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Chapter 9: Solution-Based Therapies

“We intend to influence clients’ perceptions in the direction of solution through the questions we choose to ask and our careful use of solution language. Reflection upon these questions helps clients to consider their situations from new perspectives.”

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Lay of the Land

Three Main Strands

Solution-focused brief therapy (SFBT): Focus on the future with minimal discussion of the presenting problem or the past; interventions target small steps in the direction of the solution.

Solution-oriented therapy: This and possibility therapy incorporate a future orientation while drawing more directly from the language techniques used in Ericksonian trance; uses more interventions that draws from the past and present to identify potential solutions.

Solution-oriented Ericksonian hypnosis: Both solution-focused and solution-oriented therapies were inspired by the work of Milton Erickson, whose strength-oriented trance work is one of the most popular modern approaches to hypnosis.

Because of numerous commonalities, solution-focused and solution-oriented therapies presented together under the general term solution-based therapies.

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Solution-Based Therapies

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

In a Nutshell: The Least You Need to Know

Solution-based therapies

Brief therapy approaches inspired by MRI in Palo Alto and Milton Erickson’s brief therapy and trance work.

Increasingly popular with clients, insurance companies, and county mental health agencies.

Spend minimum of time talking about problems; focus on moving clients toward enacting solutions.

Not “solution-givers,” therapists work with client to envision potential solutions.

Assist client in identifying small, incremental steps toward realizing goal.

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Common Solution-Based Therapy Myths

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Myth: Solution-Based Therapists Propose Solutions

Fact: Solution-based therapists do not suggest logical solutions to clients.

Client identifies solutions with help of the therapist.

Therapist identifies:

Exceptions to problem.

Descriptions of what is already working.

Client resources to help the client envision potential solutions.

Once a clear, behavioral goal is identified, the therapist works with the client to take small steps in this direction.

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Myth: Solution-Based Therapists Never Talk About Problem

Fact: Solution-based therapists, like all therapists, must spend some time talking about the problem.

Spend less time talking about the problem than most other therapists, especially SFBT therapists.

Therapists typically follow clients’ lead in determining how much and how often they need to talk about problem vs. solution.

Hallmark techniques, such as exception questions, require talking about the problem as part of identifying the solution.

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Myth: Solution-Based Therapists Never Talk About the Past

Fact: Solution-based therapists actually have numerous techniques that are grounded in talking about the past.

However, when they talk about the past, they focus on strengths as well as the problem.

Talking about the past is one of the most important means of identifying solutions: what has worked and what has not.

The past is talked about in ways that facilitate the enactment of solutions.

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Myth: Emotions Are Not Discussed

Fact: Emotions cannot be avoided in any therapy.

Solution-based therapists do not view expression of emotion as curative in and of itself, as is in humanistic therapies.

Emotions used as clues to what works and what does not and where clients want to go.

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

The Juice: Significant Contributions Field

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Assessing Client Strengths

Strengths

Include resources in a person’s life and may include family support, positive relationships, and religious faith.

Therapists often have to ask subtle questions and attend to vague clues in order to assess strengths well.

Assess strengths

By directly asking about strengths, hobbies, and areas of life that are going well.

By listening carefully for exceptions to problems and for areas of unnoticed strength.

Any strength in one context has the potential to be a liability in another context (and vice versa).

Key to successfully assessing strengths is belief that all clients have meaningful strengths no matter how dire their situations appear.

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Rumor Has It: The People and Their Stories

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Significant Contributors

Behind-the-scenes inspiration

Milton Erickson

Solution-focused brief therapy

Steve de Shazer

Insoo Kim Berg

Scott Miller

Yvonne Dolan

Linda Metcalf

Solution-oriented therapy

Bill O’Hanlon

Michelle Weiner-Davis

Collaborative, strength-based therapy

Matthew Selekman

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Solution-Focused Associations

Solution-focused brief therapy

SFBT has been influential in the United States, Europe, Latin America, and Asia.

European Brief Therapy Association: Serves as a network of brief therapy practitioners in Europe. They sponsor research projects in brief therapy and meet annually, bringing together therapists from across Europe and the world.

Solution-Focused Brief Therapy Association (SFBTA): In 2001, Steve de Shazer and Terry Trepper began organizing SFBTA to bring together North American SFBT practitioners and researchers. SFBTA is an active and engaged community of practitioners, educators, and researchers who work to further develop and refine SFBT practices.

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

The Big Picture: Overview of Treatment

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Small Steps to Enacting Solutions

How it works

Therapists help clients identify preferred solution and work to take small, active steps in this direction each week.

Sometimes, this is a very time-limited approach.

As few as 1 to 10 sessions.

Solution-focused therapists advocate possibility of single-session therapy.

In more complex cases, such as the treatment of sexual abuse or alcohol dependency, therapy may take years.

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Making Connection: The Therapeutic Relationship

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

The Zen of Viewing: The Beginner’s Mind

How it works

Zen saying: “In the beginner’s mind there are many possibilities; in the expert’s mind there are few.”

Use concept of a beginner’s mind when forming a relationship.

Involves listening to client’s story as if for first time, not filling in blanks with personal or professional knowledge.

Therapist should be curious about how this person experiences his/her unique symptom.

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Echoing the Client’s Key Words

Attend to Client Word Choice

Echo their key words.

Example: Rather than clients using psychiatric terms such as depression or hallucinations to describe experience, clients use own language such as “feeling blue” or “schizos.”

Using client language often makes problem more solvable and engenders greater hope.

“Ending the blahs” or “getting back to my old self” is a more attainable goal than treating a psychiatrically-defined problem.

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Carl Rogers with a Twist

Channeling language

Solution-oriented reflections delimit difficult feeling, behavior, or thought by reflecting on a time, context, or relational limit.

Reflections forms:

Past tense rather than chronic state or characteristic: Therapists reflect statements back to clients in the past tense.

Partial rather than global: Therapists reflect global statements back to clients as partial statements.

Perception rather than unchangeable truth: Therapists reflect a client’s “truth” or “reality” claim as a perception.

Solution-oriented twist emphasizes limited time and relational context in order to:

Define problem in more solvable ways.

Create hope.

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Optimism and Hope

“Hope is like a road in the country; there was never a road, but when many people walk on it, the road comes into existence.” — Lin Yutang

Assume that change is inevitable and that improvement is always possible.

Change is always happening: moods, relationships, emotions, and behaviors are in constant flux.

Hope that change will be positive because client is in therapy to make improvement and because over 90% of clients report positive outcomes in psychotherapy.

Hope is cultivated early in therapy to develop motivation and momentum.

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Assumption of Solution and Possibilities

Client resiliency

View all clients as capable of enacting solutions to presenting problems.

Assumption is realized in word choice, descriptions, and verb tense:

“When you two are getting along better” or “As you recover from trauma.”

Belief that clients are fully capable of change inspires clients to believe in themselves.

Key to making the interventions associated with this approach work.

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

The Viewing: Case Conceptualization and Assessment

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Exceptions and “What Works”

How it works

Most clients spontaneously offer exceptions and examples of what works.

Ex.: “His ADHD is less of a problem in his math class.”

Exceptions provide clues to what works and what clients need to do more frequently.

Therapists identify exceptions and descriptions of what works:

Indirectly, by listening for spontaneous descriptions.

Directly, by asking questions.

Use exceptions to help clients enact preferred solutions in their lives.

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Examples of Exception Questions

Exception questions

Are there any times when the problem is less likely to occur or be less severe?

Can you think of a time when you expected the problem to occur but it didn’t?

Are there any people who seem to make things easier?

Are there places or times when the problem is not as bad?

How they work

Problem varies in intensity; times when problem is less severe are exceptions.

Diagnoses experienced most of the time on most days; focus on variations of intensity rather than absence of the symptom.

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Client Motivation

Client motivation for change

Visitors: Don’t have a complaint, but generally others have complaint against them. Typically brought to therapy by other.

Complainants: Identify problem but expect therapy or someone else to be primary source of change.

Customers: Identify a problem and want to take action toward solution.

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Client Motivations

Assessing Client Motivation

People come to therapy with mixed emotions and levels of motivation.

Most mandated clients are “visitors;” therapists need to find a way to connect with them while still working with referring party’s agenda.

Often the case with children, teens, and even one-half of a couple.

With complainants, therapists need to either:

Find ways client can contribute to making a difference.

Help shift the viewing of the problem to increase client willingness to take action.

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Targeting Change: Goal Setting

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Goal Language: Positive and Concrete

Positive and observable

Positive goal descriptions emphasize what client is going to be doing rather than focusing on symptom reduction.

Observable descriptions include clear, specific behavioral indicators of the desired change.

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Examples of Observable/Nonobservable Goals

Positive, Observable Goals	Negative (Symptom-Reducing), Nonobservable Goals
Increase periods of enjoyable activity, social interaction, and hope for future	Reduce depression
Increase frequency of couple’s emotionally intimate conversations	Reduce couple conflict
Increase cooperation and pro-social activities	Reduce defiance

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Solution-Based Goals

Qualities of goals

Meaningful to client: Goals must be personally important to the client.

Interactional: Rather than reflect a general feeling, situational goals are stated in situational terms.

Small steps: Goals should be short-term and with identifiable small steps.

Clear role for client: Goals should identify a clear role for the client rather than for others.

Realistic: Goals need to be realistic for this client at this time.

Legal and ethical: Goals should be legal and adhere to client, therapist, and professional ethics.

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Miracle and Solution-Generating Questions

Solution questions

Miracle questions

Crystal ball questions

Magic wand questions

Time machine questions

These questions help clients envision a future without the problem, generating hope and motivation.

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Successfully Delivering the Miracle Question

The set-up

Obtain client agreement (wait for nod #1).

Custom tailor initial set up (wait for nod #2).

Set up for miracle (wait for nod #3).

Introduce the miracle (wait for pause).

Specifically and clearly define the terms of the miracle.

Add the mystery (nod #4, optional).

Ask what is different.

The Follow-Up

Therapist helps focus answer by asking about behavioral changes.

Not interested in what client is not doing, but in what client is doing.

If client says, “I will not be depressed anymore,” therapist responds with, “What will you be doing instead?”

Therapist continues until (3 or more) concrete miracle behaviors are identified that can be useful for developing direction for change.

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Small Steps: Scaling Questions

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Scaling Questions and the Miracle Scale

What they are

Clients define goals and rate progress towards them using a scale.

Most often a 10-point scale but sometimes percentages or shorter, non-numeric versions.

How they are used

To assess strengths and solutions, set goals, design homework tasks, measure progress, and manage crises with safety plans.

They can be used in the first session and can be reused weekly until the last.

Recommend having 0 represent “when you decided to seek help” rather than when things are “at their worst.”

When scaling 0 to mean “at their worst,” this can refer to decades earlier or have different meanings to different people.

Scaling from “when you decided to seek help” allows for clearer system for measuring progress; refer to these as “miracle scales” and use these scales to follow up with the miracle question.

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Two Approaches to Scaling

Miracle scale: Measures progress from beginning of counseling

When you decided to seek help Miracle Situation

0--------1--------2-------3------4--------5-------6-------7--------8-------9-----10

Worst-to-solution scale: Measures progress in general

Things at their worst Solution

0--------1--------2-------3------4--------5-------6-------7--------8-------9-----10

Scaling questions can be used early in the counseling process to help identify meaningful long-term goals.

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Scaling Question for Long-Term Goal Setting

Assessing solutions and setting goals

Counselor listens for clear, specific descriptions of what life would be like at a 10, helping the client to paint a clear, behavioral picture: What is the client doing, what are others doing, how does the day go?

Once a clear description of the 10 scenario is developed, the counselor can then ask where things are today and obtain a behavioral description of the current situation.

A concrete description of when things were at the point the client decided to seek help or at their worst (0 or 1) can also be useful assessment information.

Once the big picture is assessed, the same scale can be used to identify what works.

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Scaling Question for Assessing What Works

If 0 is where you were when you decided to seek help and 10 is where you would be if the problem you came here for was resolved, where are you today?

[If above a 0] What are you doing or what is happening that tells us you are at a 3 and not 0? How did you get from a 0 to here?

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Scaling Question for Week-to-Week Interventions

On a scale from 0-10, with 10 being your desired goal, where are you this week? If you are at a 3 this week, what things would need to be different in your life for you to come in and say you were at a 4, one step higher?

Counselors need to practice patience, silence, and encouragement to help clients identify mini-steps towards their goal.

Once a clear description of next step is developed, this information is used to identify specific, small tasks the client can take during the next week to move one step higher on the scale.

Generally takes entire session to fully flesh out concrete steps that are realistic and meaningful, and something the client is motivated to try.

For intervention to work, counselor and client need to develop micro-steps taking into account client’s motivation, willingness, schedule, variations in the schedule, reactions of others, etc.

Therapist asks questions to identify potential barriers as well as helpful resources, working with client to find ways to negotiate these.

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Scaling Question for Measuring Progress

Last week you said you were at a 3. Where would you say you are this week and why? What did you do that helped move you up the scale? What happened that kept things the same (or made them worse)?

Counselor follows up next week to see if the homework tasks helped move clients closer to their goals.

If so, they explore what helped and how to do more of it.

If clients don’t report progress or report that things got worse, the counselor goes back to more carefully assess whether the solution has been meaningfully assessed and concretely identified, and whether task was small enough, concrete enough, and motivating enough.

This scale can be used to measure progress from the beginning to end of the counseling process.

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

One Thing Different

Client-generated change

In the beginning, key is to do one small thing different.

Call one friend rather than visit with someone every day.

Goal of “get up and exercise one day this week” more likely to generate change and motivation for further change than goal of “get up and exercise every day this week.”

Making one small change starts a cascade of change events inspired from client’s own motivation.

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

The Doing: Interventions

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Solution-Focused Tenants for Intervention

Tenants

If it isn’t broken, don’t fix it.

If it works, do more of it.

If it’s not working, do something different.

Small steps can lead to big changes.

The solution is not necessarily related to the problem.

The language for solution development is different from that needed to describe a problem.

No problem happens all the time; there are always exceptions that can be utilized.

The future is both created and negotiable.

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Formula First Session Task

Formula first session task: “Between now and next time we meet, I would like you to observe so that you can describe to me next time what happens in your [family, life, marriage, relationship] that you want to continue to have happen.”

Paraphrase with introduction: “As we are starting therapy, many things are going to change. However, I am sure there are many things in your life and relationships that you do not want to have changed. Over the next week, I want (each of) you to generate a list of the things in your life and relationships that you do not want to have changed by therapy. Notice small things as well as big things that are working right now.”

Stimulates clients to notice what is working, identifies their strengths and resources, and helps generate hope in their ability to change.

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Scaling Questions for Weekly Task Assignments

How they work

Scaling questions are used for goal setting as well as for developing weekly tasks and homework.

Once client identifies what behaviors constitute moving up the scale, identify specific small changes needed to enact behaviors.

Can be used weekly to develop homework assignments to move clients step-by-step toward goals.

If clients don’t complete assigned tasks, therapists need to reassess.

Am I expecting a complainant to be as motivated as a customer for change?

Was the task too big or can smaller steps be taken?

Are the right people involved?

What actually motivates the client to take action and move toward change?

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Asking Presuppositional Questions

How they work

Help clients envision a future without problem, generating hope and motivation.

Therapists assume change based on observation that all things change: a client’s situation cannot not change.

Knowing that change is inevitable, therapists can be confident when they ask presuppositional questions.

What will you be doing differently once we resolve these issues?

Do you think there are other concerns you will want to address once we resolve these issues?

When the problem is resolved, what is one of the first things you will do to celebrate?

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Utilization

What it is

Draws on hypnotic work of Milton Erickson

Refers to finding way to use whatever client presents as a strength, interest, proclivity, or habit to develop meaningful actions that will lead in direction of solutions.

Ex.: If client has difficulty making friends but has numerous pets, utilize client’s interest in animals to develop more human connections. Perhaps have the client take a dog for a walk in public places, join a dog agility class, or volunteer at a pet shelter.

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Coping Questions

How they work

Generate hope, agency, and motivation.

Used when client is not reporting progress, describing an acute crisis, or otherwise feeling hopeless.

Direct clients to identify how they have been coping with a current or past difficult situation.

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Compliments and Encouragement

How they are used

Motivate clients and highlight strengths.

Compliment only when clients are making steps toward goals they’ve set or compliment specific strengths that relate to the problem.

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Therapeutic Compliments

Rule for making compliments

Compliment client progress, not their personhood.

Therapeutic compliment:

Wow! You made real progress toward your goal this week.

Even better therapeutic compliment:

I am impressed; you not only followed the chart idea we developed last week but you came up with your own additional strategies to improve your relationship with your son.

Not-so-good therapeutic compliments:

I really admire what you have done with your life.

You really are a great mom.

Complimenting anything other than client’s goals and strengths is a judgment on the client or his/her life.

When clients can set goals and make progress toward them, they develop a greater sense of self-efficacy.

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Interventions for Specific Problems

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Couples Therapy and Divorce Busting

Solution-oriented couples therapy is popular because emphasis on strength and hope is well-suited for working with negative, interpersonal conflict.

Especially with couples who are in crisis or considering divorce.

Solution-oriented couples therapies have unique interventions.

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Videotalk

What it is

Based on distinguishing between facts, stories, and experience.

Facts are a behavioral description of what was done and said.

Story is interpretation and meaning associated with the behaviors.

Experience is the internal thoughts and feelings each person had.

Separate behaviors from the interpretation of the behaviors.

Couples become less defensive and able to better understand each other and identify meaningful ways to reduce future conflict.

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

From Complaints to Requests

How it works

Encourage clients to ask for what they want rather than what they don’t want.

Move from making complaints to making requests.

Ex.: “You don’t do anything romantic anymore.”  “I would really enjoy adding romance back into our relationship.”

Requests need to be behavioral and specific.

Ex.: “I’d like to go away for a weekend; go to dinner and a movie; go to the beach for a sunset walk.”

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Therapy for Sexual Abuse and Trauma

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Honoring the Agency of Survivors

Honor agency of survivors, allowing them to determine pacing of their treatment.

Work with clients to identify if, when, how, and to whom it is best to tell their stories.

By honoring their agency, survivors regain full authority over private aspects of their lives.

Directive role in working with survivor may unintentionally replicate abuse pattern by forcing clients to reveal parts of their sexual life before they are ready.

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

The Recovery Scale

Solution-focused recovery scale

Identify what areas of client’s life weren’t affected by abuse.

Reduce sense that client’s whole life and self have been affected.

Success strategies in these areas are used to address areas that are affected by the abuse.

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

3-D Model

Dissociate, disown, and devalue

Abuse leads people to dissociate, disown, and devalue aspects of self.

Develop symptoms that inhibit experience or create intrusive experiences.

Goal of therapy is to reconnect people with disowned parts.

Symptoms related to sexual abuse experienced as negative trance.

Feeling that experience is uncontrollable and involves only part of self.

Use permissive, validating, and inclusive language to encourage clients to revalue and include devalued aspects of self that were disowned through abuse.

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Constructive Questions

Examples

What will be the first (smallest) sign that things are getting better, that this (the sexual abuse) is having less of an impact on your current life?

What will you be doing differently when this (sexual abuse trauma) is less of a current problem in your life?

What will you be doing differently with your time?

What will you be thinking about (doing) instead of thinking about the past?

Are there times when the above is already happening to some (even a small) extent? What is different about those times? What is helpful about those differences?

What differences will the above healing changes make when they have been present in your life over an extended period of time (days, weeks, months, years)?

What do you think your significant other would say would be the first sign that things are getting better? What do you think your significant other will notice first?

What do you think your (friends, boss, significant other, etc.) will notice about you as you heal even more?

What differences will these healing changes you’ve identified make in future generations of your family?

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Videotalk (Action Terms)

Survivors have difficulty identifying current effects of abuse in present life.

Videotalk with survivors helps identify specific actions and patterns of behavior that recreate the traumatic experience.

Once recurrent patterns are identified, therapists help clients:

Change part of context to interrupt the cycle and create space for new responses.

Identify new, alternative solution-generating actions.

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Solution-Oriented Ericksonian Hypnosis

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Ericksonian Hypnosis

Solution-oriented hypnosis

Also known as Ericksonian hypnosis or naturalistic trance.

Aims to evoke client strengths and resources to resolve problems.

Grew out of the work of Milton Erickson, preceding solution-focused and solution-oriented therapies.

Many solution-focused premises and techniques directly evolved from Erickson’s approach to hypnosis and therapy.

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Difference from Traditional Hypnosis

Permissive rather than hierarchical.

Traditional hypnosis is hierarchical; whereas solution-oriented hypnosis is permissive

Evokes client’s natural resources.

In traditional hypnosis, therapist effectively “reprograms” the client once he/she is in a trance; in solution-oriented therapy, the therapist tries to “evoke” or stimulate the client’s natural resources for healing.

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

The Big Picture: Overview of Treatment

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

The Process

How it works

Invites client to go into trance in order to evoke strengths client already has.

May be done with or without clear induction into hypnotic trance state.

Erickson known for using stories, analogies, and directives to activate latent abilities; enable clients to resolve problems.

Arguably first brief therapy.

Developed when psychiatry and psychotherapy were dominated by psychodynamic ideas.

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

The Doing: Interventions

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Permission

In the trance state

Therapists give clients permission to think, experience, and feel whatever they’re experiencing without pressure to do something.

Clients given explicit permission to have doubts, allow their mind to chatter, lose focus, entertain distracting thoughts, and accept other thoughts or feelings.

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Presuppositions

How it works

Presuppose that clients will enter a trance state by delivering certain questions and comments to client.

Example:

“Have you ever been in a trance before today?”

“You can choose to keep your eyes open or closed when you go into a trance.”

“Don’t go into a trance too quickly”

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Splitting

What it is

Split two things that client may habitually consider as one.

Conscious and unconscious mind or the left brain and right brain.

Problem-saturated thoughts and feelings are attributed to conscious mind and positive thoughts to unconscious to allow client to trust trance process.

Example:

“Your conscious mind may doubt that trance is even possible, but your unconscious mind knows exactly what to do.”

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Class of Problems Versus Class of Solutions

How Erickson worked

Often seemed to discuss issues and topics that were unrelated to problem.

Erickson would assess class of problem and identify class of solution that would most likely solve problem.

Focus on evoking class of solution in any other area of the person’s life rather than trying to solve literal problem.

Evoke solution through both dialogue and trance.

Identifying class of solution is useful when assessing strengths; all strengths are not created equal.

Important to identify client strengths that are in same class of solutions that relate to presenting problem.

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Tapestry Weaving: Working with Diverse Populations

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Ethnic, Racial, and Cultural Diversity

Successful use with:

Populations in North and South America, Europe, Middle East, Asia, and Australia.

Schools, prisons, hospitals, businesses, and colleges.

Pros: Behavior considered in context, client-generated, behavioral goals, behavioral rather than emotional focus, and future orientation.

Asian-Americans

Compatible because of its positive reframing, relation-based perspective and its focus on pragmatic solutions.

Considerations for working with Asian clients include:

Filial piety, form and content, practical solutions, saving face, and brief treatment.

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Sexual Identity Diversity

Use “beginner’s mind”

Inquire about role in client’s presenting problem.

Has been used to facilitate adjustment to one’s spouse coming out.

Used to help client identify own solutions to situation in a supportive, non-pathologizing context.

Use seven stage model for partner adjustment to news that their spouse is homosexual or bisexual:

Disorientation/disbelief, facing and acknowledging reality, accepting, letting go, healing, reconfiguring and refocusing, and transforming.

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart

Research and the Evidence Base

Empirical support

Solution-focused brief therapy has modest effect sizes and equivalent outcomes to other approaches but does so in less time at less cost.

Office of Juvenile Justice and Delinquency Prevention has recognized it as a promising practice.

Effectiveness of solution-focused brief therapy with a wide range of clinical populations and problems.

Domestic violence offenders, couples, schizophrenics, child abuse, troubled youth, school settings, parenting, alcohol, foster care.

Presuppositional questions, miracle question, first-session task, scaling questions, and solution talk have been found to accomplish intended therapeutic effect.

Solution-focused therapists are positive in formulations and questions as compared with client-centered and cognitive-behavioral therapists, whose formulations and questions were primarily negative.

Mastering Competencies in Family Therapy (2nd ed.)

Diane R. Gehart