Solution Focused Therapy
SFBT’s evolution started with the work of Milton Erickson and the mental research institute in the States. Essentially therapists started to look at analytical practices back in the 60’s and realise that it had limitations, and Erickson’s approach that you had to tailor the therapy around the individual and not fit them into an existing model meant that therapy moved more towards the clients resources being utilized more. By 1965 the Brief therapy project was developed. With analytical therapies there was a presumption that the problem stemmed back to a defining moment in that person’s life. This could take considerable time and did not necessarily come to any solid conclusions.
With Brief Therapy, the origins of the problem were by and large avoided because recognising it did not necessarily mean a solution could be found. They started to look at what resources the individual already had and how they could interrupt the problem cycle. Insoo Kim Berg recognised that her clients were leaving after 6 or 7 sessions, and at first she thought she was not being effective, but when she looked into this, she realised that the methods they were developing were considerably speeding up the therapy – which up to then may have gone on for years. From this SFBT developed. Steve De Shazer along with colleagues at the Milwaukee based Brief Family Therapy Centre realised that looking forward to a hoped for future that was devoid of the ‘problem’ and building upon how the client was able to do other things well. There are always exceptions to every problem and when the client was not experiencing the problem – what were they doing?
It was out of this approach that one client suggested a miracle must happen before her situation got better and so the miracle question was born and this has become central to the SFBT process. By focusing on what we want instead of what we don’t want, we are much more capable in finding a solution. An example might be “I don’t want to feel lonely” the miracle question would concentrate on what would be happening if you we’re not feeling lonely, this then might prompt the person to find out activities they might enjoy where they meet people. This may appear common sense, but often people focus on the negative when they find themselves in such a situation.
Weight loss is another area which the Miracle Question can uncover some interesting underlying reasons why they have problems with food. So instead of “I would wake up slim”, further questioning may bring forth answers such as “I’d be more sociable”, “I’d go out dancing” etc all these then can help focus on different activities that will help the person move towards some kind of behaviour that helps.
In the SFBT has been transformed into a great way to supervise practitioners and is used within the NHS as part of their management strategy and is recognised as a benchmark of good practice by the Department of health. It can be used not only individually but also as a business model, helping companies make changes when they have problems they are having difficulties solving.
I was one of the founding executive committee members of the Association of Solution Focused Hypnotherapy between 2010 and 2015.
Cognitive behavioural therapy
Cognitive behavioral therapy (or CBT) is a psychotherapeutic approach that aims to solve problems concerning dysfunctional emotions, behaviors and cognitions through a goal-oriented, systematic procedure. CBT refers to therapy based upon a combination of basic behavioral and cognitive research.
Background to CBT
Siddhartha Gautama otherwise known as Buddha, was one of the first to teach that our perception of the world comes from within, and we cannot escape the inevitable. So instead we must pay attention to the now by being in the moment and not judging, and by being kind to oneself and others. It is concerned with cause and effect and how good and bad behaviour has an effect on our future.
Using these ideas in CBT has developed the idea of useful and adaptive thinking and problematic or maladaptive thinking – as well as using mindfulness as a method of focusing attention away from rumative thinking.
Socrates – the Greek philosopher – used a form of enquiry that was insightful and purposely brings out the values, beliefs and meanings of the answers given. Open questions that find out what lies at the heart of the problem. This form of questioning is used in scientific enquiry and used extensively in CBT to try and understand why people do or think a certain way.
Immanuel Kant – realised one could break down the way one fits into the world at large as objective – the reality of the world (as Noumena) and the subjective – the way things appear – how we individually perceive the world (as he called Phenomena)
We cannot truly perceive the real world as we all have different backgrounds, understandings and influences that colour our perception. He popularised the notion of Schema, which is taken up in CBT where patterns of behaviour over a period of time are recognised and may need to be changed to get desired results.
Schema is an individuals view of the world. It is the accumulation of knowledge to make up a framework of understanding. It is information processing that enables us to classify information and to anticipate events. How the person behaves is much to do with how they experienced events in the past. Because no two people will have the same experiences, no two people will respond in the same manner.
In a depressed person their perception of themselves will tend to be negative, “who wants to be with me, I feel miserable” so they avoid social situations because they perceive no one wants to be with them, while they feel that way, and so it becomes a self fulfilling prophesy because they have withdrawn. If people make positive remarks, quite often it will be responded to with a negative response such as “what do they want?” or “They’re only being nice to me – but I don’t deserve it”.
By pushing away the very thing that will make them feel better, depressed people can become more isolated and become convinced no one cares – so the cycle continues.
A depressed person is more likely to ruminate on a number of core beliefs, such as “I’m unlovable” for example, and this becomes a focus for negative self-hypnosis. Their attention being drawn to events that support their belief, and ignoring contradictory information.
The modern roots of CBT can be traced to the development of behavior therapy in the early 20th century, the development of cognitive therapy in the 1960s. The therapeutic approaches of Albert Ellis and Aaron T. Beck gained popularity among behavior therapists.
Today due to the fact that measured outcomes have helped show good results, it is currently the therapy of choice for the NHS, though SFBT is gaining ground here.
The particular therapeutic techniques vary within the different approaches of CBT according to the particular kind of problem issues, but commonly may include keeping a diary of significant events and associated feelings, thoughts and behaviors; questioning and testing cognitions, assumptions, evaluations and beliefs that might be unhelpful and unrealistic; gradually facing activities which may have been avoided; and trying out new ways of behaving and reacting. Relaxation, mindfulness and distraction techniques are also commonly included.
In areas such as phobias, it is usually accepted to expose the person to the thing that is causing the anxiety slowly over a period of time and the person gets used to it slowly. The fast phobia technique of NLP has largely overwritten this technique as it helps scramble the panic template we’ve engrained in our minds.
CBT has it’s place in psychotherapy and can be useful if a person has limited resources, such as the elderly, those with serious physical illness and children.
Neuro-Linguistic Programming (NLP) originated when Richard Bandler – a student at University of California Santa Cruz – and linguist John Grinder were listening to and selecting portions of taped therapy sessions of the late Gestalt therapist Fritz Perls.
They recognised that the way people used language had some effect on their behaviour. Using this model they were able to come up with a whole range of complicated names of ways we use language and interect.
More ideas were developed when the pair were introduced to Milton Erikson – his use of language and the individual way he addressed each person made them realise that it was an effective way to taylor therapy.
NLP was originally promoted by its co-founders in the 1970s as an effective and rapid form of therapy capable of addressing the full range of problems such as phobias, depression, habit disorder, psychosomatic illnesses, and learning disorders.
There is some debate how effective NLP can be, but certainly the fast phobia technique and the Swish have proven to be effective, certainly to myself and the clients I have used it on. Using metaphors and reframing situations can help getting people focusing on the more positive aspects of their lives. Such techniques as anchors are repeatedly used in sports hypnosis, to fix a certain feeling, thought or action firmly in the mind of the sportsperson so they perform exactly how they rehearsed mentally. If you watch sports events carefully, you may see a sportsperson move their hand or finger in a slightly odd way, this is the anchoring technique in action.