Solution-Focused Brief

Therapy With Families

Solution-Focused Brief Therapy With Families describes SFBT from a systemic

perspective and provides students, educators, trainers, and practitioners
with a clear explanation and rich examples of SFBT and systemic family
therapy. Family therapists will learn how SFBT works with families, solution-
focused therapists will learn how a systemic understanding of clients and
their contexts can enhance their work, and all will learn how to harness the
power of each to the service of their clients.
The book starts with an exploration of systems, cybernetics, and
communication theory basics such as wholeness, recursion, homeostasis,
and change. Following this is an introduction to five fundamental family
therapy approaches and an overview of Solution-Focused Brief Therapy.
Next, the author considers SFBT within a systems paradigm and provides
a demonstration of SFBT with families and couples. Each step is explicated
with ideas from both SFBT as well as systems. The final chapter shows how
SFBT practices can be applied to a variety of family therapy approaches.
This accessible text is enhanced by descriptions, case examples, dialogue,
and commentary that are both systemic and solution-focused. Readers will
come away with a new appreciation for both the systemic worldview of
SFBT and SFBT principles as applied to systemic work.

Thorana S. Nelson, PhD, is Professor Emerita in Family Therapy at Utah

State University. She has co-written and edited numerous articles and
books on Solution-Focused Brief Therapy and training, including Handbook
of Solution-Focused Brief Therapy (with Frank N. Thomas) and Doing
Something Different: Solution-Focused Brief Therapy Practices.
Solution-Focused Brief
Therapy With Families

Thorana S. Nelson, PhD

First published 2019
by Routledge
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ISBN: 978-1-138-54116-0 (pbk)
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 Contents

Forewordviii
Prefacex

1 Systemic Thinking 1
Our Lenses2
System Concepts3
Cybernetics14
Communication Theory22
Therapy: Systems, Cybernetics, and Communication24
And So . . .28

2 Family Therapy Approaches 29

Structural Family Therapy29
Strategic Family Therapy (Mental Research Institute)35
Strategic Family Therapy (Haley and Madanes)41
Bowen Family Therapy44
Integrative Approaches50
And So . . .52

3 Solution-Focused Brief Therapy 53

Development of SFBT53
SFBT Stance55
Assumptions57
General Practices62
Specific Practices71

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Contents

Emotions83
Changes in the Approach83
And So . . .84

4 SFBT Integration Within a Systemic Perspective 85

Stance85
Change Is Constant and Inevitable88
If It Ain’t Broke, Don’t Fix It; Once You Know What Works,
Do More of It; If It Doesn’t Work, Do Something Different90
Clients Have Resources; Our Job Is to Help Identify and
Use Them94
Relationship Between Problems and Solutions94
Focus on Future and Change100
Small Change Leads to Bigger Change101
Clients Are Experts on Their Experiences and Lives101
Therapy Is Co-constructed103
Client-Therapist Relationship104
Well-Formed Goals104
Curious Questions105
Relationship Questions105
Miracle Question, Preferred Future106
And So . . .107

5 Solution-Focused Brief Therapy With Families 108

Families108
Session 1110
Session 2129
Session 3135
Session 4136
Couples139
Blended Families143
And So . . .143

6 Using SFBT Practices With Four Family Therapy Approaches 145

Structural Family Therapy146
Strategic Family Therapy (Mental Research Institute)151
Strategic Family Therapy (Haley and Madanes)157

vi
 Contents

Bowen Family Systems Therapy163

And So . . .172

References173
Bibliography177
Systems177
Solution-Focused Brief Therapy177
Appendix: Major Marriage and Family Therapy Models Charts 179
Index212

vii
 Foreword
Frank N. Thomas

I maintain that nothing could be more practical than to become more

familiar with the patterns of movement life requires. The goal is not to
crack the code, but rather to catch the rhythm.
—Nora Bateson (2016)

Solution-Focused Brief Therapy (SFBT) and family therapy models based on

systems thinking have a common link: Steve de Shazer, one of the pioneer-
ing creators of the approach. While many in the SFBT world only learned
more current constructions and expressions of the approach, the well-
informed easily recall de Shazer’s early writings across which he created
the solution-focused approach. Patterns of Brief Family Therapy (1984a)
is subtitled An Ecosystemic Approach and is clearly systems-oriented. The
forewords were written by de Shazer’s mentor John Weakland, co-creator of
the interactional-strategic approach of the Mental Research Institute (MRI),
and Bradford Keeney, the leading cybernetics theorist in family therapy at
the time. Keys to Solution in Brief Therapy (1985), de Shazer’s second book,
radiates a systems approach throughout. And as late as 1991, de Shazer was
still leaning on systems concepts and understandings as evidenced in his
fourth book, Putting Difference to Work.
So why have I started this Foreword with a de Shazer history? The context
of this book is this: systems thinking and SFBT are inextricably entwined.
While some in the SFBT world may seek to leave systems thinking behind
(or never acquired the perspective), Thorana S. Nelson takes us in a different
direction: toward complementarity, connecting ideas of SFBT and systems
thinking. Nelson is one among few scholar/practitioners who could record

viii
 Foreword

this beautiful harmony, creating a score that unites systemic family therapy
with SFBT, an integration without forced conflation. What she places in our
hands is a practical application of complex thinking about clinical work
with clear applications for readers who wish to utilize the best of SFBT’s
practices within major family therapy models; recursively, Nelson guides
readers in applying SFBT with families, keeping a systems view while out-
lining ways to view and do SFBT when working conjointly.
Nelson’s writing is a lingua franca for those only acquainted with one,
solution-focused or systems approaches. Using a familiar, less formal style
than most academic writing, she connects us to challenging concepts and
clinical models in a way I have not experienced before. Nelson success-
fully communicates complex ideas without diminishing their complexity.
Her therapy examples demonstrate practices and ideas so readers can get a
sense of possible applications. And her appendix is a gold mine for anyone
wanting a concentrated yet profound overview of most major marriage and
family therapy (MFT) models.
SFBT practitioners will “catch the rhythm” of systems thinking; family
therapists approaching their work from systems perspectives will benefit
from Nelson’s thoughtful and useful integration of SFBT tenets and practices
into their specific models. In a nutshell: I wish I had written this book.
Frank N. Thomas
Fort Worth, Texas, USA

ix
 Preface

In the early 1980s, I was introduced to a book called Patterns of Brief Fam-
ily Therapy. I was a master’s student in a family therapy within a counsel-
ing department at the University of Iowa. Several of us were interested in
working with families, and I had heard of family therapy while I was an
undergraduate at the University of Houston. I had read Virginia Satir’s (1967)
Conjoint Family Therapy and become fascinated with the idea of working
with families from a holistic perspective. My family was troubled as I was
growing up and I thought that if we had had something like Satir’s work, life
would have been different. So, I aimed to be a family therapist.
My fellow students and I learned about requirements for Clinical Mem-
bership in the American Association for Marriage and Family Therapy and
worked to help faculty develop courses. Many of them were independent
studies modeled after courses in accredited programs. In many ways, our
faculty were learning alongside us (the main difference being that we were
paying for the privilege). By focusing on family therapy approaches and sys-
tems thinking, I became even more impassioned about learning as much as
I could and helped develop courses in a master's program.
During my second year, our professor introduced us to a new book he had
read: Patterns by Steve de Shazer. In it, he described fascinating new ways
of looking at the problems people bring to therapy, something he called the
binocular view. By recognizing that looking at something from one lens only,
we miss a whole other perspective, we could ask different questions, use
different interventions, and help our clients reach their goals more quickly.
de Shazer was coming to Iowa from Wisconsin as the keynote speaker
at a conference. The chair of that conference had to resign and I was asked

x
 Preface

to fill in. That’s when I met Steve de Shazer and became fascinated with
the Solution-Focused Brief Therapy approach. I continued to use the model
I was trained in (Structural/Strategic/Bowen) but started adding pieces of de
Shazer’s work when it seemed appropriate. I met Insoo Kim Berg at another
conference and became an even more interested devotee of the approach.
It became evident that SFBT was becoming an integral part of my think-
ing when I was working on a research grant with colleagues for substance-
abusing women. We were approaching the work through a couple therapy
perspective and quickly learned—all four of us—that we couldn’t not use
solution-focused ideas when things started to improve for the clients. We
had to build it into our evolving manualized approach.
Even later, I was invited to attend what have become known as the “Ham-
mond meetings.” de Shazer, Berg, and colleagues Yvonne Dolan and Terry
Trepper in Hammond, Illinois brought 30–35 of us together to talk about the
approach, using it, and training people in it. After three meetings, we talked
about how to keep things going, in part because we wanted to keep meeting
and needed a good reason to do that. We hosted a conference and I edited a
book on Education and Training in Solution-Focused Brief Therapy based, in
part, on training exercises that we talked about during the Hammond meet-
ings. We also started an association and hosted or first annual conference in
1993 in Loma Linda, California.
Through all of this, I was reading more, editing, writing, and using the
SFBT approach. However, I have not been completely satisfied by the books
that have been authored. It seems that new books are needed to discuss
how the approach is used with different clinical problems and settings such
as drinking, home-based therapy, sexual abuse, children, schools, and so
forth. de Shazer and Berg had been trained at the Mental Research Institute
in Palo Alto, California, steeped in systems, cybernetic, and communication
theories. But I wasn’t seeing that critical perspective echoed in the books
I was reading. Nor were any books or articles being published on systems,
SFBT, and family therapy. I heard people talking about their family therapy
approaches as being solution-focused when in reality, they were borrowing
some practices to enhance their work. I also heard people talking about
SFBT without demonstrating a systemic sense to it. It became evident that
people were thinking about SFBT as a stand-alone theory of how problems
develop or of therapy, something that de Shazer was very clear about: SFBT

xi
Preface

is an approach to therapy, a description of what happens in therapy, not a

theory of any sort.
Several years ago, colleague WeiSu Hsu of Taiwan invited me to do a series
of two-day workshops on SFBT and families in China and Taiwan. I met with
counselors, school counselors, counseling students, psychologists, and psy-
chiatrists. The workshops were composed of lecture on the basics of system
thinking and SFBT as well as exercises and practice in SFBT. Over nearly
four weeks, I conducted six, two-day workshops and several short talks, all
on SFBT and families. After coming home, I became determined to write a
book on SFBT and families. This book would help family therapists learn
more about how to use SFBT in a systemic way with families and help SFBT
therapists learn about system thinking as a backbone of SFBT and how to use
it with families. The book in your hands is the product of that determination.
In this book, Solution-Focused Brief Therapists will learn more about sys-
temic ideas and how to use them in work with individuals, couples, and fam-
ilies. Family therapists will learn more about Solution-Focused Brief Therapy
assumptions, concepts, and practices, whether adopting the approach as
foundation or using aspects of it within systemic work.
The book starts with an overview of systems, cybernetics, and communi-
cation theory basics such as wholeness, recursion, homeostasis, and change.
It’s necessary to see systems as a worldview and this chapter provides the
foundation for that.
The second chapter then introduces five basic family therapy approaches
including one integrated approach: Structural, Strategic (Mental Research
Institute as well as Haley and Madanes), Bowen, and Johnson’s Emotionally
Focused Therapy. Although not comprehensive, this chapter gives readers a
sense of family therapy approaches. This chapter may be especially useful
for solution-focused therapists who are not familiar with family approaches.
The third chapter is an overview of the Solution-Focused Brief Therapy
approach. Beginning with a short description of the development of the
approach, the concepts and practices are described in detail. Emphasis is
on seeing SFBT as an approach, a description of what is done with clients
rather than a theory or Theory.
The fourth chapter explicates SFBT within a systems paradigm. System
concepts and ideas are used to understand SFBT concepts and practices.
The fifth chapter is a demonstration of SFBT with families and couples.
Each step is explicated with ideas from both SFBT as well as systems.

xii
 Preface

The sixth and final chapter shows how SFBT can be used with the
described family therapy approaches. Not all people who read SFBT lit-
erature are interested in using the approach in its more “pure” form. This
chapter shows how different practices can enhance family therapy through
demonstration with several family therapy approaches.
I hope that this book piques your interest in system thinking and in solu-
tion-focused ideas. It brings together my two professional passions and I am
happy to offer it to you. Much of what follows is reflective of extensive reading
and integrating from systems, cybernetic, solution-focused and other books,
articles, and chapters as well as attendance at international conferences and
conversations with solution-focused colleagues all over the world. Influences
include Ludwig von Bertalanffy, Gregory Bateson, John Weakland, Paul Wat-
zlawick, Richard Fisch, Janet Beavin Bavelas, Steve de Shazer, Insoo Kim
Berg, Frank N. Thomas, and others cited in text and listed in a bibliography.
I want to thank my professors, students, clients, and colleagues who have
accompanied me along this journey. Thank you to Frank N. Thomas, for
many hours of discussion and emails, writing with me, and being a great
colleague and friend. Thank you to my colleagues in the Solution-Focused
Brief Therapy Association. Without the Association, I would have missed
out on learning more about the approach as well as opportunities to meet
wonderful people all over North America and the world. For my colleagues
in the European Brief Therapy Association, thank you for providing a dif-
ferent enough perspective on SFBT to make a difference for me and my
thinking as well as my practice, teaching, supervising, and writing. Thank
you to Tomasz, Artur, and Jacek in Poland for opportunities to present, meet
wonderful people, travel and eat together, and great conversations. I want to
especially thank my solution-focused knitting friends. Thanks to Terry Trep-
per for getting me started on the book-publishing part of my career, and to
Steve de Shazer and Insoo Kim Berg for sharing their incredible wisdom,
experience, and talents, as well as good food and great conversation. I am
most grateful to my friend and colleague, Dale Blumen, for reading earlier
drafts of this book and giving helpful feedback. Finally, I thank my husband,
Victor Nelson, who has shared this journey with me (even playing ping-
pong in China!) and who has ideas that are different enough from my own
to be interesting and useful.
Santa Fe, New Mexico, USA
June 2018

xiii
 1 Systemic Thinking

Systemic thinking (von Bertalanffy, 1968) is a worldview, a lens, a para-

digm. Often presented as theory, systemic thinking does not present testable
hypotheses, constructs, or explanations and therefore is not a theory. The
concepts lead to a way of thinking and seeing things not as isolated parts
operating autonomously, but as residing in contexts and relationships with
other parts, each interacting with, affecting, and being affected by all others.
Systems are groups of parts and their relationships to each other that,
when viewed together, have a meaning and purpose that cannot be under-
stood by observing the parts separately. Mechanistically, such a group might
be something called a car. We can lay out the parts and see metal, plastic,
tubes, cables, round things, square things, and so forth. However, unless
and until these parts are put together and we see how they relate to each
other for a purpose, they are not a car—they are just a bunch of things.
A human system is a group of individuals with a purpose related to a
task. For example, we might see some people at a table listening carefully to
someone at one end of the table. We might call this a committee, although
without knowing its purpose and context, we can’t really know; it might be
a class. Each person has a role, each relates to all others in some way that
helps describe the group as a whole, and their interactions together serve
some purpose related to the aim of the group such as organizing an event
or learning about something. Now, we could take the same people and put
them all into a restaurant at a table with food. They are the same people,
but no longer function as a committee or class. Rather, we may see them as
friends at dinner with no particular hierarchy, but still relating to each other,
this time around food and general conversation. The “leader” in the other

1
Systemic Thinking

setting no longer serves in that role. Members relate to each other differently
than when they are interacting as a committee or a class.
This notion is called wholeness, sometimes described as “the sum of the
parts is more than the whole,” or “the sum of the parts is different from the
whole.” In order to understand the whole, we need to understand the pur-
pose of the group, the roles each part plays, and the rules for the way the
parts interact with each other. Each part interacts with all other parts, influ-
encing and influenced by all other parts, by the interactions of other parts,
by the meanings that arise from interactions, by the purpose of the group,
and by its context.1

Our Lenses
When we look at parts—such as individuals—especially those that have
been labeled or described as problematic in some way, we tend to see the
parts through the lenses we have been taught, often in terms of psychology
and biology. These lenses can lead us to logical conclusions that fit into
the systems of thinking and describing that we have learned. For example,
we may have been told that a child “has” Attention Deficit-Hyperactivity
Disorder (ADHD; American Psychiatric Association, 2013). In our minds,
we tend to see fidgeting, distracting behavior, reports of problems in school
with friends and schoolwork, difficulty focusing, frustration for teachers, and
worry for parents. If we watch the child in a classroom, we might see inter-
actions with other students, concentration on a particular object, gazing out
a window, and a swinging foot, as well as other children and their behaviors,
the teacher and his or her behaviors, the setup of the room, the noises both
inside and outside, and so forth. With the notion in our heads of ADHD, we
might actually “see” the child’s actions as evidence of ADHD and nothing
else. Our pre-judged ideas based on our education, experience, and reports
about the child make us actually, literally see things a certain way. We may
automatically label something as attention deficit or hyperactivity. Without
these prejudgments and labels, we may see the child very differently: social,
dreaming, thinking about something, bored, interested in something in the
corner or another child.
If we view the same child at home with family at dinnertime, we might see
giggling with a sister, poking or arguing with another sibling, asking father

2
 Systemic Thinking

questions about something, and asking for more potatoes. What judgments
might we make about what we see? What explanations might we have? Fur-
ther, if we have the family with us in a therapy setting, things will look dif-
ferent still as people take on different roles in the process called “therapy”;
the child’s behavior will look different to us because of our lenses, and to
the family because of theirs.
One time, when I was teaching on-site practicum for a master’s program,
we saw a family for a fifth session. As usual, the mother took charge, com-
plaining about one of the children and the crisis of the week. The four chil-
dren operated in various ways, alternating boredom with attention to the
mother and therapist, and arguing with each other. The child on the current
“hot seat” tried to interrupt her mother and was shushed. The mother talked
fast, scolded her daughter, and hardly let the therapist speak. The session
appeared to be in chaos with other children twirling in their chairs, hid-
ing behind drapes, and teasing each other. After the session, our practicum
group went to dinner before conducting other sessions. At the restaurant, we
saw the same family. The older children were helping the younger ones with
their meals, the identified child during the session was talking to the mother,
who was calm and listening. The family-in-therapy did not appear to be the
same family-eating-in-a-restaurant.

System Concepts
Following are a number of system concepts that may be helpful at enlarging
perspectives as we work with clients. For more detailed discussions, I refer
you to some of the literature listed in the bibliography.

Wholeness

Wholeness is the idea that the whole is different from the sum of the parts—
it’s the parts plus the interactions and relationships among the parts plus
the context of the system. It consists of many different subgroupings or sub-
systems and resides in a context called a macrosystem. The client family
described above can be seen as two different families, each depending upon
context and the ways that people interact with each other as well as their
relationships. In therapy, the relationship between mother and daughter

3
Systemic Thinking

appeared to be very hierarchical; in the restaurant, it appeared to be more

collaborative.
Systems are made of parts that often are organized into subsystems. Chil-
dren in a family form a sibling group, and grownups form subsystems that
may be called couples or parents, depending on the particular interactive
situation and purpose. Females form one group, males another. In large fam-
ilies, there often are the “older ones” and the “younger ones.” Within the
subsystems are individuals, who also have subsystems: biological, psycho-
logical, cognitive, and behavioral. Each of these subsystems may have yet
further subsystems, and so on.
The group as a whole can be seen as a subsystem within larger systems:
neighborhoods; schools; work; churches, synagogues, or mosques; com-
munities and even larger communities. Some of the subsystems are more
involved in some larger systems than others. Children, for example, may
be more involved as students in schools, members of peer groups, or par-
ticipants in sports teams or other groups. Parents as individuals or together
may be involved in politics, interest groups, hobbies, and so forth. People of
similar races, ethnicities, political or interest groups, social location identi-
ties, and so forth form systems. Each of these groups may be subsystems of
even larger groups such as associations, states, countries, political parties,
ethnicities, races, and so on, and may overlap with other groups. The lists
are nearly endless with individuals and subgroups having different identi-
ties, functions, and roles in each system or subsystem and influences on
each other.

Boundaries and Rules

Each system and subsystem is defined by its boundaries—the invisible lines

that separate groups and subgroups. The rules for what makes up these
boundaries are often unspoken but are very powerful: Who is in a group
and who is not? What may each person do within a group and what must
they not do? Whom may they invite into the group and whom may they not?
For how long? For what purpose? What are the rules for the person entering
the group temporarily? Permanently? What are the consequences of break-
ing the rules? What are the mechanisms for changing the rules (metarules)?
Mechanisms or rules about changing the rules are called metarules—
rules about rules. Metarules include things such as who can change rules

4
 Systemic Thinking

and how. Rules in families may change easily but metarules tend to be
less flexible. In therapy, we are tempted to help families change their rules
(let children have more say in their lives; encourage parents to take more
charge), which may be sufficient for resolving their difficulties. However,
changing the metarules typically results in more lasting change as well as
in more flexibility or adaptability of rules in the future when other changes
present challenges.
For example, families may have difficulties resolving a child’s school
problem. Rather than focus on the child and changes he or she needs to
make, a family therapist would focus on the family, not as the cause of
the problem, but as perhaps maintaining the problem and certainly as
involved in change. The father may have ideas about how the child could
change, the mother other ideas, and the children still others. A therapist
might help the parents engage in more homework time with the child or all
children. In this case, the rule addressed would be “how homework gets
done.” And this may be sufficient. However, if the parents are in disagree-
ment about who is going to help or enforce homework and how that help
will look, and the mother refuses to participate in a discussion about this,
the therapist may see a metarule that mother is in charge of this function in
the family and changing who works with homework and how isn’t going
to change unless mother agrees. It might be different if the stated difficulty
in the family is one of the children’s misbehavior around family tasks or
curfew.
Metarules are often unspoken but very powerful. By focusing on the
metarules around how rules are made, who is in charge of what in the
house, and so forth, the therapist may be able to help the parents operate
more as a team so that the metarule of mother-in-charge changes to parents-
as-a-team, which will change boundaries in the family and the dynam-
ics around homework (and other things) in a dramatic way. We call this
second-order change, discussed below. Settling for first-order change may
result in short-lived changes and no overall resolution of the difficulties the
family experiences, especially when those difficulties are maintained by
patterns of interaction or family dynamics that have not been addressed.
Second-order change results in a change in the system itself—it becomes a
different system (e.g., a system where decisions around schoolwork include
parents as a team rather than decisions around schoolwork being made by
one parent). This altered system has different boundaries and rules about the

5
Systemic Thinking

boundaries. The parenting subsystem about schoolwork now includes both

parents instead of only the mother.
Boundaries may be open, closed, or exhibit varying degrees of permea-
bility, with rules governing their nature. Open boundaries allow information
to go between subsystems or systems easily; closed boundaries allow no
flow of information or so little that its almost imperceptible. In the movie Vir-
gin Suicides (Soffia Coppola, 1999), the family had such closed boundaries
and rigid rules that the sisters had no room to be individuals or schoolmates
with other teens, to grow as children naturally do. In one scene, the parents
had decided that one of the girls could “date” a boy, but it had to be in their
house with the whole family. Watching a movie, the girl sits on one side of
her mother and the boy on the other, with the mother sitting on the edge of
the couch between them like a barrier.
In another family, the parents might not even know where the daughter
is—a more open boundary with more flexible rules or perhaps no rules at
all about how people are connected to each other. In this kind of situation,
the saying is that the police come to the door with a child and the parents
didn’t even know the child was not home. These are very loose boundaries.
It would be very easy to see each of these families as dysfunctional, but
we cannot be judges of that, we can only describe what we see. Each family
might be quite functional in itself for many things, although perhaps with
some challenges for others. Our judgments about the appropriateness of the
family’s way of being are typically based on our own cultural values and
beliefs and may be more or less rigid or loose than the family’s.
When a system enters therapy, they often describe one of the members
as “the” problem or as causing problems in the family. However, by look-
ing at the system as a whole, describing it in multifaceted ways with sus-
pended judgment, we have choices about how we characterize the system,
the members in it, their boundaries, and their system rules.
It is easy to see individuals or isolated interaction patterns as problematic
or as causing problems. Problems identified this way often lead to ther-
apy that does not include observations of their contexts, especially when
the theory or approach to therapy focuses exclusively on one person’s biol-
ogy, thoughts, feelings, or behaviors. When we see problems in context,
we see interactions among members of a family or other group and with
larger systems; we see relationships; we see values, beliefs, culture, family

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 Systemic Thinking

norms and rules, family stresses, other individuals who could also be seen as
problematic, resources and constraints from outside the family, and so on.
We understand the complexity of the whole system of individuals and their
interactions and relationships.
It also is easy to see some families as dysfunctional based on judgments of
what is normal and functional from a societal or cultural view of boundaries
and rules. I believe that the families we see in therapy are not so different
from other families. Rather, they are the ones who choose therapy or have
been referred by someone to help them resolve their difficulties. Other fam-
ilies, faced with similar challenges, may find other ways to resolve their
problems, ones that do not include therapy. Based on our theories about
how problems develop, what needs to change for them to be resolved, and
how that change will occur, we often see dysfunctional boundaries (too
permeable, too rigid) or skewed structures and rules (children in charge of
parents, father and child in charge of mother). A common such structure is
a child who has responsibility for younger siblings such that he looks like a
“parentified” child. But it may be necessary for the child to care for younger
children because her parent(s) are overwhelmed with other matters such as
a special needs child, ailing extended family members, a financial situation
that requires multiple jobs that leave little time at home, and so on.
In some cultures, it is much the norm for older children to care for younger
siblings, and in others, quite the opposite. Some views of boundaries as too
rigid or too loose are often based on cultural expectations. When a family’s
culture, values, and beliefs do not mesh well with the dominant society’s or
those of someone with power over them, there may be clashes. Rather than
viewing these boundaries and norms as inappropriate, from a systemic per-
spective we may see that the family is functioning quite well within its own
context and the only concern is based on the values and beliefs of a person
who is observing the family.
Semipermeable boundaries allow measured amounts and kinds of infor-
mation to flow through the boundaries. This is especially important in fami-
lies as children grow and circumstances change. There are rules about what
this information might be and with whom it is shared. In parts of our society,
for the most part, children do not know much about certain aspects of their
parents’ lives. This may be sex, finances, or relationships with extended fam-
ily or other adults. Other knowledge, however, such as what kinds of things

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the family likes to do together inside or outside of the house, indicate more
permeable boundaries.
Further, boundaries often change when there is stress. Losses in the fam-
ily, for example, may lead to a closing in of the family, a closeness among
members that wasn’t apparent before the loss. In other situations, such as a
hurt person, the boundaries may need to be looser to allow medical profes-
sionals and other helpers access with more than usual information going in
and out of the family.

Rules and Roles

We may be quick to judge through our observations but we must be care-

ful. Judgments are made based on our own experiences, values, roles, and
rules that form our ideas about what is and is not appropriate, often based
on norms in the larger societal or cultural context. Certain things may not
be appropriate to us, but quite acceptable to others. For example, when
I was growing up, we had family dinner at 6:00 each night. We each had
our usual place at the table, we ate using certain manners, and we did
not leave the table unless our mother excused us. I observed other families
when I visited them, families that did not seem to have “manners,” who sat
wherever they wanted, who reached for the salt instead of asking for it, and
who left the table and came back for no clear reason or without permission.
This looked like chaos and rudeness to me. I now understand that family
rules and norms are different in different families and are not necessarily
right or wrong.
Rules define roles: within each subsystem and system we have parts to
play, functions to serve, things we must, may, or may never do. When is it
acceptable for a child to act like a parent to other children? When is it not
acceptable? Which behaviors are acceptable in this role and situation and
which are not? When is it OK for people to switch or take on others’ roles?
Who is responsible for what functions? When? For how long? In what man-
ner? Is there flexibility for enacting roles or must they be done the same way
each time they are needed? Are they sometimes enacted even when they are
not needed? Who decides what changes are acceptable, and when might
those rules and roles change?
Most of these rules are unspoken and people adapt to them easily as they
change. This means that there are rules about rules and change (metarules).

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Metarules may be the most important kind in systems: How is change man-
aged? Many rules and metarules just develop over time as things happen;
others are brought into a nuclear family from families of origin and may
need to be negotiated. People come together for a certain task or purpose,
forming a system that may dissolve as soon as the task is complete or pur-
pose is served. Two people get married and begin to “fit” with each other
around roles, rules, tasks, and function; they are now less parts of their
families of origin and have formed a new family or subfamily. Children are
brought into the group and the original members must adapt, developing
new roles, rules for those roles, norms, processes, and so on.

Homeostasis, Morphogenesis, and Change

Homeostasis is a concept that describes stability of a system—the tendency

for the system to remain the same, although not necessarily static. We might
think of this as limited change in motion, a dynamic that maintains the sys-
tem’s equilibrium, adapting to small changes that do not require change of
the system as a whole. This can happen on a micro level with such things
as places where people sit at the dinner table or even whether and when
the family eats together. Another example might be gradual changes in chil-
dren’s bedtimes as they age. Or, homeostasis can be seen at a more macro
level: Over generations, what constitutes a “family” or group? After several
generations, none of the original members are alive, so is it the same “fam-
ily” or a different one? From whose perspective?
An important understanding of families as systems includes the idea that
change is happening all the time in small and large ways. How much change
is acceptable within homeostatic parameters and how much is allowed for
morphogenesis? With each change, the family adapts its parameters and
shape or growth, termed morphogenesis. This process allows the function
or purpose of the system to adapt to changing needs and circumstances in
ways that continue to support the individuals within the system in their own
changes and, at the same time, support the integrity of what is called “fam-
ily.” The system grows as purposes and needs evolve.
Boundaries in systems that have tight rules may be closed, or only closed
or “rigid” as perceived by others, and perhaps only for some functions.
Changes are not easily accomplished or adapted to. When new informa-
tion comes into a system or develops from within (e.g., maturing children

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and their abilities to accept new roles and responsibilities), the system must
adapt. For example, at some age, children begin to have more influence over
their own lives, negotiating some rules instead of having them imposed. If
the new information is acceptable, it may require large or small adapta-
tions, but the system remains basically the same. If the new information is
not acceptable, it may be rejected in order for the system to have stability.
Some families have great difficulty accepting a grown child’s partner into the
family, and the partner may forever be an “out-law” with limited acceptable
interaction with family members. In some families, this may even mean
rejection of the child.
Boundaries that are very loose within a family may be perceived as allow-
ing too much information in or out. Such might be the case in what some
would call an “enmeshed” family—one with very loose boundaries inside
the system and a more rigid one around the system. Children know a lot
about what’s going on in adults’ lives, and parents are very involved in their
children’s lives.
However, in families—indeed, in most systems—boundaries are neither
overly rigid nor loose, but appropriate for the system’s purpose and needs
for functioning. In families, this means adapting to the natural changes
that occur with children’s development, new jobs or lost jobs, moves, new
friends, lost friends or extended family members, and so forth. Systems must
have rules and processes for maintaining the integrity of the system and
allowing some change but not too much or too fast. They have rules about
rules and rules about change (what constitutes change or a difference, when
and how rules change). How is new information adapted to the family and
how does the family adapt to the new information? What constitutes accept-
able change and unacceptable change? Acceptable adaptation and unac-
ceptable adaptation? How is change managed?
One purpose of families, as perceived by anthropologists and sociolo-
gists, is the protection of children and, at the same time, the socializing
of the children into the larger community. In parts of society, this is often
shown through children’s ages and abilities as the family adapts by gradually
increasing experiences, responsibilities, and privileges that children have,
starting with day-care and playdates, moving to preschool and kindergarten,
then into elementary, middle, and high school. At some point, the norm
may be for children to move out of the nuclear family into trade or further
education, and then, perhaps, joining with others to form new families. At

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some point, either gradually or quickly, children’s autonomy and rights to

self-govern change.
Other changes may be instigated from outside the system: involvement of
a school or the judicial system, health problems, a job change, a move to a
new neighborhood or community, the death of an extended family member,
a new member coming into the family. These changes also require adapta-
tion and often involve a period of disruption before the system settles into a
new homeostasis and set of rules.

Equifinality

For all changes and functions or purposes, the system develops processes
for promoting or managing them. Groups have ways for getting things done,
and there may be greater or less flexibility for how they get done. For exam-
ple, in families, food must be provided, but there may be many ways for this
to happen. This is called equifinality or the idea that there are many ways to
accomplish a particular end. As with boundaries, roles, and rules, the pro-
cesses may be more or less acceptable or even workable for a given family.
Expecting a 3-year old child to fix a meal for herself may not be reasonable
without help, but expecting an 11-year old to manage her own meal may be
quite acceptable. In each case, the end is the same—food for the child—but
the means differ.
As children grow, they typically need more time with friends and less
with the family, and the family must adapt to this change. But there are
many ways to do so. For example, some families prefer meeting children’s
new friends and their parents before allowing a child to visit a friend’s home.
In other families, such a visit is considered minor, and such “previewing” is
necessary only if the other family is taking the child on an outing. Values,
experience, many contextual variables (e.g., nature of the community), and
whether others’ ideas are sufficiently similar are also parts in systems and
have influence over interactions and decisions.
For therapy, equifinality also is an important concept. Therapists must
constantly attend to what is working toward clients’ therapy goals and what
is not. Therapists need important skills for adjusting to different interven-
tions or techniques, working with different groups of family members or
with individuals, inviting other people in for sessions, or changing therapy
approaches altogether in order to meet therapy goals.

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Process Versus Content

The reason for focusing on hows (process) rather than whats or whys is partly
due to another concept we use in terms of focusing on process or content.
Content refers to the topic at hand—providing food, planning an agenda,
or financial problems. From a systemic perspective, we are more interested
in the interactive dynamics of how things work, how people interact, how
decisions are made, how purposes are served, and how ends are met rather
than individual people and their behaviors or concerns. Because we under-
stand equifinality, we believe that there are many ways for things to work
and that we are not necessarily the judges of which ways are most appro-
priate for a given situation or family. Within certain limits, mostly related to
the safety of everyone involved, we focus on processes and how they may or
may not be helpful for certain purposes rather than blaming individuals for
their roles in the matter. When we focus on content, we become judges of
how things should work, whether the family should be focusing on that con-
tent or something else, and who should be making what kinds of changes.
When we focus on process, we pay attention to how family members inter-
act around the perceived problem and help them change their interaction so
that they can solve their problems.
For example, as therapists, we are often faced with labels and diagnoses
that have explanatory usefulness, but not necessarily usefulness for change.
The “ADHD” child may live in a family where there are lots of supports or
none, parents who prefer medication to those who don’t, varying resources
for helping the child, and so forth. Because of equifinality, we focus on how
things are done and whether that works in ways that reach the desired out-
come. Because of equifinality, we understand that there are many ways to
reach desired ends and that processes for arriving at the ends will depend
to a great extent on the values, beliefs, norms, abilities, resources, and so
forth to which the family and school have access. If we get caught up in the
content, on the label of ADHD, we are likely to put on our “expert” hats
that suggest that certain processes are best or better than others, that we
know what those are, and that the family will be able to utilize them even
when they don’t fit the family’s values, rules, and norms. If changing the
rules and norms may be useful, we will help the family more by focusing
on their processes than on being experts on the topic (content) and telling
them what they should be doing. As a small example, some families find

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that adjusting diet and paying more attention to helping their children man-
age their emotions and behaviors, easing parental scolding, and allowing
free play in contained situations fits their values more than medication and
specified parenting methods.
However, because of all these complexities we have discussed, roles and
rules, boundaries, norms, and context, we are more able to see that our
function with families is to help them find ways to reach their goals, and
that the processes for reaching those ends must fit within acceptable limits
of the family.
As a new family therapist, I learned to judge and diagnose family pro-
cesses derived from their ways of doing things, as more or less functional
or dysfunctional, often either good or bad. These judgments and diagnoses
came from studying various family therapy theories and approaches to ther-
apy as well as using my own values and beliefs as touchstones. By simply
observing families and helping them determine processes that work and
don’t work for themselves, based on their ideas rather than mine, I am now
being truer to the notions of equifinality and morphogenesis. Each family
must find its own way of developing within acceptable limits, of developing
new processes or rules and roles, and for determining for themselves both
what they want (content) and how they get there. If new ideas don’t work, as
a therapist, I can stand by to re-examine the process without judgment and
help the family work out processes that will work better for them.
By honoring the family’s definitions, by not getting caught in the “shoulds”
of content, I am more able to be of service. Of course, because I have edu-
cation and experience, I may be able to steer them away from potentially
dangerous processes and ends, and may be able to share what others in
similar situations have found useful, but my expertise is more along the lines
of helping them find their way than telling them which way to go (which, by
the way, I have tried and has seldom worked in my practice).

Isomorphism

Isomorphism refers to the notion that patterns of interaction in families, the

way they interact with each other, are reflected in several different areas of
the family’s functioning. That is, the way the family makes decisions—their
patterns of interaction—are similar whether the topic is what to have for
dinner or where to go on vacation. I describe patterns in more detail in

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the next section on cybernetics, but for now, suffice it to say this is import-
ant when working with systems because change in one area of interaction
can easily be reflected in others. Sometimes, when parents bring children
to therapy, it appears to us that the “real” problem is the way the parents
interact with each other—the marriage. However, because of isomorphism,
we may be able to help the parents be a better team in making decisions
and enforcing rules around parenting, the topic they came to therapy for,
and the changes they make in their parental teamwork may transfer to their
marital teamwork. This is quite helpful, because it means we don’t always
need to know everything about the family’s interaction patterns to be help-
ful to them.

Cybernetics
Cybernetics is the study of feedback mechanisms in self-regulating systems
(Wiener, 1948). A self-regulating system is one that is able to maintain itself
or its homeostasis. A common example of a self-regulating, homeostatic
system is the temperature function in a home. A thermostat serves to govern
the amount of change allowed before regulating functions kick in: When the
temperature of a room (one of the parts) goes higher than the thermostatic
“rule,” the furnace is triggered to shut off and perhaps for an air conditioner
to activate. When the temperature goes below a threshold, the air condi-
tioner is shut off or perhaps the furnace is activated (parts are activated to
interact with other parts that allow fuel to enter the system, pilot lights ignite
the fuel, etc.) until the temperature again rises above the higher rule. When
the temperature reaches the higher level . . . and so forth. The plus and
minus allowances of the system are built in so that there is some flexibility
and furnaces and air conditioners are not constantly running.
Applied to families and using a system lens, boundaries are usually less
easily regulated because many more factors are at play, and change is con-
tinuous in both large and small ways. The rules that govern the family are
similar to the rules that govern thermostats, although much more complex.
The thresholds that trigger activation of certain rules or actions are based
on many more factors than the temperature of a room and change with
circumstances. For example, 2-year-old children are typically not allowed
to stray as far from their parents as 12-year-old children, depending on

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circumstances (playgrounds and family homes are typically different from

crowded amusement parks and other people’s homes).

Circularity

We cannot say that the thermostat or the furnace or the air temperature
cause the system to work the way it does; each fulfills its function as trig-
gered by other parts and in combination with those parts. This is called cir-
cularity or circular causality. Similarly, in families, we see circular patterns
of interaction. It’s easy to say that a child’s behavior is causing the disruption
in the family. However, when viewed as only one part in a whole, we begin
to see the context, complexity, and perhaps function of the child’s behavior:
it likely makes sense given its context. For example, a child may have more
difficulty falling asleep when the parents are experiencing some distress,
whether that is verbal or just “in the air.” We can’t say that what led to the
parents’ distress caused the child to have trouble sleeping, and it is quite
possible that the child’s sleep difficulty exacerbates the parents’ distress,
leading to even more difficulty on the child’s part. We also don’t know about
other factors that may affect the sleep difficulty or the parents’ stress: a room
that is too dark and “scary,” parents’ distress over finances, marital prob-
lems, extended family health matters, another child’s problems, and so on.
Another example in families is when a teenager takes a parent’s refusal to
let her do something as “control.” She stomps off to her room and slams the
door. The meaning control influences her next interaction with her parent.
Further, the meaning the parent derives from the interaction (disrespectful
child) also influences the next interaction. I’m sure you can picture a possi-
ble next interaction: the teen says (with attitude, which the parent expected),
“I don’t suppose you’ll let me . . .” and the parent says, “Not as long as you
take that disrespectful tone with me.” Who is to blame? Neither. It’s a circu-
lar interaction where meaning is one part. Each affects the other, which is
called reciprocity, and the pattern repeats itself, which is called recursion.
In a linear perspective, we look for the causes of problems, believing
that we must find the causes in order to resolve the problem. The medical
model and our typical Western way of thinking have promoted this, and it’s
important in some instances (appendicitis, for example). However, when
we look at the larger picture of human behavior, relationships, and context,
we see many factors. Can we say that the teen in the previous example is

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disrespectful and that caused the mother’s refusal (there could have been
another reason but that didn’t get into the discussion before the teen stomped
off)? Can we say that the mother is stifling the daughter and that caused the
daughter to stomp off? We need to know much more about the family’s typ-
ical dynamics, the context of the request including what has happened in
other interactions, the relationship between the mother and daughter, how
the father’s perspective or behavior might influence what’s going on, and so
on. It’s just not as easy as diagnosing an inflamed appendix.
Similarly, if daughter tells her mother about something difficult that hap-
pened at school, and mother is sympathetic, daughter may feel comforted.
The next time something difficult happens at school, the daughter may be
even more willing to tell her mother, expecting a comforting response in
return. Mother is pleased that daughter is willing to come to her and so
repeats the comforting. The daughter’s request for something may be met
with a very different response from her mother.

Recursion

Recursion is a concept that relates to circularity. It means that A and B

respond to each other in interaction in repeated ways and that responses
influence the system as well as other interactions. Again, we cannot say
that the interaction causes an outcome in a linear way, but we can say
that the outcome and its meaning are fed back into the system, influencing
ensuing interactions in patterned ways. For example, a child delays home-
work until bedtime, father scolds, child cries, father relents, and the whole
pattern repeats itself the next night. The pattern on the first night influences
the pattern on the second night. It may be replicated or change in small or
large ways. We can’t say that the child’s crying causes the father’s relenting,
or that the father’s relenting causes the child’s delay of homework the next
night, or that this pattern caused a change in either’s behavior ever. How-
ever, because it is a repeating pattern, it is worth looking at. The pattern also
is contained in a context of a number of other things, including the child’s
experiences at school, what the mother is doing, what the mother and father
may have discussed about homework or the pattern itself, etc. In therapy,
we are able to see the pattern differently from the family and help them see
it as systemic rather than blaming the child or the father and requiring that
the person at fault must change.

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Feedback Loops

Feedback is a cybernetics concept that is often confusing because of its

name. It is not referring to the colloquial use of the term, whereby we cri-
tique something and provide either praise or criticism. To further confuse
things, the cybernetic term also uses adjectives of positive and negative to
qualify the meaning of the term. In the colloquial sense, positive feedback
is considered good and negative feedback bad or at least not-good. Not so
in cybernetics.
In a cybernetics sense, feedback refers to information that is the result of
an interaction being fed back into the system (the loop). This new informa-
tion may affect the homeostasis of the system in terms of maintaining it or
allowing change such as morphogenesis. However, the information needs
to be a “difference that makes a difference” (Bateson, 1972, p. 453) in order
to effect change. A child’s request to change primary sports might not make
much difference. A request to change to a sport the parents disapprove of
might make a very big difference.
Positive feedback is the result of a change that the system is able to allow,
adapt to, or even welcome; the rules of the system are flexible enough to
adjust to the change, whether minor or significant. Change is OK and ampli-
fied: it’s acceptable for the child to request a different sport and, in fact, may
show growing maturity that the parents like. Positive feedback is not the par-
ents’ saying something like, “That’s a good choice” (colloquial feedback) but
the metamessage that the change (the child is making this request instead
of the parents’ imposing the change) is acceptable: the system is accepting
the change in the rule that parents decide sports activity whether spoken or
nonverbal. The positive aspect is that the change is a change in a rule and
is amplified.
Negative feedback is the result of a change that the system is not able to
allow or adapt to; the rules of the system are such that the change is damp-
ened so that the system can maintain its homeostasis. Using our example of
a child’s request for sport choices, the child may choose something and the
parents do not approve this change. This may be breaking the rule that par-
ents choose children’s sports activities, in which case whatever message or
metamessage is given would dampen the change, returning the system to its
most recent homeostasis. The child is not likely to make such a request later.
Again, the change is not necessarily words from a parent such as, “You may

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not attend that sport; you must attend the ones I chose for you”; the message
may come nonverbally such as raised eyebrows and the dreaded, “Do you
really think that’s a good idea?”
Positive feedback can result in adapted systemic change that is not good,
even dangerous, such as a young child who suddenly comes and goes
whenever and wherever she wants, even late at night or the parents’ not
knowing where she is. If the parents or other aspects of the family system do
nothing to dampen this change, to send a message that this new behavior
is unacceptable within family rules, the result is positive feedback that the
change is acceptable.
As you can probably see by now, negative feedback in response to a
change such as the one described above can be good: the child receives a
message in some form that this new behavior is not acceptable. Coming and
going at will is not acceptable for young children (negative feedback that
is good). Understanding positive and negative feedback helps the therapist
observe the family’s process and stay out of content matters such as at what
age children may have more control over their own lives and focuses on the
family’s dynamics around such issues according to its purposes and func-
tions. When potential harm may be involved, the therapist may point this
out to the family in terms of consequences of their decisions: they may be
reported for child neglect or abuse. If the family accepts this, therapy may
focus more on outcomes and how decisions are made that promote positive
welfare of the individuals and family as a whole. If the family rejects this
information, the therapist may be placed in a position of needing to report
the potential neglect and/or the family does not return to therapy.
Moderate changes may go either way depending upon a variety of factors.
For example, a 13-year-old child may be used to a certain bedtime, and, at
the beginning of a school year, ask for a later bedtime or even a curfew. This
signals at least two potentially important changes: later bedtime or curfew
for the child resulting in other consequences, perhaps, for the parents such
as not having as much alone time in the evenings, or for the child to take on
more responsibilities in the family. It may also result in insufficient rest for the
child. A second and systemically-oriented change may occur that the rules
of the family change: the child may now participate in changing the rules,
which is a change in the rules about who may influence the rules—a meta-
rule. The parents would discuss the situation and decide that the requested
new bedtime is not acceptable but that they and the child can talk about a

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number of things related to bedtime, responsibilities, consequences, and so

on, perhaps leading to the child’s earning a later bedtime or a probationary
time. Prior to this, the rule was that the parents made decisions about bed-
time; the new rule is that children may negotiate some rules with parents.
This is a change in the metarule and signifies a fundamental change in the
system—it’s now a system with parents and children negotiating rules.
In this sort of case, the potential rule and metarule changes affect many
aspects of the family and may call for further family negotiation, another
rule, this one about how rule changes are made. The ripple effect can be
extensive, particularly during times of big changes such as when children
become teenagers or move out of the house, or when someone dies. Most
families and even therapists do not pay sufficient attention to metarules,
focusing instead on content issues and sometimes getting stuck in less pro-
ductive cycles of first-order change (see p. 20). In addition, many of these
changes in systems occur without any thought about them—they just change
and life goes on in new ways without comment.
These concepts can get very confusing: rules, metarules, changes, positive
and negative feedback, and so forth. And most families negotiate changes
rather easily. There will be adjustments (remember that change requires
adaptation, which is change) and some may be more uncomfortable than
others, necessitating more discussion and negotiation. This process is called
morphogenesis or the growth of a system as it adapts and changes its ability
to adapt through many cycles of positive and negative feedback, changes in
rules and metarules.

Pattern and Sequence

Pattern refers to the dynamics we see in systems that occur repeatedly over
time and across content areas (recursion). Sequences are the recurring and
circular actions that take place among the parts of the system and are typi-
cally predictable. For example, a child misbehaves  parents deliver conse-
quences  the child objects  one parent responds one way to the child’s
objection and the other parent responds differently  later, the child mis-
behaves  and the dynamic repeats itself. This may look like a circle or an
infinity sign:

A∞B

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Systemic Thinking

I, personally, like the infinity symbol because I think it is easier to under-

stand how communication and patterns cross each other, changing meaning
and outcome, thus affecting the next occurrence of the interaction. I some-
times explain that the meeting point is usually related to meaning. A says
something and it curves around to reach B, who makes meaning of it. This
meaning is affected by a host of things: previous interactions between A and
B, the particular topic, other aspects of the context including culture, and so
forth. Therefore, B may not hear exactly what A intended to convey. B then
acts not on what A intended, but what B heard and responds to that. This
communication act also curves toward A, with A hearing not necessarily
what B intended but what A thinks B meant and responds in kind. Remem-
ber the game of telephone where someone whispers a phrase to the next
person in a circle, the next whispers to the third, and so on. And then we all
laugh at what the last person claims was the phrase. Except in families, it’s
not always funny.

Punctuation

When a family recursively repeats patterns, there is no starting or ending

point, only circularity. We have a tendency, however, to “believe” that there
is a starting point: “it all started when . . .” This is called punctuation: We
punctuate the beginning as the initial cause and the end as the result. How-
ever, if we punctuate the beginning elsewhere in the sequence, we can see
that there are many ways to understand so-called cause and effect. Does a
nagging parent cause a withdrawing teen? Does the teen’s withdrawal cause
the parent’s nagging? Which comes first, the chicken or the egg?
By punctuating sequences in different places in therapy, people may be
freed from their frustration about blame and become more easily able to
see, admit to, and change their own parts of the sequence interaction.

First- and Second-Order Change

Change can also be seen in terms of systemic quality. First-order change is

like changing from toast to bagels for breakfast. A change, perhaps even a
significant one for someone (lox on bagels may taste much better than jam
on toast), is still rather minor in terms of the system. One parent’s making
decisions about children’s curfew and then switching to the other parent’s

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making the decision is still “one parent makes decisions.” These are system
rule changes typically signifying first-order change.
Second-order change is a change in the rules such that the system itself
changes—change in the rules about the rules, or metarules. Using the above
example, at some point the parents may decide that it is necessary for them
to act as a team in making certain decisions. They may decide that it is
acceptable for children to negotiate their own breakfast or curfew and other
rules. This is a change in rules about rules: children at a certain age or matu-
rity may participate in making rules. This kind of change occurs as children
get older and changes in the family’s life cycle require changes in metarules.
The system itself is different and would have great difficulty going back to
old metarules.
Another example of second-order change occurs when something so
significant in difference occurs from outside the system that the system’s
ability to adapt is challenged. If a family goes from two parents to one, or
a new adult comes into the family, or even a new child or other person,
the whole system must adapt with significant changes in both rules and
metarules. A family’s inability to adapt to such changes may present as
physical, mental, behavioral, and/or emotional difficulties for one or more
people in the family, or in the family as a whole. Family therapists rec-
ognize that anxiety, depression, acting out, or even violent interactional
patterns are not “caused” by such changes, are not necessarily solely the
problem or blame of one member or another or event, but result from sys-
temic changes that require adaptation that the family is not able to make
effectively.
Some people seem to think that first-order change is change in behavior
and second-order change is change in thinking. This is a linear way of look-
ing at first- and second-order change, although it certainly can appear this
way. Rather, first-order change is change within a system and second-order
change is a change of the system so that it is no longer the same system.
First-order change is moving the deck chairs around on the Titanic, and
second-order change is adding lifeboats. First-order change is helping parents
develop different consequences for their rules without seeing the broader
picture. Second-order change is helping the parents determine whether a
child is ready to participate in making the rules and, perhaps, the conse-
quences for breaking them. The system changes from parents’ making the
rules to parents and children negotiating the rules together.

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Systemic Thinking

Communication Theory
Axioms

There is much about communication theory (e.g., Watzlawick, Bavelas, &

Jackson, 1967) that we could discuss in relation to system thinking and
cybernetics. For our purposes here, it is sufficient to focus on concepts that
are most directly perceivable in circularity, sequences, and patterns. These
are the “tentative axioms of communication” that inform our understanding
of how people communicate in systems. Axioms are “established rule[s] or
principle[s] or . . . self-evident truth[s]” (Merriam-Webster, 2018). An exam-
ple of an axiom is “one cannot give what one does not have.” The statement
does not require “proof.” Therefore, the following axioms are presented not
as hypotheses or theory, but as assumptions that help us understand our
observations of interaction and communication among family members.

Can’t Not Communicate

Couples often come to therapy claiming that their problem is that they can-
not communicate. In fact, they are communicating a lot, but not effectively
toward whatever ends they desire. Even when someone says nothing, she
or he is communicating in a way that is a comment on the interaction: I
refuse to comment; what you say deserves no comment; I have no idea how
to respond to what you just said; and so on. The communication may be
ambiguous and not easily or correctly understood, but it is communication.

Content and Relationship Properties of Communication

The content aspect of communication, sometimes referred to as “report,”

is the topic being discussed. The relationship aspect (“command”) is a sys-
temic understanding of the nature of the relationship among the people in
the interaction as well as the particular situation, and adds information to
the content. For example, the statement, “your socks are on the floor” has
face-validity of socks on the floor. However, the meaning of this statement
depends upon several things, including the relationship between the people,
the tone of voice used, previous interactions (see the discussion of circular-
ity above), and other nonverbal factors because there are so many things
beyond words that contribute to meaning. For example, the statement may

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 Systemic Thinking

mean, simply, “your socks are on the floor” as communication to someone

who is looking for socks. Or it may mean, “pick up your socks” if the rela-
tionship is one of parent and child. The relationship between the people in
former may be equal in this interaction. In the latter, the speaker has author-
ity over the other person—the relationship aspect of the communication.

Punctuation

I discussed this concept earlier in the previous section of this chapter. It

­connotes a circular, repeated sequence that cannot easily be described as
starting at one point or another. Where we punctuate the beginning for pur-
poses of discussion may be arbitrary and intended to help interrupt the cycle
so that blame is not cast on the previously chosen beginning. Did the argu-
ment begin when he asked about her day, or did it begin the night before
when they had an unresolved argument, leaving her feeling frustrated and
alone?

Digital and Analogic Communication

Digital and analogic communication refer to different aspects of commu-

nication, one of which can easily be perceived (digital) and the other that
may have more subtlety or nuance (analogic). Digital communication has
direct referents: “chair” refers directly to something upon which one may sit.
Analogic communication does not have such clear referents and requires
more understanding about such things as relationship, context, and pre-
vious interactions. Analogic communication is typically nonverbal (coval-
izations such as “uh-huh” could be considered nonverbal) and quite open
to misinterpretation. It includes posture, tone of voice, loudness, gestures,
and so forth. The words themselves typically require context to convey the
speaker’s full meaning, and the receiver will have his or her own context
that may influence meaning different from the speaker’s.
Refer back to the infinity symbol earlier in this chapter. You might think of
it this way: Speaker A says something with an attempted meaning attached
through analog. The words, the digital aspect, can be said to be filtered
through contextual factors understood by Speaker B. Speaker B does not
respond to what A said directly, but to what B attaches to the words based
on the filter. Then B responds, but it is clear that B responds not to what
A intended to mean, but to the filtered communication. This response also

23
Systemic Thinking

has digital and analogic components and goes through another filter that
is A’s context. Therefore, A hears a response not necessarily related to B’s
intended meaning, but to what B heard as filtered, responded to, and was
further filtered before it reached A. Again, remember the game of telephone?
“I know you think you understand what you thought I said but I’m not sure
you realize that what you heard is not what I meant” (Alan Greenspan, n.d.).

Therapy: Systems, Cybernetics, and

Communication
Understanding systemic ideas permits the observance of recursive, circular
patterns, wholeness, homeostasis and morphogenesis, isomorphism, feed-
back, and so on, helping therapists in a variety of ways. First, instead of
acting as experts on a particular content or family’s dynamics, we become
experts on process in general. Observing the family systemically, we have a
multitude of ideas that keep us from becoming stuck in the family’s content
areas and recurring patterns. This understanding allows us to actually “see”
family dynamics in context, as wholes, as patterns, as influences rather
than causes, and to help families change dynamics that prevent them from
resolving their issues themselves. Equifinality encourages us to see the fam-
ily’s dynamics in multiple ways, each lending itself as more or less helpful
to resolving the family’s presenting difficulty. Getting stuck often results in
trying to “fix” the content or dynamic from an expert position, often without
success (the new information may not be appropriate or accepted by the
family). Finally, understanding these ideas can sometimes help us to explain
confusing dynamics to families without blaming anyone, which may help
them feel more empowered to change their own parts.
In family therapy, we don’t act as mediators, trying to determine who
most needs to change their part in the process, or exactly what changes
need to take place. We ask about the steps in the process around the dif-
ficulty and help the family change the pattern of the interactions and their
meanings. This change needs to introduce a significant difference so that it
interrupts the pattern in a way that the system cannot continue with the next
predictable step, and something else must happen. This “something else”
may not be strong enough to effect a large change at the moment but may

24
 Systemic Thinking

lead to other changes that are more beneficial. For example, encouraging
a teen to speak up for himself may not result in immediate change; how-
ever, as time goes on and the teen thinks about it more, he may try it. The
“something else” may also lead to a different cycle that is not helpful but
that may stir the system enough that a more beneficial change may or must
take place. The teen’s manner of speaking up may not be acceptable to the
parents but lead to another attempt with a different tone or attitude. Finally,
it may lead to something unhelpful, which must be evaluated and may result
in changing to a different way of interrupting the cycle. The particular thing
the teen speaks up about may be totally unacceptable to the family, or the
parents may determine that the teen is not ready to have this privilege.
A common intervention with couples who argue is to change the context
of the argument: sitting back to back in a bathtub, for example. Another
change may be the modality of the discussion from talking to writing let-
ters or taking a break with a set time for resuming the conversation, allow-
ing time for cooling off and perhaps absorbing what each other are saying.
Other common interventions include examining the sequential pattern and
asking each partner what she or he can do differently at each step. Changing
one part of the sequence requires that the ensuing responses must change.
Changing the pattern can interrupt similar patterns that are potentially very
serious. This is the helpfulness of learning about isomorphism. I explained
this kind of thinking to some clients who tended toward loud arguments
about finances that each feared were getting out of hand in ways they
didn’t like. I asked them about arguments or differences they had in other
aspects of their lives and assigned homework of making lists of differences
that didn’t matter much, differences that were so significant that emotions
tended to run high, and differences that could be considered somewhere in
between (Nelson, 1994). The next week in therapy, we compared lists and
I asked them to choose a topic from the middle area. Using this content to
find a way to change their pattern capitalized on isomorphism: If we could
change that pattern and perhaps practice it on other moderately tough areas,
they might be able to tackle difficult areas more easily or even on their own,
never needing to discuss the hot topics in therapy. The content wouldn’t go
away, but their ability to work together to resolve it would be enhanced. If
we discussed easy topics, the difference might not be different enough to
make a difference. If we worked immediately and quickly on difficult or

25
Systemic Thinking

“hot topic” areas, emotions might run too high and prevent an ability to
change the pattern of discussion, resulting in even more discouragement.
In another example of using sequences, the pattern went like this: She
came home from work before he did and started some household chore
such as laundry, he came home and asked when dinner would be ready,
she would say that she would start it after she finished what she was doing,
and he would say that she could do the laundry later and should start din-
ner earlier. She said that he could start dinner himself or get a snack, and
he would say that he needed to get the children started on homework and
didn’t have time, irritation and discord increasing with each part of the inter-
action. This repeated pattern had become very frustrating for both and it
escalated one evening when she slammed the dryer door, breaking it, and
he left the house.
In therapy, the couple were able to describe the pattern well, and said
it was similar to other argument patterns they had. I drew the pattern on
a piece of paper, explained what we were doing, and asked where they
thought each could do something different—themselves, not the other. I also
asked about the meanings and beliefs that were parts of the pattern. She
said that she could plan dinner and get ingredients ready before she started
laundry because he had said that he was frustrated partly because he didn’t
like planning the food and finding everything. Getting things ready would
mean she wouldn’t be starting dinner too early, he could move into getting
it started before he helped the kids, and she could take over when her tasks
allowed or at least they could discuss the situation instead of arguing about
it. He wasn’t sure what he could do and agreed to observe the situation
during the week and see what he could come up with.
The first night went smoothly (as often happens) and the husband started
dinner, and so forth. The second night, however, the wife was late getting
home, started the children on their homework (thinking that might be help-
ful), and he arrived home with no dinner ready to fix, tired and hungry,
and the old pattern started. However, she did not respond to his frustration
by arguing, he realized what was happening when she just looked at him
without arguing, so he went to the pantry, got himself a snack, and started to
simultaneously eat it and work with his wife on getting dinner things ready
so she could work with the children.
In therapy with people who tend to become violent, we are careful to
make determinations that some patterns not only maintain problems but

26
 Systemic Thinking

can easily get out of hand, especially once violence has been used by one
or both partners. In those cases, we interrupt cycles by asking people where
in the cycle they might be able to do something to keep themselves and
each other safe. We can give suggestions but have found that when people
choose their own interruptions, they do better.
I received a call from an emergency room late one evening. The person-
nel had noticed a couple in an intense discussion with a baby carrier and
baby sitting on the floor between them. They had determined that having
disagreements in public made it easier for them to keep them reasonable,
not hurting the other with words or actions, and more likely to result in good
outcomes. They didn’t want to do this in a restaurant where others could
overhear so, its being winter and rather late, decided to try a corner of an
emergency room where things were not very busy. Of course, an admitting
person asked what they were doing and they said it was part of their ther-
apy. I explained the situation to the person who called me, who thought it
was creative and went on about her work without bothering them but did
ask if they would like something to drink. This kindness on her part further
helped the couple to find creative ways to take care of their business without
escalation.
Getting away from each other—timeouts that have prescribed endings—
is also helpful. One man told me he got so angry sometimes that he didn’t
trust himself to drive and feared that police would notice him if he walked.
He feared arrest for intimate violence. So, he drove a short distance to the
police department, told them he was really angry and needed to cool off,
asking permission to sit in the police waiting area. Everyone appreciated this
interruption in the couple’s argument pattern.
Some couples become violent so easily that couple or family therapy is
not likely to produce change until other things such as substance abuse or
misuse have changed, including the ability of partners to take responsibility
for themselves and their actions instead of blaming the other or quickly
moving to violence. In those cases, individuals may benefit from separate
therapy on anger management or rehabilitation from substance use. It’s
very important with couples who have been violent to make sure to keep
both partners safe and not exacerbate violence patterns. There are many
resources for working with couples experiencing intimate violence from a
systemic perspective that keep the couple dynamics in mind while working
with individuals to reduce violence.

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Systemic Thinking

And So . . .
In this chapter, I attempted to describe some elements of systemic thinking,
cybernetics, and communication theory that impact therapy from a systemic
perspective. By seeing wholes, interactions, patterns, and meaning instead
of neurological or behavioral problems in ways that include identifying
causes so that specific interventions can be applied, we operate in a way
that honors each family, couple, or individual that we see—their unique
contexts, understandings and meanings of their worlds, and ways that may
help them with their concerns that incorporate those contexts in our inter-
ventions. For those who are interested in more in-depth descriptions, I refer
to the Bibliography at the end of this book.

Note
1 Many sources were used to develop this chapter and this book. Unless specified,
ideas are often found in many places. The Bibliography at the end of the book
may be useful for further reading and understanding.

28
 2 Family Therapy
Approaches

In this chapter, I describe a few foundational family therapy approaches and

an integrative approach that has a research basis. In each description, I pro-
vide the basics of the approach, how change is viewed, and typical inter-
ventions. The information is gleaned from many resources and produced in
common format by my Marriage and Family Therapy master’s students from
Utah State University. I edited the material for accuracy, comprehensive-
ness, and formatting. The entire document is reproduced in the appendix of
this book and may be used freely as long as credit is given to my students
and me. Seminal references for each approach are included in the charts.

Structural Family Therapy

Structural Family Therapy was founded by Salvador Minuchin, a psychiatrist
(e.g., Minuchin, 1974). He grew up in Argentina in a neighborhood made
up of family members: parents, siblings, aunts, uncles, cousins, all related
to him. Through this experience, he came to believe that psychiatry was
not sufficient for understanding people’s problems; rather, he believed that
everyone grows up in a context of relationships that affect their ability to
individuate, grow, and develop lives of their own. Problems develop when
the structure of the family is not sufficient to promote the growth of the
individuals in the system or the system itself. His work at a New York City
school for boys showed him that families are systems with subsystems and
individuals, with boundaries and rules that govern how the family manages
life. Charles Fishman (e.g., Fishman, 1988, 1993) also has contributed to the
development and publishing of Structural Family Therapy.

29
Family Therapy Approaches

A number of concepts of Minuchin’s Structural Family Therapy have

become almost synonymous with family therapy. Among these are family
structure, boundaries, roles, and rules, described in some depth in the first
chapter of this book. If you are interested in these and other concepts in
more depth, I suggest family therapy texts and resources listed in the MFT
Model Charts in the appendix.

Structure

Structural Family Therapy is based on the assumption that problems reside

in systems’ organization and in contexts of relationships, most notably fam-
ily relationships. These relationships form subsystems and systems that are
defined by boundaries that form structures. The structure of the family is the
context within which people operate according to roles and rules. Some-
times, these structures maintain dysfunctional behaviors, inhibit the growth
of individuals, and prevent the natural or morphogenic development of the
family.
According to system thinking, problems do not belong only to the person
perceived as carrying them (the identified patient); they exist in a context
of people, relationships, situations, resources, and constraints. This is not
to say that the family causes the problem, but that its structure needs to be
sufficient so change is supported and the difficulty can be resolved. Chang-
ing the structure of the family changes the way that people in it experience
themselves, others, and relationships. A clearer or rearranged system may
provide better support so that problems can be resolved. Sometimes, the
problem is more in the relationships among people, in which case, clarify-
ing the relationships, boundaries, and acceptable roles may be helpful.
Changing structures drastically too soon may be met with homeostatic
resistance stronger than the pull toward change. In therapy, Minuchin
and colleagues who use the structural approach usually do not attempt to
change a family’s structure with one intervention or goal; it often is better to
change one part of the structure (e.g., help parents form a bond as a team)
and then work toward a structural issue that may be more directly related to
the problem (e.g., reducing one parent’s overinvolvement with the child or
increasing another parent’s involvement so that the child has more access
to both parents and perhaps other resources). However, a slight change may

30
 Family Therapy Approaches

be welcomed that will then lead to another slight change, leading to overall
restructuring of the system.

Boundaries, Roles, and Rules

Boundaries are the invisible lines that define functions of systems and sub-
systems. They define what information may go into or out of the system/sub-
system, and what behaviors are acceptable. For example, individuals have
boundaries that help define an individuated self. Couples have boundaries
that define them as a couple and exclude others as not a part of the couple.
The same people in a couple as intimate partners may have boundaries that
define them as parents that operate in different ways from those of the inti-
mate partnership.
Boundaries may be quite solid or rigid, disallowing much or any infor-
mation into or out of the system, or they may be quite diffuse (enmeshed),
allowing a lot of information in and out. When families are experiencing
difficulties, its boundaries often are too rigid or too loose to be helpful in
resolving the difficulty and maintaining optimal and appropriate functioning.
Boundaries are bound by rules that define who is in and who is not in a
system/subsystem, what kinds of activities or behaviors are acceptable or
unacceptable, and who may change these rules (metarules; cf. Ch. 1). Rules
in families govern all aspects and are often unspoken. Things such as who
sits where at a dinner table, what privacy means, or when children may
leave the house or apartment are examples. Rules may be explicit, such
as bedtimes or curfews, but often are implicit and people sometimes don’t
know a rule has been broken or challenged until something happens. For
example, children may not explicitly know the limits for how far they may
go from parents without going too far. Once they go too far, parents typically
respond in some way that helps make the rules more explicit and brings the
child back within boundaries. This can mean physical distance for a toddler
or attitude and language from a teenager. Boundaries are also defined by
the recursive patterns of interaction among family members. For example,
repeated requests to leave a room when a parent is working emphasizes a
boundary between the parent and child at certain times. However, there
may also be an implicit or explicit rule about when the child can breach that
boundary, such as an emergency of some sort.

31
Family Therapy Approaches

Minuchin was clear that someone or subsystem needs to be in charge

of the system, especially when there are children. Parents form the exec-
utive subsystem and are the ones who make sure that people are safe and
nurtured appropriately. Often, when children are experiencing problems, a
rearrangement of the executive subsystem helps support resolution of the
problem. At times, this requires flexibility, for example, when parents can-
not fulfill all necessary functions. At those times, another person may be
charged with the care of the children temporarily: a day-care provider, older
child, or grandparent. When an older child is put in charge of younger chil-
dren too much, the child is termed “parentified,” which may interfere with
his or her growth, individuation, and independence. A rule that defines who
may take these roles, under what conditions, for which activities, with how
much authority, and for how long is often necessary.
The roles and rules might be quite different in families with separated
parents where children are sometimes with one parent and other times with
the other. In these situations, the children belong in two subsystems and the
combination can still be considered one whole. It is most necessary that
boundaries be flexible so that each parent has some measure of autonomy
over his or her own household, but that the parents still operate as a team for
the wellbeing of the child. This sometimes means that there are both differ-
ences and similarities between the two households with an understanding
that this is OK, and that the parents are still in charge. A boundary that pulls
children into the parenting or executive subsystem can result in a structure
that supports problems. A good example of this is when one parent quizzes
children about the other parent, blurring the boundary around the parents
and bringing the child into the parental subsystem. This may result in the
child’s feeling tugged between two loyalties resulting in lies and other unac-
ceptable behavior. A therapist might help the parents work together to firm
up the boundary around them and loosen the boundary between them so
that there is adequate and appropriate communication with everyone.

Goals of Therapy

The goal of therapy is not to solve the presenting problem, but to change
the structure of the family so that it can support its members and resolve life
difficulties, both large and small. The focus is on the boundaries, roles, and

32
 Family Therapy Approaches

rules of the family rather than the identified patient. The therapist watches
the family interact (enactment as assessment) to infer the boundaries and
roles of the family. Changing these patterns realigns the boundaries to make
them more appropriate for the tasks at hand. Rigid boundaries are loosened;
diffuse boundaries are strengthened. Parents work as a team, and children
are allowed to act appropriately for their developmental levels and family
needs. Relationships that are disengaged or enmeshed are strengthened
appropriately through various interventions that challenge and alter the
relationships and boundaries around them. Specifics about these roles are
not normative—that is, there is flexibility in the roles that each parent takes
vis-à-vis the children, with one parent perhaps in charge of school and the
other in charge of family life. Different cultures and family structures (e.g.,
ethnic norms, separated or divorced parents, families with step-parents,
same-sex parents, families that involve extended family members in their
functions, etc.) have diverse viewpoints about what constitutes appropriate
roles, rules, and boundaries, and should be respected unless consequences
might include harm to someone. Admonishing or lecturing children may
be appropriate in one family and considered ineffective by another; that
family may apply direct behavioral consequences such as loss of privileges
when children misbehave. The “norm” is defined by the family and culture,
not the therapist, although research about certain practices certainly might
be suggested.

Role of the Therapist

The role of the therapist in Structural Family Therapy is to actively perturb

the system (information in) so that the structure is questioned or challenged
and may even become disorganized. This can look quite provocative, such
as overemphasizing or challenging roles that contribute to rigid or diffuse
boundaries. Therapists may encourage and coach two people to discuss
something difficult beyond their typical ability or threshold for managing
stress. This challenges or perturbs the boundary between them and forces
them to continue talking, learning that they can do it without harm, which
may enable them to more easily resolve their difficulty. The therapist facil-
itates the restructuring of the relationship so that the boundaries and struc-
ture support problem-solving.

33
Family Therapy Approaches

Problems as Embedded in Structures

An assumption of the structural approach is that children’s problems are

often related to the boundary between the parents (marital vs. parental sub-
system) and/or the boundary between parents and children. When bound-
aries are clear rather than too rigid or too diffuse, and relationships are
balanced rather than disengaged or enmeshed, normal life difficulties are
more likely resolved rather than becoming bigger problems. The therapist
takes a directive, expert position, assigning changes within the therapy room
as well as between sessions. Change must begin in the therapy session,
though, and assigned tasks between sessions solidify this change. For exam-
ple, a disengaged relationship between father and son may prevent the son
from knowing how to grow as a man. In session, the therapist would put the
son and father in direct contact with each other, with other family members
physically placed away from them but observing. The therapist would then
help the son and father talk about something and help them break through
a hesitancy or barrier in their relationship without usual interference from
other family members, who would be blocked by the therapist but com-
plimented for their intentions of wanting to be helpful. This intervention in
the session marks the boundary around the father and son as an important
subsystem and is called an enactment (intervention rather than assessment).
The therapist might then assign them the task of doing something together
during the week without either the mother or siblings.
If it seems the mother or siblings are likely to interfere with this task, the
therapist would assign them a task of their own that would help them stay
away from the father-son subsystem boundary. Staging an enactment in the
therapy session would further emphasize changed boundaries; difficulties in
enacting the new interaction are helped by the therapist through reframes
of attempts to help, challenging the system, and coaching members toward
the new interactions so that change is evident in the therapy room. The task
assigned for between-session interaction further accentuates the change.

Practices of Structural Family Therapy

Minuchin believed that therapists must be fully trusted by the family and
wrote about the initial stages of therapy as entering the family system as a
part of it; this is called joining. Many therapy approaches use this idea and

34
 Family Therapy Approaches

research even bears out the importance of the therapist-client relationship in

change. However, joining is not a technique nor an isolated intervention. It is
an ongoing pattern of being part of the family so that change can be effected
from within. The therapist dances a delicate choreography of being the
expert needed to help the family change and, at the same time, be enough
a member of the family to understand its dynamics. The therapist must then
find ways to exit gracefully, leaving a more functional family structure.
Important interventions include raising intensity so that the family
becomes disorganized (disrupting homeostasis) and the therapist can help
it reorganize in a more functional manner (morphogenesis). This requires
unbalancing the family in sometimes dramatic ways, such as requiring
an overinvolved parent to leave the house for a period of time so that the
other parent can take on the parenting responsibilities. The therapist also
challenges unproductive ideas the family may hold about the problem, its
causes, and necessary solutions.
A famous and important intervention that is also an assessment tool is
enactment. As an assessment tool, the therapist asks the family to demon-
strate their usual pattern, allowing the therapist to observe boundaries and
roles. As an intervention, the therapist requires that family members change
their pattern, often in ways beyond their usual ability to handle intensity, so
that they can disrupt the usual pattern and develop a new one that is more
helpful. In this way, the therapist acts as a coach to the family, helping them
practice new relationships and boundaries.
As the family structure changes, the experiences of the members of the
family change, allowing boundaries and relationships to settle into more
functional and helpful ones that promote growth and an ability to resolve
problems. It is not unusual for the therapist to never discuss the presenting
problem, or to do so only in terms of relationships with people who are
involved, such as teachers, police, and so forth.

Strategic Family Therapy

(Mental Research Institute)
Gregory Bateson (e.g., Bateson, 1972, 1979), an anthropologist, was awarded
a federal research grant to study the communication patterns of families in
which one person was diagnosed with schizophrenia. Others (e.g., Don

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Family Therapy Approaches

Jackson, John Weakland, Paul Watzlawick) joined this work in Palo Alto,
California, and later developed ideas for using their observations in therapy
for such families. Their very large contribution to the study and treatment of
schizophrenia resulted in the establishment of the Mental Research Institute,
an arm of the research and therapy institution.
Prior to this time, mental health difficulties were treated as problems of
neuroses or psychoses in individuals, and treatment required extensive psy-
chodynamic analysis. Treatment at the MRI was a radical shift in this treatment
thinking. Instead of extensive weeks and months of treatment, the number of
sessions was kept to 10; focus of treatment was on the problem and interac-
tions of the people involved in the problem; and the goal of therapy was the
resolution of the presenting problem instead of “underlying” issues.

Assumptions of MRI Strategic Therapy

Several assumptions guide the therapy:

1. Family members often perpetuate problems by their own actions

(attempted solutions)—the problem is the problem maintenance (pos-
itive feedback escalations or negative feedback inhibitions). For exam-
ple, attempts to help people cheer up when they are depressed are
tried over and over again, don’t work, and actually make the depressed
person more discouraged and depressed.
2. Problematic behaviors make sense in context. A child who avoids
school may be experiencing bullying; argumentative teens are stretch-
ing their boundaries in preparation of leaving home.
3. Directives tailored to the specific needs of a particular family can
sometimes bring about sudden and decisive change. Change does not
need to take weeks, months, or years. Some small change may be big
enough to make a big difference, getting the family on track for resolv-
ing their own difficulties.
4. People resist change. Change is hard, even when wanted; we like
things to be familiar.
5. You cannot not communicate—people are always communicating,
even when it appears they are not. Silence communicates loudly.
6. All messages have report and command functions—working with content
(report) is not sufficient, you must look at the relationship (command).

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7. Symptoms are messages—symptoms help the system survive (some

would say they have a function).
8. It is only a problem if the family describes it as such.
9. The therapist needs to perturb the system and find a difference that
makes a difference (similar enough to be accepted by the system but
different enough to make a difference).
10. It is not necessary to examine psychodynamics to work on the problem.

Role of the Therapist

In MRI Strategic Therapy, strategies are devised by the therapist, who takes
an expert position vis-à-vis the family, prescribing interactional changes that
will interrupt the patterned sequences that maintain the problem. As with
Structural Family Therapy, the therapist may ignore the presenting symptom
in favor of working with the family’s observed processes, particularly around
the presenting problem.

Practices of MRI Strategic Therapy

Therapists assess the interactional communication patterns of the family

around the presenting issue, determining what people have done to try to
resolve the issue. Repeating something that has not worked is not likely to
work.

Direct Interventions

Some families are more ready for change than others and respond to
directives, willing to experiment with the therapist’s ideas. In these cases,
the therapist may simply be directive and prescribe the desired change.
For example, a couple may have endless and exhaustive arguments about
finances, leaving each feeling demoralized and alone. The therapist would
not give them advice about finances because she or he would focus on the
pattern of interaction in which each partner might attempt to outdo the other
with logic and “arguing patterns” (tone of voice, pace, pitch, language, a
relationship aspect that one is more in charge of finances than the other,
etc.). The therapist might work to interrupt the recursive, sequential pat-
tern that the couple’s arguments typically take. This would involve getting a

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detailed description of the cycle, finding out where each partner attributes
the “beginning” (punctuation), and choosing another step in the process
to focus on potential change (the earlier, the better, before emotions are so
high that the couple cannot remember what to change).
The therapist might ask the partners to each describe something differ-
ent they could do early in the cycle, pointing out that the cycle will have
to change to accommodate the difference. One might say that he could
remember his partner’s good intentions and fears about not having enough
money instead of taking a remark personally. Another partner might say that
instead of walking out of the room, which may be shortchanging the dis-
cussion, she will stay present and ask questions instead of assuming intent.
The MRI leaders saw that the context of a pattern often is the way a prob-
lem is viewed and the meanings that are inferred in interactions. That is,
the way people frame their difficulties influences the way they attempt to
resolve them. If parents think that a child is deliberately trying to drive them
crazy, their responses will be different than if they believe the child is exer-
cising normal developmental stretches to the family rules.
A strategic therapist once worked with a family with a presenting prob-
lem of sibling fighting that was driving the mother mad. She would arrive
home from work, see the children playing video games instead of finishing
homework, tell them to do their homework while she fixed dinner, and then
tell one of them to set the table. This set up a situation of arguing in endless
circles about whether homework was finished and whose turn it was to set
the table. The children argued with each other and the mother yelled at all
of them to be quiet and go to their rooms.
In therapy, the therapist saw the pattern as an endless, escalating cycle
that needed to change early in the cycle, not at the point of the mother’s
exhaustion and children’s confusion about whether to do homework or set
the table—chaos! Since it is normal for siblings to fight with each other, the
therapist saw that the context of the arguing included the mother’s interfer-
ence in the sibling argument as well as her exhaustion and request for two
things, not just the arguing. The therapist told the mother that she thought
the children were acting like normal children since siblings are always vying
for power with each other, especially over a parent. She said that the prob-
lem was that the children were not given sufficient opportunities to exercise
their power as fully as they would like rather than arguing because they
didn’t want to do the task (reframe—change in viewing). In order to have full

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opportunity to demonstrate their power, they should be instructed to go out-

side, stand at least 100 feet apart from each other, and have their argument
as loudly as they could until it was resolved. They should develop a way
to accurately measure the distance among them. Then, when they started
arguing with each other about anything that the mother didn’t want to hear
about, she was simply to tell them to take it outside. After a few episodes of
this (which did not require the same frustration level of the mother and, in
fact, was rather amusing), all it took was a signal from the mother that they
might have to “take it outside” for them to find a different way to resolve
their disagreement. And then she would choose one of them to set the table.
Another time, a family presented with a 7-year-old who either had melt-
downs or did nothing when asked to clean her room. After determining
the specific pattern as well as patterns around other requests, the therapist
instructed the little girl to ask questions of her parents. “What questions?”
“Whatever comes to mind.” The little girl started hesitantly and then became
bolder. Her parents responded appropriately, but sometimes in silly ways
to silly questions. Then the therapist instructed the parents to tell the girl to
get everything ready to go home. They complied. The therapist instructed
the girl to ask, “What should I get first?” This startled the parents at first, but
then, after looking at the therapist and receiving a nod, they said, “Put the
toys you and your brother have been playing with into the toy box.” So,
the therapist said to the girl, “When your parents ask you to do something
and you’re not sure what to do, can you ask them what to do first?” And, of
course, the girl said she could. The parents canceled the next appointment.
This demonstrates a way of interrupting a pattern that had turned into a
mighty struggle in the family.

Indirect Interventions

Other families, however, are reluctant to give up their attempted solutions,

often fearing that doing so will make things worse. An example of this may
occur when parents fear a teen will leave home prematurely and have
problems with drugs or not finish school if they don’t give in to the teen’s
demands. In these cases, the therapist might use more indirect methods such
as metaphors or paradoxical prescriptions.
Metaphors are indirect ways of calling attention to a family’s patterns of
interaction. When people are very sensitive to feeling blamed, metaphors

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are often very helpful. For example, the therapist might tell a story about an
old lady who lived in a shoe who had so many children she didn’t know
what to do. So, she ended up yelling at some of her children and ignoring
others. Neither of these methods worked, so the old lady consulted with a
wise owl, who asked her, “What do you think each of your children is capa-
ble of?” In this case, the mother in the family is the old lady and the owl is
the therapist. The therapist does not directly ask the mother what she thinks
about the children as individuals but seeds a thought for her to consider
each and assess their capabilities.
Paradoxical interventions rely on the confusion of logical levels that can
easily happen in communication interactions. For example, it is paradoxical
for me to say that all statements on this page are false. If that statement is
true, the statement itself is false. If the statement is false, then all statements
must be true, including “the statement.” One level is the literal meaning of
the message (digital, report, the words) and the other the context of the mes-
sage (relationship, command, its relationship to all other statements). Telling
people to not change in a context of change (therapy) is paradoxical. One
such paradoxical intervention is prescribing the symptom.
People sometimes tell us that they have tried everything, and anything
that we might suggest is met with, “we tried that and . . .” or “that won’t
work because . . .” A therapist might tell such a family to fully engage in their
pattern exactly during the week, paying careful attention to what happens so
that they can tell the therapist about it in great detail. Of course, this seems
odd and is asking for no change in the context of change (with therapy as
the context, which is supposed to help the family change). If the family is
willing to follow the task and comes back with a detailed description of
the interaction, this suggests that they are willing to follow the therapist’s
directives and the therapist can move to changing sequences directly. It also
means that they are able to change an interaction (that is, paying attention is
a change in the pattern). The therapist’s next intervention might easily further
interrupt the family’s cycle of interaction around the presenting problem (if
that didn’t happen spontaneously because of the slight difference of paying
attention to what happens) in a way that is more helpful.
If the family refuses to follow the therapist’s directive, which is frequent in
such cases because it seems silly, it usually means that they did something
different, which may have resolved the problem or at least can be explored
in therapy resulting in further directives from the therapist. A slight change

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in the pattern may make it more open for further changes. A true paradox is
a win-win for the therapy: if followed, the clients are willing to do what the
therapist asks; if not followed, it often means the symptom did not occur.
Another example of a paradoxical intervention is to tell the clients that
change must not happen quickly, that it must go slowly so that it can be seen
as true change, not a fluke. Of course, most clients want change to happen
yesterday, so they are unwilling to follow the directive, resulting in quick
changes. As you can see, the therapist is active and focuses on behavioral
patterns of interaction.
Interventions in Strategic Family Therapy are designed to interrupt inter-
actional patterns. This can happen by changing the viewing of the problem
(context that leads to certain responses) or the doing of the problem—the
behavioral interactions themselves. Interventions are tasks designed by the
therapist to change the patterns and may be direct (do something different)
or indirect (metaphor or paradox). The aim of therapy is the disappearance
of the presenting problem as a problem. That is, the behavior may remain
the same, but the family may not see it as problematic and therefore does
not interact around it in the usual ways.

Strategic Family Therapy (Haley and Madanes)

Jay Haley (e.g., Haley, 1977) also was one of the early MRI developers of
strategic therapy. Both his and the MRI approaches focus on the presenting
problem rather than “underlying” issues and see the role of the therapist
as active and responsible for change. When therapy is successful, credit
is given to clients for their hard work; when therapy is not working, it is
the therapist’s responsibility to do something different. Haley’s work was
influenced by Minuchin, with whom he had a close relationship, and this
influence can be seen in Haley’s ideas about hierarchy and power. Haley
and his wife, Cloé Madanes (e.g., Madanes, 1984), developed a form of
strategic therapy that is slightly different from that of MRI. Rather than focus
mostly on behavioral interactions around presenting issues, Haley and
Madanes keyed in on a communication idea that symptoms are messages
in the system. Haley saw these messages as resulting from imbalances in
power, whereas Madanes saw them as messages about misplaced love in
the system. They had become familiar with Minuchin’s (1974) Structural

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Family Therapy ideas and saw that family problems were issues of hierarchy:
Symptoms had power in the family, and the family needed to get in charge
of the problem instead of the other way around. Children who had problems
were often perceived to be standing on the shoulders of one of the parents,
giving that parent more power over the other. These are skewed hierarchies
and need to be realigned.
Haley and Madanes also saw presenting issues as problems in the func-
tioning of the family, with symptoms being metaphorical for the patterns that
maintain them. For example, a father’s headache may be a metaphor for his
“headaches” at work that he tends to bring home. Haley thought that effec-
tive therapy sometimes works because interventions serve as ordeals that
interrupt typical responses. Ordeals as interventions would include things
that replaced the symptoms, so they would be given up.
I once had a client who had trouble with eating during the night. She had
tried all kinds of strategies with no relief. I asked her what else was going
on in her life that she would like changed and she said that she wished
her closets were better organized (see Haley, 1984 for more ideas about
“ordeal therapy”). I suggested that if she woke and could not get back to
sleep because she wanted to eat, she get up and organize a closet, taking
everything out and carefully putting it back in an organized way. If she still
wanted to eat, she should repeat the task with a different closet. Regardless
of the outcome, she would either be sleeping without getting up to eat,
have more organized closets, or both. She complied with the request, was
happy with a couple of organized closets, and decided she’d rather sleep
than organize closets. She told me later that whenever she had a seemingly
unresolvable issue, she thought about cleaning closets. We looked at the
behaviors she wanted changed, not underlying issues that might be “caus-
ing” the eating behavior.
Haley believed that power was the motivator in symptoms and designed
interventions that took the power from the symptom. Madanes saw love
as the chief motivator and designed interventions that changed patterns of
interaction so that needs for nurturance and love were met without unfortu-
nate symptoms. The Mental Research Institute as well as Haley and Madanes
designed interventions as strategies unique to the client system’s issues and
dynamics; there were no “one size fits all” interventions.
Madanes developed the art of “pretend” tasks, arguing that one cannot
pretend to do something and actually do it at the same time—it’s either

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real or a pretense, but not both. A family was suffering because one of the
children had horrible nightmares, waking with screams of terror. The whole
family interacted to help soothe the child. Because Madanes believed that
symptoms were metaphors related to love, she framed the meaning of the
symptom as related to soothing of the child—the family’s typical attempt to
resolve the difficulty.
In the office, Madanes directed the child to pretend to have a nightmare
and the family to pretend to soothe the child. After showing Madanes that
they could accurately replay the situation, she told them to go home and
enact the “play” every night before the child’s bedtime. This interrupted the
family’s usual pattern and allowed them to show love and concern without
the child’s nightmares. In MRI’s terms, this is a paradoxical intervention with
the added twist of pretense, which Madanes found less objectionable and
more likely to be followed.
Haley and Madanes also reframed presenting problems so that people
could not respond to them in the usual ways. An example of this is a college
student who cannot get out of bed, is eating poorly and neglecting personal
hygiene, skipping classes, and failing in grades. Now, many therapists would
diagnose this student as depressed, which is what many parents suspect and
request medication to fix the illness. Naturally, they are very worried about
their child, and want to do what’s best. Their frame is that the child is sick.
Another frame, though, is that the child is unmotivated and does not deserve
to have her life supported by parents when she is not doing what she is sup-
posed to do: going to classes and passing her courses. When parents see a
child as unmotivated rather than sick, they treat her differently and might tell
her she has to quit school, come home, and get a job until she’s ready to do
what she needs to do as a college student.
Haley’s notion of power would see the skewed hierarchy in the family
where the parents are helpless in the face of the symptom, and therefore the
hierarchy needs to be rearranged so that the parents are in charge. Madanes
might say that the issue is that the child is lonely and needs more comforting
from her family, is not ready to make a life on her own at college, and there-
fore must remain home until the family sees her as ready to do something
different about her loneliness or to find other ways to have sufficient love
and caring in the family without the symptom that keeps her parents worried
about her, calling frequently, and taking her emotional temperature, so to
speak. Sometimes, either would frame a child’s behavior as an unfortunate

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way of keeping the parents focused on the child and his or her problems
rather than problems in the marriage. The problem is a distraction.
The point is not which frame is “correct,” but which one the family is
willing to “buy.” By accepting a different frame, they cannot act in the
same old ways and must interact in accordance with the new frame. This
means disrupting the family’s ways of attempting to solve the problem,
which frees up strategies that have more promise for change in the family’s
interactions.
Regardless of the therapist’s view of dynamics and motivations, strategic
interventions are designed to interrupt patterns of interaction among peo-
ple that maintain symptoms. Strategic approaches to therapy use interven-
tions that are designed for specific situations and that change the viewing
of problems (context) in session, which leads to changes in behavior (doing)
between sessions. These changes are solidified in next sessions and therapy
ends when the presenting issue is resolved.

Bowen Family Therapy

Murray Bowen (e.g., Bowen, 1978) was trained as a physician during World
War II. He received further training at the Menninger Foundation in Topeka,
Kansas, as a psychiatrist. There, he became interested in the dynamics of
families with a person who was diagnosed with schizophrenia and followed
this idea after moving to Maryland to work at the National Institute of Men-
tal Health and later, Georgetown University.
As a pioneer in family therapy, he developed a theory of family dynamics
that kept people locked into symptoms as the result of generations of unre-
solved family function. Bowen came to these ideas when he noticed how
much more easily he could see his own family dynamics when he was not
physically caught up in emotional struggles with them; when he was with
them, old family patterns prevailed. He also noticed that he could more
easily see dynamics of the Menninger Foundation when he was away from
it, only to get reinvolved upon his return. He called this differentiation of
self, defining it as the ability to maintain a sense of self in emotional settings
while staying connected to them. When self is lost, emotionality ensues,
which prevents objective thinking.

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Assumptions and Concepts

Bowen assumed a number of things as he developed his theory over his

lifetime. One is that the past is currently influencing the present although
individuals can change and become more differentiated. Another is that
a change in differentiation of self results in a different experience of the
family—it feels different and therefore people respond differently to each
other. A third is that differentiation is both internal and external: internal dif-
ferentiation is the ability to think during a highly emotional situation; exter-
nal differentiation is the ability to maintain a self and still stay connected
to one’s family. Anxiety is normal but can inhibit thinking and needs to be
calmed in order for people to think clearly and facilitate change.
Differentiation of self is the ability to separate internal intellectual from
emotional systems, to remain well connected to family members during
anxious times, and to maintain ones’ own sense of self, not unduly influ-
enced by family emotionality. I think of differentiation of self as the hinge
pin between individual and systemic functioning. Bowen noted that as peo-
ple could increasingly separate thinking from emotions, allowing emotional
influence but focusing more on thinking, they could more easily manage
family anxiety without either getting caught up in the anxiety and giving in
to family norms, or leaving the family altogether. Knee-jerk reactivity could
change to thoughtful responsiveness. The reverse also was true: As people
could manage family anxiety better, they were more able in general to use
their thinking abilities without being overrun by their emotions. In therapy,
both are attended to.
A large contributor to the dynamics of differentiation of self is anxiety.
When emotions are in charge (emotionality), it is difficult to think about
reasonable solutions to difficulties. We’ve all had the experience of later
thinking of what we could have said during an argument or situation that we
couldn’t think at the time. We were literally unable to think of it at the time,
our brains flooded by emotional reactivity.
Families develop patterns of managing anxiety that are transmitted and
taken on by further generations. These patterns take the form of distance;
conflict; physical, emotional, or social symptoms; or triangling. Symptoms
are indications of an inability to manage anxiety, of undue influence by
emotions and family patterns, of stress, and of relatively lower levels of

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differentiation of self. Anyone can become symptomatic with sufficiently

high levels of stress. However, those with higher levels of differentiation of
self are more able to manage the stress without symptoms and/or to return
to baseline differentiation of self and eliminate symptoms quickly. Finally,
intimate partners tend to have similar levels of differentiation of self and pass
these on to their children. Some children, depending on many factors, are
relieved from the family anxiety and develop higher levels of differentiation
of self. Others, again depending on multiple factors, develop lower lev-
els. Some of these factors include birth order, patterns of managing anxiety
through generations, and triangling by parents. We’ve all wondered how
it is that some children, raised in the same family, can be so different. It’s
actually because no two siblings are ever raised in the same family with the
same circumstances. One is older, more important because of sex, or very
much like another relative. Another has a different birth order, thus different
experiences of negotiating with peers and parents. One may have a physical
ailment or disability, another be particularly favored by grandparents. These
contextual factors influence everyone’s experience.
Two other important concepts are related: fusion and cutoff. Families tend
to have members with similar levels of differentiation of self. In families with
low levels, members can be said to be fused, a concept similar to Minuchin’s
enmeshment. In fused relationships, members are easily influenced by oth-
ers and unable to think for themselves. In families with higher levels of
differentiation, members are able to maintain their own ideas, influenced
but not driven by others’ opinions. Emotional cutoff refers to what appears
to be an opposite dynamic: People do not pay any attention at all to other
family members’ opinions and make all decisions for themselves. We say
these dynamics are similar because people caught in cutoffs typically make
decisions based on doing the direct opposite of what others think. If the
family says that children should live nearby, they get as far away from them
as possible. This may be either physically or emotionally. Cutoff members
may live in the same communities but cross the street if they see a family
member approaching. Either way, their decisions are just as driven by family
opinions and they lack the ability to make autonomous lives for themselves
and, at the same time, stay in contact with family members.
People tend to fall along the continuum with different levels of ability to
function in different kinds of situations. People may be more differentiated
at work than home, or when involved in less anxiety-provoking situations.

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During stress and anxiety, levels of differentiation of self tend to go down,

but return to base levels or even higher levels after a situation is over. Think
about how many people vow to stay in touch after coming together at funer-
als or weddings, but soon lose the momentum. It is natural for families to
become fused when important family members die, and then to develop
new levels of differentiation as emotionality subsides.
I used Bowen Family Therapy with many of my clients as they approached
holidays, recognizing that they would easily fall into old patterns and allow
themselves to lose sense of self. Bowen coaching helped them to plan for
these times, with ideas about how they could stay connected and maintain
their senses of self at the same time. I often suggested possibilities of staying
in motels instead of in family homes as a way of maintaining a sense of
autonomy and distance. When people described fears of falling into family
patterns of arguing over certain topics or overplayed situations (e.g., a father
who usually drank too much, a mother who criticized too much), I coached
them to find planned ways to manage the situation. This sometimes meant
taking a break such as going for a walk to get back a sense of self, changing
topics, or refusing to play one’s usual role. The latter plan could include not
drinking even though that was the usual pattern, or complimenting mother
on something rather than arguing about the criticism or giving in to hurt
feelings. This involves maintaining a sense of autonomy without giving up
intimacy. Of course, the best remedy is for everyone to be able to talk about
the distressing dynamics, but high-stress times such as holidays often are not
the best time to do that.
Engaging in the planning for such situations helps people engage their
thinking as separate from their emotional processes. Behaving according (or
nearly so) to plans helps maintain self in the midst of anxiety. Each reinforces
the other and, with practice, the hinge becomes less rusty and squeaky and
allows the gate to move freely. Planning often can involve the help of a part-
ner who is less emotionally involved, more objective, and can send a signal
about the plan sooner because she or he sees the struggles developing.
Another important concept is that of triangulation. I have modified my
thinking about this concept over the years because so many therapists con-
sider triangles to be bad and needing to be broken and banned. However,
according to Bowen, triangles exist by nature. By themselves, as a concept,
they are neutral—balanced and neither good nor bad. However, when over-
ridden by emotions and anxiety, they contribute to poor differentiation of

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self. Triangles are the most stable geometric construct in nature. They are
used to stabilize all sorts of things, such as walls and bridges, and are simi-
larly used in family dynamics. Dyads may be quite stable under normal con-
ditions but tend to need stabilizing when stressed. One of the easiest and
most common such stabilizing move during stress is to triangle in another
person (or topic or activity). As both people focus on the third part, the dyad
restabilizes and functions better.
The third person in a triangling situation often feels special and helpful to
one or both parties. However, as the original dyad stabilizes and does not
need the third person as much, that person may feel pushed out and seek
other ways to either re-enter the dyad as a helpful person, or find another
way to triangle someone and restabilize.
When the third person can remain neutral and not overly involved with
one person or the other, that person is more able to leave the triangle when
the dyad restabilizes. However, if the triangling is so intense that it produces
a symptom in the third person, I call that triangulation (more like strangu-
lation) as a dysfunctional dynamic. This happens when one parent pulls in
a child to take her or his side in some way, or to change the topic from a
disagreement to caring for the child. Often, this can be a stabilizing thing by
providing some time and space needed for the original dyad to recover their
abilities to think during emotional or anxious times. After a while, calmed
down, they can get back to whatever the stress was about and find solutions
together that do not involve the third person.
Under stress, several dynamics can serve to relieve anxiety. These
may range from temporary and almost trivial to deadly. Over time, if the
dynamic is repeated or becomes more exclusive, symptoms may occur.
Bowen suggested that these include distance (either a short break all
the way through divorce or death), conflict (productive disagreement to
murder), physical symptoms (headache or cancer), emotional symptoms
(sadness or psychosis), social symptoms (shoplifting or grand larceny),
or triangling (temporarily or ongoing). Thus, Bowen saw all symptoms as
results of anxiety, stress, differentiation of self, patterns of managing anxi-
ety, and triangulation. Stress reducers are not necessarily bad unless they
are the only ones used, used chronically, or used to extremes, often in
intergenerational patterns. Triangling is ubiquitous in families, but may not
be damaging, depending on its severity.

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Practices in Bowen Therapy

In Bowen Family Therapy, the therapist helps clients understand the theory’s
concepts and uses genograms (family maps like family trees) to identify tri-
angles, patterns of managing anxiety, emotional connections, and topics that
are typically either avoided or always hot. By seeing these patterns objec-
tively using thinking abilities, people are able to practice ways of increasing
thinking, avoiding patterned and dysfunctional ways of managing anxiety,
and keeping senses of self during extreme family anxiety. At the same time,
the therapist encourages one-on-one emotional intimacy, coaching clients
to be in contact with family members without the interference of or tempta-
tion to triangle other members or avoid anxiety.
The therapist remains a nonanxious, third part of triangles, and helps cli-
ents plan strategies that will increase their autonomy and senses of self. As
differentiation of self increases, people need less frequent therapy. However,
because no one is ever fully differentiated or has resolved all family conflict,
therapy can continue for years, although perhaps less frequently or only
when stressful times are anticipated or occur.
Therapy takes the form of educating about the theory, helping to identify
intergeneration patterns, and coaching change. Immediate goals include
detriangling and lowering anxiety so that thinking abilities are activated.
Intermediate goals are planning for intense situations, practice in separat-
ing thinking from emotions, and changing one’s patterns in family of ori-
gin to enhance autonomy while staying engaged. The therapist asks process
questions—questions that engage clients’ thinking as informed but not ruled
by emotions. This decreases reactivity and makes it easier to make objective
decisions.
Therapy does not necessarily end when the presenting issue is resolved,
although that often is when clients wish to end sessions. Because differ-
entiation of self is an ongoing matter, therapy or coaching may be used
periodically when stressful things happen or there are changes in the family
requiring an adjustment of roles and interaction.
Because the therapist must take the role of a nonanxious third part of
a triangle, it is important for therapists to work on unresolved issues and
rigid roles in their own families of origin so that they don’t get caught up in
the anxiety of the dyad. Therapists can help clients differentiate only to the

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extent that they, themselves are differentiated, so ongoing Bowen coaching

for therapists is important.

Integrative Approaches
I think it is safe to say that most of the therapy work done today is integra-
tive. Especially in family therapy, ideas across models are viewed through
systemic lenses, and combine good ideas.
There are many ways to integrate approaches. One is to have a founda-
tional approach and “borrow” interventions from other approaches that fit
the assumptions, goals, or dynamic descriptions of the approach. Another is
almost the opposite: to take assumptions, concepts, and interventions from
several approaches and combine them into a new, coherent whole. Others
may take two approaches and combine them, although it is important to
be careful that assumptions do not cancel each other (e.g., Minuchin’s idea
of needing to raise intensity so that families must reorganize and Bowen’s
opposite idea that raised anxiety [intensity] prevents the clients from finding
solutions). If one wants to use both approaches in one’s work, it is possible,
but requires careful planning and perhaps using each for different ends or
different times or situations. For example, as a therapist, I often used Struc-
tural Family Therapy to help parents reclaim their authority with respect to
their children. However, with the same couple, this time addressing couple
matters, I might help them see the repeated triangles and patterns of manag-
ing anxiety in their families of origin so that they can make choices for them-
selves about themselves and their relationship. What is generally thought
of as not good is an approach that draws from many approaches upon the
whim of the therapist in the moment with no clear rationale.
Examples of integrative models that have research supporting them
include Functional Family Therapy (e.g., Sexton & Alexander, 2005), Mul-
tidimensional Family Therapy (Liddle, 1995), and Multisystemic Therapy
(Henggeler, Schoenwald, Bourduin, Rowland, & Cunningham, 2009), each
focusing on troubled adolescents and their families. Functional Family Ther-
apy focuses on separateness and togetherness forces in the family and uses
a variety of family therapy interventions to help the family develop their
optimal balance of closeness and distance that does not require a symptom.
Multidimensional Family Therapy uses a variety of family therapy techniques

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 Family Therapy Approaches

to address interactional difficulties in the family, between the family and

other institutions such as schools and the justice system, and behaviors that
are intended to enhance intimacy in the family but backfire. Multisystemic
Therapy uses intensive in-home therapy (several times a week) to help fami-
lies develop behavioral patterns that keep the parents in charge and address
adolescents’ antisocial behavior. Interventions are drawn from Cognitive
Behavioral Therapy and Behavioral Parent Training as well as others. Each
of these approaches requires intensive training after basic family therapy
training, strict protocols, and intense ongoing supervision. Each is used in a
number of community-based and other therapy centers and has a positive
research base for effectiveness.

Emotionally Focused Therapy

Sue Johnson worked with Les Greenberg on ways of looking at interactional

dynamics that stem from attachment needs and styles (Bowlby, 1979). Each
of us develops in contexts of important relationships and patterns of getting
needs met that develop into attachment styles that we carry throughout life.
Similar to object relations theory (e.g., Scharff & Scharff, 2012), patterns of
getting needs met are matched in relationships with complementary styles
from partners. Acting on attachment styles without understanding them can
easily lead to conflict, avoidance, and hurt. Greenberg and Johnson have
divided interests with each going their own way: Greenberg (e.g., 2009) is
more interested in attachment styles and physiological expressions, Johnson
(e.g., 2008) in couple/partner interactions that maintain rather than meet
partners’ needs.
Johnson stated that “the inner construction of experience evokes interac-
tional responses that organize the world in a particular way. These patterns
of interaction then reflect, and in turn, shape inner experience” (Johnson,
2008, p. 109). This recursive, circular pattern is what gets couples into trou-
ble, especially when the inner experiences polarize away from intimacy to
avoid further hurt.
Therapy helps couples expand their perceptions of themselves and their
partners, and the way they interact with each other as bids for closeness
that go awry. There is no sense of pathologizing one partner or the other. For
Johnson, the key in therapy is emotion as both the target of attachment-based
needs and as the agent of change. With a skilled therapist who creates a safe

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Family Therapy Approaches

place for disclosure and dialogue, couples are able to maintain contact long
enough and in different ways to (a) understand themselves and their partners
better, and (b) develop new patterns that will maintain intimacy.
The therapist helps the couple interrupt the negative patterns, and then to
look at emotions that drive behaviors. Primary emotions (e.g., fear, loneli-
ness, shame, joy) are expressed as secondary emotions (e.g., anger, jealousy,
resentment) and behaviors (e.g., withdrawal, fight/flight, engagement). The
therapist helps the couple identify their primary emotions borne of attach-
ment needs, and to change their negative cycles that tend to push each other
away rather than connect. Understanding a partner’s primary emotions and
attachment styles can lead to empathy, a changed perspective, and different
behaviors.
The approach is nonpathologizing and creates new experiences so that
partners can understand each other, develop empathy, and help their part-
ners and themselves get needs met. This draws them together and restores
their original hope and belief about having partners in satisfying and safe
relationships. When there are addictions, violence, or affairs present, Emo-
tionally Focused Therapy is contraindicated until those issues are resolved.

And So . . .
In this chapter, I described only a few family therapy approaches; there
are many, many more. From a systemic perspective, each looks at how the
members of families interact with each other, forming subsystems and sys-
tems, for the purpose of supporting and nurturing each other, eventually
launching grown members into society to form their own families. I do not
define families as white, middle class, educated, and heterosexual. There
are many forms to families and, from a systemic perspective, all interact in
patterned ways within their own contexts, influenced by and influencing
each other and the broader communities in which they reside. This includes
families with step-parents, foster families, kinship families, chosen families
and many more. The next chapters in this book examines Solution-Focused
Brief Therapy and its place within systemic family therapy.

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 3 Solution-Focused
Brief Therapy

Development of SFBT
The development of Solution-Focused Brief Therapy (SFBT) has an interest-
ing history. I refer you to a wonderful chapter by Brian Cade (2007) in the
Handbook of Solution-Focused Brief Therapy: Clinical Applications, edited
by Frank N. Thomas and myself (Nelson &Thomas, 2007). In his review of
the development of SFBT, Cade describes how several perspectives came
together into the interactional view that was developed by colleagues at
the Mental Research Institute (MRI; e.g., Watzlawick & Weakland, 1977;
Watzlawick, Weakland, & Fisch, 1974), reviewed in Chapter 1 of this book.
What was not reviewed in depth in that section is the tremendous influence
that Milton Erickson (e.g., Erickson & Rossi, 1979) had on the development
of the therapy ideas at the Brief Therapy Center (BTC), the therapy arm of the
MRI. Cade (2007) reported:

I one day asked Jay Haley what he thought was the most important
contribution Bateson had made toward family therapy. He replied
that it was finding the money to send John Weakland and him to
spend time with Milton Erickson on a couple of occasions each year.
(p. 33)

Erickson, a hypnotherapist, focused not on problems but on areas of com-

petence and resources that people brought with them to therapy. Erickson’s
ideas were added to the mix of Bateson’s ideas, systems theory, and cyber-
netics at the Brief Therapy Center to form the MRI brand of strategic therapy.

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Solution-Focused Brief Therapy

Insoo Kim Berg and Steve de Shazer trained at the MRI, meeting each other
at the urging of John Weakland. They appreciated the change in views of
therapy from analyzing problems and prescribing solutions for the underly-
ing “real” problem to what clients said they wanted help with. Erickson had
seen no need to search for underlying issues based in theory, but respect-
fully used what the clients described as problematic. The MRI adopted this
stance and both de Shazer and Berg found it most promising.
After moving to Milwaukee, Wisconsin, de Shazer and Berg set up the
Brief Family Therapy Center (BFTC) in 1978 with several colleagues. Using
the brief approach of the MRI, de Shazer continued to consult with John
Weakland. The BFTC team took to heart Weakland’s admonition to listen
to clients without believing that you know what the client really means or
what the problem really is. This means listening to clients and their language
rather than thinking under, around, and above the words to what a theory
might say is going on. de Shazer, Berg, and colleagues met in de Shazer
and Berg’s house, seeing clients in the living room, teammates sitting on
the stairs to the second floor. Similar to MRI’s format, they broke midway
through the session to discuss the family’s situation and to send a message
to the family through the therapist.
At first, the messages were similar to MRI messages that reframed the fam-
ily’s situation and were directive in prescribing tasks that would change the
family’s interactional patterns. As time went on, though, they began to hear
clients talk about small things that contradicted the pervasive nature of their
problems, most specifically, times when the problem did not exist, when it
was less intense, when it was not problematic, or when they were coping
with it better. They heard words like “almost always,” “usually,” “mostly,” and
“a little bit.” When clients said the problem was 90% there, they focused on
the 10% it wasn’t. They asked whether “always” and “never” were actually
accurate: “Are there times when it’s not there?” or “Nothing is all bad all the
time. When are some times when it’s not so bad?”
Using the MRI’s way of therapy based on an interactional view, they
became more curious about what clients were telling them about their inter-
actions with each other and others. By asking curious questions about the
details of the clients’ views of interactions, they learned about the wealth of
information that clients already had that could be used to help them resolve
their presenting problems.

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 Solution-Focused Brief Therapy

SFBT Stance
de Shazer was clear in his writings, workshops, and conversations that
he was not developing a theory, which is explanation. Rather, SFBT is
an approach to therapy, not even a model, that describes what happens.
A model might be seen as a step-by-step description of what proponents
do. However, because the approach was developed by listening to clients
and continuing to do what worked to help them move toward their goals,
I prefer to call it an approach. An approach starts with worldview (systemic
thinking) and stance.
The stance of SFBT is a worldview that closely attends to the clients’
views of what they want and the resources they bring to therapy. According
to Thomas and Nelson (2007), this stance or posture includes the following
and is the fundamental way of viewing therapy and other applications of
SFBT. Without this stance, SFBT is just another set of concepts and practices.
With the stance, it is a worldview through which practitioners work with
clients from an SFBT perspective.

Curious

We do not know or hypothesize about what might be underlying the client’s

perspective or description of their concerns. We are curious about clients’
experiences and expressions of their experiences.

Respectful

We respect clients’ ways of working with us, believing that whatever and
however they tell us is important to them and therefore worthy of respect.

Tentative

We do not assume that we know what the client means, what is really going
on, or what is best for them, and when we have an idea about this or any-
thing about their lives, we present our ideas tentatively, leaving lots of room
and a context that allows and encourages clients to correct us. We are slow
to know (Thomas, 2007).

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Solution-Focused Brief Therapy

Non-Normative and Nonpathologizing

We do not see presenting concerns as symptoms of underlying pathology,

problems of structure or relationships, or anything else. We take presenting
concerns at face value as having importance for the family, and that the
family is doing the best it can with the resources it has.

Belief in Client Competence

We do not assume that clients are less than we are in any way, or that we
have expertise about their problems or about them and their lives. We believe
that they tell us whatever they can to the best of their ability, have resources
they know about or could become aware of, and are capable of develop-
ing solutions with the help of a curious therapist utilizing these resources.
Some say that the approach is strength-based; it is more accurate to call it
“resource-based” because we look for clients’ resources, which may include
strengths, but resources are so much more than just strengths. Further, some
strengths (e.g., ability to sell drugs) are not necessarily resources for change.

Therapy Is Positive, Collegial and Collaborative,

and Future- and Solution-Focused

We are not Pollyannas; it is important to acknowledge clients’ pain. How-

ever, we work more toward hope than analyzing problems and their etiol-
ogy. We work as non-hierarchically as we can, keeping in mind our duties
regarding harm, of course. We collaborate with our clients rather than edu-
cate them and lead them through theories of how problems develop and
how they should be solved. And we look to futures for clients that do not
include a sense of their difficulties as problematic (perhaps they are still
present but not perceived as problematic).
With these basics of the SFBT worldview or stance in mind, we can see
that there are many ways to help clients. Several practices were developed
at BFTC in Milwaukee, and more have developed since then in the world
of SFBT practice. In this section of the book, I focus on the ones that came
most directly from the work of Berg and de Shazer and their colleagues,
with a few comments about more recently developed practices that fit the
stance.

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 Solution-Focused Brief Therapy

Assumptions
There are several assumptions in addition to the stance or posture principles
that drive SFBT and its evolution. One of these is that change is constant;
nothing stays the same in human systems. This is a useful concept because
we can help clients utilize changes in ways that help them toward what they
want. I have learned that a very important skill to develop is the listening
ear that hears tiny things that point toward difference and change, and to
become curious about how we might amplify these differences and changes
toward therapy goals. The following come from Thomas and Nelson (2007,
p. 10 ff).

Change Is Constant and Inevitable

In SFBT, following Erickson’s ideas of utilization, we recognize that change

is happening all the time and strive to use what is already changing to help
clients toward their goals. This doesn’t mean that all changes are good or
wanted or necessary, only that we use this principle to help us co-construct
solutions with clients.
If it ain’t broke, don’t fix it! Once you know what works, do more of it!
If it doesn’t work, don’t do it again—do something different! This adage has
become a sine qua non of SFBT. First used by the MRI, de Shazer changed
the order: the last two were in reverse order in the MRI, but Steve thought
this order made more sense and was simpler. He was fond of using Ock-
ham’s Razor, posed by the philosopher William of Ockham, as a basic tenet
in SFBT. Following Ockham, de Shazer suggested that we look for the sim-
plest explanation that fits a situation. Although other solutions also may fit,
they may be cumbersome and time-consuming (de Shazer, 1985); if we find
something that is working for the client, it only makes sense to keep doing it
and perhaps amplify it. We should look for exceptions, however small, first;
only if conversation reveals no exceptions, should we do something differ-
ent. de Shazer once told me a story about a workshop attendee who was
fascinated by de Shazer’s idea of simplifying. He met de Shazer at a break,
showed him a piece of paper on which he had written, “Simplify! Simplify!
Simplify!” He was quite proud of himself that he had understood something
important in SFBT. de Shazer took the paper, crossed out two of the “Simpli-
fy!”s, gave it back, and said, “There, that’s better.” This applies to us as well

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Solution-Focused Brief Therapy

as to clients’ situations: if what we are doing is working, we keep doing it; if

it’s not working, we do something different.

Clients Have Resources; Our Job Is to Help Identify

Them and Utilize Them Toward Therapy Goals

This assumption comes from experience at fighting so-called client resis-

tance. One of the biggest favors de Shazer did for us was declare the death
of resistance (de Shazer, 1984b). According to this assumption, clients don’t
resist either us or therapy; rather, they communicate how they are cooperat-
ing in many ways. Our job is to maintain a relationship in which resources
are identified and, when appropriate, used. This sometimes means identify-
ing resources outside a current system and helping the client determine how
to use them. Their capability is not necessarily already having everything
they need, but the ability to use what can be found. For example, I may not
know how to cook a particular dish, but I know how to use a recipe, and
I may find others’ suggestions about particular recipes helpful.
So-called homework or between-session tasks or experiments bring forth a
good example of this assumption. Sometimes, more so when the therapist assigns
a task rather than co-creating one with clients, clients do not do the task. This is
information for the therapist: the wrong task, the wrong time, the wrong people,
the wrong intensity—something that makes the task not a good idea for the cli-
ents. Tasks, like goals, must be important to the client, doable, realistic, and so
forth. If the clients don’t do it, it means it was incorrect; it does not mean that the
clients are resisting therapy. Sometimes, clients don’t tell us they didn’t do the
task, but do mention something else they did that was helpful. This shows that
the clients are being cooperative and helpful by designing their own changes.
However, they sometimes believe that they were doing what was asked. It was
not uncommon for clients to tell me, “We did what you suggested. It was really
helpful!” and when I asked what it was, not recognize it. That was OK; it meant
the clients were doing what they needed to do, not what I needed them to do.

There Is No Necessarily Logical Relationship

Between the Problem and Solution

In the SFBT approach to therapy, we do not assume that we need to know

the problem or its details in order to be helpful. Understanding the origin of

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 Solution-Focused Brief Therapy

problems is not always helpful because it typically is something that hap-

pened in the past and the past cannot be changed. We have bought into
the medical-model way of looking at correlations (strong relationships) as
causal. For example, I was trained to believe that teenage girls who cut
themselves, misuse alcohol or drugs, or engage in other self-harmful actions
were likely sexually abused when they were younger. Somehow, this high
correlation has translated to a need to do “trauma” work with teens who
cut, which often means re-experiencing the trauma and to “work through”
it. And we don’t know very much about teens who were sexually abused as
young children and who do not display self-harm behaviors. I don’t deny the
correlation—it’s just not useful in SFBT. Using SFBT assumptions, we work
toward finding ways for clients to obtain what they want and don’t neces-
sarily need to reprocess events to achieve therapy goals. I have worked with
clients who were reluctant to tell me their problems—which was fine with
me; I do not consider myself a voyeur—and didn’t need to know the prob-
lems in order to be helpful. By focusing on what the clients wanted instead,
clients found that the prior disturbing problems or events were no longer
problematic. They couldn’t change the past, but they could learn how to
have a better present and future.
Sometimes, clients want to discuss problems, whether because of a belief
that therapists need to know these things or because they want to ventilate.
In those cases, it is sometimes useful to ask how talking about the problem
will be helpful. They might say that talking about it will help them under-
stand it better and what is causing it. When this happens, sometimes I will
ask whether they want to focus on the problem or have it go away. If they say
they want to understand how the problem developed, I’ll usually ask how
that would be helpful and then whether they would be willing to focus on
resolving the presenting concern first, and then, if they still want to under-
stand, we can do that later. Only once have I had a client who said she
needed to understand first, and so we talked about that with my listening ear
toward openings for later solution-building instead of problem talk.
I worked in a women’s center when I was in graduate school, and the
center had both groups and individual counseling for women who had been
sexually abused. I was on reception duty one night when one of my clients
came out of her group session in tears. She asked if we could talk and,
because no one else was around, I asked her what was up. She said that she
had been in group for six weeks while everyone talked about their abuse.

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Solution-Focused Brief Therapy

Tonight, she had told them that she didn’t want to talk about the details of
her abuse any more, she wanted to talk about how to have good relation-
ships with men. The group leader’s response was that this was evidence
that she needed to talk about the abuse more, so she left. I learned then to
honor clients’ wisdom about therapy, what would be good for them, and
what might be potentially harmful, believing firmly that it is not necessary to
thoroughly dissect traumatic events in order to have a better life.

A Focus on What Is Possible and Changeable Is More Helpful

Than Focusing on What Is Overwhelming and Intractable
(Thomas, Durrant, and Metcalf, 1993)

Clients often want things to be perfect and bring things to therapy that cannot
be changed. de Shazer once told me that if something cannot be resolved,
it is a situation, not a problem. As therapists, we often get stuck wanting to
help clients attain the impossible. We need to empathize with this desire,
and then to focus on what may make it easier to cope with the situation. This
may mean looking to what in the context can be different so that the situa-
tion is not experienced as a problem: “Dinnertime is fast approaching.” That
is a situation; it cannot be changed. “I don’t know what to fix for dinner.”
That is something we can work on!

Small Changes Lead to Bigger Changes

Because we assume that change is always happening, we (our clients and

us) have some influence over how to use change to the benefit of therapy
goals. Often, we need only a small change to get things started and then the
change can be amplified or lead to other changes that move toward the cli-
ents’ desired goals. In many therapy approaches, the therapy must continue
until the theoretical goals of the approach are met. These may be changed
family structure, rearranged sequences of interaction, differentiation of self,
and so on. In SFBT, there are no goals related to theory, only goals that the
client wants. Because small changes can help people move in a direction
toward their goals instead of ruminating about the problem, we can help
them get started and then get out of their way. What is enough therapy?
When the client says there is enough—we stay with them as long as they say
therapy is needed and can identify goals.

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Clients Are the Experts on Their Lives; Therapists Are Experts on

Asking Questions That Help Them Reach the Lives They Want

For many therapists, this assumption takes away their purpose for being
therapists. We have been taught that we must analyze problems, under-
stand them thoroughly from the point of view of theory, and use interven-
tions designed and tested to ameliorate problems in line with the favored
approach. This is a medical model way of seeing problems and concerns
that clients bring to therapy much like appendicitis or strep throat. When we
are talking about concerns of mental, emotional, and relational difficulties,
though, science is not as exact.
Clients know, sometimes with our help, what they want instead of the dif-
ficulties they bring to therapy. Clients are the ones who know what is going
on, what the difficulties mean in their lives, and the consequences of various
changes. We have our own lives to draw on and we have experience of hav-
ing talked with many clients and many therapists. So, we have some ideas
about what might be helpful (e.g., “This is what helped a different client in
his couple relationship”), but there is no way we can know for certain what
will be most helpful to clients. What we do know is how to ask questions
about what they want, details about what that looks like, and what steps
they might have already taken that move them toward what they want. That
is, we believe that clients are the experts on their lives, not us, and that we
are experts on solution-building conversations.

Therapy Is Co-constructed

By co-construction, we mean that conversation is mutual back-and-forth

talk with ideas emerging from the conversation rather than mostly from our
ideas related to a theory of change (e.g., structural, Bowen, psychodynamic)
or what we think is a sure-fire way to make the clients’ problems go away. As
collaborators on this journey, we pay attention to the general formulation of
conversation in therapy: as practitioners, after we carefully listen to clients’
speech, we keep part of what they say (preserving language), ignore part,
and add or transform something (Bavelas, McGee, Phillips, & Routledge,
2000) that helps keep the conversation in future talk and solution build-
ing. We have choices about what we ignore, keep, and add, and by care-
fully listening, honoring the client’s words, and gently adding something

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solution-focused, we help clients clarify their thinking and move toward

their goals.
Through these understandings of the SFBT stance and some basic assump-
tions and understandings of the approach, we demonstrate a fundamental
difference between this approach and others that are driven by theories of
pathology and what needs to change for clients to resolve their problems.
We call this leading from behind. It means that we pay close attention to
how the client is leading us and how we help by asking questions that clar-
ify the path they are on or want to be on, not the one we think they should
take. We stand behind or beside them to gently nudge them toward a future
focus and what their lives look like when they are no longer focused on the
problem.

General Practices
I talk about practices of SFBT because the word feels better to me than inter-
ventions. de Shazer (1982) called these methods and procedures. Interven-
tions connote something we do to the system rather than things we do with
the system to co-construct preferred futures. Cantwell and Holmes (1994)
called this “leading from one step behind” (p. 17) and it was a favorite
phrase of Insoo Kim Berg’s. Berg called this “taps on the shoulder” (Berg &
Dolan, 2001, p. 3). It’s a gentle way of drawing the clients’ attention to
something present that they have not (yet) noticed.
In SFBT, using the stance, we walk beside clients in collaborative conver-
sations in which we guide the direction much as a sheep dog guides sheep.
Different from guiding sheep into a known pen, though, we are constantly
changing directions as clients move along a path toward their goals. First
this way a bit, then that, then a third, perhaps back to the first, and so on.
Our practices help keep them from falling off the path entirely and we let
them determine the path itself. And sometimes, the goals change, requiring
changes in the path.

Client-Therapist Relationship

An interesting and sometimes intense debate surfaces and resurfaces

occasionally in the solution-focused community about the importance of

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establishing a safe and trusting relationship with clients before embarking

on treatment. de Shazer was fond of saying that we don’t need to “establish”
relationships with clients—we already have them by virtue of the fact that
they have come to see us. Rather, we must simply be careful to not mess
them up! Further, he believed that treatment starts with the decision to make
an appointment for therapy. He believed that most people are more inter-
ested in getting on with business and chit-chatting, and that we maintain
relationships with clients when we pay attention to them and listen care-
fully for what they want. Thus, the main practice is “a positive, collegial,
solution-focused stance” (de Shazer et al., 2007, p. 4).

Well-Formed Goals

Whenever we ask questions or engage in solution-building conversations,

we keep in mind the notion of well-formed goals. Well-formed goals include
the following characteristics:

• Important to the client. We may have ideas based on our training in

various theories about goals clients should reach. These include parents’
being in charge of children, changes in communication patterns, dif-
ferentiation of self, and even such specific things as gaining or losing
weight, taking certain kinds of medications, or developing a stronger
social network. However, if these goals are not important to the client,
we’re not likely to make much progress. In SFBT, it is very important to
work on goals that clients state are important to them.
• Interactional. Because of their convictions that the MRI and Brief Therapy
developers were onto something very important, de Shazer and Berg
stressed that goals that include changes in the interactional life of the
client were necessary. For example, how will the client be interacting
with an important other in their lives when they have reached their goal?
How or what will that person notice about this change and how will the
client know that the person has noticed? How will that make a difference
to them?
• Specific rather than global. It is tempting to move toward generalized
goals that may include a sense of “always” or “never.” Because one
of the tenets of SFBT is that nothing is happening all of the time, it is
much more useful to identify goals that target something specific as well

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as interactional and important. If there are other situations where the

change will be useful, clients will recognize this and either ask for help
co-constructing similar changes or make the changes themselves.
• Presence rather than absence of something. It is very difficult to move
toward the absence of something. “My depression will be gone.” OK,
but what clues does that give us about what it means to the client, how
they will know it is gone, or how we can help them other than theories
of what we should suggest from our expertise on “depression”? However,
we can help change an absence goal to a presence one by asking ques-
tions such as, “What will be there instead?” Or, “What will you notice
when it is gone that perhaps you might not be noticing now?” The “what
there” and the “what noticed” may become the goals for therapy. Further,
the client may be able to describe what others would notice better than
what they, themselves, would see as different.
• Well-formed goals are the beginning rather than final step. We believe
that small changes can snowball into larger changes without our expert-
led help. Of course, the client will determine what is enough change but
we always start with a small step after identifying a goal. This is usually
done with the help of scaling questions such as, “Suppose you are one
step or even a half step further toward your goal from where you are
now, what does that look like? What’s happening? What are others seeing
about you that’s different?” After asking detail and relationship and other
questions, we might ask, “Suppose you are at that higher point. How do
you think you got there?” We keep the detailed preferred future in mind
but acknowledge that change starts with one small step.
• Along with being important to the client, well-formed goals include a
role for the client and for all members of systems attending therapy. Mir-
acles may happen but it’s clients who make changes that get them to
those miracle days. In an interactional way, this may mean that after
responding to how an important other person would notice a change
and how the client would know that person had noticed and what dif-
ference it would make, a next question might be something like, “And
given this difference, how do you think that person would respond?” or
“What would that person say you are doing differently?” Each person in
the family may describe goals differently, and it’s the job of the therapist
to help co-create common goals that everyone can agree upon.

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• SFBT goals are also concrete, behavioral, and measurable in some

way. This is where asking questions to get very exact details is help-
ful. Vague differences such as, “I’d feel better” are not very useful for
solution-building. “I would first notice that I wanted to get out of bed”
is much more concrete. “I would get out of bed when the alarm goes
off” is both concrete and behavioral. “I would get out of bed when the
alarm goes off three days out of five” is concrete, behavioral, and mea-
surable. It also provides a much more detailed description of an action
that is different.
• Realistic. Clients often state goals that are not realistic: a deceased spouse
would be alive, the accident wouldn’t have happened, or financial diffi-
culties would magically disappear. This is often when therapists new to
SFBT get discouraged because they are not sure how to help clients turn
these unrealistic goals into ones that may respond to solution-building.
So, we sympathize or empathize and ask what would be different in
their lives should that goal somehow be reached. This elicits the concrete
differences that are more likely to be used toward well-formed goals. For
example, a magically reappeared spouse may mean the client does not
feel lonely. So, another vague goal; keep those curious questions going!
“What would you be noticing instead of loneliness?” “Who would be
there, what would they notice, what difference would that make to them
and to you?” “So, you’d be OK being alone. What would you be doing?
Where? What else?”

Questions

Questions are the main tool in solution-focused work. We might make sug-
gestions, observe what others may have experienced, and so on as tentative
ideas, but seldom prescribe tasks or intervene in the traditional way. When
we do, these ideas arise from the conversation and clearly relate to the
client’s situation and language. We ask questions in terms of what clients
have already said, using their language to inform our ideas and responses,
and in terms that lead toward solution talk rather than problem talk as soon
as possible. Questions about the past are asked to help understand excep-
tions to concerns and details about those situations, moving toward solution
building as soon as possible.

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Solution-focused therapists are not “problem phobic”; we simply have

found that talking about problems easily leads to more problem talk, and
talking about solutions leads to more solution building. However, we must
take care that we are not so solution forced (Nylund & Corsiglia, 1994) that
we “mess up” the relationship and have to backtrack or even lose the client.
Rather, we have found that problem talk is not necessary and that solution
building helps clients reach their goals faster. Questions rather than state-
ments typically elicit more of the client’s context and ideas and less of ours.
That said, some clients feel a strong need to tell us a lot about the problem,
sometimes because they have learned that it’s necessary and helpful in ther-
apy, partly because they need to express themselves. In those cases, we
listen empathically and carefully, listening for openings for solution talk.
Bateson (1972) wrote about the importance of differences and differences
that make a difference. This includes noticing differences, eliciting differ-
ences, finding differences, and enhancing and amplifying differences. In
therapy, we need to find out about these differences that make a difference
for clients. It does not matter whether a partner starts doing dishes before
the table is cleared or after (a difference in behavior) if this does not make
a difference to someone. Refer back to the system thinking section on first-
and second-order change: rearranging the deck chairs on the Titanic made
a difference while the ship was sinking, but was it a difference that made a
difference? Probably not, at least not in terms of saving lives. We ask clients
whether something they describe is different and, if so, how it is different
and whether it makes any difference to them or to others.

Relational Questions

Relational questions are very important in SFBT. At the Mental Research

Institute, systemic and interactional ideas provided an overall sense of cli-
ents, the difficulties they bring to therapy, and how changes in relationships
are necessary for lasting change. Whenever possible, it is helpful for fam-
ily members to attend therapy. This helps everyone to know about desired
changes, to notice changes that already have happened or are happening,
and to participate in the co-constructed conversations for building solutions.
However, even when important others cannot or do not attend therapy,
we may keep them in mind as important aspects of the client’s attending
context. Therefore, we ask questions that elicit perspectives of these other

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people that are important to the client. This helps to make the picture circu-
lar rather than linear. It also helps to anticipate how others may respond to
changes so that practitioners can help clients plan for unhelpful responses
from others or to develop other changes that will meet goals without such
responses. It also helps clients become better observers of themselves,
which helps them assess changes they are thinking about. Further, relation-
ship questions help identify others as resources for helping clients move
toward their preferred futures.
Examples of relationship questions include such queries as, “Who will
notice this small change? What difference will this make to them? What
difference will their noticing make to you? What else will they notice? What
difference will that make?” and so on. Even when clients claim that no per-
son in their contexts will notice, we can elicit ideas about people who are
no longer in their lives (e.g., a grandmother or teacher) and ask what they
would notice if they were present. We can even ask about pets! One time, a
client was struggling mightily to identify a meaningful and possible change.

TSN: That’s OK. You have a dog, right? Suppose this heaviness you
describe was gone and you were feeling lighter and more like doing
things [using client’s language]. What would your dog notice?
Client: (laughing) Well, first off, he’d notice that I go outside with him
more for walks instead of just letting him out to roam the backyard
on his own.

Of course, I was thinking, “Yay! Exercise! Good for depression!” But

I calmed myself so as to not get ahead of the client and asked what differ-
ence the dog’s noticing or the walk would make to her. She responded
that she would feel better about herself as a dog parent. This is a great
solution-building opening, so we explored that in detail and then I asked
what else the dog would notice. And by that time, she was able to think
about differences that other people would notice.

Details

Asking about details is a very important aspect of solution-focused work

that many do not understand. Details, details, details! We want detailed
details about who, what, when, where, and how as well as what else. We’ll

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learn more about who in a little while, but it’s worth starting here: we do
not live in isolation; others notice things about us more than we realize, and
it’s important to find out who will notice differences, what they will notice,
when they will notice them, and how they will know something, as well as
what difference those noticings will make to them. Asking about details is
important because it is easy for us as practitioners to believe that we know
what clients are talking about, make all kinds of incorrect assumptions, and
get the work, ourselves, and our clients off track. Asking about many details
helps to fill in the picture for both our clients and ourselves so that we are
more likely to notice differences that might make a difference for the clients.
Remember the idea of not fixing what’s broken and doing more of what
works? When clients come to us believing that they have tried everything
and that nothing has been helpful, we search for tiny openings of things that
have been helpful (exceptions and instances) a little bit and gently nudge
clients toward doing more of that (de Shazer et al., 2007). This greatly helps
to instill hope and a sense of competence if done gently. Asking questions
about details and what clients did to make something happen helps instill
new perspectives and a belief in themselves as competent.

Compliments

Compliments are important for validating clients’ concerns and progress and
what they are doing well. Compliments also are useful for validating diffi-
culties by showing that the therapist cares and is listening, especially when
there is a glimpse of something that is working. A client came to therapy
because she was so depressed that she could hardly get out of bed in the
morning. The therapist responded, “And yet, here you are, dressed, out the
door, into a car, driving all this way, parking (which isn’t easy around here!),
coming inside, and talking to me. Well done! How did you manage all
that?”
We must be careful, however, not to become too optimistic lest clients
think we don’t understand the gravity of their situation. Solution-focused
work is often like a chess game of careful listening for clues from clients that
will tell us what a next move might be that would be helpful.
It is vitally important that we not give the impression that we know what
a client means. In those cases where we are so tempted, a compliment

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can sound hollow or as though it is forcing (Nylund & Corsiglia, 1994) a

perspective rather than using clients’ leads. Also, overdoing compliments
may come across as patronizing. Compliments must be genuine and relate
realistically to something the client does or says.

Suppositional Frame

Another basic practice in SFBT is asking suppositional questions. These

questions assume that something already has happened or that it will hap-
pen. Think about the difference: “What will you be doing if you reach your
goal?” or “What will you be doing when you reach your goal?” The second
phrasing is much more likely to elicit the client’s imagination and picture
of something concrete and behavioral, as well as hope. There’s a general
idea that if we can imagine something, we are much more likely to be able
to make it happen than if it is only a vague, abstract thing such as, “I’d be
happier.”

Timing

When to apply various practices is part of the art of solution-focused work

and practitioners must learn for themselves when to use specific practices.
In my own work, I prefer to find out about preferred futures rather quickly.
Clients may say that in their ideal future, the problem will be gone. We fol-
low up with a number of possibilities:

• What will be happening instead?

• What will you notice that is different?
• What will others notice that is different, and what difference will this
make to them?
• What difference will that make to you?

We may then move in a couple of different directions, keeping each in

mind as we explore others:

• When is some of that happening already, even a little? What are some
signs that tell you that it is possible?

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Or, when the client wants to focus more on the problem, we can encour-
age solution-building talk:

• You’ve solved many problems in your life; how did you go about doing
that? (Clues for the client’s usual problem-solving method that might
work in this instance; exception finding for feeling stuck in making
decisions.)
• Problems are usually more and less intense in our lives. When was a
time in the last couple of weeks when the problem was not so present
for you?

What Else?

With nearly any phase of the work, we can ask what else questions. These
questions help to fill in details and enlarge the frame for possibilities of
change. We can ask what else about the miracle day, about other people
who would notice changes, what other differences a change would make
to the client or to someone else, what else is happening when the client
is one step up the scale, and so on. I have found that I typically want to
stop asking what else questions sooner than the client needs me to. Clients
continue to imagine and tell us about more and more when we ask them
what else.

Situations Versus Problems

There are times when the client sees something as a problem that we would
frame as a situation. Problems are things that can be solved; situations just
exist. Grieving the loss of a loved one is one example of a situation. Sim-
ilarly, responses to the miracle question may be unrealistic (e.g., “I would
win the lottery”). In those cases, we can either wait, knowing that the client
realizes the goal is impossible, or express sympathy and wait, or ask how
that would make a difference for them. We would then use that information
to help them formulate a reasonable, attainable goal.
For situations that present problems for the client, such inability to sleep
(grief) or wanting another person to change, we can ask coping questions.
Coping questions often open up possibilities for either finding more con-
crete preferred future goals or ideas for coping even better.

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Specific Practices
Pre-Session Change

Fairly often, clients come to therapy already experiencing changes in their sit-
uations that led to calling for help. Of course, most therapists don’t know this
because we don’t ask questions that might reveal these changes. It’s fairly easy
to ask about pre-session changes: Since the time you called for your appoint-
ment, what have you noticed about your situation? Clients often will tell us
things that are already happening related to the problem and it’s the perfect
time to ask detail questions and find out how to keep these changes moving.
Therapists can come back to this question later in therapy as they learn more
about clients’ preferred futures and ask about how changes (exceptions) they
already are noticing help move them toward the preferred future.
When clients report no changes, we can simply move on to finding out
what they want from their time with us. If they report things are the same or
worse, we can find out how they kept them from being worse than that or
how they coped. It is very interesting to note that asking clients about how
they cope brings forth descriptions of changes they hadn’t noticed before.

Previous Solutions

Like pre-session change, previous solutions questions assume that clients

have solved many difficulties and problems in their lives before coming to
see us. Asking about these times helps give clients and therapists ideas about
how clients go about managing their lives in more and less successful ways.
Clients and therapists can use ideas from these patterns for co-constructing
current solutions, drawing on the clients’ knowledge. I often start this part of
a conversation by commenting that clients have solved many problems and
difficulties in their lives, and wondering how they went about doing that.
What resources did they use? What knowledge that they already had did
they use? What skills did they show? Who might have been helpful?

Exceptions

Another important practice is looking for exceptions. Throughout all of the

work with clients, practitioners listen for exceptions. In solution-focused

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work, we listen specifically to exceptions to the problem (when it is not

happening, when it is not as intense, when it is not experienced as prob-
lematic, or what might have been helpful in the past, perhaps with differ-
ent problems). Just as change is happening all the time, problems are not
experienced the same all the time. Clients use words like “always” and
“never,” and sometimes “mostly” or “usually.” When we hear “always,”
it’s a good time to ask about exceptions. When we hear “mostly,” it’s a
good time to ask about times when it’s not happening. When clients say
“sometimes,” we pounce like cats on feathers and ask for details about the
“sometimes.”
Exceptions can also be a term used for looking for instances when parts
of the miracle or preferred future already are happening. This is a specific
exception to the clients’ view that the problem is happening all of the time
or having overall prominence in their lives. Some practitioners do not ask
about exceptions to the problem (e.g., “Tell me about a time in the last
couple of weeks when things were different”), preferring to stay away from
“problems” as much as possible. Similarly, some practitioners prefer to not
ask about “solutions” because preferred future details are not necessarily
solutions to problems, but instances of when whatever was characterized as
a problem is no longer problematic.

Preferred Future

We focus on a preferred future in some form. This might be in response to

the miracle or best hopes question (see below), or it may evolve through
conversation spontaneously about what clients want. This has been phrased
in the past as well-formed goals, which took the form of being important to
the client, stated in interactional terms (what others will notice), that have
situational features (specific place and setting rather than global), the pres-
ence of something desirable rather than absence of problems, steps rather
than final results, recognition of a role for the client, concrete, behavioral,
measurable, realistic, and at least somewhat of a challenge for the client
(DeJong &Berg, 2013). Often, through responses to questions about clients’
preferred futures, we learn about their ideal lives. This is useful, and we use
these ideas to help them get started, remembering that we must start with
one step and that clients may decide they’ve done well enough in therapy
before reaching their ultimate goals. Clients sometimes change their ideas

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about preferred futures as we move through therapy, recognizing limita-

tions, values, desires, and new ideas for those futures.

Miracle Question

The sine qua non that many associate with the solution-focused approach
is the miracle question. The story goes like this: Insoo was working with a
client who described things such that it sounded like her whole life was
falling apart. Insoo asked her what needed to happen so that their time
together was useful. The woman replied, “I’m not sure. I have so many prob-
lems. Maybe only a miracle will help, but I suppose that’s too much to ask”
(DeJong & Berg, 2013). Insoo, ever listening to what clients tell us to ask
more about, said, “OK, suppose a miracle happened, and the problem that
brought you here is solved. What would be different about your life?”
The way the miracle question can be asked varies from practitioner to
practitioner and situation to situation. Some believe it should be asked in the
way that the BFTC team ended up with, which uses an hypnotic-like way of
helping the client move into a light trance and vivid picture of the miracle.
Others have said that it needs to be modified to fit the client’s situation, cul-
tural norms, and language. Regardless, the basic idea is this:

I’d like to ask a strange question. Suppose that while you are sleeping
tonight and the entire house is quiet, a miracle happens. The mira-
cle is that the problem which brought you here is solved. However,
because you are sleeping, you don’t know that the miracle has hap-
pened. So, when you wake up tomorrow morning, what will be dif-
ferent that will tell you that a miracle has happened and the problem
which brought you here is solved?
(de Shazer, 1988, p. 5, italics in original
denote hypnotic emphasis)

The question can be asked in many ways, some to deepen the trance
(e.g., “Suppose, after leaving here, you go about your day, doing what you
usually do, eat your dinner, finish your evening, and go to sleep. It’s a very
nice, deep sleep.”). Some add emphasis (“The problem that brought you
here is solved, just like that! [finger snap]”). Others ask about the morning a
little differently (“What is the first thing you will notice that will tell you that

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a miracle must have happened?”). Some therapists ask about the “miracle
day,” imagining what a whole day would look like in detail after the mira-
cle. We will discuss scaling in a little bit, but the scale point of reaching 10
easily can be called the miracle day. Clients know that the full miracle day
may not be possible, but that noticing what’s happening already or signs that
parts of the miracle day could happen, and naming points on the scale is
often heartening and helpful.
Now, at this point, I’d like to note that some therapists seem to think that
the purpose of the miracle question is to determine goals for therapy. How-
ever, it is much more than that: it is a process, a way to help therapy move
from problem solving to solution building, focusing on details of a preferred
future that will then lead to questions about exceptions—what parts of the
miracle that are already happening, even in small ways, or signs that the
miracle is about to happen, even in small ways—or to what will be happen-
ing instead, which may not seem at all related to the presenting problem. It’s
about shifting conversation from problems to what happens when problems
are no longer problematic, changing the whole tone of a session. It might
be better called the miracle set or future perfect question or something else.
So, there is no way that the miracle question won’t work if the practitioner
keeps in mind that it is the first question in a series that will amplify what
clients want and what is already happening toward what they want. It some-
times helps to ask detailed curious questions about the miracle day: what
happens, and then what, and what about that is different, and so on, which
helps to amplify the picture, perhaps making it more vivid, and provid-
ing more openings for asking about relationships and exceptions. This is a
solution-building rather than problem-solving conversation, which distin-
guishes SFBT from other therapy approaches and is the keystone of SFBT.
An incredibly important and often overlooked aspect of the details of the
preferred future is its interactional nature. de Shazer and Berg were trained
in systemic thinking at the Mental Research Institute and were quite aware
that problems (and solutions) exist in interactional, systemic contexts. This
means that important others in the clients’ contexts are a part of the problem
picture as well as the future picture, and relationships with those people as
well as the clients’ views of those people hold clues to what will be different
when the problem is gone.
A great example of this relates to the notion that solutions are not neces-
sarily related to problems: A client reported that her reason for coming to

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therapy was because she was depressed. She went into some detail about
what was happening that led her to this belief and the therapist listened
respectfully. When she found an opening, the therapist asked her the mir-
acle question. She noticed that one thing the client mentioned in her pre-
ferred future was that she would be going out more with friends. By asking
relationship questions, the therapist found out what the friends would notice
that was different, what they would be doing when they went out, what she
might be wearing, where they would go, what she would see and hear, and
so on—great details about the preferred future. She also asked—and this
is important—what this difference would mean to her friends: what they
would notice, what that would mean to them, and what difference that
would make to the client. Having a greatly detailed though small part of
the preferred future picture, the therapist then asked when some of that was
happening already, even a small part.
This client was able to describe a small exception in detail, which led to
a useful conversation about what she could do to keep it going and amplify
it. Another client might not be able to describe such an exception, and that’s
OK. We have other tools in our practice box.

Scaling

Another tool that also is famous in solution-focused work is scaling. In this

practice, the preferred future or miracle day becomes a 10 on a scale of 0
or 1 to 10, whichever you prefer. We describe this scale to the client, mak-
ing 10 the preferred future or miracle day and 0 or 1 the opposite. The first
question asked, then, becomes, “Where are you now on that scale?” Clients
are usually quite able to provide a number that is something more than 0
or 1. We then ask about what is happening that tells them they are at that
number and ask how that number is different from ones below it. This is a
good way of helping to identify existing exceptions and instances, and what
others notice, what difference that makes to them, and so forth.
On occasion, clients will say that they are at 0 or 1 or even worse. We can
work with that! We can ask what has kept things from being even worse, or
how they have coped with things given how difficult they have been.
After finding out what is different from where they are now and what is
worse, we can now ask about a step or even one-half of a step up the scale:
“You have said you are at 3; what does a 4 look like? What’s different about

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4?” It is amazing to me that clients almost always go along with this line of
questioning—one might think that clients would find it silly, but they don’t;
clients begin to get into a rhythm of responding to strange questions, detail
questions, relationship questions, scaling questions, and so on. And, in the
process, they often realize that they are already experiencing some of what
they describe as better. It seems that, when people can imagine something,
they can imagine the details around it that make it more than imagining,
that make it real.
In early years of SFBT, practitioners often asked people what they would
need to do to move from where they were to that number plus 1. Some-
where along the line, it became clear that an easier question for clients to
work with, one that better engaged their imaginations toward the future, was
to ask what is different at their number plus 1, to ask detail and relationship
questions, perhaps exception or instance questions, and then to say some-
thing like, “OK, you have described your number plus 1. How do you think
you got there? What helped? What is different? What else?” At this point,
clients often surprise themselves by noticing that they already are at the plus
one number, or plus one-half, or are moving toward a higher number. For
me, this is a clue to ask about their number plus 2, but I have to be careful
to not get ahead of the client and sometimes must slow myself down. When
so tempted, I usually ask detail and “what else” questions.
We also can ask scaling questions about others’ scaling ideas, realizing
that responses are impressions and perceptions rather than “truth.” This can
be quite enlightening for others as well leading to more relationship and
scaling questions, and solution-building conversations. In a session with a
teenager and her parents, the teen said that her parents were at 2 in terms
of trusting her. She thought they should be at 7 based on her perceptions
of her behavior. I asked what she thought they would be doing that would
tell her they were at 3, one step up the scale. She started to describe some
things, and then said she realized that they were already doing some of
them. I also asked the parents where they thought they were in terms of
ability to trust their daughter; they responded 5—about half and half. When
I asked what they would see different when trust was at 6, they had some
really good ideas that the daughter was able to understand. She also seemed
more hopeful, saying that maybe it wasn’t as bad as she thought.
By the way, it doesn’t always go this smoothly. Although many conver-
sations seem smooth and easily navigated, others are fraught with tension

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and mind-changing. The teen in the previous example could just has easily
have argued with her parents that there was “no way” they could be at 5
and what their “real” position was. In these circumstances, it is important to
stay focused on exceptions and perhaps back up a step. I might have said
something like, “5 seems like a long way from 2 to 2.5. Parents, what else
tells you that you are at 5?”
Sometimes, clients cannot imagine anything better. Their worlds are so full
of problems that they just can’t see any other possibilities. In those cases, we
can ask about how they keep things from being worse and how they cope
with such difficult situations (see the next section on coping questions). We
can ask relationship questions about what others might notice about them
that says they haven’t given up. Responses then give us clues about their
resources and abilities to use resources. For those of you wondering about
safety for suicidal clients, I refer you to solution-focused authors such as
Heather Fiske (2008) and John Henden (2005). As long as someone is alive
in front of you, there is room for asking questions that can bring people hope
for better lives.
Scaling can be done in many ways. My colleague Pamela King (2017) has
written a book about working with children and their families that includes
creative ways that she, her young clients, and their parents have devised to
use scaling that fits a young person’s world. These include abacuses, hop-
scotch, lines on floors from one corner of a room to another, ladders, and
many more. The aim is the same: to help people realize that change happens
in increments and that they don’t have to resolve their issues completely in
one fell swoop. They can envision something a little better and when that’s
happening, something even better.
In my own work with clients, we seldom have reached 10 during ther-
apy. Once they are started in the direction of their goals, they may decide
that where they are is good enough or that they can continue on their own,
calling for more appointments if they need to. When some of my clients
have called, all I have needed to do sometimes is ask them what they think
I would say or what they have forgotten about our work together. If that
is not sufficient for them, we have an appointment and continue on from
where they are and what they want. Sometimes, that’s a completely different
issue.
Scaling also can be used for many aspects of conversations, often using
the client’s language. For example, after determining a picture of one step up

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the scale and discussing how the client got there, the client may comment
that he’s not certain he has enough courage to do what he knows he needs
to do. We can ask scaling questions around courage: “Suppose 10 is that
you have all the courage you need? Where are you now?” You can then ask
other questions around that: What’s different from where you are now and
one point lower on the scale? One point higher? Relationship questions,
difference questions, and what else questions.
Or, you can ask about confidence: How confident are you that you will
be able to go home and do this? Ability? Who can help you? What will
they do? How will you show them you appreciate their help? These kinds
of questions help with what other therapists call motivation. Clients are not
necessarily unmotivated for change, but honestly aren’t certain they have
what it takes. Genuine, empathic, curious questions about what a little more
courage, confidence, or ability would look like and how they got there can
go a long way toward helping with solution building. If we press matters in
the preferred future or goal scale, we may be forcing solution-building too
soon.
Harry Korman once had a client who was paraplegic and whose mother
was very worried about him. Seeing him alone, at some point in the con-
versation, the client admitted that he didn’t want things to be better but
wanted to want that. Steve de Shazer re-enacted this session, which is quite
powerful (SFBT, n.d.).
One thing I hope you have noticed is that doing questions are aimed at
the client: what the client can do. Clients often talk about what they would
like others to do, but there are no ways that people outside the therapy room
can know about this. Rather, we ask clients how they will respond when the
other person does what they want. This may nudge the client to think about
doing those things and see how changes in their part in systemic interactions
influences changes in others.
For example, a father may wish that his son, who is not present in ther-
apy, would “listen” more and “mind” better. First, we check to be certain
we understand that “listen” and “mind” mean that the father wishes the son
would obey more often. Asked how he would respond if the son “minded”
more often, the father will likely give several answers, each of which may
give him ideas about his part in the interaction. Asking about the last time
the father did this and how the son responded helps the father move even
closer toward his goal.

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Situations, Coping Questions, and Interviews About Harm

Sometimes, clients are so discouraged about their situations that they are
not responsive to our questions that might lead to solution-building. Of
course, it is important to offer empathy and to listen, taking care to not
be solution-forced. Situations are times when there’s nothing that can be
changed. No one can go back in time and undo an event, for example.
How people respond or cope are things that are changeable. If they indi-
cate that their goal is to change the way they respond or cope, we can help
them with that goal in the usual solution-building ways. But sometimes,
such as when things were worse during the previous week and nothing we
ask helps bring about even the tiniest meaningful change, we can help them
identify how they kept things from being worse, how they are coping, and
what better coping would look like, who would notice, what difference
that would make, and so on. Gentle compliments are very helpful at these
times. Responses then give us clues about their resources and abilities to
use resources.
Asking coping questions has helped me as a therapist find stronger ground
for helping rather than getting as discouraged as the client. How do I cope
with clients who just can’t identify anything concrete? I ask myself how
I have coped with that in the past.
As long as someone is alive in front of you, there is room for asking
questions that can bring people hope for better lives. Insoo Kim Berg (SFBT,
n.d.) interviewed a teenager who had been tasked with helping her during
a workshop and who told her that he had almost killed himself the night
before. She asked if it would be OK for them to talk after the workshop. He
said it would be and did a good job helping her throughout the day. During
the interview, Insoo elicited many ideas about how killing himself was not
a good answer to his desires and helped him realize what he wanted and
what was going on that supported his preferred future. She did not do a
“standard” suicide risk assessment, she did not stop her preparations for the
workshop, but you can be sure she kept an eye on the young man. She knew
that as long as he was alive in front of her, she had room to work with him,
and that did not include asking him about all the reasons for his hopeless
feelings.
I just now realized that one thing that has been difficult for me is when
clients identify vague rather than concrete goals and differences. At one

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time, de Shazer (1988) said that when clients get vague, we can get more
vague. I also remember that we don’t need to know the content of problems
to be able to be helpful, which is hard to remember when the content of
the stated problem tempts me to become the expert when I don’t need to be
(situations of potential harm being times I may need to be more directive).
At those times, when clients are vague, I ask them to imagine what will be
happening instead and about details about those imagined times. This also
is helpful when clients are reluctant to talk about problems (even when
we don’t ask them to) because they are embarrassed, afraid, and so forth.
We don’t even need to know details about the scales in some cases. I once
co-constructed a first session with a client by asking them only to imagine
responses to my questions. I never did learn details, and the client ended
the session by saying he knew what he needed to do and would call me if
he needed more help.

Breaks

During sessions, many SFBT practitioners take breaks about midway or two-
thirds of the way through to collect their thoughts and form a message.
This practice was used at the Brief Therapy Center of the Mental Research
Institute and has been carried out in one form or another in many other
approaches, including the Milan approach to family therapy (Palazzoli,
Boscolo, Cecchin, & Prata, 1978), Peggy Papp’s (1983) family therapy work
at the Ackerman Institute in New York City, Tom Andersen’s (1991) work in
Norway, and the Narrative Approach, first described by Michael White and
David Epston (1990). At the Brief Family Therapy Center in Milwaukee, after
the break, teams of therapists provided a summary of what they heard, com-
plimented the clients on something, and then made a suggestion, assigned
a task, or asked clients what ideas they might have about what to do next.
Many, many solution-focused therapists continue this practice, whether
they can leave the room or not. Simply taking a few minutes to collect
thoughts and perhaps review notes can help bring the session together as
a whole and lead to either new ideas or solidifying ideas that have already
been explored. Before the break, some therapists ask clients what questions
the therapist didn’t ask or what else the client wants the therapist to know.
This further cements the idea that therapy belongs to the client and that the
therapist needs to keep that in mind. Some therapists ask clients to think

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about next steps during the break and ask about those after the break. “Next
steps” is a rather vague phrase that allows clients to think about whatever it
means to them.

Directives, Tasks, and Signs

Directives, tasks, homework, or experiments may be posed when clients are

unsure of clear ideas in response to questions. For example, when asked
about exceptions to the current difficulty and faced with little information
about what the client’s preferred future or what others would notice when
the problem is no longer prevalent, the therapist might ask the client to
watch for exceptions, even tiny bits, or to watch for signs that the miracle or
parts of it might be happening already, even a little. Other tasks (e.g., taking
turns in helping children with homework) might be phrased as experiments.
Because we believe that clients know what is best for themselves and their
situations, we are not concerned if they don’t follow the suggestion, change
it, or do something else. Whatever they do is best for them and information
for us. Perhaps a different experiment would be better; ask the clients what
they might do that would be helpful!
Clients often surprise us when we ask them for signs that things can
improve. A couple on the brink of divorce had a very difficult first session
with me. They were so steeped in their pain that they did not know what
anything better in their relationship would look like; they did say that they
thought it was possible because they had once been happy together, just
that they didn’t know what it would be. They identified some things from
their early days together, but these did not seem to fit the future very well.
I asked them whether they wanted to come back for another session, and
they did, so I asked them to watch for signs that it would be possible to
work through the difficulties and stay married. The next week, I asked if
they had seen any signs. I was flabbergasted when the wife said that she
had told herself that if she saw a red car after leaving our session, it would
be a sign that there might be hope. She saw a red car as they were leaving
my office and her spirits had lifted a little. This was a sign that the husband
was looking for: that his wife would be even a little more hopeful, which
made him more hopeful. You might have guessed that I worked with them
on scaling hope rather than the preferred future, because hope needed to
come first.

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What Was Helpful?

At the end of each session, I ask clients what was helpful to them. I often
am surprised by their responses, because they are different from my own
ideas about what was helpful. I believe that thinking about and responding
to this question helps solidify changes and ideas for changes for clients and
gives me clues about how to keep doing what’s working in therapy. I also ask
whether they might like to make another appointment; I never assume that
they want one. If they hesitate, I may suggest that we make an appointment
that they can cancel, or I might suggest that we have at least one more. We
might space sessions out for a while or make an appointment for a month
later as a booster or as a session “in the bank” that they can cancel if they
want and come back for later.

Second and Further Sessions

Second and subsequent sessions look a lot like first sessions. We often say
that every session should be assumed to be a first and only session. Some
therapists like to ask about the previous session and what was helpful or how
the homework went. Many ask about what is better and then conduct the
session as though it were a first: differences, who noticed, what difference
that made, scaling the miracle day or a similar scaling question, and so on. It
is useful to pay attention to the unexpected. Whatever happened, clients usu-
ally mention things they would not have noticed at a lower number or some-
thing that happened that was important to them. When they say that changes
have been helpful, we remember to suggest they keep doing what works: if
something is working, continue doing it, if it isn’t, do something different.
I do not worry if clients say things are better and then report lower num-
bers. Ideas about what the numbers mean are fluid and clients sometimes
change ideas about what goals of therapy look like. Clients often catch on
to the process of the approach and start doing the therapy themselves: “So
I asked myself, look, here’s where I am. How is that better than before and
what would be a little better from here? What did I forget to do?”
One way to think about the process of therapy sessions is to remember the
acronym EARS: elicit, amplify, reinforce, and start over. Elicit means asking
about the preferred future, exceptions, or changes in scaling as well as rela-
tionships. Amplify means eliciting details about exceptions or movement on

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the scale. Reinforce means using the clients’ language to solidify important
changes. And starting over means asking what else and more detail ques-
tions. This formula can be used for all sessions as a general template, modi-
fying as needed to fit circumstances.

Emotions
de Shazer and colleagues (2007) wrote a chapter about the myth that SFBT
is not concerned with emotions. Eve Lipchik (2002) wrote a whole book
on the importance of considering emotions in the context of SFBT. What
I take from what I have read, learned, and discussed with others about emo-
tions and SFBT is that they are an inner state and easily reduced to linear,
non-wholistic matters residing inside a client and are to be dealt with there.
In SFBT, a systemic approach that includes context, we look for the contexts
in which emotions arise and are expressed, especially relational contexts.
By learning more about details of preferred futures, emotions are attended
to in difference questions. When the preferred future is happening, or parts
of it, what difference does that make to clients? If we asked only about
feelings, we close down rather than open up the context for noticing new
or other possibilities. Rather, we can think of emotions in therapy as mani-
fested in behaviors that can be identified and become part of the co-created
conversation. Clients tell us about their emotions whether we ask or not,
and we must be respectful of what they find important to tell us. However,
scrutinizing or exploring emotions, especially painful ones, is more likely to
reify problems and difficulties. Asking details about behaviors, relationships,
contexts, and what the client is doing when problems are resolved and emo-
tions are different is more likely to lead to resolution.

Changes in the Approach

Over time, the solution way of doing therapy has evolved in many places
and many ways. Whereas at first, de Shazer’s books were the manuals, we
now have articles, books, workshops, and trainings all over the world that
exemplify the best of solution-focused work: learning from clients in their
contexts. Using the tenets of learning from clients and doing what works,
this means that solution-focused therapists may develop their own ways

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of asking questions or conducting sessions. Steve de Shazer once asked

clients how they would know that their time with him would be useful.
Intrigued with this question and de Shazer’s tendency to make things more
and more simple as well as learning from clients, the BRIEF therapists of
London, England honed the question: “What are your best hopes from our
time together?” (George, Iveson, & Ratner, 1999). Other practitioners no
longer give compliments or assign tasks but may ask clients after a break and
summary what else they need to talk about. They may ask a question before
the break such as, “Is there anything else you would like me to know?” or
“What question should I have asked but didn’t?” The point is to pay very
close attention to what clients are telling us about their lives, not what we
imagine they are telling us. Although debates are ongoing about what SFBT
“is” or what we “should” or should not do as an SFB therapist, we should
remember the systemic notion of equifinality: there are many ways to reach
goals. There are many ways to conduct Solution-Focused Brief Therapy, and,
I believe, they are all potentially useful as long as they hold true to the
solution-focused stance and basic assumptions.

And So . . .
Solution-Focused Brief Therapy was developed by listening very carefully to
clients. Of course, therapists from all approaches would say that they listen
carefully to clients. The difference is that of perspective: instead of listening
for opportunities to deconstruct the problem or for information that our the-
ories tell us what is wrong, SFBT therapists listen for what will be different in
the future when the stated problem is no longer a problem. Therapists do not
assume any kind of dysfunction or pathology, instead assuming that clients
have all kinds of resources available to them that will help them attain their
preferred future. Therapists help them identify, utilize, and evaluate these
resources instead of telling them how to fix the problem or even how to
attain the preferred future.
In this chapter, I have laid out the basic assumptions, principles, and prac-
tices of SFBT. As de Shazer would say, the approach is simple but not easy.
This means that in addition to understanding the approach, it is necessary
to practice it with supervision in order to use it as an art of helping people
obtain the lives they want.

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4 Within a Systemic
Perspective

In this section, I will use several of the key tenets and concepts of Solution-
Focused Brief Therapy and discuss my view of them from my systemic lens.
The SFBT approach was developed by Steve de Shazer and Insoo Kim Berg,
who had been trained in the Mental Research Institute’s perspective and
method. Although they upended the method by suggesting a focus on solu-
tions rather than problems, the overall lens through which they worked was
systems/cybernetics (von Bertalanffy, 1968; Watzlawick et al., 1967). Each
concept below fits into the web of circularity, wholeness, and context that
are the hallmarks of systemic and cybernetic thinking, and helps us under-
stand solution building as different from problem solving.
All of these ideas work together as a whole—systems, cybernetics, and
SFBT—and therefore, it’s important to keep in mind a few basic ideas.

1. Clients are experts on their own experience, what works for them; ther-
apists are experts on solution-building conversations.
2. From a systemic perspective, therapists become a part of a clinical sys-
tem that is unique for each client system. Therapists are participant-ob-
servers and as such, experience the family within the clinical system
rather than simply being observers.

Stance
The stance of SFBT is one of being curious, respectful, tentative, and non-
pathologizing, believing in client competence, and being collaborative. The

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systemic lens enlarges our understanding of clients within their contexts that
include us as practitioners and the context of therapy, not just clients’ cog-
nitions, behavior, and emotions. Their context includes people important to
them (relatives, teachers, coworkers, justice people), circumstances of life
(work, school, health, religion and religiosity or spiritual beliefs, education,
neighborhood, relationships, etc.), as well as schools, probation, and any
other entity, value, or belief with which they may be involved and with
which they interact. Agencies and others that refer for therapy are especially
important because they (a) may hold power over clients, and (b) have ideas
about what needs to be different.
The stance is one of being curious about the clients’ situation, ideas, rela-
tionships, preferred futures, and resources, as well as about what others’
ideas are about what needs to be different. We especially are respectful of
clients, not assuming that others’ ideas or desires are the same as the clients’
or that we know what clients’ reasons for therapy or preferred futures should
be; we remain curious about our clients’ ideas and how they interact with
others’ thoughts. This sometimes means that the clients’ preferred futures do
not directly address the issue for which they may have been referred to ther-
apy. For example, Lee, Sebold, and Uken (2003) refer to goals that clients
develop in their solution-focused domestic violence groups. The therapists
do not judge the goals or require ceasing violence for group participants.
Instead, they remain curious, follow the basic tenets of the approach,
and strive to help clients reach their goals within their own contexts. We
believe that clients know their lives and experiences better than we do,
and we respect that knowledge. Anderson and Goolishian (1992) called
this “not-knowing”: we do not know the clients’ experience, we don’t know
what is best for them, we don’t know what their goals “should” be, and we
don’t know how they are going to reach their goals. We remain curious as
we journey with clients, discovering their preferred futures and how they
will get there.
Being tentative, viewed systemically, assures us that we are looking
broadly at clients’ contexts and situations. We do not attempt to determine
the “correct” hypothesis, cause of a problem, or solution, and when we
have ideas about those things, we present them tentatively to clients, leaving
room for them to disagree. This often leads to other ideas instead, sometimes
things they had not thought of previously. We must be tentative because we
can never know the fullness of clients’ systems and experiences.

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We do not try to diagnose our clients or try to determine what is wrong

with them. Systemically, labels can foreclose our thinking, preventing us
and our clients from seeing the breadth of their experiences and contexts
outside diagnoses, sometimes requiring solutions that may not fit for them
and preventing other possibilities. Clients do sometimes come to therapy
with diagnoses that someone else gave them; however, we do not assume
that diagnoses or labels encompass the wholeness of clients. We ask what
the diagnoses or labels mean to clients and how they might be helpful.
We tend to look at diagnoses as descriptions rather than explanations of
difficulties, and, as descriptions, they cannot be complete (cf. Simon &
Nelson, 2007). Descriptions of patterns of what is happening lead to cyber-
netic explanation rather than pathology (Papp, 1983). Meanings that are
constructed around labels are fed back into the therapy system (circularity)
and affect clients’ interactions with us and with others.
One of my clients came to me with a diagnosis of bipolar disorder (BPD).
She went through the list of descriptors from the DSM (American Psychiatric
Association, 1994) and claimed that the items all fit her and her situation. As
I asked curious questions, though, it became clear that some of the descrip-
tors had not shown up until she read an article in a magazine about BPD.
This did not take away from the comfort that she had from knowing that
there was a word for her experience, but it did help her to see that she did
not have to have all of the descriptors in order to keep the diagnosis. She
did not need to pathologize herself, could see the list as descriptions of her
experience rather than traits or symptoms of some disease, and understand
that they were about behaviors that could change. We do not ignore poten-
tial biological concerns, but keep them tentative, and help clients make their
own decisions about medical interventions for their situations. We consider
more in clients’ contexts than labels and consider other descriptions that
might be appropriate, ones that are not descriptors of disease but of existing
behaviors that suggest possibilities toward preferred goals. For example, this
client was an avid reader and I became curious about what she had read or
might read that was pertinent to her life other than her diagnosis.
The stance also includes a dearly held belief that clients are competent
at working with us to resolve their difficulties. Clients do come with disabil-
ities and limitations, and it is wise for us to understand this as part of their
contexts. But we believe that no matter what their situations, if they can
have conversations with us, we can co-construct better futures with them

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even when they have been mandated to therapy. This is especially important
when viewed through a systemic lens. My husband worked with a family
where the parents were quite concerned that their 19-year-old Down Syn-
drome son might be schizophrenic. Their presenting wish was that the clinic
evaluate him for this diagnosis, which we could not do (there are no reliable
tests for this disorder in developmentally delayed persons). It became appar-
ent that their concern was easily dealt with (the “voices” he was talking to
were his own self-talk so that he would get things “right,” e.g., bus numbers
and routes to work), but they were still concerned about his future. My hus-
band asked the young man in a family session what more he needed from
his parents that would help him reach his dreams. He replied, “Mom, Dad,
you can help me more if you help me less.” Although he was cognitively
limited, he very well understood what kind of relationship he needed with
his family, one that promoted his independence and competence.
Finally, the stance suggests that we are collaborative in therapy. From a
systemic perspective, this means that we honor clients’ expertise on their
lives, remain curious rather than knowing about their contexts and situa-
tions, and work with them as collaborators and co-constructors to help them
reach their preferred futures. Our expertise is on the kind of conversations
that help build solutions rather than dissect problems, and we exercise that
carefully as co-travelers with our clients on their journeys. At each step, we
use feedback from successes to help guide next steps, trusting that system-
ically, missteps will become apparent and can be useful information for
moving forward.

Change Is Constant and Inevitable

It has been said that the only things that are certain are death and taxes. And
even then, there are many variables that factor into how we might die and
how much and what kinds of taxes we pay. In my graduate training, I had a
supervisor who described therapy as operating on the edge of a river. This
spot in the river was opposite an island that acted as a divide for the water
as it moved downstream. Part of the river flowed down the main channel,
and our part of the river was an “oxbow” that contained only a portion of
the river. That portion is what we, as therapists, can see and interact with,
and what it is made of is only what clients share with us. Nonsystemically,

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we might see the oxbow as all we need to have in our sights, that we can
tell from what we see what needs to change, that we can change that piece,
and that that change will take care of everything, or it should. However,
systemically, we know that there is much, much more to the wholeness of
clients’ lives. The river is bigger and ever-changing. We can dip our toes into
it (e.g., via a conversation with a client), and that becomes part of the whole
as it flows farther downstream—a change that may or may not be one that
makes a difference for the client, and we cannot know exactly how it might
affect the whole. What we do know is that it is moving, it is not stagnant
(even stagnant water has changes occurring from biomes, evaporation, and
small currents), and we can have hope that systemic changes will help cli-
ents toward their preferred futures.
I have many esteemed colleagues who use linear approaches or work
with individuals as self-contained vessels upon which they act to make lives
better. Their work often is useful, perhaps because the change they intro-
duce is fitting to the situation, sufficient for lasting change for the client,
and not met with resistance from others. However, they often are perplexed
and frustrated that an intervention is not sufficient and may blame the client
or family members for not utilizing the intervention well, perhaps even for
resisting it or dismissing it. Other therapists recognize that if families do not
adapt well to individual members’ changes, the changes may not hold and,
if they do, make things more difficult for everyone.
Many people who choose family therapy as careers do so because they
recognize that helping teenagers, for example, make appropriate changes
in their lives often is not helpful in the long run if the family system remains
the same. The same can be said when individuals are seen in therapy, make
desired changes, and then report that their partners are not happy with the
changes and that their relationships are worse. By understanding wholeness
and the inevitability of change, recursion and feedback, we can help cli-
ents anticipate others’ changes and anticipate negative impacts. Asking for
parents and partners to come to therapy may be the most efficient way of
minimizing these influences; however, it is possible to work with individuals
from a systemic perspective by keeping in mind others and their potential
responses to change.
By understanding the systemic nature of change (think of all the things
in the river that are changing at once, influencing each other in large and
small ways), we can better help utilize the flows to build solutions toward

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preferred futures. Of course, there is no way we can know all the aspects of
the system or the parts that are changing, but we can focus ourselves and
our clients on existing changes and those parts that are most likely going to
be helpful resources and upon which to build. When our efforts or those of
our clients don’t work, we can refocus on a different aspect of the system.

If It Ain’t Broke, Don’t Fix It; Once You

Know What Works, Do More of It; If It
Doesn’t Work, Do Something Different
This adage has become such a part of SFBT that it is almost a cliché. How-
ever, it is very important to our understanding of the approach, of our clients
and their desires, and the work we do. Viewed through a systemic lens, we
can see that there are many parts in the system and many aspects that we
know about and don’t know about. Because systemically, change that is
occurring has both known and unknown consequences, and we need to
understand more than just what might be included in a problem description.
If we allow ourselves or our clients to look only at problem descriptions,
we may be joining them on a path that leads nowhere, nowhere near their
preferred futures, or even into dangerous places. So, the first thing we need
to think about is whether something needs to be different. If not, we don’t
work to change it.
A young woman came to see me because her co-workers said she was
depressed. I asked her what her coworkers were seeing that led them to
this description, and she replied that she was quiet at work, introspective,
and had been sad about the death of her beloved cat. I asked whether
she thought she was depressed and she said she didn’t think so. She said
she was satisfied with her life for the most part and didn’t experience any
of the symptoms she thought meant depression. We quickly decided she
wasn’t depressed but going through some normal changes and differences
in relationships.
I was aware that my early graduate training would have me looking for
all sorts of behaviors that would be symptomatic of depression or some-
thing else. It was my job to find something because we assumed that people
came to therapy because something was wrong. We needed to find out what
that was. However, as in this case, sometimes there’s nothing wrong except

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perhaps normal adjustments to life circumstances. Systemically, when peo-

ple mention “symptoms” or “problems,” it is wise for us to look beyond
descriptions to see how something is problematic or whether it even is prob-
lematic for the client.
The point is this: just because someone else says something is broken
does not mean it is. I also worked with a client for one session because she
was grieving the loss of her husband of 40 years and her friends thought
she needed help with this process because it had been six months and she
was still quite sad and having some difficulty focusing at work. We talked
about what she thought was normal and not-normal grieving, and what she
thought she wanted different. She knew what her preferred future looked
like, and she knew where she was on the 10-point scale toward that future.
However, she did not want yet to move up the scale because she perceived
her grieving as a way to keep her husband close, not yet ready to change her
relationship with him or her grief. She knew what she needed to do to reas-
sure her friends that she was OK and said that she didn’t think she needed
therapy. I asked what might tell her she had become stuck in her process,
and she was quite articulate about that, agreeing to call me if she wanted
help at that time. I saw her about a year later and she thanked me for our
time together, saying that she had become a bit stuck, but used our talk to
help herself decide what to do, and was doing fine. Nothing was broken,
so I saw no need to try to fix it. Her systemic context (wholeness) was such
that she was drawing on previous knowledge about herself to take care of
herself, and to do what she could in terms of work and social life. She real-
ized what she appreciated about those aspects of her life and recognized
what about them nurtured her and helped her with her grief. Systemically,
she had no sense that something was wrong with her or that she needed to
blame anyone or anything for her sadness. And she knew which friends she
could rely on without burdening them.

Once You Know What Works, Do More of It

This corollary to if it ain’t broke reminds us that some things are already
working and that we need to see what we can do to become aware of them
and keep them going. I saw Carol, a client who had been sexually abused by
brothers and a cousin when she was quite young. She came to therapy not
to process what she was told was trauma, victimization, and abuse, because

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she didn’t identify with any of them. She did want, however, to have a good
relationship with a man. We talked about what a good relationship with
a man would look like, and she readily noticed exceptions and men with
whom she had enjoyed safe, good connections. She was able to identify
things she did and was doing in those relationships that she thought were
enriching and detrimental. She also recognized the circularity of her rela-
tionships, what she appreciated, and how she responded when partners said
or did certain things. She easily recognized qualities of a relationship that she
wanted in a long-term connection with someone. Systemically, we looked at
relationships and what in them made them valuable for her as well as what
she didn’t want, and what would make relationships valuable in the future.
Because Carol had already identified aspects of her life that she thought
showed her capabilities, she was able to think about how to use them. One
thing she noticed in her preferred future was that she probably would not be
in the same small town in which she was living, which had limited oppor-
tunities for her. This led to conversations about what might change some of
those aspects, what they would look like, what she was doing and where,
who was there, what they saw as different about her, what difference that
might make to them, and so on. And we also talked about what a preferred
location would be like, what it would mean to move, and so on.
Through our conversations, Carol realized that she knew what she needed
to do, and the steps to make that happen. This included talking with her
relatives’ spouses, recognizing that they might or might not be receptive,
and this would likely change relationships in her family. She did not want
to confront her brothers or cousin, thinking that they either knew and cared
about what they had done or not; she did not think “closure” was important
for her as described in some of the books she had read—she only wanted
to do what she could to protect the children of her brothers and cousin, and
to develop a good relationship with a man. Systemically, she had thought
about the changes she was making, what they would mean in her family
systems, and was ready to face consequences.

If It’s Not Working, Do Something Different

One of the basic concepts of systemic thinking is equifinality, the property

of systems that there are many ways to achieve something. For example,

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when I use the maps program on my phone, several possibilities are laid
out. Each has pros and cons and, if I am on one and decide it’s not work-
ing, I can back up or take another path to reach my destination. This hits
at the heart of doing something different when something is not working.
This applies to clients and their natural systems, helping them identify
different kinds of exceptions and behaviors in themselves and others,
and it also applies to our work with our clients. When future questions
do not seem to be helpful, we can switch to exceptions, or coping, or
scaling. Another client had discovered his wife was having an affair with
a friend of theirs. He felt betrayed on many levels. His preferred future
included his wife and marriage, but every time he tried to imagine this
future, he broke down, sobbing. He said that he didn’t think he could
ever trust his wife again, and this was requisite for an acceptable mar-
riage. However, neither could he allow himself to divorce her because
of the vows they made when they married. He also grieved the loss and
betrayal of his friend.
I understood this client’s goal, and I also understood his inability to
respond to a scaling question toward a preferred future, one that was slightly
different from the one he was trying to imagine. I asked about aspects of
the miracle day that he could imagine happening, and we looked for times
those were already happening. I then asked scaling questions, and the
immediate goal became one step or even a half step up the scale. This, he
could imagine. Had this not been helpful, I could have switched to coping
questions. He called several years later, asking for help with his daugh-
ters, who were now teenagers. He said that he had moved one step up the
scale and realized that he would not initiate divorce and accepted his new
reality of not having complete trust in his wife. He admitted that she had
done what she could to help him trust her, but he remained vigilant and
took what happiness he could from his life. Although this definitely was not
something that I would want in my own marital relationship, I respected
his choices.
On occasion, clients do not fit the solution-focused approach. Wampold
(2015) is quite clear that no one therapy approach is more effective than oth-
ers. We should be ready to switch to a different approach entirely, or to refer
to a different therapist when we find that what we are doing is not working
and decide a different approach might be more helpful.

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Clients Have Resources; Our Job Is to

Help Identify and Use Them
So-called individual approaches often have therapists working in very linear
ways, believing quite strongly that their approaches are best for helping cli-
ents. We have learned that a solution-focused way of working encourages
doing something different when necessary. This helps us understand that
there are many ways to help clients, and that includes helping them to help
themselves. If we believe that we truly are magicians and can wave our
magic wands or peer into crystal balls to see what is truly wrong and how
someone must act to effect desired changes, I believe that we are not doing
our best work as therapists. Yes, we have resources, and clients come to us
because they believe and hope that we can help them. However, if we for-
get that clients already have many resources of their own at their disposal,
and that they can access them and any others we identify together, we are
limiting their possibilities for better lives. A systemic approach recognizes
that resources exist not only in the client and their close context, but also in
all sorts of people and relationships around them. Perhaps a partner is much
more willing to help with career decisions than a client believed, ready
to support changes that may help lift sadness and other symptoms called
depression. Perhaps a parent is willing to notice much more about a child
who is struggling in school than only their failures, attributes that may help
resolve the school problem, but may not, yet can be recognized as enriching
a family’s life. Perhaps a consultation with a different sort of professional will
provide new possibilities for clients. If we stick only with what we believe
we know, we may not see other possibilities.

Relationship Between Problems and Solutions

Using systemic thinking, we can understand the relationship between prob-
lems, what we do, and the outcomes of therapy better. Let’s suppose we
have a flat tire on our car and need to have it fixed. To get it fixed, we do
not need to know how the tire got flat. There are many possibilities of cause,
and it may be useful at some point to look at those causes to prevent more
flat tires, but at this point, we just need the tire fixed.

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In the realm of the problems and difficulties that people bring to therapy,
there is even less need to know how the difficulties developed, although we
have been trained to believe that we do our clients a disservice if we don’t
thoroughly understand the problem, its etiology, and its ramifications. In
one of my therapy consultation groups, one of the therapists asked for some
ideas for a client who had suffered much trauma in her childhood, most
of it forgotten. As therapy progressed—the kind that examines all details
of the trauma and repressed memories—the client remembered more and
more details and more instances of abuse. The therapist talked about this
case nearly every week in consultation for quite a while and I found myself
getting more and more frustrated: first, I didn’t like hearing the sordid details
of the client’s abuse, and second, I was frustrated that it appeared that the
client was not experiencing any relief from her symptoms by discussing
the details. The therapist was using a psychodynamic approach to therapy
that assumed that the client could not feel relief until she had talked about
everything (and I mean everything!). When I asked what the client wanted
from therapy, the therapist looked at me as though I had two heads. She said
that she had diagnosed the problem, knew how to help the client “work
through” the issues, and that after explaining this to the client, the client
agreed it was what she wanted. She thought that working with the symp-
toms only would be a “Band-Aid” and that “true healing” required years of
weekly or more frequent therapy, including hospitalizations during crises.
I recognized that although this was a good consultation group for the
most part for me, I really did not resonate with that sort of therapy. I have
worked with clients with histories of trauma and supervised therapists who
were working with similar clients. Clients’ expressed difficulties were indeed
distressing, and it appeared to me that further discussion and unearthing of
the details added to the clients’ distress. I acknowledged that what had hap-
pened was horrid, often expressing great empathy and anger for them about
the way they had been treated. I recognized the connections between the
trauma events and current distressing concerns. However, there was nothing
we could do to change the past events. We could not go back and take the
nail out of the road so that it didn’t puncture the tire. What we could do
was co-construct a preferred future with the client, one that did not include
the negative effects of the trauma (e.g., flashbacks) or that included ways of
managing these effects. For some, a “normal” life and preferred future was

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not doing away with nightmares or body memories but managing them so
that they did not interfere with enjoyment of other aspects of life.
Carol remembered the times she had been molested by her brothers and
cousin, and she hated the memories. When she had them, she became angry
and sad, and distracted from things she wanted to think about or do. So, we
focused on ways she already was coping with the memories and managing
to put them aside. She thought of several things: singing a favorite, upbeat
song; deliberately thinking about a friend and remembering a pleasant time
with that friend; focusing intentionally on something else, like work or read-
ing or projects. She found that being more intentional about these behaviors
(solutions?) was so effective that she had to consciously remember a bad
incident in order to practice them!
I also asked Carol about things that would be happening on her mira-
cle day. She mentioned that she would have a different relationship with
her mother. Working with her anger about the way her mother dismissed
her when she told her about the molestation was more difficult for Carol
because it had more systemic facets: she cared about her relationship with
her mother and wanted to be closer to her. She didn’t really care much about
her relationship with her brothers or cousin, so it was easier to put those
relationships aside, but she knew that her mother didn’t have the same feel-
ings about her brothers. We used the same techniques we had used before—
looking for existing exceptions—and scaled a miracle of what her preferred
relationship with her mother would be like. She was able to picture a pre-
ferred relationship and to identify aspects that were in her current relation-
ship with her mother. By learning details of those aspects and responding
to many, many detailed relationship and difference questions about them,
she began to identify things she could gradually change that brought her
closer to her mother. For example, she said that her miracle picture included
baking with her mother, talking about other family members and their lives,
and planning a small trip together. I asked where she was on the 0–10 scale,
with 10 being the miracle, and she said she was at 4 because she could
picture herself baking with her mother that weekend. I actually was rather
surprised by this because I had expected a much lower number. It’s a good
thing I didn’t diagnose her low number because she might have gone along
with that, assuming that I knew what was going on better than she did!
I asked Carol was about what was happening that told her she was at a 4.
I also asked her relationship questions about how this affected her mother

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and others in the family (particularly a beloved grandmother) and what that
meant to her and to them. The next step was to ask her similar questions
about what 5 looked like—what was happening in her relationship with her
mother, what her mother noticed, what difference that made to her, what
else (about a dozen times), and so on. She realized that some of those things
were already happening, so she revised her current number to 4.5.
It might have been useful or interesting to learn more about this client’s
relationship with her mother at the time of the molestations, perhaps using
positive things from that time that were helpful to her. However, she didn’t
want to revisit that time, preferring to see what could change for the future,
including that evening. She told me that she would be satisfied with a 7 or 8
in terms of her relationship with her mother, because she believed that there
were some things that she and her mother would never be able to see eye-
to-eye on or even agree to disagree. She would be happy with that because
it would be much better than what she had experienced in the past, which
she had believed meant the only solution was to not talk about what had
happened to her.
It’s easy to see how the SFBT approach might have been useful with
Carol, a client who was not experiencing symptoms of Post-traumatic Stress
Disorder, and who was quite adept at separating past experiences from
desired future ones. Yvonne Dolan (1992), in her book on resolving sexual
abuse, wrote about techniques for helping clients who experience severe
flashbacks, physical symptoms, and anxiety and panic. I encourage you to
review this book for yourself. Dolan acknowledges the effects of the trau-
matic event, but also looks for exceptions and resources that often are not
noticed in trauma treatments. Her belief is that the traumatic event may have
“caused” the symptoms, but that other things were happening also that can
be used to help clients (personal communication). For example, disassocia-
tion is a common occurrence for trauma victims. Instead of framing this as
a symptom of pathology, it is easy to comment on it as a resource, one that
should be kept as long as it is useful. This means that sometimes framing
parts of a self (cf. Schwartz, 1995) as useful and developing ways to manage
them rather than “integrating” them into a single whole is an acceptable
outcome of therapy.
Emma was referred to me by her therapist, who said that she did not have
experience with sexual abuse but that her colleague (me) did. Even though
the referral was because of sexual abuse, I did not assume that we would be

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talking about that. I was more interested in Emma’s desired goals for ther-
apy with me. She didn’t mention abuse, but did talk about depression, her
difficult relationship with her husband, and her upset with one of her grown
daughters, who had cut off Emma’s relationship with her grandchildren.
There were so many directions we could go! And many of them were quite
interesting to me, especially the relationship with her daughter—I could not
imagine being cut off from my grandchildren—as well as the relationship
with her husband, because couple issues were a large part of my practice.
But I knew that our direction needed to be where Emma wanted to go, so
I asked the miracle question. She was able to identify many differences, how
relationships would be different, what that would mean to her and to others,
and so on. Over time, Emma reported tiny, tiny improvements toward her
preferred future (we used tenths and smaller on the scale), but also many
distressing and disturbing events that kept her from appreciating the positive
changes that were happening. I wondered how much her unhappiness in
her marriage was affecting her and tentatively asked whether her husband
would come to therapy; she refused to include him.
It was at this time that Emma told me about sexual abuse from her hus-
band during the first 15 years of their marriage. It had turned her off so much
and she was so angry with him about it that she couldn’t begin to imagine a
better relationship with him. I asked her how she had coped with these feel-
ings, listening for openings that might lead to solution building. I also asked
her, given this very difficult situation, what her miracle might look like. She
told me about her childhood abuse and how much that affected her feelings
toward her husband, that her miracle would be being able to put those feel-
ings aside so that she could care for him as much as possible. I asked her
again how she had coped with her feelings for so long and she was quiet.
I then noticed that she was rubbing the palm of her hand with a fingernail
and was not responding to my questions; she was looking at her hand and
a blister was forming in her palm. It appeared she was disassociating, so
I asked if I could take her hand (she nodded), and said I was concerned she
was hurting herself. I then asked if this was one of the ways she coped with
her childhood abuse. She didn’t look at me but nodded. This part of the ses-
sion took a lot of time and I alerted my secretary to cancel my next session.1
Emma and I sat for some time, my asking gentle questions about coping
and exceptions, her nodding or sometimes looking out the window, but let-
ting me lightly hold her hand, which seemed to keep her from rubbing it with

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her fingernail. After a time, I asked her whether the part of her that wanted
to go away was satisfied that she was safe, and could we find out what she
(the part) wanted for Emma that would be different. I was using SFBT with
an Internal Systems Therapy approach (e.g., Schwartz, 1995), careful to stay
with her current state because I believed that it was important to her and
was a sign that she trusted me, something that she was not experiencing in
other relationships. We identified another part that could more easily pic-
ture a future without distressing feelings and behaviors, could identify cur-
rent exceptions, and was willing to help the scared part feel safer. I gradually
helped Emma recognize where she was and what we were doing. She was
very tired and assured me she was all right and would be safe (naming some
things she would be doing). We agreed to meet again the following week
with a check-in from her midweek. Emma reported the following week that
she had had a couple of days of being tired, but was otherwise OK, and
that she actually had started to remember something about her abuser but
allowed herself some distance from this memory rather than disassociating
to flee it. She also reported feeling a bit calmer (what she would feel instead
of anger) with her husband and mentioned some instances where she could
have been reactive but stayed calm. She never experienced that state again
in my office. Systemically, it seemed that something had shifted in her total
context that allowed her to have a different relationship with the events, her
memories of them, and her parts that had helped her survive them.
Emma said that an important part of her miracle that she thought we could
work on was her relationship with her daughter. After focusing on this in a
solution-building way for several sessions, she announced that she was get-
ting a dog who would be her companion at home, because she didn’t see her
husband as a companion. I asked how she had made that decision and she
said that she had seen a dog that she really liked and realized that her current
unhappiness was loneliness, not depression or trauma, and had been asking
herself how she could feel less lonely at home. Seeing the dog lifted her
spirits and she was quite busy acquiring the dog and all the necessary food,
toys, beds, leashes, and so on. Some time later, when she was describing
all sorts of changes and differences, I asked what she thought her husband
noticed and she said she wasn’t sure, but she realized she was calmer (not as
annoyed) with him most of the time and that they were doing things together.
Soon after, Emma told me that she and her husband would be moving
away, so we would need to end therapy. As I often do, I asked her what had

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been helpful and she replied that the way I listened to her and helped her
see “outside the box” had helped. I asked her how she had come to the real-
ization that her unhappiness was related to loneliness. She said it was when
she realized that her miracle picture didn’t include a close relationship with
her husband, and that if she was ever going to feel better, she’d have to start
doing something herself rather than praying for a miracle in her marriage.
What she intended to work on in her new home was more friendships with
others. We never did talk about her childhood sexual abuse or the abuse she
suffered at the hands of her husband.

Focus on Future and Change

The purpose of most approaches to therapy is to effect change for clients in
some way. The SFBT approach focuses most specifically on small changes
that can be amplified for the ultimate change that clients desire (see the next
section for more detail). One reason I am writing this book is because I see
many solution-focused practitioners focusing on individuals and the changes
they want to make, sometimes asking relationship questions, but focusing
mostly on the individual and changes they will make or observe. I would like
to see more solution-focused practitioners working with couples and families,
recognizing that including others can (a) remove the stigma of a problem
from an identified client, and (b) make therapy more efficient by including
others physically rather than what clients believe they would say.
Viewed through a systemic lens, solution-focused practices are interested
in changes made in various parts of a client system, regardless of whether
practitioners work with individuals, couples, families, or other groups. The
systemic notion of wholeness emphasizes that parts are organized as sys-
tems, subsystems, and suprasystems as well as relationships among the
parts. We can actually see relationships as connections among the parts,
and that when something changes with one part, the other parts, including
relationships, connected to it must adapt to that change. Adaptation means
change. Using a mobile or a windchime as metaphors, we see that a change
in one part requires changes in the other parts, some large, some small,
some almost unnoticeable.
By focusing on changes that are already happening, we can amplify those
that are parts of or signs of desired change. By focusing on future desires and

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changes clients identify, we can co-construct other changes with clients for
them to become aware of in their contexts.

Small Change Leads to Bigger Change

In SFBT, we recognize that small changes can and often do lead to bigger
changes, especially when they are noticed and tended—a ripple or dom-
ino effect. Ladona, a teenage client referred for poor schoolwork, noticed
that her therapist used a lovely brocade appointment book to keep track
of appointments, tasks, and other lists. The next week, she made a small
change in her life of buying a beautiful notebook, one that she found invit-
ing, and she started to write her school assignments in it. She then discovered
that she enjoyed being able to check things off that she had accomplished,
which led to her doing her homework so that she could check it off in
her notebook. Her mother noticed this change that started with the pretty
notebook and took Ladona shopping for another notebook she desired and
lunch together. As they were shopping, Ladona’s mother realized that such a
strategy would be useful for her in her own busy life, but she was afraid she
would misplace the notebook. Ladona suggested a whiteboard on the back
of the pantry door instead, which her mother found quite interesting. This
led to conversations between them about how they were similar and differ-
ent in many ways. One evening, Ladona asked her father how he thought
they were similar and different, and learned that her father also had had
trouble keeping track of school assignments and shared some of his trials
and successes. This meant a significant change in her parents’ interactions
with Ladona around school, changes that led to encouragement rather than
expressions of anger and disappointment.

Clients Are Experts on Their

Experiences and Lives
In more traditional treatment approaches, therapists are experts on the types
of things hypothesized by their therapy approaches. For example, Structural
Family Therapists are experts on boundaries, hierarchies, and individuation.
Bowen therapists are experts on anxiety, triangles, and multigenerational

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transmission. Psychodynamic therapists are experts on the inner workings

of clients’ minds. The SFBT therapist is an expert on solution-building con-
versations. This requires understanding the stance and basic tenets of the
approach, and much practice in listening for tiny openings that might lead
to solution building rather than problem solving. We are not experts on cli-
ents’ experiences, even when they give us clues such as diagnoses that oth-
ers have given them or they have given themselves, details about what they
see as problematic, and how others are involved with and affected by the
problem. And we most certainly are not experts on either what problems or
their effects mean to clients, how they and others might experience change,
and whether or not certain changes are “good” for clients.
From a systemic perspective, this means that we can be free to move
with clients, responding to changes in helpful ways, noticing movement
that clients desire, and being vigilant about other aspects of clients’ lives
and contexts that might be useful to discuss as potential resources when
they are introduced by clients. We do not make assumptions about clients’
experiences based on theory, our own experience, or what others have told
us. We do not make assumptions about how other people in clients’ lives
experience problems, effects, or potential solutions. And we certainly do
not make assumptions about what goals clients should work toward or what
ways of reaching those goals will be best for them.
Carol had been angry when her mother did not help her when her broth-
ers and cousin molested her, but she also loved her mother and had learned
many things from her mother about life. My early training had taught me
that I needed to pay attention to her feelings of neglect because this surely
was part of the root cause of Carol’s difficulties. She did not experience
either the molestation or her mother’s response as problematic. It was not
up to me to tell her that it was problematic and force her into talking about
things that she thought were unnecessary. If she had then or later labeled the
events or feelings and relationships as problematic and wanted to talk about
them, I would have trusted her desire, continuing to listen for openings that
might help us move toward solution-building so that the experiences did not
rule her current and future lives.
Systemically, it was very important that I realize that I was part of her
system and that how I initiated conversation or responded to her would feed
back into the system of therapy in either helpful, neutral, or unhelpful ways.
I had noticed that when she talked about the abuse as her friends thought she

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should, she became more sad and withdrawn. If I had continued talking about
the abuse, asking for details, and so on, she likely would have complied but
stayed sad and withdrawn (system maintenance, dampening change, neg-
ative feedback), perhaps becoming even more sad. After introducing ques-
tions about her future, she become more animated and engaged (amplifying
change, positive feedback). At the end of one session, in response to my
question about how therapy was going, what was helpful, Carol responded
that she was pleased we didn’t talk about what had happened with her broth-
ers, cousin, or mother, but focused on what she wanted different. She assured
me that if she had other ideas about change, she would let me know, and left
the session more upbeat than when she first came in.
Carol’s response to the way we worked together to co-construct her future
and what steps along the way looked like suggested to me that what we were
doing together was working. She was responsive to my questions that were
based on responses to previous questions, did not appear to wish that we
would talk about other things, and her response at the end of the session
reassured me that solution-building ideas were helpful to her. So, I continued
to use them. Carol returned to the next session reporting other exceptions she
had noticed, signs that she was moving up the scale, and more detail about
her preferred future. I had not taken an expert role of telling her what was
really going on or what she should do, instead exploring details about the
abuse, her mother’s reaction, or anything else about her life, trusting that she
knew her experience and what would be good for her to talk about and when.
I know many therapists who have good advice for their clients about what
they should read, what they should do, when they should leave their part-
ners (or not), and so on. Some of this advice is certainly helpful, there is
no doubt about it. However, whether it will fit a particular client’s situation
or needs is something only clients can decide. Another person can give us
ideas about what might be helpful, but we’re the only ones who can evalu-
ate and judge the advice.

Therapy Is Co-constructed
The cybernetic notions of communication suggest that communication is
not a spectator sport. That is, we are involved even when we don’t say any-
thing (the axiom of “cannot not communicate”). Circularity suggests that the

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outcomes of our interactions with others affect future interactions. Therefore,

although we certainly influence conversations with clients by the kinds of
questions we ask, we cannot predict exactly how clients will respond or
what that will mean for further conversation. Therapy is not a series of pre-
formatted questions but uses utterances and language of clients. We con-
struct ideas together: co-construction. The process is circular, contextual, and
involves both subtle and obvious changes in thinking, talking, and acting.

Client-Therapist Relationship
Because ideas in SFBT are co-constructed, this means that the therapist and
client are in a relationship. We don’t need to “make” a relationship or “join”
with clients because we already have a relationship by virtue of the fact that
we now know each other and have specific roles as client and therapist.
When asked about this in workshops or presentations, Steve de Shazer often
said that we already had relationships with clients and it was our jobs to not
mess them up. When we listen carefully to what clients are saying and what
they want rather than interjecting our own hypotheses, solutions, or advice,
we are following their leads, being respectful, and honoring their expertise.
They are more likely to trust us, let us know when roads are not right, and
tell us the things we need to hear to help them determine and work toward
their preferred futures.

Well-Formed Goals
When we help clients with goals that we have determined for them, usually
in well-intentioned ways and based on our training in certain approaches,
the goals are less likely to be formed well enough for clients and us to know
when they have been reached or whether our process is helping them with
changes toward those goals. Systemically, aspects of SFBT well-formed goals
work together to assure they fit clients, their contexts, and others in their sys-
tems. Think of “well-formed goals” as a system itself. Changes in some parts
effect changes in others. Any system is a subsystem of larger systems, and
changes affect other subsystems and systems, and are, in turn, affected by
them. Well-formed goals will help make differences that make differences to
clients and other parts of their systems that are important to them.

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One of my training supervisors was also a psychoanalyst. I was learning

systemic therapy from him and asked how these two seemingly antithetical
approaches could work together. He said that they were like two sides of
the same coin, one side the individual and the other, the family. He said
that he had worked for many years in analysis with a patient and near the
end, the patient had said, “Now I know why I’m a jerk; but what am I going
to do with that?” The patient had come to my supervisor saying he needed
analysis because of his neuroses and so my supervisor had complied. He
never asked what the person wanted out of therapy. I realized some time
later after learning about SFBT that if the person had come to me, I would
think of him as a client (less hierarchical than the medical model, enhancing
the collaborative relationship), and that asking him about what he wanted
out of therapy might have cost me a lot of lost fees, but a greater likelihood
that the client would reach meaningful goals for himself.

Curious Questions
Therapy approaches tend to dictate the kinds of questions and interven-
tions we use. Sometimes, therapists seem to “know” the “right” answers
to these questions. Genuine curiosity means that we not only don’t know
the answers but that we’re not even sure what the next question is going to
be or in what direction it might take us. We take “not-knowing” or “slow-
to-know” (Thomas, 2007) stances so that we can be open to whatever the
client says. From a cybernetic perspective, this means that we recognize
that whatever the client says or does is communication and we must con-
sider the words, nonverbal behaviors, and our relationship with the client
to make sense of the conversation and keep it moving in solution-building
ways. Genuinely curious questions keep us in a mindset of clients as experts
on their own lives and our jobs as leading from behind to help them formu-
late and move toward their goals. I believe this communicates to clients that
they are trustworthy and capable of what is best for themselves.

Relationship Questions
As you may have learned by now, other people in clients’ lives are incred-
ibly important in Solution-Focused Brief Therapy, not as the people or

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relationships that cause clients’ distress, but as resources, as observers, as

walking with clients whether they attend therapy or not, as part of the cli-
ents’ systems. Asking clients what they think others will observe about them
at different points along the way toward reaching goals helps them think
about relationships and what they mean to clients. It also helps clients posi-
tion themselves as observers of themselves and their relationships. What
do I want my relationships to look like? What will I be doing? Will that be
helpful? What does that say about my relationship with my future self? What
will others notice? What difference will that make to them? What difference
will their noticing make to me and to our relationship? This way of thinking
is at the heart of a systemic approach.
Relationship questions can be especially useful when clients are having
difficulty thinking about preferred futures. de Shazer sometimes used a “best
friend” question: What would your best friend say would be different about
you? Clients’ responses to questions say something about them and what they
think their best friends think about them, and strengthen relationships between
them whether the answers are accurate or not. What would your best friend
say about your miracle day? What tells your best friend that you are capable
of making a small change toward the person you want to be? This question
requires that clients look at past behaviors or attributes in themselves that they
might be able to use toward desired change, and also encourages them to look
at themselves as someone whose friends respect and care about them. Rec-
ognizing such positives about oneself, attaching change to what others might
experience about oneself, encourages further change (positive feedback).

Miracle Question, Preferred Future

Regardless of how a preferred future question is phrased, the goal is to
understand in detail how a person’s or family’s system will be operating
when the problem is gone or is no longer problematic. Responses to future
and follow-up questions provide great information for clients and therapists
about how to proceed to amplify existing exceptions, co-create new ideas,
and amplify changes that clients make, either in observing themselves or in
doing something different outside of therapy.
When working with couples or families, we ask the same question of every-
one, and also ask circular questions (e.g., Fleuridas, Nelson, & Rosenthal,

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1986). When partners or family members respond to future, exception or

instance, scaling, or other questions, we can connect those responses to the
family system by finding out who shares the ideas, who experiences things
differently, what difference those differences make to everyone, and so on.
This helps the therapist and family see the system as a whole—the individu-
als and their relationships with each other. It also becomes information that
is fed back into the system, helping people understand each other in different
ways, requiring changes in the ways they respond to each other.
Finding agreed-on preferred futures for couples and families can be
challenging. However, when we remember that goals in systemic solution-
focused therapy must be relational and co-constructed, we can help clients
talk about what their lives in the context of relationships will be like.

And So . . .
Although Solution-Focused Brief Therapy is often practiced and useful for
work with individuals, it is enhanced when used within a systemic under-
standing of people’s lives. Because relationships and interactions were so
important to de Shazer and Berg, keeping systemic ideas in mind enhances
the work, whether with individuals, couples, families, or other groups.

Note
1 What I have written is only a small part of my work with Emma. I know that there
is much that can be critiqued, including my use of coping questions when I did,
which resulted in her showing me her coping instead of telling me about it.

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 Solution-Focused
5 Brief Therapy With
Families

I was fortunate that my initial training in counseling and therapy was sys-
temic. Although I learned about so-called individual approaches such as
those of Freud, Adler, Jung, Ellis, and Perls, among others, the courses that
resonated most with me and matched what I wanted to do were the family
and interaction courses. In these courses, I learned about systemic and cyber-
netic ideas, as well as several family therapy approaches that were current
at that time. Since then, I have learned about other approaches, including
integrative ones, and taught both general family therapy courses and several
specific ones, including one that included Solution-Focused Brief Therapy.
What appealed to me most was the way that each of the approaches could
be adapted to different family systems, subsystems, and individuals. In this
chapter, I will present ideas about using SFBT systemically with these vari-
ous client systems.

Families
Several of my colleagues who were trained to work with individuals have
commented that they find couple and family therapy difficult because they
are unable to keep track of all that is going on with the individuals and com-
munication in the therapy room. When working with couples and families,
the most important skill is one of being able to see the family as a whole
and to track patterns of interaction, not individuals or their behaviors per se.
M’Lin and Janine, a lesbian couple in their 30s, came to therapy with
their three children, two of whom were M’Lin’s from a previous relationship,

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and one that they had together, with Janine as the biological mother. The
donor father was anonymous to them. Jamel, 12, and Cora, 10, were M’Lin’s
biological children from a previous relationship, and Fancy, 6, was theirs
together, adopted by M’Lin. The presenting complaint was Cora’s acting out
in school by hitting other children and refusing or ignoring requests from
the teacher. M’Lin had visited the school unannounced and watched Cora
in her classroom with her teacher. She observed Cora’s talking with other
children and getting out of her seat while the teacher was talking. M’Lin and
Janine agreed that Cora’s schoolwork was acceptable, although not as good
as they thought she could do. They had asked Cora what was going on and
received little information and many tears, accompanied by, “you don’t get
it!” Further queries about what this might mean produced no ideas about
what was going on with Cora.
M’Lin and Janine reported that Jamel was doing well at school and at
home, beginning to spend more time with friends playing sports. Fancy was
the family darling, had recently lost her two front teeth and delighted in
making family members (except Cora) laugh by purposely lisping.
There are a number of things about this family that are worth noting, but
not necessarily pertinent to solution-focused therapy. It would be easy to
hypothesize about Cora’s behavior as part of her sibling position, and as
having many features (skin color, hair, eyes) that were very different from her
younger sister’s. We might want to know more about hers and Jamel’s father
and other family members, what contact Cora and Jamel had with their
father, and what those relationships were like. We might want to know more
about cultural and ethnic heritage and experiences of the family. We might
want to know how M’Lin and Janine were doing as a couple and how their
sexual orientations were viewed in their families of origin and their commu-
nities. We might even wonder whether Cora had been abused or been tested
for Attention Deficit Hyperactivity Disorder or any other learning or physical
disabilities such as hearing loss. As you can see, depending on our training
and experience, there are many things we could wonder about.
Solution-focused therapists are sometimes accused of not being concerned
about contextual factors that affect families such as race, sexual orienta-
tion, economic resources, and family constellation. Berg, who was Korean,
once said that it is sometimes useful to have a general idea of the kinds
of resources that families have, but that people will tell us what we need
to know about their circumstances (personal communication). Therefore,

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the therapist in this case did not start therapy by gathering information that
might or might not be useful in solution building.

Session 1
Th: Hello everyone. I am so pleased to meet you! Please tell me your
name and kids, I’d like to know how old you are and what grades
you are in.
Fancy: I’m Fancy and I’m 6. I just had a birthday and lost a tooth!
Th: Fancy. I’m pleased to meet you. May I see where you lost your tooth?
Fancy: Here! See? [sticks tongue through hole where tooth used to be]
Th: Wow. Did it hurt?
Fancy: Nah. I’m a big girl. Jamel helped, and it bled. I got a dollar from the
tooth fairy.
Th: A dollar? Do you know what you are going to do with it?
Fancy: Yes. I’m going to put it in my house bank and save it so I can buy a bike.
Th: House bank?
M’Lin: She has a bank shaped like a house.
Th: Ah. Sounds like a good idea, Fancy. What grade are you in?
Fancy: Kiddygarten. It’s fun.
[therapist looks at Jamel]
Jamel: I’m Jamel and I’m 12.
Th: What grade are you in, Jamel?
Jamel: Sixth. At Highlands Middle School.
Th: Middle school. What are you best at?
Jamel: In school?
Th: Or anything else!
Jamel: I play pretty good soccer, forward.
Th: You enjoy soccer? Yes? That’s really good. What else do you like at
Highlands?
Jamel: Not much. It’s OK, I guess. I do OK because I have to get OK
grades to play soccer.
Th: That’s very forward-thinking of you, Jamel, pun intended. It’s good
you know what you need to do to keep doing something you like.
What’s your best subject?

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Jamel: Art.
Th: Art? That’s amazing! May I see some of your art sometime, maybe?
Jamel: [ducking his head] I guess so.
Th: And you must be. . .
Cora: Cora.
Th: Hi Cora. How old are you?
Cora: 10.
Th: So, is that . . . fourth grade?
Cora: Yes.
Th: And what do you like best?
Cora: Playing four-square with my friends.
Th: Four-square. You know, my friends and I didn’t play four-square
when I was your age, so I never really understood it. Could you
show me sometime?
Cora: [looking up for the first time with a quizzical expression] I guess so?
Th: I’d like that.

Children are generally doers. Their experience with adults is mostly about
talking, not doing, so I think it’s helpful to connect with what they do.

Th: M’Lin and Janine, I’m not going to ask your ages, but which of you
is which? What would you like me to call you?
M’Lin: I’m M’Lin.
Janine: I’m Janine.
Th: What would you like me to know about you?
[M’Lin and Janine look at each other]
M’Lin: Um, I guess that we’re a blended family, that I stay home most of
the time with the kids, and I do some home-based work as a finan-
cial consultant.
Janine: I work at a bakery making specialty cakes and other stuff.
Th: Finances? Bakery? Do you like your jobs?
Both: Yes.
M’Lin: Sometimes, I wish I could go to an office, and Janine works odd
hours, so sometimes I wish she had a more regular job.
Janine: I get up at 3:00 am, so go to bed 8:00, which is hard on M’Lin
because she has to do all the bedtime stuff with the kids.

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As I write this, I find myself wondering as a Solution-Focused Brief Ther-

apist about the purpose of all these questions. Some therapists would start
by simply introducing themselves and asking about the family’s best hopes
for the session, and moving to the next question from there, making sure
that they heard from all family members. Personally, I like a little bit of
getting-to-know-you time because it helps me settle down a bit and
learn what is important to the family members. Structural Family Therapy
(Minuchin, 1974) would call this joining. This sounds too much to me like
a technique for getting the family to accept me. I think it’s useful for clients
also to have some settling-in time and to have a chance to get to know me a
little. I think of this as reinforcing a relationship and limit the time we take.
Clients usually are eager to get to business. However, when children are
present, parents typically enjoy hearing good things. That said, therapy can
start by asking about their best hopes from the session, what would tell them
that the session was useful, just their names and what they would like to be
called, or something else. What is not considered useful in SFBT is to ask
them about the problem that brought them to therapy. If they feel a strong
need to talk about the problem, they will.

Th: Yes, I can see how that would be tough. I’m sure you’re eager to tell
me what’s going on in your family, but first, I’d like to find out where
we’re going. Is it OK if I ask a strange question and then get ideas
from each of you? [everyone nods or otherwise indicates assent]
OK. Now, this strange question: Suppose that tonight, after we’re
finished with our time together, you go home, do your usual things,
and go to bed. You sleep really, really well and, while you are asleep
a miracle happens. Fancy, do you know what a miracle is?
[Fancy looks at Janine with a puzzled face]
Janine: It’s when something wonderful and unexpected happens and
everything is perfect.
Fancy: Ohhh . . .
Th: So, this miracle happens, and all the things that brought you here
today are gone. Just like that! But you don’t know the miracle hap-
pened because you were asleep. What’s the first thing you would
notice that would tell you that a miracle must have happened?
[family members are quiet]

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M’Lin: Well, I guess I’ll start. Cora has been a problem at school. She
doesn’t listen to her teacher and has been hitting other kids.
Th: OK. Suppose the miracle happened, how will you know?
M’Lin: Oh. [looks at Cora] I guess the first thing I’d notice is that I would
wake up without dread. Cora’s teacher has been calling again and
I dread the calls.
Th: You’d wake up without dread. What will you feel instead?

The formulation idea of communication helps us make choices about

what we say: we keep something, ignore something, and add something. In
this case, ignoring the comment about the teacher’s phone calls helps move
the conversation from problems to solution building, yet we keep it in mind
for later in case we might need it. We trust that if there’s anything else we
need to know, we’ll hear about it.
The therapist also could have asked what would tell family members that
their time with the therapist was useful. This would have brought more short-
term responses that could have provided information about exceptions and
small changes that would be helpful.

M’Lin: I’d feel relaxed, looking forward to the day. Fancy would come into
my room and I wouldn’t snarl at her, I’d be happy to see her.
Th: Relaxed, looking forward to the day. Smiling?
M’Lin: Yes.

It’s very helpful to repeat clients’ words; I write them down so that I can
be sure to use their exact words later. I think it also helps to show that I think
the words are important and to solidify them in everyone’s minds, being as
concrete and behavioral as possible; in this case, smiling is connected to
relaxed but was added tentatively as the opposite of “snarl.”

Th: Who will notice that you are relaxed? Fancy? What would she
notice?
M’Lin: She’d notice that I stayed in bed for a few minutes to snuggle
instead of getting up right away.
Fancy: She’d tickle me!!
Th: You like tickling? Who else would notice, what would they notice?

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M’Lin: Well, Janine would be gone, so she wouldn’t notice,

although she might notice that I wouldn’t call or text
her about Cora.
Th: What would she notice instead?

Using the same pattern of speech, I believe, helps clients begin mov-
ing toward a solution-building rather than problem-solving ways of talking
about things. Instead of the problem thing, what would there be?

M’Lin: [looking at Janine] I’m not sure she would although she
might notice at some point that I hadn’t called or texted
her. Or maybe I would text something nice like, “We’re
up. Hope your day is going OK.” Something like that. Or
maybe later, after the kids are off to school, I might text to
see if we could maybe have lunch when she gets off work.
Th: So, you might have something to talk with Janine about
that’s nice, maybe suggest lunch together.
M’Lin: Yes. That would be nice.
Janine: That would be very nice. I would like that. We used to
do that sort of thing a lot.
Th: So, you used to do things like that together? That would
mean something to you? That is nice. OK, so who else
would notice. What would Cora notice?
M’Lin: I guess she might notice that I wake her up with smiles
and a nice voice instead of all tired like and snarly.
Cora: That would really be a miracle.
Th: What else would you notice, M’Lin?
M’Lin: I’d get up and fix a regular breakfast for the kids instead
of just throwing cereal on the table.
Jamel and Fancy: Yeah! We’d like that! Pancakes!
Th: Pancakes? Wow.
Th: Cora, what’s the first thing you would notice that would
tell you that a miracle happened?

Systemic and solution-focused therapists time their questions to family mem-

bers for many reasons. Usually, it’s better not to start with the person identified

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as a problem. Starting with others allows everyone to get a sense of how the
therapist works. In this case, the therapist moved to Cora after M’Lin instead of
to Janine, which would be logical: to start with the parents. However, because
Cora spoke up, the therapist wanted to capitalize on her participation.

Cora: [with some welling tears] Mama wouldn’t be yelling at me to get up.
I get stomachaches when she yells at me.
Th: That doesn’t sound like fun. I don’t like stomachaches at all.

Solution-focused therapy isn’t all fun and positivity. It’s not problem-
phobic. Solution-focused therapists have empathy and compassion for cli-
ents and acknowledge problems and pain when appropriate.

Cora: Sometimes I don’t want to eat breakfast and she yells at me even
more, and then I get hungry at school. When I told my teacher I was
hungry, she asked why my mothers don’t feed me, so I quit telling
her. I just keep it to myself until lunchtime.
Th: You keep it to yourself. That you feel hungry.
Cora: Yes. I don’t want Mama and Mommy to get into trouble.

As a systemic therapist, I might be wondering about the connections

among M’Lin’s yelling, Cora’s stomachaches, and the complaints from
school as well as other things that may be going on in the family. As a
solution-focused therapist, I want to be careful to not move toward linear
cause-and-effect thinking or thinking that this is what we need to focus on in
therapy. It’s hard for Cora and M’Lin, but I want to stay confident and broad
in my thinking, focusing on exceptions and what can be better, using the
whole family as a resource. I want to trust the approach.

Th: That’s very thoughtful of you Cora. When the miracle happens, and
your mama is no longer yelling at you, and you don’t have a stom-
ach ache, is fixing a nice breakfast . . . pancakes?
Cora: [looking up] Yes.
Th: Something else?
Cora: Maybe waffles or fixing Fruit Loops for me?
Th: OK. What else will you notice that’s different?

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It’s OK to incorporate others’ miracles at times as long as we are tentative

and check them out.

Cora: [more tears] Mommy [Janine] might call and tell me she hopes
I have a good day.
Th: That would be really nice, I bet. Has she done that before?

It would make sense to assume that this has happened before, but the
therapist wants Cora to paint pictures as vividly as she can and to begin
hunting for exceptions. It appears that tension has been demoralizing this
family for some time and we want to start bringing more hope to them as
soon as possible.

Cora: Yes, she used to call us every morning when she could. 7:45.

Cora was certain of the time, indicating that it was important to her. In
SFBT, we are always on the watch for what’s important to clients.

Janine: I’d like that, too Cora.

Th: What else would you notice, Cora, that the miracle happened?
Cora: No more stomachaches.
Th: Of course. How else would you feel in the morning?
Cora: Hungry. Like on weekends.
Th: Yeah! Hungry. What would you be looking forward to?
Cora: Maybe seeing my friends?
Th: Sure. That would be great. Playing four-square?
Cora: [looking up at the therapist] Yes.
Th: Thanks, Cora. That was very helpful.

Clients like it when we remember things they have said, especially

children. They often are not used to adults remembering “little” things.
I think that children are more likely to trust us when they think we listen
to them.

Th: Janine, what’s the first thing you would notice that would tell you
a miracle must have happened?

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We certainly could stay with Cora, asking more questions, getting more
details, but sometimes it’s best to keep things moving. Timing is an art and
asking “what else” is seldom a poor move.

Janine: I’d call at 7:45 and hear happy sounds. It’s been a while.
Th: So, you still call?
Janine: Oh, yes, I like talking with them in the morning since I can’t be
there.
Th: Makes sense. What else would you notice?
Janine: [laughing] If M’Lin called me and it wasn’t about a call from the
teacher. That would be terrific!
Th: Yeah, I guess that really would be terrific. What might she call
about?
Janine: Well, like she said, maybe to see if we could have lunch or some-
thing. Or maybe something about the kids that was fun.
Th: Something fun about the kids, invitation to lunch. Sure, it’s your
way of staying in touch?
Janine: Right.
Th: OK. M’Lin would be happy, Janine would get a nice phone call.
Cora would be looking forward to seeing her friends at school.
What else might you two notice?
M’Lin: I think I’d notice that Janine seemed like she wanted to come home
instead of avoiding us.
Janine: Yeah, that makes sense. I would look forward to coming home.
Th: OK. Kids [meaning Jamel and Fancy], what’s the first thing you
would notice?
Jamel: Mama [M’Lin] wouldn’t be yelling at Cora to get up. It would more
quiet, like [soft voice], “It’s time to get up, kids.”
Fancy: Yeah! Not, “Cora, Cora, you gotta get up! You gotta get up for
school!” [bouncing on her chair, clearly having fun]
Th: What else would you notice, Fancy? What might you notice about
Jamel?

When someone has been named as the problem in the family, it’s very easy
for everyone to point to that person for both problems and not-problems. In
systemic family therapy, we view the named client within the context of the

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whole family. The therapist wanted to spread the focus around, including all
family members.

Fancy: [looking at Jamel] I don’t know. Maybe he wouldn’t be complain-

ing about the yelling. He doesn’t like yelling.
Th: What do you think he’d be doing instead?
Fancy: Helping me get my backpack ready?
Th: Helping you. Would you like that?
Fancy: Yes. I like it when he helps me. I don’t like it when he’s cranky with
me. [cranky voice] “Fancy, get your backpack.”
Th: Jamel, would that be part of your miracle?
Jamel: [a bit grudgingly, but mostly in an embarrassed big-brother sort of
way] I guess.
Th: What would you notice instead of yelling?
Jamel: I guess I’d notice the quiet. Or Mama in the kitchen fixing break-
fast. Cora would be up, so I wouldn’t be thinking I should get her
up, or if she wasn’t, I could just shake her and tell her it’s time to
get up.
Th: Cora, what would you notice about others the day after the miracle?
Cora: I don’t know.

This response may have been a signal to the therapist that she had
allowed too much attention on Cora’s behavior and M’Lin’s yelling. How-
ever, “I don’t know” also may simply means the person is thinking. People
often say “I don’t know” because, in the moment, they really don’t know.

Th: [waiting to give Cora time to think]

Th: [after some time, but not so much that it becomes an uncomfort-
able silence] That’s OK. When you think of something, you can tell
me, OK?
Cora: OK.

Cora has already mentioned a few things, so it might be best to move on

to other things. The therapist can always come back to Cora’s ideas.

Th: Janine, suppose the miracle happened. What do you think your
employer might notice? What would she. . .

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Janine: He.
Th: He. What would he notice?
Janine: I think he would notice that I’m not worried and quiet. I’d be
talking with everyone, participating in the conversation.
Th: Participating in the conversation. What difference do you think that
might make to everyone?
Janine: I don’t know that they’d all notice, but when we’re all in a good
mood, everything goes better. We work as a team, get things done
and then the shop has a good atmosphere when we open.
Th: Wow. That sounds good. What would that mean to you?
Janine: That things are better, that I don’t have to worry about home, or
Cora, or the phone calls, or anything.
Th: M’Lin, who else would notice that something has happened, that
things are better?
M’Lin: Well, Cora’s teacher would notice right away. Cora wouldn’t be
such a problem. She’d be nice to the other kids, listening to the
teacher, maybe getting better scores.
Th: What difference would that make to you? What would that
mean?
M’Lin: It would mean that I don’t have to worry about Cora, that she’s
unhappy or something. I don’t know why she hits and doesn’t lis-
ten, but I worry it means something is wrong with her or something
bad is happening.
Th: And if that were so, if worry continued, what do you think would
happen?
M’Lin: I worry that she’ll always have a hard time in life, that other kids
won’t like her, that she won’t have opportunities for a happy life.

The therapist wants Cora to hear what she (the therapist) thinks she’s
hearing: that Cora’s parents don’t see her as a bad person, but that they’re
worried.

Th: Do you agree with that, Janine?

Janine: Yes. We worry that what we see as a sweet girl will not be seen by
others, and it could get worse.
Th: You want to keep things from getting worse, you want everyone to
see the sweet girl.

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Janine and M’Lin: Yes.

Th: OK. And you see the sweet girl she is.
Both: Yes.
Th: What do you see in Jamel and Cora and Fancy that
makes you smile, that tells you they are sweet, good
kids?

The therapist wanted to spread focus to all of the children, and also
noticed that Cora had been paying close attention to the conversation.

Janine: When I come home, and everyone is in a good mood,

I see lots of things. I see Fancy helping M’Lin in the
kitchen, I see Jamel helping Cora with homework.
I might see Jamel teasing Fancy in a fun way or playing
with Cora. Fancy might bring me a picture she drew.
Th: So, you see three kids who like to work together, to play
together, to be helpful.
Janine: Yes. And they’re just sweet. They make us happy. When
we’re out, they have fun, behave themselves, listen to us.
M’Lin: [smiling] I couldn’t have said it better and can’t really
add anything. Cora helps with Fancy sometimes and
I think after the miracle, I’ll see her helping get Fancy
ready for school while I fix breakfast. She sometimes
helps on weekends.
Th: I can tell you both love your children very much and
I’m glad you came here today to see what we can do to
get you back on track with a happy family. Not perfect,
of course . . .
M’Lin and Janine: Of course.
Th: . . . but more happy than worried.
M’Lin and Janine: [smiling] Yes.
Th: OK. Kids, are you good with numbers?
All: Yes!
Th: I want to do some number games with you, but there’s
no math involved—no adding or subtracting or any-
thing. Would that be OK?
All: [sure, head nod, etc. from kids, smiles from mothers]

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Th: OK. First, I want all of you to imagine that the things that are going
on the day after the miracle are a 10. And we’ll draw it here [draw-
ing a vertical line on a piece of paper, writing “10” at the top and
“0” at the bottom]. Now. Ten means the day after the miracle and
all the things you want to happen are happening. Zero means the
opposite. Where are you now?
[M’Lin and Janine look at each other]
M’Lin: I guess I’m at a 3. I’m pretty discouraged with all the phone calls
from Cora’s teacher.
Th: 3? What’s the difference between 2 and 3?
M’Lin: Well, there are some days when the teacher doesn’t call, and we
do have fun as a family on weekends. Cora doesn’t complain about
stomachaches as much.
Th: I’m sure you both prefer days when people are having fun. What
else do you see at 3?
M’Lin: Um, we’re taking care of things without fussing?
Th: I’m not sure I know what you mean. What kind of things?
M’Lin: Oh, like homework, house things, bedtime routine—necessary
things.
Th: OK, getting things done, going more smoothly. And that’s happen-
ing now? Better than 2?
M’Lin: Yes, somewhat. Not too much fussing.
Th: That seems pretty good to me. How do you think the others notice
you’re at 3 instead of lower?
M’Lin: I probably don’t yell as much.
Th: What do you do instead?
M’Lin: I’m more likely to ask what they want for breakfast, make some fun
plans for the day. Laugh. If there’s work to do, ask instead of grouch
about it like I used to.
Th: OK, thanks. Before I ask the others about their numbers, could you
tell me what 4 looks like for you?
M’Lin: 4. Well, 4 includes some days where Janine and I get to have coffee
or lunch together without talking about Cora’s problems.
Th: What do you talk about instead?
M’Lin: Oh, normal things. Like Jamel’s soccer game, or a birthday party
Cora’s been invited to. What might be coming up on the weekend.
What Fancy is up to.

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Th: That sounds really pleasant. When was the last time something like
that happened?
M’Lin: It’s been a while. Not this week, but the week before, we did have
lunch after I took Fancy to school and talked about some things
that are happening with her brother.
Th: Janine’s brother?
M’Lin: Yes. He started a new business and we’re hoping it goes well.
Th: It was nice to talk about something pleasant. What else will be
different? How will you know you are at 4?
M’Lin: Um. I’ll feel more like doing things in the apartment. Like clean up
the kitchen, start some laundry.
Th: Get some things done in the house. That sounds good. What do
you think the others will notice?
M’Lin: [laughing] They’ll see me fixing dinner without cleaning the kitchen
first?
Th: What difference will that make to them?
M’Lin: Probably not much. Except I’ll be in a better mood because I don’t
have to clean the kitchen.
Th: Who will notice first?
M’Lin: Janine will see it first. She might even help with dinner.
Th: OK, so you will have lunch with Janine and talk about something
pleasant, get some things done around the house. Are you sure
that’s 4? That sounds a bit better than that to me.
M’Lin: You’re probably right. That’s probably 6; it’s a pretty big step.
Th: Yes. Is some of that happening now?
M’Lin: Hmmm . . . I see more energy around the house—maybe getting
the kitchen cleaned up and straightening the living room.
Th: Janine, what difference will it make to you when M’Lin is at 4?
Janine: Seeing the kitchen cleaned up when I get home from work would
be really nice. It would make a difference.
Th: How so?
Janine: It will mean she’s doing better.
Th: How do you think you will respond?
Janine: I’ll probably ask how I can help with other stuff, maybe homework.
Th: So, M’Lin’s energy might help you with some of your own?
Janine: Yeah.
Th: What difference do you think that might make to M’Lin?

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Janine: I think she’d like it a lot. We used to work more together in the house.
Th: What else would it mean to you that M’Lin’s feeling a bit better?
Janine: I’d have more hope that we can pull this off together, not have to
worry about Cora, feel more like we can handle things as they come.
M’Lin: Actually, I already have more hope, coming here and talking. And
Janine called me one day instead of waiting for me to text her. So,
maybe I’m on my way to a 4 already.
Th: So, you’re already making progress? Three and a half, maybe?
[M’Lin nods] More hope. And Janine called. Is that different?
M’Lin: Yes; usually I’m the one to call, which I don’t mind.
Th: Janine, did you know this made a difference to M’Lin?
M’Lin: Yes, but not that much.
Th: Wow. So, it made a difference to both of you. And there’s more
hope. Janine, do you like that? Do you agree?
Janine: Yes, I agree that we’re a little more hopeful.
Th: What number do you think you are at, Janine?
Janine: I think I’m at 5. I’ve seen kids have problems like these and families
figure out how to help them. I think we can do it. I think M’Lin is
more worried than I am.
Th: 5. More hopeful than M’Lin?
Janine: Yes.
Th: So, what does 6 look like for you?
Janine: M’Lin has even more hope, is not as discouraged, talks with me
more about other things. Is more confident we can figure this out?

Notice that the therapist is not asking about Cora and her problems, how
they started, details about what happens at school, in the phone calls, or
the conversations about how to “fix” Cora. Also, the therapist noticed that
Janine was tentative and already getting into the pattern of SFBT with scaling
and presumed future focus.

Th: And that would make some difference to you?

Janine: Yes, it’s hard enough to be worried about Cora, but it’s worse when
I have to worry about M’Lin, too.
Th: OK. So, M’Lin is 3 plus, maybe 3.5 and moving toward 4. Janine is
5 and knows what 6 looks like. Jamel, where are you? Where are
you toward your miracle day?

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Jamel: Oh, I’m OK. Most of the time, it doesn’t bother me. I’d say I’m at 7.
Th: And what tells you that you are at 7, not 6? What’s different?
Jamel: Well, weekends are nice, everyone gets along pretty well. Mama
doesn’t yell much.
Th: OK, weekends are nice. What else tells you that you are at 7?
Jamel: When we come home from school, Mom [Janine] tries to make a
better mood. She says hi and gives us hugs.
Th: Wow, that’s a lot. You notice that? That means something to you?
Jamel: Yeah, that’s what normal families do. If Mama is working, Mom
tries to talk to Cora about school and stuff because when Mama
talks with Cora, it gets nasty sometimes.
Th: So, it’s better when Mom talks with Cora? What does that mean to
you?
Jamel: It means she cares about her even if everyone’s kinda mad and all.
Th: Your moms show they care when they talk with you? Even about
tough stuff?
Jamel: Yeah. But I don’t think Cora sees it that way.
Th: OK. So, you’re at 7. What does 7 and a half or 8 look like?
Jamel: Yeah. What does better look like? Hmm . . . Maybe more days like
that? Mama and Mom both seeing us when we come home?
Th: OK. You think about that. Cora, where are you on this scale toward
the miracle day?
Cora: 2.
Th: 2. How come not 1? What’s different?
Cora: I know Mama and Mommy care about me. I just don’t like yelling
and talking when the teacher calls.
Th: You know that your moms really care. That’s good, because I think
so, too. I think they care a lot or they wouldn’t have brought all of
you here to help make things better. What does a little better look
like for you? Just a little.
Cora: [silent, looking down] I guess if Mama didn’t act so mad at me.
Th: What would she do instead?
Cora: Help me with my reading. Or just give me a hug when I get home
instead of “talking” to me or telling Mommy to “talk” to me.
Th: That would make a difference to you? How would they know it
matters?
Cora: I’d stick around in the living room instead of going to my room.

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Th: What would you be doing in the living room?

Cora: I don’t know. Maybe watching TV or playing with Fancy. Reading.
I like to read.
Th: So, tell me, Cora: when does a little bit of your miracle day happen,
even a little?
Cora: [quiet for a bit] I don’t know. Maybe when Ms. Ackle hasn’t called
Mama?
Th: What does that mean? That Ms. Ackle didn’t call?
Cora: It means she’s not so mad at me.
Th: And what happens at home when Ms. Ackle doesn’t call?
Cora: Mama’s in a better mood, not stuck off working in her room. Mommy
doesn’t “talk” to me.
Th: What does she do instead?
Cora: I guess she’s watching TV or cleaning the kitchen. Maybe playing
with us or asking for help with laundry or something.
Th: And what are you like when it’s like that? What are you doing?
Cora: I kinda wait to see if it’s going to stick, see if they’re waiting before
“talking” to me.
Th: And if you wait long enough. . .
Cora: If nothing happens, I sorta relax a bit, start teasing Fancy or playing
dolls with her.
Th: That sounds like fun. And that happens sometimes?
Cora: Yeah, sometimes.
Th: So, you’re at 2 and not 1 because you know your moms care about
you, and you see that they’re just doing regular things. What does 3
look like?
Cora: Hmmm. . . [brightening a little] When I’m at 3, I’ll think maybe I’m
not going to get into trouble.
Th: Really? What will that look like? If I were to see you going into your
apartment building, how would I know you are at 3?
Cora: [looking up] I don’t know. This is hard. I’d just feel better. [therapist
waits] Well, if you knew me better, maybe you’d see me swing-
ing my backpack. If I knew Ms. Ackle probably hadn’t called so
I wouldn’t get into trouble.
Th: Wow. Does that happen sometimes now?
Cora: Yes. When I know she hasn’t called.
Th: M’Lin, Janine: did you know that Cora sees that sometimes?

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Janine: No, I didn’t know that. I guess I’ve been paying more attention to when
the teacher calls and M’Lin is unhappy than when she doesn’t call.
M’Lin: I had no idea Cora saw that. I had no idea she sees the difference.
Th: Hmmm. . .
Th: [after letting this sit for a while] Where do you think you two will
be when Cora is closer to 3?
[M’Lin and Janine talk over each other] Better. Things will be better.
I’ll feel better. I feel better already.
Janine: Cora, do you think you know what you need to do so Ms. Ackle
isn’t mad at you?
Cora: [quietly] Yes. I need to sit in my seat and not talk to others when
she’s talking.

The therapist could have followed up on this but decided not to at this
time because she wanted to focus more on the miracle day and small signs
of progress toward that. She also did not want the mothers to start telling
Cora how to fix the problem.

Th: M’Lin, Janine, what will you be doing when Cora comes home
swinging her backpack?
M’Lin: Well, I wouldn’t need to talk to her about a phone call.
Th: What would you do instead?
M’Lin: Just give her a hug, ask if she wants a snack, tell her to go play with
Fancy?
Janine: That sounds good to me.
Th: What will you be doing, Janine?
Janine: Oh, I’m not sure. Maybe ask her how her day was.
Th: What might she say?
Janine: If it was a good day, she’d tell me about her friends, maybe what
lunchtime was like.
Th: When was the last time something like that happened?
M’Lin: Hmm. About 6 months ago. Ms. Ackle called to tell us that Cora
had been advanced in reading.
Th: Really? What did you do?
M’Lin: Well, I told Janine, of course, and asked Cora about it when she got
home.
Th: So, the teacher called and it was good news.

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M’Lin: Yes. I guess the she doesn’t always call with bad news.
Th: Cora, do you remember that?
Cora: I remember getting advanced, but I don’t remember what hap-
pened when I got home.
Janine: Don’t you remember? We had special dessert at dinner. Strawberry
shortcake.
Cora: Oh. Yeah. Now I remember.
Th: Is special dessert part of your miracle?
Cora: Yes! Every day! [moms and therapist laugh; therapist notes that
Cora is more animated than when the family first came in]
Th: OK. Fancy, I haven’t asked you yet: What number do you think you
are at on this scale from zero to 10? [showing her the paper] 10 is
the miracle day, which, if I remember right, means pancakes.
Fancy: Pancakes! Yeah, but I think I’m at 7 because we usually get pan-
cakes on weekends. But I want them more!
Th: [laughing; moms are laughing] OK, OK. You’re at 7. How will you
know you’re at 8? Almost to the miracle day?
Fancy: I’ll be bouncing on the bed, waiting for Mama to tell me that the
pancakes are ready!
Th: That sounds really great! Maybe I’ll come and get some, too!
Fancy: Yeah!

One of my rules as a therapist is to do my best to help therapy end on a

good note. Watching the family’s reactions, seeing some lightness, could
help a therapist gauge how to end a session. Solution-Focused Brief Ther-
apy makes this easy. In this case, M’Lin and Janine seemed to gain some
understanding of what things were meaning to Cora and what would be
different on the miracle day as well as signs that some of that already was
happening. From a systemic perspective, the envisioned different behavior,
well within capabilities, could mean that the cycle of Cora’s behavior 
teacher’s phone call  yelling or “talking” to Cora  Cora’s behavior can
change, replaced with a different cycle. Without explicitly pointing it out,
the parents seemed to understand without feeling blamed.

Th: We’re nearly out of time. I’d like to take a few minutes to think
about what we’ve talked about and then give you my thoughts. I’ll
want to hear yours, too. OK?

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Th: [after a few minutes] OK, everyone, what are your thoughts? What
are you thinking about helping your family reach everyone’s mir-
acles? Maybe what’s already happening, perhaps a little bit, that
you can do more of.
M’Lin: I think that there’s more that Janine and I can do to help Cora
besides just talking to her. We’ve been assuming she’s mad about
something or has some sort of problem that makes her act like she
does at school. And maybe there is, but we need to do something
different. Cora, I don’t like giving you lectures or cross-examining
you any more than you do. I’ll try to change that. And when Ms.
Ackle calls, I’ll just thank her for calling and see what we can do
next. It’s worth a try.
Janine: I’ll try, too.
Th: [waits to see if any of the children have anything to say] Well,
it’s clear to me that all of you care about each other a great deal.
You enjoy doing things together, you like to laugh together. I’m
not sure what’s going to make a difference yet, but I’m wondering
whether you’d be willing to do an experiment for me if you want
to come back. Do you want to come back?
Parents: Yes.
Th: OK. When would that work for you? [they schedule another
appointment]
Th: OK. Here’s the experiment: Would each of you please watch
what’s going on in the family that tells you that things are moving
toward the miracle day—for yourself and for others? You don’t
have to talk about it, just watch for it so we can talk about it.

There are a number of tasks or suggestions or experiments that the

therapist could have mentioned, including asking the family what they
thought might be a good thing to try. When there are many people, find-
ing a common idea about a task or experiment can be demoralizing if
some come up with unrealistic ideas. In this case, the therapist wanted
to let the new information settle and see how it informed the systemic
dynamics.
Of course, it’s not likely that there will be a quick miracle, and that’s all
right. We’re not looking for 10s and whatever happens will be information
for the family and for the therapist if they come for a second interview.

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Session 2
All troop into the therapy room. Fancy seems a bit subdued and Janine
explains that she’s had a cold and still isn’t feeling great. The others seem a
bit bouncier than the previous week.

Th: Hi everyone. Hi Fancy, I’m sorry you’re not feeling well. I hope you
get better soon.
Fancy: Thanks.
Th: So, what’s better?
[M’Lin and Janine look at each other and Janine indicates that
M’Lin should go first]
M’Lin: Well, we got a phone call from Ms. Ackle only twice. Janine didn’t
ask about specifics when I told her. I did call her after Ms. Ackle
called the first time and we had lunch and decided what we’d do
when Cora came home: no yelling, no lectures, no quizzing about
what she did or why or anything. Just standard operating proce-
dure. Except we asked her where she thought she was on the scale
and she said 3 because she really tried, she just couldn’t help her-
self that day. So Janine asked her what 3 and a half would look like.
Th: Wow. That seems like a big change. Cora, did you notice some-
thing different one day?
Cora: Yeah. I’d been trying real hard but I knew I messed up at school
and thought they’d be mad, but I hoped they wouldn’t be. They
weren’t. It was just like the day before.
Th: So where are you now on your scale, Cora?
Cora: 4.
Th: 4? Wow! That’s a big change! How did that happen?
Cora: I tried really hard to be good at school. Mommies didn’t yell at me.
And the second day I knew I was in trouble, so I told them I tried
really hard to be 3.5.
Th: You tried hard? How did you do that?
Cora: When I started to talk out of turn, I pinched my mouth. Ms. Ackle
didn’t like that, though. She told me to quit showing off.
Janine: Cora, I don’t think that was showing off. I think it was trying hard
and that when you’re more used to not talking, you won’t have to
pinch your mouth.

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Th: That’s a very clever idea, Cora. How did you think of that?
Cora: Well, I started to open my mouth and thought, “I better shut it” but
it was staying open, so I pinched it shut.
Th: Amazing! It worked?
Cora: Yeah, I did that every day.
Th: Your mom seems to think that was a good idea, too. And you
thought of it yourself?
Cora: Yeah.
M’Lin: Ms. Ackle called another day because Cora was doing that and it
was disrupting the class; the kids were laughing at her. Janine and
I talked over lunch before Cora got home and decided not to say
anything because we didn’t want to make things worse, and we
could talk about it here. We thought you might have some ideas
for Cora. But then she told us about it on her own.
Th: It sounds like it might have been easy to fall back into old patterns
but you didn’t. How did you do that?
M’Lin: Well, I decided to not call Janine about the phone call and wait
until we were together later. That way, it wouldn’t ruin the mood of
the day. Besides, I thought it was a little funny, in a way, and a good
sign. [to Cora] But not so funny it’s OK to keep doing it. We’ll find
another way, OK?
Cora: Oh-kay. . .
Janine: So, she told me over lunch so we could discuss it instead of calling
me right away or texting.
Th: So, instead of texting or calling Janine, you decided to wait. And
the two of you talked and made a plan to leave it alone until you
could talk more. Do I have that right?
M’Lin: Yes. So, when Cora got home, we didn’t say anything.
Th: Cora. Do you know what day that was? Did you notice any differ-
ences when you got home?
Cora: Well, I was expecting trouble, but it didn’t happen. I wondered
if maybe Ms. Ackle hadn’t called like she usually does when I’ve
been bad. But I wanted to tell them anyway.
Th: It was just normal at home this week?
Cora: Yes, except Jamel didn’t get home ‘til later most days. He has soc-
cer practice.

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Th: So, something changed, it was good, and things are better. Is that
right? [all nod their heads]. Do you think your moms knew you’d
say 4?
Cora: [looking at M’Lin and Janine] I don’t know. Did you?
M’Lin: [looking at Cora] I knew things were better for us, and I thought
they’d be better for you, but I didn’t think you’d feel this much better.
Th: M’Lin, what told you that things were better?
M’Lin: Things were more peaceful around the house. I felt more like get-
ting up in the morning and even fixed breakfast once instead of just
throwing cereal on the table.
Th: So, where are you on your scale?
M’Lin: Solid 4, moving toward 5.
Th: Solid 4, moving toward 5. That’s great. I want to come back to that,
but I’d first like to talk some more with Cora. Would that be all
right?
M’Lin: Sure.
Th: OK. Cora, what told you that things were better, so much better
that you now are at 4?
Cora: Well, Ms. Ackle was nicer to me.
Th: She was? How so?
Cora: She didn’t tell me to sit down and be quiet, and she didn’t do that
heavy sigh thing she does [demonstrates].
Th: What did she do instead?
Cora: She just went on with the lesson. Once she looked at me and
pointed to her lips, so I quit pinching my mouth. But she didn’t
look mad.
Th: She didn’t look mad? And she noticed you were behaving better?
How do you think she figured that out?
Cora: The other kids weren’t laughing at me so much or frowning and
looking away.
Th: Yes, you are a clever girl. What else told you that you are at 4?
Cora: That’s about it. Oh, Mommy gave me a special hug one day when
I got home from school. I could tell that Ms. Ackle had called
because both Mama and Mommy were looking at me when I came
in. But they didn’t yell or anything and Mommy gave me a hug and
was smiling.

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Th: [noting that M’Lin and Janine are smiling now] Oh, what was that
about?
Janine: Well, Ms. Ackle had called about the mouth pinching and we
weren’t sure what to do. We wanted to wait to talk about it until
we were here. But we did think it was clever and so like Cora. Like
the Cora we used to have. So, we were smiling a little.
M’Lin: She’s quite an imp and good at making people laugh. Too good. So
even though things are better, we need to help her find a way to
keep it up without making the other kids laugh and disrupting the
class.
Th: Hmm. M’Lin, you said that you are a solid 4 moving toward 5.
M’Lin: Yes. Cora’s impishness is something we really love about her except
when it gets out of hand. I think that’s normal because she’s smart,
and we just need to help her learn when it’s OK and when it’s not.
And that just will happen over time; she’s only 10.
Th: Keep her impish self, learn to control it. That’s how much better. . . ?
M’Lin: Oh, I think that’s part of 10. I don’t think we need to have that
completely now. Just a little better. Maybe 5 is she’s coming up
with ideas that aren’t disruptive instead of pinching her mouth.

Note that the conversation has shifted to talk about what Cora needs to
do instead of not do. This process needed to shift to the whole family for
systemic purposes.

Th: And when you are 5 [noting that Janine seems to have been com-
pletely engaged and in agreement], and you, Janine, you’re at. . . ?
Janine: 7.
Th: And you’re at 7, Janine, what will you notice? What will be differ-
ent for you two?
Janine: We’ll be talking about the kids in terms of normal ups and downs,
helping them with whatever comes up.
M’Lin: I think that sounds more like 10. I think we have some things to
learn about how to do that, first.
Th: How do you do that? How do you do that now? Suppose Jamel has
some difficulty with something. How do you help him?
[after a pause in which Janine and M’Lin look at each other]

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M’Lin: [to Janine] I don’t know. How do we do that?

Janine: I don’t know.
Th: I don’t want Jamel to think we’re looking for problems, but when
was a recent time when you two or one of you had to help him
with something?
Jamel: When I got mad about math and broke Fancy’s tower.
Janine: [to therapist] He was having trouble with his homework, got started
late, had come home in a bad mood, and when he threw his book,
it took down a tower Fancy had been building with her blocks.
Th: Oh. Thanks. Sorry about your tower, Fancy.
Fancy: It’s OK. He apologized later and helped me build another one.
Th: So, Janine, M’Lin. What did you do to help Jamel? Something other
than yelling and “talking” maybe?
Janine: Well, we were both in the kitchen, so we talked for a minute about
what to do, then decided M’Lin would go and talk with Jamel
about what was going on with his day to put him in such a mood.
Th: And that helped?
Janine: I think so. Do you think so, M’Lin? [M’Lin nods yes]
M’Lin: He apologized to Fancy and then went into his room for a while.
When he came out for dinner, he was in a better mood. Some-
times, he just needs space. And he might have been hungry, too.
Th: Jamel, does it help for one of your moms to talk to you when a
day’s been hard?
Jamel: Yeah. I’m glad they don’t yell at me. They listen and try to under-
stand. They just can’t always.
Th: No, I don’t suppose so. They’ve never been a middle-school-aged
boy. But they listen? You’re willing to tell them what’s happened?
Jamel: Not always, but if they give me some space, I usually can tell them.

M’Lin and Janine realized that they talked about what to do together
and a few things they did that were helpful to Jamel instead of yelling and
“talking.” The therapist complimented them on being able to stay calm and
work together. This is what she saw as how they were helpful when Ms.
Ackle called about Cora—they stayed calm and worked together to develop
a plan. This is isomorphism: seeing that patterns in one area can be and are
replicated in others.

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Th: Do you think there’s something there that might be helpful with
Cora?
M’Lin: Maybe. Cora’s a different child, though.
Th: Sure. It sounds a lot like what you did after Ms. Ackle called,
though.
Janine: Yes, it does. Maybe we can use that.
Th: We have a few minutes left. So, I’m curious: Jamel, what did you
notice this week?
Jamel: I was busy this week with soccer, so I didn’t really notice much.
I guess things were quieter and dinnertime was nicer. Cora wasn’t
all quiet and such.
Th: So, where do you think you are on your scale toward the miracle?
You were at 7 last week.
Jamel: 8, I guess. I don’t know. If things keep up like this, I don’t know
why we would need to be here.
Th: OK. Thanks. Fancy, are things better for you at home except for
your cold?
Fancy: I guess. Mama’s not yelling in the mornings and she fixed me some
medicine for my cough.
Th: That was a good thing for her to do. I hope you’ll feel better soon.
M’Lin: I hope so, too.
Th: So, M’Lin and Janine, what difference did all these changes this
week make to you?
Janine: Well, it meant a lot to me. It felt like M’Lin and I could work
together again, you know, to help Cora.
M’Lin: I agree, although I’m not sure what we’ll come up with.
Th: Do you think this clever, smart Cora of yours can help with that?
Janine: [laughs] Oh, I’ll bet she can!
Th: OK. Let me take a few minutes to think and then we’ll wrap
things up.
Th: [after a break] Do any of you have anything else you want to add?
[they shake their heads] Well, first, I’d like to say how impressed
I am with all of you. Cora came up with a clever idea for staying
quiet at school, M’Lin and Janine worked together to decide how
to handle some things. It seems you’re going in the right direction.
Is that correct?
M’Lin: Yes. I think so. But I don’t want them to go backwards.

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Th: Of course not. But if there’s a bit of kerfuffle, you can learn from
that. Ups and downs are normal. Do you want to come back?
Jamel: Do we have to? I’m missing soccer.
Th: That’s up to your moms.
M’Lin: Can we come back without Jamel?
Th: Sure, if that’s what you two decide will be helpful.
[the mothers look at each other]
Janine: I think I’d like to come back at least one more time. I’m worried
that Cora doesn’t quite understand.
M’Lin: Me, too, but I think we’ll be able to handle it if we remember to
talk with each other. I think that’s on me.
Janine: Only partly; I need to let you know if you’re getting ahead of us.
M’Lin: Yeah. [to therapist] We want to come back.

Note that the therapist did not ask about the experiment. This is a matter
of debate and preference. Some think that if it’s not discussed, the therapist
loses credibility and the experiment was not necessary. Others, including
myself, think that it depends on a number of factors. In this case, the family
was doing better, didn’t bring it up themselves, and the therapist knew that
she or the family could bring it up later if anyone thought it would be useful.

Session 3
The next session was very similar to the second. Things were a bit better, no
big leaps up the scale. M’Lin and Janine had talked and decided to just chat
with Cora about some things. They told her that they thought she was clever
and smart but that she needed to learn to not disrupt class. They realized
that this was hard for her and before they could talk about what she would
do, she said she had an idea. She would write her thoughts on paper and
if she thought they were really important, she would raise her hand. They
asked her how she came up with that (quick learners) and she said that she
needed to do something with her mind and find a better way to use her
hands that the other kids wouldn’t laugh about. The therapist complimented
all of them, asked detail questions about their scale, exceptions, and their
future, then asked if they wanted to come back. They did, but not right away,
so they set an appointment for a month.

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Session 4
When the family came to the next session, they said that there had been
a setback: Jamel had gotten into trouble in soccer for throwing the ball at
another child’s head. They said that at first, they were really mad and M’Lin
started to yell at him. Janine reminded her that they needed to talk, so they
sent Jamel to his room so they could talk. Janine reminded M’Lin that they
needed to remain calm and not yell or lecture. When Jamel came out of his
room, they asked him what had happened and what he thought would have
been a better move. He responded well so they thought they were back on
track for parenting. They each said they were at 8 or 9 on their scales and
thought they could continue without therapy.
This looks like a wonder case because there were so few sessions and the
changes were so dramatic. It demonstrates the approach as rather simple.
However, it’s not always that easy. For example, kids are often quite sullen
in therapy, refusing to talk. I believe that’s OK. I tell them they can listen
and, if they want to say something, we’d like to hear it, so they should let us
know. We don’t need kids to “open up” in order to be helpful to them and
their families.
Systemically, what we notice about this case is what de Shazer pointed
out some time ago:

People come to therapy wanting to change their situation, but what-

ever they have attempted to do to change has not worked. They have
been getting in their own way, perhaps have accidentally made their
own situation worse, and have developed unfortunate habit patterns.
(de Shazer et al., 1986, p. 208)

The authors go on to say that when we try to force our position, we are
likely to be met with so-called resistance. Structural Family Therapy (e.g.,
Minuchin, 1974), for example, might see that the parents are not working
well together and intervene to help them become more of a team. Notice
that by following what the clients want and how they have managed similar
situations in the past, M’Lin and Janine discovered for themselves that team-
work was helpful. Although yelling and lecturing were not helpful and thus
they needed to do something different, their perspective on what needed
to change was Cora. Looking at the circularity of the family, the mothers’

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parenting was not “causing” Cora’s distressing behavior, yet changing their
parenting became part of a solution. There may have been other solutions
as well. For example, helping Cora change her behavior separately may
have affected how M’Lin and Janine interacted with her, and lessened the
tension between them. Talking with M’Lin and Janine without the children
would have left Cora out of the spotlight and might have led to some good
ideas. Systemically, I believe that by seeing the whole family, parents are
better able to understand their children, and are left with ideas about how
to manage on their own better and how to come up with other ideas when
necessary.
People come to therapy wanting change. They usually see the needed
change as someone else’s behavior. A systemic SFBT therapist sees the
needed change as understanding resources and helping the family access
those resources (such as ability to work as a team) and change their process.
We are culturally conditioned to believe that we have to dissect the problem
in order to understand it thoroughly. Only then can we, as experts, diagnose
and intervene correctly. Often, people come to therapy saying they need
to understand what’s wrong. At that point, I ask them, “What if we work
on changing things first, and then, if you still want, we can talk about what
went wrong.” They usually agree to this. If clients say they really need to
understand, I say something like, “OK, let’s look at this a bit.” Then, after
hearing about the problem (some people really need to tell us something of
their problems and that’s OK), I’ll say something like, “I see. [reflect some
understanding] What if I told you I thought the problem is ‘x.’ What would
you say we need to do?” Getting the client’s ideas may help move more
quickly into solution-building by avoiding what may look like resistance.
Then, “So, we could do . . . Suppose that’s successful, what will be differ-
ent? What will you see that will tell you that things are better? Suppose the
problem is ‘y.’ Then what would we do and how would that be helpful?”
And proceed from there.
In the case we just reviewed, the parents may have said that Cora needed
to learn how to behave better at school. The therapist could have indicated
understanding, perhaps by asking what “behave better” looks like and reiter-
ating some details. So many people think that things like Cora’s behavior are
symptoms of an underlying problem. In fact, as therapists, we tend to talk this
way: “What are the presenting symptoms?”—symptoms being signs of some-
thing “deeper.” Cora’s behavior could be a symptom of or distraction from

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tension between M’Lin and Janine. Or just the behaviors of a creative and
active child. If Cora’s behavior at school reflected something such as abuse,
I think she would have said something like, “I wouldn’t have to visit my dad
anymore.”

Th: What difference would that make to you, Cora? Staying with your
moms?
Cora: [looking at mothers] Sometimes he hurts me or Fancy. Jamel gets
mad at him.

Somehow, details about what would be different in a preferred future help

bring forth information about abuse when it’s present. In those cases, ther-
apists must follow their jurisdictional requirements for reporting to author-
ities or keeping the child safe, and do their best to not let this be the final
or only intervention. If the therapy has been mandated for abuse reports,
it’s very important to follow required guidelines and, at the same time, help
the system work together so that everyone is safe and doing well. Andrew
Turnell and Steve Edwards (1999) have written an excellent book on Signs
of Safety for therapists working with family abuse matters using solution-
focused ideas. Two questions in such instances are “What will you do to
keep your children safe?” and “How will you do that?,” which provide
needed safety information that can be used for solution-building.
You may be asking yourself about other “what ifs”: “What if the present-
ing problem is a teenager and his/her acting out?” Jamel easily could have
been labeled as troubled at some point. He might begin coming home later
than he is supposed to, or acting secretively, or, later, showing signs of drug
abuse or other problems evidenced by problems at school and mood at
home. He might not want to come to therapy, but it’s a good idea to start
there. Some therapists prefer to have the parents come first because they
don’t want the teen to hear all the bad things about them. The fact is, the
teen probably already knows this and, besides, a solution-focused therapist
is likely to cut short any litanies of bad behavior. Instead, the therapist can
do the same thing as we saw with Cora and her family: find out what is
important to them, what they want, exceptions to the problem, evidence
that what they want is possible (i.e., signs it has happened in the past or is
happening a little now or can happen in the future), making sure to get each

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person’s ideas, scaling, asking relationship questions to help bring desires

together, and so on. It’s my experience that kids know what needs to change
in order for them to reach their goals. One of my early supervisors used to
see teens alone for a session in these situations. He would say, “Your parents
are on the ceiling. What are we going to do to bring them down?” Also,
it’s sometimes helpful to ask parents how much they see their children’s
behavior as developmentally normal: “Is it normal or just frustrating and
annoying? What will be different when you are not frustrated and annoyed?”
For example, asking Jamel about what he would like for himself for the
future might reveal he would like to go to college or other training, a decent
job, marriage and family, and so on. I’ve never heard a teen say that she
or he wanted to go to jail, really drive parents crazy, or die young. Their
impulsivity might get in the way of what they want and finding out what
happens when things are a little better usually gets the ball rolling. I’ve also
found that it is helpful to ask parents what they want for their teens and then
compliment them on how much they love and care. There’s a story about
how Insoo Kim Berg was called in the night to attend a domestic call with
police officers. The situation they found was a woman holding her very
large teenager at bay against a wall by holding a frying pan as though she
were ready to hit him with it. She was yelling and cursing. Insoo said to the
woman, “You must care a great deal to be willing to hit your son with that
thing.” The woman replied something like, “You bet. If he’s gonna go out,
it’s not going to be by gangs and getting shot or overdose or something. It’s
going to be by me!” I have never seen that complimenting parents on how
much they love and care about their children resulted in more damage.
Indeed, parents are likely to appreciate recognition of their efforts, even the
ones that look bad. At least as important, systemically, is that this may be
the first time the kid really hears how the parents’ behavior is about love
and care, not control.

Couples
Brad and Janet came to therapy because, as they said, they were on the brink
of divorce. Janet was an attorney and Brad was a middle-school teacher.
Both were very busy with their jobs and their two young children. Finding

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time for themselves or each other was a challenge. Brad had begun to sus-
pect that Janet was a little too friendly with a coworker, which she denied.
His second suspicion was that she was stopping for drinks after work often;
she smelled of alcohol and cigarettes when she came home late.
The beginning of therapy is the same as with families: settling in, getting
to know the couple as individuals and as a whole. I often ask if there’s any-
thing they would like to know about me, reserving the right to not answer.
After getting to know each other a bit and how I work, we’ll work on finding
out what’s important to them and what they want.
Brad said that he wanted the marriage to work but was tired of the way
things were. The therapist asked about how things would be when the mar-
riage is working the way he would like.

Brad: We’d be working together more. She’d be coming home earlier more
often or at least calling when she’s going to be late like she used to.
Th: She used to call when she was going to be late?
Brad: Yes, she used to call or text fairly often, even knowing I couldn’t
respond when I was at school.

This clearly is an invitation for solution-building, and the therapist writes

it down and marks it, so he can come back to it later.

Th: OK. You’ll be working together, Janet will call when she’s going to
be late, maybe more calling and texting in general?
Brad: Yes.
Th: And what about you? If I were a fly on the wall, watching you, how
would I know that things are better, the way you’d like them to be?
Brad: [pause] I think you’d see me smiling more, being more affectionate
toward Janet. [turning to Janet] I just don’t feel much like being with
you right now.
Janet: I know.

The therapist asks more questions about Brad’s preferred future. Notice
that the therapist did not ask the miracle question; he would have if neces-
sary. The point is to find out what the client wants, not a particular way of
getting there. After learning more about Brad’s future, scaling can proceed

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as usual: 10 is the preferred future, who notices, what they will notice, what
that will mean to them, and so on.
The therapist asks similar questions of Janet and learns that she would feel
more like coming home instead of staying at the office so much. She also
says that Brad would not be complaining about their kids or the kids and
teachers at school so much. “He’s a complainer,” she said. The therapist asks
what Brad would be doing instead, and then what she would be doing. The
pattern for working with complainers is to not get hooked into their com-
plaining and to keep “instead” as well as “what will you be doing when he
is doing that more?” in mind as mantras. Another mantra is “what else” and
relationship questions. I like to get good pictures of details, then move to
exceptions (when was it like this before, even a little) and scaling.
A good experiment for couples is to notice what they want to keep in the
relationship without talking with each other. They often come back to ther-
apy reporting that things are better, which wasn’t the task, but is such a good
response! The therapist can ask whether they found the experiment useful
and follow up with their response, asking for details, other exceptions, scal-
ing toward the miracle day or preferred future, etc. If they say they didn’t do
it, or one of them didn’t do it, the therapist can ask them to list some things
now as they look back at the week.
Couples come in expecting us to ask about their latest fight. Interaction-
ally, we can do that, asking about sequences and patterns, for example.
From a solution-focused perspective, this would look more like learning
details of sequences and patterns that are different, or how they would be
different in the preferred future. When couples get stuck, we can still draw
the patterned sequence, point to a place on it, and ask what either of them
could do differently at this point. Compliments, exceptions, and scaling are
logical follow-ups along with, of course, relationship questions.
Relationship questions can involve any number of other people, includ-
ing each of the partners. Children, parents, friends, coworkers, pets, and so
forth are potentially going to notice something that’s a little different, at least
in the imagination of the couple.
When couples work hard and still decide that they want to divorce, we
do what we can to help them make that as amicable as possible. Some-
times, their final decisions don’t work out very well and neither does ther-
apy. I worked with one couple where the wife had had an affair with the

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husband’s best friend, so he felt twice betrayed. We worked and worked on

trust on both sides, how he would know he could trust her, what she would
be doing to earn the trust, how she would know she could trust him to keep
moving forward, what she would be doing, and so forth. I realized that we
were talking about trust too much and switched to “what difference will that
make” and “what else will be happening,” remembering that solutions don’t
always look like they are related to problems.
Whenever I tried to get away from the affair into their preferred future,
it seemed to always fail. It could only look like what he thought they had
before but he was wrong, he didn’t want a divorce, it was against their
religion, he thought they needed time, and back to trust—trusting her or
trusting himself. She definitely didn’t want the divorce and wanted to keep
working on the marriage, professing many times that the affair was over,
she wasn’t seeing him, she didn’t respond to his calls or texts, had told
him she was done, and so on. She asked for a private session and wanted
my help in letting go of the affair, so we worked on that for a few sessions,
helping her figure out how to resist temptation to text him, how to rein-
force to him that she wanted to work on the marriage, what her preferred
future would look like. We also talked about how she was coping with
what seemed to be an impossible situation (therefore, not a problem that
could be resolved).
I saw the wife about a year later in a store parking lot. She came up to me
and said that she’d been thinking about calling me for a follow up, that things
were pretty much the same, they continued to argue about the affair, but that
they were able to get along decently enough because they still had one child
at home, the others being grown and on their own. She said she didn’t think
they’d be able to divorce because the kids wouldn’t allow it and she would
be excommunicated from her church if he didn’t agree to the divorce.
This case was very sad for me. I consulted with solution-focused col-
leagues and they didn’t have any other ideas for me. I encouraged the wife
to take care of herself and to feel free to call me for an appointment. I did not
want to talk further in the parking lot, and don’t think that would have been
wise for her, either. I offered to refer them to a different therapist.
Another difficult situation is when working with divorcing or divorced
parents who insist on blaming each other and can’t get past their own per-
sonal hurts and anger. There are many ways of working with difficult clients,

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and sometimes it’s best to refer to other therapists whom we trust and who
work from different perspectives.

Blended Families
On a happier note, it is a joy to work with so-called blended families when
they are struggling so much to make things work and are willing to do almost
anything. Kids are bound to be jealous of step-siblings (Brady Bunch not
withstanding) and parents are bound to resent step-parents’ interference in
parenting. Using literature and systemic ideas can be quite helpful at under-
standing what seems to work well in such families. For example, a general
idea is that until and unless the kids accept their step-parents as legitimate
parent-figures, it’s best for the biological parents to enforce discipline with
the support of step-parents. It’s also good for parents to be sure to make time
to discuss what’s going on and make decisions together, even about the
other’s children. My daughter-in-law, step-parent to two, said that her job as
a step-parent wasn’t to set rules or enforce them unless requested to do so;
her job was to be awesome. I sort of like that.
A final thing to keep in mind, in general, about blended families is the
myriad ways that ex-spouses interact and are involved. Because the compli-
cations of some of these scenarios are plentiful, it’s good to make decisions
about which systems and subsystems to see based on the particulars of the
situation and the preferred futures that emerge. In these cases, it’s important
to stay on top of what’s realistic because often a preferred future is for some-
one else to be doing something that the speaker has no control over. Even
then, ideas about how one would act if the other did change can be helpful
at managing and coping.

And So . . .
Working with families from a systemically informed, solution-focused per-
spective is very gratifying. An extensive overview of working with various
kinds of difficulties is beyond the scope of this book. What’s most import-
ant is keeping in mind the basics of each lens. From systemic ideas, think

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about wholeness, relationships, interactions, and patterns. The process of

how people interact is what maintains both problems and solutions. From
solution-focused ideas, keep in mind preferred futures, solutions are not
always clearly connected to problems, exceptions, scaling, and “what else?”
When using SFBT as the primary lens and stance, systemic ideas fall easily
into place. The next section of this book looks at somewhat the opposite:
when you want to keep your primary approach and use solution-focused
practices also.

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 Using SFBT Practices
6 With Four Family
Therapy Approaches

In this section, I will recap basics of four family therapy approaches and
show how you might use solution-focused practices with them. My best
hope is that these demonstrations will help readers use SFBT with their own
therapy approaches. Solution-Focused Brief Therapy as a basic approach
assumes a paradigm shift of looking at therapy through a lens that incorpo-
rates a future focus, privileges clients in terms of what is important to them
and what they want, and is collaborative rather than expert-based. It is not
primarily a set of practices, although several are identified in this book and
elsewhere. Instead, it is a way of thinking that does not assess for underlying
pathology or disease, that assumes that clients have ideas about what they
want, and that assumes that clients are the experts on their own experi-
ences and what works or will work for them. We may provide ideas about
resources for clients, but they are the ones who will access such resources
and use them in ways that are best for them. Therapists are experts on
solution-focused conversations, but not on what might be best for clients.
An appendix in this book includes a set of systemic models that are pre-
sented in a common format. The model charts were developed by myself
and students and are free to use as long as we are given credit. Each chart
includes areas or cells that include prominent leaders, assumptions, con-
cepts, goals of therapy, role of the therapist, assessment for the approach,
interventions, how change is viewed, how termination is determined,
matters related to the self of the therapist, any evaluation of the approach
existing at the time the charts were developed, and main resources for the
approach. The information is not exhaustive and has not been updated to
account for more recent research. Seminal literature is listed; each approach

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has many other uses than those listed and many resources describing the
approach and its uses. When used in a word-processing document, a chart
can have its cell data removed and the chart becomes a template for an
individual practitioner’s own approach to therapy.
Although I name and illustrate some ways to use SFBT with four approaches
in this chapter, descriptions are not exhaustive and other SFBT practitioners
may not agree with my way of thinking. Many are concerned that simply using
a few solution-focused techniques as part of other approaches dilutes the
solution-focused approach and should not be encouraged. Based on my
experience, using solution-focused practices in family therapy helps to make
therapy richer and sometimes faster. Clients seem to appreciate developing
their own goals and recognition for their hard work.
Solution-focused practices also can be used by therapists to gauge how
well they think they did in sessions or cases. They can evaluate sessions,
cases, their own use of preferred or SFBT practices, and so on. Further,
solution-focused scales can be used to ask families to evaluate their therapy
on different dimensions: toward goals, how well they think they cooperated,
how motivated they were at the beginning of therapy and at the end, how
well the therapist listened and understood, and so forth.
At its core, solution-focused approaches aim at doing more of what
works toward clients’ goals rather than deconstructing problems or assum-
ing underlying structures or problems that require close examination. What
I am suggesting is a way of getting things started in therapy and, when prog-
ress toward goals is noticed, to get out of the client’s way and help them
continue toward their goals. In SFBT lingo, you are the expert on your work
and this chapter only provides some ideas to get you thinking about how
solution-focused ideas can be used with other therapy approaches.

Structural Family Therapy

Salvador Minuchin’s first book, Families of the Slums, was published in 1967
(Minuchin, Montalvo, Guerney, Rosman, & Schumer, F., 1967). It was fol-
lowed by articles on working with families and then by the book Families
and Family Therapy in 1974. These and other books discussed practices of
Structural Family Therapy in more detail (e.g., Minuchin & Fishman, 1981).
After many articles, books, workshops, and published video examples,

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Structural Family Therapy continues to be popular in family therapy training

programs and practice.
The main premise of Structural Family Therapy is that families are systems
that are organized to support growth of the system, individuation of family
members, and patterns that maintain problematic and helpful behaviors.
Tenets of Structural Family Therapy do not support a notion of family or
organization causation of troubling behavior, but suggest that reorganizing
the family structure provides a better context for resolving the concerns.
Unfortunately, the approach often is used as a way of blaming families for
their members’ woes, which may lead to “rescuing” the identified patient
from the family. In appropriate Structural Family Therapy, no one is blamed
and all members participate in making changes.

Concepts of Structural Family Therapy

Important concepts of Structural Family Therapy include boundaries, subsys-

tems, and roles and rules. Boundaries mark the margins of systems and sub-
systems, distinguishing them from other systems and subsystems. Minuchin
was particularly noted for placing the parents or parent and support system
at the head of the family as the executive system. He believed that every
system needs to have someone who is in charge, aware of what is happen-
ing with members, serving to reinforce the often-unspoken rules that define
boundaries, and encouraging the growth of individuals in the family as well
as maintaining the integrity of the family.

Practices of Structural Family Therapy

Therapy practices in Structural Family Therapy flow from assessments of the

family structure. This is best accomplished by first joining the system: enter-
ing and becoming a part of a newly formed therapy system so that the family
dynamics can be experienced first-hand by the therapist. After assessing by
experience and by staging an enactment (asking the family to demonstrate
their dynamics through an in-session assignment such as discussing the
problem or planning a family event), the therapist works to first disrupt the
family’s structure by increasing intensity so that the normal structure is chal-
lenged and stressed, and then helping the family reorganize into a structure
that supports new behaviors that do not support the problem behavior. The

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person defined as the problem is called the identified patient, a term that
spreads the difficulty from the individual to the family and perhaps to others
in the family.
Challenging and realigning boundaries is accomplished by challenging
family beliefs and current dynamics, sometimes by simply requesting that
people talk about them. This will uncover different views and encourage the
people involved to resolve them or agree to disagree and move on. Bound-
aries can be marked and changed by intensifying conversations between
people, which often is accomplished by rearranging people in the therapy
room, putting two people together to talk or marking boundaries by separat-
ing a person or subsystem from another. For example, a therapist might seat
parents together instead of with a child between them, then asking them
to talk directly with each other rather than using the child to buffer their
conversations. Rearranging can also include separating different subsystems
and asking them to discuss something, allowing others to observe but to
keep out of that conversation. For example, if a father is discussing his con-
cerns with a son, the therapist would not allow other children or the mother
to interrupt, perhaps even blocking eye contact with his own body. Thera-
pists support conversations by coaching, aligning themselves with first one
then another person, and encouraging family members to continue talking
when they reach their usual point of stopping. They may find out that the sky
does not fall if they deepen their conversation.
Therapists are very active, leaning in to increase discussion of intense top-
ics, settling back as people discuss and talk in ways that indicate a realigned
boundary, or moving their own chairs to support or challenge one fam-
ily member and then another. Minuchin much preferred to have all family
members present in therapy because even the youngest ones are part of
family dynamics. I was quite taken when observing a therapist’s work with
a couple who had been unable to secure a babysitter and so brought their
infant to therapy. They took turns holding the baby, especially when one or
the other was tense and discussion was heating up. At one point, the father
even stood with the baby, rocking it back and forth, but expressing him-
self clearly to his wife. I believe he could not have talked to her so clearly
without both the support of the therapist to not give up and the comfort of
having the baby in his arms. This enactment of helping people interact in
a new way led to the parents’ calmer discussion of their situation with the
baby in her seat.

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Examples of Solution-Focused Practices

With Structural Family Therapy

Solution-focused practices can be used at any point in the therapy. During

assessment, families can be asked what they would like out of therapy or
what they think their family life will look like when the problem is gone.
They can be asked about times some of those behaviors are present. Just
as Structural Family Therapists might ask the family about the last time the
problem happened and to show the therapist what that looked like (assess-
ment enactment), the therapist also can ask the family about the last time
one of the future-preferred behaviors was present and what that looked like
(exception finding).
Structural Family Therapists often prescribe homework that consists of
continuing some change that occurred in therapy. For example, after hav-
ing a mother and daughter discuss their relationship and helping them to
first tolerate increased intensity by supporting them and blocking other
family members, and then helping them to discuss the topic in a different
way, the therapist might assign them the task of getting together during
the week for ten-minute discussions, practicing the new way of talking.
Alternatively, the therapist might assign them the task of a mother-daughter
date without any other family members present. At the next session, the
therapist could ask about the homework. When there are signs that the
mother and daughter were more able to talk with each other in a calmer
and more productive manner, the therapist could use SFBT practices by
complimenting them, asking how well they thought they were doing on a
scale, and asking other family members how well they thought the mother
and daughter did and how well they thought they had done at staying out
of the discussion. If the family reports that things did not go well, using
solution-focused ideas, the therapist would assume that at least some small
part was better and ask about that. It’s also possible that some other thing,
not already discussed, went better that might be part of a better pattern. The
therapist would use whatever the family brings up in therapy as potentially
important and useful.
As the family progresses, the therapist can use exceptions, future focus,
and scaling to help therapy continue moving toward goals. Instead of revis-
iting the presenting problem in a way that might reinforce it, the therapist
can compliment the family on their progress, assign tasks that use behaviors

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that are working for the family, and assign new tasks that align with stated
goals and progress.

Th: [to family] How did the homework go?

Mo: I think it went fairly well. Sherri mouthed off a couple times and
I was able to calmly ask her to talk with me about it.
Fa: I knew it was happening, so Geri and I went into another room so
I wouldn’t interfere [it was common for him to tell the girls, “listen
to your mother,” thereby undermining his wife’s parenting].
Mo: Yeah, he did stay out of it pretty good. He came into the kitchen
once but left when he saw that we were talking in loud voices but
not as loud or as intense as usual.
Th: That’s impressive. Dad, how did you manage to stay out of it
[exception]? Mom, how did he do that?
Fa: I just remembered what you said, and I knew I needed to not get
into it, to let them deal with it. I stayed in the other room.
Th: I’m really impressed. Mom, on a scale of 1–10, 10 being the abso-
lute best you could have done, where do you put yourself?
Mo: 5. I was pretty upset, especially the first time, so I think I was louder
than I needed to be.
Sherri: Yeah. And I tried to keep it going, but when I saw that you weren’t
going to give in, I got mad. But I didn’t leave. I stayed and tried to
talk with you.
Mo: And I think I listened fairly well.
Sherri: Yeah.
Th: And the second time, when you were less upset, where were you
on the scale?
Mo: Oh, well, I guess I was at 6.
Th: 6. How did you do that? How did you get there or what was
different?
Mo: Well, I think I must have remembered from the first time that
I didn’t give in, so I wasn’t as scared about it.
Th: That’s impressive. And it sounds like Sherri figured that out, too.
Mo: Yes. I think she did. Then, the next time, she wasn’t as loud and
didn’t stomp out when I held firm.
Th: So, Sherri, scale of 1–10, where do you think you and your mom
were on that one, the better one?

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Sherri: Ummm . . . Maybe 4. I think we can do better.

Th: 4? Hm. Not 3?
Sherri: No, 3 would be my staying in the room, but Mom getting worked
up.
Th: And what does 5 look like for you?
Sherri: Getting what I want without having to yell!
Th: [laughs] OK. Do you want to show me? Dad, you and Geri can sit
over there. Sherri and mom, show us what 5 or 6 looks like.

In Structural Family Therapy, therapy is designed to be complete when

the so-called symptom is gone. However, if the structure of the family has
not changed, the therapist may advise that the family continue in therapy
until the executive subsystem or other system boundaries are clearly differ-
ent from when the family first came to therapy. Without structural change,
the family may find that another symptom develops that requires a similar
change as the earlier one, substituting the identified patient or problem with
another family member or situation. Using SFBT practices, the therapist may
be able to determine the degree of change more easily. For example, if a
family says that they are at 8 toward their goals and that’s good enough, the
therapist may still ask what 9 looks like. In the above example, one of the
parents may state something like, “when something else happens and we
remember to use our new skills.”

Strategic Family Therapy

(Mental Research Institute)
There are two versions of Strategic Family Therapy in the model charts:
Mental Research Institute (MRI; Watzlawick et al., 1974) and Haley and
Madanes’ version (e.g., Haley, 1977; Madanes, 1984). As discussed in
Chapter 1 of this book, Gregory Bateson formed a group of professionals to
help him with a grant on communication patterns of families with a mem-
ber who had been diagnosed as schizophrenic. Out of these studies came
a way of looking at communication as interactional (Watzlawick & Weak-
land, 1977), that is, between and among people, and that symptoms are
communication acts. They determined that so-called symptoms were not
evidence of underlying problems or pathology but made sense within the

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context of the individual. An arm of the project is the Brief Therapy Center,
a therapy-focused center that uses systemic and cybernetic ideas to explain
and intervene with problematic behaviors. Seminal therapy books include
Watzlawick, Bavelas, and Jackson’s (1967) Pragmatics of Human Commu-
nication and Watzlawick, Weakland, and Fisch’s (1974) Change. Strategic
Family Therapy continues to be popular in educational programs, therapy
clinics, and as part of integrative approaches.

Concepts of Strategic Family Therapy (MRI)

At its core, this Strategic Family Therapy approach focuses on presenting

problems as attempts to solve problems that have themselves become prob-
lematic. Prior to this way of viewing human difficulties, mental and behav-
ioral problems were viewed as evidence of underlying pathology related to
psychodynamics. The MRI way of looking at such matters was quite revolu-
tionary: troubling behaviors make sense within their contexts; such behav-
iors have become habits as attempts to fix something else and have become
problematic themselves. Instead of hypothesizing and looking at those possi-
ble difficulties through pathological theoretical lenses, MRI Strategic Family
Therapists work directly with the family on their presenting issue. If the family
were able to work on another issue directly, their attempts would have been
successful, and they would not have presented to therapy with something
else. The approach is called strategic because interventions are designed
uniquely for each family and situation. Therapists take expert roles in devis-
ing interventions and expect family members to follow their directives.

Practices of Strategic Family Therapy (MRI)

In the MRI Strategic approach, it is not necessary for all family members to
attend therapy. Helping one person to successfully change their own behavior
necessitates other members’ changes to adapt to the initial change. In gen-
eral, there are three types of interventions: reframes that change the viewing
of the problem, interrupting sequences that help change interactional patterns
that support the problem, and paradoxical interventions that are used when
reframes and interrupting sequences directly are not possible or helpful.
An important aspect of strategic approaches to family therapy is the
reframe. Because behaviors are based on people’s views of what’s going

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on—their own logic or reasoning—the frame that is used during problem-

atic times is considered to lead to logical but ineffective ways to solve the
problems. When a person’s behavior is perceived as sickness, others tend to
use care-taking roles and behaviors. When the same behavior is perceived
as rebellious, others tend to set limits on behaviors. Reframes are stated in
such a way as to try to “sell” them to the family so that they make sense and
clients are then willing to follow the therapist’s directives. This idea is based
on the concept of constructivism—the notion that reality is constructed from
views (contexts and perspectives) and the process of constructing meaning.
This is especially important in interactions because each person has his or
her own view; in fact, we might say there is no observable reality of mean-
ings that influence interactions, there only are views.
Interrupting sequences has become an intervention in many forms of
therapy and focuses on the patterns that develop over time and are repeated
in such a way that they support the identified concerns rather than changing
them. Because changes in one part of a system or pattern require that others
adapt to those changes, helping families change even small parts of interac-
tions can lead to completely different interactional patterns and dissolution
of presenting concerns. For example, if a spouse comes home from work
and asks when dinner will be ready, thereby setting off a pattern of arguing
about household contributions, that person may change one small thing
when coming home: asking about another person’s day, or folding laundry,
or something. At another point in the sequence, one of the family members
might agree with something rather than becoming defensive.
Paradoxical interventions can be used when families seem resistant to
suggestions. These interventions utilize the clients’ energy in a different way
and therapists should be well-schooled in them before attempting them.
One example of paradoxical interventions includes clients’ continuing to
do or doing more of what they’re doing that is problematic so that the ther-
apist can see how it works. A symptom or behavior cannot be spontaneous
and uncontrollable if the clients are able to make it happen. This directive
can change a part of the pattern such as the place, time, or length of the
behavior as well as one’s sense of control over it. Another example of a par-
adoxical intervention is the “go slowly” message. In essence, it suggests that
change takes a long time and it is important that it not happen so quickly
that unexpected and negative consequences aren’t prevented. If the family
slows down, they are following the directive and the therapist can better

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understand subtleties of the family’s patterns of interaction. If the family

does not slow down, but does something to make the presenting concern
dissolve, their problem is solved.
Much attention has been given to strategic approaches’ use of paradox,
which often is misunderstood but appears clever. The misunderstanding
comes when therapists prescribe behaviors with a belief that clients will
resist the prescription and do the opposite—reverse psychology so to speak.
However, a true paradox is a prescription that is a win-win for therapy:
if the clients don’t follow the prescription, they don’t make the symptom
appear on purpose, and the symptom disappears. If they do follow the pre-
scription (somehow make the symptom happen), they are not resisting ther-
apy or therapist and thus will cooperate with directives that will interrupt
problematic sequences of behavior that support the problem, and thus the
problem behavior will disappear. Many therapists, especially those who are
influenced by feminist approaches, do not like paradoxical interventions
because they seem excessively manipulative and “tricky” or “clever,” which
can be quite detrimental for people who have grown up in contexts that are
paradoxical (such as having parents who act like children rather than par-
ents or abusive homes where caretakers are supposed to protect children,
not harm them). Further, paradoxical interventions that prescribe the symp-
tom as a way of gaining control over it should never be used when clients
may actually follow through with harmful intentions or behaviors such as
homicide, suicide, or self-harm.
Centered more appropriately in the tenets of the MRI approach are
reframes and interventions that interrupt sequences of behavior. Because
troubling behaviors are supported by failed attempts to change them, MRI
therapists examine sequences by asking about these failed attempts to
change things, and then helping family members interrupt sequences by
changing at least one part. When two or more people attend therapy, each
person’s parts in the sequence are targets for change, increasing the chances
that something different will happen.

Examples of Solution-Focused Practices

With Strategic Family Therapy (MRI)

Developing joint goals for therapy can include clear pictures of what will
be different and how that will make a difference to the family. During

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assessment, as therapists interview clients for their perspectives on the

presenting problem and strive to determine sequences of behavior that
support the problem, solution-focused practices that can be helpful may
include complimenting family members on their cooperation or looking for
exceptions in the failed attempts (how the attempts helped even a little or
changed things into a slightly different pattern). For example, therapists and
clients can look for times when the problem was either not present or could
have been present but was not as problematic. Interactional behavior of
family members at those times can be built upon or used to help interrupt
sequences when the problem is present or more severe.
A family comes to therapy complaining about their 18-year-old daugh-
ter’s “rebellious” behavior. After discussion about each person’s goals for
therapy and determining joint goals, the therapist speaks.

Th: Tell me about the last fight the three of you had about this.

The family describes the situation, mostly agreeing except when each
characterizes another’s intention. Emily frames her parents’ behavior as con-
trolling; the parents describe Emily’s behavior as irresponsible.

Th: Thanks. I think I have a picture of what happens, although there are dif-
ferent beliefs about why people do certain things or what things mean.
Does this sketch show it? [shows a drawing of the sequence, bringing
the last action around to show its lead-in to the first] Emily does some-
thing that breaks a rule, Sarah [the mom] calls her on it, Emily says
something that makes sense to her about how unfair the situation is,
but that Sarah finds disrespectful, Phil interjects that Emily needs to be
more responsible and respectful, Emily says that the parents need to be
more respectful of her, stomps off, and later breaks a rule. Do I have it?

And so it goes. The “starting point” is where the family punctuates the
beginning; the start could be labeled as any of the behaviors and meanings
of the family members. For example, Sarah and Emily would have to have
a different pattern if Phil didn’t interject. Perhaps that is the “start” of the
problematic interaction. In systemic terms, it doesn’t matter: the “start” can
be described as any place in the sequence. One of my brothers once said,
“It all started when he hit me back!”

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Fam: Yep [head nods].

Th: Well, it looks to me like you are all correct: Emily is working to be
ready to be independent and on her own, practicing, so to speak,
and parents are doing their best to help her do that by protecting
her while she’s at home. In this way, she can learn skills with a
safety net [positive reframe]. So, you, Phil and Sarah, try to hold
her back from doing too much before she’s ready, and Emily helps
you by showing what she needs help with and what she wants:
more space and control over her life. This tells you what you need
to work on: appropriate space and degree of self-control for Emily.
But you get into fights about what that means and that’s what you
really don’t like.
Fam: Yes.
Th: It strikes me that you started to tell me about a time when you were
able to talk about one of the house rules that Emily doesn’t like, but
you talked with much less heat. Using a scale of 0–10, where 10
represents the ideal way of talking about house rules and potential
changes, where would you place that conversation?
Phil: [after a pause] 6. We were angry, but we didn’t get so argumenta-
tive. No one stomped out, slamming doors.

Many therapists have a hard time believing that clients are so compliant
with scaling questions. It amazes me, too, that it happens nearly all the time.
Once in a while, a client may ask for clarification.

Th: Sarah?
Sarah: 10 is everything is perfect? OK: 5. It really hurts that she wants to
grow up so fast. She’s only 18. I left home when I was 18 and really
wish I had stuck around a while longer.
Emily: 4. I thought they were trying to understand where I was coming
from, but they wanted me to change my thinking, to agree that I’m
not ready to be on my own. I know that, but sometimes, they are
so unreasonable about things!
Th: OK. You were angry, hurt, trying to understand, but not quite there.
Emily, suppose during this next week, for one of the arguments,
you were at 5. What would be different?
Emily: They’d try harder to understand me.

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Sarah: Maybe you’d try harder to understand us.

Th: Emily, suppose you saw them trying harder. What would be differ-
ent about what you would do?
Emily: [pause] I guess it wouldn’t be so loud and intense.
Th: Sarah, suppose you and Phil were showing Emily that you were
trying harder to understand her, and she was quieter and calmer,
what would you do?
Sarah: I’d probably calm down, too.

The therapist goes on with this exception to the problem behavior.

Solution-focused practices such as scaling can be very helpful when work-
ing to change sequences of behavior. In ensuing sessions, as clients describe
and show changes, they can be complimented and scales can be further
used to gauge progress. Therapists can use relationship and future-oriented
questions to further understand, reframe, and interrupt sequences, especially
to reframe meanings that family members are using to justify their behaviors.

Strategic Family Therapy (Haley and Madanes)

In addition to the MRI version of Strategic Family Therapy, Jay Haley, who
was involved in the early years of developing the therapy, and his wife,
Cloé Madanes, moved to Philadelphia. Both were quite steeped in the MRI
approach to therapy using systemic and cybernetic ideas. Haley commuted
to work with Salvador Minuchin (Structural Family Therapy) and each influ-
enced the other during their long talks.

Concepts of Strategic Family Therapy (Haley and Madanes)

Haley and Madanes developed a version of Strategic Family Therapy that

used different frames for behavior and emphasized hierarchical structures,
particularly skewed structures when children had power over their parents
with their behaviors and symptoms. In fact, they suggested, when children
were displaying troubling behavior that was not successfully corrected by
the parents, they (the children) were “standing on the shoulders” of one of
the parents relative to the other, thus caught in a triangle between them.
The behavior served to exacerbate the parents’ marital difficulties. Once the

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child’s behavior was no longer viewed as problematic, the parents either

resolved their marital difficulties via isomorphism (using a team-parenting
metaphor that was successful as a template for marital communication) or
were willing to use therapy to help with the marriage. Problematic behav-
iors were viewed as messages in the system, communicating something that
could not be discussed directly. Resolving the “something” could isomor-
phically resolve the presenting concern.

Practices of Strategic Family Therapy (Haley and Madanes)

Therapists help families develop better boundaries and communication pat-

terns that do not support the problematic behavior, resulting in either the
disappearance of the problem or a view that the behavior is not problem-
atic. Haley believed that the motivator of behavior was control and thus
used metaphors and reframes that reflected this belief. Madanes, on the
other hand, saw behaviors as motivated by love and used metaphors and
reframes that reflected this belief. Other reframes are used in ways that are
similar to those in the MRI version of Strategic Family Therapy. Reframes
help family members view the problem behavior from a different perspec-
tive, which requires different responses, responses that support more effec-
tive structures and communication. This form of therapy is not as likely to
work with communication sequences per se; instead, interventions rely on
reframes and directives that support behaviors consistent with the reframe.
Because Haley saw presenting concerns as related to control, his pre-
scribed homework was designed to realign the hierarchy in the family. The
college student described earlier was first framed as depressed (thus sick)
by the parents. This meant that the symptom had control of the parents.
A reframe from a Haley strategic perspective would put the parents back in
charge by labeling the situation as the child’s being irresponsible. The par-
ents’ behavior vis-à-vis an irresponsible child would be very different from
their behavior vis-à-vis a sick child.
Haley (1984) saw therapy as influential because clients didn’t really want
to be in therapy and would do whatever was necessary to get out of it.
This included doing things that appeared nonsensical or paradoxical. Cli-
ents would typically give up the problematic behavior because continuing
the contradictory, prescribed behavior was worse. For example, a person
who cannot sleep might be directed to get up and clean the kitchen floor (a

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second wanted outcome) for an hour and then go back to bed. The ordeal is
worse than the problem (not sleeping) and the client would fall asleep rather
than get up again and clean the floor.
Madanes, on the other hand, saw metaphors as communicating some-
thing related to care and concern, and would describe them as beneficial
to the family in some way, a positive reframe. The unwanted behavior was
described as an unfortunate way of resolving a family difficulty. This allowed
the problematic behavior to be set aside so that the corresponding concern
could be resolved. For example, the college student who was not going to
class, ignoring her hygiene, and so forth might be praised for helping her
parents. The frame for this help might be that the child was really very con-
cerned that her parents would be lonely without her or that without her to
moderate their arguments, they might divorce. The prescription might be,
then, that she needed to go home and stay with her parents, perhaps until
they died and she was an old lady, having never been able to leave. This, of
course, is a paradoxical prescription because the child was being asked to
do something contrary to what her stage of life dictated: she was directed to
stay home at a time when she should be leaving. If the girl rebelled against
the prescription, her behavior at college would change, and her parents
likely would be helping her grow up in different ways, such as setting new
rules around grades. If the girl followed the prescription, the parents would
attend therapy to address their loneliness or arguments until the girl was
satisfied that they could be all right without her.
Madanes liked pretense directives. A real behavior and a pretense could
not co-exist. If one is pretending something, that something is not real. If it’s
real, it’s not a pretense. Instructing a father to pretend to have headaches in
the session, the therapist would instruct the other family members to act as
though the headache were real, bringing him a pretend cool cloth, settling
him in his pretend recliner, putting on pretend soothing music, and so forth.
The therapist would instruct the family members to practice the pretense
in great detail during the session and then prescribe the pretense at home
every night during the week. This could be seen as improving the nurturing
communications of the family so that the father did not need to have a real
headache to receive family care. At some point, the family would give up
the pretense because they tired of it and would develop more nurturing
behaviors at home, or find avenues for discussing troubling things outside
the home.

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Examples of Solution-Focused Practices With Strategic

Family Therapy (Haley and Madanes)

Examples of SFBT practices with the Haley and Madanes approach to Stra-
tegic Family Therapy are similar to those of the MRI approach. The first thing
that happens after introductions and getting to know each other is to develop
clear understandings of the goals for therapy, which may need to be negoti-
ated among family members with the therapist. In this phase, therapists may
use SFBT practices to help them get very clear and detailed pictures of what
will be different when goals are reached for the family, both for individuals
as well as the family system. The therapist would attempt to get pictures of
changes in both the stated problem and in the suspected issue that requires
the stated problem. Further, during assessment, it is common in strategic
work to find out what clients have done to try to resolve their difficulty.
This information gives clues to the underlying behavior that the attempted
solution is matching and the family may like to change. There may be times
when the attempted solutions worked in the past, perhaps a little. These are
not necessarily occasions that “prove the rule,” but could provide clues to
clients and therapists about some differences that might make a difference.
For example, the spouse and children of the father who comes home from
work with a headache may give him lots of attention, rub his shoulders, and
so forth, which helps relieve the pain for a time. With this information, the
parents and therapist may be able to learn more about what helps and find a
way to have the family do it more (if it’s working, keep doing it). The family
may not realize that the attempted solution to the headache is helpful, but
not different enough to make a difference. Doing more soothing and inter-
personal caring may provide support to the father that he needs in order to
resolve the “headache” at work.
A Haley-type directive may instruct the father to deliberately develop a
headache so that the family can soothe him. Since it’s nearly impossible to
force a physical symptom, the father may give it up, especially if the family’s
nurturing interactions continue without it. Madanes might ask the father to
pretend headaches when he doesn’t have them and instruct the family to pre-
tend to soothe him. This behavior may morph into family members’ soothing
and caring for each other without requiring the actual headache. The father
cannot have a real headache if he’s pretending and the intervention may

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include telling the therapist at the next session when the headache was real
and when it was pretend, but the family didn’t know the difference.
At this point, the therapist might use scaling to gauge the various mem-
bers and the family as a whole in terms of progress toward the goal. Other
scales also could be used, such as asking people on a scale of 0–10, 10
being no need for real headaches in order to receive family support, where
they consider the current situation on the scale. Further questions could ask
about differences between family members in numbers and meaning, and
what numbers up the scale might look like. This especially might be useful
if it seems difficult for the family to move toward their ultimate goals. They
may need to work on scales about family support in order to help under-
stand better what each number on the scale means to them, or to increase
motivation or hope.

Th: So, how did the homework go? Were you able to pretend the terrors,
Korley?

The family had come to therapy because 6-year-old Korley was suffering
from night terrors, which had been clearly distinguished from bad dreams
because Korley could not be calmed, didn’t recognize her parents, and
didn’t remember them the next morning. She had been examined by the
family physician and a psychologist, who could find nothing wrong. The
parents had described to Korley what usually happened so that she could
pretend to have the night terrors and they could pretend their usual attempts
to comfort her.

K: Yes [giggles].
Th: And did everyone else remember to pretend their parts?
K: Yes [more giggles].
Th: Great. Let’s find out what everyone else thinks. Mom, Dad, when
did Korley pretend?
Mom: Tuesday. She couldn’t help giggling. But she did pretty well.
Dad: Yep—Tuesday.
Th: Is that right, Korley? Was it Tuesday?
K: Yes. And Saturday.
Dad: Saturday, too? We thought that was real!

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A therapist not using SFBT might ask for details about what happened,
how the others did their parts, etc. A therapist using some SFBT practices
might ask other questions, such as questions about exceptions.

Th: Korley. Were there other times when it didn’t happen?

K: I don’t know. Mommy?
Mom: She didn’t wake us after that for three nights. And then she did, but
I thought it was real. I was hoping they had gone.
Th: We have to go slowly so we can see what’s working. How confident
are you that we’ll be able to work on this so that Korley doesn’t have
such a hard time? Maybe she’ll have regular bad dreams, but not the
night terrors where she doesn’t know what’s happening and you can’t
wake her? Scale of 0–10, 10 being all the confidence in the world?
Mom: 4. If she hadn’t had one on Saturday, I’d have said 6. And maybe since
she said it was a pretend one, 5. I thought maybe it was something she
ate. Maybe she’s allergic to something, although the doctor said not.
Th: 5, higher during the week. What does 6 look like?
Dad: I think she’d feel more confident that things are changing for Korley.
Mom: 6. Well, I guess 6 would be more confident and fewer nights. Three
nights was awfully good, though, so maybe I’m closer to 6 than
I realized.
Th: OK, so maybe you’re closer to 6. Suppose that’s happening. What’s
different? Besides fewer nights, that is.
Mom: Well, I’d be getting more sleep, wouldn’t be as worried for Korley.
It really takes a lot out of her and I worry that she’ll always have to
deal with them.
Th: Of course. You’d sleep better. What would you be doing other than
worrying about Korley and her sleeping?
Mom: I’d be more relaxed. I’d be able to go to bed without wondering if
she’s going to have another bad dream and wake us up.
Th: You’d be more relaxed, perhaps enjoy bedtime more?
Mom: Yes.
Th: And if you were enjoying bedtime more?
Mom: Her dad and I could enjoy some time together without worrying.
We could talk about other things. Do other things.
Th: Do other things. And what difference do you think that would
make to your husband?

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The therapist might or might not have been thinking that the night terrors
and waking her parents were connected to the parents’ general relationship
or sex life, as Madanes might think. The mother brought it up and the thera-
pist saw it as an exception that could be explored further. However, before
going into details about those exceptions as goals, the therapist wanted to
help the family be relieved of the symptom.

Th: [later] So, you both agree that people would be more relaxed in
the family, more enjoyment, confident that Korley would be OK.
Tell me more about what will be different [more future-focused
discussion].

Because Strategic Family Therapy of any version was developed as com-

pletely different from standard therapy at the time, therapy is focused on
goals and getting rid of symptoms, rather than discovering underlying
pathology. We would not say that the cause of Korley’s night terrors was
the parents’ relationship. However, it is likely that improving the symptom
(problem-focused therapy) through strategic means (directives aimed at
changing interactions) can certainly include solution-focused practices of
asking about details of what’s happening in various relationships when the
preferred future is reached. Therapists can then use this information to either
help develop reframes and directives, use more SFBT practices, or deter-
mine when therapy is no longer necessary.

Bowen Family Systems Therapy

Murray Bowen (1978) is famous in the family therapy field for developing
what some consider to be one of the very few actual theories of families and
change in families, most of which are often called “theory” but actually are
models or approaches to therapy. A theory is explanatory of why something
works the way it does, not only descriptive of how therapy is conducted.
Bowen theory is nearly the opposite: it provides a comprehensive expla-
nation for how so-called symptoms develop from a family systems point of
view and what constitutes change. However, it provides little in terms of how
therapy is conducted. Others (e.g., McGoldrick & Gerson, 2008; Kerr with
Bowen, 1988; Lerner, 1989) have written about Bowen coaching and how

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ideas in the theory can be used in therapy and coaching. Intergenerational

approaches are not popular at this time, generally because they take more
time than therapists and clients want to spend, focus on change is slow, and
insurance is less likely to reimburse for it. However, Bowen’s theory has
informed many therapists who find family dynamics across generations to
be both interesting and useful in helping people change and reach goals.

Concepts of Bowen Family Therapy

The main premise of the Bowen theory is that patterns of interacting are
transmitted across generations of families. Patterns that are important include
how people manage stress, emotional processes, and differentiation of self.
Bowen hypothesized that patterns used in nuclear families are projected
to ensuing generations. When these patterns become fixed or exaggerated,
symptoms are likely to occur (distance; conflict; mental, physical, or social
dysfunction in one person; and triangulation). Differentiation of self-connects
internal functioning (emotions and thinking) with external relationships
(reactions to others and maintaining a sense of self) and is the keystone of
Bowen’s theory. People with low differentiation of self are easily swayed by
family members and reactive to them, and more prone to symptoms, includ-
ing schizophrenia, than those with higher levels of differentiation of self;
people with higher levels of differentiation of self are more able to maintain
a sense of self, remain close to family members, and to manage and recover
from stress more easily with fewer and less intense symptoms.

Practices of Bowen Family Therapy

Therapy consists of examining multiple generations of family, looking for

patterns of emotional responses, especially during stressful times; triangles;
anxiety; and both overly close relationships (fusion) and overly distant ones
(emotional cutoff), and discussing them with the clients. By recognizing such
patterns, clients are able to re-pattern themselves in terms of their responses
in their families, detriangling (removing oneself from others’ anxious rela-
tionships but staying in contact with family members), and making attempts
to reconnect with distant family members. By changing oneself and one’s
interactions in one’s family of origin, one is more able to separate emotions
from thinking and change responses in relationships other than extended

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family, primarily with spouses and children. Changing emotional reactivity

and thinking helps to change responses in families of origin, which then
circles back to current nuclear family functioning. Therapy, or coaching, as
Bowen theorists prefer, does not have a clear ending because no one can
ever experience complete differentiation of self. Rather, there may be times
for sessions as well as periods of fewer sessions or none throughout life.
Genograms are the basis for Bowen therapy. A minimum of three gen-
erations is mapped like a family tree, with the current client as the latest
generation of focus, although a fourth generation of the client’s children
might be added. Emotional relationships among the client, siblings, parents,
parents’ siblings, parents and their parents, client and grandparents, and
grandparents and their siblings are mapped according to levels of emotional
closeness or distance, patterns of managing stress, and topics that were or
are particularly important (either because they are constantly discussed or
avoided). Births, deaths, marriages, illnesses, addictions, moves, and losses
are noted as important stressors. The client’s role in the family and relation-
ships with others are noted, particularly in triangles where stress has pulled
the client into a position of importance as a confidante or caretaker.
Process questions help clients think about the patterns and interactions in
their families of origin and nuclear family relationships. First by noting such
patterns, and then by asking clients where else they might notice them, the
therapist encourages thinking about the patterns rather than experiencing
strong feelings (which are the labels we give to physiological phenomena
called emotions in Bowen theory). When clients report current experiences,
the therapist helps the client connect them to family patterns of one’s role in
the family, how anxiety is typically managed, and how the client is triangled in
relationships. These questions are designed to engage clients’ thinking ability
and awareness of their roles in the family interactions from a more objective
rather than experiential position. Clients are then encouraged and coached
to think of different stances and responses, ones that maintain their senses of
themselves while also maintaining connections in their relationships.

Examples of Solution-Focused Practices With Bowen Therapy

Solution-focused ideas can be used throughout Bowen therapy. Because

assessment and therapy are continuous, solution-focused questions can
be asked that help continue a path of differentiation of self from family of

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origin. Differentiation of self is not separating oneself away from family but
staying emotionally close and maintaining self at the same time. As patterns
and roles are identified, ones that suggest differentiation of self, the therapist
can focus on those instead of the ones that point more toward fusion or cut-
off, toward problems instead of development of self.
Scott and Bry Johnson came to therapy because they were arguing about
her family. They had a similar argument every year around the holidays in
terms of whose family they would spend time with: Bry preferred to spend
time with his family, not hers. Bry had left home at 17, graduating from
high school early so she could leave. She had an older brother and two
younger sisters, all about 2 years apart. She had experienced her family
as stifling with her parents’ constant arguments, a mother with a drinking
problem, and a lot of responsibility placed on Bry for taking care of the
younger siblings as well as the cooking and laundry. She was embarrassed
to bring friends home because her mother, when she wasn’t working,
lounged around the house with a drink in one hand and a cigarette in
the other. Since Bry married Scott, her parents had been demanding that
she spend holidays with them because they missed her. However, she felt
more accepted by Scott’s family and preferred spending time with them,
particularly his mother.
Scott’s family of origin was different. His parents were separated and had
divorced when Scott was 7. He had an older sister and a younger brother,
all of whom lived with their mother as they grew up, seeing their father
frequently on weekdays and for overnights on weekends, as well as for vaca-
tions with their dad’s family. Even though they were divorced, Scott’s parents
did not attempt to pull their children into their relationship business and got
along fairly well with each other, attending weddings and birthdays mostly
without incident. Each had a new partner: Scott’s dad had remarried; his
mom had a “boyfriend.” Scott, however, identified that the standard pattern
of managing stress in his family was conflict, and he often argued rather
heatedly with his father, who would give up and separate before an issue
was resolved. This had been the pattern in his family and between him and
Scott’s mother.
The difficulty was that Scott thought Bry should be more interested in
maintaining contact with her family. He was willing to help in whatever way
he could because “family is important.” Bry agreed to therapy to see what
might be accomplished but wasn’t promising anything.

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 Using SFBT With Family Therapy Approaches

After learning some basic information about their reason for coming to
therapy, the first thing the therapist—or “coach,” as referred to in Bowen
therapy—did was draw three-generation genograms of Scott’s and Bry’s fam-
ilies. During this phase, the therapist learns about clients’ siblings and birth
order, geographical distance between clients and their siblings, emotional
distance patterns, information about siblings’ lives including whether they
are in relationships and have children, and emotional connections among
nuclear family members. The therapist might also ask questions about work
and education, and about basic health or patterns of dysfunction such as
trouble with drugs or alcohol. Similar information is gathered about the
parents’ generation and family relationships.
During the assessment phase, a therapist learns how people managed
basic family interactions and events, along with identifying difficulties and
strained relationships. The therapist looks for triangles and how they have
been managed over time, and asks about fused or cutoff relationships,
keeping in mind patterns of managing stress: distance (or cutoff), conflict,
triangling, and symptomatic people (physical, mental, or social). Solution-
focused questions can be used to look for exceptions in intergenerational
patterns.
When people are reticent or seem overly emotional when talking about
family members and relationships, it sometimes is better to start with another
member or a generation removed. It often is easier for people to talk about
grandparents and aunts/uncles than about parents and siblings. In Bowen
work, we want to focus on thinking, on helping clients be observers of them-
selves and their positions in their families of origin, so we avoid discussions
that evoke strong feelings.
In what follows, I will focus on Bry’s family. Bry had a hard time
talking about her parents, so the therapist switched to her grandparents
and aunts/uncles. Solution-oriented thinking at this point can be used to
note exact language that clients use, listening for exceptions, asking how
different people might have preferred their lives and relationships, how
much those preferences are shared by the client, and what all of that
might mean to different people. The therapist learned that Bry’s grand-
father on her mother’s side was a shopkeeper and seldom home. Her
grandmother was a bookkeeper and managed the finances for the shop,
which kept her quite busy. Bry reported that her mother had said that
she usually went home to an empty house. She wasn’t sure about her

167
Using SFBT With Family Therapy Approaches

grandparents’ relationship because her grandfather had died when she

was young, and her grandmother and mother never talked about him.
This indicated distance in the grandparents’ marriage and between Bry’s
mother and her parents. In this case, the therapist explores relationships
among the women in the family and notes the distance between Bry and
her mother.

Th: Hmm. It seems your grandparents were both quite busy keeping the
family going financially. What do you think they enjoyed together?
[focusing on connections in family as well as distance]
Bry: I’m not sure. I didn’t see Grandma very often because Mom wasn’t
too keen on that. [indicates distance or conflict between Bry’s mother
and grandmother]
Th: Would you describe their relationship as distant or conflictual?
Bry: Mom and Grandma or Grandma and my grandfather?
Th: Oh, I’m sorry. Your mom and grandma. [Bry seemed able to talk
now about “nearer” relationships, but still not between her and her
mother]
Bry: It was OK, no fighting that I know of, just not close. Grandma was
closer to my Aunt Sylvie.
Th: [therapist makes notes on genogram as she is drawing it] Is Sylvie
younger or older than your mom? [younger] Was she your mom’s
only sibling?
Bry: Yes. And she and Mom are pretty close. Not on the phone all the
time, but they talk and visit at least every other month.
Th: OK. I would like to come back to that later because it might be help-
ful. What’s your relationship with your Aunt Sylvie like?
Bry: I’d say it’s good. She’s my favorite aunt. She’s my only biological aunt;
my dad has a brother and he’s married. But I don’t see them very
often, maybe every few years or so.
Th: So, you’re pretty close to your Aunt Sylvie. You can talk with her
about things? Things you’re going through, family, school, etc.? Scott?
[getting even closer to emotional relationships]
Bry: Yes, to a certain extent. I wouldn’t call her up, but when we’re
together, she asks questions and I like talking with her. More than
with Mom.
Th: So, how would you describe your relationship with your mom?

168
 Using SFBT With Family Therapy Approaches

Bry: Not very good. I mean, it’s not like we fight or anything, but we
don’t have anything in common and I don’t like being around her
with the smoking and drinking. She’s always asking about school
and stuff but it’s not like she really listens or cares.
Th: [solution-focused exception question] What’s the best thing about
your relationship?

The therapist is getting a picture of Bry’s family and some of the difficult
relationships she has been in or witnessed. A problem-focused way of look-
ing at her family would be to find out where the triangles and anxiety have
been, events that have precipitated distance or conflict, and perhaps how
the other people might describe the same relationships. The therapist might
be thinking about those as frames, context, or causes for the conflictual
relationship between Bry and her mother. In a solution-focused way, the
therapist can also look at the good parts of even distant relationships, or
potentially good aspects as exceptions.

Bry: [quiet for a moment] Not much. I can’t really think of anything. We
weren’t close when I was home, we’re not close now. I guess one
thing I can think of is that she likes Scott. She thinks he’s good for
me. In some ways, they’re closer than Mom and I are.
Th: Do you agree with that, Scott? Do you have a good relationship with
your mother-in-law?
Scott: I wouldn’t say it’s good, but it is better than Bry’s and hers is. I think
I try harder than Bry does. Bry doesn’t understand that her mom
cares about her, worries about her.
Th: What would you say are some of the ways Bry tries, perhaps a little?
[exceptions, also looking for patterns to amplify]
Scott: Well, she’s learned that when things get tense on the phone, it’s
better to end the conversation than get confrontational.
Th: Yeah? How does she do that?
Scott: She’ll say something like, “Well, I gotta go fix dinner” or something.
“I’ll talk to you later.”
Th: Bry? How do you do that? It seems that could be hard, but you do it?
Bry: Well, we got into a big fight one time and Scott said, “Why don’t
you just tell her the conversation is over and hang up?”
Th: Did you do that?

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Using SFBT With Family Therapy Approaches

Bry: No. That would have fueled the fire and would have made things
worse next time. [Note: circularity and feedback: Bry notices that the
outcome of an interaction would be fed back into the system.] But
I knew he was right about ending the conversation, so I decided to do
it differently. Making something up about why I had to leave seemed
better than fighting.
Th: What happened the next time you talked?
Bry: Actually, it wasn’t as bad. We talked for quite a while.
Th: You know, sometimes, when people are having such problems
with family members, we ask whether something else might be
helpful: talking with them about the pattern during a calm time—
not during a heated discussion, but a calm time—and telling them
you don’t like the pattern and will end the conversation rather than
continue it and make things worse. Do you think you could do
something like that?

This is a condensed version of a conversation that would last longer

over several sessions after learning more about the family’s interaction pat-
terns. For example, in this instance, the therapist was thinking that a pattern
between Bry’s mother and Bry was similar (isomorphism) to one between
her mother and her grandmother. This transmission of patterns is something
that occurs frequently in families, that is not the fault of or caused by one
person or another but just the way families operate. Helping clients break
these patterns can take time and be difficult, but is possible. It might take
several ideas, attempts, learning, and revising.

Bry: I’m not sure. I think she’d feel hurt and fight back.
Th: Sure. And we would have to plan for that. I was just wondering if the
pattern between you and your mom is similar to that between her and
your grandma.
Bry: Oh. Yeah, I’ll bet. Aunt Sylvie told me that they would fight and Mom
would stomp out of the house.
Th: OK. So, do you see that there might be a triangle between your mom,
your grandma, and your grandfather? Was your mom caught in some
way, perhaps? [tentative language rather than expert pronouncement;
therapist had talked with Scott and Bry about triangles]

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Bry: Umm. Could be. They didn’t see each other much and Grandma
might have fought with Mom rather than with Grandpa. It sounds
like Mom made that pretty easy, gave them things to fight about.
Th: And could you be caught in a triangle with your mom and grandma?
Bry: Oh. Actually, I don’t think that’s it. See, Aunt Sylvie and I get along
better than Mom and her. I think it might be easier for Mom to fight
with me than for her to talk with Sylvie. Aunt Sylvie said they used
to be close before I was born.
Th: Ah. So, the triangle might be between you, your mom, and your
Aunt Sylvie?
Bry: Yeah.
Th: So, when was the most recent time you and your mom talked with-
out a fight?
Bry: Gosh . . . I don’t know.
Scott: Two weeks ago, when you first started talking with her about going
home for the holidays. You said you didn’t want to fight and you
didn’t.
Bry: Yes, that’s when I said I had to fix dinner and got off the phone.
Th: What had you been talking about? [taking advantage of a thinking
moment; emotional content is a trigger for old patterns]
Bry: I had said that I hoped Aunt Sylvie and her family might be there.
Th: Did you realize that might trigger a reaction from your mom?
Bry: No. But I do now!
Th: So, you managed to keep the reaction from escalating. You didn’t
allow yourself to get into it because you had thought about what
you wanted to do different. Yes?
Bry: Yes! I didn’t even realize what was happening except I didn’t want
it to continue.
Th: But you did it. So, on a scale of 1–10, 10 being you and your mom
having the best relationship possible, where were you when you
first called me for an appointment?
Bry: Negative 10. I just hated it but couldn’t see any way to make things
better. But I knew I didn’t want to just leave the family.
Th: OK. And where do you think you are now?
Bry: 2, maybe 3.
Th: Wow. And what’s different from negative 10? That’s a huge difference.

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Using SFBT With Family Therapy Approaches

A Bowen therapist or coach would continue asking about relationships

and triangles, helping clients think and act differently. Using solution-
focused practices helps by noticing what is working rather than what’s not, or
in addition to what’s not. I believe that these practices help to calm anxiety,
increasing thinking, which leads to more thoughtful responses when pos-
sible. When the responses work, the work continues. When the responses
don’t seem to have been helpful (“we did what we planned, but nothing
changed”), a solution-focused question about coping can help backtrack a
step and calm things again.

And So . . .
We end this chapter and the book on this note. I have enjoyed thinking about
systems and Solution-Focused Brief Therapy. I hope that by learning more
about system thinking, SFBT, and how they integrate, your work is enriched.
Whether you think about systems in a different way as you use SFBT prac-
tices or think about how you can use SFBT practices in systemic work with
families, I believe that what is important is to think about our clients: what
is important to them, what they want, and how we can help them, however
we do that. What is most important is that we continue to learn from our
clients about their unique situations and about helping people in general.
Obviously, I have a passion for both system and solution-focused work and
hope that a little of that has rubbed off on you.

172
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Appendix
Major Marriage
and Family Therapy
Models Charts
Developed by Thorana S.
Nelson, PhD and Students1

179
Appendix

STRUCTURAL FAMILY THERAPY

LEADERS ASSUMPTIONS:
• Salvador Minuchin • Problems reside within a family
• Charles Fishman structure (although not necessarily
caused by the structure)
• Changing the structure changes the
experience the client has
• Don’t go from problem to solution, we
just move gradually
• Children’s problems are often related
to the boundary between the parents
(marital vs. parental subsystem) and the
boundary between parents and children

CONCEPTS: GOALS OF THERAPY:

Family structure • Structural change
• Boundaries  Clarify, realign, mark boundaries
 Rigid • Individuation of family members
 Clear • Infer the boundaries from the patterns of
 Diffuse interaction among family members
 Disengaged • Change the patterns to realign the
 Normal range boundaries to make them more closed
 Enmeshment or open
 Roles
 Rules of who interacts with
whom, how, when, etc.
• Hierarchy
• Subsystems
• Cross-generational coalitions
• Parentified child

ROLE OF THE THERAPIST: ASSESSMENT:

• Perturb the system because • Assess the nature of the boundaries,
the structure is too rigid roles of family members
(chaotic or closed) or too • Enactment to watch family interaction/
diffuse (enmeshed) patterns
• Facilitate the restructuring of
the system
• Directive, expert—the
therapist is the choreographer
• See change in therapy session;
homework solidifies change
• Directive

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INTERVENTIONS: CHANGE:
• Join and accommodate • Raise intensity to upset the system,
 Mimesis then help reorganize the system
• Structural mapping • Change occurs within session and is
• Highlight and modify interactions behavioral; insight is not necessary
• Unbalance • Emotions change as individuals’
• Challenge unproductive experience of their context changes
assumptions
• Raise intensity so that the system
must change
• Disorganize and reorganize
• Shape competence through
enactment (therapist acts as
coach)

TERMINATION: SELF OF THE THERAPIST:

• Problem is gone and the • The therapist joins with the system
structure has changed to facilitate the unbalancing of the
(second-order change) system
• Problem is gone and the • Caution with induction—don’t
structure has not changed (first- get sucked in to the content areas,
order change) usually related to personal hot spots

EVALUATION:
• Strong support for working with psychosomatic children, adult drug addicts,
and anorexia nervosa.

RESOURCES:
Minuchin, S. (1974). Families and family therapy. Cambridge, MA: Harvard
University Press.
Minuchin, S., & Fishman, H. C. (1981). Family therapy techniques. Cambridge,
MA: Harvard University Press.
Minuchin, S., Rosman, B. L., & Baker, L. (1978). Psychosomatic families.
Cambridge, MA: Harvard University Press.
Fishman, H. C. (1988). Treating troubled adolescents: A family therapy
approach. New York, NY: Basic Books.
Fishman, H. C. (1993). Intensive structural therapy: Treating families in their
social context. New York, NY: Basic Books.

NOTES

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Appendix

STRATEGIC THERAPY (MRI)

LEADERS: ASSUMPTIONS:
• John Weakland • Family members often perpetuate problems by their
• Don Jackson own actions (attempted solutions)—the problem
• Paul Watzlawick is the problem maintenance (positive feedback
• Richard Fisch escalations)
• Directives tailored to the specific needs of a particular
family can sometimes bring about sudden and decisive
change
• People resist change
• You cannot not communicate—people are always
communicating
• All messages have report and command functions—
working with content is not helpful, look at the
process
• Symptoms are messages—symptoms help the system
survive (some would say they have a function)
• It is only a problem if the family describes it as
such
• Based on the work of Gregory Bateson and Milton
Erickson
• Need to perturb system—difference that makes a
difference (similar enough to be accepted by system
but different enough to make a difference)
• Don’t need to examine psychodynamics to work on
the problem

CONCEPTS: GOALS OF THERAPY:

• Symptoms are messages • Help the family define clear,
• Family homeostasis reachable goals
• Family rules—unspoken • Break the pattern; perturb the
• Cybernetics system
 Feedback loops • First- and second-order change,
 Positive feedback ideally second-order change (we
 Negative feedback cannot make this happen—it is
• First-order change spontaneous)
• Second-order change
• Reframing
• Content and process
• Report and command
• Paradox
• Paradoxical injunction

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 Appendix

• “Go slow” messages

• Positive feedback escalations
• Double binds
• “One down” position
• Patient position
• Attempted solutions maintain
problems and become problems
themselves

ROLE OF THE THERAPIST: ASSESSMENT:

• Expert position • Define the problem clearly and
• Responsible for creating conditions find out what people have done to
for change try to resolve it
• Work with resistance of clients to • Elicit goals from each family
change member and then reframe into
• Work with the process, not the one, agreed-upon goal
content • Assess sequence patterns
• Directive
• Skeptical of change
• Take a lot of credit and
responsibility for change; however,
therapist tells clients that they are
responsible for change
• Active

INTERVENTIONS: CHANGE:
• Paradox • Interrupting the pattern in any way
• Directives • Difference that makes a difference
 Assignments (“homework”) that • Change occurs outside of session;
interrupt sequences in-session change is in viewing;
• Interrupt unhelpful sequences of homework changes doing
interaction • Change in viewing (reframe) and/
• “Go slow” messages or doing (directives)
• Prescribe the symptoms • Emotions change and are
important, but are inferred and not
directly available to the therapist

TERMINATION: SELF OF THE THERAPIST:

• Client decides when to terminate • Therapist needs to be very careful
with the help of the therapist with ethics in this model; it can
• When pattern is broken and the be very manipulative (paradox)
client reports that the problem no and a lot of responsibility is on the
longer exists therapist as an expert
• Therapist decides

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EVALUATION:
• Very little research done
• Do clients report change? If so, then it is effective

RESOURCES:
Fisch, Richard, John H. Weakland, & Lynn Segal. (1982). The tactics of change:
Doing therapy briefly. San Francisco, CA: Jossey-Bass.
Lederer, W. J., & Don Jackson. (1968). The mirages of marriage. New York, NY:
W. W. Norton & Company.
Watzlawick, P., Bavelas, J. B., & Jackson, D. J. (1967). Pragmatics of human
communication. New York, NY: W. W. Norton & Company.
Watzlawick, P., Weakland, J., & Fisch, R. (1974). Change: Principles of problem
formation and problem resolution. New York, NY: W. W. Norton & Company.

NOTES

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STRATEGIC THERAPY (Haley and Madanes)

LEADERS: ASSUMPTIONS:
• Jay Haley • Family members often perpetuate problems
• Cloé Madanes by their own actions (attempted solutions)—
• Influenced by Minuchin the problem is the problem maintenance
(positive feedback escalations)
• Directives tailored to the specific needs of a
particular family can sometimes bring about
sudden and decisive change
• People resist change
• You cannot not communicate—people are
always communicating
• All messages have report and command
functions—working with content is not
helpful, look at the process
• Communication and messages are
metaphorical for family functioning
• Symptoms are messages—symptoms help the
system survive
• It is only a problem if the family describes it
as such
• Based on work of Gregory Bateson, Milton
Erickson, MRI, and Minuchin
• Need to perturb system—difference that
makes a difference (similar enough to be
accepted by system but different enough to
make a difference)
• Problems develop in skewed hierarchies
• Motivation is power (Haley) or love
(Madanes)

CONCEPTS: GOALS OF THERAPY:

• Symptoms are messages • Help the family define
• Family homeostasis clear, reachable goals
• Family rules—unspoken • Break the pattern; perturb
• Intergenerational collusions the system
• First- and second-order change • First- and second-order
• Metaphors change, ideally second-
• Reframing order change (we cannot
• Symptoms serve functions make this happen—it is
• Content and process spontaneous)
• Realign hierarchy
(Madanes)

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• Report and command

• Incongruous hierarchies
• Ordeals (prescribing ordeals)
• Paradox
• Paradoxical injunction
• Pretend techniques (Madanes)
• “Go slow” messages

ROLE OF THE THERAPIST: ASSESSMENT:

• Expert position • Define the problem clearly
• Responsible for creating conditions for and find out what people
change have done to try to resolve
• Work with resistance of clients to change it
• Work with the process, not the content • Hypothesize metaphorical
• Directive nature of the problem
• Skeptical of change • Elicit goals from each
• Take a lot of credit and responsibility for family member and then
change; however, therapist tells clients that reframe into one, agreed-
they are responsible for change upon goal
• Active • Assess sequence patterns

INTERVENTIONS: CHANGE:
• Paradox • Breaking the pattern in any
• Directives way
o Assignments (“homework”) that interrupt • Difference that makes a
sequences difference
• Interrupt unhelpful sequences of interaction • Change occurs outside of
• Metaphors, stories session; in-session change
• Ordeals (Haley) is in viewing; homework
• “Go slow” messages changes doing
• Prescribe the symptoms (Haley) • Change in viewing
• “Pretend” techniques (Madanes) (reframe) and/or doing
(directives)

TERMINATION: SELF OF THE THERAPIST:

• Client decides when to terminate with the help • Therapist needs to be
of the therapist very careful with ethics in
• When pattern is broken and the client this model; it can be very
reports that the problem no longer exists manipulative (paradox)
• Therapist decides and a lot of responsibility
is on the therapist as an
expert

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EVALUATION:
• Very little research done
• Do clients report change? If so, then it is effective

RESOURCES:
Haley, Jay. (1980). Leaving home. New York, NY: McGraw-Hill.
Haley, Jay. (1984). Ordeal therapy: Unusual ways to change behavior. San
Francisco, CA: Jossey-Bass.
Haley, Jay. (1987). Problem-solving therapy (2nd Ed.). San Francisco, CA:
Jossey-Bass.
Madanes, Cloé. (1981). Strategic family therapy. San Francisco, CA: Jossey-Bass.
Madanes, Cloé. (1984). Behind the one-way mirror: Advances in the practice of
strategic therapy. San Francisco, CA: Jossey-Bass.
Madanes, Cloé. (1990). Sex, love, and violence: Strategies for transformation.
New York, NY: W. W. Norton & Company.
Madanes, Cloé. (1995). The violence of men: New techniques for working with
abusive families. San Francisco, CA: Jossey-Bass.

NOTES

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Appendix

MILAN FAMILY THERAPY

LEADERS: ASSUMPTIONS:
• Boscolo • Problem is maintained by family’s attempts to fix it
• Palazzoli • Therapy can be brief over a long period of time
• Prata • Clients resist change
• Cecchin

CONCEPTS: GOALS OF THERAPY:

• Family games (family’s patterns that • Disrupt family games
maintain the problem)
 Dirty games
 Psychotic games
• There is a nodal point of pathology
• Invariant prescriptions
• Rituals
• Positive connotation
• Difference that makes a difference
• Neutrality
• Hypothesizing
• Therapy team
• Circularity, neutrality
• Incubation period for change;
requires long periods of time
between sessions

ROLE OF THERAPIST: ASSESSMENT:

• Therapist as expert • Family game
• Neutral to each family member— • Dysfunctional patterns (patterns
don’t get sucked into the family that maintain the problem)
game
• Curious

INTERVENTIONS: CHANGE:
• Ritualized prescriptions • Family develops a different game
• Rituals that does not include the symptom
• Circular questions (system change)
• Counter paradox • Requires incubation period
• Odd/even day
• Positive connotation
• “Date”
• Reflecting team
• Letters
• Prescribe the system

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TERMINATION: EVALUATION:
• Therapist decides, fewer than • Not practiced much, therefore not
10–12 sessions researched
• Follow up contraindicated

RESOURCES:
Campbell, D., Draper, R., & Crutchley, E. (1991). The Milan systemic approach
to family therapy. In A. S. Gurman & D. P. Kniskern (Eds.), Handbook of
family therapy (Vol. II) (pp. 325–362). New York, NY: Brunner/Mazel.
Campbell, D., Draper, R., & Huffington, C. (1989). Second thoughts on the
theory and practice of the Milan approach to family therapy. New York, NY:
Karnac.
Cecchin, G. (1987). Hypothesizing, circularity, and neutrality revisited: An
invitation to curiosity. Family Process, 26(4), 405–413.
Cecchin, G. (1992). Constructing therapeutic possibilities. In S. McNamee & K.
J. Gergen (Eds.), Therapy as social construction (pp. 86–95). Newbury Park,
CA: Sage.
Palazzoli, M. S., Boscolo, L., Cecchin, G., & Prata, G. (1978). Paradox and
counterparadox: A new model in the therapy of the family in schizophrenic
transaction. New York, NY: Jason Aaronson.
Palazzoli, M. S., Boscolo, L., Cecchin, G., & Prata, G. (1978). A ritualized
prescription in family therapy: Odd days and even days. Journal of Marriage
and Family Counseling, 48, 3–9.
Palazzoli, M., & Palazzoli, C. (1989). Family games: General models of
psychotic processes in the family. New York, NY: W. W. Norton & Company.

NOTES

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SOLUTION-FOCUSED BRIEF THERAPY

LEADERS: ASSUMPTIONS:
• Steve de Shazer • Clients want to change
• Insoo Kim Berg • There’s no such thing as resistance (clients are telling
• Yvonne Dolan us how they cooperate)
• Eve Lipchik • Focus on present and future, except for the past in
terms of exceptions; not focused on the past in terms
of cause of changing the past
• Change the way people talk about their problems
from problem talk to solution talk
• Language creates reality
• Therapist and client relationship is key
• A philosophy, not a set of techniques or theory
• Sense of hope, “cheerleader effect”
• Nonpathologizing, not interested in pathology or
“dysfunction”
• Don’t focus on the etiology of the problem: Solutions
are not necessarily related to problems
• Assume the client has is able to access resources
• Only need a small change, which can snowball into
a bigger change
• The problem is not occurring all the time

CONCEPTS: GOALS OF THERAPY:

• Problem talk/solution talk • Help clients to think or do things
• Exceptions differently in order to increase
• Smallest difference that makes a their satisfaction with their lives
difference • Reach clients’ goals; “good
• Well-formed goals (small, concrete, enough”
measurable, important to client, • Shift the client’s language from
doable, beginning of something, not problem talk to solution talk
end, presence not absence, hard • Modest goals (clear and specific)
work) • Help translate the goal into
• Solution not necessarily related to something more specific (clarify)
the problem • Change language from problem
• Clients are experts on their lives and to solution talk
their experiences
• Therapeutic relationships: customer/
therapist, complainant/sympathizer,
visitor/host

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ROLE OF THERAPIST: ASSESSMENT:

• Cheerleader/coach • Assess exceptions—times when
• Offer hope problem isn’t there
• Nondirective, client-centered • Assess what has worked in the
past, not necessarily related to
the problem; develop realistic
goals
• Assess what will be different
when the problems are gone
(becomes goal that might not
be clearly related to the stated
problem)
• Assess when parts of the miracle
are already happening

INTERVENTIONS:
• Help set clear and achievable goals (clarify)
• Help client think about the future and what they want to be different
• Exceptions: Amplify the times they did things that “worked” when they didn’t
have the problem or it was less severe
• Compliments:
 “How did you do that?”
 “Wow! That must have been difficult!”
 “That sounds like it was helpful; how did you do that?”
 “I’m impressed with. . . ”
 “You sound like a good. . . ”
• Formula first session task: Observe what happens in their life/relationship
that they want to continue
• Miracle question:
 Used when clients are vague about complaints
 Helps client do things the problem has been obstructing
 Focus on how having problems gone will make a difference
 Relational questions
 Follow up with miracle day questions and scaling questions
 Pretend to have a miracle day
• Scaling questions
• Midsession break (with or without team) to summarize session, formulate
compliments and bridge, and suggest a task (tasks used less in recent years;
clients develop own tasks; therapist may make suggestions or suggest
“experiments”), sometimes called “feedback” (feeding information back into
the therapy with a difference)
• Predict the next day, then see what happens

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TERMINATION: SELF OF THE THERAPIST:

• Client decides • Accept responsibility for client/
therapist relationship
• Expert on therapy conversation,
not on client’s life or experience
of the difficulty

EVALUATION:
Therapy/Research:
• Franklin, C., Trepper, T. S., Gingerich, W. J., & McCollum, E. E. (2012).
Solution-focused brief therapy: A handbook of evidence-based practice.
New York, NY: Oxford University Press.

RESOURCES:
Berg, I. K., & Miller, S. (1992). Working with the problem drinker. New York,
NY: W. W. Norton & Company.
Berg, I. K. (1994). Family-based services: A solution-focused approach. New
York, NY: W. W. Norton & Company.
DeJong, P., & Berg, I. K. (2013). Interviewing for solutions (4th ed.). Pacific
Grove, CA: Brooks/Cole.
de Shazer, S. (1982). Patterns of brief family therapy: An ecosystemic approach.
New York, NY: Guilford Press.
de Shazer, S., Dolan, Y., Korman, H., Trepper, T., McCollum, E., & Berg, I. K.
(2007). More than miracles: The state of the art of solution-focused brief
therapy. New York, NY: Haworth.
Dolan, Y. (1992). Resolving sexual abuse. New York, NY: W. W. Norton &
Company.
Lipchik, E. (2002). Beyond technique in solution-focused therapy. New York,
NY: Guilford Press.
Nelson, T. S., & Thomas, F. N. (Eds.). (2007). Handbook of solution-focused brief
therapy: Clinical applications. New York, NY: Haworth.

NOTES

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NARRATIVE THERAPY

LEADERS: ASSUMPTIONS:
• Michael White • Personal experience is ambiguous
• David Epston • Reality is shaped by the language used to describe
• Jill Freedman it—language and experience (meaning) are recursive
• Gene Combs • Reality is socially constructed
• Truth may not match historic or another person’s
truth, but it is true to the client
• Focus on effects of the problem, not the cause (how
problem impacts family; how family affects problem)
• Stories organize our experience and shape our
behavior
• The problem is the problem; the person is not the
problem
• People “are” the stories they tell
• The stories we tell ourselves are often based on
messages received from society or our families (social
construction)
• People have their own unique filters by which they
process messages from society

CONCEPTS: GOALS OF THERAPY:

• Dominant narrative: beliefs, values, • Change the way the clients
and practices based on dominant social view themselves and assist
culture them in re-authoring their
• Subjugated narrative: a person’s own story story in a positive light;
that is suppressed by dominant story find the alternative but
• Alternative story: the story that’s there preferred story that is not
but not noticed problem-saturated
• Deconstruction: take apart problem- • Give options for more/
saturated story in order to externalize different stories that don’t
and reauthor it (find missing pieces; include problems
“unpacking”)
• Problem-saturated stories: bog client
down, allowing problem to persist
(closed, rigid)
• Landscape of action: how people do
things
• Landscape of consciousness: what
meaning the problem has (landscape of
meaning)

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• Unique outcomes: pieces of

deconstructed story that would not
have been predicted by dominant story
or problem-saturated story; exceptions;
sparkling moments

ROLE OF THERAPIST: ASSESSMENT:

• Genuine curious listener • Get the family’s story, their
• Question their assumptions experiences with their
• Open space to make room for problems, and presumptions
possibilities about those problems
• Assess alternative stories and
unique outcomes during
deconstruction

INTERVENTIONS: CHANGE:
• Ask questions • Occurs by opening space;
 Landscape of action and landscape of cognitive
meaning • Client can see that there are
 Meaning questions numerous possibilities
 Opening space • Expanded sense of self
 Preference
 Story development
 Deconstruction
 To extend the story into the future
• Externalize problems
• Effects of problem on family; effects of
family on problem
• Restorying or reauthoring
 Selfstories
• Letters from the therapist
• Certificates of award

TERMINATION: SELF OF THE THERAPIST: EVALUATION:

• Client • Therapist’s ideas, • No formal studies
determines values, prejudices, etc.
need to be open to
client, “transparent”
• Expert on conversation

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RESOURCES:
Freeman, Jennifer, David Epston, & Dean Lobovits. (1997). Playful approaches
to serious problems: Narrative therapy with children and their families. New
York, NY: W. W. Norton & Company.
Freedman, Jill, & Gene Combs. (1996). Narrative therapy: The social
construction of preferred realities. New York, NY: W. W. Norton & Company.
White, Michael. (2007). Maps of narrative practice. New York, NY: W. W.
Norton & Company.
White, Michael, & David Epston (Eds.). (1990). Narrative means to therapeutic
ends. New York, NY: W. W. Norton & Company.

NOTES

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COGNITIVE-BEHAVIORAL FAMILY THERAPY

LEADERS: ASSUMPTIONS:
• Ivan Pavlov • Family relationships, cognitions, emotions, and behavior
• Watson mutually influence one another
• Thorndike • Cognitive inferences evoke emotion and behavior
• B. F. Skinner • Emotion and behavior influence cognition
• Bandura
• Frank Dattilio

CONCEPTS: GOALS OF THERAPY:

• Schemas: core beliefs about • To modify specific patterns of
the world, the acquisition and thinking and/or behavior to
organization of knowledge alleviate the presenting symptom
• Cognitions: selective attention,
perception, memories, self-talk,
beliefs, and expectations
• Reinforcement: an event that
increases the future probability of a
specific response
• Attribution: explaining the
motivation or cause of behavior
• Distorted thoughts, generalizations
get in way of clear thinking and
thus action

ROLE OF THERAPIST: ASSESSMENT:

• Ask a series of question about • Cognitive: distorted thoughts,
assumptions, rather than challenge thought processes
them directly • Behavioral: antecedents,
• Teach the family that emotional consequences, etc.
problems are caused by unrealistic
beliefs

INTERVENTIONS: CHANGE:
• Questions aimed at distorted • Behavior will change when the
assumptions (family members contingencies of reinforcement are
interpret and evaluate one another altered
unrealistically) • Changed cognitions lead to
• Behavioral assignments changed affect and behaviors
• Parent training
• Communication skill building
• Training in the model

TERMINATION: SELF OF THE THERAPIST:

• When therapist and client • Not discussed
determine

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EVALUATION:
• Many studies, particularly in terms of marital therapy and parenting

RESOURCES:
Beck, A. T., Reinecke, M. A., & Clark, D. A. (2003). Cognitive therapy across the
lifespan: Evidence and practice. Cambridge, UK: Cambridge University Press.
Dattilio, F. M. (1998). Case studies in couple and family therapy: Systemic and
cognitive perspectives. New York, NY: Guilford Press.
Dattilio, F. M. (2001). Cognitive-behavior family therapy: Contemporary myths
and misconceptions. Contemporary Family Therapy, 23(12), 1–18.
Dattilio, F. M., & Padesky, C. (1990). Cognitive therapy with couples. Sarasota,
FL: Professional Resource Press.
Epstein, N. B., & Baucom, D. H. (2002). Enhanced cognitive-behavioral therapy
for couples. Washington, DC: American Psychological Association.
Jacobson, N. S., & Christensen, A. (1998). Acceptance and change in couple
therapy: A therapist’s guide to transforming relationships. New York, NY: W.
W. Norton & Company.
Jacobson, N. S., & Margolin, G. (1979). Marital therapy: Strategies based on
social learning and behavior exchange principles. New York, NY: Brunner/
Mazel.

NOTES

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CONTEXTUAL FAMILY THERAPY

LEADERS: ASSUMPTIONS:
• Ivan Boszormenyi-Nagy • Values and ethics are transmitted across
generations
• Dimensions (all are intertwined and drive
people’s behaviors and relationships):
 Facts
 Psychological
 Relational
 Ethical
• Trustworthiness of a relationship (relational
ethics): when relationships are not trustworthy,
debts and entitlements that must be paid back
pile up; unbalanced ledger gets balanced
in ways that are destructive to individuals,
relationships, and posterity (e.g., revolving
slate, destructive entitlement)

CONCEPTS: GOALS OF THERAPY:

• Loyalty: split, invisible • Balanced ledger
• Entitlement (amount of merit a person has
based on trustworthiness)
• Ledger (accounting)
• Legacy (we behave in ways that we have
been programmed to behave)
• Relational ethics
• Destructive entitlement (you were given a
bad ledger and it wasn’t fair so it’s OK to
hand it on to the next person—acting out,
neglecting important others)
• Revolving slate
• Posterity (thinking of future generations when
working with people) this is the only model
that does
• Rejunctive and disjunctive efforts

ROLE OF THE THERAPIST: ASSESSMENT:

• Directive • Debts
• Expert in terms of assessment • Entitlements
• Invisible loyalties

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INTERVENTIONS: CHANGE:
• Process and relational questions • Cognitive: awareness
• Multi-directional impartiality: everybody and of legacies, debts, and
nobody feel special—all are attended to but entitlements
none are more special • Behavioral: very action
• Exoneration: help people understand how oriented—actions must
they have been living out legacies and debts- change
ledgers—exonerate others
• Coach toward rejunctive efforts

TERMINATION: SELF OF THE THERAPIST: EVALUATION:

• Never—totally • Must understand own • No empirical evaluation
up to the legacies, entitlements,
client process of balancing
ledgers, exoneration

RESOURCES:
Boszormenyi-Nagy, I. (1987). Foundations of contextual therapy: Collected
papers of Ivan Boszormenyi-Nagy. New York, NY: Brunner/Mazel.
Boszormenyi-Nagy, I., & Krasner, B. (1986). Between give and take: A clinical
guide to contextual therapy. New York, NY: Brunner/Mazel.
Hargrave, T. D., & Pfitzer, F. (2003). The new contextual therapy: Guiding the
power of give and take. New York, NY: Brunner/Routledge.
van Heusden, A., & van den Eerenbeemt, E. (1987). Balance in motion: Ivan
Boszormenyi-Nagy and his vision of individual and family. New York, NY:
Brunner/Mazel.

NOTES

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with Families, Routledge
Appendix

BOWEN FAMILY THERAPY

LEADERS: ASSUMPTIONS:
• Murray Bowen • The past is currently influencing the present
• Michael Kerr (works • Change can happen—individuals can move
with natural systems) along in the process of differentiation
• Edwin Friedman • Differentiation: ability to maintain self in the face
of high anxiety (remain autonomous in a highly
emotional situation)
 Change in experience of self in the family
system
 Change in relationship between thinking and
emotional systems
• Differentiation is internal and relational—they
are isomorphic and recursive
• Anxiety inhibits change and needs to be reduced
to facilitate change
• High intimacy and high autonomy are ideal
• Emotions are a physiological process—feelings
are the thoughts that name and mediate
emotions, that give them meaning
• Symptoms are indicators of stress, anxiety, lower
differentiation
• Anyone can become symptomatic with enough
stress; more differentiated people will be able
to withstand more stress and, when they do
become symptomatic, recover more quickly

CONCEPTS: GOALS OF THERAPY:

• Intimacy • Ultimate: increase differentiation
• Autonomy of self (thoughts/emotions; self/
• Differentiation of self others)
• Cutoff • Intermediate: detriangulation,
• Triangulation lowering anxiety to respond
• Sibling position instead of reacting
• Fusion (within individual and • Decrease emotional reactivity,
within relationships) increase thoughtful responses
• Family projection process • Increased intimacy one-on-one
• Multigenerational transmission with important others
process
• Nuclear family
• Emotional process

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 Appendix

• Four sub-concepts (ways people

manage anxiety; none of these is
bad by itself—it’s when one is used
to exclusion of others or excessively
that it can become problematic for
a system):
 Conflict
 Dysfunction in person
 Triangulation
 Distance
• Societal emotional process
• Undifferentiated family ego mass

ROLE OF THERAPIST: ASSESSMENT:

• Coach (objective) • Emotional reactivity
• Educator • Degree of differentiation of self
• Therapist is part of the system • Ways that people manage anxiety/
(nonanxious and differentiated) family themes
• Expert—not a collaborator • Triangles
• Repeating intergenerational
patterns
• Genogram (assessment tool)

INTERVENTIONS: CHANGE:
• Genogram (both assessment and • Reduced anxiety through
change tool) separation of thoughts and
• Plan for intense situations (when emotions—cognitive
things get hot, what are we going to • Reduced anxiety leads to
do—thinking; process questions) responsive thoughts and actions,
• Process questions—thinking changed affect, changed
questions: “what do you think about relationships
this?” and “how does that work?” • When we think (respond), change
• Detriangulating one-on-one occurs (planning thinking)—when
relationships, one person with the you know how you would like
other two in the triangle to behave in a certain emotional
• Educating clients about the situation, you plan it, it makes
concepts of the model it easier to carry through with
• Decrease emotional reactivity— different consequences
increase thoughtful responses
• Therapist as a calm self and calm
part of a triangle with the clients
• Coaching for changing own
patterns in family of origin

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Appendix

TERMINATION: SELF OF THE THERAPIST: EVALUATION:

• Ongoing—we • Important with this • Research suggesting
are never fully model; differentiated, validity: not much, not
differentiated calm therapist is the a lot of outcome
main tool • Did not specify
• We don’t need to join symptom reduction
the system • Client reports of
• We must be highly different thoughts,
differentiated so we can actions, responses
recognize and reduce from others, affect is
reactivity evidence of change
• Our clients can
only become as
differentiated as we
are; we need coaching
to increase our own
differentiation of self

RESOURCES:
Bowen, M. (1978). Family therapy in clinical practice. New York, NY: Jason
Aaronson.
Friedman, E. (1987). Generation to generation: Family process in church and
synagogue. New York, NY: Guilford Press.
Kerr, M. E., & Bowen, M. (1988). Family evaluation: An approach based on
Bowen theory. New York, NY: W. W. Norton & Company.

NOTES

Copyright material from Thorana S. Nelson (2019), Solution-Focused Brief Therapy

with Families, Routledge
 Appendix

PSYCHODYNAMIC FAMILY THERAPY (OBJECT RELATIONS)

LEADERS: ASSUMPTIONS:
• Freud • Sexual and aggressive drives are at
• Erik Erikson the heart of human nature
• Nathan Ackerman • Every human being wants to be
• Several others who were trained, appreciated
but their models were not primarily • Symptoms are attempts to cope
psychodynamic: Bowen, Whitaker, with unconscious conflicts over sex
etc. and aggression
• Object relations: Scharff and • Internalized objects become
Scharff projected onto important others;
• Attachment theory: Bowlby we then evoke responses from them
that fit that object, they comply,
and we react to the projection
rather than the real person
• Early experiences affect later
relationships
• Internalized objects affect inner
experience and outer relationships

CONCEPTS: GOALS OF THERAPY:

• Internal objects: mental images • To free family members of
of self and others built from unconscious constraints so that
experience and expectation they can interact as healthy
• Attachment: connection with individuals
important others • Separation-individuation
• Separation-individuation: the • Differentiation
gradual process of a child
separating from the mother
• Mirroring: when parents show
understanding and acceptance
• Transference: attributing qualities
of someone else to another person
• Countertransference: therapist’s
attributing qualities of self onto
others
• Family myths: unspoken rules and
beliefs that drive behavior, based
on beliefs, not full images of others
• Fixation and regression: when
families become stuck they revert
back to lower levels of functioning
• Invisible loyalties: unconscious
commitments to the family that are
detrimental to the individual

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Appendix

ROLE OF THERAPIST: ASSESSMENT:

• Listener • Attachment bonds
• Expert position • Projections (unrealistic attributions)
• Interpret

INTERVENTIONS: CHANGE:
• Listening • Change occurs when family
• Showing empathy members expand their insight to
• Interpretations (especially realize that psychological lives are
projections) larger than conscious experience
• Family of origin sessions (Framo) and come to accept repressed parts
• Make a safe holding environment of their personalities
• Change also occurs when more,
full, real aspects of others are
revealed in therapy so that
projections fade

TERMINATION:
Not sure how therapy is terminated

EVALUATION:

RESOURCES:
Sander, F. (2004). Psychoanalytic couples therapy: Classical style. In Feld,
B. & Livingston, M. (Eds.), Psychoanalytic inquiry issue on psychoanalytic
treatment of couples (Vol. 24, pp. 373–386).
Scharff, J. (Ed.). (1989). Foundations of object relations family therapy.
Northvale, NJ: Jason Aronson.
Slipp, S. (1984). Object relations: A dynamic bridge between individual and
family treatment. Northvale, NJ: Jason Aronson.

NOTES

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with Families, Routledge
 Appendix

EXPERIENTIAL FAMILY THERAPY

LEADERS: ASSUMPTIONS:
• Carl Whitaker • Family problems are rooted in suppression of feelings,
• Virginia Satir rigidity, denial of impulses, lack of awareness, emotional
deadness, and overuse of defense mechanisms
• Families must get in touch with their real feelings
• Therapy works from the inside (emotion) out (behavior)
• Expanding the individual’s experience opens them up to
their experiences and helps to improve the functioning
of the family group
• Commitment to emotional well being

CONCEPTS: GOALS OF THERAPY:

• Honest emotion • Promote growth, change, creativity,
• Suppress repression flexibility, spontaneity, and
• Family myths playfulness
• Mystification • Make the covert overt
• Blaming • Increase the emotional closeness of
• Placating spouses and disrupt rigidity
• Being irrelevant/irreverent • Unlock defenses, enhance self-
• Being super reasonable esteem, and recover potential for
• Battle for structure experiencing
• Battle for initiative • Enhance individuation

ROLE OF THE THERAPIST: ASSESSMENT:

• Uses their own personality • Assess individual self-expression
• Must be open and spontaneous, and levels of defensiveness
empathic, sensitive, and • Assess family interactions that
demonstrate caring and acceptance promote or stifle individuation and
• Be willing to share and risk, be healthy interaction
genuine, and increase stress within
the family
• Teach family effective
communication skills in order to
convey their feelings
• Active and directive

INTERVENTIONS: CHANGE:
• Sculpting • Increasing stress among the family
• Choreography members leads to increased
• Conjoint family drawing emotional expression and honest,
• Role playing open communication
• Use of humor • Changing experience changes
• Puppet interviews affect; need to get out of head into
• Reconstruction emotions; active interventions
change experience, emotions

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Appendix

• Sharing feelings and creating an

emotionally intense atmosphere
• Modeling and teaching clear
communication skills (Use of “I”
messages)
• Challenge “stances” (Satir)
• Use of self

TERMINATION: SELF OF THE THERAPIST:

• Defenses of family members are • Through the use of humor,
broken down spontaneity, and personality, the
• Family communicating openly therapist is able to unbalance the
• Family members more in touch family and bring about change
with their feelings • The personality of the therapist is
• Members relate to each other in a key to bringing about change
more honest way
• Openness for individuation of
family members

EVALUATION:
• This model fell out of favor in the 1980s and 1990s due to its focus on the
emotional experience of the individual while ignoring the role of family
structure and communication in the regulation of emotion
• Emotionally Focused Couples Therapy (Sue Johnson) and Internal Family
Systems Therapy (Richard Schwartz) are the current trend
• Need to assess in-therapy outcomes as a measure of success due the fact that
they often result in deeper emotional experiences (and successful sessions)
that have the potential to generalize outside of therapy

RESOURCES:
Satir, V. (1967). Conjoint family therapy. Palo Alto, CA: Science and Behavior
Books.
Satir, V. (1972). Peoplemaking. Palo Alto, CA: Science and Behavior Books.
Napier, A. Y., & Whitaker, C. A. (1978). The family crucible. New York, NY:
Harper/Row.

NOTES

Copyright material from Thorana S. Nelson (2019), Solution-Focused Brief Therapy

with Families, Routledge
 Appendix

EMOTIONALLY FOCUSED THERAPY

LEADERS: ASSUMPTIONS:
• Susan Johnson • “The inner construction of experience evokes
• Les Greenberg interactional responses that organize the world in a
particular way. These patterns of interaction then reflect,
and in turn, shape inner experience” (Johnson, 2008,
p. 109)
• Individual identity can be formed and transformed by
relationships and interactions with others
• New experiences in therapy can help clients expand
their view and make sense of the world in a new way
• Nonpathologizing, not interested in pathology or
“dysfunction”
• Past is relevant only in how it affects the present
• Emotion is a target and agent of change
• Primary emotions generally draw partners closer;
secondary emotions push partners away
• Distressed couples get caught in negative repetitive
sequences of interaction where partners express
secondary emotions rather than primary emotions

CONCEPTS: GOALS OF THERAPY:

• Attachment needs exist throughout • Identify and break negative
the lifespan interactional patterns
• Negative interactional patterns • Increase emotional engagement
• Primary and secondary emotions between couple
• Empathic attunement • Identify primary and secondary
• Cycle de-escalation emotions in the context of negative
• Blamer softening interactional pattern
• Withdrawer re-engagement • Access, expand, and reorganize
key emotional responses
• Create a shift in partners’
interactional positions.
• Foster the creation of a secure
bond between partners through
the creation of new interactional
events that redefine the relationship

ROLE OF THERAPIST: ASSESSMENT:

• Client-centered, collaborative • Assess relationship factors such as:
• Process consultant  Their cycle
• Choreographer of relationship  Action tendencies (behaviors)
dance  Perceptions
 Secondary emotions
 Primary emotions
 Attachment needs

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Appendix

• Relationship history, key events

• Brief personal attachment history
• Interaction style
• Violence/abuse/drug usage
• Sexual relationship
• Prognostic indicators:
 Degree of reactivity and
escalation; intensity of negative
cycle
 Strength of attachment/
commitment
 Openness, response to therapist,
engagement
 Trust/faith of the female partner
(does she believe he cares about
her)

INTERVENTIONS
• Reflection
• Validation
• Evocative questions and empathic conjecture
 Self-disclosure
 Tracking, reflecting, and replaying interactions
 Reframe in an attachment frame
 Enactments
 Softening
 Heightening and expanding emotional experiences

TERMINATION: SELF OF THE THERAPIST:

Therapy ends when the therapist and • Accept responsibility for client/
clients collaboratively decide therapist relationship
that the following changes have • Expert on process of therapy, not
occurred: on client’s life or experience of the
• Negative affect has lessened and is difficulty
regulated differently • Collaborator who must sometimes
• Partners are more accessible and lead and sometimes follow
responsive to each other
• Partners perceive each other as
people who want to be close, not
as enemies
• Negative cycles are contained and
positive cycles are enacted

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with Families, Routledge
 Appendix

EVALUATION: CHANGE:
Therapy/research: • Change happens as couples
• Difficult model to learn have a new corrective emotional
• When using the emotionally experience with one another
focused therapy model, it is • When couples are able to
important to move slowly down experience their own emotions,
the process of therapy; this can be needs, and fears and express them
difficult to do to one another and experience the
• Learning to stay with deepened other partner responding to those
emotions can sometimes be emotions, needs, and fears in an
overwhelming, but the therapist accessible, responsive way
must continue to reflect and
validate
• Empirically validated, more than
20 years of research to back up

RESOURCES:
Johnson, S. M. (2004). The practice of emotionally focused couple therapy (2nd
ed.). New York, NY: Brunner/Routledge.
Johnson, S. M. (2008). Emotionally focused couple therapy. In A. S. Gurman
(Ed.), Clinical handbook of couple therapy (4th ed., pp. 107–137). New York,
NY: Guilford Press.
Johnson, S. M., Bradley, B., Furrow, J., Lee, A., Palmer, G., Tilley, D., & Woolley,
S. (2005). Becoming an emotionally focused couple therapist: The workbook.
New York, NY: Routledge.
Johnson, S. M., & Greenberg, L. S. (1994). The heart of the matter: Perspectives
on emotion in marital therapy. New York, NY: Brunner/Mazel.

NOTES

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with Families, Routledge
Appendix

GOTTMAN METHOD COUPLE THERAPY

LEADERS: ASSUMPTIONS:
• John Gottman • Therapy is primarily dyadic
• Julie Gottman • Couples need to be in emotional states to learn how to
cope with and change them
• Therapy should be primarily a positive affective
experience
• Positive sentiment override and friendship base are
needed for communication and affect change

CONCEPTS: GOALS OF THERAPY:

• Negative interactions (four • Empower the couple
horsemen) decrease acceptance of • Problem-solving skills
repair attempts • Positive affect
• Most couples present in therapy • Creating shared meaning
with low positive affect
• Sound marital house
• Softened startup
• Love maps

ROLE OF THE THERAPIST: ASSESSMENT:

• Coach • Four horsemen are present and
• Provide the tools that the couple repair is ineffective
can use with one another and • Absence of positive affect
make their own • Sound marital house

INTERVENTIONS: CHANGE:
• Sound marital house • Accepting influence
• Dreams-within-conflict • Decrease negative interactions
• Label destructive patterns • Increase positive affect
• Enhance the marital friendship
• Sentiment override

TERMINATION: SELF OF THE THERAPIST:

• When couples can consistently • Not discussed
develop their own interventions
that work reasonably well

EVALUATION:
• Theory is based on Gottman’s research

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with Families, Routledge
 Appendix

RESOURCES:
Gottman, J. M. (1999). The marriage clinic. New York, NY: W. W. Norton &
Company. www.gottman.com

NOTES

Note
1 May be used in workshops, courses, and for other use as appropriate. Please give
© credit to Thorana Nelson and students. ©Thorana Nelson and Students

Copyright material from Thorana S. Nelson (2019), Solution-Focused Brief Therapy

with Families, Routledge
 Index

Ackerman Institute 80 45, 165; practices 49 – 50; process

adaptation means change 100 questions 49, 165; reactivity
anxiety 45 – 49, 101, 164 – 165, 169, 45; symptoms 45; therapist as
172 nonanxious third part of a triangle
attachment: needs 51; styles 51 49; triangles 164 – 65; triangling
axioms of communication 22 45, 46
Brief Family Therapy Center 54,
Bateson, G. xiii, 17, 35, 53, 66, 151 80
Bertalanffy von, L. xiii, 1, 85 Brief Therapy Center 53, 80, 152
best friend question 106
best hopes 72, 84, 112 can’t not communicate 22
boundaries 4 – 11, 14, 29 – 34; balanced circular causality 15
34; clear 34; diffuse 31 – 34; circularity 15 – 16, 19 – 22, 51, 67, 85,
enmeshed 31; permeable 7; rigid 7, 87, 92, 136, 170
31; roles and rules 31 – 32; and rules circular questions 106
31 – 32; semipermeable 7 client as expert 85, 101 – 103, 145
Bowen Family Therapy 44 – 50, co-construct 62, 80, 87, 95, 103
163 – 172; anxiety 45, 49; co-construction 57, 61
assumptions and concepts 45 – 48; Cognitive Behavioral Therapy 51
autonomy 47, 49; detriangling 49, communication: command 22; content
164; differentiation is both internal and relationship 22; digital and
and external 45; emotional cutoff analogic 24; formulation 61, 113;
46, 164, 166; emotional intimacy report 22; theory 22 – 28
47, 49; emotionality 44, 47; compliments 68 – 69
emotional system 45; emotions 165; constructivism 153
emotions, separate from thinking coping questions 70, 75, 79
45; family emotionality 45; fusion culture 8, 20, 33, 73, 109
46, 164, 166; managing stress 164; cultural view 7
multigenerational family transition cybernetics 14 – 21

212
 Index

detriangling 49, 154 leading from behind 62, 105

development of Solution-Focused Brief linear 15, 16, 21, 67, 83, 94, 115
Therapy 53 – 54
diagnoses as descriptions 87 Menninger Foundation 44
differentiation of self 44, 45 – 49, Mental Research Institute 36, 53
164 – 165; internal and external 45 metaphor 39, 41, 159
metarules 4 – 5, 9, 18, 21, 31;
EARS 82 second-order change 21
Emotionally Focused Therapy 51; MFT model charts 145, 179
emotion as agent of change 51 Milan approach 80
emotion attachment 51 Minuchin 29, 30, 32, 34, 41, 46, 50
enactment: assessment 33, 147, 149; miracle day 64, 70, 74
intervention 34, 148 miracle question 73 – 75
equifinality 11, 84, 92 morphogenesis 9, 17, 19, 35
Erickson, Milton 53, 57 motivator: control or power 158;
executive subsystem 32 love 158
experiments 81 MRI Strategic Therapy 35 – 41, 151 – 157
Multidimensional Family Therapy 50
feedback 14, 19, 36, 170; negative 17, Multisystemic Therapy 50
36, 103
feedback loops 19 Narrative Approach 80
first- and second- order change 5, National Institute of Mental 44
19 – 21 nonanxious third part of a triangle 49
Functional Family Therapy 50 not-knowing 86
future talk 61
object relations 51
genograms 49, 165 – 167 Ockham’s Razor 57
Georgetown University 44 ordeal 42, 159
go slowly 41, 153 oxbow in a river 88

harm 18, 56, 60, 154 Palo Alto, CA 36

homeostasis 11, 17, 35 paradox 39 – 41, 152 – 154, 158 – 159
homeostatic resistance 30 parentified child 7, 32
parents as team 32
identified patient 30 past: cannot be changed 59; exceptions
integrative approaches 50 – 52 65; influencing present 45
interactional patterns 21, 41, 54, pattern and sequence 19 – 20
152 positive reframe 156
Internal Family Systems Therapy 99 preferred future 62, 64, 67, 69, 70 – 75,
interrupting sequences 152 78, 84, 86, 106 – 107, 143
isomorphism 13 – 14, 25, 133, 158, 170 pretend intervention 161
primary emotion 52
joining 34, 112, 147 problem phobic 66, 115

213
Index

problems as embedded in structures 34 Family Therapy (Haley and Madanes

problems in context 6 157–63; with Strategic Family
process 12 – 13, 18, 24, 37 – 38, 104, Therapy (Mental Research Institute)
132, 137, 144; vs. content 12 – 13 151 – 57; with Structural Family
punctuation 20, 23, 38 Therapy 146 – 51; therapy is
co-constructed 61; well-formed
raising intensity 50, 147, 149 goals 72
reciprocity 15 Solution-Focused Brief Therapy
recursion 15, 16, 19, 51 integration with family therapy:
reframe 34, 38, 152, 158; positive 159 change is constant and inevitable
relational questions 66 – 67 88 – 90; clients are experts 101;
resistance 136 – 137; client 58; death of clients have resources 94; client-
58; homeostatic 30; from others 89 therapist relationship 104; co-
construct 103; curious questions
scaling: ability 78; confidence 78; 105; do something different
courage 78; hope 81; miracle day 93; focus on future and change
75; motivation 78; preferred future 100 – 101; if it ain’t broke. . . 91;
75 miracle question 106; once you
secondary emotions 52 know what works 91 – 92; preferred
second-order change 5 future 106; relationship between
Signs of Safety 138 problems and solutions 94 – 100;
Simplify 57 relationship questions 105; small
slow to know 55 change leads to bigger change
Solution-Focused Brief Therapy: 101; stance 55 – 56; Therapy Is Co-
assumptions 57 – 62; with Bowen Constructed 103 – 4; well-formed
Family Systems Therapy 163 – 72; goals 104 – 5
change is constant and inevitable Solution-Focused Brief Therapy
57; changes in the approach 83 – 84; practices: breaks 80; client-therapist
client as expert 61; clients have relationship 62 – 63; compliments
resources 58; couples 139 – 43; 79, 84; coping 79; coping questions
emotions 83; exceptions 57, 65, 68, 75; details 67 – 68; directives, tasks,
71 – 72; experiments 58; families and signs 81; exceptions 74, 81;
108 – 39; focus on what is possible instances of miracle or solution
60; future perfect 74; general 72; interviews about harm 79; not
practices 62 – 70; homework 58, 81; solution-forced 69; preferred future
identifying resources 58; if it ain’t 72 – 73; pre-session change 71;
broke. . . 57; instances (of miracle previous solutions questions 71;
day) 99; leading from behind 62; questions 65; relationship questions
miracle set 74; relationship between 75; scaling 75 – 78; second and
problem and solution 58 – 60; further sessions 82; situations 79;
resource-based 56; situations vs. strength-based 56; suppositional
problems 70; small changes lead to frame 69; tap on shoulder 62; timing
bigger changes 60; with Strategic 69 – 70; well-formed goals 63 – 65;

214
 Index

what else? 70, 76, 141; what was subsystems 30

helpful 82 suggestions 65
Solution-Focused Brief Therapy stance system concepts 3 – 14
55 – 56; client competence 56; Systemic thinking as worldview or
collaborative 88; curious 55; non- lens 1
normative and nonpathologizing 56; systems 30
preferred future 86; respectful 55; systems therapy 24 – 27
tentative 55
Strategic Family Therapy (Haley tasks 34, 54, 84; ordeal 42, 159;
and Madanes) 41 – 44, 157 – 163; pretend 42
metaphor 41; motivation 41; ordeal therapy team 158
42, 159; pretend 42 Timing 69 – 70
Strategic Family Therapy (Mental Titanic 66
Research Institute) 35 – 41; triangulation 47
assumptions 57 – 62; direct
interventions 39; indirect utilization 57
interventions 39 – 41; metaphor 39;
practices 41; reframe 43; role of vague (de Shazer) 80
therapist 41; symptoms are messages vague responses Solution-Focused
in the system 41; symptoms as Brief Therapy 65
metaphor 42; tasks 41 violence 27
Structural Family Therapy 29 – 35; goals Virgin Suicides 6
32 – 33; practices 34 – 35; problems
as embedded in structures 34; Wampold 93
raising intensity 35; Role of the Watzlawick 22, 36, 53, 85
Therapist 33; rules and roles 8 – 9; Weakland 36, 53, 54
tasks 34; unbalancing 35 wholeness 2 – 4, 85

215