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”
Eileen Murphy
Twitter: @EileenHMurphy @SFBT_Solutions
Email: info@brief-therapy-uk.com
www.brief-therapy-uk.com
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There is a world of difference between the two in my experience. As the saying goes you get more of what you focus on, SFBT encourages reflection on your life but does so to search out what works and to identify your strengths and coping strategies. CBT also gets you to examine your world but in order to pick holes in it and find out where you are going wrong. How depressing.
Thanks jeni for sharing your experience with us.I am also fallowing solution therapy It is really worth full.If anybody wants than they can try it.
I wanted to respond to the above statement that CBT ” gets you to examine your world but in order to pick holes in it and find out where you are going wrong.” A person visits a therapist for a reason… especially since the cost is $80-$150 per hour. In that case a counselor doesn’t need to search for problems to deal with, but people usually have problems they want help with. That is a big difference. Peace.
David, I agree that the client does indeed have a problem they need help with, and if the client wants to talk about the problem, analyse the problem, trace the pathology of the problem then no one should stop them but…..and here is the thing of it…..Solution Focused practictitioners holds the ethos that the “therapist” shouldn’t analyse, pathologise and decide what would help. Only the client knows exceptions to their depression for instance, or times when they resist the urge to do x, y or z. And it is that information that we dig around for. We don’t agree that proactively instigating conversations about times the client fails will be helpful and we tell the client that this is our stance. There is nothing wrong with looking at the past David – we just don’t have to stare. So I agree with Jeni’s take.
I have to say too that there is no therapist or counsellor that I ever met who knew the client better than the client knew themselves. When we are meeting a client with a problem, we are meeting the expert: the expert of times when s/he deals with the problem differently, how they did that and what life will look like when the problem is resolved. The client has the ultimate road map and only the client knows the journey they’ve been on and the benefits of a new journey forward – the therapist should just be the chauffeur, asking pertinent questions.
If this reads as if the problem is dismissed and it’s all about “tomorrow” – then forgive me because that is not what the model is at all. I listen while clients talk about all the wrong roads they took that did them harm, all their failings and their dread of the future – it would just be a sad intervention that left them there so I am always curious about exceptions (no one does depression 24 hours a day, or drugs, or loses their temper every time they’re angry) and I want to build on the little that works, the little they get right. I am curious too about the emotional and physical benefits to them once they have resolved some of their difficulties (not bad things to be curious about – the brain is very obedient is it not…). Only they know the answer.
I am grateful for you taking the time to post and hope you will do again.
Best regards
Eileen
Eileen! Super interesting discussion. I am curious, in your view, which method has best experimental support?
Because, even though your arguments are very convincing I always try to be skeptical and wait for the data. I try not to trust my own intuition or personal experience too much, as we know how easy it is to fool oneself. Randomized controlled trials are the gold standard in so many times, so as to get away from our motivations and biases. I am very curious to hear your thoughts about the research behind behind CBT and SFBT?
Also, Jeni, you said “CBT also gets you to examine your world but in order to pick holes in it and find out where you are going wrong. How depressing.”. Whether or not this is an accurate representation of CBT, as far as I know, CBT is one of the most well researched therapies out there. Perhaps the method can feel or seem depressing, but should we not look at the data when deciding on what therapy is better instead of going with what feels good? (I am not saying CBT is necessarily better, I just think we should not trust our own intuitions or experiences too much. We know from the cognitive science literature that we constantly fool ourselves.
Again, I love the discussion above and look forward for your thoughts.
Henrik, thank you for contributing. I am taking a risk here in saying this, but, randomized controlled trials would have to be implemented with everyone on the planet to convince me that they are the gold standard but let’s go with your presumption that they are. Given that CBT was offered as the leading “talking therapy” by the university which was visited when the UK government requested a review into “what was out there” (there was only a minor review into SFBT which I was a small part of) it will always have better outcomes than other talking therapies when it is the “only recognised one” – would you agree?
I do agree with Jeni that “CBT gets you to examine your world in order to pick holes in it….” and because I do not believe that it is the best way to affect change, I do not prescribe to it but it certainly isn’t “the devil’s work” – just not for me. I know CBT Practitioners who also prefer SFBT in practice. The lean towards Hypnotherapy and connecting with subconscious to affect change would indicate that in light of how powerful the subconscious is in sabotaging any change the conscious mind chooses to make – visualisng and moving forward through subtle conversations that are peppered with “talk me through the benefits that this change will bring….” and “what difference will that make to you….?” are conducive to healthy and collaborative change.
Your final comments, Henrik, could actually describe what SFBT most definitely is – in that it holds the opposite ethos to yours: “…but should we not look at the data when deciding on what therapy is better instead of going with what feels good?” and “I just think we should not trust our own intuitions or experiences too much“. In fact, if you wanted a fine example of a description of SFBT then I would say, in exact opposition to yours “Go with what feels good” “Trust your own intuition and experience“. Best to be fooled by yourself, I think, Henrik, than be fooled by someone else prescribing what will work for you.
I love the discussion too Henrik and thank you for joining it.
each therapy has its purpose and some are better for certain personality types and some disorders than others, so to disregard or insult one line of therapy which has been effective for many who have availed of it. CBT is a form of therapy that has stood the test of time and one of the most known and empirically studied fields of psychology in the contemporary world. I’m by no means a cognitive behavioural therapist as my primary field is more humanistic but to hear the first comment disregarding such a model of therapy is unprofessional and can only be described as ignorance in my humble opinion
Barry, I’m sorry that you see my view as dismissing CBT, not at all – I was quoting directly from source to explains the difference between CBT and SFBT. Of course my preference is Solution Focused Brief Therapy – I am an SFBT practitioner after all. I welcome all discussion including yours Barry.
I recently began providing treatment in an agency that practices Problem-Solving Therapy (PST). I have heard that it is a form of CBT but it seems to be oddly similar to SFBT. Does that mean that CBT is closer to SFBT than you originally said? Is PST a form of SFBT? Sorry, I am just thoroughly confused.
Hi Neda,
Thank you for your comment on my post. The definition of PST seems to me to be very much a “do to” rather than “doing with” which is more the ethos of SFBT. Researching the PST model on verywellmind.com I found “While other forms of psychotherapy (such as cognitive-behavioral therapy) can be helpful for dealing with negative thoughts, problem-solving therapy can help if you are struggling with life problems and stressors and you don’t feel you have the tools and strategies to solve”. Another major difference can be found in the statement on the website “Can be administered by a doctor or mental health professional” which seems to make it a clinical model only, which is not the case for SFBT, and it is also suggests that the Practitioner is the person giving “advice” and “strategies”.
SFBT, as you will undoubtedly know: Elicits the client’s current successful strategies, no matter how small. Amplifies and discusses these from a “curiosity” stance and is also curious about tomorrow. The client is very much in the driving seat (as the expert of the minutia of their lives) with the Practitioner a curious passenger on the client’s journey.
So, I guess I’m saying that it is not, for me, similar to SFBT and if at all affiliated to another model, that would be CBT simply because of that “doing to” clinical approach that I am reading. Please feel free to comment further or to ask further questions if you wish Neda. Thank you again. Kind regards, Eileen Murphy