Solution-Focused Therapy: Theory, Research & Practice: Theory, Research and Practice

225 Pages·2007·1.16 MB·English

by  Dr Alasdair Macdonald

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Solution-Focused
Therapy
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Praise for the Book
‘Packed full of ideas and exercises for trainers and therapists. A comprehensive
account of key solution-focused ideas and how to apply them in the workplace. An
essential read for professionals wishing to develop their solution-focused practice.
Alasdair communicates the wisdom accumulated over years as a practitioner,
researcher and enthusiast for the solution-focused approach.’
Bill O’Connell, Director of Training, Focus on Solutions
‘Alasdair’s book is a welcome addition to the literature in the field of solution-focused
brief therapy. His wealth of experience in this approach to therapy is effectively
communicated through simple explanations of solution-focused skills and useful
examples of therapist–client interactions that illustrate implementation. The book
contributes and builds upon the existing literature. The chapter regarding ethical
considerations is unique for a book outlining this therapeutic approach, and the
chapter exploring the status of SFBT research is contemporary and comprehensive.
Alasdair’s book will be a useful resource for those students training in the SFBT
approach.’
Fred Ruddick, Senior Lecturer (Mental Health Studies) RMN, RGN,
Advanced Dip. Counselling, MA Counselling
‘This book by Alasdair Macdonald provides an interesting and useful introduction to
solution-focused brief therapy from the perspective of a well-respected consultant
psychiatrist. Dr Macdonald’s position as the research co-ordinator of the European
Brief Therapy Association means that readers will easily be able to reference the
claims and examples throughout the book. The chapter on research is comprehensive
and this alone makes the book worth buying.
‘Although not everyone will agree with his views on the links between solution-
focused brief therapy and other medical or problem-focused models, there is no
doubt that he demonstrates many practical ways of integrating a solution focus into
one of the most demanding areas of medical practice. In addition, the chapters on
research and the history of brief therapy will be valued by experienced solution-
focused practitioners and provides an excellent picture of the current place of
solution-focused brief therapy in contemporary mental health practice.’
Rayya Ghul, co-author of Creating Positive Futures: Solution Focused
Recovery from Mental Distress
‘Alasdair Macdonald has produced a landmark in the development of solution-
focused approaches. He brings together the history, research and evidence for SF prac-
tice with many practical strategies for contexts from severe mental health cases to
workplace conflict. The book is packed with concise insights, connections and
thought-provoking questions presented with great authority and clarity.’
Mark McKergow PhD MBA, author of The Solutions Focus:
The SIMPLE Way to Positive Change, co-founder of SOLWORLD
‘Alasdair has made a particular and important contribution to the world of solution-
focused brief therapy through his long-standing interest in research. This interest,
and his background in adult mental health work, are both reflected in this book
thereby setting it apart from other introductions to the approach. At a time when
resources are tight and professionals under pressure this book highlights the particu-
lar relevance and flexibility of the solution-focused approach which can be drawn
upon usefully by clinicians and managers alike.’
Evan George, BRIEF, www.brieftherapy.org.uk, London
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Solution-Focused
Therapy
Theory,
Research &
Practice
Alasdair J. Macdonald
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© Alasdair J. Macdonald 2007
First published 2007
Apart from any fair dealing for the purposes of research or
private study,or criticism or review, as permitted under the
Copyright, Designs and Patents Act, 1988, this publication
may be reproduced, stored or transmitted in any form, or
by any means, only with the prior permission in writing of
the publishers, or in the case of reprographic reproduction, in
accordance with the terms of licences issued by the Copyright
Licensing Agency. Enquiries concerning reproduction outside
those terms should be sent to the publishers.
SAGE Publications Ltd
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British Library Cataloguing in Publication data
A catalogue record for this book is available
from the British Library
ISBN 978-1-4129-3116-8
ISBN 978-1-4129-3117-5 (pbk)
Library of Congress Control Number: 2006932845
Typeset by C&M Digitals (P) Ltd, Chennai, India
Printed and bound in Great Britain by The Cromwell Press Ltd, Trowbridge, Wiltshire
Printed on paper from sustainable resources
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Contents
Introduction 1
1 The solution-focused therapy model: the first
session; Part 1 6
2 The solution-focused therapy model: Part II 24
3 Case study 46
4 Ethical issues in therapy 66
5 The historical roots of solution-focused brief therapy 77
6 The research and evidence base for solution-focused therapy 88
7 Applying solution-focused brief therapy within
mental health services 115
8 Solution-focused approaches to severe mental illness 137
9 Solution-focused approaches in the workplace 160
10 Future directions in solution-focused therapy 179
Appendix 1 Useful links and addresses 188
Appendix 2 Hyperventilation: a curable cause for
‘anxiety’ symptoms 192
References 199
Index 214
* An additional case study is available at www.sagepub.co.uk/case
studies/31175
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To my wife Jill.
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Introduction
CCoonntteennttss
• The author
• This book
• The structure of the book.
Solution-focused brief therapy was developed in the 1980s by Steve
de Shazer and Insoo Kim Berg of the Brief Family Therapy Center in
Milwaukee, Wisconsin. Both were social workers, among their other
skills, and had met at the Mental Research Institute (MRI) in Palo Alto in
California, where much of the early work on strategic therapy took
place. After marriage they moved to Milwaukee, planning to form ‘The
MRI of the Midwest’. They continued their research in their clinic, mod-
ifying existing brief therapies by using feedback from clients about suc-
cessful outcomes. This process led to the gradual removal of many of the
usual elements of psychotherapy because nothing was retained that did
not show specific benefits for client outcomes.
As a consequence there are a number of differences between solution-
focused brief therapy and traditional psychotherapy. The central assump-
tions are that the goals for therapy will be chosen by the client and that the
clients themselves have resources which they will use in making changes.
A detailed history is not essential for solution-focused work.
A solution-focused interview will contain certain specific elements.
Problems and goals are defined in practical terms which enables the client
to focus on solutions. Asking about presession changes, exceptions to the
problem, scaling the problem from 0–10 and asking the ‘miracle question’
keep the focus on effective solutions. At the end of the session the feedback
encourages change. Tasks such as ‘Do more of what is working already’ or
‘It is time to try something different’ help to maintain change after the
session.
In solution-focused work, individuals, couples or families may be
seen; the sessions follow a similar pattern. Clients find the method
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Solution-Focused Therapy
non-threatening and many enjoy the collaborative aspects of the
process. Sufficient improvement is often achieved within three to five
sessions and about 25 per cent of clients require only one session. As with
other psychotherapies, problems of long standing are less responsive to
treatment. Medication and other treatments can be combined with a solu-
tion focus. Hospital stays and waiting lists are reduced when this approach
is adopted since it focuses on empowering service users. Mental health
staff have found that it gives them increased confidence in their work
with clients.
TThhee aauutthhoorr
My father was a physician and psychoanalyst and so I was exposed to
psychotherapeutic ideas from an early age. During my psychiatric train-
ing I had experience of psychodynamic therapy with individuals and
groups. I attended an analytic groups course at the Scottish Institute of
Human Relations and underwent a personal psychoanalysis. My training
in systemic family therapy progressed to strategic therapy and then to
solution-focused therapy. I employed solution-focused approaches in
psychiatric practice, in my role as a medical manager and in manage-
ment consultancy.
I have experience working with children and families, in University
posts and as a supervisor of experienced and trainee therapists. I have
been a consultant in adult psychiatry for 25 years and have worked in
community settings and secure units. As the Medical Director of two
Mental Health Trusts I had wide experience of personnel and strategic
issues.
TThhiiss bbooookk
This book is intended as a basis for introductory courses and will also
describe ways of applying solution-focused skills in a number of special-
ist areas including mental health, child protection and organisational
consultancy.
Therapists are often of a temperament that does not lend itself to
research. However, within developed countries it is increasingly neces-
sary to produce an evidence base for therapies. This means that therapies
have to be shown to be effective within the scientific research paradigms
traditionally adopted for the examination of medical remedies. This
book contains an extensive review of the current research, including
2
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Introduction
pooled data from our own research studies (Macdonald 1994a, 1997,
2005). The historical roots of solution-focused ideas are also examined.
As the scope of this book includes the application of solution-focused
approaches to organisational situations, I hope that it may be useful as
a text for managers and management consultants in their constant
search for more effective interventions.
TThhee ssttrruuccttuurree ooff tthhee bbooookk
1 The solution-focused therapy model: the first session; Part 1
describes the development of the method and its introduction to men-
tal health practice in this country. The core of the chapter is a system-
atic account of the basic solution-focused method and its application to
a first session. This includes details of the therapy process and extended
commentaries on the micro-skills of interviewing in its use. Chapters 1
and 2 are based on the teaching materials for the accredited course at St
Martin’s College, Carlisle, and on the feedback received from trainees
since the courses began in 1997.
2 The solution-focused therapy model: Part 2 completes the first ses-
sion process, discussing the value or otherwise of taking a break and pro-
ceeding to the feedback element. The procedure for constructing feedback
is presented. The question set for subsequent visits is described. Each ele-
ment is illustrated by vignettes of dialogue taken from an actual case.
Applications in specific settings are discussed such as family practice,
couples and families, teenagers and schools.
3 Case study. This chapter contains a full length transcript of the
first interview with a couple. This demonstrates the main features of the
approach in a clinic setting. The transcript is annotated throughout with
discussion of options. This material exemplifies the method described in
Chapters 1 and 2.
4 Ethical issues in therapy addresses some of the common ethical
issues in the practice of counselling and psychotherapy. Some of these
are general, applying to therapists everywhere. Others have been specif-
ically raised in relation to specific therapies or therapy situations. Ethical
issues specific to solution-focused brief therapy are included.
5 The historical roots of solution-focused brief therapy. Solution-
focused brief therapy is often described as a postmodern therapy that
employs very different assumptions from other past and present
approaches. However, there are numerous elements within solution-
focused brief therapy that owe their origin to previous schools and
techniques of therapy. This is of importance for practice, teaching and for
3