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Beyond Technique in Solution-Focused Therapy: Working with Emotions and the Therapeutic Relationship

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Solution-focused therapy is often misunderstood to be no more than the techniques it is famous for--pragmatic, future-oriented questions that encourage clients to reconceptualize their problems and build on their strengths. Yet when applied in a "one-size-fits-all" manner, these techniques may produce disappointing results and leave clinicians wondering where they have gone wrong. This volume adds a vital dimension to the SFT literature, providing a rich theoretical framework to facilitate nonformulaic clinical ...
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Overview

Solution-focused therapy is often misunderstood to be no more than the techniques it is famous for--pragmatic, future-oriented questions that encourage clients to reconceptualize their problems and build on their strengths. Yet when applied in a "one-size-fits-all" manner, these techniques may produce disappointing results and leave clinicians wondering where they have gone wrong. This volume adds a vital dimension to the SFT literature, providing a rich theoretical framework to facilitate nonformulaic clinical decision making. The focus is on how attention to emotional issues, traditionally not emphasized in brief, strengths-based interventions, can help "unstick" difficult situations and pave the way to successful solutions. Written by leading practitioner and SFT codeveloper Eve Lipchik, the book will enhance the work of novice and experienced clinicians alike.
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Editorial Reviews

From The Critics
Clinical therapist Lipchik argues that without a basic theoretical grounding, solution-focused therapy (a form of brief therapy) can devolve into a one size fits all approach that fails to be helpful. She discusses how therapeutic assumptions guide the process of therapy, exploring the theoretical background of the client-therapist relationship, goal clarification, and the use of emotions to facilitate solutions. Latter chapters describe how to apply the theoretical background to working with co uples, families, "involuntary" clients, long-term cases, and patients in crisis. Annotation c. Book News, Inc., Portland, OR (booknews.com)
From the Publisher

"For our master's students, I have to create a curriculum that brings together a complex array of theory and practice. Lipchik's book is invaluable for this purpose. She clearly conveys the strengths of solution-focused therapy while linking the approach to processes valued in other models, particularly the therapeutic use of emotion."--Douglas C. Breunlin, MSSA, LCSW, LMFT, program director, Master of Science in Marriage and Family Therapy, The Family Institute at Northwestern University

"An excellent book for both novice and practiced therapists. My graduate students found this book extremely helpful in guiding them through their first therapy sessions. Lipchik does a wonderful job of integrating emotion and relationship into the practice of solution-focused therapy. What makes this book exceptional is its combination of candid writing, insightful case material, and commentary that applies the theory and techniques across several therapeutic modalities. I highly recommend it."--Elise Cole, PhD, Department of Psychology, California State University, Chico

"At last, someone has written a book that integrates the practical simplicity of solution-focused work with the crucial presence of emotion and relationship. Eve Lipchik liberates our understanding of feelings from cumbersome theoretical frameworks, and shows how they are a basic currency in the therapeutic exchange. This book is eminently practical and theoretically illuminating. I highly recommend it."--Stephen Gilligan, PhD, private practice; Author of Therapeutic Trances and The Courage to Love

"Rarely does a book convey its message so well or so strongly. Eve Lipchik's mantra, 'I cannot change clients, they can only change themselves,' gently recontextualizes solution-focused work. This book shows that when therapists listen to and talk about struggle and emotion--as well as strengths and hope--clients make their own changes. Eve Lipchik writes like she works, sensitively weaving her ideas through many case examples and applications, from the emotionally overwhelmed individual to violent couples, crisis situations, and long-term situations. Treat yourself to the richness and practical wisdom of her experience and perspective."--John Walter, LCSW, and Jane Peller, LCSW, authors of Recreating Brief Therapy

"In this clear yet clinically and theoretically sophisticated volume, Eve Lipchik dispels all the stereotypes of solution-focused therapy (SFT), so that even SFT skeptics will want to give the model a second look. Her version cherishes the uniqueness of clients, is nonformulaic, emotion-focused, and privileges the client-therapist relationship over technique. For Lipchik, SFT goes slowly; clients, not therapists, determine when they want to talk about solutions. Replete with rich case illustrations (which heretofore I would have assumed to be 'too complex' for SFT), the volume has left me with the imprint of a master teacher and clinician and has greatly enriched my practice. With warmth and wisdom, Lipchik shows that SFT is a living, breathing, sensitive, and evolving model."--Douglas H. Sprenkle, PhD, Marriage and Family Therapy Program, Purdue University

"In this inclusive, simply written book, studded with clinical stories like raisins in a cake, Lipchik walks the reader through a deeply unusual approach to solution-focused therapy. She has broadened the theoretical base to include the idea of love as a biological given, and adds concern for emotions to the clinician's repertory. Links are made to Sullivanian theory and to practical humanism, creating a user-friendly path to guide more traditionally trained psychotherapists. This book is a gift for therapists of all stripes and a 'must-have' for training programs and libraries."--Lynn Hoffman, ACSW, Adjunct Lecturer, St. Joseph College, West Hartford; Author of Foundations of Family Therapy and Family Therapy: An Intimate History

Private Practice

"An ideal introduction to SFT and it has already had an impact on the way I work with clients....A useful and enlightening read which widened my view of SFT. I see now that SFT can be empowering for clients and a flexible framework for counsellors of many orientations."--Private Practice
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Product Details

  • ISBN-13: 9781572307643
  • Publisher: Guilford Publications, Inc.
  • Publication date: 5/31/2002
  • Series: Guilford Family Therapy Series
  • Edition description: New Edition
  • Edition number: 1
  • Pages: 230
  • Product dimensions: 6.28 (w) x 9.18 (h) x 1.01 (d)

Meet the Author

Eve Lipchik, MSW, a certified member and approved supervisor of the American Association for Marriage and Family Therapy, cofounded ICF Consultants, Inc., in Milwaukee, Wisconsin, in 1988. Previously, she was a core member of the Brief Family Therapy Center in Milwaukee, where she participated in the development of solution-focused therapy. In addition to her private practice, she teaches, consults, and lectures both nationally and internationally. She is the editor of Interviewing and has been published in numerous books and journals, including Psychotherapy Networker, Journal of Systemic Therapies, and Family Process.

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Read an Excerpt

Beyond Technique in Solution-Focused Therapy

Working with Emotions and the Therapeutic Relationship
By Eve Lipchik

The Guilford Press

Copyright © 2002 The Guilford Press
All right reserved.

ISBN: 1-57230-764-1


Chapter One

A Theory of Solution-Focused Therapy

A solution-focused therapist felt stuck with a case and asked for help. He had had four sessions with John, a 46-year-old married attorney, with two teenage daughters, but after an initial report of improvement the solution seemed unclear. John had described his reason for coming to therapy as "being at the end of my rope in dealing with my widowed father." His brother-in-law, a physician, had suggested he ask his doctor for some medication, but John considered medicine a crutch.

John appeared extremely agitated during the first session. He was flushed, picked at one of his cuticles constantly, and spoke so rapidly that he had to stop and catch his breath at times. He related that his mother had died 5 months ago at age 75, leaving his 78-year-old father alone after 51 years of marriage.

John was one of four siblings, and the only one who lived in the same city as the parents. Since his mother's death, John and his family had made a special effort to be supportive to his father. At first this effort was appreciated, but as time went on his father became increasingly hostile and hard to satisfy. John's wife had urgedJohn not to take his father's behavior so personally, but John was not able to avoid such feelings. The final straw had been when his father had refused to speak to him while on a visit to John's sister because "he didn't want to hear my voice." Since then, John had been unable to sleep or concentrate on his work.

John perceived that his relationship with his parents prior to his mother's death had been agreeable. He and his family saw John's parents at least once a week and spent all major holidays and birthdays with them. Although the father had always expressed criticism more than praise, his mother's warm, nurturing ways had more than made up for it.

When the therapist had attempted to get John to define his problem and goals in behavioral terms, the best John could do was to say he wanted to learn to cope with his father's ways so he could be a good son. He recognized that he could not change an old man. He described his father's behavior toward him as "eating away my insides." He would know he was better when "his father's words would go in one ear and out another." John was unable to answer how his own behavior would change when that began to occur. The therapist had asked an exception question in relation to that goal: "Are there times when you already let your father's words go in one ear and out another?" John could think of only one example, shortly after his mother died, when he had felt very sorry for his father. The therapist tried to build on that exception by asking, "What was different at those times? What would you have to do now to make that happen, even a little bit?", but John was unable to answer.

The therapist then turned to another technique, the miracle question. "If you go to bed tonight and a miracle happens while you are asleep, and when you wake up in the morning your problem is solved, how will things be different?" John had answered that he would ignore the behavior. "Does that happen already at times?" the therapist asked. Not at present, said John. "What will you have to do to make that happen? Is there anything someone else could do to make that happen?" John said he felt he had no control at present to change anything.

At the end of the first session the therapist had composed an intervention message which complimented John for his desire to learn to cope with his father's behavior and for wanting to be a good son. It expressed empathy with John's difficult position, having to mourn his mother at the same time that he had to deal with his father's rejecting ways. The intensity of John's reaction was reframed as an unusually strong commitment to family. The therapist had also designed a task for John to give him a sense of control again. The task suggested that John give himself a break from being in touch with his father for 3 days as his father was being cared for by his sister. If, during that time, he ever felt comfortable about calling and wanted to do it to make himself feel good rather than to please his father, he could do so. However, if he felt ambivalent about calling, he was to remind himself that he did not have to make that decision until the fourth day. On the fourth day he was to call but talk only to his sister and to tell her to tell his father he called to inquire about him.

When John returned a week later the therapist measured change by asking a scaling question: "On a scale from 1 to 10, with 10 being that you are as stressed as you can be, and 1 being that you are totally relaxed, where would you say you are today?" (de Shazer, 1991a, p. 148). John reported that his stress level had decreased from a 10 to a 7. He had chosen to call his father on the second day and had not felt as uncomfortable as he expected to even though his father had been short and unfriendly. Since then he had made one more call and also tolerated it better.

During the second session the therapist and John worked on reinforcing this increased comfort and tolerance John had described by discussing "What will have to happen for more of that to happen? What could you do? What could others do to help you?" The therapist also looked for resources from the past that could help John in the present situation by asking, "How have you dealt successfully with stressful personal relationships in the past?" At the end of the session the therapist complimented John on having gained some control in relation to his father and told him to continue doing what he had been doing.

During the third session John reported that his father had returned home. John had picked him up at the airport, and his father had immediately criticized John for not having been clear whether he would meet him at the gate or at the baggage claim. Since then there had been several difficult phone conversations that led John to feel his stress level was an 8 on a scale of 10 again. John repeated that he wanted to find a solution without medication.

In an effort to stay away from the problem and look toward a solution the therapist had revisited the exception that occurred between the first and second session. What was different then? John thought it might have been the fact that his father was in another city. It made him feel less responsible when his father was with his sister. At the end of the session John was given the task to pretend his father is in another city when he speaks with him over the phone. When he met with him in person he was to imagine his sister, or his brother in the room, as well. John did not report any improvement as a result of this task and appeared discouraged about his lack of progress.

Why was this case not progressing? The therapist was clearly doing solution-focused therapy (hereafter SFT) as it is generally understood. He had the client describe the problem and define a goal in behavioral terms. Once John had described his problem, the therapist had used the exception question (de Shazer, 1985; Lipchik, 1988a), and the miracle question (de Shazer, 1988; Friedman, 1993; Lipchik, 1988a; Nan & Shilts, 2000). At one point, when the therapist was not getting any useful responses from John he had asked the coping question (Lipchik, 1988a): "How come things aren't worse? What have you done to keep things from getting worse?" This question often produces some strengths clients can build on, but it had not helped in this situation. The therapist had used the scaling question (de Shazer, 1991a) to measure change.

At the end of the sessions the therapist had offered thoughtful intervention messages and tasks that built on positives and made use of the client's way of experiencing the world, such as his need for control and his particular use of language. Why didn't any of these techniques lead to a solution for the client?

The answer is simple: SFT is more than the trademark techniques it is known for. It is a sophisticated therapeutic model that has been applied to a variety of situations such as adoption (Shaffer & Lindstrom, 1989), aging (Bonjean, 1989, 1996; Dahl, Bathel, & Carreon, 2000), alcohol abuse (Berg & Miller, 1992; Brasher, Campbell, & Moen, 1993), child protection services (Berg & Kelly, 2000; Turnell & Edwards, 1999), domestic violence (Lipchik, 1991; Lipchik & Kubicki, 1996; Lipchik, Sirles, & Kubicki, 1997; Tucker, Stith, Howell, McCollum, & Rosen, 2000), family-based services (Berg, 1994), multiple personality disorder (Barker & Herlache, 1997), physically impaired clients (Ahlers, 1992), residential treatment (Booker & Blymer, 1994; Durrant, 1993), sexual abuse (Dolan, 1991; Kowalski, 1987), school problems (Durrant, 1995; Kral, 1992; Metcalf, 1995; Molnar & Lindquist, 1989; Murphy, 1996), spirituality (Simon, 1996), children (Selekman, 1997), and more. SFT takes time and experience to master, just like any other therapeutic approach.

Perhaps SFT has been misunderstood because it was conceived as a minimalist way of intervening, a pragmatic way of problem solving (de Shazer, 1982, 1985, 1988, 1991a, 1994). Minimalism may have been interpreted to mean that all the therapist needs to do is to ask questions. Of course, that was never intended. At the Brief Family Therapy Center the prerequisite for trainees was a master's degree in a mental health discipline and 2 years of clinical experience. We expected people who were going to learn our model to be skilled in establishing and maintaining a therapeutic alliance. Unfortunately, we did not emphasize that in the literature but concentrated on describing the new ideas. I never realized that misunderstanding until much later, when I showed a videotape at a seminar to demonstrate the use of questions as interventions. After watching for a few minutes a well-known colleague heaved a sigh of relief and said, "Oh, you contextualize those questions."

Although minimalism may have been misunderstood in practice, it did have a theoretical base and assumptions that offered guidelines beside questions. However, under the influence of postmodernism, theory was dismissed as antithetical to truly individualized treatment (Held, 1996, 2000). This new direction reduced SFT to "nothing but language" (de Shazer, 1994; Miller & de Shazer, 1998), another description that is open to misinterpretation. Language in postmodern theory is generally thought of in the broad sense

as located in the consensual behavioral interactions between persons, not inside "the mind" of either. Rather than a vehicle that carries abstract communication back and forth between individual minds, it is a coordination of bodily states within members of a social group that preserves the structural integrity of both the social group and that of each group member. (Griffith & Griffith, 1994, p. 312)

Language is not intended to mean only the words people speak. However, even the broad description of language fails to guide therapists in using language to help clients find solutions. No wonder the solution-focused questions appear so attractive! They offer something concrete with which to work. The problem is that emphasis on form over substance usually does not give the desired results (Cecchin, Lane, & Ray, 1992).

The case of John, described previously, illustrates my point. The therapist used the basic techniques in the first session and had some positive results. When these changes were not sustained after the second session, the therapist continued to follow what he understood to be the right solution-focused direction. He tried scaling and coping questions to no avail.

To help this therapist get unstuck in consultation he was asked to think, "What is going on between John and me that might be causing this impasse?" He answered, "I am asking questions and giving tasks that are not making a difference. I have to do something different." However, he was perplexed about what that might be, given that he had used all the right techniques.

The next suggestion was to consider the following assumption: Therapists can't change clients, clients can only change themselves. How might that be helpful? The therapist answered that it made him think more about what was going on with John, particularly about the death of John's mother. This therapist's message at the end of the first session is evidence that he was aware that John was in the midst of intense mourning for his mother. However, he believed that he should not talk about it with the client because, first, it would distract from talking about positives and the future; second, it dealt with John's emotions; and third, it had not been identified as a problem or a goal. When the therapist was encouraged to address the mourning it proved to be the key to the solution. John started to cry and to vent about how much he missed his mother. He spoke about how he never realized how much his mother had compensated for his father's personality, and how he had no idea how he would manage without her in the future. This outpouring of emotion prompted the therapist to put aside thoughts about intervention at the time and just to be supportive. Toward the end of the session John made a confession. He told the therapist that he felt more stressed from guilt than from anger at his father because he had been wishing all along that his father had died instead of his mother.

Notice how the therapist's shift from a formulaic concept of SFT to one driven by emotion and theory lead to a more trusting relationship in which John felt safe to confess his shameful feelings. When these feelings were not judged but understood and normalized, John expressed some relief. The therapist then wondered how John thought his guilt was affecting his tolerance of his father's behavior. John made the connection that the more hostile his father was, the more guilt he felt, and the more guilt he felt the less he could tolerate his father's hostility.

John's new understanding led to a redefinition of what he wanted from therapy. He now declared he would feel comfortable if he could reduce his guilt about his shameful feelings from the present level of 10 to below 5. Once John was clear about that he began to find behaviors that helped him. He talked to his wife about his feelings and discovered that she and their children had had similar thoughts.

Continues...


Excerpted from Beyond Technique in Solution-Focused Therapy by Eve Lipchik Copyright © 2002 by The Guilford Press. Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

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Table of Contents

Pt. I Theory and Practice
Ch. 1 A Theory of Solution-Focused Therapy 3
Ch. 2 The Therapist-Client Relationship 24
Ch. 3 Understanding Clients 44
Ch. 4 Emotions in Solution-Focused Therapy 62
Ch. 5 The Process of Clarifying Goals 78
Ch. 6 The Team Behind the Mirror and the Consultation Break 99
Ch. 7 The Summation Message and the Suggestion 108
Pt. II Applications
Ch. 8 Couple Therapy 127
Ch. 9 Family Therapy 144
Ch. 10 Working with Involuntary Clients 158
Ch. 11 Long-Term Cases 176
Ch. 12 The Solution-Focused Approach to Crisis 198
Final Thoughts 213
References 215
Index 225
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