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Nền tảng của SFT
Khi phát minh ra động cơ hơi nước lần đầu tiên được công bố vào thế kỷ trước, người ta cho rằng một nhà khoa học nổi tiếng và thông minh đã nhận xét: 'Nó hoạt động trong thực tế, nhưng nó có hoạt động trên lý thuyết không?'
(trích trong O'Hanlon và Wilk, 1987)
Lipchik và cộng sự. (2011) đưa ra một tài khoản thú vị về cách Trị liệu Tập trung vào Giải pháp (SFT) được phát triển từ công việc của nhóm tại Trung tâm Trị liệu Gia đình Tóm tắt (BFTC) ở Milwaukee Hoa Kỳ. Họ tuyên bố rằng mô hình này phát triển từ thực hành lâm sàng (de Shazer và cộng sự, 1986) và xuất hiện từ hàng nghìn giờ quan sát đằng sau màn hình và các cuộc thảo luận kéo dài giữa nhóm quan sát viên. Họ phát hiện ra rằng khách hàng đã đạt được tiến bộ bằng cách nói về tương lai mong muốn của họ mà không phân tích lịch sử 'đầy vấn đề' của họ. Họ cảm thấy được trao quyền khi mô tả những gì họ muốn xảy ra trong cuộc sống (giải pháp). Những 'giải pháp' này không chỉ giúp giải quyết vấn đề của họ mà còn bao hàm nhiều khía cạnh trong cuộc sống của khách hàng. Việc sử dụng cái được gọi là Nhiệm vụ phiên công thức đầu tiên, trong đó khách hàng được yêu cầu 'chú ý và ghi nhớ những điều đã xảy ra trong tuần này mà họ muốn tiếp tục', đã tạo ra những kết quả tích cực đến mức nó trở thành bệ phóng cho một cách tiếp cận hoàn toàn tập trung vào giải pháp (de Jong và Berg, 2008). Nhóm lâm sàng nhận ra rằng 'giải pháp' không nhất thiết phải phù hợp với 'vấn đề' – chúng phải phù hợp với khách hàng. Họ cũng nhận thấy rằng thông qua quy trình đặt câu hỏi, họ có thể gợi ra những ý tưởng rõ ràng về sự thay đổi từ khách hàng. Những câu hỏi này, được de Shazer (1985) mô tả là “chìa khóa khung xương”, đã mời gọi khách hàng:
trở nên ý thức hơn về những trường hợp ngoại lệ - những lúc họ đã thành công trong việc khắc phục vấn đề của mình;
sử dụng các nguồn lực cá nhân và xã hội của họ;
hãy tưởng tượng tương lai ưa thích của họ – câu hỏi kỳ diệu;- take small steps forward.
Những câu hỏi này được định hướng mạnh mẽ về tương lai chứ không phải quá khứ trên cơ sở “tương lai không tồn tại và không thể đoán trước được”. Nó phải được tưởng tượng và phát minh ra' (Gelatt, 1989). Ở một mức độ nào đó, tương lai ít gây tranh cãi hơn quá khứ - ít nhất nó cũng mở ra những khả năng mới để mọi thứ trở nên khác biệt. Việc phát hiện ra rằng các biện pháp can thiệp định hướng tương lai đã trao quyền cho khách hàng đã thay đổi hoạt động của nhóm. Trong nhiều bài báo và sách, de Shazer đã mô tả cách các thành viên trong nhóm thử nghiệm các biện pháp can thiệp được thiết kế để tạo điều kiện thuận lợi cho việc thảo luận về giải pháp (de Shazer, 1984, 1985; de Shazer và Molnar, 1984; de Shazer và cộng sự, 1986). Bằng cách bám sát chương trình nghị sự của khách hàng, họ bắt đầu phát triển mối quan hệ hợp tác bền chặt với họ. Họ khuyến khích khách hàng tập trung vào những gì có thể thay đổi và có thể đạt được, thay vì để cho quy mô và sự phức tạp của vấn đề làm mất đi sức mạnh và quyền lực của họ. Nhóm nghiên cứu tỏ ra nghi ngờ về những nhãn hiệu vấn đề mà khách hàng hoặc người giới thiệu mang theo, thay vào đó họ muốn tập trung nhiều hơn vào những mô tả không có vấn đề về hành vi và năng lực của khách hàng, với niềm tin rằng mọi người có xu hướng cư xử tốt khi được đối xử tốt và hành động thành thạo khi được đối xử tốt. được coi là có năng lực. Các thành viên nhóm BFTC nhấn mạnh tầm quan trọng của việc học hỏi từ khách hàng cách cộng tác với họ. Khi họ suy ngẫm về trải nghiệm của mình với khách hàng, nhóm bắt đầu phát triển cơ sở lý luận về mặt triết học và nhận thức luận. Đặc biệt, de Shazer bắt đầu công bố ý tưởng của mình và nghiên cứu của nhóm. Cade (2007) trình bày đầy đủ hơn về triết lý đằng sau cách tiếp cận này. Schwartz (1955) đã xác định ba giai đoạn mà các lý thuyết mới sẽ trải qua.
Trong giai đoạn đầu tiên – Chủ nghĩa Bản chất – có nhiều trường phái cạnh tranh nhau, mỗi trường phái đều khẳng định ưu thế. Những người theo họ có xu hướng là những người theo đạo Tin lành, hẹp hòi và không khoan dung. Giai đoạn này kéo dài cho đến khi những sai sót và hạn chế của lý thuyết xuất hiện và/hoặc nó được tích hợp vào các thực tiễn đã được thiết lập.
Trong giai đoạn thứ hai – Chuyển tiếp – bản thân những người theo sau bắt đầu nhận ra những hạn chế trong mô hình của họ. Điều này có thể dẫn đến một cuộc nội chiến giữa những người cấp tiến chấp nhận những hiểu biết mới này và những người chính thống 'bảo vệ đức tin' và coi mình là những tín đồ chân chính. Sau đó, họ có thể chọn rút lui vào giai đoạn Chủ nghĩa Bản chất. Sự căng thẳng biện chứng giữa hai thái cực có lẽ có thể tạo ra một đảng trung dung.
Giai đoạn thứ ba – Sinh thái – là một quá trình tích hợp với các ý tưởng khác, kèm theo sự hiểu biết về bản chất không ngừng phát triển của lĩnh vực này. Trong giai đoạn này, một quan điểm chiết trung hơn có thể xuất hiện.
Chuỗi sự kiện này thường áp dụng cho các mô hình trị liệu mới vì mỗi mô hình này đều tìm cách tìm chỗ đứng của mình trong một thị trường cạnh tranh. Việc chuyển đổi sang một cách tiếp cận mới có thể, giống như việc chuyển đổi vì bất kỳ mục đích nào, ngăn cản thay vì giành được những người sùng đạo mới do quá cứng rắn trong lời chứng và việc truyền giáo của họ. Tôi hy vọng trong các chương sau sẽ tránh được điều này bằng cách chỉ ra cách các ý tưởng và biện pháp can thiệp tập trung vào giải pháp có thể được tích hợp vào danh mục của các nhà trị liệu, bất kể định hướng của họ là gì, đồng thời cũng thừa nhận những hạn chế của nó. Không chỉ các nhà trị liệu nhận thấy cách tiếp cận tập trung vào giải pháp là hữu ích mà nhiều người khác cũng làm việc để hỗ trợ mọi người - huấn luyện viên, cố vấn, giáo viên, y tá, người lạm dụng chất kích thích, nhân viên thanh niên và nhiều người khác. Cách tiếp cận này có thể được điều chỉnh để phù hợp với nhiều bối cảnh và nhóm khách hàng khác nhau.
Epistemology
In understanding theories of therapy it is essential to address the philosophical and epistemological positions that underlie them. In advocating the use of questioning as the major intervention in solution-focused work we need to explore why this should be so. Lynch (1996) identifies three perspectives on knowledge and reality that are available to the counsellor and researcher. The first perspective, a modern position, argues that there is an objective reality, of which we can have objective knowledge by virtue of our use of reason. This is the stance taken by the scientific/medical model, with its emphasis on testing hypotheses by a rational analysis of cause and effect.
The second, a social constructionist postmodern perspective, claims that there is no objective meaning to reality and all meaning is a human creation influenced by social and cultural factors. As language is a public phenomenon, our knowledge of reality is shaped by the linguistic context in which it is used. What was previously considered a definitive ‘truth’ was actually the dominant discourse of the powerful. Historically in the Western world, this has meant a white, male, heterosexual viewpoint. Other views of the world, such as black, female, or gay, have been regarded as deviations from the norm. The postmodern position takes a critical, anti-authoritarian stance towards establishment dogmas. It is pragmatic and pluralistic in its approach.
The third perspective, which emphasises context, takes the view that there is an objective order and meaning in reality, but we are unable to know it because we are always constrained by our social context.
Practitioners will vary in terms of how aware or committed they will be to these epistemological stances. Their lack of awareness does not alter the fact that their practice inevitably makes many epistemological assumptions. While the current prevalence of pragmatic attitudes within psychotherapy is more creative than the narrow, defensive and polemical mentality that has characterised much of the history of psychotherapy, failing to pay rigorous attention to theoretical assumptions can lead to a largely technical practice that will be divorced from the ideological root from which it sprang. Just as a particular artefact found in an archaeological dig derives its meaning from its relationship to other items unearthed on the same site, understanding particular therapeutic interventions only comes from paying attention to the context – that is, the bigger picture.
SFT belongs to the constructionist school of therapies, included among which are Kelly’s (1955) personal construct theory; neuro-linguistic programming (Bandler and Grinder, 1979); the brief problem-solving model developed at the Mental Research Institute (MRI) in Palo Alto, California, by Watzlawick, Weakland and Fisch (1974); and the narrative approach described by White and Epston (1990). The MRI and the SFT model owed much to the seminal thinking of Gregory Bateson (1972) and Milton Erickson (1980). Brian Cade (2007) offers a more detailed history of the Brief Solution-Focused approach.
Constructionism
In ancient Greece, the word theoria referred to a privileged group of male citizens who attended ritual cultic events, the athletic games and major public ceremonies. Their report back to the rest of the populace was considered to be ‘the truth’ about these occasions.
We use the term ‘theory’ to mean a speculative explanation for particular realities – it is a framework for making sense of information. The social constructionist epistemology that underpins SFT critiques the power claimed by the theoria to be the one, true interpreter of reality. Constructionism argues that meaning is created in the process of social interaction and negotiation. For example, the value of gold is disconnected from gold’s physical properties, but attributed to it by a process of consensus by human beings. The value of gold is not the gold itself. It is attributed to gold by culture, consensus and interaction, and may be different from moment to moment, from individual to individual, from culture to culture. We have no direct access to objective truth independent of our linguistically constructed versions of reality. Theories are not objective versions of an external reality, but socially constructed views that emerge within a cultural, political and social context. According to Walter and Peller (1996: 14):
The implications of seeing meaning-making as a social event of at least two selves while at the same time realizing that language is not tied to an objective reality, are that in a conversation there are at least two stories, at least two constructions, and a mutual, coordinated construction process. No one person or school of thought possesses more of ‘the truth’ than another, so, the therapist, while having the expertise to guide the process, does not have access to truths that the client cannot access.
As Allen (1993: 31) writes:
The social constructionist values not knowing – knowledge is created out of conversations. There can be no drawing of irrevocable conclusions which are substantiated by selectively gathering and attending to data which support the theory. The knower actively participates in constructing what is observed.
According to Segal (1986), constructionism challenges our belief that reality exists independent of us, the observers. It undermines our wish for reality to be discoverable, predictable and certain. Constructionism claims that this inseparability of the known from the knower destroys the myth of absolute truth and the rigid dogmas that accompany it. Von Foerster’s puzzle demonstrates the point by presenting us with a sentence and inviting us to fill in the missing word:
This sentence has … letters.
The answer must include itself in the number of letters and there could be different answers depending on which number is chosen. You could not choose just any number, as there are already 22 letters before you insert your chosen number. In other words, there are different ‘correct’ answers to the problem (Segal, 1986).
Constructionism claims to present us with a much richer and more diverse way of looking at our world – one in which we have greater choices. In therapeutic interactions, the client and the therapist explore an extensive repertoire of meanings in order to negotiate a provisional understanding. This does not mean that any explanation for a ‘problem’ will suffice, but it underlines the subjectivity and cultural relativity of the language we use to describe our realities. Therapy becomes a dialogue in which both partners will construct the problem and its solution. It is a game of linguistic chess. The ‘problem’ (which now is placed in postmodern quotation marks) does not carry an objective, fixed meaning that a client brings with them. Instead, they will tell and retell their story using language that reshapes the social reality by which they live. In Watzlawick’s (1984) phrase ‘reality is invented, not discovered’. Language does not reflect reality, it creates it.
Historically, a structuralist representational view of language has dominated therapy. According to this the task of the therapist is to get ‘behind’ or ‘beneath’ the client’s language in order to discover its meaning. The interventions a therapist uses will depend on her philosophical and epistemological stance with regard to knowledge, pathology and the nature of the human being. In the structural approach, language represents ‘real’ things out there which have an objectivity that is independent of our knowledge of them – for example, concepts such as personality, behaviour, self-esteem. From this perspective, the skilled therapist’s task is to help the client find this lost ‘truth’ which will confer meaning on the client’s experience. The enlightenment arising from this discovery will hopefully guide and motivate the client towards living more resourcefully. The quest for the ‘truth’ of their life will take different paths according to whether or not the therapist believes that the key to the door lies in identifying repressed damaging experiences from the past, faulty irrational beliefs, patterns of learned maladaptive behaviour or a lack of self-actualisation. On that journey, the therapist will gather evidence that either confirms or challenges the original hypothesis. At some stage, the therapist will share this ‘evidence’ with the client, who will then either accept or reject it. If the client owns this discovery, both parties can feel that they have stumbled on something ‘real’ that was waiting there, hidden but discoverable. They can also feel that they have created a ‘common vantage point from which to survey the world together’ (Taylor, 1985). Russell (1989: 505) describes this as a ‘public space in which the character of social/physical realities are crafted and essayed linguistically’. This newly acquired knowledge will hopefully prove valuable to the client in understanding and changing the problem situation.
Figure 2.1 highlights many of the key qualities of a form of constructionism that focuses on the social context of language. These are as follows:
- It gives precedence to the client’s perceptions and experiences, rather than ‘the facts’.
- It utilises the multiplicity of narratives that clients could choose from in order to bring about the changes they desire.
- It emphasises the importance of ‘joining with’ the client in order to co-create a new and empowering narrative.
- It invites the therapist to affirm the expertise and unique experience of the client and disown a privileged position of knowledge and power.
- It affirms the therapist’s knowledge and skills in conducting conversations that will create therapeutic spaces for the client.
- It pays attention to the context in which the client’s narrative developed. This increases its potential for respecting and working with difference.
- It acknowledges people’s competence and strengths.
- It demands that the therapist develop a clear sense of her own values, blind spots and biases.
Problem-focused approaches
These tend to do the following:
- Assume a necessary connection between a problem and its solution and that the solution should look like the problem. If, for example, the client has had a problem for a long time, it is commonly thought that it will take a long time to find and implement a solution. If the problem is complicated, then it is assumed that the solution will also need to be complicated. The solution-focused position challenges this by claiming that clients can change without an in-depth analysis of their problems and that the solution construction process is separate from the problem-exploration process.
- Privilege the search for causal connections. In the psychological realm, these connections are frequently tenuous and unprovable. There may be many associated factors that have contributed to the development of a problem but to settle on one and for that to determine the course of treatment is often misguided and unhelpful. Is a client depressed because he has a genetic predisposition towards depression and/or because his family life was disrupted when his parents split up when he was ten and/or he lacked the social skills and confidence to make close relationships and/or he has low self-esteem and/or he is long-term unemployed? How are we to weigh up these factors? How do we know how significant they are? How do we know when we have gone ‘deep’ enough? Where does a therapist start to work given an agenda as diffuse as this? How long is it going to take for change to take place? What a priori values and principles determine the line of enquiry to which the therapist will give precedence? As Segal (1986) states in his discussion of the work of Von Foerster, we are obsessed with efficient causality, a form of explanation in which the cause precedes the effect. Yet there are other forms of causality as well: SFT attaches greater importance to final causality, where the effect precedes the cause. This focuses attention on how our future goals shape what we do in the present. Clarity about our preferred future then motivates us to do what is needed in the present. For example, a driver planning a journey will work back from the time he wants to arrive at his destination when plotting the course, speed, amount of fuel and stopping-off places along the way. The end point will therefore determine the means. And in engineering, manufacturers will examine and dismantle a competitor’s product, such as a car engine, in order to work out how it was made. In solution-focused therapy, therapists facilitate clients’ hopes of the desired end ‘product’ and then help them to work back to find out how they might get there. Instead of clients trying to analyse why they have the life they do, they will redirect their energy to create the life they want.
- Require clients to undergo certain stages or events in therapy before their attempts to change will be legitimated. For example, some therapies stipulate that a client must have a cathartic experience in which deep, previously unexpressed emotions are brought to the surface. Similarly, some therapies hold that clients must achieve insight about themselves if their apparent progress is to be anything more than just a superficial fix. There is an assumption that the ‘deeper’ the investigation of the psyche, the more ‘truthful’ the findings. However, there will be many clients who will apparently achieve this insight yet will remain none the wiser about how to bring about change. Some will suffer from ‘paralysis by analysis’. It can also happen that such insight proves unhelpful when it induces a fatalism born of a conviction that the past has unalterably determined the future.
In problem-focused work, the therapist uses a psychological map to explore the client’s problematic terrain. As the client explores this territory she becomes aware of the obstacles in her path and, hopefully, also learns how to overcome them. In this scenario, the therapist occupies the role of an expert guide who knows where to find the signposts and short cuts. Which route they choose will depend on the kind of journey that the two parties are willing to embark on. In long-term work, they may choose the scenic route; in short-term work, the fastest and most direct.
The solution-focused therapist also has a navigational system, but it is clients’ map-reading skills and self-knowledge of their interior and exterior landscape that will provide the crucial directions for the journey. In keeping with his role as a ‘travel companion’, the therapist resists adopting professional jargon which disempowers the client. Instead he takes a ‘not knowing’ position from which he disowns the role of expert or ‘the keeper of the truth’ in the client’s life. Together, they collaborate to negotiate a meaning for the client’s experience. The purpose of their dialogue is to negotiate a meaning for the client’s situation that will open up possibilities of change. For the social constructionist, language constructs and deconstructs our changing realities.
Negotiating narratives with clients is the essence of any type of therapy. For the solution-focused practitioner, certain types of narrative are more likely to motivate and support a client towards change than others. These are future-focused, competence-based and client-centred narratives. Future-focused narratives challenge beliefs that the future will be the same as the past. This is not to say that the past is not useful – it helps us to learn from our mistakes and successes. When driving a car it is essential we look in the rear-view mirror occasionally, but it is also advisable to spend most of our time looking through our front windscreen! The Mental Research Institute (MRI) model:
Every wrong attempt discarded is another step forward. I have not failed 10,000 times, I have successfully found 10,000 ways that will not work.
Thomas Edison
The MRI brief therapy model claims that problems emerge because people take action to solve these and the actions themselves then become part of the same problems. These actions include under-reacting to a problem by avoiding or denying it, or adopting strategies that will either have little positive effect or even compound the problem. In this view, the problem is the sum of the client’s failed solutions.
Practitioners from the MRI school (e.g., Weakland and Jordan, 1992: 245) have clearly described how clients will repeat such failed solutions. They will:
- use more of the same type of ‘solution’ and only vary the performance slightly by, for example, turning up the volume or increasing the frequency;
- avoid doing something that needs to be done: a client may not be able to summon up the energy or effort to do what she knows needs to be done;
- act in ways that are irrelevant or inappropriate to the problem (i.e., the ‘rearranging deck chairs on the Titanic’ syndrome): they may engage in strategies such as overworking in order to prevent them from having to think about the problem;
- try to move in two directions at the same time, and in desperation will choose solutions that cancel each other out – for example, fasting and bingeing;
- keep looking for the perfect solution: ‘Attempts to do the impossible in actuality will prevent doing what is possible and desirable, and will also make what might otherwise be bearable appear intolerable because it is imperfect’.
Using this model demands that the therapist identifies and explores the vicious circles that surround a problem and finds ways for the client to interrupt this problem cycle. It is vital to clarify precisely why a client has come for therapy and what exactly she hopes to gain from it. This, as any practitioner will know, is not always easy as clients can be vague and unsure about the nature of their problems and also ambivalent about what they hope to achieve from therapy. The therapist also tries to discover what the client or other significant people are doing to maintain the problem. Clients are thus encouraged to set clear, specific, small, but realistic, goals. The aim of these strategies is to displace the failed or attempted solution by either disrupting the status quo and/or by encouraging a quite different way of looking at or acting on the problem. Clients are usually given tasks to perform between sessions.
The focus of the work is on clients’ presenting problems, not on the underlying issues: ‘The presenting problem offers, in one package, what the patient is ready to work on, a concentrated manifestation of whatever is wrong, and a concrete index of any progress made’ (Weakland et al., 1974: 147). Cade (2007) argues that the MRI approach is not problem-focused, but like SFT is primarily focused on the future and on client resilience and resources.
Both the MRI and the SFT models were influenced by the innovatory work of Milton Erickson, ‘the father of strategic therapy’. According to Lankton (1990), the characteristics of Erickson’s therapy were:
- a non-pathology model: problems result from a limited repertoire of behaviour and attitudes on the part of clients;
- indirection: the therapist helps clients to tap into resources of which they were previously unaware, without the role of the therapist interfering in this;
- utilisation: this consists of mobilising any aspect of the client’s experience that could usefully contribute to resolving the problem;
- action: the therapist expects clients to act outside the therapy sessions to make the changes they want;
- strategic: the therapist designs interventions that are specific to each client;
- future-orientated: the emphasis is on the future rather than on the past or present;
- enchantment: the therapy seeks to engage clients in ways that appear attractive to them.
Most of these principles can be found in SFT, although therapist-designed strategic interventions are rarely used. Instead, the therapist trusts the client’s best instincts and sees that person as creative, imaginative and resourceful. The therapist, too, is optimistic, hopeful, creative and imaginative. He helps the client to keep heading towards her goals, but is not an expert who knows or chooses what that direction should be.
The epistemological basis of SFT offers therapists rich and varied access to clients’ worlds. Its sensitivity towards the power of language in socially constructing problems creates many possible therapeutic conversations. Its acknowledgement of the presence of many different ‘truths’ and standpoints validates clients’ worldviews while also providing a basis for ‘reauthoring’ (White, 1995) their narratives. Its recognition of the social context of language highlights the powerful impact of culture, race and gender discourses in therapy. It offers a model of the therapist-client relationship, characterised by a respect for each client’s expertise. Its reluctance to reify problems into fixed and defined ‘truths’ about clients highlights the dynamic process of change and increases the possibility of change happening.
Practice points
- Solutions fit the clients, not the problem.
- Sometimes it helps to know as little as possible about your clients before you meet them (except where risk is a consideration).
- Exploring failed solutions can be a useful starting point.
- You can help clients without identifying the ‘causes’ of their problems.
- Consider how it would affect your work if you believed that ‘truth was not there to be discovered, but to be invented’.
- There are power implications when taking a therapeutic stance based on social constructionism. How would you handle giving away much of your power to clients?
