Since Sigmund Freud popularised Psychoanalysis back in the early 1900s, most Psychiatric theories have, in one way or another, attempted to unmask and solve patient’s problems through exploring them in varying degrees of depth. While Psychoanalysis focuses primarily on past trauma, more recent approaches such as Cognitive Behavioural Therapy focus on the here and now, identifying maladaptive cognitive strategies and attempting to challenge the cognitions themselves and the behaviours associated with them. What these theories and others have in common is that identifying and treating the problem itself is central to a successful outcome.
Brief Solution-Focused Therapy takes a different approach. Developed by de Shazer and colleagues as a form of family therapy, it focuses on building solutions and believes that the problem itself is often almost irrelevant. In her new book, Learning Solution Focused Therapy: An Illustrated Guide, Dr Anne Bodmer Lutz takes us through the principle techniques it uses to do so. Dr Lutz, who is the Director of Training of the Institute for Solution-Focused Therapy, Massachusetts and has extensive experience in this field, does an admirable job in presenting a brief and clear outline of what Solution-Focused Therapy involves and a practical guide on how to utilise its techniques.
Solution-Focused Therapy was developed through examining hours of videotaped sessions with patients in an attempt to ascertain what practical techniques work best in a therapeutic setting. What resulted was very much a patient-centred approach focusing on positive techniques such as complements, goal negotiation and focusing on the patient’s strengths and resources. This is in contrast to the standard medical model in which eliciting pathology is regarded as key to treatment. While this book focuses mainly on its use as a form of therapy for children and families, Dr Lutz is keen to point out that the techniques used can also be integrated into the standard Psychiatric assessment and other areas such as Psychopharmacotherapy and Addiction.
One of the strengths of this book is the use of case studies and practical examples to illustrate the application of Solution-Focused Techniques in a clinical setting. Cases are laid out as conversations between the patient and therapist and include discussion and commentary from the author. For example, Beth is an 18 year old who has suffered significant loss and trauma as a child and subsequently has been diagnosed with a non-verbal learning disorder as well as depression and executive functioning difficulties. The Solution-Focused Therapist uses key sets of questions while interviewing Beth. She begins by asking what she is good at or enjoys, and helps her to identify the most important people in her life (known as VIPs). The patients main goals are established (goal negotiation), and times when she felt well are explored for differences to her current situation (amplification of positive differences). Throughout the interview, rating scales of 1–10 are used to help the patient rate her emotions and experiences (scaling questions). These questions and others help focus the patient on solutions through exploring times when their problems were either not present or not as troubling as they are now. Another prime example of this is when the patient is asked to imagine a ‘miracle day’, where they wake up and their problem has magically disappeared. The therapist then ascertains what is different about this miracle day as a means to identifying possible solutions to the problem presented.
Throughout these sets of questions, the author gives detailed commentary on their purpose, how they should be asked and what is hoped to be achieved by asking them. A high degree of importance is placed on the language used and avoiding negative statements or those that could be construed as judgmental. Detailed case studies such as this are used throughout the book and are particularly useful in illustrating the practical applications of Solution-Focused Techniques.
The core techniques outlined above (i.e. beginning with strengths and resources, scaling questions and amplification of positive difference, etc.) are explored in more detail in subsequent chapters. The book is well structured and concise, with each chapter containing a brief introduction, tables with sample questions, links to video illustrations, case vignettes and commentary. Key points and references for further reading are also given at the end of each chapter. This gives the book a very practical feel, with case vignettes taken from real cases that the author has worked with and good descriptions and commentary adding clarity to the practical application of Solution-Focused Techniques. A library of 30 video links is easily accessible online, showing how one might use these techniques in real patient scenarios. These videos are short but serve to illustrate specific aspects of Solution-Focused Therapy, such as beginning with problem free talk or using scaling questions, by showing a simulated interview between therapist and patient. The book ends with useful chapters on how to integrate Solution-Focused Techniques discussed into other areas such as the Psychiatric assessment and its uses in Psychopharmacotherapy and Addiction.
Although the Solution-Focused Approach doesn’t necessarily come intuitively to doctors used to being taught how to illicit and describe pathological processes, there is much to be gained from reading this concise and practical book. The therapeutic alliance is key to our encounters as Psychiatrists and doctors, and at the very least, the Solution-Focused Approach provides us with valuable skills in this area. It can be adopted either partially or fully and can be integrated into the more standard Psychiatric Assessment and into other areas such as Psychopharmacotherapy and Addiction. This interesting and practical book gives an excellent guide to utilising these techniques and presents an easy and stimulating read for mental health care professionals and others alike.
