Assessing Solution-focused Brief Therapy in Social Work Context: An evaluation of the case of Hong Kong
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Assessing Solution-focused Brief Therapy in Social Work Context: An evaluation of the case of Hong Kong
Solution-focused Brief Therapy (or SFBT) simply speaks for its own description. The key words solution and brief characterize the whole therapy. Many practitioners accept and believe on the effectiveness and applicability of this therapeutic intervention to common psychotherapy cases (including social work setting) provided that it targets the solution to a problem and it is seemingly brief in ways. However, there are critics who believe otherwise. This paper discusses on the fundamental information about SFBT particularly how it works and its limitations. Further, it will extend on the social work setting with consideration of the local social context of Hong Kong.
Solution-focused Brief Therapy (SFBT) in Action: How does it work?
Most research articles (i.e. Lloyd and Dallos, 2008; Freeman and Wilshaw, 2007; Rothwell, 2005) acknowledge that SFBT was developed primarily by Steve de Shazar and Insoo Kim Berg together with other colleagues at the Brief Family Therapy Centre in Milwaukee way back in 1980s. It is also supported by social constructionist and linguistic analyses (Rothwell, 2005; Smith, 2005). In every research discussion, theoretically or empirically in approach, directed to SFBT, researchers always present an inclusive definition. This paper is not an exemption so it will provide various descriptions from a variety of sources. According to Burns (2005), solution-focused brief therapy (SFBT) is an intervention based on conversation that intends to support clients in discovering their individual solutions to problems they are facing. SFBT, on the case of traditional health care, provides solutions for clients’ problems. Majority of solution focused therapies work with an unusual approach since they are using the underlying assumption that the client has the solution to their own set of problems. What makes the difference is the fact that the aid of the therapist, coach or counselor is needed in order to discover solutions. The emphasis of these types of therapy is on client’s empowerment (Burns, 2005). Additionally, Devlin (2006) refer SFBT as “a type of therapy that is typically used in a counselling or clinical setting by practitioners to help clients make improvements to various aspects of their life and/or experience (p. 101).” For Smith (2005), the consideration of the constructionist foundation of SFBT leads to “focusing on skills rather than deficits, producing a unique intervention for each client based upon their particular skills and needs, and providing the client with ‘expert status’ (and hence a sense of self-efficacy) within the therapeutic relationship” (p. 102). The therapeutic focus of SFBT is “a future orientation specifically based on the client’s expressed aims” (Rothwell, 2005, p. 402). The process is mainly communicative in agenda and present opportunities for the client to see his/her desired future outcomes at the same time discovering his/her personal strengths and resources. Further, Rothwell (2005) reports that the therapy, on some instances, is characterized as ‘atheoretical’ mainly because of the listening strategy being employed by the therapist, coach, or counselor. The listening strategy allows the SFBT practitioner “to accept directly what the client is saying rather than seeking to match it to a specific conceptual framework” (Rothwell, 2005, p. 402).
Moreover, Beyebach (2000) considers the ‘Miracle Question’ as the signature of SFBT. Lloyd and Dallos (2006) assert that SFBT is a therapeutic approach that is consequential from clinical practice rather than theoretical model. In SFBT, its theoretical and clinical background is based on strategies that include family, brief and narrative therapies. The core assumptions of SFBT as adapted from George, Iveson, and Ratner (2003), Beyebach (2000), and Rhodes (2000) are the following:
- The problems are directed and subjected to the own perception and interpretation of the client.
- There is no consideration on the past experiences and details of the problem.
- There are instances where problems are less or absent (exceptions).
- The belief of practitioners that their clients are capable to make changes is certain.
- No matter how small changes are, they can have significant value and impact.
- Cooperation, like in major types of therapeutic interventions, is emphasized and resistance is invaluable concept.
- The goal of the client is essentially central.
The basic process of SFBT starts by allowing the therapist, coach, or counselor to explore using the client’s frame of reference and language. The client’s condition is recognized through adoption of a respectful, guiltless or non-blaming position, and works towards the client’s goals. The early phases of SFBT cover pretreatment change, coping questions and problem-free talk. The therapist, coach or counselor should emphasize on this phase as it is considered the building blocks or fundamental elements of the whole therapeutic process. Macdonald (2005) notes that problems are briefly identified, considering time factor, directed to achievement of goals in practical and recognizable ways.
Freeman and Wilshaw (2007) affirm that SFBT is “brief in effect” as compared to other therapeutic approaches that are “brief by design” (p. 32). The principle “not one minute more than is necessary and not one minute less” (p. 32) is employed by almost all SFBT therapist, coach, and counselor. O’Connell and Palmer (2005) identify the key philosophical and practical principles of SFBT. Like any other therapeutic intervention, SFBT necessitates a modification of expertise headed for the client and explores the ways where the client concentrates on things that do good on his/her part and minimizing things that do not do contribute to his/her goodness (O’Connell and Palmer, 2005). Macdonald (2005) identifies example of advices such as ‘Do more of what is working already’ or ‘It is time to try something different’ that will aid the client to change after the session. Solution-focused brief therapy (SFBT) is rooted on communication so the client and the therapist, coach or counselor are able to spend time through conversations, interview, and questionings. In SFBT, there are elements to be considered. Lloyd and Dallos (2008) adopted the works of Beyebach (2000), George et al. (2003), Rhodes and Amjal (1995) to come up with the list and as follows:
- Language – Because the notion that problems and solutions are subjected to individual perceptions and possess high tendency to change, language is the common linking agent.
- Problem-free talk – The act of asking in the areas of the client’s life is based on competence and strength.
- Exceptions – Sometimes, the problem is absent and/or deficient, manageable with or less intense in relation to interest.
- Goals – The client should elicit specific, measurable, achievable, relevant, as well as observable goals.
- Hypothetical future – A variety of ways is elicited in realizing the client’s vision of his/her preferred future (e.g. the ‘Miracle Question’).
- Rating scales – The client is asked to rate his/her self from 1-10, 1 for worst things have ever been and 10 for best things could be.
- Task and compliments – This is focused on the part of the therapist, coach, or counselor and should be given sufficient time for formulation.
Upon considering these elements particularly on the aspect of conversation and interviewing, SFBT practitioners are given maximum assurance on the effectiveness of the approach. Beyebach and colleagues (1996) recommend that in order to have successful SFBT sessions, there should be extended listening period and a brief ending in which the therapist, coach or counselor speaks more. At the end phase of SFBT, the practitioner presents a sequence of compliments and tasks for the client to accomplish. These compliments and tasks are rooted on the result of the conversation between them.
The ‘Miracle Question’ is considered as the signature of the SFBT (Beyebach, 2000). It is designed by De Shazer. It is also deemed as “the most controversial part of the approach” and “potentially highly sensitive and difficult to understand for some people” (Lloyd and Dallos, 2008, p. 8). A common example of the ‘Miracle Question’ and usually used by SFBT practitioners is:
“Suppose that one night when you were asleep there was a miracle and this problem was solved. The miracle occurs while you are sleeping, so you do not immediately know that it has happened. When you wake up what are the first things you will notice that will let you know there has been a miracle? (Lloyd and Dallos, 2008, p. 7)”
The ‘Miracle Question’ is the externalization of people of the current situation they are into and by using their imagination, they (the client and the therapist, coach, or counselor alike) are having an idea of how would that preferred future be like (Freeman and Wilshaw, 2007). It also allows both participants (client and practitioner) to establish cooperation particularly in defining the resources needed as well as the steps in achieving the preferred future. In further exploration of the response to the ‘Miracle Question’, the client is asked by the therapist, coach, or counselor based on “respected curiosity” (p. 34). Good sets of questions that might be asked include: “What else? Who will notice? Who else? What will they see?” (p. 34). Scaling questions are then encouraged to be sequentially asked. In general, the ‘Miracle Question’ is the key agent or factor that motivates the client or presents the client the actual solutions to problems as well as real aspirations in his/her life. For Freeman and Wilshaw (2007), “it is more a recognition of the fact that most people, most of the time, are able to come up with concrete and achievable goals which are less that perfect and yet acceptable. (p.34)”
Looking on the fundamental principles of solution focused brief therapy (SFBT), it holds on the idea that every person has the solution to every problem that they encounter. The only problem is their difficulty to discern and discover such solution and that they need an intervention of a therapist, coach or counselor. They are empowered by the skills that the therapist, coach or counselor has particularly in helping them to cope up with the conditions that affects their attitudes, behaviors and overall wellbeing. Despite the recognition of the advocates of SFBT, there are some limitations that potentially question the overall effectiveness of this specific type of therapeutic intervention.
One size fits all? – The limitations of SFBT
A considerable number of therapeutic interventions or techniques are largely activity-based. Essentially, some therapies like SFBT centre on the client and its advantage by doing things differently, or more or less often variations. Despite the acknowledgement of interests for SFBT as form of therapeutic intervention, evidence-based support on effectiveness (e.g. in social work practice) is limited (Lloyd and Dallos, 2005). There are many empirical investigations that test the potentiality of SFBT in addressing different types of condition that needs psychotherapeutic intervention. Some are successful, others are not. In reference to some research studies, the limitations of SFBT is said to be on the aspect of applying caution in performing the questioning; rigidity, unnaturalness, too much optimism, insensitiveness, and lack of support; and the emphasis on questions that result to lack of empathy as main ingredient of a successful therapy.
According to Stalker, Levene, and Coady (1999), practitioners should be cautious when applying the SFBT model to new client groups. This is applicable on cases where a client is unable to express him/her self or have social communication difficulties. Caution is carefully applied in the process of questioning. There are other clients that are not very cooperative. This will limit the potential of a progressive therapy. Communication is a crucial ingredient in the process of SFBT, wherein the client must be able to express his/her self in the most inclusive and liberated way possible as the practitioner needs to collect information that will be used all throughout the session or therapeutic process. Conversations between the client and the practitioner may use formal and informal methods but interpersonal in origin. Donatelle and Davis (1998) recognize the role of communication as among the most powerful techniques of involvement. Through communication, the practitioner is able to have choices and hints that will help in predicting the essential steps or course of actions that will work toward the ultimate progression or success of the psychotherapeutic case. In particular, practitioners need to pay more attention to considerable number of issues relating to the client’s boundaries and sense of self. They should be cautious of taking on clients who have deprived character particularly in crossing fragile boundaries that may eventually disintegrate to a point where respect in terms of specific boundaries between self and other are no longer apparent. Exercising caution in the process of communication will help clients to cultivate trust on the therapist, coach, or counselor. Trust will basically result to development of connection between the two interacting bodies. In the process of SFBT, the communication process is dynamic and may go beyond the expected set of deliberate communicative functions. For example in dealing with Chinese clients in the social work setting, trust is not easy to gain. Trust and bonding are dependent on some mutual identity (Hardcastle, Powers and Wenocur, 2004). People tend to trust people who are members of their communities. If a Chinese client seeks the services of a non-Chinese therapist, coach or counselor, there is an issue of fostering trust among themselves. Trust stems from community. It involves commitment to others (Haley, 1999). This behavior is also connected to the experiences of the clients. Therefore, a SFBT practitioner should exercise caution not only to encourage the client to express his/her self but also in fostering trust and bond for a harmonious and positive client-practitioner relationship. In communication, the challenge to the part of the practitioner is on the interpretation information being relayed by the client. The practitioner should then again exercise caution. Generally, caution in communication becomes effective when both parties – the client and the practitioner involved in the therapeutic experience – are honest, sincere, and open to share information.
Several criticisms of SFBT, as based on parents’ experiences and views, include rigidity, unnaturalness, too much optimism, insensitiveness, and lack of support (Lloyd and Dallos, 2008). This echoes the criticism that SFBT can appear to be solution-forced therapy (O’Hanlon, 2003). Rigidity is seen on the question-answer mechanism. Since clients are obliged to respond on questions being asked by the therapist, coach, or counselor, there is unnatural flow of conversation. They might respond because they are asked to do so without the consideration that they are actually giving the best information needed. The issue of unnaturalness is also embedded on the presence of rigid questioning process. People, on certain instances, are more motivated to speak up if they feel that they are in a natural phase or setting and out of premeditated circumstances. Too much optimism, on the other hand, is a limitation on the effectiveness of the SFBT as therapeutic intervention because the practitioner is already conclusive, even at the start of the session, that he/she will be able to succeed in the end. The practitioner tends to be overly secured and positive on the outcome of the process without even looking on the gravity or existing conditions affecting the client’s problem. Although SFBT is no longer looking on the past, there is a need to have background information, to certain extent, so as to fully understand what the client is experiencing at the moment. The idea of the present and the future will give false feeling of recovery and may result to failed expectations. The possibility of client change or success in the chosen therapeutic intervention is challenged by the limitations caused by personal emotion including fear, individual differences, parental (societal) acceptance and stress, problematic behaviors, anxiety, emotional disturbance (Costas, 1998), and external forces such as social norms and measures. On the issue of insensitiveness, the practitioner is so engrossed in collecting information during the conversation and that he/she is not considering the sensitivities of the client. This instance in the SFBT process affects effectiveness. It is also referent to client’s mistrust or resistance towards the practitioner. The mentality of the clients towards resistance is related to refusal of the implementation of social work practice. Refusal may be interpreted as lack of concern or care. In moments where the client is resistant, there is no other solution needed but to understand what the client have been through and how hard for him/her to accept it. Lastly, the argument of lack of support is felt by the client in instances where the practitioner keep on exploring the client’s problem and forgot that the client is still affected by the problem during the period of conversation. This projects an impression of lack of support. It is appropriate that social workers are aware of the conditions of the clients before undergoing any actions towards them. The establishment of rapport or working relationship among each other will greatly help in extending the most effective social work service.
Supervision is also an ambivalent factor in SFBT. According to Bernard and Goodyear (2004), supervision is the basis of counseling and psychotherapy. It serves in assuring clients that they have the best therapy possible while facilitating professional development. In SFBT, supervision is “done in systems where time is sacred and where brief is the mandate” (McCurdy, 2006, p. 141). Due to the strict requisite of supervision, the client is placed in a situation where he/she is not able to act naturally. There is a rigid environment that will prevent the client to succumb on the principles of the therapy being utilized. This is also related to the limitations identified by parents in the study of Lloyd and Dallos (2008). Solution focused brief therapy (SFBT) is guided with principles and it is up to the ability of the practitioner to execute and supervise the ways in which such principles will do eventual good on the part of the client. Looking on the general point of view of counseling regardless of any approach used, it is a risky yet challenging and rewarding occupation.
Arguably, the emphasis on questions means absence of empathy (Milner, 2005). The principles of SFBT are generally considered and executed in manner of interviewing. Since all counseling approaches acknowledge the importance of empathy in any therapeutic intervention, the rigid and unnatural questioning is perceived as form of distress on the client’s perspective. The uninterrupted asking of questions might be misinterpreted by the client. This is also similar to the argument of lack of support that client feels in certain instances where the practitioner keep on exploring the client’s problem and forgot that the client is still affected by the problem during the period of conversation. On the case of social workers, empathy is as important as the complete social work practice. Social workers are always reliable in terms of empathic listening. In the process of executing SFBT and its underlying principles, the social worker must be keen enough in understanding the concept of the ‘right thing at the right time’.
The identified limitations of the solution focused brief therapy (SFBT) is said to occur in case-to-case basis. Like in any other type of therapeutic intervention, the welfare of the client is always prioritized. These limitations, in one way or the other, are matter of fact addressed by SFBT practitioners. Whatever exemption to the principles of SFBT is taken by the practitioner, it is surely bounded on a sincere and premeditated motive that is directed to the whole success of the process.
In conclusion, solution focused brief therapy is a therapeutic intervention that is guided by a simple premise that all people are aware of the solutions to their problems but are too blinded or unable to discover it on their own. People needed empowerment from experts. This is the key selling point of SFBT. The presence of the ‘Miracle Question’ facilitates the opportunity of a person to explore the future specifically on the aspect of his/her preferences. Many research studies support the applicability of SFBT in relation to particular situations yet it must be remembered that there are also limitations. In contrast to any other therapeutic approach used in addressing client’s conditions and needs, SFBT is toward the implementation of the most effective solution to a problem in the shortest way and time possible.
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