INTRODUCTION
Before embarking on an examination of SFT itself, it is necessary firstly to consider the background of ‘therapy’, ‘family therapy’ and ‘brief therapy’ from which it emerged; and secondly to contextualise SFT in relation to both its roots and its emergence as an increasingly popular approach at a specific point in time: the 1990s. Thirdly, the research literature pertaining to SFT will be summarised and reviewed.
The literature regarding the use or potential use of SFT in social work will be critically reviewed and some tentative hypotheses suggested regarding its place in social work practice.
(I)BACKGROUND TO THE DEVELOPMENT OF SOLUTION FOCUSED THERAPY Therapy
There are basically two ways of accounting for the emergence of the psychological therapies around the late eighteenth and early twentieth centuries. One explanation points to advances in psychiatric and psychological knowledge that led to the discovery of this new form of treatment. From this perspective, therapy can be seen as part of the ‘technology’ of psychology and psychiatry…The other approach to explaining the rise of therapy looks not forward with science and progress but backward towards some very old cultural traditions. From this perspective, all cultures possess ritualised ways of enabling members to deal with group and interpersonal tensions, feelings of anger and loss, questions of purpose and meaning. These rituals evolve and change over generations, and are part of the ‘taken-for-granted’ fabric of everyday life. Looked at in this light, psychotherapy can be viewed as a culturally sanctioned form of healing that reflects the values and needs of the modern industrial world (McLeod, 1997:1 – 2)
‘Therapy’, ‘psychotherapy’ and ‘counselling’ are now common currency in the lexicon of the individually-focused helping professions and are widely used to denote different forms of intervention with individuals, couples, families and groups. They are most commonly employed in developed Westernised societies where the satisfaction of basic human needs for the majority of populations is thought to have been achieved70 and where attention has shifted to emotional needs. Practice in social work or therapy is predicated on Western belief systems centred on individual needs and rights and derived from the Judeo-Christian ethos and the capitalist mode of production. Its relevance to non-Western contexts and cultures has been rightly questioned (Payne, 1997; Graham, 1999).
There are now literally hundreds of different approaches to psychotherapy and counselling71, and they are classified in varying ways. While ‘therapy’ has become popular and can be defined as a form of talking cure which aims to assist people with individual problems, it has not become the exclusive domain of any one profession.
What we call counselling or psychotherapy is rightfully owned by lots of different professions, disciplines, fields, each of which can state their rightful claims to legitimate ownership. (Feltham, 1995: vii)
Social work, then, is not the only profession to claim legitimate engagement in therapeutic endeavours. It is one of many.
Therapy, however, has remained a contested term within social work discourse, due in part to the pervasive influence that psychoanalytic and psychodynamic theories are seen to have had on social work’s development (Howe, 1987; Payne, 1997) but also due to the debate on whether social workers should focus on individual change or collective action. Compton and Galaway (1994) suggest that the association of social change with community organisation and of individual change with social casework may oversimplify social work
… inasmuch as work with individuals can be directed towards change in social standards and work with groups or communities can be directed towards helping people adapt to their current situations. (p. 7)
A robust defence of the case for individual change-work with clients is made by Barber (1991) who draws on Freire’s (1972) notion of ‘the pedagogy of the oppressed’ and on the concept of ‘learned helplessness’ (Seligman, 1975) to argue that clients who suffer oppression may need to be motivated and energised on an individual level before they can consider taking on structural inequalities.
The influence of psychoanalysis is feared to have led to an image of the social worker as … a psychoanalytic caseworker, steeped in Freudian psychology … who talks about potty training experiences with the client while above the roof leaks, at the door the rentman shouts for his money, and all around run children without winter coats. (Howe, 1987: 79)
While this image of a social worker may now be mythical, it is also the case that a number of social workers actively subscribe to a narrow clinical or therapeutic role72. While some social workers with further training move into the fields of counselling and psychotherapy and abandon the role of social work, many social workers have borrowed psychotherapeutic concepts, practices and techniques to develop further a practice which has remained within the social work tradition.
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The terms ‘counselling’ and ‘psychotherapy’ are often used interchangeably and appear to be derivatives of cultural differences as much as anything else. The distinction between counselling and therapy becomes more spurious when one examines the different meanings attributed to both: for example, much of what is called counselling in the UK and Ireland would be called therapy in the USA.
The case for therapy in social work also depends on the construction of therapy, or psychological change-work: does it denote the worker as ‘expert’ who knows what is best for the client and how to fix it, or can therapy, be conceptualised in a different way, to connote the worker as collaborator who works with a client to co-construct new ways of talking, understanding and doing?
One therapeutic field which has been of particular significance to social workers has been that of family therapy.
Family Therapy
SFT was developed in a family therapy setting in the USA in the early to mid 1980s, a particular context at a particular point in time.
A review of the development of family therapy as a particular discipline in the years 1960-1980 indicates a dynamic and ever-changing development of ideas focused on a family orientation. Initially linked to psychoanalytic thinking, it become more centrally influenced by systems thinking and communication theory, which primarily emerged from the USA but with some related contemporaneous developments elsewhere. An ever-increasing range of approaches in the 1970s widened its popularity and influence beyond the USA, primarily through individual, charismatic and gifted therapists who became international celebrities such as Salvador Minuchin and Virginia Satir. As the field became bigger and more complex, attempts to classify different approaches met with varying degrees of success, with one author by the mid 1980s admitting defeat: ‘It is said there are as many ways of practising family therapy as there are workers in the field’ (Burnham, 1986: 62).
The emergence of family therapy as a popular method of intervention in the latter part of the twentieth century can be traced to:
(i) The dominance of individual charismatic leaders or ‘pioneers’ and their particular brands of therapy;
(ii) The importance of workshops and conferences featuring live and videotaped demonstrations; and
(iii) The lack of attention paid to outcome and consumer studies.
The characterisation of ‘change merchants’ as pioneers in the family therapy movement has been criticised for the superficiality it engenders:
For nearly half a century family therapists have had a tradition of being pioneers, but we have to face the fact that this is now an old-fashioned idea. We pay a very high price for our pioneering glory as every new idea proposed has to flag new territories, new discoveries. This means that ‘not new ideas’ are discarded, so instead of weaving an even richer and deeper understanding of families that thinking becomes as superficial (or profound) as the newest fashion. Worst still, no fashionable ‘pioneering’ ideas can be seen to come from other disciplines, such as developmental or cognitive psychology or individual therapy, or their research data although many so-called ‘new’ ideas, such as
narrative, have been explored by other disciplines well before we ‘discovered’ them’. (Byng-Hall, 1998: 139)
This criticism echoes one point made in the previous chapter regarding the ‘politics of theory’ – the extent to which advocates of particular models may vie for an increased position of power and may exaggerate claims for the effectiveness or superiority of their particular brand.
Critiques of Family Therapy
In relation to family therapy generally, there has been concern that claims for its effectiveness have been overstated. Criticisms have also focused on its lack of user-friendliness (Howe, 1989; Reimers & Treacher, 1995). One analysis (Gurman, Kniskern & Pinsof, 1986) which claimed that outcome studies supported the efficacy of family therapy was critically scrutinised (Reimers & Treacher, 1995) and different conclusions were reached.
Firstly, Reimers and Treacher found that, with the exception of behavioural and psycho-educational models, claims for most family therapy models were not supported by empirical findings; and secondly, that many of the major theorists of the time (such as Satir and Whitaker) had shown ‘remarkably little interest either in validating their results or recording what their users experience when they are at the receiving end of therapy’ (p. 21). Reimers and Treacher concluded that there was little evidence that therapists are attracted to particular models by their demonstrable efficacy: ‘the attraction of the model is at a personal and not a rational-scientific level’ (p. 21). This, they relate to features associated with the development of the family therapy movement itself which:
… has been disproportionately shaped by the influence of charismatic leaders performing (literally) as showmen at important conferences and workshops … apparently highly effective interventions are demonstrated by skilful practitioners who are excellent showmen. Failures are typically not shared and there is usually little attention paid to research findings. Many of the presenters of such workshops actually earn their living from their presentations so there is often an in-built marketing factor which militates against presenters being objective about their own successes and failures. (Reimers & Treacher, 1995: 24-5)73
Reimers and Treacher concluded that changes were needed if family therapy was to fulfil its potential as an ethical and effective practice. In particular, they argued that more attention should be paid to the user’s perspective and less to a fascination with versions of systems theory which rendered the user invisible and were ‘anti-humanistic’ in orientation. They identified some developments within the family therapy field from the mid-1980s onwards as hopeful, particularly those related to the development of ‘second-order’ approaches (Hoffman, 1990, 1991) 74 and feminist critiques of family therapy75.
73 This analysis and critique of the family therapy movement up to the mid-1990s is of some importance
because the authors were both practising family therapists with a commitment to the approach.
74 ‘Second-order’ approaches can be characterised as those which question the expert position commonly
Brief Therapy
A key ongoing debate in the field of therapy has focused on the length of treatment and the relative efficacies of short-term versus long-term approaches.
As early as the mid-1950s, psychiatrists and family therapists such as Erickson, Weakland and Haley were using brief treatment approaches, although these had not yet been formalised into models for practice (Haley, 1973; Erickson, 1954). Long-term work was seen to be expensive; demanding for practitioners and clients; and risked creating problems of dependency for the client to resolve when the therapy neared an end. There were fears that long-term therapy could become directionless and that motivation, thought to be highest at the initial crisis point of seeking help, would dissipate in longer-term treatments.
The growth of the ‘short-term movement’ in both psychotherapy and social work is thought to date from the late 1960s and early 1970s76 and four factors have been identified which contributed to its advance:
(i) Disillusionment with psychoanalytic dominance in psychotherapy and social work and lack of evidence of its effectiveness.
(ii) Client choice: Research results indicated that, clients tended to stay in therapy for only 6-10 sessions (Reid & Shyne, 1969; Garfield & Bergin 1978; Koss, 1979) and preferred brief interventions. Reid and Shyne’s (1969) study of Brief and Extended Casework confirmed that a significant number of social work clients tended to leave treatment after ten sessions and were less likely to engage initially if offered open-ended treatment.
(iii) Evidence of the effectiveness of brief methods: Reid and Shyne found that those receiving brief treatments achieved significantly more positive change than those receiving the open- ended service. Research evidence on the impact of the first 6-8 sessions (Reid & Epstein, 1972); and that changes made in short-term treatments are at least as durable as those in longer-term interventions (Reid & Shyne, 1970; Fisher, 1984) strengthened the appeal of brief methods.