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Solution Focused Brief Therapy (SFBT) The Missing Link Support Services Approach Borrowing from the considerable work done with children and families, as well as within adult mental health, I began trying to use Solution Focused Brief Therapy (de Shazer, 1985) with people who have autism and their carers. As mentioned above, the preliminary outcomes from initial case studies look very promising in a number of ways. Like other forms of therapy, Solution Focused Brief Therapy aims to focus on an individual’s preferred future (in other words where they want to be or what they would like their life to be like) and then gather the strategies and resources needed for the person to get there. This makes SFBT goal oriented and helps the therapist and client remain accountable for the direction their work takes. The essence of SFBT, (i.e. what makes it different from other types of therapy) is that the therapist needs to listen closely to hear the client’s theory of how change will happen for them. This requires a leap of faith from the therapist and a willingness to abandon academic theories of how behaviour change happens in favour of the client’s belief about how change will happen. Some people with autism appear unaware of how their behaviours affect others, and seem to prefer a belief that change happens randomly, or as a result of luck. For others, change is a complete mystery and something which in and of itself is undesirable. If this is ignored, as it might be if a therapist were following their theory of what should happen in therapy, the therapist and client will be at odds, with one working hard to affect change, and the other working perhaps even harder to see that everything stays the same. SFBT focuses on getting to know the person apart from the problem(s). There is a focus on existing resources rather than deficits and a view towards the present and the future rather than reviving a history of the problem. This often leads to discussions about the person’s area(s) of interest, such as trains, buildings or videos. Allowing time to talk about areas of particular interest seems to put the client more at ease, and generally uncovers a wealth of competencies, abilities and strengths which the therapist can highlight for the client. The hope is then that these strengths, abilities and competencies can eventually be applied to help the person attain steps towards their preferred future. In SFBT the therapist, who has set aside his or her professional view of what is wrong with the client (in intellectual terms the ‘formulation of the problem’), works together as an equal partner with the client to co-construct a view of what changes for the better would look like. Every bit of understanding is checked with the client in an effort to ensure the whole process is making sense. The therapist becomes the learner and the client becomes the teacher – teaching the therapist how things work in their world. The therapist is relieved of their expert stance of having to know all the answers, and takes on an even more intense role as a good listener. A sound knowledge base of academic theories of behaviour change is still helpful to the therapist (so those years of hard professional training have not been wasted!). Principles of reinforcement are applicable, some cognitive ability and memory skills are important, a degree of insight into one’s achievements and difficulties is helpful. A main difference in using this information within the context of SFBT is that they apply equally to therapist and to client as joint work is done. For example, a client with a poor memory needs a therapist who has a good one and who can hear within the client’s own story ways that have already worked to help him or her improve their memory for things that they want to remember. Insight into one’s own abilities and disabilities is as important for the therapist as it is for the client. In common with more traditional therapies, SFBT focuses on concrete observable measures of forward movement and sets targets which are measurable and make sense to the client. Principles of reinforcement are an integral part of the process, although these are more often internal events with the client rewarding him or herself. SFBT also requires both the therapist and the client to have some degree of memory and ability to attend during appointments. SFBT has been widely used with a variety of mental health issues, but it has not been tried extensively with people who have learning disabilities or autism. Over half of the psychology case load in Chorley and South Ribble consists of adults who have characteristics of Asperger’s Syndrome. The experiences of the therapist as well as the clients and carers are leading out work as we try to adapt the principles of SFBT for use with this population. |
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