WHAT IS SOLUTION-FOCUSED THERAPY?     Source: Harvard Mental Health Letter, Apr97, Vol. 13 Issue 10, p8, 1p

Most psychotherapy begins in a way that seems to make intuitive sense. Patients describe their problems and therapists question them for a better understanding; patient and therapist then discuss the predicament, and the therapist tries to help the patient develop alternatives. Yet many psychotherapists find that concentrating on failures and inadequacies in this way can make patients feel worse rather than better, at least in the short run. If the focus on shortcomings and mistakes continues, the patient's self-esteem may decline and the situation may deteriorate.

Clinicians in growing numbers are now trying to avoid this problem by using a different approach, solution-focused therapy, which does not fit perfectly into any of the classical psychotherapeutic categories. It is neither exclusively supportive nor exclusively exploratory and insight-oriented. Originally developed by the Family Therapy Center in Milwaukee, it uses methods largely adapted from the work of Milton Erickson.

Solution-focused treatment begins from the observation that most psychological problems are present only intermittently. People with panic disorder obviously do not spend every minute of every day in a panic; even depression fluctuates in severity. Solution-focused therapy tries to help the patient notice when symptoms are diminished or absent and use this knowledge as a foundation for recovery. If a patient insists that the symptoms are constant and unrelieved, the therapist works with him or her to find exceptions and make the exceptions more frequent, predictable, and controllable. In other words, therapy builds on working solutions already available to the patient. As a corollary, the therapeutic dialogue is often deliberately diverted from a discussion of the problems themselves.

Solution-focused therapists make a special point of asking patients to describe as fully as possible what they believe their lives would be like without the problem for which they have sought therapy. It turns out that many patients are so preoccupied with their troubles that they have not given much thought to this question. When their attention is drawn to it, they often come up with useful ideas. One way to phrase it is known as the miracle question: "If a miracle occurs tonight while you are asleep and the problem is eliminated, how will you know the next morning How will others know? What will you be doing differently or saying differently?" This question incorporates solution-focused therapy's emphasis on healthy functioning and its interest in helping patients generate their own solutions. A related question, designed to encourage patients by helping them evaluate their progress, is, "What is the smallest sign that would prove to you conclusively that you were getting better?"

One reason for the increasing popularity of this approach is its simplicity. No complex theory is involved, and the method is easy to understand and learn. Manuals and case studies are readily available. Some critics regard the approach as simplistic, but proponents believe it shows the value of making few theoretical assumptions in psychotherapy. Furthermore, the short-term emphasis characteristic of solution-focused therapy is becoming more acceptable in psychotherapy than it used to be. Another reason for the popularity of this technique is the growing conviction that psychological problems can often be solved without investigating their origins.

According to its proponents, solution-focused therapy is useful for anxiety disorders, depression, bulimia, alcohol and drug dependence, and various kinds of marital and family conflict. All of these problems are said to respond fairly quickly, with results that persist in long-term follow-ups. However, no controlled studies are yet available.