What is “Brief” in Solution-Focused Brief Therapy?
Many people mistakenly think it is about number of sessions. There is a myth out there that this model is superficial and focused on just fixing an immediate problem in order to get the client in-and-out of therapy quickly. That is not true at all. The word, “Brief,” actually means, “Not one more session than is clinically necessary.” It is all about being purposeful in our work and not assuming in advance. In reality, we never really know how much time we have with the client. Nor can we effectively predict how long a client needs to be in therapy. Many clients in psychotherapy drop out of treatment without ever letting the professional know they aren’t planning to come back. In Solution-Focused Brief Therapy, we act as though every session could be the last. This influences what we deem to be important in our interaction with our clients. We are much more focused on what matters to the client and what the client is telling us would be helpful. We are less likely to take the direction of the conversation away from the client to our own agenda as well as less likely to let the client lose focus on what matters to them and their purpose in coming. We don’t put things off to future sessions that may not materialize. At the end of each session, we explore if there is more work to be done and if the client thinks that another session is needed. It is not assumed. By working in such a purposeful way, we become more efficient. The research shows that fewer sessions are ultimately needed when one works in this way. While there are some dialects of Solution-Focused Brief Therapy that strive to be as brief as possible, including dropping out key elements of the original structure and measuring success by only needing one or two sessions, that was never the intent of Steve and Insoo. Quality, connection, and lasting change for the client always come first.
Why Does the Word “Brief” get Removed from the Title?
There are two main reasons that the official name of the model gets shorted to Solution-Focused Therapy. The first is simply for convenience. When writing about the model, it is a lot of words/letters, and once we have clearly established the formal name, shortening it is convenient.
Second, many therapists have a negative association with the word “brief.” Unfortunately, in some academic settings, the class on Solution-Focused Brief Therapy is not taught by someone with expertise and experience actually using this model in the toughest of situations. This can lead to professors mistakenly introducing the model as something to use when you don’t have the time or resources to address the client’s needs more effectively. It can be erroneously described as superficial. In addition, in many agency settings it has been misused to signify a connection with “time limited” or resource rationing. This can result in some mental health professionals avoiding using this model for fear that underlying client issues will not be appropriately addressed and the changes will be superficial. While these fears are not at all founded when this model is used correctly as designed, this association can be lessened by simply eliminating the word “brief.”
People (Clients) Have Good Reasons
In Solution-Focused Practice, we assume the best about people . . . particularly when they appear to be making poor choices. We do our best to stay curious and suspend judgement. This is called the “not knowing stance.” We can’t be curious and think we know the answer at the same time. This is by far the most difficult aspect of Solution-Focused Brief Therapy to learn. Insoo Kim Berg once said, “Solution-Focused Brief Therapy is very simple, but it is the most difficult to learn. . . for it takes discipline to learn to stay this simple.” Ironically, as soon as we start to assume or think we know what is best for our client, we are no longer Solution-Focused.
Solution-Focused Brief Therapy is a Systemic Model
Because SFBT is systemic, We focus on interactions between people rather than looking for pathology from within people. This allows us to use “Relationship Questions” to be curious about what other important people see in the client that is working, what these people will see different when the problem is resolved, etc. While systemic thinking is always important in this model, it is pivotal when working with clients who are externally motivated for services. This not only invites clients to develop empathy, but to explore change and potential change from an outside perspective.
Small Steps Lead to Big Changes
In this model, we believe that small steps are important. We encourage clients to explore the tiniest of successes, believing that these are instrumental for change.
Isn’t this a Question-Based Approach?
One of the biggest and most harmful myths is that Solution-Focused Brief Therapy is a question-based approach. Because of this it is common for people to ask for a list of questions that they should ask. I understand where new learners are coming from. It would be very comforting to simply memorize a list of questions. Because of this, a common marketing tactic of some Solution-Focused Therapy trainers is to publish lists of Solution-Focused Questions. Unfortunately, these lists tend to make learning SFBT more difficult, and I strongly discourage people from using such lists. True Solution-Focused Brief Therapy is not a question-based approach, but it is instead a connection-based approach. When we focus on what questions we should ask, we are focused on ourselves rather than the client. This results in a technique-like, impersonal interaction. Conversely, when we shift to seek to connect with the unique human in front of us, we are much more genuine, and conversational questions flow more naturally. The key is to understand the purpose behind the types of questions rather than asking pre-made, generic questions. Steve de Shazer used to say that he had no idea what question he would ask until he heard the client’s response to the previous question. He also said that he never knew what question he had asked before he heard the answer.
Aren’t We Looking for Strengths?
This is another very common myth. Many of the books published on Solution-Focused Therapy were written by academic professors. In an academic setting, all of the therapeutic models can be classified as either deficit-based or strength-based models. When we think from this very narrow, categorical lens, it does make sense that Solution-Focused Therapy would then, have to be put into the strength-based category. In addition, Insoo once explained to me that as she was teaching the model to professionals (many of whom were Social Workers, who are classically trained in strengths based theory), people oftentimes immediately assumed that what she was doing was looking for strengths. She told me that she purposefully decided not to correct them. She said it wasn’t technically true, but leaving this myth unchallenged made it easier for problem-focused professionals to make the necessary paradigm shift away from problem solving.
Later in Steve de Shazer’s career, he actively addressed this misperception. Steve once said, “I am not looking for strengths.” He went on to explain that instead, “I am looking for what works.” These are very different things. This distinction is very important, for I find that when learners think from an academic stance and thereby approach Solution-Focused Therapy as a strength-based model, this leads to professionals actively looking for strengths and resources during client sessions. This results in an agenda-based, overly positive, and Pollyannaish feel to the work. The work can then become very superficial and is more consistent with problem-solving, as the well-intended professional seeks to get the client to build on their strengths and resources rather than simply becoming curious about what they would be doing in the future when things are working.
In truth, I find that when clients are successful in treatment, they most often are not building upon their strengths, but instead have overcome their weaknesses. By focusing on what is working (as clearly stated in the original Solution-Focused Principles) we invite clients to set aside the idea of strengths and weaknesses and encourage them to simply explore what skills, behaviors, and ways of thinking they will be using when things are working in their life. Maybe they will have pulled forward some strengths, but most often they have overcome many weaknesses as well.
Avoiding Jargon and Terms
One of the many things I really appreciated about Insoo, was her natural way of talking about what was happening in a client session. She was very easy to talk with, and her writings are easily understood. It can be tempting to create terms and unique labels when teaching a model. Categorizing things can bring a kind of comfort to professionals. Steve de Shazer was known for saying, “Don’t think. Observe.” This concept of just being in the moment and not shifting to an analytical place is key in Solution-Focused Therapy, for once we have created a label for something, we tend to immediately return to this predefined term and no longer see the uniqueness of the person or interaction that is in front of us. For example, when working with a client, we tend to no longer see the uniqueness of the person once we have used a label (aka diagnosis) of “Borderline Personality Disorder.” The same is true of positive labels as well. Because of this, I have tried hard to stick to most of the original names used by the founders for the questions and tools, without cluttering the model with additional, unnecessary terms.
General Therapy Session Structure
There are three general parts to a Solution-Focused session. They are:
- What does the client want? (Future Tense)
- What does the client already have? (Present and Past Tense)
- What’s next? (Immediate Future Tense)
The analogy I often use is that of driving a car. Every trip has three parts: the starting up process, the driving process, and the parking process. No matter where one is driving, we always do all three parts in that order. The same is true with having a Solution-Focused conversation. We always start by understanding what the client is hoping to be different (Goal Formation Questions). We then move to what the client already has (Scales, Exceptions), and lastly to what is next (Scaling, End-of-Session Message, Noticing Assignments). By understanding these three parts, the therapist can easily have very natural conversations that guide the client through the process of change.
There are two parts of learning Solution-Focused Brief Therapy; The mindset (as discussed above) and the tools. Unfortunately, most often people are just taught the tools and therefore think it is the tools that are central to the model. While tools (such as scaling questions, exceptions, Miracle Questions, etc.) can be helpful, when used outside of the Solution-Focused mind-set the tools are just tools being used in a problem-solving way. When people are first learning this model, it is tempting to want to first learn the questions or tools. However, learning the mindset is the place to start.
Solution-Focused Questions and Tools
Once the mind-set is learned, focusing on how to use the specific Solution-Focused tools, or Solution-Focused Therapy exceptions, can be very helpful. While these are kinds of questions, it is important to remember each must be personalized to the unique human being and to the client’s previous response. It takes practice and skill to learn to use these in a non-scripted way. Here’s a summary of some of the most common ones.
Goal Formation Questions
There are four distinct Goal Formation Questions that have been developed over the years. The purpose of all of the Goal Formation Questions is to help the client to suspend their disbelief and to imagine life without the problem. Goal Formation Questions form the first third of the client session. A therapist can use one or more of these categories of Goal Formation Questions to help the client think about how they want their lives to be different as a result of treatment.
The Solution Focused Miracle Question
The Solution-Focused Miracle Question was one of the first Goal Formation Questions developed and is the one that is most commonly taught in graduate school. Here is the traditional wording for this question:
“Imagine that when you go to bed tonight, a miracle happens. The miracle is that the problem that brought you here is gone! However, since you were asleep, you are unaware that a miracle happened. What would be the first things that you notice that let you know that this miracle happened?”
While this question appears so simple, most professionals don’t realize that there are actually five distinct parts within it. If a part is inadvertently left out, the question may not be helpful. Likewise, a skilled practitioner must purposefully modify the question to match every client.
For example, it is important to understand that this question is not asking the client to imagine an ideal or magical future. The miracle is clearly defined as “the problem that brought you here is gone.” This means that we must first listen to the client to understand what change they are hoping to be different as a result of talking to the therapist. This is the change we are exploring through the Miracle Question. When this element is missed or misunderstood by the professional, the question can become unrealistic and unhelpful when used by an unskilled therapist.
This is the one question in Solution-Focused Brief Therapy that cannot be asked naturally and will always sound like a technique. It takes great skill and practice to do it well. It is an incredibly powerful question, but it is often not the Goal Formation Question that is the best fit for many clients or situations.
The Fast Forward
This Goal Formation Question is one of the most natural and most versatile. It is simply moving the client in their imagination through time and yet still clearly defining what will be different. For example, I might ask, “Imagine it is six months from now and things were a little better. What would be different?” It gives the message of hope while honoring that the desired change might take some time. This question can be very helpful when what the client is struggling with is something that involves a time element (such as finding a job or housing, getting off probation, etc.). It can also be very helpful when helping a client through the grief process or through a traumatic event.
This question is another form of the Fast Forward. It goes like this:
“Imagine it is the end of our time together. What would we have talked about [or ‘what would be different’] that lets you know this has been a good use of our time?”
This was one of Insoo Kim Berg’s favorite Goal Formation Questions at the end of her career. It is a very natural question that simply invites the client to suppose whatever they fear didn’t happen. What might that look like? For example, if a client was talking about how their life will never get better, I might compassionately agree followed by this question. It might sound like this:
“Maybe. . . and. . . suppose it did get better. What might that look like?””
The timing and compassion are key when using this tool to ensure it doesn’t come across as flippant or dismissive.
Exceptions- Using the Exception Question in Solution-Focused Therapy
As previously mentioned, Exceptions are those times in which the problem is resolved or less severe. These are used during the second part of the session, since these invite the client to explore past or present actions that are working. I find that it is most helpful to listen for or notice exceptions rather than to hunt for exceptions. For example, rather than asking, “Have there ever been times in the past when you were able to do that?” I encourage professionals to simply notice small exceptions that are present in the room. An example of this would be a client who states that they can’t get out of bed or make appointments due to their depression, yet they are in the office for an appointment. I find it most helpful to validate their struggle and difficulty and then gently become curious about the small success. I might say, “Wow. That must be very difficult. I’m glad you are here. . . It makes me wonder. . . . How were you able to make it here today?” This way of noticing exceptions vs. hunting for exceptions is much more compassionate and respectful of the client’s current struggle while still benefiting from exploring exceptions.
Another tool that is used in the second and third parts of the session is scales. Scales are simply a way to have a conversation about more vs. less. They are a wonderful way to help clients determine where they are in relationship to their goal. Exploring why a client is at a given number and not lower on the scale is another way to identify exceptions (times when the problem is less severe). In the last third of the session, scales can be used to help the client to identify what would be happening when things are a little bit better. It is important to understand that Solution-Focused scales are not to be used to problem-solve next steps. Instead, they are used to help the client explore signs that change is occurring. For example, we don’t want to ask, “What would it take to be one step higher?” This is problem-solving. Instead, the Solution-Focused question would be, “What would be different that would let you know things were getting better?” This second question is simply inviting the client to begin to think about what “better” means. It is not trouble shooting for an action plan for change.
Initially scales were done using 1-10 (Steve preferred scales of 0-10). The top of the scale is always defined by what the client is striving for (the definition of the Goal Formation Question). The bottom of the scale is typically kept more vague . . . often with statements such as “the worse you can imagine.” It’s important to understand that these are very different from Likert scales, and that the numbers in-between are not defined. They are meant to be subjective and personalized to each person and cannot be pre-made or used for outcome measures.
Given that many problem-focused models (including the medical system) routinely use 1-10 scales, number-based scales have become more clinical and impersonal in nature. Because of this, I don’t recommend using numbers unless initiated by the client. Instead use more real life scales that are personalized to the client. For example, for a person who loves to hike mountains I might ask, “How far up the mountain are you?” For a teenager who loves video games, I would use wording from the video games. (i.e., “What level are you on?”). The more creative you can be to ensure the scale is personalized to the person you are working with, the greater the effectiveness of the tool.
Solution-Focused Brief Therapy is a systemic model. We use Relationship Questions to invite the client to think from other people’s perspective to explore what will be different when things are better. We can use relationship questions in all three parts of a Solution-Focused session. These questions invite the clients to think beyond their own perspective and from the viewpoint of someone else. They can be useful for developing empathy, increasing motivation for change, as well as helping clients to explore areas otherwise not considered. For example, when working with a client who is involved with Child Welfare who doesn’t see her alcohol use as problematic, I might ask, “What would your caseworker see that lets her know that your children are safe and no one is worried about them?” An example of using Relationship Questions in the second third might be, “Where would your caseworker rate you on the scale? . . . Why would she say there and not lower?”
Traditionally, the therapist would end the session by giving the client compliments as well as a task. Part of this tradition came from the Eriksonian influence and the expert-based training that all therapists (including Insoo and Steve) receive. As with most professionals, there was a softening and shifting more toward connection with and empowerment of the client as the years went by. The message became less expert-based and more focused on inviting the client to shift their focus onto what the client had identified was working in their own life.
Solution-Focused compliments are many times confused by new learners to be an opportunity to do a behavioral reinforcement. That is not what a Solution-Focused compliment is about. Instead, I encourage people to think of the compliment as a genuine gift to the client. I listen for what the client has said that is important to them and/or what is working. I then express my genuine appreciation for them as a person and what they have discovered. There is no hidden professional agenda. . . just appreciation, and a moment to connect with this amazing human being.
For the task, I encourage professionals to word this as a noticing task. I rarely if ever give an action task (these tend to trigger a physics reaction . . . for every action [telling someone to do something] there is an opposite and equal reaction [them telling me why it won’t work]). To create a noticing task, I listen carefully for what they already told me they plan to do. I then invite them to “notice what difference this makes” or “how they decide when and how to do it” once they leave my office.
Some Solution-Focused dialects prefer to delete out the end-of-session message. I don’t find that clients prefer this. Maybe this is a cultural thing here in the United States. People like to end well and walk away with closure. I use the example of giving a gift. I can give someone a gift without putting in the extra effort of the finishing touches of wrapping it. The gift is still valued. However, there is something special and personal when one takes the time to present it well. It doesn’t change the gift at all. It just shows connection, care, and purposefulness.
About the Author
I am Teri Pichot, LCSW, MAC, LAC. I was originally trained as a therapist in the late 1980s and early 1990s, and have since run a county-based outpatient substance misuse treatment program, published five books, and currently run a private practice in addition to a Solution-Focused training center. I provide training internationally (both in-person and via Zoom) about how to use Solution-Focused Brief Therapy with some of the most challenging client populations and settings. However, I remain a therapist at heart, and my passion has always been connecting with clients and ensuring that my work is making a meaningful and lasting difference in their lives. My favorite population with which to work are those whom other professionals find difficult. This might be those struggling with chronic mental illness or substance misuse, or those who are mandated into services such as those involved in child welfare, the legal system, or the school system. Because of this, I have worked a lot in highly regulated, problem-focused, high-pressure systems. I have found this to be an ideal place to use Solution-Focused Brief Therapy.
A significant part of my passion includes helping others to think differently and find hope when working with some of the most challenging clients. The secret in using Solution-Focused Therapy in these settings and with the most challenging client situations, is that we must learn to use it correctly and with purpose. The most difficult clients are much more likely to challenge or dismiss what a professional says. They are more sensitive and/or aware when a professional appears insincere, has an agenda, or is technique focused. While the client's challenge is uncomfortable to the professional, these are the clients that push us to become good at our craft.
I originally met Insoo Kim Berg and Steve de Shazer in 1994. I knew instantly that their way of compassionately working with clients was the right path for me. They were kind enough to include me on their professional path and to mentor me until their passing in 2007 and 2005, respectively. It was Insoo, who I turned to, who helped me learn how to use this amazing practice not only with clients, but as a supervisor and agency manager as well. It is her and Steve’s voices and their way of working with clients that I seek to share through my writing and teaching.