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Brief Problem-Focused Therapy

Brief problem-focused therapy had its beginnings at the Mental Research Institute in Palo Alto, California. In 1966, Richard Fisch opened the Brief Therapy Center with the express purpose of finding what therapeutic results could occur in a period of a maximum of 10 one-hour sessions. These sessions focused on the main presenting problem, used active techniques to promote change, and searched for the minimum change required to resolve the problem (R. Lewis, 2005). The therapeutic goal was on resolving the presenting problem as it occurs between people with emphasis placed on change and outcomes, not knowledge, insight, or other such concerns. It was assumed that change would be easier if people did something differently.

According to Fisch, Weakland, and Segal (1982), clients come to therapy for the following reasons: (a) Clients are concerned about behavior, actions, thoughts, or feelings of themselves or someone with whom they are involved; (b) clients describe the problem as deviant in the sense of being unusual or inappropriate; (c) clients' efforts to stop or change the behavior have been unsuccessful; and (d) clients seek professional help as they have not been able to make changes on their own. Clients want change, but the problem formation and problem maintenance form a vicious circle leaving them stuck. In fact, the clients' misinterpretation of ordinary life difficulties and their unsuccessful attempts at a solution often aggravate the problem. On the basis of these assumptions, the therapeutic goals for the brief problem-focused therapy approach are to interrupt this vicious circle and initiate resolution of the problem by assessing where clients are stuck, what they are doing to get unstuck, and to stop them from doing what they see as logical or necessary (Fisch, 1990). Reframing – the infusion of new meaning into a situation – is a technique often used in this initial process.

During the initial stages of treatment, assessment, via data gathering, is very important. The counselor or therapist, being persistent, firm, and polite and working within the client's position, language, and values, attempts to answer the following questions:

• What is the essential complaint, to whom does it belong, who is doing what that presents a problem to whom, and why does such behavior constitute a problem?

• What solutions have been attempted to solve the problem?

• What are the client's minimal goals, and how will he or she evaluate the achievement of these goals?

• Who is most invested in change?

According to Fisch et al. (1982), it is important that counselors or therapists keep their options open and avoid taking positions prematurely. It is important to take time and encourage clients to be specific in committing to a position. Counselors or therapists need to take a one-down position and put clients at ease by asking for their assistance. It is also important to determine who is most discomforted by the problem, the clients or other persons.

Because the solutions attempted by clients maintain and perpetuate the problem, interventions are directed toward helping clients depart from these solutions either by stopping the problem-maintaining behavior or by altering the clients' view of the problem so that it is no longer viewed as a problem. Counselors or therapists, using this approach, view problems arising from the following five basic solutions that clients tend to maintain: (a) attempting to force something that can occur spontaneously; (b) attempting to master a feared event by postponing it; (c) attempting to reach accord through opposition; (d) attempting to attain compliance through volunteerism; and (e) confirming the accuser's suspicions by defending self.

Other interventions include (a) "going slow," directed at clients whose main solution is trying too hard; (b) recognizing the dangers in resolving the problem too quickly; (c) making a "U-turn" or going in an opposite direction because the strategy being used is not working; and (d) continuing the ineffective approach at arriving at solutions. This is used with clients who are having difficulty changing what they are doing (Fisch et al., 1982). Termination is done without fanfare and includes assessing goals in a cautious way.

 
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