Introduction of Henry & Eng
Henry (aged 49) was `shocked’ when his wife, Eng (aged 46) filed for a spousal maintenance order at the Family Court. He felt that he has always been very consistent in providing for the material needs of his wife & 3 children aged 19, 15 & 12 . Henry & Eng are no longer functioning as husband and wife sexually for some 3 years now. They sleep in separate room albeit under the same roof. Henry maintained that their marriage is irreconcilable as they are no longer able to talk to each other calmly. He thinks that Eng is irresponsible and irrational. Occasionally he would issue threat of divorce. Eng is thus plagued by a nagging sense of insecurity. Nevertheless, the couple has opted to stay put for the sake of their children.
Henry focuses on all his three children especially his eldest daughter whom he thinks takes after him in many ways. The youngest son was born pre-matured & a slow learner but the parents are satisfied with his academic progress at this point in time.
Area of Concern
The couple is barely coping with their 2nd child, Ed (aged 15), whom they claimed defiant and out of control. Ed’s obesity became a great concern when he was found to develop breathing difficulty at night when he sleeps. He was placed under a weight control programme at a local hospital. Henry ferries Ed to the doctor for regular medical reviews. Ed is perceived to be addicted to the computer games and the school is after his parents for the poor academic performance. Henry & Eng are not happy with each other’s disciplining methods. Henry has on many occasions ended up in physical fights with Ed while disciplining him. Eng is warned by Henry not to interfere and to leave the disciplining to him solely. Eng thinks that Henry’s methods will not work.
Prior to meeting Ed, I aimed at establishing a respectful relationship with the couple on separate sessions by finding out their individual expectations of Ed, and giving credence to their concerns and goals. At the same time, they were helped to view themselves as caring parents and as experts on their own children. I sensed that although Ed is better able to describe his problems at age 15, he also might be more defensive and reluctant to do so. He would probably be self-conscious and vulnerable when being asked to disclose things he felt confused and uncomfortable about. Therefore when Henry conceded that Ed was an unwilling client of mine, I did not take offense.
Constructing the genogram of Henry & Eng (Appendix 1) during the counselling process help they and I discover the unique pattern of interaction between individuals in the family. I would discuss next how I approached Ed’s case using Solution Focused Brief Therapy based on the 8 basic assumptions, solution-building stages & questioning techniques found therein. (DeJong & Berg, 1998) Lastly, I would state the strengths and limitations of this approach.
Approach based on Solution Focused Brief Therapy (SFBT)
SFBT is guided less from a theory & more from a curiosity to learn what works. (de Shazer, 1985)
My mission as a therapist is to empower Ed to live a more productive & satisfying life. If I focus on his obesity or addiction, he may become discouraged & feel that he is a victim of some disease or dysfunction. Saleebey (1997) “People are always working on their situation… As helpers, we must tap into that work, elucidate it, find & build on its promise.”
The SFBT approach has developed a useful set of assumptions about clients, therapists and the helping process. Its practice proceeds from the following assumptions (Simon and Berg, 1999). I would like to illustrate them by incorporating them into my conversation with Ed using relevant questioning techniques.
Upon meeting Ed, I reassured him that I understood how awkward he must feel being brought to the session. I informed him that I would at some point into the session take a short break to give some thought to the conversation (Campbell, Elder, Gallagher, and Simon, 1999).
Therapist: Ed, I was told you have been regularly going for your weight-control review. Can I say you do care about having a better future?
[SFBT therapists ask pre-session change questions to identify what useful actions clients take before they see a therapist. For many clients, the very act of thinking about how therapy will make a difference for them raises possibilities (Miller, Duncan and Hubble, 1997). In Ed’s case, I affirmed him of his positive behaviour despite noticing a certain degree of unwillingness.]
From onset, I took the posture of not knowing in exploring Ed’s concern by inviting him to describe himself from his own perspective.
T: Ed, in order to help me understand you a little, how about describing yourself in just 2 words.
Ed: Er… Moody, Peace-loving …
T: U huh, peace-loving. Now, could you recall the happiest day you have spent with your father?
Ed: Er….. I must say it was the one NAG-free day we spent together.
T: That does explain your peace-loving nature, huh? How would you like to make NAG-free day a permanent feature in your family life?
Ed: If only I can be left to do things all by myself, with no nagging from my parents or anybody.
T: You attended the medical review for your weight-control programme this morning and now you are here wishing for NAG-free day. These are positive changes that can make a difference in your life & such change is already happening by you doing the above.
[Assumption 1 – Change is constant and inevitable.]
Ed: I have no choice but to listen to my father & do what the doctor asked me to do. I will just finish the slimming pills and see what happen next.
T: You are sensible enough to set small goals.
[Assumption 2 - Small change leads to bigger changes.]
Ed: Actually I have lost some weight already.
T: Wow! What did you do apart from taking those pills?
Ed: Sometimes I forgot to take so I have to try to remember to take them regularly to help suppress my hunger pangs...
T: Great, what will you keep doing to lose more weight?
[Assumption 3 – The past cannot be changed. Steve de Shazer (1985), a co-developer of the solution-focused brief approach, quoted Erickson: Emphasis then should be placed more on what Ed does in the present and will do in the future. It will help for me to dwell on the details of Ed’s past successes.]
Ed: My father nags at me every day to get me to jog. He pays me $5 an hour if I do so.
[Assumption 4 - People have the resources necessary for change and they are the experts on themselves.]
T: Your father is applying positive reinforcement to keep you motivated in losing more weight. What will it be like for you to have your father jog with you?
Ed: He won’t jog with me, lah. I think he will be too embarrassed to be seen jogging with me…
But I think it will be nice if he jogs with me…
[Assumption 5 - What people do has an impact on other people. The meteorologist, Edward Lorenz, coined the term “The Butterfly Effect” (Butz, Chamberlain and McCown, 1997.]
T: Do you think your father is embarrassed to be seen with you at the Weight-control clinic too?
Ed: I don’t know. May be. May be not. I think he is worried about me too.
T: Do you also sense your father’s care in other areas of your life too?
[Assumption 6 - Every problem has at least one exception. At this point, the focus of the therapy shifted from the description of the problem to details of exceptions. It was this shift that moved the therapy from problem management to solution development.]
Ed: He nags at me when I don’t study. You can say he cares for me but I just can’t stand it.
T: How do you think your father will stop nagging at you?
Ed: He allows me to play on the computer for one and a half hour. But when I exceed it, he will get upset and start to nag.
T: And that upset you ….
Ed: He does not understand there are days I don’t play because no one invites me to play. I hate it when he hides the computer cable ..
T: I hear you say you stay away from the computer if no one invites you to play. It shows that you do have a good amount of self-control and will-power. What did you do instead?
[I asked Exception Questions to allow Ed to reflect on his positive behavior.]
Ed: I read a book.
T: Thank you for your input and feedback. What do you think you need to do to stop him from nagging again?
[I moved on to ask future oriented questions. These questions move the conversation from details of the problem to possibilities of how Ed’s life will be better in the near future.]
[Assumption 7 - Every human being, relationship and situation is unique. Erickson designed his therapy differently for each client (O’Hanlon, 1987). This process of fitting the therapy to the client requires client input and feedback.]
Ed: I guess I’ll have to stick to the one and half hour play time lor.
T: Does it make you feel in control of your life too?
Ed: I don’t like to be told to stop playing.
T: How do you keep yourself from exceeding the one hour and half?
Ed: It is very difficult but I have to try lah.
T: If you stick to the one hour and half, your dad will not say a word. How would this change in your dad make a difference in your life?
Ed: It would be like heaven on earth!
[I would at this juncture pose the Miracle Question to further encourage conversations about a better future.]
T: I’m going to ask a strange question. [pause]
Let’s suppose that after our conversation, you go home tonight and go to sleep. [pause]
While you’re sleeping, a miracle happens. The miracle is that the problems that we talked about are gone. [pause]
You can’t know about the miracle since you’re asleep.
When you wake up in the morning, what will tell you that the problem is gone?
Ed: I don’t know….perhaps I have lost all the excess weight when I look into the long mirror. And the dark ring around my neck disappears.
T: What else has changed?
Ed: I felt elated and eager to step out of the house.
T: Uh huh?
Ed: I was relieved the computer is still around…. [smile]
T: What else would you be eager to do?
Ed: Er…. I think I would do the things I have not done for years, like a visit to the national library or to catch a movie with my friends. Even to the gym to keep fit.
T: Wow, these are wonderful activities you can enjoy to make your life better!
[Assumption 8 - Changes come from many directions. Therapy is not the only way people change. According to Miller, Duncan and Hubble, (1997): “Research shows, in fact, that improvement between treatment sessions is the rule rather than the exception.” Ed is encouraged to take advantage of the many resources he can utilize by focusing on what makes his life better between sessions.]
Taking the Break
[As I did not work with an observing team behind a one-way mirror, I formulated the feedback on my own.]
After the break, I invited Ed & his father back into the room for feedback.
T: Ed, it is perfectly understandable that your parents reacted to the current situation you are in.
And they are not alone. I would like to reflect on your preference, dreams, interest, ability, resources… that we spoke about during the conversation… [The feedback is taken directly from what Ed has said. His key words are used as much as possible.]
At the end of the session I posed a Scaling question to expand on both exceptions and future visions.
T: I would like at this juncture for you to rate yourself on a scale from zero to ten where your determination level is to tackle the problems you are facing.
Ed: Err… It was at 2 before I came...
T: How did you stay above zero?
[I asked coping questions to elicit anything Ed has that implies that he has done something positive toward solving the problem. This reminds Ed that he has been successful in achieving small tasks.]
Ed: I think my father’s helping me a lot. May be without him, I could be at 1.
T: Uh huh. That still exceeds zero. How about now?
Ed: May be 2.5 ..
T: Great, that is a good 1.5 points increase. And you are already on the way toward a 10.
How did you know that you have moved to 2.5 and how that will make a difference in your live?
Ed: I think my dad needs help. He is tired of nagging … I will try my best … the difference is now I am no longer upset with my father for bringing me here…
T: [To Henry] What do you know about your son that tells you that he can learn to follow the rules?
Henry: I know he can. He had done so in the past.
T: Uh huh..
Strengths & Limitations of SFBT
Strengths
The focus is on the future instead of the past. It is a solution talk instead of dwelling on problems.
By allowing the Client to self-intervene, we can expect him to take ownership of solutions.
The approach is less prescriptive therefore good for mandated client as solutions are developed collaboratively.
The client is empowered to take charge of his own life. (De Jong & Berg, 2002)
Limitations
During the questioning phase, the challenge is for the therapist to avoid asking closed questions which can shutdown curiosity as such questions invite “yes” or “no” answers. (http://www.subud-britain.org/journal/article.html?article_id=79 retrieved on 23, August, 2006.) Some feel that the Brief model, with its emphasis on brevity and focus on finding solutions, do not take enough time to explore the causes, affective states, and experiences of the client. There is limited opportunity for catharsis. Emotions are respected but not fully addressed due to little insights into client’s struggles. The next question is therefore: can lasting change happen – briefly?
Another downside, poorly motivated & hostile clients will require therapist who have the skills of handling resistance and know something about “motivational interviewing” to get them going. In another instance, clients who have a history of poor relationships will need a helper who is able to establish a collaborative working alliance. The third group of clients who can pose as a challenge will be those who are passive, of low IQ as they may not be able to derive solution by themselves.
(Egan, 2002)
Summary
Research has shown that brief interventions can produce substantive & lasting changes. Brief therapy can be brief but comprehensive (Lazarus, 1997). The SFBT conversation helped me to focus on developing with Ed a well-formed goal & simultaneously, leading to solution-building. Such conversation can be described as individuals engaged in the process of meaning-making. (de Shazer, 1991) Recounting the past mistakes & poor performance would have turned Ed off. Educating or enlightening Ed would be redundant as his teachers & parents are already doing it. SFBT approach inherently fosters a respect for Ed while working on resources, success & solutions.
References
DeJong, P., Berg, I. (1998). Interviewing for solutions. California: Brooks/Cole Publishing.
De Shazer, Steve (1985). Keys to Solution in brief therapy. New York: W.W. Norton & Co.
Saleebey, D. (Ed.).(1997). The strengths & perspective in social work practice. (2nd ed.). New York: Longman
Simon, J. and Berg, I. (1999). Solution-focused brief therapy with long-term problems. Directions in Rehabilitation Counseling. Vol.10, Lesson 10, pp. 117-127
Campbell, J., Elder, J., Gallagher, D. and Simon, J (1999). Crafting the ‘tap on the shoulder.” A compliment template for solution-focused therapy. The American Journal of Family Therapy. 27;(1):pp.35-47
Miller, S., Duncan, B. and Hubble, M. (1997). Escape from babel: toward a unifying language for psychotherapy practice. New York: W.W. Norton & Company
Butz, M., Chamberlain, L and McCown, W. (1997). Strange attractors: chaos, complexity, and the art of family therapy. New York: John Wiley & Sons.
O’Hanlon, William (1987). Taproots: underlying principle of Milton Erickson’s therapy and hypnosis. New York: W.W. Norton & Company.
Egan, G. (2002). The skilled helper. California: Brooks/Cole Publishing
Lazarus, A.A. (1997). Brief but comprehensible psychotherapy: The multi-modal way (Springer series on behavior therapy and behavioral medicine). New York: Springer.
De Shazer, Steve (1991). Putting difference to work. New York : W.W. Norton & Company
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