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Solution-Focused Brief Therapy (SFBT)

for Alcohol and Substance Use Disorder

Treatment for Alcohol & Substance Use Disorders A Training Resource


By Jim Messina, Ph.D., CCMHC, NCC, DCMHS-T

Solution Focused Brief Therapy (SFBT)


CEU’s: 3 hours based on request (CE Broker Tracking #: 20-615492)


Resource for Course on Coping.us: 

http://www.coping.us/alcoholsubstanceuse/sfbtforalcoholsuds.html


Program Description: This program is focused on providing an Evidence Based Practice of Solution Focused Brief Therapy which when implemented appropriately will get unmotivated clients to become active in their recovery. To understand this model, one must also understand the Application of the Stages of Change Model. Case studies will be utilized to assist the trainees to become skilled in strategies for evoking self-motivation; the art of asking open-ended questions and how to utilize motivational enhanced therapy in a brief interventional format.


Learning Objectives

1. To learn how in Solution Focused Brief Therapy that emphasis is placed on building exceptions to the presenting problem and making rapid transitions to identifying and developing solutions intrinsic to the client or problem.


2. To learn a whole new way of dealing with clients which focuses on their competence rather than their pathology, while finding unique solutions for each person and using past successes to foster resilience and belief in self-empowerment.


3. To learn how the model looks at the clients as the experts and how to share responsibility with the clients by using exceptions to help open their minds' doors to optimism.


4. To learn about additional methodologies or strategies which can be incorporated in the SFBT model and to then put them into practice in role-play experiences with fellow workshop participants.
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Solution Focused Brief Therapy (SFBT) Presentation
Role of Motivation in Treating Alcohol or Substance Use Disorders
In working with people who have Alcohol or SUDs one must be ready to deal with the question of readiness to change and level of motivation needed to change. Some tools to be used to address these issues are: 
  • Motivational Interviewing
  • Motivational Enhancement Therapy
  • Evoking self-motivation
  • Asking open-ended questions
  • Stages of change model
We will focus on the Stages of Change Model to prepare us to work with Solution-Focused Brief Therapy (SFBT) with Alcohol and SUDS.

Questions to ask in evoking motivation of the Individual Change

Questions to ask

  • What things make you think that this is a problem?
  • What do you think will happen if you do not make a change?
  • What are the reasons you see for making a change?
  • What makes you think you need to make a change?

What does it take to evoke self-motivation?
  • What makes you think that if you decided to make a change, you could do it?
  • What do you think would work for you, if you needed to change?
  • How much does your use concern you?

What Open Ended Questions should you ask?
What brings you here today?
  • So you are here to talk about quitting.

In what ways are you concerned about your marijuana use?
  • Do you use marijuana too much?

What do you think you want to do about your use?
  • When do you plan to quit?
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Stages of Change with Complete Explanations and Examples
Stages of Change Model

  1. Precontemplation
  2. Contemplation
  3. Preparation
  4. Action
  5. Maintenance

1. Precontemplation
Task - to increase discrepancy
  1. Educational confrontation - How many joints do you smoke?
  2. Use progression models
  3. Accurate information about disease
  4. Educational model


Good and less good aspects

  • Invites defensiveness
  • Narcissistic defense


Broad based assessment

  • Alcohol and drug history
  • Psychosocial history
  • Psychiatric evaluation
  • Medical evaluation

2. Contemplation

Task - tip the decisional balance scale

Normalize ambivalence

  • I know many other clients who felt the same way as you and they succeeded.
  • You are the best judge of which way to go.
  • Use reframing

What are the options?

  • Move from external to internal motivation
Real from perceived
  • There are many problems
  • Deal with first other issue
“Natural link”
  • Quit drinking for a week
  • Take meds for a month

List of concerns  

“Pro’s and con’s”

Questions

  • It’s up to you…….
  • What do you plan to do next?
  • What is most important reason to change?
  • Where do we go from here?
  • How would you like for things to turn out?

3. Preparation
Identify and assist in problem solving re: obstacles
Help client identify social support
Verify that client has underlying skills for behavior change
Encourage small initial steps 

4. Action
Practicing new behaviors
Focus on restructuring cues and social support
Bolster self-efficacy for dealing with obstacles
Combat feelings of loss and reiterate long-term benefits 

5. Maintenance
Continued commitment to sustaining new behavior
Plan for follow-up support
Reinforce internal rewards
Discuss coping with relapse

Relapse is an Expected Part of the Change Cycle
Resumption of old behaviors: "Fall from grace"
  • Evaluate trigger for relapse
  • Reassess motivation and barriers
  • Plan stronger coping strategies
Solution-Focused Brief Therapy (SFBT)
SFBT was developed by Steve De Shazer and his colleagues at the Brief Family Therapy Center in Milwaukee, Wisconsin. In solution-focused brief therapy, the emphasis is placed on building exceptions to the presenting problem and making rapid transitions to identifying and developing solutions intrinsic to the client or problem. 

Highlights of SFBT
  • Focusing on competence rather than pathology
  • Finding a unique solution for each person
  • Using exceptions to the problem to open the door to optimism
  • Using past successes to foster confidence
  • Looking to the client as the expert
  • Using goal-setting to chart a path toward change
  • Sharing the responsibility for change with the client

The 3 Golden Rules of SFBT
1. "If it ain't broke, don't fix it!"

2. Once you know what works, do more of it!

3. If it doesn't work, then don't do it again – do something different!

What is SFBT?

Solution-Focused Brief Therapy:

  • Helps clients develop a desired vision of the future wherein the problem is solved, and explore and amplify related their exceptions, strengths, and resources to co-construct a client-specific pathway to making the vision a reality.
  • Thus clients find their own way to a solution, based on their emerging definitions of goals, strategies, strengths, and resources.
  • Even in cases where clients come to use outside resources to create solutions, it is the clients who take the lead in defining the nature of those resources and how they would be useful. 

Tenents of Solution-Focused Brief Therapy (SFBT)
  1. It is based on solution-building rather than problem-solving.
  2. Therapeutic focus should be on client’s desired future rather than on past problems or current conflicts.
  3. Clients are encouraged to increase the frequency of current useful behaviors
  4. No problem happens all the time. There are exceptions – that is, times when the problem could have happened but didn’t – that can be used by client and therapist to co-construct solutions. 
  5. Therapists help clients find alternatives to current undesired patterns of behavior, cognition, and interaction that are within clients’ repertoire or can be co-constructed by therapists and clients
  6. Differing from skill-building & behavior therapy interventions, the model assumes that solution behaviors already exist for clients.
  7. It is asserted that small increments of change lead to large increments of change.
  8. Clients’ solutions are not necessarily directly related to any identified problem by either client or therapist.
  9. Conversational skills required of therapist to invite client to build solutions are different from those needed to diagnose & treat client problems.

Key Concepts of SFBT
  • Therapy grounded on a positive orientation - people are healthy & competent
  • Past is downplayed, while present & future are highlighted
  • Therapy is concerned with looking for what is working
  • Therapists assist clients in finding exceptions to their problems
  • There is a shift from “problem-orientation” to “solution-focus”
  • Emphasis is on constructing solutions rather than problem solving

Basic Assumptions of SFBT
  • The problem itself may not be relevant to finding effective solutions
  • People can create their own solutions
  • Small changes lead to large changes
  • Client is the expert on his or her own life
  • Best therapy involves a collaborative partnership
  • Therapist’s not knowing affords clients an opportunity to construct a solution

Questions Used in SFBT
  • Skillful questions allow people to utilize their resources
  • Asking “how questions” that imply change can be useful
  • Effective questions focus attention on solutions
  • Questions can get clients to notice when things were better
  • Useful questions assist people in paying attention to what they are doing
  • Questions can open up possibilities for clients to do something different
3 Kinds of Relationships in SFBT
1. Customer-type relationship: client and therapist jointly identify a problem and a solution to work toward

2. Non-compliant relationship: a client who describes a problem, but is not able or willing to take an active role in constructing a solution

3. Visitors: clients who come to therapy because someone else thinks they have a problem

Techniques Used in Solution-Focused Brief Therapy (SFBT)
1.Pre-therapy change (What have you done since you made the appointment that has made a difference in your problem?)

2.Miracle question (If a miracle happened and the problem you have was solved while you were asleep, what would be different in your life?)

3.Scaling questions (On a scale of zero to 10, where zero is the worst you have been and 10 represents the problem being solved, where are you with respect to __________?)

4.Taking "time-outs" Suggesting to the client "While I step out, I want you to think of the next smallest step you could take that would bring you to the next number on the scale."

5.Affirm client competencies (e.g., tell the client, "I am impressed you are sitting in that chair again after what you just went through"). Many of these clients have never had this success acknowledged before.

6.Task assigning: Suggest tasks that the clients can perform to improve their situation (e.g., ask them to do something achievable that would provide useful information or move them closer to the "miracle" they has chosen).

7.Exception questions (Direct clients to times in their lives when the problem did not exist)
Deliberate and Random Exceptions to Substance Abuse Behaviors

Deliberate exceptions are situations in which client has intentionally maintained a period of sobriety or reduced use for whatever reason. For example, client who did not use substances for a month in order to pass a drug test for a new job has made a deliberate exception to his typical pattern of daily substance use. If he is reminded that he did do this in the past it will demonstrate that he can repeat the behavior.

Random exceptions are occasions when client reduces use or abstains because of circumstances that are apparently beyond her control. The client may say, for example, that she was just "feeling good" and did not feel the urge to use at a particular time but cannot point to any intentional behaviors on her part that enabled her to stay sober. This type of exception is more difficult for the therapist to work with but can also be used to help client perceive her own efficacy. In such instances the therapist can ask client to try to predict when such a period of "feeling good" might occur again, which will force her to begin thinking about behaviors that may have had an effect on creating the random exception.
How Do You Ask the Miracle Question?

Language of the intervention may vary, but basic wording is:


“I am going to ask you a rather strange question [pause]. The strange question is this: [pause] After we talk, you will go back to your work (home, school) and you will do whatever you need to do the rest of today, such as taking care of the children, cooking dinner, watching TV, giving the children a bath, and so on. It will become time to go to bed. Everybody in your household is quiet, and you are sleeping in peace. In the middle of the night, a miracle happens and the problem that prompted you to talk to me today is solved! But because this happens while you are sleeping, you have no way of knowing that there was an overnight miracle that solved the problem. [pause] So, when you wake up tomorrow morning, what might be the small change that will make you say to yourself, “Wow, something must have happened—the problem is gone!” 

(de Shazer and Isebaert, 2003)


Benefits of the Miracle Question

What clients are able to co-construct with the therapist in answer to the miracle question can usually be taken as the goals of therapy.

With a detailed description of how they would like their lives to be, clients often can turn more easily to building enhanced meanings about exceptions and past solution behaviors that can be useful in realizing their preferred futures. 


Miracle Questions can be used with families and groups

In therapy with couples or families or work groups, the miracle question can be asked to individuals or the group as a whole.


If asked to individual members, each one would give his or her response to the miracle question, and others might react to it.


If the question is asked to the family, work group, or couple as a whole, members may “work on” their miracle together.


The SFBT therapist, in trying to maintain a collaborative stance among family members, punctuates similar goals and supportive statements among family members. 

Use of Scaling Questions in SFBT 

SFBT therapists use “scaling” questions to help clients/patients assess their progress towards achieving goals.

A progress scale is usually constructed in the first session with “10” standing for how the patient imagines life will be when the problem miraculously disappears and “0” signifying how things were at the point the patient arranged for therapy to begin.

In each subsequent sessions, the patients are asked to use this scale to assess their progress.

  • Additional individualized versions of this scale are then developed as needed throughout the therapy process to help the clients further assess changes and concretize progress in the specific areas of their lives they have targeted.


Keeping Daily Logs while Inpatient Using Scaling Questions

In SFBT inpatient treatment, clients are encouraged to keep a daily log form about their cravings and what they do instead of drinking or using drugs

This log contains the following information:

  1. How strong was the urge to drink or use drugs? (0-10)
  2. Where did this occur?
  3. With whom?
  4. How come?
  5. How did you stop this urge?
  6. How difficult was it to stop this urge? (0-10)

On Discharge Clients Keep Daily Logs using Scaling Questions 

Once clients are sent home and on their own they are encouraged to keep a daily log to bring back into outpatient individual or group counseling and asked to respond to the following:

  1. What day and hour did they drank some alcohol or use some drug?\
  2. What kind?
  3. How much?
  4. With whom?
  5. How come?
  6. Where?
  7. How did they stop drinking or using drug at the point at which they stopped?
  8. How difficult was it to stop drinking or using drug at that point? (0-10)      
(de Shazer and Isebaert, 2003)
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Example of SFBT in Practice with a Client
Guidelines in Setting Goals in SFBT
Goals must be:
  • Salient to the client rather than the therapist or treatment program.
  • Small rather than large.
  • Described in specific, concrete & behavioral terms.
  • Described in situational & contextual rather than global & psychological terms.
  • Stated in interactional & interpersonal rather than individual & intrapsychic terms.
  • Described as the start of something rather than the end of something.
  • Described as the presence of something rather than the absence of something.
  • Realistic & immediately achievable within the context of the client’s life.

Mechanics in SFBT

Solution(s) to the problems that a client brings into treatment may have little or nothing to do with those problems. This is particularly true in the treatment of problem drinking, where any of a variety of life experiences or actions on the client’s part, which have little to do with his or her use of alcohol, may result in a resolution of the problem.

While the number of potential solutions is limitless, one example is a problem drinker who stops using problematically when he or she:

  • Obtains employment
  • Ends or begins a relationship
  • Makes new friends
  • Relocates

Treatment therefore need not make alcohol the primary focus to resolve the drinking problem. Rather, the focus returns to helping the client achieve the personal goals he or she sets
Conception of SUDS Causative Factors

Problems with alcohol & other drugs are seen as multidimensional, resulting most likely from a combination of factors both environmental & biological. There is no one alcoholism but many different alcoholisms. The sheer diversity of causative factors & problems resulting from alcohol & other drugs suggests that:

  • No one treatment methodology can help all people.
  • A diverse package of treatment strategies is needed.
  • Treatment strategies should be developed & matched to meet the needs of the individual clients

Criteria for use of SFBT with SUDS Cases
  • Dual diagnosis issues such as a coexisting psychiatric disorder or developmental disability
  • Range and severity of presenting problems
  • Duration of abuse
  • Availability of familial and community supports
  • Level & type of influence from peers, family & community
  • Previous treatment or attempts at recovery
  • Level of client motivation (brief therapy may require more work on part of client but a less extensive time commitment)
  • Clarity of client's short & long-term goals (brief therapy will require more clearly defined goals)
  • Client's belief in value of brief therapy ("buy in")

Criteria for use of SFBT in work with SUDS Clients
  • Less severe substance abuse, as measured by an instrument like Addiction Severity Index (ASI)
  • Level of past trauma affecting client's substance abuse
  • Insufficient resources available for more prolonged therapy
  • Limited amount of time available for treatment (e.g., 7-day average length of stay in county-jail-level correctional facilities; 30- to 45-day limitation in Job Corps program)
  • Presence of coexisting medical or mental health diagnoses
  • Large numbers of clients needing treatment leading to waiting lists for specialized treatment

Typical Themes or Topics in SFBT Sessions with SUDS Clients

Typical themes in solution-focused therapy include:

  • The outcome that the client desires from the treatment process.
  • Strengths & resources of the client that can be used to achieve the desired outcome.
  • Discussion of previous successes of the client.
  • Discussion of exception & instance periods.
  • Discussion of changes in the client’s life from session to session.
  • Exploration of what the client does to achieve those changes.
Initial Session Goals in SFBT
  • Producing rapid engagement
  • Identifying, focusing, and prioritizing problems
  • Working with client to develop possible solutions to substance abuse problems and a treatment plan that requires client's active participation
  • Negotiating route toward change with client (which may involve a contract between client and therapist)
  • Eliciting client concerns about problems and solutions
  • Understanding client expectations
  • Explaining structural framework of brief therapy, including process & its limits (i.e., those items not within the scope of that treatment segment or agency's work)
  • Making referrals for critical needs that have been identified but can not be met within the treatment setting

Setting Goals in Treatment

Treatment goals should focus on the central problem of substance abuse and may include the following:

  • Making a measurable change in specific target behaviors associated with substance abuse
  • Helping client demonstrate a new understanding and knowledge of problems and issues related to substance abuse
  • Improving client's personal relationships
  • Resolving other identified problems (e.g., work problems, support group attendance)

Goals in Subsequent Sessions
  • Work with client to help maintain motivation and address identified problems, monitoring whether any accomplishments are consistent with the treatment plan and the client's expectations
  • Reinforce-through an ongoing review of the treatment plan and client's expectations-the need to do the work of brief therapy (e.g., maintain problem focus, stay on track)
  • Remain prepared to rapidly identify and troubleshoot problems
  • Maintain an emphasis on the skills, strengths, and resources currently available to client
  • Maintain a focus on what can be done immediately to address the client's problem
  • Consider, as part of an ongoing assessment of progress, whether the client needs further therapy or other services and how these services might best be provided
  • Review with the client any reasons for dropping out of treatment (e.g., medical problems, incarceration, the emergence of severe psychopathology, treatment noncompliance)

Ending SFBT Treatment
  • Leave client on good terms, with enhanced sense of hope for continued change & maintenance of changes already accomplished
  • Leave door open for possible future sessions dealing with client's other problems
  • Elicit commitment from client to try to follow through on what has been learned or achieved
  • Review what positive outcomes client can expect
  • Review possible pitfalls client may encounter (e.g., social situations, old friends, relationship issues) and talk about the likelihood of a good outcome and indicators of a poor outcome
  • Review the early indicators of relapse (e.g., depression, stress, anger)

SFBT in conjunction with other Therapies

SFBT can be used with other therapies. One of the original and primary tenets of SFBT – “If something is working, do more of it” – suggests that therapists should encourage their clients to continue with other therapies & approaches that are helpful. For example, clients are encouraged to

1.Continue to take prescribed medication
2.Stay in self-help groups if it is helping them to achieve their goals
3.Begin or continue family therapy. 

SFBT Works well with other SUDS Groups

Finally, it is a misconception that SFBT is philosophically opposed to traditional substance abuse treatments.

Just the opposite is true. If clients are in traditional treatment or have been in the past & it has helped, they are encouraged to continue doing what is working.

SFBT could be used in addition to or as a component of a comprehensive treatment program. 

Solution Focused Brief Therapy Overview in Non-SUDS Settings


The key concepts of SFBT - consist of the following major shifts to depart from traditional psychotherapy that sought after constructing solutions from problem descriptions and speculating on causality.

  • Shift from past to the present and the future.
  • Shift from problem-solving to solution-focused.
  • Shift from hierarchical therapeutic relationships to collaborative and cooperative relationships.


Basic Assumptions of SBFT - The following assumptions provide the framework on which solution focused therapy is founded:

  1. There are significant advantages in focusing on the positive and on solutions for the future. Focusing on strengths and solution-talk will increase the likelihood that therapy will be brief.
  2. Individuals who come to therapy do have the capacity to act effectively. This capacity, however, is temporarily blocked by negative cognitions.
  3. There are exceptions to every problem.
  4. Clients tend to present one side of the problem. Solution focused counselors invite clients to view their problems from a different side.
  5. Small change fosters bigger change.
  6. Clients want to change, they have the capacity to change and they are doing their best to make change happen.
  7. As each individual is unique, so too is every solution.


The three types of client-therapy relationships:

  • Visitor is the client who comes to therapy because someone else considers that the client has a problem.
  • Complainant is the client who expresses a problem, however, is unable or unwilling to assume a role in establishing a solution.
  • Customer is the client who is in cooperation with the counselor to identify a problem and a solution to work forward.

SFBT has designed different strategies to approach clients at different relationship stages. The visitor-complainant-customer relationships alter before, within, and between sessions. SFBT is doing what works and what is best for clients.


SFBT applicational techniques and questions:

  • Miracle Questions. Asking miracle questions help the client envision how the future will be different when the problem is no longer present.
  • Exception Questions. The counselor asks the client to think of a time in their life when the particular problems did not exist or less problamatic for them.
  • Scaling Questions. Scaling is a tool to identify useful differences for the client and may assist in establishing goals.
  • Coping Questions. Coping questions are supportive and start to challenge and shift the focus away from the problem-focused narratives.


The Miracle Question

The miracle question is a technique that counselors can use to assist clients to think ‘outside the box’ in regard to new possibilities and outcomes for the future. The question is best asked deliberately and dramatically.

Now, I want to ask you a strange question. Suppose that while you are sleeping tonight and the entire house is quiet, a miracle happens. The miracle is that the problem which brought you here is solved. However because you are sleeping, you don’t know that the miracle has happened. So, when you wake up tomorrow morning, what will be different that will tell you that a miracle has happened and the problem which brought you here is solved?


Asked this way, the miracle question requests clients to make a leap of faith and imagine how their life will be changed when the problem is solved. This is not easy for clients. It requires them to make a dramatic shift from problem saturated thinking to a focus on solutions. Most clients need time and assistance to make that shift.


Exception Questions

Having created a detailed miracle picture, the counselor has started to gain some understanding of what the client hopes to achieve and the counselor and client can begin to work towards these solutions. This is achieved through highlighting exceptions in a client’s life that are counter to the problem. This helps empower clients to seek solutions.

Exception questions provide clients with the opportunity to identify times when things have been different for them.

Examples of exception questions include:

  • Tell me about times when you don’t get angry.
  • Tell me about times you felt the happiest.
  • When was the last time that you feel you had a better day?
  • Was there ever a time when you felt happy in your relationship?
  • What was it about that day that made it a better day?
  • Can you think of a time when the problem was not present in your life?

When exploring for exceptions, be aware that such questions can be phrased to ask for the client’s perception of exceptions (individual questions) and the client’s perception of what significant others may notice (relationship questions).

Examples of each follow.

Elicit — So when the miracle happens, you and your husband will be talking more about what your day was like and hugging more. Are there times already which are like the miracle — even a little bit? If your husband was here and I were to ask him the same question, what do you think he would say?


Amplify — When was the last time you and your husband talked more and hugged more? Tell me more about that time. What was it like? What did you talk about? What did you say? When he said that, what did you do? What did he do then? How was that for you? Was else was different about that time? If he were here, what else might he say about that time?


Reinforce —

  • Nonverbally: Lean forward raise eyebrows, take notes. Do what you naturally do when someone tells you something important.
  • Verbally: Show interest. (Was this new for you and him? Did it surprise you that this happened?) And compliment. (Seems like that might have been difficult for you to do, given everything that’s happened in the relationship. Was it difficult?)


Explore how the exception happened — What do you suppose you did to make that happen? If your husband was here and I asked him, what do you suppose he would say you did that helped him to tell you more about his day?


Use compliments — Where did you get the idea to do it that way? That seems to make a lot of sense. Have you always been able to come up with ideas about what to do in difficult situations like this?


Project exceptions into the future — On a scale of 1 to 10, where 1 means every chance, what are the chances that a time like that (the exception) will happen again in the next week (month, sometime in the future)? What will take for that to happen?) What will it take for that to happen more often in the future? Who has to do what to make it happen again? What is the most important thing for you to remember to do to make sure that _________________ (the exception) has the best chance of happening again? What’s the next most important thing to remember?

What do you think your husband would say the chances are that this (the exception) will happen again? What would he say you could do to increase the chances of that happening again? Suppose you decide to do that, what do you think he would do? Suppose he did that, how would things be different for you?around your house? in your relationship with him?


Scaling Questions

Scaling questions invite clients to perceive their problem on a continuum. Scaling questions ask clients to consider their position on a scale (usually from 1 to 10, with one being the least desirable situation and 10 being the most desirable). Scaling questions can be a helpful way to track coachees’ progress toward goals and monitor incremental change.

 

To use these types of questions, the counselor begins by describing a scale from one to ten where each number represents a rating of the client’s complaint(s). The counselor might say, “On a scale of one to ten, with one being the worst this problem has ever been, and ten being the best things could be, where would you rate things today?”

Once a counselor is given a number, s/he explores how that rating translates into action-talk. For example, if the client rates his or her situation at a three, the counselor asks, “What specifically is happening to indicate to you that it is a three?” The next step is to determine the goals and preferred outcomes. To do this the counselor asks the client where things would need to be for him or her to feel that the goals of treatment have been met or that therapy has been successful. Aim for small changes that will represent progress in the direction of goals and preferred outcomes.”


Examples of scaling questions include:

  • You said that things are between a 5 and a 6. What would need to happen so that you could say things were between a 6 and a 7?
  • How confident are you that you could have a good day like you did last week, on a scale of zero to ten, where zero equals no confidence and ten means you have every confidence?


Coping Questions - Presupposing Change

When clients are focused on changing the negative aspects (or problems) in their lives, positive changes can often be overlooked, minimized or discounted due to the ongoing presence of the problem.

The solution focused approach challenges counselors to be attentive to positive changes (however small) that occur in their clients’ lives. Questions that presuppose change can be useful in assisting clients to recognize such changes. Questions such as, “What’s different, or better since I saw you last time?” This question invites clients to consider the possibility that change (perhaps positive change) has recently occurred in their lives.

If evidence of positive change is unavailable, counselors can pursue a line of questioning that relates to the client’s ability to cope.

Questions such as:

  • How come things aren’t worse for you?
  • What stopped total disaster from occurring?
  • How did you avoid falling apart?

These questions can be followed up by the counselor positively affirming the clients with regard to any action they took to cope.
Online Resources on Readiness to Change Model


From Precontemplation to Contemplation: Building Readiness Chapter 4 inTreatment Improvement Protocol (TIP) Series, No. 34. Center for Substance Abuse Treatment. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 1999.  at:http://www.ncbi.nlm.nih.gov/books/NBK64968/


Measuring Components of Client Motivation Chapter 8 in Treatment Improvement Protocol (TIP) Series, No. 34. Center for Substance Abuse Treatment. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 1999. at: http://www.ncbi.nlm.nih.gov/books/NBK64975/


Prochaska and DiClemente’s Stages of Change Model at: http://stepupprogram.org/docs/handouts/STEPUP_Stages_of_Change.pdf


A theory of organizational readiness for change published online 2009 Oct 19. doi:  10.1186/1748-5908-4-67   at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2770024/



On Line Resources on Solution Focused Therapy for Alcohol and Substance Abuse Disorder Treatment

Brief Therapy in Substance Abuse Treatment Chapter 3 in Treatment Improvement Protocol (TIP) Series, No. 34. Center for Substance Abuse Treatment. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 1999. at:


Brief Strategic/Interactional Therapies Chapter 5 in Treatment Improvement Protocol (TIP) Series, No. 34. Center for Substance Abuse Treatment. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 1999. at:


Solution Focused Therapy Treatment Manual for Working with Individuals Research Committee of the Solution Focused Brief Therapy Association  by: Terry S. Trepper, Eric E. McCollum ,Peter De Jong, Harry Korman Wallace Gingerich,and Cynthia Franklin at:

References for SFBT and Readiness for change

Cunanan, E.D. & McCollum, E.E. (2006). What works when learning solution-focused brief therapy: A qualitative study of trainees’ experiences. Journal of Family Psychotherapy, 17(1), 49-65. doi:10.1300/J085v17n01_04

 

De Shazer, S. & Isebaert, L. (2003). The Bruges model: A solution-focused approach

to problem drinking. Journal of Family Psychotherapy, 14(4), 43-52.

doi: 10.1300/J085v14n04_04

 

DiClemente, C.C., Prochaska, J.Q., Fairhurst, S.K., Velicer, W.F., Velasquez, M.M., & Rossi, J.S. (1991). The process of smoking cessation: An analysis of precontemplation, contemplation, and preparation stages of change. Journal of Consulting and Clinical Psychology, 59(2), 295-304.

 

Gingerich, W.J. & Eisengart, S. (2000). Solution-focused brief therapy: A review of the outcome research. Family Process, 39(4), 477-487.

 

Osborn, C.J. (2002). Does disease matter? Incorporating solution-focused brief therapy in alcoholism treatment. Journal of Alcohol and Drug Education, 46(1), 18-30.

 

Prochaska, J.Q. & DiClemente, C.C. (1983). Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51(3), 390-395.

 

Prochaska, J.Q., DiClemente, C.C. & Norcross, J.C. (1992). In search of how people change: Applications to Addictive Behaviors. American Psychologist, 47(9), 1102-1114. doi: 0003-066X/92/$2 00

 

Shafer, K.C. (2005). The disease concept and SFT: Difference in action. Journal of Family Psychotherapy, 16(1/2), 75-78. doi: 10.1300/J085v16n01_19

 

Smock, S.A, Trepper, T.S., Wetchler, J.L., McCollum, E.E., Ray, R. & Pierce, K. (2008). Solution-focused group therapy for level 1 substance abusers. Journal of Family Psychotherapy, 34(1), 107-120.

 

Trepper, T.S., Dolan, Y., McCollum, E.E. & Nelson, T. (2006). Steve de Shazer and the future of solution-focused therapy. Journal of Family Psychotherapy, 32(2), 133-139.

 

Weiner, B.J. (2009). A theory of organizational readiness for change. Implementation Science, 4, 67. doi:10.1186/1748-5908-4-67