Who is Larry and why did he cut the legs off his bed? A reflection on Solution-Focused Brief Therapy (Dec 2010)

Who Is Larry And Why Did He Cut The Legs Off His Bed?

A Reflection on Solution-Focused Brief Therapy

David Johnson

COUN 520 Theories of Counseling and Psychotherapy

University of San Diego 

School of Leadership and Education Sciences

December 15, 2010

           Could you guess my orientation just by looking? First year clinical mental health counseling students generally select one particular theoretical orientation that essentially defines their approach and articulates their philosophy of helping. I have selected Solution-Focused Brief Therapy (SFBT) for my theoretical orientation because: I believe it is the best match for my particular strengths as a counselor, it best suits my personal motives for becoming a counselor, it is most applicable for the populations with which I will likely work, and SFBT is supported by a large number of counseling professionals already in the particular clinical setting I am most likely to enter as a Licensed Professional Clinical Counselor Intern. The following is my preferred outcome for this reflection: I will explain what SFBT is and provide greater detail for my reasons for selecting it. In conclusion, I will explain how SFBT is used in a multicultural context.

           What is Solution Focused-Brief Therapy? According to London-based counselor Bill O’Connor (2001), “the Solution-Focused approach…aims to help clients achieve their preferred outcomes by evoking and co-constructing solutions to their problems.” Essentially, SFBT differs from other theoretical approaches in that it concentrates the client’s efforts on the present circumstances and his or her hopes for the future, rather than on the root cause of the problem, which is in the past. Being a form of brief therapy, SFBT is highly goal-driven and expeditious. Clients and counselors decide together which goals to work on and co-construct a plan with incremental steps that help the client achieve the goal.

           Note the reference to social constructionist thought in the use of the term “co-construct”. I will expand a little bit on the philosophical foundations of SFBT. Constructivism (or post-structuralism) is a contemporary movement in philosophy, sociology and the arts that rejects the notion of a single knowable objective reality (called essentialism) in favor of a focus on how “individuals and groups participate in their perceived social reality” ("Social Constructionism," 2010). As a result, SFBT counselors acknowledge the subjectivity of reality as perceived by the client. Thus, SFBT tends to be more client-centered than other forms of therapy which may focus on the the therapeutic relationship or on the expertise of the counselor.

           To further contrast SFBT with other theoretical approaches, consider the following narrative from Dudley, Johns, Duchamp, & Tzara (n.d.) that I believe highlights contrast between Solution-Focused Brief Therapy and one of its antecedents, Jungian psychoanalysis.

Larry went to an analyst. "Doc," he said, "I've got trouble. Every time I get into bed, I think there's somebody under it. I get under the bed, I think there's somebody on top of it. Top, under, top, under ... you gotta help me, I'm going crazy!"

"Just put yourself in my hands for two years," said the shrink. "Come to me three times a week, and I'll cure your fears."

"How much do you charge?"

"A hundred dollars per visit."

"I'll sleep on it," said Larry.

Six months later the doctor met Larry on the street. "Why didn't you ever come to see me again?" asked the psychiatrist.

"For a hundred bucks a visit? A bartender cured me for ten dollars."

"Is that so! How?"

"He told me to cut the legs off the bed!"

In the above example, the problem-centered approach of the doctor and the great investment of time and money required to cure Larry of his fears exceeded the effort he was willing to make. Rather, Larry’s true goal was not to be cured of fears but to be able to go to bed at night untroubled. Proponents of a solution focused approach, such as Insoo Kim Berg (n.d.), argue that “solutions…are already within the person, [and] repeating these successful behaviors is easier than learning a whole new set of solutions that may have worked for someone else. Since it takes less effort, people can readily become more eager to repeat the successful behaviors and make further changes.”

            Why have I chosen this approach? As I mentioned in the introduction, my reasons for selecting this approach are personal, professional, and pragmatic. SFTB can be described as a strengths-based approach since it helps clients by encouraging them to discover and develop their innate strengths to move toward solutions. As a counselor, my strengths include encouragement, insight, and articulation. I believe these qualities will be useful in a strengths-based context. In application, I will encourage client to access their own strengths in order to define a goal that moves them toward their ultimate goal of a healthier better-function self, I will offer them insights on practicability of their progress toward their goal. And finally, by helping clients spell out specific objectives refining the tactics that achieve those objectives, I will partner with clients to help them to effect the newer healthier version of themselves. I tend to use my analytical skills and insight to develop systems and structures for managing complex processes. In other words, I do well with structure and I enjoy bring order and planning to complicated problems. I will draw upon my positive experiences in planning to help my clients improve their planning skills for better mental health.

Professionally, my previous five years experience as a counselor in various settings have provided me with much exposure to various brief therapies as well as the solution focused approach. Working in nonprofit agencies providing government-subsidized counseling services has helped me to see the importance of getting to the point quickly. Agencies operating with taxpayer funds are under constant pressure to demonstrate effective measurable outcomes using only evidence-based techniques. Thus, brief therapy has become the standard. Most of the professionals I know practicing in the field use brief therapy to comply with the parameters established by funding sources, usually county government.

As I continue my academic career, I will be looking for opportunities to work with combat veterans who may needs assistance reintegrating into society. Solution-focused techniques may show promise as an alternative for trauma survivors and those with PTSD symptoms when exposure therapy has not worked. Due to the relative short history of SFBT, 20 years, more research studies are needed to confirm this. I am interested in the opportunity to conduct research in this area and advance the field of knowledge.

Why didn't I opt for some other theoretical approach instead? Since I have an undergraduate background in theatre arts, and I continue to be involved in the local theatre, I briefly considered psychodrama. However the more I learned about its therapeutic value and efficacy in helping people overcome serious problems, the less I was interested. If my strengths included challenging or provocation, I might have selected Gestalt therapy. Unfortunately, my earliest experiences with Gestalt therapy were in a performing arts rather a clinical psychology context. Although I have a profound respect for the powerful techniques of that approach, I do not feel comfortable with the level of confrontation that would be necessary for a Gestalt therapist. Another approach that appeals to me, the Person-Centered approach developed by Carl Rogers, provides several useful models and techniques, such as unconditional positive regard and the "ideal self". In fact, many of the foundations of SFBT are influenced by Rogers and his work. Ultimately, I concluded the amount of time required for Person-Centered therapy to generate sufficient therapeutic results with clients in the community-based agency settings I am likely to find employment would be constantly challenged. 

Does Solution Focused Brief Therapy work for everyone? Or just white people? All of my previous work in the field has involved multicultural experiences. I have worked successfully with clients from a variety of ethnic and racial backgrounds. As a member of more than one minority, I have experienced discrimination and prejudice first hand. Since I expect to continue providing counseling services culturally diverse populations for the length of my career, I maintain a commitment to cultural competence that extends to my theoretical orientation. According to British Psychiatrist Alasdair J. Macdonald (O’Connell, & Palmer, 2003), most of the effectiveness research on SFBT included relatively small samples, 100 or less, and subjects’ demographic differences were generally statistically insignificant, suggesting outcomes differed little among members of different racial and ethnic groups (p. 16). In addition, significant contributions (O’Connell, & Palmer, 2003) have been made regarding the use of SFBT approaches with women, children and families, as well as in intercultural settings such as public schools, human services, group therapy, substance abuse treatment centers and corrections settings (p.168). Since so much of SFBT is client-centered, it makes sense that the efficacy of SFBT is directly connected to individual clients rather than the cultural groups to which they belong.

Solution-Focused Brief Therapy is an emerging theoretical approach that offers an innovative set of techniques and concepts grounded with a constructivist thought framework. I personally identify with this approach because it compliments my experience in the field and offers opportunity for growth particularly with the populations and clinical settings I am most interested in serving. Although I considered a variety of theoretical options, I feel SFBT is most in line with my particular strengths as a counselor and my preferred outcome as a professional. Finally, SFBT meets my criteria for being applicable in a multicultural context. As I continue to develop my skills as a counselor and further my academic understanding of therapy, I will begin to filter new concepts and ideas through the lens of a solution focused approach.

References

Dudley, A, Johns, J, Duchamp, M, & Tzara, T. (n.d.). Psychology jokes and tricks –

op.44. Retrieved from http://www.opusforfour.com/psy_fun.html

Egan G. (2009). The skilled helper: A problem-management and opportunity-

development approach to helping. Belmont, CA: Cengage

Kim Berg, I. (n.d.). About solution-focused brief therapy. Retrieved from

http://www.sfbta.org/about_sfbt.html

O'Connell, B. (2001). Solution-focused stress counseling. London: Continuum.

O’Connell, B, & Palmer, S. (2003). Handbook of solution-focused therapy. Thousand

Oaks: Sage Publications Ltd.

Social Constructionism. (2010). Wikipedia, the free encyclopedia. Retrieved December

15, 2010, from http://en.wikipedia.org/wiki/Social_constructionism