Doing What Works in Brief Therapy

A Strategic Solution Focused Approach

Ellen K. Quick

• Publisher: Academic Press
• Year: 2008
• eBook ISBN: 9780080557328
• Edition: 2
• Topic: Psychologie
• Subtopic: Klinische Psychologie

Doing What Works in Brief Therapy: A Strategic Solution Focused Approach is both a set of procedures for the therapist and a philosophy– one that is shared with clients and one that guides the work of the therapist. This second edition continues its excellence in offering clinicians a guide to doing what works in brief therapy- for whom, and when and how to use it. Psychotherapy that follows these guidelines validates the client's most important concerns – and it often turns out to be surprisingly brief. Author, Ellen Quick integrates strategic and solution focused therapy and includes guidelines for tailoring technique and interventions to client characteristics and preferences. With clinically rich examples throughout, this book offers applications for couples, including indications for individual or conjoint sessions.- Chapter summaries highlighting key points- Presents ways of eliciting what clients most want to remember- Describes the "Doing What Works Group, " including outcome research findings and all materials needed to run the group- Addresses the relationship among the positive psychology movement and this approach and the potential for collaboration- Emphasizes an acceptance-based stance and how acceptance commonly leads to change- Proposes that "doing what works and changing what doesn't" can provide a transtheoretical perspective for therapists of any orientation

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The Model and Its Origins

Publisher Summary

This chapter describes specific theories and a set of techniques for conducting psychotherapy and different models focusing on strategic solutions. It also describes principles or philosophies that can guide therapists—of any orientation— and clients. The strategic solution focused approach describes the blended approach: its theory, techniques, and applications. Those principles and techniques remain applicable today. Brief- and solution focused therapies are widely practiced, and courses on the topic are included in the curricula of general psychology, clinical and counseling psychology, social work, and marriage and family therapy training programs in the United States and abroad. The positive psychology movement focuses on the scientific pursuit of optimal functioning and encourages practical applications. Another development in psychology has been acceptance based therapies. Mindfulness and approaches such as Dialectical Behavior Therapy and Acceptance and Commitment Therapy emphasize the acceptance of all experiences. Strategic solution focused therapy, with its emphasis on doing what works and changing what does not, addresses the discovery and amplification of client strengths, on one hand, and changing unrealistic expectations and unproductive behavior, on the other. Another development has been the recognition of the role of common factors in psychotherapy. The principles that guide strategic solution focused therapy can be summarized as a three-part theory: (1) What’s the trouble? (2) If it works, do more of it, and (3) If it doesn’t work, stop doing it. Do something different. The first and third points come primarily from brief strategic therapy, while the second comes primarily from solution focused therapy. The difference is what is emphasized in each of the models.

This is a book about the “doing what works” approach to psychotherapy. Doing what works refers to two things. First, it is a specific theory and set of techniques for conducting psychotherapy, the strategic solution focused model. Second, “doing what works” is a principle or philosophy that can guide therapists – of any orientation – and clients as well.

Strategic solution focused therapy emerged in the early 1990s. This was a time when demands for service skyrocketed, while resources dwindled. Practice guidelines were increasingly imposed, and frequently these standards limited the number of times clients could be seen.

In attempts to accommodate to the external changes, the author, who at that time had twenty years experience with psychodynamic, cognitive behavioral, Gestalt, existential, and Ericksonian approaches, took an eclectic approach. However, as she experimented with brief strategic therapy and then solution focused therapy, she increasingly discovered that some of the frustration with external limits seemed to diminish. Brevity became a natural result of conducting therapy with these models.

The strategic solution focused approach, described in the first edition of Doing What Works in Brief Therapy: A Strategic Solution Focused Approach, describes the blended approach: its theory, techniques, and applications. Those principles and techniques remain applicable today. Brief and solution focused therapy are widely practiced, and courses on the topic are included in the curricula of general psychology, clinical and counseling psychology, social work, and marriage and family therapy training programs in the United States and abroad.

Additional Perspectives

Over the last ten years, there have been multiple important developments in the fields of psychology and psychotherapy. One of these is the positive psychology movement. Focusing on the scientific pursuit of optimal functioning, positive psychology encourages practical applications. Another development in psychology has been acceptance based. Mindfulness and approaches such as Dialectical Behavior Therapy and Acceptance and Commitment Therapy emphasize the acceptance of all experiences – including pain. Strategic solution focused therapy, with its emphasis on doing what works and changing what does not, addresses the discovery and amplification of client strengths, on one hand, and changing unrealistic expectations and unproductive behavior, on the other. Practical techniques for balancing acceptance and change are covered in this book.

Another development has been the recognition of the role of common factors in psychotherapy. These include hope, the therapeutic relationship, and client characteristics, along with client readiness for change. There has been controversy about whether “empirically validated interventions” for specific conditions or these common factors are the “active ingredient” in effective treatment. The doing what works approach as a transtheoretical perspective, consistent with the themes described above, is also addressed in this second edition.

The Model

The principles that guide strategic solution focused therapy can be summarized as a three-part theory:

1. What’s the trouble?

2. If it works, do more of it.

3. If it doesn’t work, stop doing it. Do something different.

The first and third points come primarily from brief strategic therapy, while the second comes primarily from solution focused therapy. (The word “primarily” must be stressed here, because strategic therapy often addresses “what works” and solution focused therapy often addresses “what doesn’t” and the nature of the problem.) The difference is what is emphasized in each of the models.

Brief Strategic Therapy: The MRI Approach

Brief strategic therapy was developed at the Mental Research Institute, frequently abbreviated as MRI, in Palo Alto, California. The MRI is a multidisciplinary corporation that was founded in 1959. Some of the original participants included Don Jackson, Virginia Satir, and Paul Watzlawick. All of these people had a grounding in psychoanalytic theory, followed by an interest in family therapy and systems theory. The MRI therapists were also exposed to the work of Milton Erickson, psychiatrist and hypnotist. Erickson’s concept of “utilization” would become important in the MRI approach. As Rossi (1976) points out, Erickson “utilized problem behaviors, thoughts, and feelings as part of the solution.” Erickson also utilized the patient’s mental processes and expectancies in different ways.

In 1965, a group of MRI therapists began a research project called the Brief Therapy Center. This project was designed to investigate what could be done in a time-limited period, up to ten sessions, by focusing on the chief complaint. Interventions would include a variety of procedures. The project, assumptions, techniques, and conclusions have been described extensively in the book The Tactics of Change (Fisch, Weakland, and Segal, 1982).

One important premise of the approach was that multiple views of reality exist. Rather than seeing reality as “one fixed truth,” the MRI theorists emphasized that “views” of reality are all we can know, and perhaps all that exist. This has been described as the “constructivist perspective” (Watzlawick, 1992).

A second premise was that behavior is constantly shaped and maintained by social reinforcement. MRI therapists generally downplayed physiological predisposition to behavior disorder. They further emphasized that even when biological factors exist, how they are viewed and dealt with makes a considerable difference in how problematic they become (Fisch et al., 1982). Current interactions were examined, not “deeper roots of pathology” (Weakland, Fisch, Watzlawick, and Bodin, 1974). Thus MRI brief strategic therapy is an interactional model. Problems are not entities that exist within a single individual; rather, they result from interactions between individuals.

The MRI therapists emphasized that ordinary life...

Table of contents

• Cover image
• Title page
• Table of Contents
• Preface
• Chapter 1: The Model and Its Origins
• Chapter 2: Clarifying the Problem: What’s the Trouble?
• Chapter 3: Amplifying the Solution: Variations on the Miracle Question
• Chapter 4: Evaluating Attempted Solutions: If It Doesn’t Work, Do Something Different
• Chapter 5: Designing the Intervention: Validation, Compliment, and Suggestion
• Chapter 6: You Can Take It With You: What Do You Want to Remember?
• Chapter 7: Therapist Decisions: Clarifying, Amplifying, or Interrupting
• Chapter 8: Practical Considerations: Using the Model in Behavioral Health Care
• Chapter 9: Couples: Problems and Solutions
• Chapter 10: Doing What Works Group Therapy
• Chapter 11: Positive Psychology and the Strategic Solution Focused Model
• Chapter 12: Acceptance and Change and the Model
• Chapter 13: Doing What Works as a Transtheoretical Approach
• Chapter 14: Case Examples: Intermittent Care
• Chapter 15: Excerpts: Single-Session Therapy
• Chapter 16: Case Examples and Excerpts: Brief Therapy
• Chapter 17: Case Example: Crisis Intervention
• Chapter 18: Case Examples: Doing What Works With Longstanding Patterns
• References
• Index