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Assessment two: case study analysis
This essay presents the case study of ‘Rosie’, and examines transcript excerpts
from a counselling session in which she participates. Rosie presents as a (presumably)
single mother of four children, who is currently pregnant. She reports problems with
fatigue related to her pregnancy, and “…everything I have to do…”. During the session, it
is revealed that Rosie’s two eldest children (her sons) have previously been placed in a
foster home. It is also revealed that Rosie has some involvement with prostitution, and
struggles to maintain financial security. The counsellor in this session with Rosie,
employs a Solution-Focused Therapy (henceforth SFT) approach. The essay will begin
with a brief introduction to the theoretical underpinnings of, and techniques endemic to
SFT. It will then move to an analysis of the presented case material respective to the
tenets of SFT, and the identifiable interventions utilised by the counsellor therein. These
specific interventions include the utilisation of the miracle question, the identification of
exceptions, focusing on strengths, and scaling questions. Finally, the effectiveness of these
interventions will be discussed, with respect to the evidence as presented in the case
study in supporting this analysis.
Solution-focused therapy
SFT is widely regarded as a postmodern approach to counselling psychotherapy,
and stands distinct from traditional and modern psychotherapies in its approach and
execution (de Shazer, et al., 1986; Trepper, et al., 2011). Many modern approaches at their
basis, assert a problem-solving or problem-centric model, in which client’s issues are
largely as a result of a deficit either personally, or in their environment (de Shazer, et al.,
1986; Froerer & Connie, 2016). Fundamentally, these models take as their focus seeking
to understand the reasons problems occur for an individual, how these manifest in terms
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of symptoms and related negative impacts for them, and how to assess, treat and best
alleviate or resolve these issues and their impacts (Frankel, et al. 2012). In contrast to
this more conventional model, SFT can be described as a competency-based approach,
whereby the counsellor’s task is to work collaboratively with the client in focusing on
solutions, rather than the problems they are experiencing (Berg & De Jong, 1996; Froerer
& Connie, 2016). The aim of SFT is to enable positive change for the individual through
identifying and developing solutions collaboratively (de Shazer, et al., 1986; Berg & De
Jong, 1996; Froerer & Connie, 2016). Rather than focusing on the problem and issues that
may have led the client to therapy, the SFT approach is instead concerned with the future,
and client formed and led goals for it (Kim, et al., 2019; Froerer & Connie, 2016). This is
accomplished by the building and conceptualisation of an envisaged future, whereby the
client’s issues are either no longer existing, or adequately resolved according to their
goals (de Shazer, et al., 1986; Trepper, et al., 2011; Froerer & Connie, 2016). The
counsellor and client explore the strengths and resources the client has available in
addressing the issue, and focus these to making positive change in realising their goals.
The fundamental premise of SFT is that individuals have some knowledge,
understanding, and capacity toward change that will improve their problems (Trepper,
et al., 2011; Grant, 2012). In focusing on future oriented solutions collaboratively, and by
utilising clients’ strengths and resources, alternatives may be realised and solutions to
their issues brought to fruition (de Shazer, et al., 1986; Trepper, et al., 2011).
Key therapeutic concepts and strategies
Within the SFT approach, there are several principles and techniques in many
ways unique to its practice. For example, the early and persistent use of goal-oriented
questioning is perhaps the most fundamental aspect of the SFT approach (de Shazer, et
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al., 1986; Trepper, et al., 2011). This is significant to the process of SFT, as it not only
underpins the very premise of the approach, but also reinforces for the client the
necessary focus on future, and the importance of considering the future in order to
facilitate change (de Shazer, et al., 1986; Trepper, et al., 2011; Froerer & Connie, 2016).
This can afford the client a new perspective in the therapeutic space, by being focused
toward envisioning positive change, and instilling optimism through considering how
their lives could be different (Trepper, et al., 2011; Kim, et al., 2019). One of the specific
techniques related to goal-oriented questioning, is that of the miracle question. The
miracle question is a technique used to enable the client to imagine an alternate
hypothetical future, in which their problems are no longer existing, or adequately
resolved to be manageable and less impactful (Santa Rita Jr., 1998; Stith, et al., 2012).
After allowing the client to envisage this preferred and positive future, the therapist will
then ask the client how they know the miracle has occurred, and what they notice is
different now their problem is solved. The benefit of this technique is in part to encourage
the identification and development of goals, as well as eliciting relevant and distinctive
details that could be practically incorporated into a solution focus for the client (Trepper,
et al., 2011; Stith, et al., 2012).
Another central focus of SFT, is the identification and consideration of exceptions
to the problem. This is facilitated by the counsellor by using positive questioning, to
discover and emphasise times where the client’s issue was not present, not as impactful
for them, or where they were able to function well despite it (Berg & De Jong, 1996;
Trepper, et al., 2011). This serves to not only evoke feelings of hope for the client, and
reinforce the client’s focus on the potential and amplification for change, but also to
examine what can be learned and applied from these exceptions in redressing the
problem at hand (de Shazer, et al., 1986; Mulder, et al., 2017). Similarly, investigation and
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discussion around a client’s previous solutions to issues, can clarify and yield potential
methods by which they can apply the same strategies and strengths, in achieving their
goals. This again reinforces the client as the locus for potential change, and gives agency
to the client’s ability to best apply their strategies, skills, and resources in attaining their
goals for change (Berg & De Jong, 1996; Grant, 2012).
Another specific focus of SFT, is an emphasis on identifying and discovering the
strengths and resources a client already has, and their potential for use in addressing the
issue at hand (Reiter, 2016). This is an underlying concept within the SFT approach, and
operates upon the premise that the capacity for change is in many ways intrinsic to the
client. In revealing and refocusing client strengths, and through developing these to work
in support of client directed goals, SFT affirms and privileges the client’s ability and
resilience (Trepper, et al., 2011; Reiter, 2016). One of the ways this can be accomplished
is through targeted questions around a client’s strategies and abilities in coping. In
highlighting for the client their already present positive strengths, and coping
mechanisms they have demonstrated to work at least to some degree in dealing with the
issue, this can serve to reinforce a client’s agency, resiliency, and self-esteem (Mulder, et
al., 2017; Berg & De Jong, 1996; Reiter, 2016). Furthermore, appropriately
complimenting a client’s accomplishments and capacity for coping and resilience, are also
a focus of the SFT approach, and further promote self-esteem and provide validation
(Campbell, et al., 1999; Reiter, 2016). When used appropriately, a focus on client
strengths, coping, resilience, and complimenting their efforts, can serve to incite change
and strengthen the therapeutic rapport (Campbell, et al., 1999; Reiter, 2016).
SFT case study: Rosie
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The transcript of the counselling session with Rosie, beings with the counsellor
allowing Rosie to detail and discuss the various issues that have presumably led her to
counselling. The counsellor engages with Rosie, and asks a simple clarifying question
“Delivering goods?”, that signals their attentiveness and allows Rosie to provide further
information. The counsellor then reinforces this by empathetically joining with Rosie, and
validating her feelings of stress and being somewhat overwhelmed (DeFife & Hilsenroth,
2011; Frankel, et al. 2012). After allowing further details of Rosie’s circumstances to be
discussed, the counsellor summarises “So you have several big problems. …”. This reflects
their engagement and attentiveness, and furthers the establishment of a therapeutic
alliance (Frankel, et al. 2012; Hackney & Bernard, 2017). The counsellor then names and
poses an example of the miracle question. Rosie at first responds unrealistically, stating
“…I would have won lotto...”. The counsellor persists, and encourages Rosie to continue
detailing a response by saying “That would be great, wouldn’t it. What else would you
notice?”. This doesn’t wholly discourage Rosie’s response, and prompts her to continue
to detail her response (DeFife & Hilsenroth, 2011; Stith, et al., 2012). Again, Rosie
responds positively, although somewhat unrealistically. The counsellor then refocuses
Rosie stating “…that sounds like a big miracle. …”, before posing a more directed question
“What do you imagine would be the first thing that you would notice which would tell you
that this day is different, it’s better, a miracle must have happened?”. The counsellor’s
persistence and refocusing results in a more reasonable and practical response from
Rosie, with which they then encourage further elaboration from Rosie (Santa Rita Jr.,
1998; Stith, et al., 2012).
The use of the miracle question in this instance yields multiple results for the
session, and helps to facilitate the identification of goals. This is the first example of goal
setting in the session, and essentially serves to structure the remainder of the session’s
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transcript toward a solution focused approach (Santa Rita Jr., 1998). The counsellor in
this example, executes the miracle question technique in a manner that directs Rosie
toward a practicable solution-based focus, and away from problem-centric thinking
(Stith, et al., 2012). By prompting Rosie to consider how things could be different, the
counsellor moves Rosie to a place where change is a real possibility. Through follow up
questions such as “And how would that be for you?”, the counsellor also incorporates
Rosie’s feelings, making the prospect of positive change emotionally real and possible
(DeFife & Hilsenroth, 2011). The use of the miracle question in this example, is key to the
progression of the remainder of the session’s transcript, and signifies a change in the
trajectory of the session toward a goal-oriented solution-focus (Berg & De Jong, 1996;
Santa Rita Jr., 1998; Reiter, 2016).
After the section of the session in which the miracle question is posed, the
counsellor then expands upon the results by asking “Are there times already, say in the
last two weeks, which are like the miracle which you have been describing, even a little
bit?”. This is an example of the counsellor attempting to find and identify exceptions, and
after some further discussion and deliberation, Rosie gives details and an example of such
an exception. The counsellor then affirms Rosie’s progress in the session, by
complimenting her capacity to envisage positive change, and highlighting the significance
of her reported example of exception (Campbell, et al., 1999). Through engaging with
Rosie and building on the progress established by the use of the miracle question, the
counsellor is able to guide her to considering exceptions to her issues, and detail how she
was able to occasion such an exception. The result of this is to provide the client with a
material example of the exception, and in this case empowers Rosie’s ability to foster
change toward solutions (Trepper, et al., 2011; Reiter, 2016). Through their use of follow
up questions related both to the exception and coping strategies such as “…How did that
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all happen?”, and “…how did you make that happen?”, the counsellor also clarifies and
reinforces Rosie’s capacity for agency, determination, and resilience (Froerer & Connie,
2016; Hackney & Bernard, 2017). As Rosie is able to identify and provide details of her
role in the exception, this emphasises a strengths based, solution focused approach to the
session, and signifies at least some level of therapeutic progress and hope (Campbell, et
al., 1999; Reiter, 2016).
While the counsellor guides the focus of the session to finding exceptions, they are
also able to identify some of Rosie’s strengths, resources, and coping strategies, through
her various detailing of the exception. After Rosie discusses the exception further, the
counsellor asks “How did you manage that, reading to four kids? That seems like it would
be really tough.”. This is an important question in the context of the session, and is
multifaceted in its positive implications for the progress of the session. Firstly, this
question would demonstrate to Rosie that the counsellor is attentive, empathetic, and
client-focused (DeFife & Hilsenroth, 2011; Hackney & Bernard, 2017). Rosie’s children
are exceptionally important to her, and the counsellor in asking this question is not only
a recognising the positivity of her efforts, but also acknowledging her ability and capacity
for mothering (Campbell, et al., 1999; Reiter, 2016). This question also provides Rosie
with the opportunity to further detail, and perhaps better understand how she was able
to mobilise toward the exception. This gives her a concrete example of how she may able
to manage such an exception again in the future, and also identifies resources she has
available to her, such as the help of her eldest son.
Directly after Rosie provides details of the exception, and some of her strengths
and resources are considered, the counsellor employs an example of the scaling question:
“I’d like you to put some things on a scale for me…”, “…the problems we’ve been talking
about are solved, where are you on that scale?”. Rosie responds to this more positively
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than she would have expected, prior to undertaking the session. This scaling question
serves to incorporate evaluation into the session, and allows Rosie the chance to reflect
on, and in some sense quantify the progress she has made throughout it (Trepper, et al.,
2011; Reiter, 2016). Regular and consistent evaluation is important to a SFT approach, to
ensure tracking of progress, and that the sessions content aligns with the client’s goals
(Froerer & Connie, 2016; Kim, et al., 2019). The counsellor follows up after Rosie’s
relatively positive response, with another scaling question that is this time more oriented
toward future planning and goal setting (de Shazer, et al., 1986; Trepper, et al., 2011;
Froerer & Connie, 2016). The use of the scaling question in this instance, prompts Rosie
to consider what may be required to positively plan for the future, and may also serve to
remind her of the potential for change and improvement.
This essay has considered the case study of Rosie, who participated in a
counselling session based on a SFT approach. First introducing the theoretical
underpinnings of SFT, and describing some of the techniques endemic to the practice of
SFT, the essay moved to an analysis of the presented case material. Those identifiable
interventions utilised by the counsellor therein were then considered, and included the
use of the miracle question, the concept of exceptions, focusing on strengths, and scaling
questions. The use and effectiveness of these interventions was discussed and
commented upon, with evidence as presented in the case study used in supporting this
analysis. The case study of Rosie presents a good example of SFT, with clear therapeutic
progress able to be identified owing to the counsellor’s use of SFT concepts and
techniques.
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References
Berg, I. K., & De Jong, P. (1996). Solution-building conversations: Co-constructing a sense
of
competence
with
clients.
Families
in
Society,
77(6),
376-391.
https://doi.org/10.1606/1044-3894.934
Campbell, J.E., Gallagher, D., Simon, J. & Taylor, A. (1999). Crafting the ‘tap on the
shoulder’: A compliment template for Solution-Focused Therapy. American
Journal of Family Therapy, 27(1), 35-47.
https://doi.org/10.1080/019261899262087
de Shazer, S., Berg, I. K., Lipchik, E., Nunnally, E., Molnar, A., Gingerich, W., Weiner-Davis,
M. (1986). Brief therapy: focused solution development. Family Process, 25(2),
207-221. https://doi.org/10.1111/j.1545-5300.1986.00207.
DeFife, J. A., & Hilsenroth, M. J. (2011). Starting off on the right foot: Common factor
elements in early psychotherapy process. Journal of Psychotherapy Integration,
21(2), 172. https://doi.org/10.1037/a0023889x
Frankel, M., Rachlin, H., & Yip-Bannicq, M. (2012). How nondirective therapy directs: The
power of empathy in the context of unconditional positive regard. Person-Centered
& Experiential Psychotherapies, 11(3), 205-214.
https://doi.org/10.1093/acprof:oso/9780195385724.003.0015.
Froerer, A., & Connie, E. (2016). Solution-Building, the foundation of solution-focused
brief therapy: A qualitative delphi study. Journal of Family Psychotherapy, 27(1).
20-34. https://doi.org/10.1080/08975353.2016.1136545.
Grant, A. M. (2012). Making positive change: A randomized study comparing SolutionFocused vs. problem-focused coaching questions. Journal of Systemic Therapies,
31(2), 21-35. https://doi.org/10.1080/17521882.2019.1599030
10
Hackney, H. L., & Bernard, J. M. (2017). Chapter two: The language of counselling, in
Professional counselling: A process guide to helping (8th digital ed.) 20-36. Pearson.
https://bookshelf.vitalsource.com/#/books/9780134297088
Kim, J., Jordan, S. S., Franklin, C., & Froerer, A. (2019). Is solution-focused brief therapy
evidence-based? An update 10 years later. Families in Society, 100(2), 127-138.
https://doi.org/10.1177/1044389419841688
Mulder, R., Murray, G., & Rucklidge, J. (2017). Common versus specific factors in
psychotherapy:
Opening
the
black
box.
The
Lancet
Psychiatry,
4.
http://dx.doi.org/10.1016/S2215-0366(17)30100-1
Reiter, M. D. (2016). Solution-focused sculpting. Journal of Systemic Therapies, 35(3), 3041. https://doi.org/10.1521/jsyt.2016.35.3.30
Santa Rita Jr., E. (1998). What do you do after asking the miracle question in solutionfocused
therapy.
Family
Therapy,
25(3),
189-195.
Retrieved
from:
https://www.proquest.com/ce5adb58c6450d219248cf1e66ceeb75/
Stith, S. M., Miller, M. S., Boyle, J., Swinton, J., Ratcliffe, G., & McCollum, E. (2012). Making
a difference in making miracles: Common roadblocks to miracle question
effectiveness. Journal of Marital and Family Therapy, 38(2), 380-393.
https://doi.org/10.1111/j.1752-0606.2010.00207.x
Trepper, T., McCollum, E., De Jong, P., Korman, H., Gingerich, W, & Franklin, C. (2011).
Solution-Focused
Brief
Therapy
Treatment
https://doi.org/10.1080/14779757.2012.695292
Manual
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