How to transform solution-focused brief therapy into a single-session intervention: techniques and practical suggestions

With today ‘s article we want to share some ways and techniques that allow us to transform an already short intervention such as Solution Centered Therapy into a single session intervention .

 

Some of the readers will already be objecting and thinking to themselves “ but if I already have specific training how can I adopt TSS in my practice without distorting my intervention?

For those who have only just started reading our articles or simply want to learn more about the topic, in a previous article Psychotherapies and Single Session Therapy: which approaches can be used to conduct a TSS ( click here ) will find bibliographic references and guidelines for orientation in integrating TSS into one’s professional practice.

 

Now let’s go back to our main theme and see what characterizes the two forms of therapy!

• Single session therapy

SST (Talmon, 1990 ) are characterized by the fact that each meeting is organized in such a way as to represent a complete therapy. The therapists who practice it start from a strong belief that therapy can take place in a single session and that in that single session it is possible to achieve significant changes regardless of the severity of the problem presented.

 

How do therapists who use SST work?

TSS therapists define the objectives of the therapy with the client and are oriented towards the research of his strengths and resources that will allow him to face the problems. From the goals they develop a concrete plan for how patients can address their concerns. In some phases of the therapy the therapist can confront his own work team if the latter operates within a service.

 

How is the method structured?

In summary, SST is a method that follows a process that consists of several differentiated phases that the Italian Center for Singe Session Therapy has identified in five moments (Cannistrà & Piccirilli, 2018) and which follow a sequential order:

1. Phase of the first contact and pre-session interview
2. Session stage with problem prioritization , goal setting and feedback
3. Phase of exploration of attempted solutions and patient resources
4. Phase of closing the session, prescription of tasks and evaluation of the session
5. Follow-up

 

•  Solution Focused Brief Therapy

TBCS (De Shazer, 1985, 1988; Berg , 1994a; De Jong & Berg, 2008) is a model that draws on general systems theory, cybernetics, constructivism, and social constructionism. His techniques were developed from the work of the Mental Research Institute team in Palo Alto , California and the Milwaukee Brief Family Therapy Center (BFTC) team.

 

What are the main techniques?

TBCS techniques are designed for the person to focus more on personal and family solutions , strengths , and resources include:

• The work on the exceptions to the problem (those moments when the problem is not present or less intense) and the Miracle Question ;
• future projection questions (what will the client do when the problem ceases to be present in his life);
• setting manageable goals ;
• the scaling procedure (“on a scale from 0 to 10, where 0 represents the worst moment of the problem and 10 the moment in which it is already satisfactorily resolved, what number are you currently at?”)

 

Let’s now see how to integrate the two interventions starting from the points in common and from the techniques that make the intervention more effective and shorter!

Each model of psychotherapy is supported by certain beliefs from which derive a series of procedures or techniques that characterize it, differentiating it from all the others. Below we list the common beliefs of a TBCS and TSS surgery.

  

1. You don’t need to know much about the problem to start solving it

 This idea allows the professional to assume the role of facilitator of change, avoiding the therapist the mistaken idea that it is possible to intervene only when a precise diagnosis of the problem has been reached. In these forms of therapy the nosographic diagnosis is replaced by the operative one, which allows the therapist to understand how the system works and to act directly on it, as in an action research process (Cunningham, 1976; Lewin, 1946).   

 

1. All it takes is a small change to start the solution

Starting from the general theory of systems, we know that a small change in one part of the system produces changes in the other elements and in the total system, therefore the professional will be able to avoid relying on the idea that the greater the complexity and seriousness of the problem, the greater it will be. the complexity and magnitude of the solutions. Small changes can produce a domino effect that will affect different areas of the person or family.

 

1. Individuals and families have the resources to deal with their challenges

People have resources , strengths , and coping strategies that enable them to overcome adversity (Bohart & Tallman, 2010, 1999). Even families faced with stress activate processes of reorganization of meanings and behaviors that allow them to recover and maintain optimal levels of functioning and well-being, balancing resources and needs.

 

1. The session can be a complete therapy!

The therapeutic process is oriented towards achieving something concrete at the end of the session which will accompany the person even outside of therapy, leading them towards the future and in the process of change.

 

1. A polyocular vision

The use of the resource of the therapeutic team composed of the different professionals participating in the session, both as interviewing therapists and as observing therapists, can be compared to the phenomenon of polyocular vision in which the differences between the visions of both eyes lead upon achieving depth perception.

 

Here are some examples of interviews in which the TBCS techniques are inserted which make the intervention faster

Insoo Kim Berg together with Peter De Jong in 2008 created a guide entitled Interwieving for Solution in which the single session prototype interview was outlined . The guide describes how to proceed in the therapeutic conversation when there is little time available and therefore only one opportunity to intervene.

 

Here are some examples of how the interview can be used in different situations:

• Interviewing customers referred by third parties
  1. Whose idea was it to come to me?
  2. What will convince this person that you don’t need to come see me?
  3. On a scale of 0 to 10 (with zero being the worst moment and 10 being the best) where would you be right now if you had to rate this situation?
  4. Where would you like to be on the scale next week?
  5. How important is making these changes to you (on a scale of 1 to 10)?
  6. How much are you willing to work on it?

 

• Interview with customers who arrive of their own free will
  1. How will you have changed following your visit and speaking with me?
  2. When was the last time you did this or did it for a short period of time?
  3. How did you do it?
  4. What would your best friend say about how you accomplished this?
  5. What would it take to do it again?
  6. What do you need to do to move up one point on the scale?
  7. What would others say you should do to move up a step on the scale?

 

• Miracle question
  1. Suppose a miracle happened while you were sleeping and the problem that brought you here is solved.
  2. What are you going to do differently?
  3. Who will be the first to notice you’re doing things differently?
  4. What would she notice differently about you?
  5. When was the last time it happened even briefly?
  6. How did you make it happen?
  7. What would it take to do it again?
  8. If I pretended, even for a brief moment, that a small part of that miracle had occurred, what one or two things would be different?

 

• Interview for third party sending client

1. 1. I support and agree with your teacher and acknowledge the hard work you have put in with the child, I understand his frustrations and the effort he has made to overcome this. I’d like to ask you some questions:
   2. What special qualities do you see in this child that tell him he will be able to do this?
   3. How do you judge this child’s potential to change for the better?
   4. What’s the least change this child needs to make?
   5. Tell me about the last time the child was, even a little longer, how he is better behaved
   6. How do you think it happened?
   7. On a scale of 0 to 10 (0 being the worst time, 10 being the best), where would you rate the child’s current behavior?
   8. What is the highest grade achieved by the child?
   9. Where do you judge this child’s potential for change?
   10. What’s the first little thing I can do to help you?

 

Conclusions

The article presented some of the beliefs that guide therapists who intervene with the use of Brief Therapy methods or models ( e.g. TSS or TBCS) , and also identified some interview methods capable of making the approach focused on the solution even shorter to the point of being achieved through a single session . But why so much effort? Isn’t it enough for an intervention to be effective and that’s it? To answer this question we quote the words of De Shazer (1991a) according to which:“Brief Therapy” simply means therapy that lasts as few sessions as possible, not one more than necessary…” . What if necessary in some situations means only one ?  

 

Angelica Giannetti
Psychologist,
Team Psychotherapist of the Italian Center
for Single Session Therapy

 

Bibliography

Cannistrà, F., & Piccirilli, F. (2018). Single-session therapy: Principles and practices . Florence: Giunti Editore.

deShazer, S. (1985). Keys to Solution in Brief Therapy . New York: W. W. Norton.

de Shazer, S., Kim Berg, I., Lipchik, E., Nunnally, E., Molnar, A., Gingerich, W., Weiner-Davis,

M., (1986). Brief Therapy: Focused Solution Development. Family Process , 14:79-93.

deShazer, S. (1988). Clues: Investigating Solutions in Brief Therapy . New York: W. W. Norton.

De Jong, P. & Berg, IK (2008). Interviewing for Solutions (3rd edn.). Pacific Grove, CA: Brooks/Cole.

Hoyt, M.F. & Talmon, M. (2014b). Editors’ Introduction: Single Session Therapy and Walk-In Services. In MF Hoyt & M. Talmon (eds.) (2014a), op. cit., pCapturing the Moment. p. 2-26.

Hoyt, M.F. (2009). Brief pychotherapies: Principles and practices. Phoenix, AZ: Zeig, Tucker & Theisen (Tr. it. Brief psychotherapies. Principles and practices. Rome: CISU).

Slive, A. & Bobele, M. (2014). One Session at a time: When you have a Whole Hour. In MF Hoyt & M. Talmon (eds.) (2014), op. cit., pp. 95-119.

Talmon, M. (1990). Single Session Therapy. San Francisco: Jossey-Bass (Tr. it. Single-session psychotherapy. Milan: Erickson).