Dr Alasdair Macdonald is a consultant in adult general psychiatry, North Lakeland Healthcare NHS Trust, Carlisle. He is also active in the European Brief Therapy Association, and is its secretary and research coordinator. (email: firstname.lastname@example.org). Alasdair summarises his experience as "thirty years in psychiatry; twenty years in brief therapy". These are his notes on his workshop at the "Connections in Practice" Conference organised by AFT Scotland and funded by the Scottish Executive especially for social workers to make links with developments in family therapy and systems methods.
Solution-Focused Therapy in
By Alasdair Macdonald
Solution-focused therapy (sft) was developed in the 1980s by Steve de Shazer and Insoo Kim Berg of the Brief Family Centre in Milwaukee, USA. They modified existing brief therapy, keeping only those elements which were linked to a good outcome for the clients.
There are a number of differences between sft and traditional psychotherapy. Central assumptions are that the goals for therapy will be chosen by the client and that the clients themselves have resources which they will bring to therapy. A detailed history is not essential for sft. The problem is briefly defined: the client's name for it, its frequency, duration and past occurrence. 'Problem talk' and speculation about motives or 'purposes' of symptoms are avoided. The therapist adopts the client's vocabulary and tracks their use of language. Expert 'jargon' is not used.
Goals are defined in practical and recognisable ways. Talk about pre-session changes, exceptions, scaling tasks and the 'miracle question' keeps the focus on effective solutions. Homework tasks are offered to continue the process of change between sessions. Individuals, couples or families may be seen; joint sessions are common even if one individual is the main focus.
An important research finding is that sft is equally effective for all social classes whereas other psychological therapies favour the well-educated and affluent. In practice those with few resources are the ones most in need of effective therapies. Another advantage is that results are usually achieved within 3 - 5 sessions. Hospital stays and waiting lists are reduced when an sft approach is adopted.
The basic techniques of sft are easy to learn and can be used in a wide variety of settings. They can be applied to non-health problems and to management consultancy. St Martin's College in Carlisle offers an accredited training and supervision module (seven days over six months).
Insoo Kim Berg, one of the founders of sft, takes on major social welfare projects such as a project to provide 6 - 8 week support worker input in child protection cases in Chicago (Berg 1991). She is currently refining child protection strategy for social workers in the state of Michigan.
Andrew Turnell, social worker, formerly of the Brief Family Therapy Center in Milwaukee and now back in his native Australia. His 'Signs of Safety' (1999) approach is realistic, easy to learn and helps workers to continue good work in difficult circumstances.
Susie Essex of Bristol works as a family therapist in cases where sexual abuse is denied. She engages families in 'signs of safety' and in 'hypothetical abuse' scenarios leading to more effective child protection without disclosure.
Luc Iseabaert and Sylvie Vuysse find 100 out of 131 Belgian alcoholics abstinent or controlled four years after treatment.
Nick Triantafillou in Canada: supervision of residential care staff for adolescents. Evaluation: 5 adolescent clients: 66% less incidents, less medication use vs 7 controls: 10% less incidents but medication increased. (16 weeks follow-up.)
Child psychiatry in Newcastle: in a comparison study John Wheeler found 23 (68%) vs 17 (44%) satisfied in an outpatient service; other clinic resources had been required by 4 (12%) vs 12 (31%) .
Unlike traditional psychotherapy sft has shown benefit with some clients from the criminal justice system. Studies include Lee (1997) on domestic violence groups in California with 83 - 93% effectiveness (measured by reoffending) and Lindforss and Magnusson - a randomised controlled trial with consistent 24% reduction in reoffending in a recidivist Swedish population. Outcome evaluation shows that sft is effective for some 70% of cases across a wide range of problems. An international research project is under development through the European Brief Therapy Association (EBTA).
The EBTA annual conference attracts delegates from all parts of the world and will be held in Turku, Finland in August 2000.
EBTA website - www.ebta.nu
Brief family therapy centre homepage - www.brief-therapy.org
Solution-focused therapy webpage - http://www.enabling.org/ia/sft
Berg, Insoo Kim (1991) Brief Therapy:A Family Preservation Workbook. BT Press: London.
de Shazer, S et al (1986) Brief Therapy: Focussed Solution Development. Family Process, 25: 207-222.
de Shazer, S (1994) Words Were Originally Magic. Norton: New York and London.
Isebaert L, Vuysse S (2000) (in preparation).
George, E, Iveson, C and Ratner, H (1990) Problem to Solution. Brief Therapy Press: London 1990.
Lee MY, Greene GJ, Uken A, Sebold J, Rheinsheld J (1997) Solution-focused brief group treatment: a viable modality for domestic violence offenders? Journal of Collaborative Therapies, IV, 10-17.
Lindforss L, Magnusson D (1997) Solution-focused therapy in prison. Contemporary Family Therapy, 19, 89-104.
O'Connell, B (1998) 'Solution-Focused Therapy' Sage: London.
Triantafillou N (1997) A solution-focused approach to mental health supervision. Journal of Systemic Therapies, 16, 305-328.
Turnell, A and Edwards, S (1999) Signs of Safety. Norton: New York.
Wheeler J (1995) Believing in miracles: the implications and possibilities of using solution-focused therapy in a child mental health setting. ACPP Reviews & Newsletter, 17, 255-261.