Book Review
Psychotherapy
Beyond Technique in Solution Focused Therapy. Eve Lipchik. New York: Guilford Press; 2002. 213 p. US$33.00.
Reviewer
rating*: Good
Review by: Llewellyn W Joseph, MD, FRCPC
Toronto, Ontario
Among the new approaches to therapy that developed from the 1950s to the 1970s was the client-centred approach. In it, the client–therapist relationship was marked by complete acceptance of the client—by finding congruence with the client to collaborate toward a solution. Solution-focused therapy (SFT) is a client-centred therapy marked by confidence and faith in clients’ abilities to find solutions to their problems. It focuses not on problems but on client strengths and resources to build a cooperative relationship and negotiate goals.
SFT was founded by Insoo Kim Berg and Steve de Shazier at the Brief Family Therapy Centre in Milwaukee. Partly based on the work of Milton Erickson, Gregory Bateson, Don Jackson, and Paul Watzlawick, among others, it has developed significantly over the years and is widely used in various counselling situations, including company employee assistance plans (EAP) and university and college mental health clinics in North America and the UK.
In this book’s preface, the author observes that SFT has gone on to become “world famous but often misunderstood and even trivialized,” mainly because of “an overemphasis on the techniques and the loss of the theoretical framework.” Her aim in writing is to “restore an interactional context to the techniques.”
It is essential for clients to feel that their therapist is listening and trying to understand. Over years of clinical practice, the author came to see that addressing emotions often enabled clients who were stuck to move forward. Therapy is both a humanistic (love-emoted) and a technical endeavour, but integrating these 2 elements poses a challenge for the SFT therapist.
The book falls into 2 major sections, titled “Theories and Practice” and “Applications.” The initial section’s first 4 chapters are foundational, addressing the author’s proposed theory of SFT, the client–therapist relationship, the importance of understanding the client, and the role of emotions in SFT. In Chapter 1, “A Theory of Solution-Focused Therapy,” the author presents the theoretical underpinnings of her view of SFT. It emphases the genetic and social development of human beings that, along with inter- personal interaction, determines their capacity to change. It sees problems as present-life situations that produce intrapersonal or interpersonal discomfort. It sees change as occurring “through language when recognition of exceptions and existing and potential strengths create new actions.” Following from this are the author’s 11 basic assumptions for SFT. Some of these are self-evident—for example, “everyone is unique,” and “nothing is all negative.” Others more specific to SFT include “there’s no such thing as resistance,” “there’s no cause and effect,” and “solutions do not necessarily have anything to do with the problem.” The theoretical or evidentiary basis for these assumptions is limited (from the point of view of research) and not systematically presented, even in the case of the author’s experience.
In a “Historical Detour,” the author describes her main influences: the ecosystems theory of the family, which implies that the family as a self supporting system contains its own solutions to problems arising within the system; the interpersonal theory of Harry Stack Sullivan; and the ideas of Humberto Maturama and Francisco Varola, including their cognitive theory suggesting that “our reality depends on who we are in terms of our structure, as well as our interactions with others,” along with the idea that living systems are autopoietic (that is, organized to survive and recreate themselves). As a solution-focused therapist, the author finds 2 of Maturama’s and Varola’s ideas most attractive: first, that “survival and adaptation is an interdependent process between living systems that is based on conserving what these interdependent living systems need to survive independently”; and second, that “we cannot know or act without biological dynamics we call emotions.” I was disappointed, however, that this chapter did not provide more evidentiary basis from research and clinical experience for the less self- evident assumptions.
The next 2 chapters mainly emphasize and demonstrate that the use of the interpersonal relationships and attending to emotions actually facilitate helping the client arrive at solutions. The remaining 2 chapters focus on the process within a session of SFT, from the initial clarifying of goals to the summation message and suggestions.
There is generous use of clinical case material to illustrate common errors SFT therapists make and to suggest more therapeutically appropriate approaches, followed in some cases by a summary message. The voice is that of a confident, experienced therapist relying at least as much on her experience as on any relevant research. The style is conversational—more like a seminar than a lecture.
The second section, “Applications,” comprises 5 chapters on the various therapy formats to which SFT may be adapted, including couples therapy, family therapy, treatment of involuntary patients, and crisis situations.
I found the chapter “Working with Involuntary Clients” to be most interesting. In several cases, the author both demonstrates and discusses how the therapist achieves cooperation with uncooperative patients mandated to therapy by their superiors or by various legal systems. One suggestion is to cooperate with the person, not with the sanctioned behaviour. In addition, an ecosystems perspective becomes particularly important in such situations.
The book ends with 3 paragraphs of “Final Thoughts” summarizing the book’s purpose: to “steer clinicians away from the arbitrary use of technique” and to “stimulate the reader to think about why they do what they do when they talk to clients.” We all should do that all the time!
This book reflects the confident voice of a wise therapist calling practitioners back to the basics of therapy. It is written in a form and language that is easy to follow and understand, with generous use of illustrative case material. It reflects a journey of rediscovery for the writer and calls errant SFT practitioners back to the core principles of psychotherapy—points I often wish to make myself! Therapy is about voluntary beneficial change. Emotions are the key to the process. Emotions indicate the salience of an issue. As well, they create the readiness to change.
This book is worth the price.
*Reviewer
Rating Scale/ Échelle d’évaluation du réviseur
Excellent / Excellent
Very Good / Très bon
Good / Bon
Fair / Passable
Not recommended / Pas recommandé
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