STEVE DE SHAZER AND THE FUTURE OF SOLUTION-FOCUSED THERAPY
Trepper, Terry S
Steve de Shazer who, along with Insoo Kim Berg, co-founded the Solution-Focused Brief Therapy (SFBT) approach, recently passed away. In this article we will offer a brief biographical sketch and then discuss the current state of the art of SFBT as it applies to practice, training, and research. Future directions for SFBT, such as the emergence of professional associations, the increased research interest in SFBT as evidenced-based practice, the recent focus on process-research to determine the mechanisms of change within SFBT, and the application of SFBT to education are discussed.
Steve de Shazer was a pioneer in the field of family therapy, and was in fact often referred to in his later years as the “Grand Old Man of Family Therapy.” An iconoclast and creative genius known for his minimalist philosophy and view of the process of change as an inevitable and dynamic part of everyday life, he was known for reversing the traditional psychotherapy interview process by asking clients to describe a detailed resolution of the problem that brought them into therapy, thereby shifting the focus of treatment from problems to solutions. Steve de Shazer passed away September 11, 2005, in Vienna, Austria, several hours after being admitted to the hospital. His wife, Insoo Kim Berg, was by his side.
A Fellow in the American Association of Marital and Family Therapy, de Shazer was a member of the of the European Brief Therapy Association Board and served as President of the Solution-Focused Brief Therapy Association Board of Directors from 2002 until his death.
In addition to countless chapters and articles, de Shazer published five ground-breaking books: Patterns of Brief Therapy, Keys to Solutions in Brief Therapy, Clues: Investigating Solutions in Brief Therapy, Putting Difference to Work, and Words Were Originally Magic (W. W. Norton). He had recently completed a new book intended to update the Solution-Focused therapy approach. Entitled More than Miracles: The State of the Art of Solution-Focused Therapy, it will be published posthumously by the Haworth Press. He lectured widely throughout Europe, Scandinavia, North America, and Asia while serving on the editorial boards of several international journals. His books have been translated into 14 languages.
Co-founder of the Milwaukee Brief Family Therapy Center (BFTC), de Shazer served as its Director from 1978 to 1989 and the Senior Research Associate for the final 16 years of his life. Beginning in the late 1970s, de Shazer along with his wife and long time collaborator, Insoo Kim Berg, devoted nearly 30 years to developing and consistently refining the approach that has subsequently become Solution-Focused Brief Therapy (SFBT).
In the remaining pages of this article, we will briefly examine the “state of the art” of SFBT in the areas of practice, training, and research, and then conclude by offering some future directions.
The Practice of Solution-Focused Therapy
Solution-Focused Brief Therapy (de Shazer, 1985, 1988, 1991, 1994; de Shazer et al., in press), which evolved from Brief Family Therapy (de Shazer, 1982) is a paradigm shift from the traditional psychotherapy focus on problem formation and problem resolution which underlies almost all psychotherapy approaches since Freud. Instead, SFBT focuses on client strengths and resiliencies examining previous solutions and exceptions to the problem, and then, through a series of interventions, encouraging clients to do more of those behaviors. Solution-Focused Brief Therapy can be applied to a myriad of family-related problems. Although deceptively easy to learn, SFBT, like all family therapies, takes great skill to practice proficiently.
Solution-Focused Brief Therapy is a future-focused, goal-directed approach to brief therapy that utilizes questions designed to identify exceptions (times when the problem does not occur or could occur less in the client’s real life), solutions (a description of what life will be like when the problem is gone or resolved), and scales which are used both to measure the client’s current level of progress towards a solution and reveal the behaviors needed to achieve or maintain further progress. Solution-Focused Brief Therapy has often been identified with its innovative techniques, but doing so only tells half the story. Underlying the search for solutions, de Shazer held an abiding belief in clients’ abilities to know what is best for them and to effectively plan how to get there. Many techniques can be integrated into SFBT as long as they do not violate this fundamental principle.
Solution-Focused Brief Therapy is one of the most popular and widely used psychotherapy approaches in the world. Because it is based on resiliency and clients’ own previous solutions and exceptions to their own problems, it is applicable to most difficulties faced by clients, and indeed has been applied to almost all problems seen by clinicians. These include family therapy (e.g., Campbell, 1999; McCollum & Trepper, 2001), couples therapy (e.g., Hoyt & Berg, 1998; Murray & Murray, 2004), treatment of sexual abuse (Dolan, 1991), treatment of substance abuse (e.g., Berg and Miller, 1992; de Shazer & Isebaert, 2003); sex therapy (Ford, in press), treatment of schizophrenia (Bakes et al., 1997), and self-help books written from a solution-focused perspective (e.g., Dolan, 1998; O’Hanlon, 2000). The solution-focused approach has been applied beyond traditional psychotherapy practice to include interventions in social service agencies (Pichot & Dolan, 2003), educational settings and model schools (Franklin & Streeter, 2004; Rhodes & Ajmal, 1995), and business systems (Berg & Cauffman, 2002).
Training in Solution-Focused Therapy
One of de Shazer’s lifelong goals was to improve the quality of training in SFBT. He recognized early that SFBT was seductive: the basics are easy to learn, but the art of doing it well, like most psychotherapy, takes many years of supervised experiences. Early on, Berg and de Shazer used to interview clients in their living room while the “team” listened from the stairs, and then moved to the kitchen to discuss the case. This manner of training was informed by that of the Mental Research Institute, utilizing team consultation and messages during the clinical session.
Since that time, SFBT training has expanded greatly. Formal trainings have been offered in formats as simple as seminars with a few people getting together to discuss the ideas, to one- and two-day offerings, week-long workshops, to full academic courses that last one or more semesters. Europeans, particularly, have embraced the approach with several agencies now specializing in conducting SFBT therapies, de Shazer and Berg have themselves consulted extensively internationally.
Early members of the initial training team at the Brief Family Therapy Center in Milwaukee also have contributed to the evolution and promulgation of the model through their own work. Some of these included Gale Miller (e.g., Miller & de Shazer, 1998); Kate Kowalski (Krai & Kowalski, 1989); Eve Lipchick, Eliam Nunnally, Wallace Gingerich, Michelle Weiner-Davis (de Shazer et al., 1986); and Scott Miller (e.g., Berg & Miller, 1992). Others such as Yvonne Dolan (e.g., Berg & Dolan, 2001; Dolan, 1991), Bill O’Hanlon (e.g., O’Hanlon & Weiner-Davis, 1989), John Walter and Jane Peller (Walter & Peller, 1992), Charles Johnson (Johnson, 2002), Matthew Selekman (Selekman, 2005), and Michael Durrant (Durrant, 1993, 1995), have used the philosophy and ideas of the approach extensively in their work and also offer training.
Trainings often utilize an approach similar to SFBT itself, particularly focusing on what people want to learn, and building on participants’ strengths (cf. Fiske, in press; and Nelson, 2005, for examples of training formats and exercises). Solution-Focused Brief Therapy training and supervision appears to lend itself to the philosophies and tenets of the approach itself, and some have proposed a supervisory model based on solution-focused tenets (Koob, 2002; Wetchler, 1990).
Research in Solution-Focused Therapy
Although primarily known as a clinician, teacher, and trainer, de Shazer had a career-long interest in research. Early on, he and others conducted follow-up studies of clients at the Brief Therapy Center in Milwaukee (see, for instance, de Shazer, 1985; de Shazer et al., 1986; DeJong & Hopwood, 1996) using clients’ assessment of their own progress and finding success rates of 70%-80%. Clinicians conducting follow-up studies outside of the Brief Family Therapy Center also found that clients benefited from SFBT although the rates of improvement were somewhat smaller. The tradition of follow-up studies of SFBT has continued. In 2003, de Shazer and Isebaert published a follow-up study of male alcoholics who were provided Solution-Focused Therapy in an adult inpatient unit in Belgium. They contacted, by telephone, 118 patients who had been treated in the program at 4 years post-discharge. Of these, 84% were judged to be improved-50% reporting abstinence and 34% reporting controlled drinking (3 or fewer drinks a day with 2 or more abstinent days per week). Contacts with family members, where available, were used to verify the patient’s own reports, de Shazer and Isebaert contrast these findings to those of Polich, Armor, and Braiker (1980) who report a 7% abstinence rate at 4 years for traditional, abstinence-only programs.
Although case reports and subjective follow-up studies have provided intriguing hints at the usefulness of SFBT, well-designed studies are needed to definitively establish the approach’s efficacy. Such work is currently underway. In the first systematic review of the outcome research literature on SFBT, Gingerich and Eisengart (2000) reviewed the existing controlled outcome studies conducted through 1999. They found 15 such studies and judged 5 of these to be well-controlled. Four of these studies found SFBT better than no treatment or treatment as usual and the fifth found SFBT comparable to an empirically supported intervention (Interpersonal Psychotherapy for Depression). The less well-controlled studies also generally supported the efficacy of SFBT. Gingerich and Eisengart conclude their paper by stating that the studies they reviewed “do provide preliminary support for the idea that SFBT may be beneficial to clients” (p. 495). By 2001, Gingerich (2005) had added two more studies to the “well controlled” group, both adding support for the efficacy of SFBT. More studies of SFBT are being published regularly although no one has yet provided an update to Gingerich and Eisengart’s critical review. The European Brief Therapy Association (EBTA) maintains a list of outcome studies from around the world that is available via their website (http://www.ebta.nu).
At present, research concerning SFBT is growing both in Europe and in North America. Like any body of scholarship, the research literature on SFBT has both strengths and weaknesses. One of the major weaknesses has been the lack of a clear specification of SFBT. Although many studies state that SFBT was delivered as a treatment, it is often difficult to know exactly what was done in session and how comparable the therapy is across studies. To address this issue, EBTA promulgated a research definition of SFBT suggesting the structure of the first session (asking the Miracle Question, Scaling Progress, and delivering Compliments) and subsequent sessions (beginning with “What’s better?” followed by Scaling Progress, and ending with Compliments) of SFBT. In North America, the Solution-Focused Brief Therapy Association (SFBTA) has also taken upon itself the task of refining the definition of SFBT, proposing mechanisms of change, and supporting the development of manualized SFBT treatment protocols. These efforts spring from the recognition that for SFBT to remain vital it must demonstrate its usefulness convincingly.
Devoted to careful observation and not theorizing ahead of the plain facts, de Shazer took seriously his dictum that clients should do what works by doing his best to make sure that SFBT “works,” too. He was instrumental in creating and guiding the two organizations (EBTA and SFBTA) that are formally supporting research in this area as well as giving generously of his time to researchers who sought his advice on their work. His encouragement will be missed by SFBT researchers worldwide.
Professional associations. de Shazer was concerned that SFBT would continue as a viable approach. To that end, one of his legacies will be his being instrumental in the founding of two SFBT associations whose missions are to encourage practice, training, and research in SFBT around the world. The European Brief Therapy Association (http://www.ebta.nu) began in 1994, and in North America, the Solution Focused Brief Therapy Association (http://www.sfbta.org) was formed in 2002. Both associations host annual conferences on SFBT and provide support and guidance for research in SFBT.
Solution-Focused Brief Therapy as evidenced-basedpractice. Although there has not been a plethora of well-controlled, clinical trial studies of the effectiveness of SFBT, those that have been done, along with the smaller, clinically-based and quasi-experimental studies, suggest that SFBT: (a) is more effective than no treatment (Lindforss & Magnusson, 1997; Newsome, 2004; Zimmerman et al., 1996); (b) is at least as effective as current psycho-social treatments (Gingerich & Eisengart, 2000); (c) in some cases and/or for some problems may be more effective than problem-focused treatments (Cockburn, Thomas, & Cockburn, 1997; La Fountain & Garner, 1996; Lambert et al., 1998; Springer, Lynch, & Rubin, 2000); and (d) in most cases, shows significantly fewer sessions to achieve similar outcomes (Littrell, Malia, & Vanderwood, 1995). Given these promising early findings, it can be argued that more extensive clinical-trial research comparing SFBT with other approaches for a variety of mental health problems should be done. In addition, some psychotherapy models that are very similar to SFBT have been shown to be effective in controlled studies. One example of this is Motivational Interviewing (Miller & Rollnick, 1991), which uses some of the same interventions as SFBT in the engagement process of substance-abusing clients, and has been shown to improve client cooperation and engagement to treatment (Lewis & Osborn, 2004). Research should be undertaken to determine what the specific processes within these models are that can actually lead to positive outcomes.
Process research. Some very exciting work using microanalysis of the language of psychotherapy is underway at the University of Victoria by Janet Beavin Bavelas and her colleagues (Bavelas, McGee, Phillips, & Routledge, 2000). Their early work has demonstrated a methodology which can show, at a communication level, the process by which SFBT leads to positive clinical outcomes, and why it may do so in a briefer fashion (Bavelas et al., 2000). For example, a microanalysis of a traditional mediation session versus a solution-focused mediation session found fascinating differences. The traditional approach treated active listening skills like paraphrasing as neutral; however, the microanalysis showed it to be a nonneutral means of communication that allowed the mediator to transform statements, select or ignore issues, and to discourage contributions to these issues, all in a problem-focused direction (Phillips, 1999). This type of research will likely continue to be an important area of research in future understanding of the specific communication processes that differentiate SFBT from problem-focused therapies.
Solution-Focused Brief Therapy in education. There has been an increase in interest in applying SFBT to school settings, both in school counseling and social work areas and within the school structure and curriculum (Franklin, Biever, Moore, Clemons, & Scamardo, 2001). Preliminary findings have shown SFBT to be effective in school counseling for elementary school children (LaFountain & Gardner, 1996; Springer, Lynch, & Rubin, 2000), middle-school age (Franklin et al., 2001), and high school age students (LaFountain & Gardner, 1996; Litrell et al., 1995). While all of these studies used quasi-experimental designs (except for Franklin et al, which utilized an ABA single-case experimental design), each showed SFBT to show improvements, and when compared with other approaches, to do as well or better in less sessions. Certainly these early studies suggest that more controlled studies in SFBT as a school counseling approach are warranted.
An exciting application of SFBT in the schools can be found in Austin, Texas. A demonstration project is currently underway at an alternative high school, comprised of high-risk students (Franklin & Streeter, 2004). This school utilizes a solution-building model that was developed from SFBT and is designed to engage the students by using solution-focused philosophies and skills. A preliminary pilot study found that 62% of the high-risk sample students graduated on time, and of those that did not, more than one half were still at the school pursuing their degree. Equally important, 91% reported that they plan to attend college or some type of post-secondary educational program. Also, results showed these students rating all three dimensions of the school domain (school satisfaction, teacher support, school safety) as assets, whereas comparison group students rated these three dimensions as either a caution or risk. Although more research is certainly needed, this study lends support to the application of SFBT principles and practices to motivate high-risk students toward post-secondary education.
Other future directions. Solution-Focused Brief Therapy is an evolving approach, and the new ideas that are being offered to expand upon its utility make it a dynamic model. For example, de Shazer and his team have been working to clarify and expand the role of emotions in SFBT (de Shazer et al., in press). Another area of future interest is the use of alternative outcome research methodologies to assess the effectiveness of SFBT. Some fascinating work was reported by Christensen, Russell, Miller, and Peterson (1998), who used qualitative methods to assess the process of change in couples therapy, and found this methodology to yield far richer information than could be gathered from quantitative methods alone. Using such qualitative, along with microanalysis of in-session communication methods (Bavelas et al., 2000) and even the use of brain-imaging as an outcome measure (Lipchik et al., 2005), may ultimately provide important clues on the reasons that SFBT seems to result in positive outcomes more quickly than problem-focused therapies, even when both lead to successful outcomes.
Steve de Shazer recognized early on that although the causes of problems may be complex, their solutions need not necessarily be. From emphasizing the importance of solutions rather than focusing on the causes of problems, grew one of the most influential approaches to dealing with the most difficult problems in mental health, education, management, and social policy. Solution-Focused Brief Therapy continues to thrive in both practice and training around the world as evidenced by two professional associations and a myriad of international professional training centers. Finally, ongoing research continues to examine the effectiveness of the SFBT approach in dealing with life problems in all of the clinical and educational areas and will inform the further development of SFBT in the future. Steve de Shazer sadly is no longer with us, but his contributions to our field and legacy will live on in the continuing evolution of SFBT.
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Terry S. Trepper
Purdue University Calumet
Eric E. McCollum
Virginia Polytechnic Institute and State University
Utah State University
Terry S. Trepper, PhD, Department of Behavioral Sciences, Purdue University Calumet; Yvonne Dolan, MA, Hammond, Indiana; Eric McCollum, PhD, Marriage and Family Therapy Program, Virginia Polytechnic Institute and State University, Falls Church; Thorana S. Nelson, PhD, Marriage and Family Therapy Program, Utah State University.
Address correspondence regarding this article to Terry S. Trepper, PhD, Family Studies Center, Purdue University Calumet, 2200 169th St., Hammond, Indiana, 46323; E-mail: firstname.lastname@example.org
Copyright American Association for Marriage and Family Therapy Apr 2006
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