More Than Miracles

The State of the Art of Solution-Focused Brief Therapy

Steve de Shazer, Yvonne Dolan, Harry Korman, Terry Trepper, Eric McCollum, Insoo Kim Berg

• Publisher: Routledge
• Year: 2021
• Print ISBN: 9780367646417
• eBook ISBN: 9781000346732
• Edition: 2
• Topic: Psychology
• Subtopic: Behavioural Management
• Index: Psychology

Written by pioneering experts in the field, More Than Miracles remains the authoritative text on solution-focused brief therapy (SFBT). The final work of the world-renowned family therapists and original developers of SFBT, the late Steve de Shazer and Insoo Kim Berg, this comprehensive resource informs practitioners and students in how to apply this practical, internationally acclaimed approach.

With a new preface, this classic edition outlines the latest developments in the fields of family therapy, brief therapy, and psychotherapy training and practice. A succinct overview orients the reader to the current landscape of SFBT and provides three real-life case transcripts that illustrate the practical applications of SFBT techniques. The seminar format of the text allows readers to:

• sit in on surprising psychotherapy sessions
• eavesdrop on the authors' commentary about the sessions
• gain a comprehensive overview on the current state of SFBT
• review and understand the major tenets of SFBT
• learn specific interventions, including the miracle question and the reasons for asking it
• understand treatment applicability
• read actual session transcripts
• understand the "miracle scale"
• get insight into the unique relationship between Wittgenstein's philosophy and SFBT
• better understand SFBT and emotions
• examine misconceptions about SFBT
• and more
  

Suitable for both advanced practitioners and ambitious beginners, this book is the ideal resource for anyone seeking an in-depth understanding of the SFBT approach, the concepts that inform it, and the specific techniques that characterize its implementation.

Chapter 1

A Brief Overview

Solution-focused brief therapy (SFBT) is a future-focused, goal-directed approach to brief therapy developed initially by Insoo Kim Berg, Steve de Shazer, and their colleagues and clients at the Milwaukee Brief Family Therapy Center in the early 1980s. Developed inductively rather than deductively, SFBT is a highly disciplined, pragmatic approach rather than a theoretical one (Berg & Miller, 1992, Berg & Reuss, 1997; de Shazer, 1985, 1988, 1991, 1994). The developers observed hundreds of hours of therapy over the course of years, carefully noting the questions, behaviors, and emotions that led to clients conceptualizing and achieving viable, real-life solutions.

The questions that proved to be most consistently related to clients’ reports of progress and solutions were carefully noted and painstakingly incorporated into the solution-focused approach, while those that did not were deliberately eliminated. Since then, the solution-focused brief therapy approach has become one of the leading schools of brief therapy throughout the world as well as a major influence in such divergent fields as business, social policy, and education.

Major Tenets Of Sfbt

SFBT is not theory based, but was pragmatically developed. One can clearly see the roots of SFBT in the early work of the Mental Research Institute in Palo Alto and of Milton H. Erickson; in Wittgensteinian philosophy; and in Buddhist thought. There are a number of tenets that serve as the guidelines for the practice of SFBT, and that both inform and characterize this approach.

If it isn’t broken, don’t fix it. This is the overarching tenet of SFBT. Theories, models, and philosophies of intervention are irrelevant if the client has already solved the problem. Nothing would seem more absurd than to intervene upon a situation that is already resolved. While this seems obvious, in reality there are some schools of psychotherapy that would encourage therapy in spite of improvement— for example, for “growth,” to “solidify gains,” or to get to “deeper meanings and structures.” SFBT is antithetical to these. If there is no problem, there should be no therapy.

If it works, do more of it Similar to the first tenet, this tenet continues the “handsoff” approach. If a client is in the process of solving a problem, the therapist’s primary role should be to encourage the client to do more of what is already working. SFBT therapists do not judge the quality of a client’s solutions, only whether a solution is effective. Following this, another related role for the therapist is helping the client maintain desired changes. This is accomplished by learning exactly how the client behaved or responded differently during periods of improvement. As a result of identifying what worked, the client is able to repeat this success and the solution further evolves.

If it’s not working, do something different. To complete the obvious first three, this tenet suggests that no matter how good a solution might seem, if it does not work it is not a solution. An odd reality of human nature is the tendency to continue to try to solve problems by repeating the same things that have not worked in the past. This is especially true for psychotherapy, where many theories suggest that if the client does not improve (i.e., solve the problem), the fault rests with the client rather than the therapy or the theory. In SFBT, however, if a client does not complete a homework suggestion or experiment, the task is dropped, and something different is offered.

Small steps can lead to big changes. SFBT can be understood as a minimalist approach in which solution construction is typically accomplished in a series of small, manageable steps. It is assumed that once a small change has been made, it will lead to a series of further changes, which in turn lead to others, gradually resulting in a much larger systemic change without major disruption. Thus, small steps toward making things better help the client move gradually and gracefully forward to accomplish desired changes in their daily life and to subsequently be able to describe things as “better enough” for therapy to end.

The solution is not necessarily directly related to the problem. Whereas almost all other approaches to change have problem-leading-to-solution sequences, SFBT develops solutions by first eliciting a description of what will be different when the problem is resolved. The therapist and the client then work backward to accomplish this goal by carefully and thoroughly searching through the client’s real-life experiences to identify times when portions of the desired solution description already exist or could potentially exist in the future. This leads to a model of therapy that spends very little or even no time on the origins or nature of the problem, the client’s pathology, or analysis of dysfunctional interactions. While these factors may be interesting, and possibly could influence client behavior, SFBT focuses almost exclu-sively on the present and future. Viewed in this way, SFBT involves a true paradigm shift from other models of psychotherapy.

The language for solution development is different from that needed to describe a problem. The language of problems tends to be very different from that of solutions. As Ludwig Wittgenstein put it, “The world of the happy is quite another than that of the unhappy” (T, #6.43). Usually problem talk is negative and past-history focused (to describe the origins of the problem), and often suggests the permanence of a problem. The language of solutions, however, is usually more positive, hopeful, and future-focused, and suggests the transience of problems.

No problems happen all the time; there are always exceptions that can be utilized. This tenet, following the notion of problem transience, reflects the major intervention that is used continuously in SFBT, that is, that people always display exceptions to their problems, even small ones, and these exceptions can be utilized to make small changes.

The future is both created and negotiable. This tenet offers a powerful basis for the practice of SFBT. People are not seen as locked into a set of behaviors based on a history, a social stratum, or a psychological diagnosis. With strong social constructionist support, this tenet suggests that the future is a hopeful place, where people are the architects of their own destiny.

SFBT has its roots in the systems theory–based family therapies of the 1950s and 1960s and the work of Milton H. Erickson (Haley, 1973). Both Insoo Berg and Steve de Shazer had strong connections to the Mental Research Institute of Palo Alto, California. While the researchers at MRI focused primarily on problem formation and problem resolution (Watzlawick, Weakland, & Fish, 1974), the Brief Family Therapy Center in Milwaukee began exploring solutions. For a number of reasons, the current SFBT approach can be seen as a systemic therapy. First, SFBT therapists routinely treat systems because couples and families—as well as individuals—come in for treatment. SFBT therapists make their decision on who to see in a session based on who shows up; whoever walks in the door is seen. Second, SFBT is systemic because the solutions that are explored are interactional, that is, people’s problems and their exceptions involve other people, very often family members, colleagues at work, or relationship partners and friends. Third, SFBT is systemic because once small changes begin to occur, larger changes often follow, and those larger changes are usually interactional and systemic.

The Role Of The Therapist

The role of the therapist in SFBT is different than in many other psychotherapeutic approaches. SFBT therapists accept that there is a hierarchy in the therapeutic arrangement, but this hierarchy tends to be more egalitarian and democratic than au-thoritarian.SFBT therapists almost never pass judgments about their clients, and avoid making any interpretations about the meanings behind their wants, needs, or behaviors. The therapist’s role is viewed as trying to expand rather than limit options (Berg & Dolan, 2001). SFBT therapists lead the session, but they do so in a gentle way, “leading from one step behind” (Cantwell & Holmes, 1994, pp. 17-26). Instead of interpreting, cajoling, admonishing, or pushing, the therapist “taps on the shoulder” of the client (Berg & Dolan, 2001, p. 3), pointing out a different direction to consider.

Therapeutic Principles And Techniques

Main Interventions

A positive, collegial, solution-focused stance. One of the most important aspects of SFBT is the general tenor and stance that is taken by the therapist. The overall attitude is positive, respectful, and hopeful. There is a general assumption that people have within them strong resiliencies, and can utilize these to make changes. Further, there is a core belief that most people have the strength, wisdom, and experience to effect change. What other models view as “resistance” is viewed in SFBT as (a) people’s natural protective mechanisms, or realistic desire to be cautious and go slow, or (b) a therapist error, i.e., an intervention that does not fit the client’s situation. All of these assumptions make for sessions that tend to feel collegial rather than hierarchical (although as noted earlier, SFBT therapists do “lead from behind”), and cooperative rather than adversarial.

Looking for previous solutions. SFBT therapists have learned that most people have previously solved many, many problems. This may have been at another time, another place, or in another situation. The problem may have also come back. The key is that the person had solved their problem, even if for a short time.

Looking for exceptions. Even when clients do not have a previous solution that can be repeated, most have recent examples of exceptions to their problem. An exception is thought of as a time when a problem could occur, but does not. The difference between a previous solution and an exception is small but significant. A previous solution is something that the family has tried on their own that has worked, but for some reason they have not continued this successful solution, and probably forgot about it. An exception is something that happens instead of the problem, usually without the client’s intention or maybe even understanding.

Questions vs. directives or interpretations Questions, of course, are an important communication element of all models of therapy. Therapists use questions often with all approaches, especially while taking a history, checking in at the beginning of a session, or finding out how a homework assignment went. SFBT therapists, however, make questions the primary communication tool, and as such they are an overarching intervention. SFBT therapists tend to make no interpretations, and rarely make direct challenges or confrontations to a client.

Present- and future-focused questions vs. past-oriented focus. The questions that are asked by SFBT therapists are almost always focused on the present or on the future. This reflects the basic belief that problems are best solved by focusing on what is already working, and how a client would like his or her life to be, rather than focusing on the past and the origin of problems.

Compliments Compliments are another essential part of SFBT. Validating what clients are already doing well and acknowledging how difficult their problems are encourage the client to change while giving the message that the therapist has been listening (i.e., understands) and cares (Berg & Dolan, 2001). Compliments in therapy sessions can help to punctuate what the client i...

Table of contents

• Cover
• Endorsement
• Half Title
• Series Information
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• About the Authors
• Preface to the Classic Edition
• Chapter 1 A Brief Overview
• Chapter 2 I Feel Really Confused
• Chapter 3 The Miracle Question
• Chapter 4 The Miracle Scale
• Chapter 5 The Friendly Stomach Discussion
• Chapter 6 Don’t Think, But Observes
• Chapter 7 My Real Self
• Chapter 8 Private Experience and the Verb “To Be”
• Chapter 9 SFBT and Emotions
• Chapter 10 Questions, Misconceptions, and Joys
• Conclusion
• References
• Index