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Solution Focused
Therapy in Inpatient,
Psychiatric Setting
Victoria Rodriguez
Clinical Assessment and Intervention Planning
Fall 2011
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Jackson South
Community Hospital
Short-term “Crisis and Stabilization” Unit, Baker Acts, Medication Management, Self
Average length of stay: 3-7 days
Doctors, nurses, mental health technicians, activity therapists, and social workers
Psychosocial assessment, case management, discharge planning, family sessions
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Client Background (“JP”)
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31 year old female
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Unmarried, no children, no pregnancies
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Living with her mother
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Unemployed, receiving disability benefits, volunteer work
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Some college
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Above average intelligence, cooperative, engaged
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No reported history or drug or alcohol abuse
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Caucasian background, does not practice any formal religion
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Interest in arts, literature, music, and animation
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Presenting Problems
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Hospitalization—Suicidal Letter (“angry letter”)
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Relationship Conflict with Mother (“Wednesday Adams”)
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History of BPD, most recent episode Depressed
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History of noncompliance with medication/treatment
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Social isolation—could not identify support systems (Aunt)
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Feelings of helplessness, hopelessness, and guilt, low selfesteem
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Dysthymic affect, disheveled, slow speech, organized thought
processes
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Environmental Factors
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Living with mother
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Large source of stress
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Mother also has a history of BPD
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Dysfunctional care-giving relationship
Father “abandoned” family when JP was 8 years old.
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JP did not have a close relationship to her father prior to this
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No siblings, only child
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No other significant social or familial relationships
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Aunt
Solution-Focused Therapy (SFT)
•An
emphasis on solution talk represents an effective
means of helping clients focus on solutions to
problems and to act or think differently than they
normally do.
•Just
as the causes of problems do not need to be
understood for significant change to occur, a
client’s decision to act differently in the future may
emerge independently of any problem talk.
•Strengths
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and resources would be highlighted
•Medical
•Goals
Model
of intervention are for clients to focus on
solutions to their problems or challenges, discover
exceptions to their problems, become more aware of
their strengths and resources, and to learn to act and
think differently.
Why SFT?
•Preferred
future
•Discharge, more
contact with the community, more autonomy
•Realistic, concrete, observable
•“Achievement
•Problem-free
stages
is recognized as a beginning rather than an ending.”
talk
•Some
patients can find their personal identity substantially defined by their
problem.
•Patient-staff
interactions
•Exceptions
•Helps
patients notice triggers and talk about safe, effective behavior
management
•Resources
•Skills
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and abilities the patient already has and use them as a foundation
•Generalize
these to other areas of behavior
•Flexibility
•Can
be delivered in short time frames
•Effectiveness
with internalizing behavior problems, depression, anxiety, selfconcept, and self-esteem. Effectiveness of SFT was also identified in family group
sessions in the areas of expressiveness, active-recreation orientation, moralreligious emphasis, and family congruence.
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Assessment and
Intervention
Approach
(Session 1)
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No large distinction between Assessment
and Intervention phases
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What does the client perceive is the
problem?
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Guilt
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Family/Gender Expectations
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Anger
What are the client’s beliefs about the
sources of the problem?
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Family Relationships
How does the problem affect the client?
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Self-blame
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Family Relationships become strained
What has helped the client cope in the past?
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Removing self from situational triggers
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Assessment and
Intervention
Approach
(Session 1
continued)
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
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The Miracle Question: “Imagine you went to
sleep and your problems disappeared, only
you didn’t know it. What would you be doing
when you woke up?”
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Book Tour (Confidence!)
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Positive relationship with mother (Less
guilt!)
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More oriented and comfortable
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Larger focus on goals
What might people notice about you when
you were focusing on your goals?
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“I would seem more ‘with it.’”
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Happiness
Introduction: “Between now and the next
time we talk, notice the things in your life
that you would like to see continue.”
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Goals and Objectives
 Goal
#1: Articulation of 3
strengths as relating to
goal maintenance
 Objective #1: JP will be
able to identify and list
personal strengths
 Objective #2: JP will be
able to identify when
these 3 personal
strengths were visible
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Goals and
Objectives
 Goal
#2: Identify 2
exceptions to problems
of guilt and family role
conflict
 Objective #1: JP will
describe 2 instances
when problem did not
exist
 Objective #2: JP will
articulate what was
different about these
experiences
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Goals and Objectives
 Goal
#3: Identification of
2 positive coping skills
 Objective #1:JP will
identify/list triggers to
changes in mood and
dysthymic feelings
 Objective #2: JP will
recognize 2 skills that
have helped her be
more positive, less
confrontational
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Assessment and
Intervention
Approach
(Session 2)
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What has helped you cope in the past?
 Removing self from situation
 Involvement and production of art
 Self-assertion
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What are your strengths?
 Intelligence
 Personal ethics
 Generosity
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Goal-setting (“… notice the things in your life
that you would like to see continue.)
 Enrolling in college classes (by the
beginning of the next semester)
 Exercise, martial arts (1x/wk, within 2 weeks
of d/c)
 Writing, reading, animating (1 hour/per day)
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Goal maintenance: What needs to happen for
these changes to occur?
 Financial Security
 Collaboration
 Self-Confidence
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Assessment and
Intervention Approach
(Session 2 continued)
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Exceptions to the Problem: “Tell me
about a time when the problem didn’t
exist.”
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Intellectual Conversations with
Mother
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Equality
Introduction: Surprise Task, “Between
now and the next time we meet, do
something that will pleasantly surprise
your mother.”
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JP’s surprise task is that she asked her
mother to come visit her.
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What do you think the possible obstacles
might be and how will you address them?
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Ending and
Evaluation
(Session 3)
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Avoiding conflict with mother
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Reflection on admission
How will you remind yourself about the
things that you know help?
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Idle time
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Social network community building
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Scaling
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JP had become aggressive with another
patient and had been medicated.
Outcome and Progress
•JP
was discharged the day following the 3rd
session. Worker will be unable to follow up with JP
unless she is readmitted to the unit.
•As
part of discharge plan, JP was referred to a
psychiatrist as well as a therapist for individual
and family counseling.
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Outcomes and Progress (Continued)
•Progress
on Goals of the SFT Intervention
•Goal
#1: Articulation of 3 strengths as relating to goal maintenance
•JP
was able to identify 3 personal strengths
•Intelligence, Ethics, Generosity
•JP
was able to identify concrete instances where she utilized her
strengths
•Mensa, group
work, confronting family issues
•Goal
#2: Identify 2 exceptions to problems of guilt and family role
conflict
•JP
was able to identify 1 situation that was an exception to the
problem
•Intellectual
•JP
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conversations with mother about literature
was able to identify what was different about this 1 situation
•Equality, lack
•Goal
of a power differential
#3: Identification of 2 positive coping skills
•JP
was able to identify 2 triggers
•Mother, family
•JP
expectations
was able to identify 2 coping skill
•Diffusion
by walking away, emotionless expression
Limitations
•Evaluation
•Agency
(Scaling)
Focus
•Medical
model focused on pathology
•No
opportunity to follow up with client after
discharge
•Medication
•Unclear
ending
•Time
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•Limited
interaction with client
•Countertransference
•Gender
•Guilt
role conflict with family
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References

Crownshurst, N. & Bowers, L. (2002) Philosophy, care, and treatment on the psychiatric
intensive care unit: themes, trends and future practice. Journal of Psychiatric and Mental
Health Nursing. Vol. 9. Issue 6. Pp.689-695

Gingerich, W.J. (2000) Solution-focused brief therapy: A review of the outcome research.
Family Process. Vol. 39. Pp. 477-498.
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Gralton, E., Udu, V., & Ranasinghe, S. (2006). A solution-focused model and inpatient
secure settings. The British Journal of Forensic Practice. Vol. 8. Issue 1. Pp. 24-30

Halpern, J. (2003) Empathy and the Practice of Medicine: Beyond Pills and the Scalpel.
New Haven: Yale University Press.

Iveson, C. (2002) Solution-focused brief therapy. Advances in Psychiatric Treatment. Vol.
8 Pp. 149-157.
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Kim, J. (2008). Examining the Effectiveness of Solution-Focused Brief Therapy: A MetaAnalysis. Research on Social Work Practice. Vol. 18. Issue 107. Pp. 107-116

Smith, S., Adam, D. & Kirkpatrick, P. (2011). Using solution-focused communication to
support patients. Nursing Standard. Vol. 25. Issue 52. P. 42-47.

Van Den Bergh, N. Solution Focused Therapy. Class Lecture. 25 Oct 2011.
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Walsh (2006). Theories for Direct Social Work Practice. (1st Edition) Belmont: Thomson
Higher Education.