This paper aims to analyze the case study of Rosie, presenting to a counselor with a problem of feeling distressed and tired because of her difficult life situation. Rosie is a single mother of four children – two girls aged two and three, and two boys of school age. She has recently found out that she is pregnant again. Rosie’s socioeconomic status is low since she has no high-school education, and she earns money by being involved in prostitution. In addition, she has been involved with the child welfare system because her children sometimes refuse to attend school. To help the client cope with her stress and anxiety, the counselor took a solution-focused approach. This paper will discuss the key concepts of solution-focused therapy (SFT), identify specific SFT methods used by the counselor in the described case, and assess the effectiveness of the intervention.
SFT was developed by psychotherapists de Shazer and Berg in Milwaukee in the 1980s. The key distinction of this therapy is that it is focused on people’s strengths and resilience and aims to find solutions rather than dive into problems. SFT posits that clients are experts in their own lives and are inherently motivated to fully realize their potential (Andriopoulou & Parry, 2019). Thus, it is the client who suggests a solution to their own problems. To resolve clients’ issues, therapists do not try to identify the roots of their troubles or develop an entirely new solution. Instead, they ask the client to recall moments when their problem was absent or at least had less influence on their lives – SFT counselors call them “exceptions” (Andriopoulou & Parry, 2019). By focusing on what already works for clients, the therapist emphasizes their strengths and assumes an optimistic, goal-oriented, and future-focused therapeutic approach.
SFT has several key assumptions that guide counselors in their practice. The first tenet is that SFT is a brief therapy, and it should be terminated as soon as the client’s problem is resolved (Andriopoulou & Parry, 2019). The other two assumptions are as follows: “If it works, do more of it” and “If it’s not working, do something different” (Zatloukal et al., 2019, p. 26). If some solution worked for the client in the past, it might be helpful in the future.
On the contrary, if the client says that something is not effective, the therapist should not encourage the client to do this, even if the suggested solution has been effective for other patients. SFT therapists also assume that big changes start with small steps and that the solution the client finds should not necessarily be related to the problem (Zatloukal et al., 2019). Finally, SFT posits that no challenging situation exists all the time, and people have the power to create their own future (Zatloukal et al., 2019). Consequently, SFT assumes that people can develop solutions for the future without looking at the cause of their problems.
Solution-Focused Strategies Applied in the Case Study
The general therapeutic process applied by SFT counselors has a distinct structure. The therapist gives the client an opportunity to describe the problem, listening carefully and noticing details that might be helpful for building the solution. Early in the session, the counselor starts developing well-formed goals, which are important to the client, specific, measurable, realistic, and focused on the presence of something (Nelson, 2019).
The therapist asks the client about times when the problem is absent or less severe and helps the client create solutions (Corey, 2017). The counselor concludes the session by using a rating scale to measure the progress (Corey, 2017). The therapist in the given case followed all the necessary steps of the therapeutic process since she carefully listened to the client’s sharing the problem and transitioned to asking solution-focused questions early in the session. She also applied several solution-focused techniques to help the client find the solution, and these methods will be described further.
The Miracle Question
The miracle question is the main SFT method that is used for developing the therapy goal. When applying this technique, the therapist asks the client to imagine what would be different if a miracle happened and the problem was immediately resolved. Frequently, the miracle question is followed by a sequence of “what else” questions to elicit details from the client and create a wider picture of available opportunities (Nelson, 2019). The benefit of this question is that it shifts the client’s attention from the past and current issues to a more satisfying future (Corey, 2017). In addition, this method brings empowerment to both clients and therapists and encourages clients to open up more (Toros, 2019). The miracle question may be especially beneficial for clients in distress or depression because it encourages them to get distracted from their negative thinking patterns and focus on the positive aspects of their lives.
In the described case, the counselor applied this technique right after learning the details of the client’s problem. The therapist appealed to the client’s imagination: “Suppose you go to bed as usual tonight and, while you’ve been sleeping, a miracle happens.
The miracle is that the problems you’ve been telling me about are solved!” Then, she asked, “What do you suppose you would notice tomorrow morning that would be different?” The first client’s response was unrealistic, and, in such cases, it is suggested that therapists should either wait or ask further questions to elicit valuable information for creating a realistic goal (Nelson, 2019). The counselor chose the second option by asking what else the client would notice if a miracle happened. This SFT technique helps clients to realize that they have a certain degree of control over their lives (Sebastian & Matheen, 2016). In the given case, it enabled the client to see that she could take specific actions to get closer to the future in which her problem was resolved.
This technique is based on the assumption that no problem is constantly present in the client’s life. Exceptions refer to the instances when the issue could have happened, but something else occurred instead (Neipp et al., 2021). Exception questions are intended to help clients understand what solutions they already use to cope with the problem (Neipp et al., 2021). In the given case, the therapist used this method when she asked, “Are there times already, say in the last two weeks, which are like the miracle which you have been describing, even a little bit?” With this question, the counselor encouraged the client to remember positive experiences from the recent past and think of what actions had led to them.
Exception questions, along with miracle questions, have been proven to reduce clients’ negativity by providing a more positive outlook on the situation (Neipp et al., 2021). In the case under review, the client seems to have adopted a more optimistic view of the problem by the end of the session because of the shift of the focus from the problem to the exception and the solution.
In the process of asking the clients about their coping with problems in the past, SFT therapists make compliments to them to appreciate their accomplishments. In the case study, the counselor compliments Rosie several times. For example, when Rosie answered the miracle question, the therapist said, “Rosie, I’m impressed. You have a pretty clear picture of how things will be different around your house when things are better.” Further, when the client shared how she coped with her problem four days before, the counselor replied, “Rosie, that sounds like a big part of the miracle right there. I’m amazed.” Compliments increase clients’ self-esteem and motivate them to pursue change, as well as help build therapeutic relationships by presenting the counselor as a person who understands and cares for the client (Andriopoulou & Parry, 2019). In the given case, this strategy seems to strengthen the therapeutic relationship since Rosie was willing to share her experiences of dealing with her problems.
This SFT method implies asking clients about what they did in the past to manage difficult situations in their lives or achieve positive outcomes. In the case under consideration, the therapist used this type of question after the client told her about the day that was close to her miracle. The counselor asked Rosie, “So, how did you make that happen?” and “How did you manage that, reading to four kids?” Coping questions realize the strength-based perspective of SFT and spark clients’ optimism about the future (Andriopoulou & Parry, 2019; Suitt et al., 2019). It is important for counselors to insist on eliciting even small clients’ actions that led to the exception because it helps build clients’ self-confidence (Miller, 2021). In this case study, the therapist continued asking coping questions until the client shared that her actions included not seeing any clients and reading to her four children with the assistance of her oldest son. This information became crucial for developing the solution for the client.
Scaling questions are another prominent technique of SFT, which is linked to the miracle question. When using this method, the therapist asks the client to determine their position on a scale from 0 to 10, where 10 is their miracle day, and 0 is the opposite (Nelson, 2019). In the given case, the counselor asked this question at the end of the session: “First, on a scale of 0 through 10, where 0 equals the worst your problems have been and 10 means the problems we’ve been talking about are solved, where are you on that scale?” This method helps notice improvements in the client’s state and allows clients to realize that they are not entirely defeated by their problems (Corey, 2017). In the case study, Rosie noticed her progress as she reported her position on the scale to increase from 2 at the beginning of the session to 5 at the end of it.
Scaling questions can also be used to assess clients’ ideas and perceptions. In the case under review, the therapist evaluated the client’s perception of the possibility of her miracle day to occur in the future. She asked, “On a scale of 0 to 10, where 0 equals no confidence and 10 means you have very confidence, how confident are you that you can make it happen again?” Then, the counselor proceeded with a follow-up question: “Suppose you were at a 6, what would be different?” Such follow-up questions help clients describe details that would make them feel better, and often, they realize that some of these desired things are already present in their lives (Nelson, 2019). In the case study, Rosie said she was currently at 5, but she would be at 6 if she always had food for her children. She might recognize that the improved situation that she described was already present in her life as there were days when her children had something to eat.
The Effectiveness of the Intervention
The intervention may be helpful for the client because it can develop a more positive outlook and encourage the client to use her strengths consciously and more frequently. SFT is used for treating depression, anxiety, personal stress, self-esteem, and substance abuse and is the most effective when the client wants to achieve a specific goal and resolve a particular problem (Murray, 2021). In the given case, Rosie intended to solve her issues of being pregnant and very tired, earning money, and encouraging her sons to go to school. She did not have a major disorder and was willing to open up to the counselor, which made SFT an appropriate option for her (Murray, 2021). By the end of the session, the woman had a more positive view of her life and developed a clear goal – to make breakfast for her children and read to them. Perhaps, she gained more self-confidence and realized that she had the strength to change her life for the better.
Contextual and Cultural Factors Surrounding the Case
The case study does not provide information about the client’s race and ethnicity, religion, or culture. However, the known contextual factors are that the woman was a pregnant and distressed single mother. Rosie had pregnancy anxiety because she already had four children and struggled to raise them. Research shows that SFT reduces pregnancy anxiety and fear of childbirth in women who have moderate and severe symptoms (Mortazavi et al., 2021). Rose and Ishak (2019) also studied the effects of SFT on distressed women and found that SFT promoted positive coping mechanisms and helped women focus on finding solutions to their problems. Based on these findings, one may conclude that SFT can help Rosie cope with her pregnancy anxiety and stress by fostering a more positive attitude toward life and focusing her attention on solutions.
SFT is a brief therapy effective for assisting clients in resolving their problems and coping with stress. It is a strengths-based approach that is oriented toward building a positive future rather than understanding the traumas of the past. SFT seems appropriate for the case of Rosie because she did not suffer from a major mental disorder and only sought support and help in dealing with her stressful situation – pregnancy, tiredness, lacking money, and children’s disobedience.
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