THE AMERICAN JOURNAL OF FAMILY THERAPY
2020, VOL. 48, NO. 2, 195–210
https://doi.org/10.1080/01926187.2019.1691083
A Case Study of Solution-Focused Brief Family Therapy
Jung Jin Choi
Department of Youth Science, Kyonggi University, Suwon, South Korea
ABSTRACT
ARTICLE HISTORY
Solution-focused brief therapy (SFBT) was developed as a
form of family therapy. Recently, these features have blurred.
This case study explores how Insoo Kim Berg interacts with
multiple family members in SFBT. The results indicate that she
used a circular procedure to ensure that all the family members were involved in the process. The analysis demonstrates
the importance of purposeful use of language and the influence of systems theory in SFBT. SFBT provides a useful framework that enables a family therapist to work together with
families to help them make the changes they want with their
own strengths and resources.
Received 26 July 2019
Revised 26 October 2019
Accepted 28 October 2019
KEYWORDS
Solution-focused brief
therapy; family therapy;
Insoo Kim Berg; case study
Solution-focused brief therapy (SFBT) is one of the many therapeutic
approaches currently favored by many individual and family therapists
(Nichols, 2014; Norcross, Pfund, & Prochaska, 2013; Trepper, 2012). The
effectiveness of SFBT has been proven in diverse populations (Bond,
Woods, Humphrey, Symes, & Green, 2013; Franklin, Trepper, Gingerich, &
McCollum, 2012; Kim, Jordan, Franklin, & Froerer, 2019; Schmit, Schmit,
& Lenz, 2016). The research, however, tends to be focused on individuals,
couples, or groups. Although SFBT was developed as a form of family therapy based on systems theory, relatively little research on process and outcome has been conducted for families (Berg, 1994; Bond et al., 2013; De
Castro & Guterman, 2008; Nelson, 2019; Trepper, 2012).
Recently, SFBT has been greatly influenced by evidence-based practice
(Kim et al., 2019). This wave of change has influenced all psychotherapeutic approaches, as well as SFBT, and has given rise to the challenge of
showing the effectiveness of each approach by means of empirical evidence
and identifying the therapeutic mechanism (Johnson, Best, Beckley, Maxim,
& Beeke, 2017). The second version of the SFBT Manual for Working with
Individual Clients (Trepper et al., 2012) is also a part of the effort.
However, as noted, in addition to the lack of research on working with
families, the manual itself is intended to work with individual clients.
CONTACT Jung Jin Choi
jjchoi@kgu.ac.kr
Department of Youth Science, Kyonggi University, 154-42,
Gwanggyosan-ro, Suwon, Gyeonggi 16227, South Korea.
ß 2019 Taylor & Francis Group, LLC
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Recently, the focus of the SFBT has presumably been more on working
with individuals than with families.
SFBT contains features of family therapy based on systems theory (Berg,
1994; Nelson, 2019; Trepper, 2012). Franklin, Streeter, Webb, and Guz
(2018) noted that changes in SFBT occur in relational and contextual
aspects of the client. In other words, the client’s problem is interactive and
defined in the context of relationships with people such as family.
However, few studies have examined how SFBT therapists work with family
members in actual family therapy cases. Results from such study will reveal
a unique interactive dynamic between the therapist and family as a hallmark of solution-focused brief family therapy. This will eventually expand
the evidence basis of SFBT by complementing the outcome research.
Although every interaction between the therapist and the clients in therapy has mutual influence (Bavelas, McGee, Phillips, & Routledge, 2000),
the therapist is mainly responsible for changing the context of the therapeutic conversation in the treatment process (Bavelas, 2012). Therefore, it
is important to understand how an SFBT therapist makes choices in the
treatment with the family. This qualitative case study explores how Insoo
Kim Berg, the most well-known SFBT therapist in the field, interacts with
family members in an SFBT session. The research question is, “How and in
what procedures is the therapist interacting with multiple family members
in implementing SFBT?”
Literature review
SFBT is an approach developed by the practitioners of the Brief Family
Therapy Center (BFTC) established in 1978 (de Shazer et al., 2007). When
the BFTC was established, members of the Center were practitioners interested in brief therapy and family therapy, and the name BFTC was a natural combination for them (Lipchik, Derks, LaCourt, & Nunnally, 2012).
The early team’s interest was on testing the effects of behavioral patterns
surrounding the client’s problem on the client’s changes (Ratner, George, &
Iveson, 2012). Then, the BFTC therapists encountered several families who
inspired the team to change their therapeutic direction from problem to
solution (De Jong & Berg, 2013). The journey from the focused resolution
model to the focused solution development model had begun (de
Shazer, 1988).
SFBT has evolved, and the progress of the change will continue. Ratner
et al. (2012) argued that in the 21st century, many of the unique features
of SFBT have disappeared or changed. During the course of the journey,
SFBT has taken social constructionism as its theoretical basis. The influence
of this philosophical tendency has made the purposeful use of language
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more prominent in the change process (De Jong & Berg, 2013; Kim et al.,
2019). Miller and de Shazer (1998), influenced by Wittgenstein’s philosophy
and the concept of language games, defined SFBT as a therapeutic
approach to helping clients build a story about the solution. These philosophical influences have had a major effect on the epistemological shifts in
which the therapist should take a “not-knowing posture” toward the client
(Anderson & Goolishian, 1992). In this process, the initial appearance of
brief family therapy, which was influenced by systems theory, was transformed to emphasize the importance of social constructionist use of language (De Jong & Berg, 2013). As a result, SFBT has been extended to
approaches that can be applied to a wide range of clients (Trepper, 2012).
However, the characteristics of family therapy of SFBT have been diluted
in this inductive developmental process.
A solution-focused conversation with a person who can try to solve the
problem “here and now” is a good start to fostering change in a family (De
Jong & Berg, 2013; Nelson, 2019). Like the miracle question, most of the
therapeutic questions of SFBT have systemic and structural features
(Trepper, 2012). SFBT views the world as a network of organically connected relationships (Franklin et al., 2018). SFBT uses questions about the
context of the client in the family relationship, such as the miracle, scaling,
and relationship questions. SFBT assumes that change is inevitable and
always occurs, and that small changes lead to greater systemic and structural changes (de Shazer et al., 2007). This understanding demonstrates the
influence of systems theory (Lipchik, 2002; Trepper, 2012). That is, small
changes in the family can affect other parts, which can lead to changes in
the whole family. The principles, philosophy, and techniques of SFBT, as
an organizing framework (Trepper, 2012), offer an appropriate approach
that helps families make the changes they want by means of their own
strengths and resources. A case study that explores how an SFBT therapist
interacts with family members in a family therapy session can provide evidence about how the organizing framework proceeds for actual families.
Methods
This study follows the traditions of case study. Yin (2009, p. 18) defined a
case study as “an empirical research method that explores the phenomenon
in depth in the context of the actual life in which it occurs.” This casestudy method provides an appropriate tool in two ways. First, it provides a
detailed understanding of the case to be analyzed (Stake, 1995; Yin, 2009).
Second, the interactions between the therapist and the family members in
the therapy room, where the family therapy was practiced, can be examined
in detail, being sensitive to the situation and context.
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There are two types of cases in case studies. First, there are “essential
cases,” which need attention only for the cases themselves; second, there
are “instrumental cases,” which are selected to understand specific problems (Stake, 1995). The case in this study was instrumentally selected to
understand the phenomena of interactions between family and therapist.
In her life, Insoo Kim Berg left several video clips on the practice of
SFBT for individuals and families. Among them, No More Lectures (Berg,
2008) has several advantages for case studies, especially for employing a
single-case study design. Most importantly, the actual family appears in
this video clip. Another advantage is the high fidelity of SFBT. The
Research Committee of the Solution Focused Brief Therapy Association
(2007, as cited in Kim & Franklin, 2009, p. 464) suggested that there are
three ingredients of SFBT: (1) use of conversations about the clients’ concerns; (2) use of conversations about co-constructing new meanings around
client concerns; and (3) use of specific techniques to help clients coconstruct a vision of a preferred future and drawing upon past success and
strengths to help resolve issues. In this respect, this case has great merits,
because the therapist was one of the developers of SFBT and is known as
the most experienced therapist in the field.
The case was conducted in English, and no transcripts were provided. To
obtain data for the case study, a professional English interpreter transcribed
the therapy session as I, the researcher, am a non-English-language professional. I compared the transcript with the original video clip several times
to confirm and supplement the data. In this process, the transcription was
further enriched. Then, I pursued a constant comparison analysis for data
analysis (Lincoln & Guba, 1985). The goal was to find the uniqueness of
the case and possible patterns that might emerge from the interactions
between the therapist and the family members.
To ensure the trustworthiness of the inquiry, the criteria, such as credibility, dependability, confirmability, and transferability, were secured
(Lincoln & Guba, 1985). To establish credibility and dependability, I chose
the case conducted by Insoo Kim Berg for theoretical fidelity of SFBT (Yin,
2009). I gave every line of the transcript a number for an accessible audit
and carefully reviewed almost all of Berg’s other educational video tapes.
This process trained me to be sensitive about Berg’s therapeutic styles,
including verbal and nonverbal communication skills. Then, I recorded a
reflexive note that documented the visible and invisible choices the therapist made in the interactions with the family. I also compared the complete
transcript with transcripts from Berg’s other educational video clips that
dealt with individual clients to find any notable differences in dealing with
multiple family members. Then, I tried to review case reports, scholarly
articles and books by Berg. Several case studies on Berg’s cases were also
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examined. The detailed description of the therapy process in the following
result section will provide the transferability of the findings. Finally, I
sought to improve the confirmability of the results by means of peer
debriefing from both a qualitative researcher and several experienced SFBT
therapists by using both a detailed transcript and a draft case-study report
to confirm that my interpretation was appropriate.
Results
The findings are presented primarily in two ways: (1) the case; and (2) the
case analysis. Whereas the case provides a case summary, the case analysis
is composed of five different sections: (1) identifying the strengths of both
the family and each family member; (2) co-constructed goal setting with
the family members; (3) asking the miracle questions to all family members; and (4) compliments to all family members and a message to the family. In these sections, the interactional patterns that emerged between the
therapist and the family members are highlighted as the therapy session
proceeded chronologically, which was designed to help readers walk
through how Berg initiated the therapeutic process with multiple family members.
The case
In this case, there were four family members, including a father (Tony)
and a mother (Dana) in their early forties, a 16-year-old son (T.J.), and a
15-year-old daughter (Jen). The parents said that their son had been suspended from school for smoking marijuana and was rebellious at home.
The daughter had recently had a life-threatening experience due to inhalation of drugs. The family was not residentially stable and was currently
staying at a hotel. This family was referred to the therapist by a team at a
Community Mental Health Center. The team could not see any therapeutic
progress with the family and wanted Berg to provide supervision for them.
Before the session began, Berg received a briefing from the team about the
family’s problems and the current situation. Then Berg met with the family
for about 68 minutes.
The case analysis
Identifying the strengths of both the family and each family member
The therapist began the session by identifying the strengths of each family
member, although she had heard a lot from the team about the problems
the family was experiencing. Berg (1994) suggested that the therapist
should make personal contact with each family member at the beginning of
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a session. She tried to identify not only the strengths of the son, but also
those of the daughter, mother, and father. It was also clear that the therapist wanted to include the viewpoints of each one. For example, she asked
about the son’s strengths from his parents’ point of view. By means of this
process, she was able to identify not only the strengths of the family, but
also the viewpoints of each of its members. Below, she identified the son’s
strengths and tried to attract not only his father and mother but also the
son himself to the conversation.
Therapist 1 (to parents): What is T.J. good at in school? … ! Therapist 3: Really?
That smart? … Say something more, what do you (father) mean, “Whatever he (the
son) puts his mind to?”
However, the therapist’s efforts to identify the son’s strengths were often
interrupted by the parent’s “problem talk,” a conversation that was centered
on the scope and cause of the client’s problems, deficits, and deficiencies
(De Jong & Berg, 2013). In particular, the father was very worried about
his son. However, the therapist used this as an opportunity to find out
when the son’s problematic behavior lessened or did not appear. To do
this, the therapist tried to turn problem talk into “solution talk,” a conversation focusing on the client’s strengths, resources, competence, and solutions (De Jong & Berg, 2013). At this time, the therapist confirmed what
these strengths were specifically and the contexts in which they appeared.
Father 8: … But lately it’s like “I’m right, and that’s it” …
Therapist 9: I see. So, he was good at listening to you at one time? … ! Therapist
11 (to parents): Is he good at listening in school also? … ! Therapist 30: … Right,
right. Okay, what about around the house? … ! Therapist 35: What about outside
the house? … ! Therapist 46: How about Jen? … (to daughter) What are you
good at in school? … ! Therapist 59: … (to mother) What about you? … !
Therapist 77: … (to father) How about you?
In the conversation above, the therapist continued to try to find the son’s
strengths, but the focus was on finding strengths in various environments.
The parents, for a while, responded to the conversation and tried to identify
their son’s strengths together with the therapist, but then their perspective
directed towards the current problems again. Then, the therapist invited the
son to participate in the conversation. Nevertheless, the parents were still
negative toward their son. Then, the therapist turned the topic of conversation toward finding the daughter’s strengths. The conversation proceeded to
ascertaining the strengths of the mother and father. It is worth noting that
none of the family members were alienated from identifying the strengths. It
appeared that the therapist mainly tried to turn problem talk into solution
talk by asking different questions, changing the dialogue partners or topics.
A study (Choi & Baek, 2017) indicated that the conversations between the
therapist and family in this case are divided into 74 solution talks and 72
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problem talks. Although Berg initiated only one problem talk out of 72, she
led 70 out of 74 solution talks. This result arguably demonstrates that the
solution-focused family therapist’s primary approach for change is to build
solutions with all family members, if possible, through deliberate solution talk.
Co-constructed goal setting with the family members
After confirming the strengths of all the family members and the family as
well, Berg worked with the family to set the goals for the therapy. Goal setting is one of the most important activities in SFBT (de Shazer et al.,
2007). Berg wanted to hear the family’s expectations about what should
happen within the session.
Therapist 82: … (to all family members) What do you suppose needs to happen
here today, that will let you know it was worth your trip … all four of you, getting
in a car, driving over here. What needs to happen, do you think?
To the question of the therapist, the parents said that the son needed to
realize that he had a problem, because the son would argue that he had no
problem. While acknowledging the efforts of the parents, the therapist also
used a “not-knowing posture” rather than judging the parents’ position. At
this time, she showed an interest in how the efforts of the parents helped
themselves and the whole family.
Therapist 90: (to mother) Right, okay, how would that be helpful for you? His
realizing that? … ! Therapist 95: (to father) Okay, … so is that what you are
hoping will happen today?
During the process of setting goals, primarily the parents appeared to
participate in the conversation. Then the therapist again invited the son to
participate in the conversation, at a point where the parents mainly were
complaining about him. However, the son said he was forced to come to
the therapy and showed extreme anxiety. He insisted on leaving the room.
In this process, the therapist showed empathy toward him to participate in
the therapy regardless of his will. However, she also continued to ask him
about his goal for the session.
Therapist 133: … (to son) I know, but since you are here anyway. You want
something out of this, right? What do you want to be different about your parents?
… ! Therapist 134: … What do you want your parents to do differently that will
be helpful for you?
Afterwards, the therapist asked the son if she could talk with him later,
and she allowed him to leave the therapy room. She had to decide whether
the treatment session could continue, because the son had disappeared
from the session. While introducing this case at the beginning of the video
clip, Berg remembered this part of the case and commented that she felt
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tremendous difficulty internally. However, she decided to continue the
therapy session by using the relationship question as below.
Therapist 138: Okay. Alright. Great. That’s fine. (to daughter) You know your
brother very well … ! Therapist 144: … What about from your point of view,
Jen? What needs to happen here? … ! Therapist 146: (to parents) What needs
to be different, so you can say, “Wow, this was worth it”?
In responding to the questions, the daughter, Jen, said that she had nothing to do with this therapy session and that she did not know what to do.
However, the therapist asked a few more similar questions, believing that
Jen would certainly have hoped to gain something for the session. Then,
Jen said that her brother had to “calm his temper down.” The therapist listened to Jen’s explanation of “temper.” By means of this, the therapist
could construct a new meaning for “temper” as “strong-headed” and “being
independent.” This rephrasing was made not by the therapist alone, but by
collaborative conversation with the family members, so that the family
could accept the newly constructed meaning of the son’s behavior. This
process of re-naming shows the importance of using solution-focused formulations in the therapeutic process by purposely using positive language
(Bavelas, 2012; Kim et al., 2019; Korman, Bavelas, & De Jong, 2013).
Asking the miracle questions to all family members
The miracle question is a part of goal setting in SFBT (de Shazer et al.,
2007). In the conversation above, the therapist continued to ask about the
family’s expectations about what should happen in the therapy session.
However, in the family, the father particularly had difficulty about answering the questions, acknowledging that their children’s problems were very
serious, and admitting that their past experiences had a negative effect on
his current perceptions. However, the focus of the therapist in this process
was that the father had a great interest in his children, that he had made a
great effort, and that he still loved his children very much. Unfortunately,
it was a one-sided expression of the father that did not connect with the
children. In the conversation below, the therapist asked the miracle question to the family struggling to set goals.
Therapist 208: … (to all family members) I’m going to ask you a very strange
question … ! Therapist 209: … And a miracle is that these kinds of problems
that get two of you worried about your children … all disappeared, gone … So,
when you wake up tomorrow morning, what might be the first small clue to you
that makes you wonder “Oh, maybe something happened in the middle of the night
when we were all sleeping?!”
Father 84: (in answering the miracle question) With my daughter? I wouldn’t
have to worry about her screaming “Don’t look at me, it’s too early in the
morning!” …
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Jen 53: That’s because you aggravate me!
Therapist 211: Wait, wait a minute. (To father) What would you see instead of
that? …
In the conversation above, the therapist made clear that she would ask
the miracle question to all the family members after she was given permission to ask the question. The therapist asked the question with a sense of
curiosity. She slowly asked the question, paused in the middle, and allowed
time for the family to think. The family listened to the therapist’s question
with a curious look. But the reaction of the family, especially that of the
father, was negative as usual. The children had already shown many of the
negative dynamics with their father within the session. The therapist
observed the dynamics and intervened before the conflicts overtook the
proceedings. Berg (1994, p. 123) noted, “Sometimes, conducting a family
session is like being a traffic cop.”
In the following conversation, the father continually showed difficulty in
answering the miracle question. Then the therapist switched the conversation partner to the mother to help the father understand the question by
listening to the dialogue between his wife and the therapist.
Therapist 213: (to father) Okay. I’ll come back to you (later). (Moving from father to
mother) What about for you, Mom? What would be the first small clue to let you
know “This is different today.”
Then the therapist asked the father the miracle question again when he
was ready. Still, his answer was vague, such as “a different value”, then the
therapist tried to turn the father’s ambiguous expression into a concrete
one, as below.
Therapist 226: Okay, how will he today let you know “Now today, Dad, I have a
different value” … ! Therapist 230: What will you be able to see? … ! Therapist
236: … What else will be different? Around the house tomorrow morning?
The miracle question does not always lead to positive content (De Jong
& Berg, 2013). This family likewise had difficulty keeping up with the
assumptions and expectations of a problem-free talk. When such a complaint by the father was followed, the therapist would use the approach of
looking at other aspects of miracles, such as the above conversation, changing the subject of conversation, or switching conversation partners,
as follows.
Father 106: And you’re sitting there and you’re going “what happened?”
Therapist 244: What happened? Okay, alright. (to daughter) So, suppose T.J. is that way,
Jen? How would he be different with you? …
Although the family did not continue to participate in the conversation
on the miracle question, the therapist invited them again to the question
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and tried to continue the conversation. Nevertheless, the father continued
to engage in problem talk, and the therapist invited the father back to the
miracle question. This process showed a dynamic of two people pushing
and pulling each other or playing a language game like “playing tennis” (de
Shazer et al., 2007). An important aspect of proceeding with the miracle
question is that the therapist focused on inviting all the family members to
talk about how each of them would look different from the present when
the miracle really happened (Berg, 1994; De Jong & Berg, 2013).
After inviting all of the family members to a conversation about what to
expect after the miracle happened, the therapist, having decided that the
description was sufficiently secured, asked the family how confident they
were about making things better, and this led to a scaling question, which
can also be used as a tool to assess the client’s degree of problem and
degree of progress, but in this case was used as a part of the miracle question, which is called a miracle scaling question (De Jong & Berg, 2013; de
Shazer et al., 2007).
Therapist 398: … (to all family members) I wanna ask you just one more question.
Let’s say … on a 1 to 10, … 10 is this day after this miracle I’ve been talking
about … And a 1 is one of those like dark days … Where would you say, generally,
things are at right now? Between 1 and 10? … ! Therapist 401: 4 (father)? That’s
great. 3 (mother)? That’s pretty good. So, it’s not the lowest you’ve even been? …
! Therapist 402: … (to mother) So, for you – what needs to happen so you can
say I am moved up from 3 to 4? … ! Therapist 403: (to father) how about for
you? … ! Therapist 404: (to daughter) how about you, Jen?
Compliments to all family members and a message to the family
At the conclusion of the session, the therapist took a break to write a message to the family. At this time, she complimented the strengths and
resources of the family, the exceptions to the problems, the efforts over
time, and the family’s resilience that she collaboratively found with the
family within the session. She included a task to further expand the family’s
changes that had already begun. As shown in the following message, the
therapist tried to compliment all family members. This included T.J., who
had already left the therapy session. A notable part was a gentle suggestion
to the father to use his smile more to his benefit.
Therapist 408: … (to all family members) Overall – oh! The other thing I wanted to
mention to you (father) – You know, Tony, when Dana was talking about what you
like when you were … relaxed … funny and all this stuff. I saw some glimpse of a
beautiful smile … ! Therapist 416: … You have to think about using it more, to
your advantage … ! Therapist 417: (to all family members) I would like all of you
to pay attention to what each of you do when things are going just a little bit better
than it is right now … because that might be the secret key of what to do to make
things even better.
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Discussion and implication for practice
The purpose of this study was to explore how the therapist interacts with
multiple family members in SFBT. It was a therapy that was not as easy as
the therapist had recalled, because the son left the room impulsively (Berg,
2008). Nonetheless, there must be reasons for this case to be published as
educational material. Among them, what I consider the most is that this case
shows the therapist’s solution-focused approaches in a detailed way. It was a
therapy session with a real family, so that real conflicts arose among family
members. This demonstrates a “real” scene of a therapy. Also, this case
showed a high fidelity of SFBT, meeting the criteria suggested by the SFBTA
(Kim & Franklin, 2009). The therapist had a conversation with the family on
their concerns. She successfully tried to co-construct new meanings of their
concerns. She also used techniques such as the miracle, scaling, exceptionfinding, and goal-setting questions, a consulting break, and a message to
help the family to draw upon past success and strengths to construct solutions. In this respect, this case is instrumental in terms of exploring the
dynamics of the therapist and a family with multiple members in SFBT.
The use of solution-focused “circular” questions in building solutions with
multiple family members
Berg once said that a good question comes from genuine curiosity. At the end
of the session, she said, “I sort of ran out of questions.” as an indicator to the
family that the session would be over soon. As being said by the therapist, the
SF questions were the main interventions that the therapist used in this case.
She asked the questions to keep the conversation focused on building solutions by using the process of “Listen, Select, and Build” (De Jong & Berg,
2013). She often invited the family to imagine what the family might look like
when the problem disappears and to converse about the problem-free future
that they had never imagined. In this case, the therapist, by using the SF questions, tried to turn the family’s problem talk into solution talk. Froerer and
Connie (2016) defined such a process of SFBT as “a solution building.”
In addition to using the major solution-focused questions, the therapist
also frequently asked questions such as “How did it help?”, “How will it
help?”, “What difference does it make?” and “What else will be different?”
These questions reflect the “not-knowing posture” that the therapist
showed during the whole process. These questions put the family in an
expert position. The therapist showed a respectful attitude by “leading from
one step behind” based on the assumption that the family is the expert
about their own lives (De Jong & Berg, 2013). Earlier, Tomm (1988, p.
5–7) called these questions “circular questions” and argued that these types
of questions could potentially have “liberating effects” on the family.
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Tomm (1998) observed that in this process, the family members listen to
each other’s answers and can make their own connections in terms of their
own interaction patterns. Bavelas (2012) argued that this can be done in
roughly two ways, a problem-focused or solution-focused way. In this case
the therapist invited the family members to explore their interaction patterns that occur when the problems were less severe and each family member was successful in the face of the problems, a solution-focused way.
Most importantly, the therapist engaged with all the family members in
using the solution-focused questions in circular ways. In other words, all
members were able to engage in multiple solution talks in which the family
realized that they were not in the most difficult situation, as indicated in
the miracle scaling question, and that they had already overcome some of
their difficulties with their own resources and strengths, an “empowering
effect.” These techniques may be called the solution-focused “circular”
questions, because they used with multiple family members to make sure
all of them engaged in solution-building conversations.
A solution-focused brief family therapy (SFBFT)
In this case, the approach taken by the therapist when the son left the therapy session is an important example of the possibilities and the use of specific solution-focused circular techniques in solution-focused brief family
therapy (SFBFT). When the son left the room, the therapist turned her
focus to the daughter and asked about her perspective on her brother. This
relationship question assumed that the family as a whole and each member
as part of the system influences each other and the whole (Berg, 1994;
Franklin et al., 2018; Nelson, 2019). This is consistent with the basic worldview of systems theory. This context-sensitive relationship question is used
to know each member’s point of view when all family members are present
but could be used in family therapy even in the absence of the person with
the problem, as shown in this case. Even though the therapy was begun
because of the problem of the son, it was the remaining family members
who were willing to change the situation in his absence and were therefore
the first to collaborate for change in the family system.
Systems theory assumes that a change in any part of the system affects the
other parts (Berg, 1994; Nelson, 2019; Nichols, 2014), and this assumption
was one of the most basic processes found throughout the case. The therapist
focused on the relationships in the family, asking not only the relationship
question but also the goal setting, exception-finding, miracle, and miraclescaling questions, and the message, that is, most of the approaches that the
therapist took in the session with the family. In the end, the family was able
to see their problem within the situational context in which the relationships
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are intertwined, not as the problems of only one person, the son. Thus, this
case demonstrates that the focus of therapeutic intervention can be anyone in
the network of relationships related to family problems, if anyone is motivated
to recognize the problem and resolve it (Berg, 1994; De Jong & Berg, 2013).
In this case, the father was a strong motivator for solving the family
problems. However, he insisted on his own way and showed a pattern of
repeating what was not effective. To do something different from focusing
on what has not been working (De Jong & Berg, 2013), the therapist delivered a message, in which she did not suggest that the father had to try to
relieve the tension that existed in the family to solve the family problem.
Instead, the therapist suggested to the father to use his smile more for his
benefit. This gentle invitation or “a nudge” can motivate a client to do
more of what is working or make a better choice (Service & Gallagher,
2017; Trepper, 2012). If SFBT uses the client’s abilities and resources as a
building block for constructing a solution, the father’s smile, an exception,
was a resource that could possibly alleviate family tensions. This represents
both the importance of social constructionist use of language and the influence of systems theory in SFBFT.
Implications for practicing SFBFT
Satir once said the family is like a mobile, and that when one-part moves,
the whole moves together as shown in this case. The implications of the
results for an SFBFT therapist are as follows. The focus is on “here and
now” and on a respectful approach to finding family strengths and resources,
so that a part of a closely connected family can move on their own. SFBFT
allows a therapist to form a collaborative relationship with the family and to
find together the functional exceptions in the past and present, so that they
can be further extended. The concrete imagining of future possibilities with
family members can enable them to know each other’s preferred future,
which can affect the following behaviors. An SFBFT therapist helps the family to talk about solutions by means of the solution-focused circular questions and strengths-oriented language. An SFBFT therapist enables the family
to look at the relationships within the family by themselves; accordingly, the
view and meaning of the family changes, and the rules are changing. From
the second-order change perspective, this is a further extension and enrichment of family therapy based on systems theory (Tomm, 1998).
Limitation
Given some limitations, the results of this study need to be viewed from a
critical perspective. Mostly, I employed a single-case study design.
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J. J. CHOI
Considering that family therapy is sensitive to its contexts, the results of
this study can be further tested and expanded by including multiple family
cases by the same therapist. However, since Berg is deceased, further case
studies with multiple families by multiple therapists with high fidelity to
SFBT is needed.
Future directions for research
This qualitative case study demonstrates that SFBFT provides a useful
approach that helps a SFBT therapist to work together with families to
make the changes they want with their own strengths and resources. A process research like this that shows the unique interactive dynamics between
the SF family therapist and the client is further needed especially for
exploring if the existing approaches provide flexibility in solving the family’s needs and problems that appear in more complex forms (Gosnell,
McKergow, Moore, Mudry, & Tomm, 2017). Although more rigorous outcome research such as using randomized controlled trials on SFBT has
greatly increased during last 15 years (Kim et al., 2019), much attention is
still required to prove the efficacy of SFBFT to be recognized as an evidence-based intervention.
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