How therapists can initiate change without really trying

Hello, would you like to introduce yourself and tell us a bit about Change?  

Hi, my name is Josephine and I'm a counsellor at Change. Change is a counselling agency that has delivered Solution Focused Brief Therapy (SFBT) and training in SFBT to anyone since 1991. It is based in inner city Birmingham and over the years has been contracted to deliver free therapy within IAPT, to individuals who may be suicidal from the MIND crisis helpline, to pupils in schools and self-referees. It is the only uniquely solution-focused agency commissioned by the NHS. Our six-week follow-up research shows continued recovery after an average of 2.2 sessions.

Why did you decide to become a solution focused counsellor? 

I discovered solution focused therapy while I was studying therapeutic counselling at college, and I was struck immediately by how empowering it felt to use this approach; both for myself and for the person speaking with me. From that first session onwards, I wanted to learn more, so that I could practise solution focused therapy in a way that fits perfectly with other types of counselling. 

Tell me about your journey to being a counsellor at Change? 

My motivation to train at Change is inextricably linked with my reason to become a therapist. In 2015 I attended the inquest of a young man who had died on the rail-tracks. I listened as his GP described his final appointment; he had seemed happy, he was clean and tidy, and his mental health seemed stable. She gave him a repeat prescription for his SSRI and asked him if he would like to talk to a counsellor, which he declined. As I heard the GP say this I thought, 'well why would he want to see a counsellor?' Also, it was clear to me that though everyone had tried to help, nothing had helped.

My head was full of questions; why didn't it help? And would counselling have made a difference? As I sat in the Coroner's court I resolved to get a real understanding of how, despite so many systems being involved in his care, his family had felt powerless and side-lined, unable to stop this tragedy. I too felt powerless, so I decided that I would become the sort of counsellor a young man such as this would want to talk to. 

I began by doing a few courses on mental health to gain some understanding of the law, and how mental health systems work, then I began to study humanistic counselling modalities at college. And two years later, I started training in solution focused therapy at Change Birmingham Brief Therapy. Now, six years later, I am just about to finish my BTEC Level 5 Diploma in Therapeutic Counselling, having completed my training at Change two years ago. 

What was the most significant difference in the training you received at Change compared to your training at college? 

At Change, the training differed from my BACP approved course in a significant way that made a crucial difference to my client work.

Though an understanding of the theoretical and philosophical differences between modalities of therapy is vital, SF is a very practical art and skill. At Change, as part of the diploma course, a student goes into their placement with a trained solution focused therapist as their mentor. It was my privilege to watch and learn from a therapist directly; to be in the sessions as she worked with clients, and then to have her support as I began to practise as a therapist myself.  

What makes the therapy at Change different from other types of therapy, and how does solution focused therapy work? 

The simple answer is that the people in the therapy room - it doesn't have to be one person, we work with families, couples friends - use the session time to explore how a situation that at first appears to be so painful and seemingly impossible to deal with, can transform into something manageable, or into something else everyone prefers!  

In a session, a description of what has happened to cause the person to seek therapy is important. But at Change we see problems as containing clues about how things can be different for people; we see problems as bridges instead of blocks.

A solution focused therapist regards the causes, faults or errors that may be part of a person's distress as less significant than the moments when that distress is reduced by something. We enact this understanding as we create a sense of cooperation and collaboration. Instead of drawing a person's attention to their 'stuck' feelings, we signify in our use of language that the problem is the problem, not the person.  

Our interventions are questions, and we use questions to direct a person's attention towards speculation; asking what they might prefer to be happening instead of the problem, and creating a heightened awareness of their agency through questions about cause and effect, such as 'how did you make that something happen?' Though we are directing a person's attention when we ask questions, we are careful to work within the client's ascribed meanings and values; within their language, and within the context of what they hope to get from therapy. 

So you give people the solutions! 

We don't give solutions even though solution is in the name. But no, we enable people to recognise their own solutions. 

I see solution focused therapy as an art based on science. SFBT is based on sound counselling theory - that for therapy to take place a person needs to feel understood; their choices respected and to feel fundamentally safe; and then we add a bit of neurobiology.  

It has been shown through medical imagining that when people imagine something happening, there are slight physical responses in the body, in accord with the imagined reality. Obviously, these responses are small, but they occur. More importantly, whatever we imagine becomes slightly easier to do.

So as a therapist I ask people questions about what better will look like for them; and I seek the small and practical details that help make that imagined reality more real; I ask about what they will be doing and what is happening. This is a powerful intervention because we build upon a person's memories of their real life, their everyday experiences.

Despite our signature intervention being called 'The Miracle Question', we do not ask someone to create a fantasy, or to retreat from the boring and frustrating realities of their ordinary day to day. On the day after the 'miracle happens' if it is normal for the car park to be full, and for you to end up parking miles away, and then to arrive late for work and have to listen to your boss making sarcastic comments; that won't change - it may even be worse! But if something about you had resolved while you were asleep (that's the miracle), and you found that actually you were doing OK, or more than OK - what would tell you? How will you know, what small thing might you, or someone else notice? 

While talking about a person's hopes is a vital part of our approach, it isn't all that we do. People often want to talk about things that seem totally unrelated to their problems. Yet within their words I hear evidence of their skills and courage despite all that is going on in their lives right now.

Listening as a person speaks about their love of buying shoes, or playing the mandolin may become important in helping them to consolidate a fragile identity after a crisis. Taking that feeling seriously, hearing a rich description of what joy feels like for them helps forge a sense of companionship for the journey. Solution focused conversations lead to people feeling safe and able to find hope and possibility. This makes a solution focused session a positive and affirming experience for our clients, and for the therapist!  

OK, thank you - it sounds good! 

I honestly think it is -  thank you for asking me the questions. I hope this makes it a bit easier to understand what we do! 

If you wish to know more about change and what we do, the website is the place to go: www.changebrieftherapy.org

 

Clive Whittaker MA BSc is Psych graduate of the seventies who taught inner city secondary Biology for 25 years before taking a Masters in Counselling and finding a placement at Change 25 years ago. He is the clinical lead and a director of Change, Team leader of the staff counselling service at University Hospitals Birmingham, Vice chair of the Birmingham mental health collective of over 120 charitable organisations and an accreditor of SFBT for UKASFP. 

X / Twitter: @ChangeBbt  /  @clive_whittaker