sadness, and how much change has occurred. This is similar to the motivational interviewing scales (1-10 how are you feelings today? 1 is the worst; 10 is the best.) (Wormer & Davis, 2008).

   Coping Questions can be used to bring out the survival strategies of people who have been managing somehow in spite of their addictions. This helps build hope and self-efficacy. For example, "You've been through a lot in this past month with your gambling. How have you coped with so much, while still holding down a job?" (Wormer & Davis, 2008)

An Example of Solution-Focused Therapy: Mr. Glue-Head

http://www.elmers.com/msds/painterswat.htm

   The individual is a young man who had to undergo treatment because of his desire to sniff glue and then be seen intoxicated in public. He had a long history of arrests and treatment episodes, but nothing had changed. Then while using a solution-focused approach that emphasized cooperation with the client, the therapist asked what he wanted to accomplish with this referral. The individual did not want to stop his glue sniffing, which he made known and very clear. All he wanted to do was stop getting arrested, so the therapist then offered an alternative solution. It was said that his sniffing could continue, just not in a public area or where people could see him. The individual agreed to try out the new idea and would return in a week to report his findings. A week later, he reported that the police never bothered him, even when they drove by to check on him. The results yielded that he did not get arrested any more and therefor did not get referred to any more treatment. This occurrence began to curtail his use of inhalants on his own (Wormer & Davis, 2008).

   This example of Mr. Glue Head illustrates several main factors of the solution-focused approach. First, the therapist avoided issues that had always been considered problems by the therapist and others but that were not identified as problems by Elmer. Also, the therapist's focus was shifted to a problem that Elmer identified (not getting arrested). By following Elmer's lead, the therapist worked on doing something different than focusing on past solutions (Wormer & Davis, 2008)

   Another example, below, from one of the founders of solution-focused therapy, Insoo Kim Berg, allows you to see how she performs her solution-focused therapy session. Notice how she steers away from the negatives of the relationship and strives toward the positives, and when the talking gets fast and negative, she redirects the conversation. The viewers can also see the difference between the first session and the last session and how different their interactions are. The couple went from being mad and yelling at each other to being happy and laughing, overall supporting solution-focused therapy.

Research:

   There are not many research studies proving the effectiveness of this therapy, so many more need to be done.  However, through some clinical trials, it has been shown to not only be as effective as other therapies, but also cost effective (Wormer & Davis, 2008).

   In a national sample of 284 alcoholism counselors, it showed that 79% of the counselors endorsed solution-focused principles which includes identifying using client strengths and abilities, client-counselor collaboration throughout the course of treatment, highlighting and promoting already occurring non problem behavior, meeting the client's goal(s), and constructing solutions rather than resolving client problems (2008). This is helpful in the strides toward research and providing its effectiveness; however, more studies need to be performed.

http://www.recoveryconnection.org/
cycle-of-addiction/#truth

The Cycle of Addiction is Characterized By:
   Frustration and internal pain lead to anxiety and a demand for relief of these symptoms. Then, fantasizing about using or behaviors to relieve the symptoms emerge. Obsessing about using drugs and alcohol occurs and how his/her life will be after the use of substances. After that, engaging in the addictive activity usually results and then losing control over the behavior. Resulting is feelings of remorse, guilt and shame. Finally a promise to oneself to stop the behavior occurs, and then the cycle continues from the beginning ("Cycle of Addiction," 2013).

Impact on addiction cycle:

   Solution-focused therapy could impact the addiction cycle for the better. It could be responsible for breaking the cycle and leading to recovery through implementing the questions (listed above) to distract the individual and think about the future without the addiction. This could be effective in the very first stage of frustration and internal pain because it could allow him/her to think of something else, which would throw off the cycle ("Cycle of Addiction," 2013).

My Thoughts:

           This approach may be extremely helpful in my career as an occupational therapist. Addictions can be found everywhere whether it is problems with gambling, substance dependence and misuse, and eating disorders (Wormer & Davis, 2008). There are many people in the world who are fighting an addiction and using this solution-focused therapy would be a great technique to use in occupational therapy. Particularly if an occupational therapist is located in a mental health unit because co-occurring conditions are common and to work on occupations and activities that effect one's life, you need to address the addiction if it is interfering. By using "big questions" to be a form of distraction, you might be able to introduce a new leisure activity into his/her life that might be enjoyed more than their addiction, or at least deter them for a short while. 

http://occupationaltherapystories.wordpress.com/

Sources:

Berg, Insoo Kim. "What is SFBT?" Received on February 17, 2013 from 

     http://www.sfbta.org/about_sfbt.html

"Cycle of Addiction" (2013) Recovery Connection. Received on February 17, 2013 from 

     http://www.recoveryconnection.org/cycle-of-addiction/#truth

Wormer, Katherine & Davis, Diane Rae (2008). Addiction treatment: A strengths perspective. 

     California: Brooks/Cole

Pictures From:

http://www.meisa.biz/solutions-focused-therapy.php

http://www.sfbta.org/about_sfbt.html

http://www.elmers.com/msds/painterswat.htm

http://www.recoveryconnection.org/cycle-of-addiction/#truth

http://occupationaltherapystories.wordpress.com/

Videos From:

http://www.youtube.com/watch?v=fQBZlgmebwY

http://www.youtube.com/watch?v=4y82_P8h0Fk