Over the past 20 plus years, many Cognitive Behavioural Therapists who attend our training courses have commented how similar Solution Focused Brief Therapy is to the CBT model. I have usually responded with “mmmm….kind of…but Solution Focused working is much more client-owned and client-directed“.
CBT is often seen a so closely related to SFBT that at least three times a year we are commissioned by teams who have funding for CBT but prefer SFBT (which is great until it comes to Evaluation time and then all the good outcomes for clients is put firmly under the “CBT Evaluation” file which is frustrating) So, given that I have had a note on my “to do” list since 1998: “write an article on the differences between CBT and SFBT” there it has sat, yellowing no doubt, somewhere in a cupboard, somewhere in storage. Thirteen years on, I will attempt to explain:
Firstly, both models focus on behaviour change. But if we look closer at the structure and ethos of both models:
According to the Royal College of Psychiatrists:
The structure of a Cognitive Behavioural Therapy session:
With the therapist, you break each problem down into its separate parts. This will help you to identify your individual patterns of thoughts, emotions, bodily feelings and actions.
Together you will look at your thoughts, feelings and behaviours to work out:
- if they are unrealistic or unhelpful
- how they affect each other, and you.
- the therapist will then help you to work out how to change unhelpful thoughts and behaviours.
- It’s easy to talk about doing something, much harder to actually do it. So, after you have identified what you can change, your therapist will recommend ‘homework’ – you practise these changes in your everyday life. Depending on the situation, you might start to:
- question a self-critical or upsetting thought and replace it with a more helpful (and more realistic) one that you have developed in CBT
- recognise that you are about to do something that will make you feel worse and, instead, do something more helpful.
- At each meeting you discuss how you’ve got on since the last session. Your therapist can help with suggestions if any of the tasks seem too hard or don’t seem to be helping.
- They will not ask you to do things you don’t want to do – you decide the pace of the treatment and what you will and won’t try. The strength of CBT is that you can continue to practise and develop your skills even after the sessions have finished.
- This makes it less likely that your symptoms or problems will return.
The structure a of Solution Focused Brief Therapy session :
As the expert on your life and what you would consider the presenting issue, you will be asked by the therapist “how specifically can I help you today?” (although if you do not want to state this, we are perfectly comfortable with that too and we would offer you The Silent Session)
The therapist will ask you what is working for you now, what things in your life you do not want to change.
The therapist will ask you about times when you managed the problem differently or the problem did not exist and the therapist will explore those times with you.
The therapist will ask you about your preferred future, your goals, what it is you want.
The therapist, using various exercises, i.e. The Scaling Question, The Miracle Question etc, will ask you about times when you managed the problem differently or the problem did not exist – the therapist will be very interested in those times..
The therapist will invite you to visualise what will be different when you have achieved your desired change, goals, preferred future
You will be invited to set a task for yourself that reflects your mindset, lifestyle, culture, family culture, the unique minutia of how you live your life.
The therapist will also be curious about how you will deal with any setbacks that may occur on the journey towards change – “rehearsing for setbacks robs them of their destructive force”. (Steve deShazer)
What I admire most about SFBT is the principle that “the client is the expert of the client’s life” and the practitioner takes a stance of “not knowing” and of “curiosity” through solution-focused questioning and responding. This is essential, in my opinion, for sustainability of behaviour change or goal achievement or indeed to really benefit from just “thinking things through”.
I welcome discussion on this with Cognitive Behavioural Therapists and Solution Focused Practitioners – it will help those who wish to access a brief intervention make an informed decision.