Question 1

How do you "begin" working with students who have depression and do not see any solutions to the barriers/challenges?

Johnny Kim · Accepted Answer

With every client, it is important to make sure you get to know them first, and I will encourage therapists to ask these questions:

* Who are some important people in your life?
* What are some things you are good at? 
* What are some activities you enjoy doing?

It's also important to find out more details from the client about their answers. You can follow up with questions like:

* What is it about Jim that makes him an important person in your life?
* How did you get so good at snowboarding?
* How does playing video games help you?

This type of opening in SFBT allows the student to answer easy, non-threatening questions and provides important information that the therapist can use later when working on the student's depression or other goals for the session. I would look for opportunities to connect the student's answers to my questions above to potential solutions that will help them feel less depressed. For example, if the student says they enjoy playing video games, I might ask if they play video games with other people and how they were able to do that. I might also ask if playing video games helps with their depression and if so, I'd follow up with a question about how it helps them. If not, I'd ask what other activities they enjoy doing when they are not feeling depressed.

Another SFBT question I would use with this student is the miracle question. This SFBT technique is useful when the student isn't sure what the answer is or how their life will be different when the problem is not there. The miracle question can be useful for both the student and therapist because it's asking the student to describe the first clues when they wake up that would let them know the depression is gone (a miracle happened overnight, but you were asleep, so didn't know it happened) and they are feeling more like themselves. The SFBTA Treatment manual (Bavelas et al., 2013) provides a more detailed example of how to ask the miracle question and provides a short example.

Question 2

What are the main interventions of Solution-Focused Brief Therapy?

Johnny Kim · Accepted Answer

In Solution-Focused Brief Therapy (SFBT), a therapist and client work together to focus on changes the client would like to make and ways the client has been successful in the past. SFBT therapists will use a variety of questions to help the client figure this out and help clients identify solutions to their problems. Some of the main interventions used are:

* Asking exception questions about times when they were able to achieve their goal or when the problem didn't exist.
 
* Asking the miracle question, which has the client imagine that a "miracle" has happened overnight while they were asleep and has the client describe what they would notice about themselves when they wake up, and the problem is gone.
 
* Asking a scaling question with follow-up questions to learn what that number the client provided means to them and how they will know they've improved one step on that scale. 
 
* Providing compliments to the client when they mention skills they have or positive changes they have made. 
 
* Collaborating on the client's goal that they can work on after the counselling session that will lead to improvements in the client's life.

Along with these main SFBT interventions, an important aspect of SFBT involves the therapist developing a positive and collaborative relationship with the client during a session. One way to accomplish this is to let the client be the expert in what they think the problem is and what they think are some possible solutions. Another important task for the therapist is to focus on having a more solution-building conversation with the client, whereby the therapist listens for words or phrases from the client's answers that have elements of success, solutions, or exceptions. Then the therapist will select those words or phrases and use them in their next line of questions to build on a more detailed aspect of some potential solution. This SFBT process is often referred to as listen, select, & build (De Jong & Berg, 2013), and the goal is to spend more time in the counselling session asking questions about solutions rather than spending time getting details about the problem that the client already knows. More details about the main interventions of SFBT can be found in the treatment manual, which is available from the Solution-Focused Brief Therapy Association website www.sfbta.org.

Question 3

Can you describe the nature of the therapeutic relationship between the therapist and client in SFBT?

Johnny Kim · Accepted Answer

This is a great question because often times therapists aren't aware of how their clinical approach can impact the client's response. This is an especially important factor when working with clients who are racially different from you or clients from other underrepresented groups where trust needs to be earned and takes time. What makes SFBT different from other therapy models is how much emphasis is placed on creating a collaborative relationship. This is done by the SFBT therapist intentionally asking questions that allow the client to be the expert in their own lives and what they want for the future. Insoo Kim Berg and Steve de Shazer, two of the main developers of SFBT, would often say that the therapist should take a not knowing approach when working with a client so that the therapist doesn't impose their own biases or opinions into the counselling session. Relatedly, Insoo and Steve would also say the therapist should lead from one step behind, which allows the client to direct what they want from the counselling session rather than the therapist directing what should be done instead (De Jong & Berg, 2013 https://www.amazon.com.au/Interviewing-Solutions-Peter-Jong/dp/111172220X). Of course, if a client wants something that is illegal or potentially harmful, the therapist would not just go along with it. Instead, the therapist (working from one step behind) would explore what benefit the client would get out of doing that and how it would help in an effort to help the client co-construct a more positive goal that might also be beneficial to them.

Question 4

What is the theoretical basis of SFBT?

Johnny Kim · Accepted Answer

The main theoretical basis of SFBT is social constructionism which posits that reality is socially constructed by the individual, and it's the interactions with and observations of other people that allows individuals to develop their ideas of what is real (Kim, 2014 https://www.amazon.com/Solution-Focused-Brief-Therapy-Multicultural-Approach-ebook/dp/B00EUHFK36). So how this applies in SFBT is around using language and Socratic questioning to help co-construct more useful client goals. For example, if a client tells me they are here to see me because they are dealing with anxiety, I would want to know what anxiety looks like from the client's perspective. But more importantly, I would ask them questions to find out things like:

* How will they know they don't have anxiety anymore? 
* When were times they weren't feeling anxious?
* What would they be doing when they are not anxious?

By focusing on these solution-building questions, I am trying to help the client change their perspective of their current situation (i.e., struggling with anxiety) with a new reality where they are not anxious.

A more recent theoretical basis for SFBT explores the role of positive emotions and how that can help a client (Kim & Franklin, 2015). Studies have shown that positive emotions can negate negative emotions while allowing clients to broaden their thought action repertoire (Fredrickson, 2001). SFBT techniques (i.e., compliments, exception questions, coping questions, and asking clients what potential solutions they have) can be very useful in helping to create positive emotions in clients during a counselling session, which in turn can help spur clients into action.

Question 5

What do you do in a situation where the client keeps reverting back to problem talk?

Johnny Kim · Accepted Answer

This is a situation many therapists using SFBT encounter and can be challenging for those just learning. But this type of client who keeps reverting back to problem-talk can be very useful in helping you assess how good you are at sticking with SFBT. If you watch old clinical videos of Insoo Kim Berg and Steve de Shazer (www.sfbta.org), you will see many times clients complaining or answering with more problem-talk. However, Insoo and Steve will just let those complaints pass by and re-ask them the solution-focused question again. So really, the key is to not give up and re-ask that solution-focused question again to see if the client comes back with a different response that isn't just complaining. 
If they still struggle with problem-talk, I will ask relationship questions which can help shift the client's perspective in answering your solution-focused question. For example, "What would your best friend say you could do this week to not get so angry?" or "How will your boss know you are doing better and not depressed as much as you have been lately?" Often times having the client think about the question from another person's perspective (someone important in their life) can lead to potential solutions that you can build off of.

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