“Complex Problems Don’t Require Complex Solutions:” Case Discussions Using Solution Focused Brief Therapy

Background

Solution-focused brief therapy (SFBT) is based on the concept of paying less attention to problems and more attention to possibilities, preferred future, and solutions. ¹ Being a postmodern therapeutic approach, it is influenced by the social constructionist theory, which emphasizes that all of us ascribe meaning to everything based on our culture and context. ² Conversations in the therapy room are helpful in co-constructing meaning; thus, solutions emerge from this interaction between the client and the therapist. ³ SFBT emerged from brief family therapy and is informed by ideas of paradigm shift, systemic therapy, positive psychology, and possibility therapy. It is a pragmatic approach that focuses on competencies and not deficits, on creating solutions instead of solving problems. ¹

Emerging in the 1980s, it presented some radical ideas that problems and solutions need not be related, the kind of thinking required to solve problems is very different from the thinking that will create solutions, and that it is not necessary that complex problems will have complex solutions. ¹ In the context of child and adolescent mental health, this is an extremely useful approach to take because young people can often find it hard to talk about their problems directly, as it can be overwhelming or associated with shame. The stereotype of “good child” or “good student” can often get in the way of talking about problems openly. Starting with problem-free conversations and gentle questions is useful to begin dismantling these notions. Another reason we find this approach a good fit is that young people tend to think creatively, they like asking questions, and are attuned to thinking about their future, their hopes, and their dreams. Furthermore, inviting young people to collaborate in the therapy room can be empowering for them. This shifts their attitude, which in itself can be enabling toward efforts for making small changes that can lead to bigger changes.^{1, 3}

This article illustrates the application of SFBT, its philosophy and techniques, with adolescents and young people through two case stories.

It Is Not a Set of Techniques but a Philosophy of Life

Kirti, a 13-year-old young girl, came into the service with diagnoses of specific learning disorder, dyspraxia, and social communication pragmatics disorder. These conditions influenced the way she perceived and interacted with the world. It affected her academic performance, social experiences, sense of self, and overall participation in life, resulting in overwhelm and frequent anger outbursts at home. Parents brought her in to address concerns related with anger as a problem-saturated narrative surrounded Kirti. When I met Kirti, she seemed shy yet extremely friendly, polite, and a pleasant young girl. In her attempt to appear “good” at therapy, she said that all her difficulties were manageable and that we need not talk about any problems because it was all in the past. I have often encountered this reluctance to acknowledge the problem when working with children and young people. Centering on the philosophy of SFBT, which says a focus on the possible and changeable is more helpful than a focus on the overwhelming and intractable, ⁴ I decided to focus on how she wanted to make use of the therapy space instead of imposing her with parents’ goals. Kirti wanted to use the space to talk about herself. I asked her how talking and sharing about herself might be helpful for her, and Kirti explained that this would help her clear her mind, worry less about the problem, and maybe create a space to share her secrets in time. Giving her the agency of deciding what to talk about and how much to talk about and focusing on her strengths and interests instead of the problem became the bedrock of our therapeutic relationship and work.

Since in SFBT it is not essential to explore the details of the problem to figure out solutions, this approach worked well both for Kirti and for her parents. Our conversations meandered from art, music, and movies to examinations, friendships, and belongingness. An important tenet prescribes figuring out what works and then doing more of that. Sen ⁵ explains the rationale of this tenet through the beautiful Buddhist philosophy of what we focus on grows. Keeping this in mind, I chose not to stress on the problem story; instead, our therapeutic conversations centered on Kirti’s strengths, interests, or exception stories. Since no problem is perfect in its existence, there exist snippets of life that are beyond the influence of the problem and thus can be seen as unique or as an exception. Even if there were small exceptions to the problem story, they were expanded upon in the therapy room. We nurtured these exception stories by linking them with her capabilities, values, and family values. This encouraged Kirti to become mindful toward more exceptions to the problem in her life, making it easier to poke holes in the problem-saturated narrative that surrounded her.

Redressing power and making space for collaborative work in the therapeutic setting, with children and young people, can be significant toward fostering agency and ownership. SFBT’s philosophy, “If it ain’t broke don’t fix it,” brings exactly this in action.^{6, 1} It essentially means that if the client does not ascribe something as problematic, then it is important to not deem it unhealthy just based on our professional knowledge. I remember in one of our sessions, Kirti and I unpacked confidence. I promptly invited her to scale her confidence, and when Kirti said it was at 1, I presumed we were heading toward a concrete goal now. I asked her where she would like her confidence to be on that scale. She replied that she was fine with it being at 1 and did not want to increase it. Perplexed, I asked her why? She explained that she had noticed people with more confidence tended to be “obnoxious” and often got into trouble at school for that. Therefore, we segued the conversation toward what she preferred by using questions such as “How do you like things to be instead?” and “What would you prefer over confidence?” This led us to discover that friendship and belongingness were important for Kirti.

Making space for her strengths, interests, and what Kirti held important made way for us to probe the problem. It is widely understood that therapy is not linear and thus often it is possible that conversations about problems take place after some changes have been noticed, or after one feels connected with their skills, abilities, and their hopes for the future. Now that Kirti had begun to develop a richer sense of self, she was able to acknowledge the problem, her anxiety, that gave rise to rigidities, which eventually were the cause of misunderstandings and anger outbursts at home. This allowed us to gather more information and make further clarifications, which resulted in psychiatrist consultations where a diagnosis of anxiety disorder was concluded. If we had launched our intervention at the site of anger outbursts, it is likely we would have made little headway while breaking down a young person’s sense of self. Now that it was clear that it was the anxiety that caused the problem, it was efficient to target intervention to decrease anxiety and not anger. It is important to bear in mind that even though Kirti was now able to talk openly about her problem, we kept one foot in acknowledgment and the other foot in possibility ⁷ by see-sawing back and forth from the territories of problem to the territories of possibilities. This ensured we stayed connected with ideas of her preferred future. So we could leverage her skills, strengths, and resources to propel her toward this preferred future.

Bridging Philosophy with Techniques

Arjun, a bright, energetic, and musically talented young person, first came in the service at the age of 10 when he was diagnosed with attention deficit hyperactivity disorder (ADHD) along with specific learning disorder (SLD)—dyslexia. At the age of 22, when parents came with him again, the presenting concerns were of hypomanic episode, and he was diagnosed with bipolar affective disorder II (BPAD). Initially, Arjun was hesitant toward restarting therapy; therefore, when he agreed to taking some sessions, it was important to prioritize the foundation of the therapeutic space as a non-judgmental, safe, and collaborative space. It was important to respect the pace Arjun was comfortable with, so it could be a space where he did not feel pressured to work on any goals or the worries parents came in with. It would have been easy to get hooked to the worries that surrounded his concerns; thus, being mindful of that, doing supportive work initially was prioritized instead of targeting problems and establishing goals immediately. To establish comfort and trust and encourage his engagement with therapeutic work, I employed several small practices such as using a room where he could pace around while talking, having him use a fidget object to channelize energy, keeping up with the low topic control and the myriad of stories he brought to the room, along with listening with curiosity.

Gradually, in conversations, we started to focus on preferred goals. In one of the sessions, he shared about his anxiety about stepping out of home and not feeling ready to socialize, as anxiety brought thoughts such as “What would other people think.” He exclaimed, “I don’t want my bedroom to become my mancave!” At this juncture, with the intention of goal setting and focusing on his preferred future, I asked him, “What did he hope for differently?” Arjun expressed wanting to be “carefree,” “having fun,” and reconnecting with the feeling of “being a grown up.” An important component of solution-focused goals is that they are clear, concrete, and real. Clients are encouraged to set smaller goals than larger ones and to frame their goals as presence of a solution rather than an absence of a problem. ⁸ With that in mind, we broke down the stated hopes, through questions such as “What ideas did he have of being a grown-up?” and “What would he be doing in his day that would bring a sense of being a grown up?” Through questions like “Was there a time earlier where you felt like a grown up or felt carefreeness?,” we explored possibilities of exceptions. These discussions helped him arrive at small doable steps going forward, such as coming for therapy sessions on his own without dependence on parents, taking steps toward basic hygiene and grooming, etc. In SFBT, goal setting essentially helps gain clearer focus and roadmap for therapy and helps the client to move from passivity to a position of ownership and prioritize what is important to them.

Soon enough, Arjun started to take more charge in the therapy session and would come prepared with some goals he hoped to work upon. When Arjun mentioned feeling his confidence was impacted, we used the technique of scaling, where we scaled “feeling confidence” on a scale of 1 to 10, where 1 was not feeling confident at all and 10 was feeling perfectly confident. Through scaling we were able to see how he was actually at a 5. Through questions such as “What makes it a 5 and not a lower number?” and “What steps he had been taking to be there?,” we were able to explore his skills, resources, and efforts, which consequently contributed to better mood and increased motivation toward taking further steps to bring changes. Even though Arjun continues to face challenges, through the use of SFBT techniques over a series of sessions, coupled with pharmacological intervention, he has started to show more coherence in his thoughts and expression and began to make choices that reflect agency.

Summary

SFBT is a future-focused, goal-directed, and solution-oriented way of working. It is a practical, goal-driven model that lays emphasis on strengths instead of weaknesses. The SFBT approach assumes that clients are capable of coming up with their own unique solutions and the therapist can only be a catalyst for the change through conversations. Further to this, it is important to note that SFBT has been noted to be effective in various contexts including schools, healthcare setups, and inpatient hospitals by showing positive outcomes in terms of self-esteem, depression, and social adjustment. ⁹ SFBT can lead to improvements in symptoms, functioning, and client satisfaction. Research also highlights its efficacy in promoting goal attainment and facilitating positive changes in a relatively short timeframe.^{10, 11} The vignettes shared here demonstrate the use of SFBT with young people who are dealing with complex problems. We have tried to highlight how when we upheld the philosophy of this practice in our work, the techniques followed. This approach guided the clients forward toward helpful and useful solutions, which were not complex at all.