Over the past 20 plus years, many people have mistakenly assumed that Solution Focused Brief Therapy (SFBT) is similar to the Cognitive Behavioural Therapy model (CBT). I have usually responded politely with “mmmm….kind of…but Solution Focused working is much more client-owned and client-directed” but I do actually consider that CBT is hard work for the client and some motivation from the client is required. Whereas with SFBT, the main resource of the practitioner is their “curiosity” and sense of “not knowing”. It is in the “not knowing” and the “curious” stance of the practitioner that the client is drawn into discovery about themselves and what will work for them.
CBT is often confused as so closely related to SFBT (it must be the B an the T!) that at least three times a year we are commissioned by teams who have funding for CBT but prefer SFBT (which is great until it comes to Evaluation time and then all the good outcomes for clients are put firmly under the “CBT Evaluation” file which is frustrating) So, given that I have had a note on my “to do” list since 1998: “Write an article on the differences between CBT and SFBT” there it has sat, yellowing no doubt, somewhere in a cupboard, somewhere in storage. All these years later, I will attempt to explain:
Firstly, both models focus on behaviour change. But if we look closer at the structure and ethos of both models:
According to the Royal College of Psychiatrists:
The structure of a Cognitive Behavioural Therapy session*:
With the therapist, you break each problem down into its separate parts. This will help you to identify your individual patterns of thoughts, emotions, bodily feelings and actions.
Together you will look at your thoughts, feelings and behaviours to work out:
– if they are unrealistic or unhelpful
– how they affect each other, and you.
– the therapist will then help you to work out how to change unhelpful thoughts and behaviours.
– It’s easy to talk about doing something, much harder to actually do it. So, after you have identified what you can change, your therapist will recommend ‘homework’ – you practise these changes in your everyday life. Depending on the situation, you might start to:
– question a self-critical or upsetting thought and replace it with a more helpful (and more realistic) one that you have developed in CBT
– recognise that you are about to do something that will make you feel worse and, instead, do something more helpful.
– At each meeting you discuss how you’ve got on since the last session. Your therapist can help with suggestions if any of the tasks seem too hard or don’t seem to be helping.
– They will not ask you to do things you don’t want to do – you decide the pace of the treatment and what you will and won’t try. The strength of CBT is that you can continue to practise and develop your skills even after the sessions have finished.
– This makes it less likely that your symptoms or problems will return.
The structure a of Solution Focused Brief Therapy session :
According to us:
As the expert on your own life and what you would consider the presenting issue, you will be asked by the practitioner “How specifically can I help you today?” (although if you do not want to state this, we are perfectly comfortable with that too and we would offer you our own The Silent Session (E.Murphy ’06)
We would always be curious too about the things you don’t want to change and will take time to explore with you what is working for you now, what you are managing well (strengths are transferable after all).
The practitioner will ask you about times when you managed the problem differently – and will be very interested in those exceptions and will spend time exploring how you managed this; what you did rather than spend time on the why because of course, motivation can change but, the “how” you did something is what we are really interested in. Once you have “heard” what these unique, individual strategies are – we hope you will do more of them. In response to the exceptions discussion, when the client says “I just breathed deeply and shrugged off the anger” – we put a magnifying glass over that “how”. The client may not be aware of “how” only “why” but its our curiosity and interest that will prompt the client to go look for the answer in order that this successful strategy can be acknowledged and repeated when s/he next needs it.
Because the practitioner is very interested in “looking at, and talking about,the day after the problem is resolved rather than tracing the pathology of the problem” – s/he will be very curious about the minutiae of what a preferred future looks like.
The practitioner, using various questions, such as The Miracle Question for instance, will invite you to visualize what will be different when you have achieved your desired change, goals, preferred future and will be very curious about the benefits, in small detail, of your achieving achieving this.
You may be invited to set a task for yourself that reflects your lifestyle, culture, family culture, the unique minutiae of how you live your life.”You said that when you get up earlier, you feel better about your potential to recover from this and I wondered, if I gave you a task to monitor how this helps, would you accept this task?”
We will not necessarily work with you to “change your negative thoughts” – it is actions that change thoughts: I’m with Aristotle – “You are what you consistently do”
The practitioner will also be curious about how you will deal with any setbacks that may occur on the journey towards change – “rehearsing for setbacks robs them of their destructive force”. (Steve deShazer)
As a practitioner of Solution Focused Brief Therapy, what I admire most about the model is the principle that “the client is the expert of the client’s life” and the practitioner takes a stance of conduit through solution-focused questioning and responding. The sessions don’t have to be formal, they don’t have to take place in a “session room” they don’t rely on paper or digital resources – they can take place in a 5 minute conversation, in a school hallway, over a garden fence. Just conversations that stir the individual to be curious too about what works now and what a preferred future will look like. This is essential, in my opinion, for sustainability of behaviour change or goal achievement.
I’m also with Cicero: “No one can give you wiser advice than yourself”
For 1 – 3 day training in the Solution Focused Approach, along with our own specialist resources and frameworks, including The Change Balloon, The Silent Session, The Relationship Map, SFBT Groupwork and The “Notice Board”, contact us at firstname.lastname@example.org or call for an informal conversation on Tel 07779 242 289.