The meaning of the message is the response you receive. The meaning of the message is the response you receive.
Sometimes trainees ask us, “What do I do after the first session?” While this is not an unusual question and while we do think that constructing solutions can be described in a sequential fashion, we do not want to promote the notion of stages or phases to therapy. We also do not want to promote the idea that subsequent sessions need to be much different than the first. What we do want to promote is the idea that constructing solutions is a way of thinking and interacting with clients. Every session is the first and every session is the last. Constructing solutions may extend over 15 minutes in a first meeting, possibly over an hour of a first meeting, over several meetings within a short period of time, or over a few meetings over a longer period of time.
To the extent that you are looking for positives, the exceptions, and solutions, and to the extent that you are promoting change by maintaining rapport and offering positive feedback and encouragement, every session is a first session. To the extent that you are asking what this client needs to be doing differently at the end of this session to be on a track toward what she or he wants, every session is a last session.
The duration of therapy is not predictable. Trying to predict the duration of therapy or the number of sessions usually gets in the way of creating successful solutions. The clients will tell you through their actions and feedback what to do next and whether or not another session is necessary.
This thinking about the span of time and need for sessions is very different than “short-term” models which determine beforehand what the problem is and how long therapy should be required.
When one approaches therapy one session at a time, there are no phases or stages. Every session is the first; every session is the last. Describing the solution process, however, as a sequence of interactions and procedures can be useful for organizing our thinking and actions, regardless of how brief or how long the time span may be. Describing the sequence of interactions and procedures will also help you decide what to do in the next session—if you think one is needed.
So far we have described solution paths in terms of therapist and client utilizing the goal, hypothetical solution, and exceptions frames to create client movies of themselves solving their problem. The paths include using the criteria of a well-defined goal to develop the movie and the client’s experience. We further invite the client not only to construct her or his movies but also to recognize their solution movies in their present experience. As the client does this, we offer positive feedback and further suggestions.
As change occurs, as solutions evolve, and as we and the client progress down the solution-constructing paths, one of the questions we as therapists ask ourselves is, “How will this client know she or he does not have to come here anymore?” or “How will this client know that her or his changing is for real and lasting?”
To some of you these questions may seem premature or you may ask why these questions would be relevant so early. In a “goaling”-oriented therapy, however, we want to know not only what clients may want to be doing but also how they will know when they are doing what they want to do. The question is relevant very early in the solution process because we want to make sure that clients not only get what they want but that they have some way of recognizing the fact of their getting what they want. If they are solving their problem but do not know how to recognize the solution, the solution is of little or no use to them.
We also believe that clients’ notion of the future can propel the present for them. So we want to help them construct a solution that is recognizable and convincing now.
Once the client is talking about changing (whether in the first or subsequent sessions), we ask, “How convinced are you that your changing will continue?”
Some clients respond unequivocally that they are solving the problem or there is no longer a problem. They may even spontaneously mention that they do not think there is a need for additional sessions.
Some clients will respond more hesitantly. We ask how they will be acting differently or what will be different when they are saying goodbye to us. They may tell us what more they need to be doing. Some will indicate an objection to the present solution. Others may say there is still a troubling aspect, usually around the meaning of the solution. Some will respond that they just need more practice or need to see the results over time in order to be convinced they are on track.
The answers to “How will you know you do not have to come here anymore?” and to “How convinced are you that your changing will continue?” lead us to one of the following conclusions?
A family came to see us because the family thought their 13-year-old son was depressed. He had suffered a broken leg several months ago and had not been able to play football that past fall. It was now winter and the family thought he was depressed because he was not doing as well as he wanted in his hockey performance.
In the family session, we asked each member’s goals in coming to see us. Both mother and father wanted their son to be feeling better and to change his attitude. To them, he seemed either depressed or irritable. They both thought these problems stemmed from his being depressed and discouraged about his injury. Father, especially, thought his son’s irritability was due to poorer performance in sports. Father was the assistant coach for his son’s hockey team.
The son thought that he might be depressed, but he was not sure if he was or not. He was not sure what “being depressed” meant. What he wanted was for his parents to be treating him differently. This was a surprise to the parents. He said that his father was treating him too much as if he were a “gofer.” This meant that at home his father was always telling him to “go for” this and “go for” that. He also thought that his father was treating him harder than the other boys on the hockey team.
At the end of the session, we complimented them all on being so open and frank about what each wanted. We thought the family’s openness showed a great deal of caring and trust in one another that permitted each to be so direct. Since the family’s goal was to have more times when the family was getting along, we asked them to take notice what they were doing when the family was in part getting along better.
The family called to cancel the next session. They said that things were going very well. They were impressed by the notion that being direct was a good thing. Since each member of the family was now continuing to be direct, relationships were going quite well. Father and son felt they had reached some new understanding and the son said he had learned that he could speak his mind to his father.
They were convinced of the solution and therapy was completed.
Often, we will see sudden change in the solution after the first session, but the client still feels she or he needs to practice the solution for a longer period of time. In response to the question, “How convinced are you—in percent—that you will continue to do what you did this past week?” clients may suggest a fairly convincing percentage that they are on track but not convinced yet that they can keep the solution going without continued practice. The percent suggested is not at the level expected when therapy is concluded. They have no objection to the track of solution. They just feel a need to repeat the solution because it is seen as a new skill.
A man came to see us for therapy for the problem of repeated masturbation in public washrooms. Prior to his entering therapy, this behavior happened almost every day and he was feeling ashamed. After the first session, the behavior did not occur during the following week. He was actually on a solution track, but not convinced that he would continue this change until he had achieved his solution on several occasions in different places. He knew that he was still tempted to perform the old behavior and so he wanted to experience more and possibly different situations without the behavior.
We saw him for a few sessions more, with a month between these sessions to allow him time to try out his new skill and continue to get reinforcement.
The client’s evidence for success is several successes or some marker the client has selected.
A couple came to see us where the wife had been afraid to say what she wanted or to say she was angry for fear that her husband would get defensive and start calling her names. Within the first two sessions, the couple had identified exceptions and ways of talking to one another whereby she could say what was on her mind without his taking it personally. She, however, was not yet convinced that this would continue because of their years of marriage when communication did not go this way. She felt a need to come in once a month over several months as a safety check and to use the time to build convincing experiences of being direct while he listened. Because she had been disappointed before, she wanted to build a history of success she could use to reassure herself when she was tempted to go back to her old ways of self-righteous silence and withdrawal.
Other clients think they are on track, but for them there is some context or event that will mark success. For example, parents who are concerned about their children’s school performance may be more convinced that their solution of being firm about homework is working when their child brings home a better report card. The report card serves as the marker.
A couple described repeated conflict in their relationship. However, the relationship had been better in the past week. Each credited the change as due to the other person’s being more giving. In other words, each explained the change as due to the other’s change rather than to her or his own change. Although they were doing better, we worried about this solution process because the solution was not well-defined. Each saw the solution as resulting from something out of her or his control, the other person’s change. Further solution development was needed for the couple to identify what each of them individually was doing that was making things better and to recognize how solution development could continue even when the other slipped back into old ways.
We start each session after the first with the question, “So, tell us what is different or better?’” This question presupposes that change is happening and that something better or, at least different, is happening. This question sets the tone for the session on a positive note and continues from the previous session the process of looking for positives, exceptions, and solutions.
In this way, we let our clients know what we think is useful and important—that is, positives and solutions. Figuratively, we “train” our clients to recognize what is useful and expected. We do not think that we instrumentally or literally train our clients. We believe, however, that as a result of our acting in accordance with our assumptions, clients learn to expect certain questions from us and our positive orientation. “Training” clients is not unique to this approach. If we thought that feelings were primary, we would probably start our sessions by asking clients, “So, how are you feeling today?” If we thought that dreams were important, we would probably start with, “So, tell me your dreams of the past week.” Clients would thus learn that we thought feelings were important or that dreams were important.
By asking positive-oriented questions, we continue a solution process. At times, we may not have accomplished much in identifying the goal or in developing a solution during the first session. Time may have been restricted because of lateness, because the clients were still too angry to focus on solutions, or because of a need to clarify the reasons for the referral. Many situations may interfere with the solution process at the first session and we may find that the task of the second session continues to be clarifying what the client(s) want. We may have elicited only half the goal or, as happens with couples or families, we may not have had time to talk with everyone as fully as we wanted.
The statement of the goal in the first session may have been stated only vaguely. In any case, we want to use the exceptions and changes from the time between sessions to sharpen the definition of the goal. We want to continue to build on the changes and keep in mind the criteria for a well-defined goal.
Client responses will run the whole spectrum from dramatic change and unbounded optimism to feeling that the situation is much worse and downright discouraging. Do not be discouraged or surprised when the client says the situation is the same or even worse.
When clients report the situation is the same or even worse, keep in mind this absolute rule of thumb: Never believe them! Keep in mind your assumption that change is occurring all the time and do believe that this is how clients have experienced the time and that it is their view as well. Their responses, however, may merely indicate that the goal or solution is still being developed and that this session is still like a first session. Their response may also indicate the size of the measuring sticks they have been using for success or the meanings they have applied which would account for their thinking there was little progress.
Therapist: So, how have things been since I saw you last? What is different or better? (Exceptions frame)
Client: Well.… things have been pretty bad… the stress and pressure I am under is not any better; matter of fact, the deadlines I am under are getting even worse.
Therapist: I am sorry to hear that and that your deadlines are all the same. How have you managed to cope with all the deadlines since I saw you last? (Exceptions frame within the client’s frame of “stress and pressure”)
Client: That is not all of it. Things with my husband have gotten worse since I saw you.
Therapist: I don’t understand. Along with your deadlines, things with you and your husband are not going well either? (Clarification)
Client: My husband is really pissed at me because I put my foot down. I told him to take care of the kids so I could go work out. I decided I had to have time for myself and that meant that I had to pull back the reins.
Therapist: You mean things became difficult with your husband because you decided to do something about the pressure, to take time for yourself, and he did not like that change?
Client: Right.
Therapist: So, actually things seem worse because you took some steps in the direction you wanted, reducing stress by taking care of yourself.
Client: Yes, that is true. I am taking care of myself and looking out for my needs. My husband is not used to it, I guess.
The client may initially have thought that the week was worse and she was not making progress. She may have hoped she would be feeling different already, she may have hoped her husband would have welcomed her change, she may have hoped the stress would have gone away by itself Regardless of the explanation, more than likely her initial criteria and evidence for progress did not allow her to notice the difference in her actions of the week. By assuming the exceptions can be created in the conversation and by being sensitive to nuances of change, you and the client can continue constructing solutions.
You may find that the client’s experiences have been better for the whole time right up to the day of the appointment. However, because of a reoccurrence of the problem the day of the session, the client has lost track of all the good time.
When clients say that things are the same or worse, this is the time for you to accept what they say as their view of the situation and then use all your exception-oriented skills to find any differences.
For example, for a client who says that the week has been about the same, acknowledge what the client says and then utilize the response to ask about exceptions.
Therapist: What is different or better?
Client: Well, things are about the same.
Therapist: So, things seem about the same. Are there times when you would have expected things to be even worse, but they were not? (Exceptions frame)
Client: Well, actually yes, I guess. We could have had a fight about my mother. Normally, when I say my mother is coming to visit, my wife and I get into a big fight about it. I don’t know why we did not this time. I guess we have been so tired of fighting, we just did not do it this time.
Therapist: So you might have had a fight but you did something different. What did you do rather than fight? (Specification and contextual differences)
Client: I guess I was not going to try to talk my wife into being nice to my mother or getting involved in my mother’s visit.
Therapist: So, that was different. How did you decide to do that? You could have tried things that you have done in the past that do not work. (Specification and contextual difference)
Client: Well, I guess I am learning that I cannot change her. Trying to make her enjoy my mother was not making it.
This sample session demonstrates how to remain true to the assumptions that change is occurring all the time and that exceptions can be found or created. First, the therapist accepted the client’s view that things were the same. Then the therapist asked about times that the relationship could have turned worse, but he and his wife did something different. The client searches for occurrences when the problem could have happened but did not or when the problem could have been much worse but was not so bad.
The idea that keeping matters from becoming worse can actually be a change can be used even more explicitly. For example:
Therapist: So, what has been different or perhaps better? (Exceptions frame)
Client: Oh, things are about the same.
Therapist: Really, I would think that given your circumstances, it could be expected that matters would be worse. How are you managing to keep things from being much worse? (Exceptions frame)
Client: Well, you are right. I am having a terribly hard time just keeping my head above water.
Therapist: So, you have been having an extremely difficult time. How have you been keeping your head above water, even though you have been separated only a few weeks? (Exceptions frame)
In this session, the therapist again accepts the client’s presentation of his circumstances and then frames the exceptions question in terms of why things are not worse. The assumption that keeping things the same despite overwhelming circumstances can be an accomplishment in itself is made explicit.
Often, clients will come back and report that their situation is much worse. After supporting their frustration and feelings of anger or discouragement, use the hypothetical solution frame in the context of the “worse” frame.
Therapist: What is different or better? (Exceptions frame)
Client: Our relationship has been much worse. We fought all week and we have not talked to each other the past three days.
Therapist: Wow, things must have been really tough. I guess, with such a week, feeling discouraged and hopeless would not be unusual. Yet you are still here. Does that mean you are still hoping to make things better? (Rechecking the stated goal)
Client: Yes, we do not want to divorce, but our relationship has to change.
Therapist: I am very sorry to hear that the week has been so rough. The time must have been very rough and frustrating. I guess you do not want to have another week like that again. Are there actions or words said that you would do differently if you had the week to do over again? (Hypothetical solution frame within their report of a worse present)
This conversation typifies the therapist accepting the “worse” frame, rechecking whether working on their relationship is still their goal, and then using the hypothetical solution frame. Once you have elicited some examples of how they might do things differently, you can then ask about times when they are doing that “somewhat” now. The exceptions that the couple may have missed earlier might come out.
In the sessions subsequent to the first, we may also ask the “confidence” question in order to make further decisions about the feedback at the end of the session, the timing of the next session, or concluding therapy.
Many of us who have been trained in traditional therapy models are accustomed to scheduling one or more sessions regularly every week. In this solution-focused approach, we schedule each session on its own merit. The criteria we consider before scheduling the next session are:
Some homework tasks take more time to do or more time for the client to perceive some meaningful difference. A task of asking a client to pretend to be in a good mood on the odd-numbered days of the week is intended to give the client the experience of difference when acting differently. Acting as if she or he is in a good mood on the odd-numbered days while going about things normally on the other days provides the client with a contrast. To do this task for only a couple of days does not provide the client with enough experience or feedback. This type of task generally takes two weeks.
Tasks take varying lengths of time and clients, unless they have been trained by other therapies, usually accept the logic of meeting in a couple of weeks, or a month, or whatever time has been suggested.
As the solution develops and the fact that the client is on track becomes apparent to her or him and to us, we want to space sessions to allow the client to have the experience of success with the solution and also in handling whatever setbacks that occur. Spacing out the sessions enables the client to have a longer perspective on solution construction and to put setbacks in perspective.
A longer time has the advantage of demonstrating change that a close-up look lacks. Metaphorically, the difference is like this: Parents who are with their children on a day-to-day basis may lose track of the extent their children are growing. A marker such as a birthday may help them notice that over a longer period of time their child has grown three inches.
As clients experience progress in their changing, the spacing of sessions over longer periods of time—from two weeks to three to six—can promote confidence in solving the problem.
We often have clients who mistakenly think that their changing is dependent on therapy and that we—the therapists—are responsible for the change. We want clients to see that they are responsible for the change and are capable of keeping the solution construction going.
We typically compliment clients on changing and suggest that we space the sessions so they can check out success in staying on track. Sometimes we spell out that part of our job as therapists is to make sure that clients recognize their own resourcefulness and their abilities to continue solutions. We might also explain how we believe it would be unethical for us to continue to see clients in a way that leads them to dependence on therapy or makes them feel we are needed when the goal is to be independent. In brief therapy, we want to promote the belief that clients are resourceful and that they are responsible for the changing.
Kral and Kowalski have described a procedure called “positive blaming,” a tongue-in-cheek name for crediting the client for all the changing (Kral, 1986; Kral & Kowalski, 1989). In “positive-blaming,” the therapist can preempt the clients crediting the therapist for the changes by saying something similar to this message: “You may falsely blame us for all your recent work and change. We believe, however, that all these positives are your ‘fault.’” This is said in a joking or teasing manner. In a more serious and straightforward style, the therapist might say, “You may be too modest to think that all these recent changes are because of your own actions, but we believe you are accomplishing a great deal and deserve all the recognition and credit. After all, no one made you do any of these changes.”
This criterion is actually part of all the previous three. We think of clients as being responsible for their therapy and we determine with them the amount of time they should be spending on a task or what seems to be a suitable length of time between the current and following session, based on the confidence they have in their solutions.
Many clients regard problems and solutions in “all or none” terms. The first time they fall back to problem behavior, they can easily think that the change does not count or that the changing is not real. In the midst of changing, clients are often vulnerable to thoughts of failure.
We attempt to foster a more positive approach by introducing the notion that change usually involves “setbacks.” We tell clients that for every three steps forward there are two steps back. While we tell clients that the two steps backward are normal, we also tell them that we are concerned that they will mistakenly see the normal two steps back as failure and possibly give up on what is working. Often, after this type of normalizing, we give clients the assignment to notice how they get themselves back on track when the setback occurs.
As change occurs, we may ask what things are going on that may make it more difficult for clients to continue to do what they are doing or ask what things could make it tempting to go back to the old ways.
This technique, described by Kral and Kowalski (1989) as “flagging the minefield,” is a way of fast forwarding into the future and facilitating how the client will handle difficulties and temptations that may come along. This questioning normalizes that there may be difficulties and focuses the solution process on how the client will handle these situations. The presupposition remains that clients will move beyond these times, that they will not be stopped by them in the longer perspective. For example:
Therapist: Are there times when you can imagine it will be tempting to go back to the old ways rather than thinking of yourself?
Client: I guess when my kids complain about my not staying home, I will probably feel guilty.
Therapist: So how will you be getting through those times despite the guilty feeling? (Hypothetical solution frame)
Client: I will remind myself that what is best for me in the long run is best for them and go out anyway. I just have to give myself a break and take care of myself.
Therapist: So, if you let your guilt stop you from going out, how will you be getting yourself back on track?
Client: I do not think the guilt could put me back for very long before I will realize that I need to be taking care of me.
Concluding therapy is usually accomplished when we and our clients think they are on track in reaching a solution or getting what they want. When we ask how confident they are in continuing the changing, their response usually matches their criteria for what they believe would be reasonable for concluding therapy.
We sometimes offer clients some final feedback that may include several options for concluding therapy. One option would be to meet again in four, five, or six weeks as a check on how they are doing or what additional changes they have seen. Another option is to schedule an appointment with the same time arrangement, but with the option of their calling to cancel if they feel the appointment is not needed. The third option is just to leave the appointment open, with no specific date and with the option that the client can call and schedule one if wanted.
Because of the steps taken to promote independence and a sense of responsibility by clients about their changing, there is no need for a formal processing of concluding therapy. Therapy can be concluded with the option to return or to call at any time in the future.
A man in his 20s came to see us because he was unemployed. When asked what he wanted, he said he wanted more “direction and flexibility.” We asked, “What would you be doing differently if you had these things?” (hypothetical solution frame). He said he would “be thinking more”—that is, thinking through his decisions about jobs right now rather than just bouncing around from one idea to another or taking the first job that came along. He said he questioned if he wanted to stay in social work and he thought he would like to make more money. In the past, when he was out of a job, he would just take the first offer without much thought about whether he would like the work. He had thought only about the fact that he needed money.
We asked if he thought that his recent questioning about jobs and career might already be the beginnings of this “thinking more” about what he wanted. This was our attempt to bridge his recent questioning as part of being on track to getting what he wanted. He said, “Perhaps.” This was our first invitation to him that maybe some of the questioning and thinking he was already doing was part of being on track toward solution. We took this questioning as an exception to his previous panic and taking of the first job that came along. We then bridged the exception to what he said he wanted, to be “thinking more.”
He allowed that perhaps his questioning and thinking more was part of being on track. We asked what else he would be doing if he were handling this job transition in the way he wanted (hypothetical solution frame). He said he would be “taking a more reasonable approach.” We asked how he will know when he is doing that. He said that if he were taking a more reasonable approach now, he would be contacting several agencies so he could create options for choice. He would also be arranging for information interviews. These would be interviews where he would talk to people in other professions so that he could check out his interest in switching from social work.
Since the client thought that he always acted impulsively in the past rather than thinking things through, we asked how he would predict he would do these other steps this time. (In our question we did not ask if he would do these other steps. Rather we presupposed that he would do them, and asked him how he would predict that he would do them.) He accepted our presupposition and predicted he would do these steps “carefully.”
After returning from our consultation break, we complimented him on taking his situation more one step at a time, the start of doing things differently this time. We also told him that we thought his creating options for himself was part of the more thoughtful approach he was looking for. Since we thought—and he had partially agreed—that he was already doing some things in the direction he wanted, we suggested he observe during the next week anything else he was doing that he thought might be somewhat on track.
Our thinking was that we had some exceptions of the goal already happening in (1) his questioning what he wanted beyond a paycheck and (2) his creating options and steps that he would take as part of his more thoughtful approach. Since he perceived these things as being under his control, our idea was to have him do more of the exceptions and observe what else then happens.
He returned the next week and reported that he was feeling calmer. He had taken intermediary steps by taking “grunt” work just to earn money while he explored his other options. He had set an appointment to talk with someone about business consulting and he had rewritten his resume. He had decided to be more “active and selective.” He had decided that by working to earn money for awhile doing grunt work, he could explore other possibilities. At the same time, he wanted to be active about seeking out other careers and opportunities. He thought this was different on his part because he felt that in the past he either procrastinated or took the first job out of fear.
We spent the remainder of the session talking about this more “active, selective” approach and how he was going to keep acting in this style (pursuing the exceptions as the goal of therapy).
We asked how confident he was that he would continue to act in this “active selective” approach. He said 85 percent, which was close to the 95 percent he thought he would be at when he would be finished with therapy. To emphasize his resolution, he said, “There is no point in sitting back.”
This answer told us that the meaning was different for him. He was convinced that he was “thinking more” and that his “active, selective” style was better for him than impulsively acting out of fear of no income. He appeared to just want more practice and time. After our break, we complimented him on the changing he was doing and on his realization that an “active, selective” approach was in the right direction. We scheduled the next appointment for two weeks ahead and that seemed about right to him.
He reported that he was continuing to do the “grunt” work, that he had checked out two jobs, and that he had been turned down on one of them. However, he did not feel this was a setback and we asked if that was different for him. He said it was very different. He was more convinced that he wanted a job that was more than a paycheck and he had created some backups for himself like the part-time job. He said he was thinking differently and was much calmer.
He was not panicking and was even giving himself “think” time to reflect on each new step or bit of information. This was much different, he said, because in the past he would have told himself that he could not afford time to just think.
We asked what could make a return more likely to his old panicky thinking and more passive ways. He said a return would be more likely only if he had a real financial setback, but he thought he would want to take it slow even then.
This answer was a sign to us that he was not only on track but was growing in his conviction that he was on track as he learned through his new experiences.
On the break, we decided to find out if an appointment in a month would suit him. Our feedback message again complimented him on his continued changing and cautioned him about setbacks. We warned him that he could confuse normal setbacks with failure and that he should notice how he put himself back on track when the normal setbacks came along.
He reported a setback in terms of having been turned down for a job that he thought would have been very good for him. However, he reminded himself that he needed to take it slow and to continue to take care of himself He asked for an additional session in a month as a check on his progress.
QUESTION:
Do you contract for the number of sessions you will meet?
No. We do not want to set any expectations, one way or the other. Some clients seem to respond to a set session contract by waiting until the session or two next to last to make the changes they want. They seem to respond as if the set-session contract is a deadline, and thus they wait.
Others react with surprise or concern as if fewer than, say, 10 sessions would be such a short time for such a serious problem.
If asked about the length of therapy, we usually say that we will take as long or as short as required.
QUESTION:
Do you have many clients returning with the same problem or for some other problem?
Many clients will return to see us for some other problem. We take the return as feedback that they were satisfied with what they did in therapy with us and now have something else they want to take care of.
If your question is related to the notion of symptom substitution, we do not subscribe to that assumption and we have not seen any evidence that would make us think that symptom language would be useful.
Ask your clients, “How will you know you do not have to come here anymore?” Then, as a follow-up, ask, “How confident are you that you are on track now to getting what you want?”
The responses to these questions will give you some hints about your next step. Are the clients saying they are on track? Are they saying they need further practice or something else?