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What Is Problem-Solving Therapy?

Arlin Cuncic, MA, is the author of The Anxiety Workbook and founder of the website About Social Anxiety. She has a Master's degree in clinical psychology.

Daniel B. Block, MD, is an award-winning, board-certified psychiatrist who operates a private practice in Pennsylvania.

Verywell / Madelyn Goodnight

Problem-Solving Therapy Techniques

How effective is problem-solving therapy, things to consider, how to get started.

Problem-solving therapy is a brief intervention that provides people with the tools they need to identify and solve problems that arise from big and small life stressors. It aims to improve your overall quality of life and reduce the negative impact of psychological and physical illness.

Problem-solving therapy can be used to treat depression , among other conditions. It can be administered by a doctor or mental health professional and may be combined with other treatment approaches.

At a Glance

Problem-solving therapy is a short-term treatment used to help people who are experiencing depression, stress, PTSD, self-harm, suicidal ideation, and other mental health problems develop the tools they need to deal with challenges. This approach teaches people to identify problems, generate solutions, and implement those solutions. Let's take a closer look at how problem-solving therapy can help people be more resilient and adaptive in the face of stress.

Problem-solving therapy is based on a model that takes into account the importance of real-life problem-solving. In other words, the key to managing the impact of stressful life events is to know how to address issues as they arise. Problem-solving therapy is very practical in its approach and is only concerned with the present, rather than delving into your past.

This form of therapy can take place one-on-one or in a group format and may be offered in person or online via telehealth . Sessions can be anywhere from 30 minutes to two hours long. 

Key Components

There are two major components that make up the problem-solving therapy framework:

• Applying a positive problem-solving orientation to your life
• Using problem-solving skills

A positive problem-solving orientation means viewing things in an optimistic light, embracing self-efficacy , and accepting the idea that problems are a normal part of life. Problem-solving skills are behaviors that you can rely on to help you navigate conflict, even during times of stress. This includes skills like:

• Knowing how to identify a problem
• Defining the problem in a helpful way
• Trying to understand the problem more deeply
• Setting goals related to the problem
• Generating alternative, creative solutions to the problem
• Choosing the best course of action
• Implementing the choice you have made
• Evaluating the outcome to determine next steps

Problem-solving therapy is all about training you to become adaptive in your life so that you will start to see problems as challenges to be solved instead of insurmountable obstacles. It also means that you will recognize the action that is required to engage in effective problem-solving techniques.

Planful Problem-Solving

One problem-solving technique, called planful problem-solving, involves following a series of steps to fix issues in a healthy, constructive way:

• Problem definition and formulation : This step involves identifying the real-life problem that needs to be solved and formulating it in a way that allows you to generate potential solutions.
• Generation of alternative solutions : This stage involves coming up with various potential solutions to the problem at hand. The goal in this step is to brainstorm options to creatively address the life stressor in ways that you may not have previously considered.
• Decision-making strategies : This stage involves discussing different strategies for making decisions as well as identifying obstacles that may get in the way of solving the problem at hand.
• Solution implementation and verification : This stage involves implementing a chosen solution and then verifying whether it was effective in addressing the problem.

Other Techniques

Other techniques your therapist may go over include:

• Problem-solving multitasking , which helps you learn to think clearly and solve problems effectively even during times of stress
• Stop, slow down, think, and act (SSTA) , which is meant to encourage you to become more emotionally mindful when faced with conflict
• Healthy thinking and imagery , which teaches you how to embrace more positive self-talk while problem-solving

What Problem-Solving Therapy Can Help With

Problem-solving therapy addresses life stress issues and focuses on helping you find solutions to concrete issues. This approach can be applied to problems associated with various psychological and physiological symptoms.

Mental Health Issues

Problem-solving therapy may help address mental health issues, like:

• Chronic stress due to accumulating minor issues
• Complications associated with traumatic brain injury (TBI)
• Emotional distress
• Post-traumatic stress disorder (PTSD)
• Problems associated with a chronic disease like cancer, heart disease, or diabetes
• Self-harm and feelings of hopelessness
• Substance use
• Suicidal ideation

Specific Life Challenges

This form of therapy is also helpful for dealing with specific life problems, such as:

• Death of a loved one
• Dissatisfaction at work
• Everyday life stressors
• Family problems
• Financial difficulties
• Relationship conflicts

Your doctor or mental healthcare professional will be able to advise whether problem-solving therapy could be helpful for your particular issue. In general, if you are struggling with specific, concrete problems that you are having trouble finding solutions for, problem-solving therapy could be helpful for you.

Benefits of Problem-Solving Therapy

The skills learned in problem-solving therapy can be helpful for managing all areas of your life. These can include:

• Being able to identify which stressors trigger your negative emotions (e.g., sadness, anger)
• Confidence that you can handle problems that you face
• Having a systematic approach on how to deal with life's problems
• Having a toolbox of strategies to solve the issues you face
• Increased confidence to find creative solutions
• Knowing how to identify which barriers will impede your progress
• Knowing how to manage emotions when they arise
• Reduced avoidance and increased action-taking
• The ability to accept life problems that can't be solved
• The ability to make effective decisions
• The development of patience (realizing that not all problems have a "quick fix")

Problem-solving therapy can help people feel more empowered to deal with the problems they face in their lives. Rather than feeling overwhelmed when stressors begin to take a toll, this therapy introduces new coping skills that can boost self-efficacy and resilience .

Other Types of Therapy

Other similar types of therapy include cognitive-behavioral therapy (CBT) and solution-focused brief therapy (SFBT) . While these therapies work to change thinking and behaviors, they work a bit differently. Both CBT and SFBT are less structured than problem-solving therapy and may focus on broader issues. CBT focuses on identifying and changing maladaptive thoughts, and SFBT works to help people look for solutions and build self-efficacy based on strengths.

This form of therapy was initially developed to help people combat stress through effective problem-solving, and it was later adapted to address clinical depression specifically. Today, much of the research on problem-solving therapy deals with its effectiveness in treating depression.

Problem-solving therapy has been shown to help depression in: 

• Older adults
• People coping with serious illnesses like cancer

Problem-solving therapy also appears to be effective as a brief treatment for depression, offering benefits in as little as six to eight sessions with a therapist or another healthcare professional. This may make it a good option for someone unable to commit to a lengthier treatment for depression.

Problem-solving therapy is not a good fit for everyone. It may not be effective at addressing issues that don't have clear solutions, like seeking meaning or purpose in life. Problem-solving therapy is also intended to treat specific problems, not general habits or thought patterns .

In general, it's also important to remember that problem-solving therapy is not a primary treatment for mental disorders. If you are living with the symptoms of a serious mental illness such as bipolar disorder or schizophrenia , you may need additional treatment with evidence-based approaches for your particular concern.

Problem-solving therapy is best aimed at someone who has a mental or physical issue that is being treated separately, but who also has life issues that go along with that problem that has yet to be addressed.

For example, it could help if you can't clean your house or pay your bills because of your depression, or if a cancer diagnosis is interfering with your quality of life.

Your doctor may be able to recommend therapists in your area who utilize this approach, or they may offer it themselves as part of their practice. You can also search for a problem-solving therapist with help from the American Psychological Association’s (APA) Society of Clinical Psychology .

If receiving problem-solving therapy from a doctor or mental healthcare professional is not an option for you, you could also consider implementing it as a self-help strategy using a workbook designed to help you learn problem-solving skills on your own.

During your first session, your therapist may spend some time explaining their process and approach. They may ask you to identify the problem you’re currently facing, and they’ll likely discuss your goals for therapy .

Keep In Mind

Problem-solving therapy may be a short-term intervention that's focused on solving a specific issue in your life. If you need further help with something more pervasive, it can also become a longer-term treatment option.

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Shang P, Cao X, You S, Feng X, Li N, Jia Y. Problem-solving therapy for major depressive disorders in older adults: an updated systematic review and meta-analysis of randomized controlled trials .  Aging Clin Exp Res . 2021;33(6):1465-1475. doi:10.1007/s40520-020-01672-3

Cuijpers P, Wit L de, Kleiboer A, Karyotaki E, Ebert DD. Problem-solving therapy for adult depression: An updated meta-analysis . Eur Psychiatry . 2018;48(1):27-37. doi:10.1016/j.eurpsy.2017.11.006

Nezu AM, Nezu CM, D'Zurilla TJ. Problem-Solving Therapy: A Treatment Manual . New York; 2013. doi:10.1891/9780826109415.0001

Owens D, Wright-Hughes A, Graham L, et al. Problem-solving therapy rather than treatment as usual for adults after self-harm: a pragmatic, feasibility, randomised controlled trial (the MIDSHIPS trial) .  Pilot Feasibility Stud . 2020;6:119. doi:10.1186/s40814-020-00668-0

Sorsdahl K, Stein DJ, Corrigall J, et al. The efficacy of a blended motivational interviewing and problem solving therapy intervention to reduce substance use among patients presenting for emergency services in South Africa: A randomized controlled trial . Subst Abuse Treat Prev Policy . 2015;10(1):46. doi:doi.org/10.1186/s13011-015-0042-1

Margolis SA, Osborne P, Gonzalez JS. Problem solving . In: Gellman MD, ed. Encyclopedia of Behavioral Medicine . Springer International Publishing; 2020:1745-1747. doi:10.1007/978-3-030-39903-0_208

Kirkham JG, Choi N, Seitz DP. Meta-analysis of problem solving therapy for the treatment of major depressive disorder in older adults . Int J Geriatr Psychiatry . 2016;31(5):526-535. doi:10.1002/gps.4358

Garand L, Rinaldo DE, Alberth MM, et al. Effects of problem solving therapy on mental health outcomes in family caregivers of persons with a new diagnosis of mild cognitive impairment or early dementia: A randomized controlled trial . Am J Geriatr Psychiatry . 2014;22(8):771-781. doi:10.1016/j.jagp.2013.07.007

Noyes K, Zapf AL, Depner RM, et al. Problem-solving skills training in adult cancer survivors: Bright IDEAS-AC pilot study .  Cancer Treat Res Commun . 2022;31:100552. doi:10.1016/j.ctarc.2022.100552

Albert SM, King J, Anderson S, et al. Depression agency-based collaborative: effect of problem-solving therapy on risk of common mental disorders in older adults with home care needs . The American Journal of Geriatric Psychiatry . 2019;27(6):619-624. doi:10.1016/j.jagp.2019.01.002

By Arlin Cuncic, MA Arlin Cuncic, MA, is the author of The Anxiety Workbook and founder of the website About Social Anxiety. She has a Master's degree in clinical psychology.

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• v.62(Suppl 2); 2020 Jan

Family Interventions: Basic Principles and Techniques

Mathew varghese.

Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, Karnataka, India

Vivek Kirpekar

1 N.K.P. Salve Institute of Medical Sciences, Nagpur, Maharashtra, India

Santosh Loganathan

Introduction.

Mental health professionals in India have always involved families in therapy. However, formal involvement of families occurred about one to two decades after this therapeutic modality was started in the West by Ackerman.[ 1 ] In India, families form an important part of the social fabric and support system, and as a result, they are integral in being part of the treatment and therapeutic process involving an individual with mental illness. Mental illnesses afflict individuals and their families too. When an individual is affected, the stigma of being mentally ill is not restricted to the individual alone, but to family members/caregivers also. This type of stigma is known as “Courtesy Stigma” (Goffman). Families are generally unaware and lack information about mental illnesses and how to deal with them and in turn, may end up maintaining or perpetuating the illness too. Vidyasagar is credited to be the father of Family Therapy in India though he wrote sparingly of his work involving families at the Amritsar Mental Hospital.[ 2 ] This chapter provides salient features of broad principles for providing family interventions for the treating psychiatrist.

TYPES AND GRADES FOR FAMILY INTERVENTIONS

Working with families involves education, counseling, and coping skills with families of different psychiatric disorders. Various interventions exist for different disorders such as depression, psychoses, child, and adolescent related problems and alcohol use disorders. Such families require psychoeducation about the illness in question, and in addition, will require information about how to deal with the index person with the psychiatric illness. Psychoeducation involves giving basic information about the illness, its course, causes, treatment, and prognosis. These basic informative sessions can last from two to six sessions depending on the time available with clients and their families. Simple interventions may include dealing with parent-adolescent conflict at home, where brief counseling to both parties about the expectations of each other and facilitating direct and open communication is required.

Additional family interventions may cover specific aspects such as future plans, job prospects, medication supervision, marriage and pregnancy (in women), behavioral management, improving communication, and so on. These family interventions offering specific information may also last anywhere between 2 and 6 sessions depending on the client's time. For example, explaining the family about the marriage prospects of an individual with a psychiatric illness can be considered a part of psychoeducation too, but specific information about marriage and related concerns require separate handling. At any given time, families may require specific focus and feedback about issues such issues.

Family therapy is a structured form of psychotherapy that seeks to reduce distress and conflict by improving the systems of interactions between family members. It is an ideal counseling method for helping family members adjust to an immediate family member struggling with an addiction, medical issue, or mental health diagnosis. Specifically, family therapists are relational therapists: They are generally more interested in what goes on between the individuals rather than within one or more individuals. Depending on the conflicts at issue and the progress of therapy to date, a therapist may focus on analyzing specific previous instances of conflict, as by reviewing a past incident and suggesting alternative ways family members might have responded to one another during it, or instead proceed directly to addressing the sources of conflict at a more abstract level, as by pointing out patterns of interaction that the family might not have noticed.

Family therapists tend to be more interested in the maintenance and/or solving of problems rather than in trying to identify a single cause. Some families may perceive cause-effect analyses as attempts to allocate blame to one or more individuals, with the effect that for many families, a focus on causation is of little or no clinical utility. It is important to note that a circular way of problem evaluation is used, especially in systemic therapies, as opposed to a linear route. Using this method, families can be helped by finding patterns of behavior, what the causes are, and what can be done to better their situation. Family therapy offers families a way to develop or maintain a healthy and functional family. Patients and families with more difficult and intractable problems such as poor prognosis schizophrenia, conduct and personality disorder, chronic neurotic conditions require family interventions and therapy. The systemic framework approach offers advanced family therapy for such families. This type of advanced therapy requires training that very few centers, such as the Family Psychiatry Center at the National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India offer to trainees and residents. These sessions may last anywhere from eight sessions up to 20 or more on occasions [ Table 1 ].

Types and grades of family interventions

Goals of family therapy

Usual goals of family therapy are improving the communication, solving family problems, understanding and handling special family situations, and creating a better functioning home environment. In addition, it also involves:

• Exploring the interactional dynamics of the family and its relationship to psychopathology
• Mobilizing the family's internal strength and functional resources
• Restructuring the maladaptive interactional family styles (including improving communication)
• Strengthening the family's problem-solving behavior.

Reasons for family interventions

The usual reasons for referral are mentioned below. However, it may be possible that sometimes the reasons identified initially may be just a pointer to many other lurking problems within the family that may get discovered eventually during later assessments.

• Marital problems
• Parent–child conflict
• Problems between siblings
• The effects of illness on the family
• Adjustment problems among family members
• Inconsistency parenting skills
• Psychoeducation for family members about an index patient's illness
• Handling expresses emotions.

CHALLENGES FACED BY THE NOVICE THERAPIST

Whether one is a young student, or a seasoned individual therapist, dealing with families can be intimidating at times but also very rewarding if one knows how to deal with them. We have outlined certain challenges that one faces while dealing with families, especially when one is beginning.

Being overeager to help

This can happen with beginner therapists as they are overeager and keen to help and offer suggestions straight away. If the therapist starts dominating the interaction by talking, advising, suggesting, commenting, questioning, and interpreting at the beginning itself, the family falls silent. It is advisable to probe with open-ended questions initially to understand the family.

Poor leadership

It is advisable for the therapist to have control over the sessions. Sometimes, there may be other individuals/family members who maybe authoritative and take control. Especially in crisis situations, when the family fails to function as a unit, the therapist should take control of the session and set certain conditions which in his professional judgment, maximize the chances for success.

Not immersing or engaging/fear or involving

A common problem for the beginning therapist is to become overly involved with the family. However, he may realize this and try to panic and withdraw when he can become distant and cold. Rather, one should gently try to join in with the family earning their true respect and trust before heading to build rapport.

Focusing only on index patient

Many families believe that their problem is because of the index patient, whereas it may seem a tactical error to focus on this person initially. In doing so, it may essentially agree to the family's hypothesis that their problem is arising out of this person. It is preferable, at the outset to inform the family that the problem may lie with the family (especially when referrals are made for family therapies involving multiple members), and not necessarily with any one individual.

Not including all members for sessions

Many therapeutic efforts fail because important family members are not included in the sessions. It is advisable to find out initially who are the key members involved and who should be attending the sessions. Sometimes, involving all members initially and then advising them to return to therapy as and when the need arises is recommended.

Not involving members during sessions

Even though one has involved all members of the family in the sessions, not all of them may be engaged during the sessions. Sometimes, the therapist's own transference may hold back a member of the family in the sessions. Rather, it is recommended that the therapist makes it clear that he/she is open to their presence and interactions, either verbally or nonverbally.

Taking sides with any member of the family

It may be easy to fall into the trap of taking one member's side during sessions leaving the other party doubting the fairness and judgment of the therapist. For example, after meeting one marital partner for a few sessions, the therapist, when entering the couple, discussions may be heavily biased in his views due to his/her prior interaction. Therapists should be aware of this effect and try to be neutral as possible yet take into confidence each member attending the sessions. Therapist's countertransference can easily influence him/her to take sides, especially in families that are overtly blaming from the start, or with one member who may be aggressive in the sessions, or very submissive during the sessions can influence the therapist's sides; and one needs to be aware of this early in the sessions.

Guarded families

Some families put on a guarded façade and refuse to challenge each other in the session. By being neutral and nonjudgmental, sometimes, the therapist can perpetuate this guarded façade put forth by families. Hence, therapists must be able to read this and try to challenge them, listen to microchallenges within the family, must be ready to move in and out from one family member to another, without fixing to one member.

Communicating with the therapist outside sessions

Many families attempt to reduce tension by communicating with therapist outside the session, and beginning therapist are particularly susceptible for such ploys. The family or a member/s may want to meet the therapist outside the sessions by trying to influence the therapist to their views and opinions. Therapists must refrain from such encounters and suggest discussing these issues openly during the sessions. Of course, rarely, there may be sensitive or very personal information that one may want to discuss in person that may be permissible.

Ignoring previous work done by other therapists

It is easy for family therapists to ignore previous therapists. The family therapist's ignorance of the effects of previous therapy can serious hamper the work. By discussing the previous therapist helps the new therapist to understand the problem easily and could save time also.

Getting sucked to the family's affective state/mood

If transference involves the therapist in family structure, the therapist's dependency can overinvolved him in the family's style and tone of interaction. A depressed family causes both: Therapist to relate seriously and sadly. A hostile family may cause the therapist to relate in an attacking manner. The most serious problem can occur when a family is in a state of anxiety, induces the therapist to become anxious and make his/her comments to seem accusatory and blaming. It is very difficult for the beginning therapist to “feel” where the family is affectively, to be empathic, yet to be able to relate at times on a different affective level-to respond according to situations. It is important to be aware of the affective state/mood of the family but slips in and out of that state [ Table 2 ].

Guidelines for conducting interventions with families

FUNCTIONS OF A FAMILY THERAPIST

• The family therapist establishes a useful rapport: Empathy and communication among the family members and between them and himself
• The therapist clarifies conflict by dissolving barriers, confusions, and misunderstandings
• Gradually, the therapist attempts to bring to the family to a mutual and more accurate understanding of what is wrong
• Counteracting inappropriate denials, conflicts
• Lifting hidden intrapersonal conflict to the level of interpersonal interaction.
• The therapist fulfills in part the role of true parent figure, a controller of danger, and a source of emotional support and satisfaction-supplying elements that the family needs but lacks. He introduces more appropriate attitudes, emotions, and images of family relations than the family has ever had
• The therapist works toward penetrating (entering into) and undermining resistances and reducing the intensity of shared currents of conflict, guilt, and fear. He accomplishes these aims mainly using confrontation and interpretation
• The therapist serves as a personal instrument of reality testing for the family.

In carrying out these functions, the family therapist plays a wide range of roles, as:

• An activator
• Interpreter
• Re-integrator

BASIC STEPS FOR FAMILY INTERVENTIONS

The initial phase of therapy, the referral intake.

• Family assessment
• Family formulation and treatment plan
• Formal contract.

Patients and their families are usually referred to as some family problem has been identified. The therapist may be accustomed to the usual one-on-one therapeutic situation involving a patient but may be puzzled in his approach by the presence of many family members and with a lot of information. A few guidelines are similar to the approaches followed while conducting individual therapy. The guidelines for conducting family interventions are given in Table 2 . At the time of the intake, the therapist reviews all the available information in the family from the case file and the referring clinicians. This intake session lasts for 20–30 min and is held with all the available family members. The aim of the intake session is to briefly understand the family's perception of their problem, their motivation and need to undergo family intervention and the therapist assessments of suitability for family therapy. Once this is determined the nature and modality of the therapy is explained to the family and an informal contract is made about modalities and roles of therapist and the family members. The do's and don’ts of the family interventions are laid down to the family at the outset of the process of the interventions.

The family assessment and hypothesis

The assessment of different aspects of family functioning and interactions must typically take about 3–5 sessions with the whole family, each session must last approximately 45 min to an hour. Different therapists may want to take assessments in different ways depending on their style. Mentioned below are a few tasks which are recommended for the therapist to perform. Usually, it is recommended that the naïve therapist starts with a three-generation genogram and then follows-up with the different life cycle stages and family functions as outlined below.

• The three-generation genogram is constructed diagrammatically listing out the index patient's generation and two more related generations, for example, patients and grandparents in an adolescent client or parents and children in a middle-aged client. The ages and composition of the members are recorded, and the transgenerational family patterns and interactions are looked at to understand the family from a longitudinal and epigenetic perspective. The therapist also familiarizes himself with any family dynamics prior to consultation. This gives a broad background to understand the situation the family is dealing with now
• The life cycle of the index family is explored next. The functions of the family and specific roles of different members are delineated in each of the stages of the family life cycle.[ 3 ] The index family is seen from a developmental perspective, and the therapist gets a longitudinal and temporal perspective of the family. Care is taken to see how the family has coped with problems and the process of transition from one stage to another. If children are also part of the family, their discipline and parenting styles are explored (e.g., whether there is inconsistent parenting)
• Problem Solving: Many therapists look at this aspect of the family to see how cohesive or adaptable the family has been. Usually, the family members are asked to describe some stress that the family has faced, i.e., some life events, environmental stressors, or illness in a family member. The therapist then proceeds to get a description of how the family coped with this problem. Here, “circular questions” are employed and therapist focuses on antecedent events. The crisis and the consequent events are examined closely to look for patterns that emerge. The family function (or dysfunction) is heightened when there is a crisis situation and the therapist look at patterns rather than the content described. Thus, the therapist gets an “as if I was there” view of the family. The same inquiry is possible using the technique of enactment[ 4 ]
• The Structural Map: Once the inquiry is over, the therapist draws the structural map, which is a diagrammatic representation of the family system, showing the different subsystems, its boundaries, power structure and relationships between people. Diagrammatic notions used in structural therapy or Bowenian therapy are used to denote relationships (normal, conflictual, or distant) and subsystem boundaries, in different triadic relationships. This can also be done on a timeline to show changes in relationships in different life cycle stages and influences from different life events
• What the client is trying to convey through his/her symptoms?
• What is the role of the family in maintaining these symptoms?
• Why has the family come now?

This circular hypothesis can be confirmed on further inquiry with the family to see how the “dysfunctional equilibrium” is maintained. At this stage, we suggest that a family formulation is generated, hypothesized and analyzed. This leads to a comprehensive systemic formulation involving three generations. This formulation will determine which family members we need to see in a therapy, what interventional techniques we should use and what changes in relationships we should effect. The team will also discuss the minimum, most effective treatment plan which emerges considering the most feasible changes the family can make

• Formal Contract: A brief understanding of the family homeostasis is presented to the family. Sometimes, the full hypothesis may be fed to the family in a noncritical and positive way (“Positive Connotation”), appreciating the way in which the system is functioning the therapist presents the treatment plat to the family and negotiates with the members the plan and action they would like to take up at the present time. The time frame and modality of therapy is contracted with the family, and the therapy is put into force. The frequency and intensity of sessions are determined by the degree of distress felt by the family and the geographical distance from the therapy center, i.e., families may be seen as inpatients at the center if they are in crisis or if they live far away.

The Family Psychiatry Center at The NIMHANS, Bengaluru, Karnataka, India, is one of the centers where formal training in therapy is regularly conducted. An outline of the Family Assessment Proforma[ 5 ] used at this center is given in Figure 1 . Several other structured family assessment instruments are available [ Figure 1 ].

Family assessment proforma (Obtained with permission from the Family Psychiatry Center, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India)

Middle phase of therapy

This phase of therapy forms the major work that is carried out with the family. Depending on the school of therapy, that is used, these sessions may number from a few (strategic) to many sessions lasting many months (psychodynamic). The techniques employed depend on the understanding of the family during the assessment as much as the family – therapist fit. For example, the degree of psychological sophistication of the clients will determine the use of psychodynamic and behavioral techniques. Similarly, a therapist who is comfortable with structural/strategic methods would put these therapies to maximum use. The nature of the disorder and the degree of pathology may also determine the choice of therapy, i.e., behavioral techniques may be used more in chronic psychotic conditions while the more difficult or resistant families may get brief strategic therapies. We will now describe some of the important techniques used with different kinds of problems.

Psychodynamic therapy

This school was one of the first to be described by people like Ackerman and Bowen.[ 1 , 6 ] This method has been made more contextual and briefer by therapists like Boszormenyi-Nasgy and Framo.[ 7 , 8 ] Essentially, the therapist understands the dynamics employed by different members of the family and the interrelationships of these members. These family ego defenses are interpreted to the members and the goal of therapy is to effects emotional insight and working through of new defense patterns. Family transferences may become evident and may need interpretation. Therapy usually lasts from 15 to 30 sessions and this method may be employed in persons who are psychologically sophisticated, and able to understand dynamics and interpretations. Sustained and high motivation is necessary for such a therapy. This method is found useful in couples with marital discord from upper middle-class backgrounds. Time required is a major constraint.

Behavioral methods

Behavioral techniques find use in many types of therapies and conditions. It has been extensively used in chronic psychotic illnesses by workers such as Fallon et al. , (1986) and Anderson et al. [ 9 , 10 ] Psychoeducation and skills training in communication and problem-solving are found very useful among families which do not have very serious dysfunction. Techniques such as modeling or role-plays are useful in improving communication styles and to teach parenting skills with disturbed children. Obviously, motivation for therapy is a major requisite and hence techniques such as contracting, homework assignments are used in couples with marital discord. Behavioral techniques used in sexual dysfunction are also possible when adapted according to clients’ needs.

Structural family therapy

Described by Minuchin; Fishman and Unbarger[ 4 , 11 , 12 ] has become quite popular over the past few years among therapists in India. This is possibly because of many reasons. Our families are available with their manifold subsystems of parents, children, grandparents and structure is easily discerned and changed. In addition, in recent years most clients present with conduct and personality disorders in adolescence and early adulthood. Hence, techniques like unbalancing, boundary-making are quite useful as the common problems involve adolescents who are wielding power with poor marital adjustments between parents. These techniques are useful for many of our clients.

Strategic technique

We have found that these brief techniques can be very powerfully used with families which are difficult and highly resistant to change. We usually employ them when other methods have failed, and we need to take a U-turn in therapy. Techniques employed by the Milan school[ 13 , 14 ] reframing, positive connotation, paradoxical (symptom) prescription have been used effectively. So also have techniques like prescription in brief methods advocated by Erikson, Watzlawick et al. ,[ 15 , 16 ] been useful. Familiarity and competence with these techniques is a must and therapy is usually brief and quickly terminated with prescriptions [ Table 3 ].

Summaries of the different schools of therapies

SES – Socioeconomic status

FAMILY INTERVENTIONS IN SPECIFIC DISORDERS

Techniques to promote family adaptation to illness.

• Heighten awareness of shifting family roles – pragmatic and emotional
• Facilitate major family lifestyle changes
• Increase communication within and outside the family regarding the illness
• Help family to accept what they cannot control, focus energies on what they can
• Find meaning in the illness. Help families move beyond “Why us?”
• Facilitate them grieving inevitable losses–of function, of dreams, of life
• Increase productive collaboration among patients, families, and the health-care team
• Trace prior family experience with the illness through constructing a genogram
• Set individual and family goals related to illness and to nonillness developmental events.

Schizophrenia

Family EE and communication deviance (or lack of clarity and structure in communication) are well-established risk factors for the onset of schizophrenia.

Psychoeducational interventions aim to increase family members’ understanding of the disorder and their ability to manage the positive and negative symptoms of psychosis.

Simple strategies would include reduction of adverse family atmosphere by reducing stress and burden on relatives, reduction of expressions of anger and guilt by the family, helping relatives to anticipate and solve problems, maintenance of reasonable expectations for patient performance, to set appropriate limits whilst maintaining some degree of separation when needed; and changing relatives’ behavior and belief systems.

Programs emphasize family resilience. Address families’ need for education, crisis intervention, skills training, and emotional support.

Bipolar mood disorder

To recognize the early signs and symptoms of bipolar disorder.

Develop strategies for intervening early with new episodes and assure consistency with medication regimens.

Manage moodiness and swings of the patient, anger management, feelings of frustration.

Family conflict and rejection, low family support, ineffective communication, poor expression of affect, abuse, and insecure attachment bonds are primary focus of family therapy associated with depression cognitive-behavioral and interpersonal interventions for depression.

Family-based treatment for anxiety combines family therapy with cognitive-behavioral interventions.

Targets the characteristics of the family environment that support anxiogenic beliefs and avoidant behaviors.

The goal is to disrupt the interactional patterns that reinforce the disorder.

To assist family members in using exposure, reward, relaxation, and response prevention techniques to reduce the patients’ anxieties.

Eating disorders

Target the dysfunctional family processes, namely, enmeshment and overprotectiveness.

To help parents build effective and developmentally appropriate strategies for promoting and monitoring their child's eating behaviors.

Childhood disorders

The primary focus is the development of effective parenting and contingency management strategies that will disrupt the problematic family interactions associated with ADHD and ODD.

Family-based interventions for autism spectrum disorder

Parents taught to use communication and social training tools that are adapted to the needs of their children and apply these techniques to their family interactions at home.

Substance misuse

Enhance the coping ability of family members and reduce the negative consequences of alcohol and drug abuse on concerned relatives; eliminate the family factors that constitute barriers to treatment; use family support to engage and retain the drug and/or alcohol user in therapy; change the characteristics of the family environment that contribute to relapse Al-Anon, AL-teen.

Termination phase

This last phase of therapy is finished in a couple of sessions. The initial goals of therapy are reviewed with the family. The family and the therapist review together the goals which were achieved, and the therapist reminds the family the new patterns/changes which have emerged. The need to continue these new patterns is emphasized. At the same time, the family is cautioned that these new patterns will occur when all members make a concerted effort to see this happen. Family members are reminded that it is easy to fall back to the old patterns of functioning which had produced the unstable equilibrium necessitating consultation.

At termination, the therapist usually negotiates new goals, new tasks or new interactions with the family that they will carry out for the next few months in the follow up period. The family is told that they need to review these new patterns after a couple of months so as to determine how things have gone and how conflicts have been addressed by the family. This way the family has a better chance of sustaining the change created. Sometimes booster sessions are also advised after 6–12 months especially for outstation families who cannot come regularly for follow-ups. These booster sessions will review the progress and negotiate further changes with the family over a couple of sessions. This follow-up period, after therapy is terminated is crucial for working through process and ensures that the client-therapist bond is not severed too quickly. It is easy to deal with the clients’ and therapist’ anxieties if this transition phase is smooth.

SPECIAL SOCIOCULTURAL ISSUES IN THERAPY SPECIFIC TO INDIA

Most Indian families are functionally joint families though they may have a nuclear family structure. Furthermore, unlike the Western world more than two generations readily come for therapy. Hence, it becomes necessary to deal with two to three generations in therapy and also with transgenerational issues. Our families also foster dependency and interdependency rather than autonomy. This issue must also be kept in mind when dealing with parent–child issues. Indians have a varied cultural and religious diversity depending on the region from which the family comes. The therapist has to be familiar with the regional customs, practices, beliefs, and rituals. The Indian family therapist has to also be wary of being too directive in therapy as our families may give the mantle of omnipotence to the therapist and it may be more difficult for us to adopt at one-down or nondirective approach. Hence, while systemic family therapy is eminently possible in India one must keep in mind these sociocultural factors so as to get a good “family-therapist fit.”

Constraint factors in therapy

The economic backwardness of most out families makes therapy feasible and affordable, in terms of time and money spent, only to the middle and upper classes of our society. The poorer families usually drop out of therapy as they have other more pressing priorities. The lack of tertiary social support and welfare or social security makes it less possible to network with other systems. We are also woefully inadequate in terms of trained family therapists to cater to our large population. In our country, distances seem rather daunting and modes of transport and communication are poor for families to readily seek out a therapist. We work with these constraint factors and so the “family-therapy” fit is an important factor for families that are seeking and staying in family therapy. 17

CONCLUSIONS

Over the last few years, a systemic model has evolved for service and for training. The model uses a predominantly systematic framework for understanding families and the techniques for therapy are drawn from different schools namely the structural, strategic, and behavioral psychodynamic therapies.

Appendix: Glossary of terms

The repetitive patterns of interaction that organize the way in which family members relate and interact with each other.

Boundaries are the rules defining who participates in the system and how, i.e., the degree of access outsiders have to the system.

It may comprise of a single person, or several persons joined together by common membership criteria, for example, age, gender, or shared purpose.

When alignments stand in opposition to another part of the system (i.e., when several family members are against another member/s.

The joining together of two or more members. It popularly designates appositive affinity between two units of a system.

Channels of communication are a mechanism that defines “who speaks to whom.” When channels of communication are blocked, needs cannot be fulfilled, problems cannot be solved, and goals cannot be achieved.

Enmeshed families

In which, there is extreme sensitivity among the individual members to each other and their primary subsystem.

Financial support and sponsorship

Conflicts of interest.

There are no conflicts of interest.

Cognitive Behavioral Therapy

Solving problems the cognitive-behavioral way, problem solving is another part of behavioral therapy..

Posted February 2, 2022 | Reviewed by Ekua Hagan

• What Is Cognitive Behavioral Therapy?
• Find a therapist who practices CBT
• Problem-solving is one technique used on the behavioral side of cognitive-behavioral therapy.
• The problem-solving technique is an iterative, five-step process that requires one to identify the problem and test different solutions.
• The technique differs from ad-hoc problem-solving in its suspension of judgment and evaluation of each solution.

As I have mentioned in previous posts, cognitive behavioral therapy is more than challenging negative, automatic thoughts. There is a whole behavioral piece of this therapy that focuses on what people do and how to change their actions to support their mental health. In this post, I’ll talk about the problem-solving technique from cognitive behavioral therapy and what makes it unique.

The problem-solving technique

While there are many different variations of this technique, I am going to describe the version I typically use, and which includes the main components of the technique:

The first step is to clearly define the problem. Sometimes, this includes answering a series of questions to make sure the problem is described in detail. Sometimes, the client is able to define the problem pretty clearly on their own. Sometimes, a discussion is needed to clearly outline the problem.

The next step is generating solutions without judgment. The "without judgment" part is crucial: Often when people are solving problems on their own, they will reject each potential solution as soon as they or someone else suggests it. This can lead to feeling helpless and also discarding solutions that would work.

The third step is evaluating the advantages and disadvantages of each solution. This is the step where judgment comes back.

Fourth, the client picks the most feasible solution that is most likely to work and they try it out.

The fifth step is evaluating whether the chosen solution worked, and if not, going back to step two or three to find another option. For step five, enough time has to pass for the solution to have made a difference.

This process is iterative, meaning the client and therapist always go back to the beginning to make sure the problem is resolved and if not, identify what needs to change.

Advantages of the problem-solving technique

The problem-solving technique might differ from ad hoc problem-solving in several ways. The most obvious is the suspension of judgment when coming up with solutions. We sometimes need to withhold judgment and see the solution (or problem) from a different perspective. Deliberately deciding not to judge solutions until later can help trigger that mindset change.

Another difference is the explicit evaluation of whether the solution worked. When people usually try to solve problems, they don’t go back and check whether the solution worked. It’s only if something goes very wrong that they try again. The problem-solving technique specifically includes evaluating the solution.

Lastly, the problem-solving technique starts with a specific definition of the problem instead of just jumping to solutions. To figure out where you are going, you have to know where you are.

One benefit of the cognitive behavioral therapy approach is the behavioral side. The behavioral part of therapy is a wide umbrella that includes problem-solving techniques among other techniques. Accessing multiple techniques means one is more likely to address the client’s main concern.

Salene M. W. Jones, Ph.D., is a clinical psychologist in Washington State.

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Family Therapy Methods: Exploring Family Counseling

Family therapy is a systemic therapy that can target various concerns between family members at any time, including conflict, communication, divorce, stress, or mental illness. It is often characterized as a strength-based treatment that aims to adjust patterns and identify individual strengths rather than blaming a specific family member or challenge. 

Different approaches 

Family therapy may be less about gathering family members in the same room and more about the methods used to address conflict and unit concerns. Depending on the concerns, your therapist may choose to have the family members meet together or separately. Some methods might involve group therapy with other families to learn new skills. If one or more of the clients present with a chronic mental health condition, these symptoms will have to be addressed as well.

Therapy might also be focused on the individual needs. For example, suppose therapy has been sought due to a child's struggles at school. In that case, the therapist might meet with the child individually and then call the family to discuss the treatment plan and instruct the parents on how to support their child best. However, the method used can vary depending on a therapist's unique approach. Below are a few standard methods utilized in family therapy. 

Bowenian therapy

If you prefer individual therapy to group options, the  Bowenian approach might suit you. This form of therapy focuses on triangulation and differentiation between family members. 

Triangulation method

Triangulation refers to involving a neutral person in a conflict between two individuals. For example, someone may be triangulating if they get into an argument with their sister and try to get their mom to see their sister as the instigator. Although this strategy might momentarily alleviate worry, it may not be a healthy response to a disagreement because it can cause an unfair power balance or misinformation. Bowenian therapy looks at how these dynamics can occur in family units. 

Family therapy can place the therapist in the role of the neutral person when you have the urge to triangulate. By hearing your concerns, marriage and therapists can identify potential errors in your thinking and strategies for connecting with your family. This strategy may be done in individual therapy, with sessions afterward.

Differentiation method

Many individuals seeking family therapy may struggle with how they see others in their family and their world. They may be exhibiting volatile emotional responses and unsure how to handle their feelings or views.

The goal of differentiation in Bowenian family therapy is to free oneself from unwanted beliefs. It is the process of learning how to form your own opinions and live your life in a way that is free from labeling or negative influences. You can learn that you are separate from your parents, siblings, or other family members and that you can have varying personalities and beliefs. 

Seeing yourself and your family as unique individuals and differentiating your views from theirs and the world around you, may help you understand the conflicts you have and offer the family clarity and communication.

Structural method

The  structural family therapy  approach may be an option for those looking to reorganize how power and family dynamics are distributed among individuals within the unit. It often takes a structured problem-solving approach to therapy. 

Structural family therapy might be utilized when a child is involved in a conflict. The therapist may begin by drawing a chart of your family and noting the relationships between you. Once positions of power are identified, they may help clarify potential changes or techniques to address conflicts and communication between each pairing. 

This therapy method was developed based on the belief that the root of many childhood problems comes from concerns that go unsolved, not from the child or their behavior. Many studies back up this belief, showing that children raised with dysfunctional family dynamics are at a greater disposition  for depression and other mental health and behavioral concerns. 

Clients may learn to restructure the family dynamic in structural family therapy after identifying key issues. Your therapist might have you participate in roleplays, acting out problematic situations that occurred in the months or weeks before your session. At times, your therapist may pretend to take certain sides or model how family members relate. This method may break up negative patterns and promote a healthier family dynamic.

Additionally, concerns within a family might come from a power imbalance, such as one parent making all of the decisions and excluding the other parent or a child making choices for their parents. No matter your concerns, reaching out to a mental health professional may help you restructure your family life. 

Strategic method

Strategic family therapy  may be ideal for families seeking a quick approach to conflict resolution. Structural therapy focuses on using specific techniques explicitly tailored toward your family, developed within a few sessions. The therapist may act as a coach or mentor for a family unit looking to learn new skills. 

Strategic therapy may not focus on your past or what has occurred in your life. Instead, it can focus on current patterns, thoughts, and behaviors you want to change and develop an immediate plan to change them, as long as you are willing. 

Your treatment plan might begin with identifying fixable concerns. You can then move on to setting goals and creating pathways to reach those goals. Once you arrive at your plan, your therapist can observe the responses and actions of your family during the session. Based on these observations, they may evaluate the overall goal for therapy as a whole. 

A licensed therapist in family therapy can be heavily involved and hands-on in your treatment. They may remain actively interested in your well-being and do all they can to ensure your outcome is long-lasting and positive. As a benefit, this type of therapy is often highly personalized. If you're looking for a unique therapy form, try strategic family therapy. You can also try strategy psychotherapy in an individual setting. 

Systemic family therapy method

Systemic family therapy believes family conflict may occur from the subconscious influence of the family members rather than actions or behaviors. Systemic therapists may believe that conflict within the family stems from interlocked issues beneath the surface. For example, a therapist might believe that each individual has connections and conflicts on a subconscious level that could contribute to their family role. 

For example, one family member experiencing a breakup in their personal life may bring personal challenges to their relationships with the whole family. Unlike structural therapy, systemic family therapy does not place power on one individual or a group. It may posit that identifying power roles could harm the family members' subconscious beliefs. 

If you choose to engage in the systemic model of family therapy strategies, your counselor or therapist may help you uncover the subconscious issues with your family members and discuss strategies for addressing them. They may help you identify cycles, games, or rituals in which you are participating, and help your family strengthen roles within the family unit. 

Systemic family therapy may offer a fresh perspective on the conflicts that many families experience and how family members interact. If you have tried many other types of therapy without results, consider this form of counseling. 

Functional family therapy method

Functional Family Therapy (FFT)  is a short-term evidence-based family therapy designed to address at-risk youth ages 11-18 years old. The family therapists that use this method will build therapeutic relationships with all members of the family as well as extra-family influences to help establish a better functioning home environment. The family plays a large role in the process, with each family unit seen as completely unique. This is one of the family interventions that can be useful for strengthening the family environment to help an adolescent who may be experiencing a mental health condition, substance abuse, or trauma.

If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.

If you are experiencing trauma, support is available. Please see our Get Help Now page for more resources.

Counseling options 

Individuals may be able to address family conflicts and concerns in individual therapy and family settings. If you are looking for a more personalized therapy focused on your experiences in your family, consider individual therapy. Even if you face barriers to counseling, such as cost and distance, various options, including online therapy, are available.  Family therapy counseling online  is an effective way for people to get their needed help.

The world is increasingly interconnected through technology. The use of technology in psychological care, such as text messaging and video calls, may enhance personalized care for those who seek psychological services for mental health problems. One study on the effectiveness of online therapy found that it was more effective than in-person treatment methods in addressing depression and common concerns like worrying, stress, or life challenges. 

Many online platforms offer flexible communication options for talk therapy. For example, you may choose between phone, video, or live chat sessions with licensed therapists. You may also gain connection to resources like journal prompts or worksheets from your therapist to use at home directly after your sessions. If you are interested in learning more about online counseling but are unsure where to start, consider using resources offered by a platform like  BetterHelp , which provides over 30,000 licensed and vetted therapists. 

Family therapy or marriage counseling offers families a deeper understanding of healthy life boundaries and functional family practices. Many types of family therapy are available to those seeking support with conflict, communication, mental health conditions, substance abuse, parenting skills, or other concerns. If you're interested in learning more about how family therapy might serve you, consider reaching out to a therapist for further guidance and support. 

Frequently Asked Questions (FAQs) 

Below are a few commonly asked questions about family therapy. , what are the methods used in family therapy.

Family therapy uses several techniques to help families relate to each other and reach their goals. Many of these techniques are utilized as part of a specific type of counseling. These techniques include:

• Bowenian family therapy, also known as family systems therapy
• Strategic family therapy
• Structural family therapy
• Systemic family therapy

These specific therapy techniques might utilize concepts from popular psychotherapy methods used by mental health professionals, like psychodynamic and cognitive-behavioral techniques.

What are the four stages of therapy?

Counseling can be broken down into four stages, including the following: 

• Preparation: The family therapist helps the family plan a course of action
• Transition: The family members may work through acceptance and transition into the treatment plan 
• Consolidation: The family starts putting the therapy techniques into practice
• Termination: The family prepares for the end of treatment and learns how to retain what they've learned to maintain healthy family functioning long-term 

What are the benefits? 

Counseling may benefit families looking to address and overcome challenges affecting their home environments. The benefits of counseling may include solving family problems, coping with mental illness, improving conflict management, and setting boundaries.

While families often use counseling to address emotional concerns, you do not need to have dysfunctional family patterns or mental illness to see a family therapist. Families may benefit from counseling by learning communication, problem-solving skills, and a different perspective. 

What are the stages of the family life cycle?

The family life cycle may be described through the following stages:

• Independence or leaving home
• Having young children 
• Raising adolescents 
• Having independent adult children 
• Being an older adult, over 50 

What are three goals of therapy?

The goals of counseling will typically depend on the types of counseling being provided, the family members participating, and the mental health professional administering the modality. The three goals of counseling may include the following:

• Improving communication and problem-solving skills
• Addressing conflicts affecting the family dynamic
• Strengthening the family bond and reinforcing family roles

By attending sessions, family therapy may offer families a way to create a healthier family system and functioning home environment. 

What do you talk about in therapy?

You can talk about any subject in family therapy. Like many other forms of therapy, family therapy can proceed differently based on the clients. Sometimes, a family therapist will help members of the family discuss conflicts that have been affecting them negatively. In other cases, family therapists may prompt participants to address the mental health challenges of an individual family member. Whatever the issue is, a qualified family therapist can guide you in the direction of resolution and teach you new skills personalized to your concerns. 

• Eight Situations That Commonly Cause Family Conflict Medically reviewed by Laura Angers Maddox , NCC, LPC
• Six Ways To Thrive As A Blended Family Medically reviewed by Nikki Ciletti , M.Ed, LPC
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Strategic Family Therapy: 9 Effective Techniques

• Fact Checked

Written by:

• Eliana Galindo

published on:

• October 15, 2023

Updated on:

• March 5, 2024

Looking for a therapist?

In the realm of  family therapy , where every family is a unique puzzle, Strategic Family Therapy emerges as an  innovative and solution-focused  approach.

This therapeutic model offers a  structured and strategic framework  to address a wide range of familial challenges. Therapists guide families  toward transformative change  and healthier dynamics through skillful intervention and precise directives.

What is Strategic Family Therapy?

Strategic family therapy (SFT) is a therapeutic approach that addresses relationships and communication patterns within a family unit.

This approach aims to identify dysfunctional interactions and establish new routines, leading to healthier connections among family members.

In SFT, the focus lies on addressing problematic behaviors by identifying and  working with precise family patterns  that contribute to those behaviors.

SFT has proven effective in resolving various emotional and behavioral problems and has been particularly beneficial for adolescents experiencing behavioral issues and substance abuse.

9 Techniques Used in SFT

Strategic Family Therapy (SFT), a  dynamic and solution-focused approach , has revolutionized the field of family therapy by introducing a set of powerful techniques designed to  create meaningful chang e within families.

Joining is a fundamental technique in strategic family therapy (SFT) that involves building  rapport and establishing trust  with the family members.

The therapist’s goal is to create a  supportive, non-threatening atmosphere  that encourages open communication among family members. They may do this by expressing empathy, validating feelings, and  showing genuine interest  in each individual’s perspective.

By joining, the therapist becomes a  neutral and supportive figure  who can help the family navigate the challenges and issues they face together.

2. Reframing

Reframing is another key technique in SFT that helps family members  see their situations in a different light.  By offering alternative interpretations or perspectives, the therapist helps individuals reframe their beliefs, attitudes, and  understanding of the problem , potentially leading to solutions and growth.

This technique is  particularly useful  when family members feel stuck in negative or unhelpful thinking patterns.

For example, a parent who views their child’s behavior as rebellious and disrespectful might be encouraged to see it as a  manifestation of the child’s need  for independence and autonomy. The family can approach the situation with  greater understanding and empathy  by shifting perspectives.

3. Restructuring

Restructuring is a core SFT technique used to alter dysfunctional family patterns and help create more  adaptive and functional relationships .

The therapist focuses on identifying and understanding the  underlying structure  that contributes to the family’s problems. Once this structure is recognized, the therapist can help the family develop strategies to modify their behavior and  adopt new ways of interacting .

This might involve  reassigning roles ,  setting boundaries , or encouraging more effective communication.

For example, if a family is struggling with overprotective parenting, the therapist might help the parents learn to  delegate responsibilities  and encourage their child to take on more independence.

Restructuring the family system allows members to experience  more balanced and healthier relationships , ultimately leading to improved well-being and more effective problem-solving.

4. Prescribing the Symptom

In SFT, therapists may prescribe or encourage the family to continue their problematic behavior or symptom. The idea behind this technique is to make the symptom less appealing or functional, leading the family to seek change.

5. Paradoxical Interventions

Paradoxical interventions involve prescribing the symptom in a way that highlights its absurdity or impracticality , encouraging the family to reconsider their behavior or issue.

6. Circular Questioning

Therapists ask circular questions that focus on the family’s interactions and patterns rather than individual blame. These questions help uncover how each family member contributes to the issue.

7. Ordeals and Rituals

SFT may involve creating ordeals or rituals that challenge the family’s problematic behavior. These experiences can serve as catalysts for change and symbolize a commitment to transformation.

8. Externalization

This technique separates the problem from the individual , allowing the family to see the issue as an external force they can work together to combat.

9. Directives

SFT therapists often give specific directives or tasks for family members to complete between sessions. These tasks are designed to disrupt problematic patterns and encourage change.

What issues can be addressed by SFT?

Strategic family therapy is an effective approach that targets conduct problems and risky behavior among individuals,  especially adolescents .

Conduct problems  encompass a range of issues, such as aggression, rule-breaking, and antisocial behavior. These challenges often  co-occur with risky behavior  like substance abuse and delinquency, making it essential to address them within the family context.

Reducing Risky Behavior

Strategic family therapy involves  assessing and modifying family dynamics  that contribute to the emergence and persistence of problem behavior.

The therapy seeks to  disrupt unhealthy patterns  and promote positive communication and problem-solving skills. By fostering an environment that supports  individual growth and healthy relationships , individuals can effectively develop strategies to reduce risky behavior.

Risky Sexual Behavior

One key aspect of strategic family therapy is  addressing the underlying issues  contributing to problem behavior rather than focusing exclusively on symptoms.

In the case of risky sexual behavior, the therapist works with the family to identify patterns that contribute to  impulsivity ,  poor decision-making , and  lack of self-regulation . This  may involve exploring  family attachments, parental involvement, or family structure.

Delinquency

When tackling delinquency, therapists work closely with parents to  establish consistent rules  and  expectations , ensuring they are clear and fair.

Implementing  consequences and rewards  is an essential component in managing and reducing conduct problems. This approach  strengthens parent-child relationships  and fosters a supportive environment where adolescents can thrive.

Substance Abuse Problems

Another  crucial area  in strategic family therapy is addressing substance abuse problems.

In this case, the therapy goes beyond addressing the addictive behavior itself to  explore the contributing factors  within the family dynamic.

The therapist works with family members to  identify and address areas of stress ,  unresolved conflicts , and  communication breakdowns  that can exacerbate substance abuse problems.

Benefits of STF

Strategic Family Therapy has a  set of benefits  for individuals and families seeking positive transformation. Some of these benefits  include:

Therapeutic Setting and Family Environment

Strategic family therapy is a type of therapeutic intervention designed to address specific family-related issues and improve communication patterns among family members.

The therapeutic setting and family environment play significant roles in the success of this intervention.

Therapeutic Setting

The therapeutic setting should be a  comfortable space  where family members feel safe to express themselves openly and honestly.

This setting can be a  professional office , a  home-based environment , or even a  community center . The key is to create an atmosphere that  facilitates trust  and the building of a  strong therapeutic alliance  with the therapist.

Some therapists prefer to offer home-based service delivery, allowing them better to understand the  family dynamics  in their  natural environment .

Additionally, Strategic Family Therapy (SFT) can  effectively adapt  to various therapeutic settings, including online therapy platforms.

Online SFT sessions typically occur via  video conferencing , which allows family members to participate from  their own environments , promoting comfort and convenience.

Online directories  such as  Find-a-Therapist.com could be helpful in finding a strategic family therapist, whether families prefer in-person or online therapy.

Family Environment

Family environment is particularly important in the context of strategic family therapy, as it serves as a  foundation for the development  of healthy family interactions.

A strong, cohesive family unit is essential in promoting  positive communication  and  conflict resolution  among family members.

During the therapy sessions, therapists may work to  replicate typical family interaction s in order to address and modify any maladaptive behaviors or communication patterns.

Family Cohesion

Additionally, family cohesion plays a  significant role in the success  of strategic family therapy.

Cohesive families have strong emotional bonds, a sense of belonging, and a supportive environment that  enables members to work together  during the therapeutic process.

Therapists  may use various techniques , such as brief strategic family therapy, to strengthen family cohesion and help members collaboratively resolve issues.

Frequently Asked Questions

What are the primary goals of this approach.

Strategic family therapy aims to identify and modify  problematic patterns  within the family system.

The  main goals  of this therapeutic approach are to improve communication, establish healthier family dynamics, address behavioral issues, and ultimately improve the overall functioning and resilience of the family unit.

What are some common interventions used?

Some common interventions in strategic family therapy  include reframing , boundary setting, and implementing behavioral changes.

For example, therapists may require family members to  engage in certain tasks  or activities designed to  disrupt dysfunctional patterns  and promote healthier interactions. They might also use various strategies to  encourage better communication and understandin g between family members.

An important aspect of this approach is directing therapy toward  specific outcomes , as evidenced by the use of strategy in Brief Strategic Family Therapy.

Which techniques are utilized in brief sessions?

Brief strategic family therapy involves an adaptation of traditional strategic family therapy techniques to create a  more time-limited and focused approach .

In these sessions, therapists might utilize  problem-solving exercises ,  role-plays , and  strategic questions  to help the family identify their dysfunctional patterns and address pressing issues.

The idea is to  maximize the impact of each session  and achieve lasting change in a relatively short span of time.

How is reframing used in this therapy?

Reframing is an important technique in strategic family therapy, which helps family members view situations or behaviors  from a new perspective .

By helping family members see issues in a  different light , the therapist can create space for renewed understanding, empathy, and change.

For example, a parent may initially view a child’s defiance as disrespectful, but through reframing, they may come to realize that the  child is merely expressing  a need for respect or autonomy.

By shifting these perspectives, families can often find  more effective ways to resolve conflicts  and engage in healthier interactions.

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The Science of Siblings

All grown up, but still fighting why more siblings are turning to therapy, together.

Carrie Feibel

Siblings may not be obvious fodder for the therapist's office, but experts say maybe they should be. "People just don't perceive those relationships as needing the type of attention and tending one might bring to a spouse or child," says Kelly Scott of Tribeca Therapy in New York. Lily Padula for NPR hide caption

Siblings may not be obvious fodder for the therapist's office, but experts say maybe they should be. "People just don't perceive those relationships as needing the type of attention and tending one might bring to a spouse or child," says Kelly Scott of Tribeca Therapy in New York.

The Science of Siblings is a series exploring the ways our siblings can influence us, from our money and our mental health all the way down to our very molecules. We'll be sharing these stories over several weeks.

For decades, patients came to psychotherapy to wrestle with a seemingly fixed cast of main characters: Father and mother. Daughter and son. Spouse. Lover. Boss. Rival.

Siblings sometimes came up, of course. But all too often they appeared as minor characters, lurking in the wings.

Now the emotional influence of siblings on our long-term development is beginning to draw more attention, and some therapists report that more siblings are seeking professional help, as adults, with ongoing conflicts or resentments.

Karen Gail Lewis has specialized in sibling therapy for decades. As she nears 80, she is focused on sharing what she has learned with other therapists. That was the impetus behind her new book, Sibling Therapy: The Ghosts from Childhood that Haunt Your Clients' Love and Work .

In childhood, sibling interactions can be fundamental to shaping who we are, Lewis says. Although parents are extremely influential, siblings are peers, with whom we practice skills of loving and fighting.

"In those early years, you either learn — or you don't learn — to argue and resolve. To use your power more effectively or not. To resolve fights, to tattle," Lewis says. "You learn all the skills that you need for living with another."

Brett, 52, and his sister Mandie, 49, underwent therapy with Karen Lewis after an argument during Christmas in 2019 led to months of them not speaking. (NPR has agreed to identify the siblings in this story by their first names so they can speak frankly about the therapeutic process.)

Brett describes the first few sessions with Mandie as emotionally "pretty rough." But he says after six sessions they not only had repaired their rift, but developed new, healthier ways to interact as adults.

"The fact that you had to go back to things [from] when you were six, seven, eight, nine years old, to get to things you're dealing with in your forties and fifties," Brett says, "it's pretty surprising that there's a connection. But there was."

As adults, strong sibling relationships can affect our emotional well-being and mitigate loneliness in midlife — and help us navigate the aging and death of parents, and eventually, ourselves.

"In the normal course of life, you will have your siblings longer than your friends. You'll certainly have them longer than your partner and longer than your parents. So if you can keep them close enough to be a loving support of you, you're going to be in better shape," says Geoffrey Greif , a professor at the University of Maryland School of Social Work and co-author of the book Adult Sibling Relationships .

Until recently, sibling relationships , particularly among adult siblings, were understudied by family therapists and researchers. That's changing, but purposely entering therapy with a sibling, to repair or strengthen that relationship, is still not as common as, say, individual or couples therapy.

"People just don't perceive those relationships as needing the type of attention and tending one might bring to a spouse or child," says Kelly Scott , a therapist and Director of Supervision and Training for Tribeca Therapy in New York City. "Relating to our siblings is like, 'You're stuck with me. We're always going to be family. You can't ever actually leave me.' "

While that's technically true (you can't divorce a sibling), experts say taking that bond for granted is risky.

'Every sibling has different parents'

There isn't a lot of research about sibling estrangement, but one study of German siblings found 28 percent reported at least one "episode" of estrangement (defined as either lack of contact or of emotional closeness). The reasons for sibling conflict vary, but common ones include parental favoritism (in childhood and adulthood), disputes over caregiving and childhood abuse by parents or siblings.

What triggered the 2019 argument between Brett and Mandie was something banal, ordinary and irrelevant, both of them say. But they went almost a year without speaking. Brett sent a long email, but Mandie says she couldn't even bring herself to read it, much less reply.

"It wasn't that he was being hurtful. It was [that] the whole thing just was painful. And I was going through so much already with COVID," says Mandie, an emergency medicine doctor in Wisconsin.

Brett lives in California and works in business. Both siblings are married and have kids. As Mandie continued to rebuff him, Brett says he realized they might need professional help.

"There was a disagreement, but it was much deeper than that," he says. "There were things that had been smoldering from a family perspective for a while."

Eventually Mandie agreed that if Brett found a therapist and set up the appointment, she would attend. "I said, 'I have a lot of walls that are built up, and I don't know how this will go. But I'll show up,' " she says.

They had five or six sessions with Karen Gail Lewis. They talked about their childhood, and while both agreed that their family had been close, and that their mom was pretty terrific, they recalled different dynamics with their parents.

"I felt that my parents treated him differently than me. They're harder on me," Mandie says.

Growing up, Brett says he wasn't aware of what Mandie was describing in therapy, but now, as an adult, he listened. "It doesn't matter whether it was right or wrong, it's the way she felt about it," Brett says. "So it's real and I had to deal with that."

The way Mandie and Brett surfaced their different experiences of being parented is important in sibling work, according to Kelly Scott. "Every sibling has different parents. Every sibling has a different upbringing."

Recognizing that emotional truth is as important as discussing the shared memories and bonds, Scott says.

Geoffrey Greif agrees that each sibling has a different perspective on how they were parented: "You can't raise all your children exactly the same. You can't be exactly fair all the time. Someone's going to need more."

Siblings also experience family events (divorce, deployment, fluctuations in income) at different ages, with different reactions and capacities for coping. In a survey of hundreds of adult siblings, Greif found that sibling relationships are characterized by a mixture of affection, ambivalence and ambiguity. Affection was present for most, with 64% describing themselves as good friends with at least one other sibling, and 45% calling a sibling their "best friend."

But ambivalence is also common: Siblings can love each other but also feel competitive or jealous or annoyed with each other. Finally, Gieif found that sibling relationships are often pervaded by ambiguity — uncertainty or doubt about the other's motivations or decisions.

"The other part of ambiguity is 'They don't know who I am today. They still treat me like I'm 16.... They just don't get me and I don't get them, maybe.' "

S tuck in 'crystallized roles'

For Mel and her younger sister Liz, the therapeutic breakthrough came from identifying their different childhood "roles" and finding new ways to relate.

"There were things that we just assumed about each other," Liz says. "We would say, 'Oh, well, Mellie's this way and she's always this way. Or, I'm this way and I'm always this way.' And we had just said it for so long, that we almost wouldn't allow ourselves to grow and admit more complicated feelings."

Mel, 51, is married and has two "wonderful, brilliant" sons with autism and ADHD. She's a paralegal and advocate for kids with special needs.

Liz, 45, doesn't have kids — but she works as a pediatric occupational therapist.

During the pandemic, Mel's sons were struggling under lockdown. They were isolated and had trouble paying attention during family Zoom sessions. Liz offered resources and professional expertise, but she still felt pressure to do more: facilitate the family Zooms, keep her aging parents connected to their grandsons, support her sister and generally put on a happy face.

Until one day, when Liz found she just couldn't do that emotional labor anymore. "I just kind of shorted out," Liz recalls. "I kind of freaked out a little bit and said, 'I don't want to talk to anybody right now. I need a break.' And subsequently, that upset my sister."

For Mel, her sister's withdrawal felt intensely painful. "I was also having a lot of emotions about the world, feeling that the world was rejecting my boys and my family," Mel recalls. "I felt like it was hurting them to have people come in and out of their lives."

And Mel couldn't understand why Liz — her beloved sister — had shut down. "I just didn't know who she was, who she really was," Mel recalls, "And I just didn't know how to have a relationship with her moving forward."

Liz, for her part, bristled at the implication that she had somehow failed her nephews or family. "It, to me, was a huge slap in the face. Because it's like 'Well, nothing I do is good enough, and nobody's acknowledging what I'm doing, you know?' "

They didn't speak for months, and when the holidays came around, just being together felt awkward and strained. But eventually, over email, they decided to try therapy.

Growing up in California, their mom had been physically and emotionally abusive, both sisters say, though most of the abuse was directed at Mel. In therapy, they discussed the "roles" they had come to play in the family: Mel, the family's "black sheep," remembers constantly trying to protect her little sister Liz, who was cast as the family's "golden child."

Although Liz says she avoided much of the abuse, she felt pressured to show up as "the happy one, the giving one, the together one, [the] person who will always help in a time of need." Until the pandemic, that is, when she says she hit a wall: "It wasn't working for me. It was damaging for me," Liz says.

These childhood roles can vary, says Sibling Therapy author Karen Gail Lewis. "The troublemaker, the funny one, the responsible one, the irresponsible one," she says, naming just a few.

The roles aren't necessarily bad, she adds. "The problem comes if it doesn't fit, and if it gets crystallized."

For Liz and Mel, identifying these family roles in therapy was just the start. The hard part was recognizing the complex feelings hidden behind the roles, Liz says.

"I didn't want to explore it," Liz says. "I mean, I already felt so horrible about it, right? I didn't want to delve into it." But they did. They talked about the resentment and jealousy over who got abused and who avoided it, over which sister always seemed to get things wrong and which always seemed to do things right.

"We were in these roles and that's not who my sister is," Mel said. "She's a real person. She's not a porcelain fairy or whatever."

The painful distance between them melted away. "I feel so much closer to her," Mel says. "I feel like I have my sister back."

Liz says she felt unburdened, freed from invisible duties and obligations. Things are also better with their parents, who agreed to attend a few sessions with their daughters.

Because of therapy, Mel realized she sometimes avoided communicating directly with Liz and instead used their parents as go-betweens. "In hindsight that was stupid. But I would use our parents to communicate about certain things or feelings back and forth, and things would get skewed."

A sibling relationship put to the ultimate test

As their therapy drew to a close, Mandie and Brett also found their communications had opened up. They even decided to try another vacation together, and it went well.

But then came some terrible news. Their mom had a bad cough, and had gotten a CT scan. She wanted Mandie, the ER doctor, to take a look at it. "Literally that one day I knew that it was a death sentence," Mandie recalls. "And so I had to call Brett and tell him."

Their mom was diagnosed with pancreatic cancer, and it had spread to the lungs. Brett flew out to see his parents and Mandie, and the four sat down to talk. Mandie led the conversation, explaining the clinical challenges to come, and suggesting changes they would have to make to their parents' home, to prepare.

"I was seeing the next couple of months in a whole different perspective than the other three," Mandie says. It was a deeply uncomfortable conversation for Brett. "It was hard because I'm thinking like a doctor and he's thinking like a son."

Brett left the meeting upset, but Mandie followed up later.

"I said 'Brett, that was the hardest moment of our lives, the four of us right there,' " Mandie says. "I think we were able to actually listen to each other and not just close off and shut off."

The illness was swift, just four months. Brett lived far away, but made frequent visits and helped with the caretaking duties. They were especially careful about making sure each of them spent as much time as possible with their mom, without getting in each other's way, while also balancing jobs and families. It took logistics and patience and communication.

Their mother sometimes called Brett and Mandie her "baby birds." That long period when they were estranged, back in 2020, had been painful for her. "She was very aware that we did therapy, and very aware it could have been a totally different situation," Mandie recalls.

"If we hadn't gone through the therapy we went through, we would never have given her the love and the wonderful last four months that she had with us. I think she died happy, knowing that her baby birds were happy in a nest together again."

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Problem-Solving Therapy: New Strategies for Effective Family Therapy . By Jay Haley. San Francisco, Calif.: Jossey-Bass, 1976. 275 pp. $13.95

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Trudy Saxton, Problem-Solving Therapy: New Strategies for Effective Family Therapy . By Jay Haley. San Francisco, Calif.: Jossey-Bass, 1976. 275 pp. $13.95, Social Work , Volume 22, Issue 3, May 1977, Page 241, https://doi.org/10.1093/sw/22.3.241

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What is Solution-Focused Therapy: 3 Essential Techniques

You’re at an important business meeting, and you’re there to discuss some problems your company is having with its production.

At the meeting, you explain what’s causing the problems: The widget-producing machine your company uses is getting old and slowing down. The machine is made up of hundreds of small parts that work in concert, and it would be much more expensive to replace each of these old, worn-down parts than to buy a new widget-producing machine.

You are hoping to convey to the other meeting attendees the impact of the problem, and the importance of buying a new widget-producing machine. You give a comprehensive overview of the problem and how it is impacting production.

One meeting attendee asks, “So which part of the machine, exactly, is getting worn down?” Another says, “Please explain in detail how our widget-producing machine works.” Yet another asks, “How does the new machine improve upon each of the components of the machine?” A fourth attendee asks, “Why is it getting worn down? We should discuss how the machine was made in order to fully understand why it is wearing down now.”

You are probably starting to feel frustrated that your colleagues’ questions don’t address the real issue. You might be thinking, “What does it matter how the machine got worn down when buying a new one would fix the problem?” In this scenario, it is much more important to buy a new widget-producing machine than it is to understand why machinery wears down over time.

When we’re seeking solutions, it’s not always helpful to get bogged down in the details. We want results, not a narrative about how or why things became the way they are.

This is the idea behind solution-focused therapy . For many people, it is often more important to find solutions than it is to analyze the problem in great detail. This article will cover what solution-focused therapy is, how it’s applied, and what its limitations are.

Before you continue, we thought you might like to download our three Positive Psychology Exercises for free . These science-based exercises will explore fundamental aspects of positive psychology including strengths, values, and self-compassion, and will give you the tools to enhance the wellbeing of your clients, students, or employees.

This Article Contains:

What is solution-focused therapy, theory behind the solution-focused approach, solution-focused model, popular techniques and interventions, sfbt treatment plan: an example, technologies to execute an sfbt treatment plan (incl. quenza), limitations of sfbt counseling, what does sfbt have to do with positive psychology, a take-home message.

Solution-focused therapy, also called solution-focused brief therapy (SFBT), is a type of therapy that places far more importance on discussing solutions than problems (Berg, n.d.). Of course, you must discuss the problem to find a solution, but beyond understanding what the problem is and deciding how to address it, solution-focused therapy will not dwell on every detail of the problem you are experiencing.

Solution-focused brief therapy doesn’t require a deep dive into your childhood and the ways in which your past has influenced your present. Instead, it will root your sessions firmly in the present while working toward a future in which your current problems have less of an impact on your life (Iveson, 2002).

This solution-centric form of therapy grew out of the field of family therapy in the 1980s. Creators Steve de Shazer and Insoo Kim Berg noticed that most therapy sessions were spent discussing symptoms, issues, and problems.

De Shazer and Berg saw an opportunity for quicker relief from negative symptoms in a new form of therapy that emphasized quick, specific problem-solving rather than an ongoing discussion of the problem itself.

The word “brief” in solution-focused brief therapy is key. The goal of SFBT is to find and implement a solution to the problem or problems as soon as possible to minimize time spent in therapy and, more importantly, time spent struggling or suffering (Antin, 2018).

SFBT is committed to finding realistic, workable solutions for clients as quickly as possible, and the efficacy of this treatment has influenced its spread around the world and use in multiple contexts.

SFBT has been successfully applied in individual, couples, and family therapy. The problems it can address are wide-ranging, from the normal stressors of life to high-impact life events.

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The solution-focused approach of SFBT is founded in de Shazer and Berg’s idea that the solutions to one’s problems are typically found in the “exceptions” to the problem, meaning the times when the problem is not actively affecting the individual (Iveson, 2002).

This approach is a logical one—to find a lasting solution to a problem, it is rational to look first at those times in which the problem lacks its usual potency.

For example, if a client is struggling with excruciating shyness, but typically has no trouble speaking to his or her coworkers, a solution-focused therapist would target the client’s interactions at work as an exception to the client’s usual shyness. Once the client and therapist have discovered an exception, they will work as a team to find out how the exception is different from the client’s usual experiences with the problem.

The therapist will help the client formulate a solution based on what sets the exception scenario apart, and aid the client in setting goals and implementing the solution.

You may have noticed that this type of therapy relies heavily on the therapist and client working together. Indeed, SFBT works on the assumption that every individual has at least some level of motivation to address their problem or problems and to find solutions that improve their quality of life .

This motivation on the part of the client is an essential piece of the model that drives SFBT (Miller & Rollnick, 2013).

Solution-focused theorists and therapists believe that generally, people develop default problem patterns based on their experiences, as well as default solution patterns.

These patterns dictate an individual’s usual way of experiencing a problem and his or her usual way of coping with problems (Focus on Solutions, 2013).

The solution-focused model holds that focusing only on problems is not an effective way of solving them. Instead, SFBT targets clients’ default solution patterns, evaluates them for efficacy, and modifies or replaces them with problem-solving approaches that work (Focus on Solutions, 2013).

In addition to this foundational belief, the SFBT model is based on the following assumptions:

• Change is constant and certain;
• Emphasis should be on what is changeable and possible;
• Clients must want to change;
• Clients are the experts in therapy and must develop their own goals;
• Clients already have the resources and strengths to solve their problems;
• Therapy is short-term;
• The focus must be on the future—a client’s history is not a key part of this type of therapy (Counselling Directory, 2017).

Based on these assumptions, the model instructs therapists to do the following in their sessions with clients:

• Ask questions rather than “selling” answers;
• Notice and reinforce evidence of the client’s positive qualities, strengths, resources, and general competence to solve their own problems;
• Work with what people can do rather than focusing on what they can’t do;
• Pinpoint the behaviors a client is already engaging in that are helpful and effective and find new ways to facilitate problem-solving through these behaviors;
• Focus on the details of the solution instead of the problem;
• Develop action plans that work for the client (Focus on Solutions, 2013).

SFBT therapists aim to bring out the skills, strengths, and abilities that clients already possess rather than attempting to build new competencies from scratch. This assumption of a client’s competence is one of the reasons this therapy can be administered in a short timeframe—it is much quicker to harness the resources clients already have than to create and nurture new resources.

Beyond these basic activities, there are many techniques and exercises used in SFBT to promote problem-solving and enhance clients’ ability to work through their own problems.

Working with a therapist is generally recommended when you are facing overwhelming or particularly difficult problems, but not all problems require a licensed professional to solve.

For each technique listed below, it will be noted if it can be used as a standalone technique.

Asking good questions is vital in any form of therapy, but SFBT formalized this practice into a technique that specifies a certain set of questions intended to provoke thinking and discussion about goal-setting and problem-solving.

One such question is the “coping question.” This question is intended to help clients recognize their own resiliency and identify some of the ways in which they already cope with their problems effectively.

There are many ways to phrase this sort of question, but generally, a coping question is worded something like, “How do you manage, in the face of such difficulty, to fulfill your daily obligations?” (Antin, 2018).

Another type of question common in SFBT is the “miracle question.” The miracle question encourages clients to imagine a future in which their problems are no longer affecting their lives. Imagining this desired future will help clients see a path forward, both allowing them to believe in the possibility of this future and helping them to identify concrete steps they can take to make it happen.

This question is generally asked in the following manner: “Imagine that a miracle has occurred. This problem you are struggling with is suddenly absent from your life. What does your life look like without this problem?” (Antin, 2018).

If the miracle question is unlikely to work, or if the client is having trouble imagining this miracle future, the SFBT therapist can use “best hopes” questions instead. The client’s answers to these questions will help establish what the client is hoping to achieve and help him or her set realistic and achievable goals.

The “best hopes” questions can include the following:

• What are your best hopes for today’s session?
• What needs to happen in this session to enable you to leave thinking it was worthwhile?
• How will you know things are “good enough” for our sessions to end?
• What needs to happen in these sessions so that your relatives/friends/coworkers can say, “I’m really glad you went to see [the therapist]”? (Vinnicombe, n.d.).

To identify the exceptions to the problems plaguing clients, therapists will ask “exception questions.” These are questions that ask about clients’ experiences both with and without their problems. This helps to distinguish between circumstances in which the problems are most active and the circumstances in which the problems either hold no power or have diminished power over clients’ moods or thoughts.

Exception questions can include:

• Tell me about the times when you felt the happiest;
• What was it about that day that made it a better day?
• Can you think of times when the problem was not present in your life? (Counselling Directory, 2017).

Another question frequently used by SFBT practitioners is the “scaling question.”

It asks clients to rate their experiences (such as how their problems are currently affecting them, how confident they are in their treatment, and how they think the treatment is progressing) on a scale from 0 (lowest) to 10 (highest). This helps the therapist to gauge progress and learn more about clients’ motivation and confidence in finding a solution.

For example, an SFBT therapist may ask, “On a scale from 0 to 10, how would you rate your progress in finding and implementing a solution to your problem?” (Antin, 2018).

Do One Thing Different

This exercise can be completed individually, but the handout may need to be modified for adult or adolescent users.

This exercise is intended to help the client or individual to learn how to break his or her problem patterns and build strategies to simply make things go better.

The handout breaks the exercise into the following steps (Coffen, n.d.):

• Think about the things you do in a problem situation. Change any part you can. Choose to change one thing, such as the timing, your body patterns (what you do with your body), what you say, the location, or the order in which you do things;
• Think of a time that things did not go well for you. When does that happen? What part of that problem situation will you do differently now?
• Think of something done by somebody else does that makes the problem better. Try doing what they do the next time the problem comes up. Or, think of something that you have done in the past that made things go better. Try doing that the next time the problem comes up;
• Think of something that somebody else does that works to make things go better. What is the person’s name and what do they do that you will try?
• Think of something that you have done in the past that helped make things go better. What did you do that you will do next time?
• Feelings tell you that you need to do something. Your brain tells you what to do. Understand what your feelings are but do not let them determine your actions. Let your brain determine the actions;
• Feelings are great advisors but poor masters (advisors give information and help you know what you could do; masters don’t give you choices);
• Think of a feeling that used to get you into trouble. What feeling do you want to stop getting you into trouble?
• Think of what information that feeling is telling you. What does the feeling suggest you should do that would help things go better?
• Change what you focus on. What you pay attention to will become bigger in your life and you will notice it more and more. To solve a problem, try changing your focus or your perspective.
• Think of something that you are focusing on too much. What gets you into trouble when you focus on it?
• Think of something that you will focus on instead. What will you focus on that will not get you into trouble?
• Imagine a time in the future when you aren’t having the problem you are having right now. Work backward to figure out what you could do now to make that future come true;
• Think of what will be different for you in the future when things are going better;
• Think of one thing that you would be doing differently before things could go better in the future. What one thing will you do differently?
• Sometimes people with problems talk about how other people cause those problems and why it’s impossible to do better. Change your story. Talk about times when the problem was not happening and what you were doing at that time. Control what you can control. You can’t control other people, but you can change your actions, and that might change what other people do;
• Think of a time when you were not having the problem that is bothering you. Talk about that time.
• If you believe in a god or a higher power, focus on God to get things to go better. When you are focused on God or you are asking God to help you, things might go better for you.
• Do you believe in a god or a higher power? Talk about how you will seek help from your god to make things go better.
• Use action talk to get things to go better. Action talk sticks to the facts, addresses only the things you can see, and doesn’t address what you believe another person was thinking or feeling—we have no way of knowing that for sure. When you make a complaint, talk about the action that you do not like. When you make a request, talk about what action you want the person to do. When you praise someone, talk about what action you liked;
• Make a complaint about someone cheating at a game using action talk;
• Make a request for someone to play fairly using action talk;
• Thank someone for doing what you asked using action talk.

Following these eight steps and answering the questions thoughtfully will help people recognize their strengths and resources, identify ways in which they can overcome problems, plan and set goals to address problems, and practice useful skills.

While this handout can be extremely effective for SFBT, it can also be used in other therapies or circumstances.

To see this handout and download it for you or your clients, click here .

Presupposing Change

The “presupposing change” technique has great potential in SFBT, in part because when people are experiencing problems, they have a tendency to focus on the problems and ignore the positive changes in their life.

It can be difficult to recognize the good things happening in your life when you are struggling with a painful or particularly troublesome problem.

This technique is intended to help clients be attentive to the positive things in their lives, no matter how small or seemingly insignificant. Any positive change or tiny step of progress should be noted, so clients can both celebrate their wins and draw from past wins to facilitate future wins.

Presupposing change is a strikingly simple technique to use: Ask questions that assume positive changes. This can include questions like, “What’s different or better since I saw you last time?”

If clients are struggling to come up with evidence of positive change or are convinced that there has been no positive change, the therapist can ask questions that encourage clients to think about their abilities to effectively cope with problems, like, How come things aren’t worse for you? What stopped total disaster from occurring? How did you avoid falling apart? (Australian Institute of Professional Counsellors, 2009).

The most powerful word in the Solution Focused Brief Therapy vocabulary – The Solution Focused Universe

A typical treatment plan in SFBT will include several factors relevant to the treatment, including:

• The reason for referral, or the problem the client is experiencing that brought him or her to treatment;
• A diagnosis (if any);
• List of medications taken (if any);
• Current symptoms;
• Support for the client (family, friends, other mental health professionals, etc.);
• Modality or treatment type;
• Frequency of treatment;
• Goals and objectives;
• Measurement criteria for progress on goals;
• Client strengths ;
• Barriers to progress.

All of these are common and important components of a successful treatment plan. Some of these components (e.g., diagnosis and medications) may be unaddressed or acknowledged only as a formality in SFBT due to its usual focus on less severe mental health issues. Others are vital to treatment progress and potential success in SFBT, including goals, objectives, measurement criteria, and client strengths.

To this end, therapists are increasingly leveraging the benefits of technology to help develop, execute, and evaluate the outcomes of treatment plans efficiently.

Among these technologies are many digital platforms that therapists can use to carry out some steps in clients’ treatment plans outside of face-to-face sessions.

For example, by adopting a versatile blended care platform such as Quenza , an SFBT practitioner may carry out some of the initial steps in the assessment/diagnosis phase of a treatment plan, such as by inviting the client to complete a digital diagnostic questionnaire.

Likewise, the therapist may use the platform to send digital activities to the client’s smartphone, such as an end-of-day reflection inviting the client to recount their application of the ‘Do One Thing Different’ technique to overcome a problem.

These are just a few ideas for how you might use a customizable blended care tool such as Quenza to help carry out several of the steps in an SFBT treatment plan.

Some of the potential disadvantages for therapists include (George, 2010):

• The potential for clients to focus on problems that the therapist believes are secondary problems. For example, the client may focus on a current relationship problem rather than the underlying self-esteem problem that is causing the relationship woes. SFBT dictates that the client is the expert, and the therapist must take what the client says at face value;
• The client may decide that the treatment is successful or complete before the therapist is ready to make the same decision. This focus on taking what the client says at face value may mean the therapist must end treatment before they are convinced that the client is truly ready;
• The hard work of the therapist may be ignored. When conducted successfully, it may seem that clients solved their problems by themselves, and didn’t need the help of a therapist at all. An SFBT therapist may rarely get credit for the work they do but must take all the blame when sessions end unsuccessfully.

Some of the potential limitations for clients include (Antin, 2018):

• The focus on quick solutions may miss some important underlying issues;
• The quick, goal-oriented nature of SFBT may not allow for an emotional, empathetic connection between therapist and client.
• If the client wants to discuss factors outside of their immediate ability to effect change, SFBT may be frustrating in its assumption that clients are always able to fix or address their problems.

Generally, SFBT can be an excellent treatment for many of the common stressors people experience in their lives, but it may be inappropriate if clients want to concentrate more on their symptoms and how they got to where they are today. As noted earlier, it is also generally not appropriate for clients with major mental health disorders.

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First, both SFBT and positive psychology share a focus on the positive—on what people already have going for them and on what actions they can take. While problems are discussed and considered in SFBT, most of the time and energy is spent on discussing, thinking about, and researching what is already good, effective, and successful.

Second, both SFBT and positive psychology consider the individual to be his or her own best advocate, the source of information on his or her problems and potential solutions, and the architect of his or her own treatment and life success. The individual is considered competent, able, and “enough” in both SFBT and positive psychology.

This assumption of the inherent competence of individuals has run both subfields into murky waters and provoked criticism, particularly when systemic and societal factors are considered. While no respectable psychologist would disagree that an individual is generally in control of his or her own actions and, therefore, future, there is considerable debate about what level of influence other factors have on an individual’s life.

While many of these criticisms are valid and bring up important points for discussion, we won’t dive too deep into them in this piece. Suffice it to say that both SFBT and positive psychology have important places in the field of psychology and, like any subfield, may not apply to everyone and to all circumstances.

However, when they do apply, they are both capable of producing positive, lasting, and life-changing results.

Solution-focused therapy puts problem-solving at the forefront of the conversation and can be particularly useful for clients who aren’t suffering from major mental health issues and need help solving a particular problem (or problems). Rather than spending years in therapy, SFBT allows such clients to find solutions and get results quickly.

Have you ever tried Solution-Focused Brief Therapy, as a therapist or as a client? What did you think of the focus on solutions? Do you think SFBT misses anything important by taking the spotlight off the client’s problem(s)? Let us know in the comments section.

We hope you enjoyed reading this article. Don’t forget to download our three Positive Psychology Exercises for free .

Antin, L. (2018). Solution-focused brief therapy (SFBT). Good Therapy. Retrieved from https://www.goodtherapy.org/learn-about-therapy/types/solution-focused-therapy

• Australian Institute of Professional Counsellors. (2009, March 30). Solution-focused techniques. Counseling Connection. Retrieved from http://www.counsellingconnection.com/index.php/2009/03/30/solution-focused-techniques/
• Berg, I. K. (n.d.). About solution-focused brief therapy. SFBTA . Retrieved from http://www.sfbta.org/about_sfbt.html
• Coffen, R. (n.d.). Do one thing different [Handout]. Retrieved from https://www.andrews.edu/~coffen/Do%20one%20thing%20different.pdf
• Focus on Solutions. (2013, October 28). The brief solution-focused model. Focus on solutions: Leaders in solution-focused training. Retrieved from http://www.focusonsolutions.co.uk/solutionfocused/
• George, E. (2010). Disadvantages of solution focus? BRIEF. Retrieved from https://www.brief.org.uk/resources/faq/disadvantages-of-solution-focus
• Iveson, C. (2002). Solution-focused brief therapy. Advances in Psychiatric Treatment, 8 (2), 149-156.
• Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change (3rd ed.). New York, NY: Guilford Press.
• Vinnicombe, G. (n.d.). Greg’s SFBT handout. Useful Conversations. Retrieved from http://www.usefulconversations.com/downloads

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What our readers think.

Thank you. I’m about to start an MMFT internship, and SFBT is the model I prefer. You put everything in perspective.

Great insights. I have a client who has become a bit disengaged with our work together. This gives me a really helpful new approach for our upcoming sessions. He’s very focused on the problem and wanting a “quick fix.” This might at least get us on that path. Thank you!

Hi Courtney, great paper! I will like to know more about the limitations to SFT and noticed that you provided an intext citation to Antin 2016. Would you be able to provide the full reference? Thank you!

Thank you for bringing this to our attention. The reference has now been updated in the reference list — this should be Antin (2018):

– Nicole | Community Manager

The only thing tat was revealed to me while reading this article is the client being able to recognize the downfall of what got them into their problem in the first place. I felt that maybe a person should understand the problem to the extent that they may understand how to recognize what led to the problem in the first place. Understanding the process of how something broke down would give one knowledge and wisdom that may be able to be applied in future instances when something may go wrong again. Even if the thing is new (machine or person) having the wisdom and understanding of the cause that led to the effect may help prevent and or overcome an arising problem in the future. Not being able to recognize the process that brought down the machine and or human may be like adhering to ignorance, although they say ignorance is bliss in case of an emergency it would be better to be informed rather then blindly ignorant, as the knowledge of how the problem surfaced in the first place may alleviate unwarranted suffering sooner rather than later. But then again looking at it this way I may work myself out of a job if my clients never came back to see me. However is it about me or them or the greater societal structural good that we can induce through our education, skills, training, experience, and good will good faith effort to instill social justice coupled with lasting change for the betterment of human society and the world as a whole.

Very very helpful, thank you for writing. Just one point “While no respectable psychologist would disagree that an individual is generally in control of his or her own actions and, therefore, future, there is considerable debate about what level of influence other factors have on an individual’s life.” I think any psychologist that has worked in neurological dysfunction would probably acknowledge consciousness and ‘voluntary control’ are not that straight-forward. Generally though, I suppose there’s that whole debate of if we are ever in control of our actions or even our thoughts. It may well boil down to what we mean by ‘we’, as in what are we? A bundle of fibres acting on memories and impulses? A unique body of energy guided by intangible forces? Maybe I am not a respectable psychologist 🙂

This article provided me with insight on how to proceed with a role-play session in my CBT graduate course. Thank you!

Hi Derrick, That’s fantastic that you were able to find some guidance in this post. Best of luck with your grad students! – Nicole | Community Manager

Thank You…Great input and clarity . I now have light…

I was looking everywhere for a simple explanation for my essay and this is it!! thank you so much for this is was very useful and I learned a lot.

Very well done. Thank you for the multitude of insights.

Thank you for such a good passage discussed. I really have a great time understanding it.

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Comparative Effectiveness of Clinician- Versus Peer-Supported Problem-Solving Therapy for Rural Older Adults With Depression

• Brooke Hollister , Ph.D. ,
• Rebecca Crabb , Ph.D. ,
• Patricia Areán , Ph.D.

Search for more papers by this author

Self-guided and peer-supported treatments for depression among rural older adults may address some common barriers to treatment. This pilot study compared the effect on depression of peer-supported, self-guided problem-solving therapy (SG-PST) with case management problem-solving therapy (CM-PST) among older adults in rural California.

Older adults with depression (N=105) received an introductory PST session with a clinician, followed by 11 sessions of CM-PST with a clinician (N=85) or SG-PST with a peer counselor (N=20).

Both interventions resulted in clinically significant improvement in depression by week 12. Depression scores in the CM-PST group dropped by 4.1 points more than in the SG-PST group between baseline and week 12 (95% CI=0.99–7.22, p<0.001, Hedges’s g=1.08).

Conclusions:

The results suggest that peer-supported SG-PST is a viable, acceptable option for rural older adults with depression as a second-line treatment if access to clinicians is limited.

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• Cited by None
• Peer-supported therapy, Problem-solving therapy, Senior peer counselors, Depression
• Rural older adults
• Geriatric psychiatry