All posts by johnsommersflanagan

Is Solution-Focused Therapy as Powerfully Effective as Solution-Focused Therapists Would Have Us Believe?

[This Blog is adapted from a previous blog posted on psychotherapy.net]

Solution-focused therapy is very popular. But is it effective?

Beginning in the 1980s, solution-focused therapy hit the mainstream and many mental health providers (and third-party payers) continue to sing the praises of its brevity and effectiveness. For example, in a 2009 book chapter Sara Smock claimed, “. . . there are numerous studies, several reviews of the research, and a few meta-analyses completed that showcase [solution-focused therapy’s] effectiveness.”

Really?

Solution-focused counseling and psychotherapy has deep roots in post-modern constructive theory. As Michael Hoyt once famously articulated, this perspective is based on “the construction that we are constructive.” In other words, solution-focused therapists believe clients and therapists build their own realities.

Ever since 2003, my personal construction of reality has been laced with skepticism. That was the year President George W. Bush included 63 references to “weapons of mass destruction” in his State of the Union address (I’m estimating here, using my own particular spin, but that’s the nature of a constructive perspective). As it turned out, there were no weapons of mass destruction, but President Bush’s “If I say it enough, it will become reality” message had a powerful effect on public perception.

From the constructive or solution-focused perspective, perception IS reality. Remember that. It applies to the solution-focused therapist’s view of solution-focused therapy effectiveness.

I recall hearing many presenters tell me that solution-focused therapy is powerful and effective. Or maybe it was powerfully effective. And I recall reading books and articles that similarly referred to the power and effectiveness of solution-focused therapy. Now we could just take their word for it, but I still can’t help but wonder: “What does the scientific research say about the efficacy of solution-focused therapy anyway?”

Here’s a quick historical tour of scientific reality.

  • In 1996, Scott Miller and colleagues noted: “In spite of having been around for ten years, no well-controlled, scientifically sound outcome studies on solution-focused therapy have ever been conducted or published in any peer-reviewed professional journal.”
  • In 2000, Gingerich & Eisengart identified 15 studies and after analyzing the research, they stated: “. . . we cannot conclude that [solution-focused brief therapy] has been shown to be efficacious.”
  • In 2008, Johnny Kim reported on 22 solution-focused outcomes studies. He noted that the only studies to show statistical significance were 12 studies focusing on internalizing disorders. Kim reported an effect size of d = .26 for these 12 studies [this is a rather small effect size].
  • In 2009, Jacqueline Corcoran and Vijayan Pillai concluded: “. . . practitioners should understand there is not a strong evidence basis for solution-focused therapy at this point in time.”

Now don’t get me wrong. As a mental health professional and professor, I believe solution-focused techniques and approaches can be very helpful . . . sometimes. However, my scientific training stops me from claiming that solution-focused approaches are highly effective. Although solution-focused techniques can be useful, psychotherapy often requires long term work that focuses not only on strengths, but problems as well.

So what’s the bottom line?

While in a heated argument with an umpire, Yogi Berra once said: “I wouldn’t have seen it if I hadn’t believed it!” This is, of course, an apt description of the powerful confirmation bias that affects everyone. We can’t help but look for evidence to support our pre-existing beliefs . . . which is one of the reasons why even modernist scientific research can’t always be trusted.  But this is why we bother doing the research. We need to step back from our constructed and enthusiastic realities and try to see things as objectively as possible, recognizing that absolute objectivity is impossible.

Despite strong beliefs to the contrary, there were no weapons of mass destruction. And currently, the evidence indicates that solution-focused therapy is NOT powerfully effective.

 

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The Classroom Swat (or Why I Don’t Believe in Spanking)

Mr. Carter was 6’2” and so I had to look up 14 inches to make glancing eye contact one last time before he said, “Grab your ankles.” Then I bent over. Then there was a loud pop. And then . . . the searing burn. 

It was my first and last classroom swat. I stood up quickly. I stuck out my chest and held my head high. I knew from watching the swat routine previously that it was all about the walk back to your seat. Don’t strut too much.  Don’t smile or Mr. Carter might call you back for an encore.  But keep your poise, don’t look defeated, and never, ever cry. 

My best friend Mark was next. When Mr. Carter told him to grab his ankles, Mark’s hands kept reflexively swinging back up to protect his backside.  And when it was over, he cried.  The whole class saw the tears rolling down his cheeks.  Mark flunked the humiliation test. His chin drooped as he walked back to his seat.

Mr. Carter was the biggest and coolest 6th grade teacher in my school.  My older sister thought he was the coolest dude on the planet; nearly everyone loved him.  He was the only African-American teacher in our school and one of the few men.  I remember him dropping an egg into a jar of coke in class; it was a quick science experiment.  And I remember his big smile.  

Part of me understands why Mr. Carter gave us all ‘the paddle’ that day. Eight of us boys were late coming in from recess.  We were in a big snowball fight and didn’t hear the bell.  We didn’t know recess was over until the playground was empty.  We sprinted to class while imagining our fate.

Mr. Carter’s swat made an impression on me. I’d never been late from recess before and I never was again.  I learned that the consequences for lateness were painful.  But I also learned that physical pain damages trust and that punishment can’t eliminate defiance.  I learned I could tolerate pain and feel scorn for the person causing me the pain.  I learned about the urge for revenge.  And I lost a little respect for Mr. Carter.

In my 25 years counseling adults and children, I’ve heard many reasons why parents hit their kids.  Some parents say: “It gets their attention” or “I only spank when I have to.”  Others tell me, “I believe in discipline” or they say “I spank because it works.”  And there’s my favorite of all: “I got spanked when I was a kid and I turned out just fine.”  It’s tempting, but I make a point of never arguing with adults when they tell me they turned out just fine.

The advantages of spanking or inflicting pain to control behavior are clear.  It’s quick.  Whether it’s Tabasco sauce on the tongue or an electric shock, pain captures your attention.  And most of the time, it suppresses the behavior it’s intended to suppress.  But research has repeatedly shown that corporal punishment is neither an effective or efficient behavior modifier. Maybe that’s why the famous psychologist B. F. Skinner was adamantly against punishment. Punishment, pain, or spanking is linked to more problems than solutions.

Estimates vary, but about 50% or more of parents still regularly use spanking as discipline.  Spanking is an American child-rearing tradition.  It’s quick and simple.  But the consequences are complex and longstanding.  Most of us recall when we were hit by our parents.  It’s hard to forget when you get hit by somebody way bigger than you are. Hitting kids almost always makes an impression.  Unfortunately, it’s an impression that’s neither healthy nor positive.  Parents can do better than to spank their kids. 

Years ago, Mr. Carter died.  I mourned his death.  Despite his paddle, he was a good man.  He taught me and others many important lessons about life.  But I still remember that swat and it spoils some of my memory of him.  I know it wasn’t necessary.  Mr. Carter could have sat down with the eight of us.  He could have looked us each in the eye.  He could have tried to understand our situation.  He could have let my friend Mark avoid humiliation.  He could have expressed his disappointment in us.  He could have had us stay in during the next recess.  He could have used many options that wouldn’t have increased my defiance and decreased my respect for him.  But he went for the quick solution. 

Discipline is about teaching and learning.  It requires patience and creativity.  Using pain as a discipline method was below Mr. Carter’s standards.  He was a creative and enthusiastic teacher; in the long run, he could have had an even more positive influence without hitting kids. And if he were alive to read this, I’m sure he’d never swat again.

 

Favorite Quotations: Clinical Interviewing – Chapter One

These are my favorite quotations from Chapter One. Unfortunately, I didn’t find one of my own:)

It is good to have an end to journey toward;

but it is the journey that matters, in the end.

—Ursula K. Le Guin, The Left Hand of Darkness

 

In his 1939 book The Wisdom of the Body, Walter Cannon {{3281 Cannon 1939;}} wrote:

When we consider the extreme instability of our bodily structure, its readiness for disturbance by the slightest application of external forces . . . its persistence through so many decades seems almost miraculous. The wonder increases when we realize that the system is open, engaging in free exchange with the outer world, and that the structure itself is not permanent, but is being continuously broken down by the wear and tear of action, and as continuously built up again by processes of repair. (p. 20)

 

Strupp and Binder {{324 Strupp 1984;}} gave to mental health professionals three decades ago: “ . . . the therapist should resist the compulsion to do something, especially at those times when he or she feels under pressure from the patient (and himself or herself) to intervene, perform, reassure, and so on” (p. 41).

 

About two decades ago, Phares (1988) concluded that the need for diagnosis before intervention is standard practice in psychology:

Intuitively, we all understand the purpose of diagnosis or assessment. Before physicians can prescribe, they must first understand the nature of the illness. Before plumbers begin banging on pipes, they must first determine the character and location of the difficulty. What is true in medicine and plumbing is equally true in clinical psychology. Aside from a few cases involving blind luck, our capacity to solve clinical problems is directly related to our skill in defining them. (p. 142)

 

As Strupp and Binder (1984) noted, “Recall an old Maine proverb: ‘One can seldom listen his [or her] way into trouble’ ” (p. 44).

How to Listen so Parents will Talk . . . Upcoming Conference Call Interview with The Practice Institute

Next Thursday, June 21, from 4-5pm Eastern time, I’ll be doing a conference call interview with Dr. Steven Walfish of The Practice Institute. The call will focus on how mental health professionals, school counselors, and others can work more effectively with parents and how parents can influence their children in positive ways. The cool thing is: It’s free! To sign up, go to: http://www.eventbrite.com/event/3657114528?ref=ecal

 

 

What Happens When You Store Your Gazebo Skeleton Under a Big Willow Tree

For years Rita has been wanting to transform a found six-sided gazebo skeleton into a real-live functioning gazebo. This has resulted in her gathering together six people at various points in time to move the gazebo skeleton from one location to another. Early this June, the bad news happened. Rita’s gazebo skeleton was crushed by a falling piece of a big willow tree.

The other bad news is that now Rita may have to depend on her husband with no particular construction skills to build her a gazebo. This could prove to be problematic because he was wanting to follow the designs of Theordore Reich and build an Orgone Accumulator (this sounds worse than it is).