Abstract
Non-expert stance or “not-knowing” position plays important role in postmodern/ poststructuralist therapies (Tarragona, 2008) and at the same time many misunderstandings and potential pitfalls for therapeutic practice arose with this concept. This paper examines “knowledge” in therapeutic conversations from the perspective of one of the postmodern therapies – Solution-Focused Brief Therapy. After an introduction to the Solution-Focused Brief Therapy and its principles, attention is given to process and content related expertise and the solution-focused therapist’s positioning in conversations. The next section describes a model, called the Pie of Inspiration, which allows for reflecting on different sources of knowledge and inviting them into the solution-focused therapeutic conversation. The application of the model is illustrated through some case examples and an activity for working with children which is called Klondike.
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The traditional way of understanding therapy presupposes that some people (clients) need help with something in their lives (problems) and visit some expert (therapist) who can help them with some meaningful changes in their lives (solution). This view implicitly assumes that clients are not experts because they need some expertise from therapists. This assumption can go even further when therapists believe they can understand clients and their lives better, more precisely, or deeper than the clients themselves. Sometimes clients expect therapists to be experts in their lives too. Postmodern/ poststructuralist therapies like solution-focused, narrative or collaborative therapy question this assumption heavily (Tarragona, 2008). They all emphasize the expertise of clients and non-expert stance of therapists, local knowledge (in opposite to global one), learning from clients, cooperation and partnership, and transparency (Anderson & Gehart, 2006; De Jong & Berg, 2012; Tarragona, 2008; White & Morgan, 2006). On the other hand, many misunderstandings and muddles evolved around this issue – therapists for example sometimes pretend “not-knowing” in sessions, refuse to share their point of view, or think they are not allowed to give any advice to clients in any situation etc. (Anderson, 2005; Guterman, 2014). For example, one seasoned solution-focused therapist suggested that “one would not see a solution-focused therapist giving advice” and Insoo Kim Berg, one of the founders of the approach, replied, “What? You mean if you know something that would help the client, you wouldn’t tell them?” (de Shazer et al., 2007, s. 155). Authors then continue with the notion that the assumption that solution-focused therapist never offers ideas, suggestions, or alternatives during therapeutic conversation is not necessarily the case (de Shazer et al., 2007).
Misunderstandings about “not-knowing” and about utilizing different sources of knowledge in therapeutic conversations may lead to serious consequences like working alliance raptures (Norcross, 2011), missing possibilities and resources, overemphasizing techniques (e.g. questions), lack of transparency, or therapists’ resignation on doing post-modern therapy any more. This article aims to offer more possibilities for how to generate potentially useful conversations, which utilize different sources of knowledge to expand opportunities for change and at the same time build on the client´s expertise and maintain partnership and transparency in the therapeutic relationship with clients.
Although the postmodern view is shared by all postmodern therapies, each of them emphasizes slightly different aspects of it and works with different assumptions and methods. I will focus particularly on solution-focused brief therapy (SFBT) in this article knowing that some perspectives will apply to other postmodern therapies as well and some of them will be rather specific to SFBT. This therapeutic approach and its view on knowledge and expertise will be presented first. “Pie of inspiration” - a model for inviting different “voices” into the conversation and organizing them - follows with some practical hints.
Solution-Focused Brief Therapy and Constructive Curiosity
The Solution-Focused Brief Therapy (SFBT) is one of the systems of psychotherapy rooted in family therapy (Becvar & Becvar, 2012; Kaslow, 2000; Prochaska & Norcross, 2018; Sharf, 1995; Sommers-Flanagan & Sommers-Flanagan, 2012). Its roots can be traced back to the work of the MRI Institute in Palo Alto, and to the late Milton H. Erickson (de Shazer, 1985) and it evolved out of the clinical practice of Steve de Shazer, Insoo Kim Berg, and colleagues at the Brief Family Therapy Center in Milwaukee, Wisconsin, in the early 1980s (de Shazer et al., 2007). SFBT is grounded in postmodern philosophy (constructivism and social constructionism) and in late Wittgensteinian philosophy (de Shazer, 1994; de Shazer et al., 2007), and is considered as one of the postmodern/ poststructuralist therapeutic approaches together with narrative and collaborative therapy (Tarragona, 2008). However, as its authors clearly state, SFBT “is not theory based, but was pragmatically developed” (De Shazer et al., 2007, p. 1). Thus, neither theory nor specific techniques can define this approach and distinguish it from other approaches. Rather, this distinction can be accomplished by exploring the set of principles or tenets which “serve as the guidelines for the practice of SFBT, and that both inform and characterize this approach” (De Shazer et al., 2007, p. 1).
There are many lists of basic tenets of SFBT available (Berg & Miller, 1992; de Shazer et al., 2007; Lipchik, 2002; O’Hanlon & Weiner-Davis, 2003). They can be summarized in my own list using the simple acronym CHANGE (see the Table 1).
The tenets of SFBT mentioned above are not strictly separated; rather, they overlap and are often manifested together in SFBT sessions. The next part of the article will focus mostly on the principle of “not-knowing”, but it is important to bear in mind all principles together.
One of the therapist’s basic attitudes when working with clients is referred to in SFBT as the “not-knowing” attitude, or the “beginner’s mind” (Bannink, 2010; De Jong & Berg, 2012). Both terms refer to the therapist’s ability to put aside his/her preconceptions, theories, prejudices, or evaluation categories, and to approach the client with an open mind and genuinely listen to what he/she is saying. Harlene Anderson, who has established the notion of the attitude of “not-knowing” in psychotherapy, associates it with the ability to hear the new, not expected, and unique (Anderson, 1997). Because both concepts can be confused with some incompetence of the therapist (“non-knowledge” or lack of experience of “beginners”) and lead to misunderstandings (Anderson, 2005), I prefer to talk about “constructive curiosity.” I was inspired by Walter and Peller, former members of the BFTC, who later contributed to a deeper connection between SFBT and postmodern philosophy. They state: “We try to be curious and open as a five-year-old, as if everything were and could be brand new” (Peller & Walter, 2000, p. 37). Authors coined a term “curiosity with the client,” or simply “curiosity with”: i.e., curiosity not only of the therapist or the client, but shared curiosity (Peller & Walter, 2000). The authors distinguish this form of curiosity from “curiosity about,” which leads to the therapist being curious about something that corresponds to his/her theories. From my point of view, the distinction between the two forms is even more subtle. I do not think that the therapist should completely give up any “direction” or “conducting” of the interview (see the principle of process expertise mentioned above); but rather, that the therapist should reflect on when their curiosity aligns with the client’s (being curious together develops dialogue and “curiosity with the client”), and when their curiosities focus in different directions and are not shared (in which case it is up to the therapist to prioritize connecting to the client over any professional “agenda”).
In addition, curiosity is called to be “constructive”. This is simply a curiosity or interest that has “constructive” effects, meaning that it co-constructs something new and valuable for the client. The attitude of constructive curiosity helps to postpone the therapist’s own pre-understanding, and at the same time to express his/her interest in the client and their view of the situation relatively clearly. This can develop new perspectives and discoveries of the client and open up space for the desired change. This stance can be associated with positive affect, playfulness, and thus with creativity in the conversation (Morgan & Wampler, 2003). One of the key elements of any consultation with people is to balance out the emphasis on developing change and an emphasis on understanding the client and validating the client’s experience or acceptance of it (De Jong & Berg, 2012; Lipchik, 2002; O’Hanlon & Weiner-Davis, 2003). Understanding is the therapist’s ongoing ability to perceive the client’s perspective, to the extent that they are able to create change or solutions together. Hence, it is not an “absolute” understanding, which is impossible from postmodern epistemology point of view, but a degree of sharing of the social world in conversation that allows solutions to be developed (de Shazer, 1991; Shazer, 1994). Inseparably paired with understanding is the notion of validation, which involves the continuous acceptance of the client as he/she is, as well as his/her view of things as he/she is. Thus, validation does neither require the therapist’s consent with client’s view nor the therapist’s “confirmation” of the “objectivity” or “truth” of what the client states (De Jong & Berg, 2012).
Many years of research on working alliance in psychotherapy – one of the most important factors of therapeutic change – show the importance of this attitude (Duncan et al., 2010; Norcross, 2011). Even in cases where the therapist fundamentally disagrees with the client’s perspective or sees obvious inconsistencies in it, the therapist’s attempts to somehow confront client’s perspective or provide some critical, pejorative, hostile, reluctant, accusing or ridiculing comments are mostly counterproductive (Norcross, 2011). On the contrary, support, validation, understanding, and finding new possibilities show a high degree of effectiveness, even in a small number of sessions (Norcross, 2011).
These very basic elements of joining the client based on “not-knowing” or constructive curiosity stance, careful listening, understanding the clients and validating them, were sometimes neglected in SFBT publications and trainings (Lipchik, 2002, 2018). It was probably because of a fascination with new techniques and methods developed in SFBT, and also because they were elements that the founders of this approach took for granted and did not feel the need to emphasize (Lipchik, 2002). Nevertheless, this “joining” with the client and collaborative therapeutic relationship is the foundation of SFBT, without which it is not possible to meaningfully co-create solutions (Berg, 1994; de Shazer, 1989; Lipchik, 2002).
The Position of the Therapists and Their Knowledge in SFBT
When Anderson (1997) encourages therapists to put aside their knowledge in a conversation with clients, she justifies this by saying that the therapist will then be able to hear what the client brings to the conversation: i.e., what is unique and special. This creates local knowledge as opposed to universal knowledge (Anderson, 1997; Peller & Walter, 2000). In the unique and special that manifests itself in local knowledge, it is easier to see the client’s resources that can be used in the process of change (Keeney & Keeney, 2013). At the same time, the whole work with the client becomes individualized, and the relationship between the therapist and the client takes the form of a partnership, rather than a dependent relationship towards authority (i.e. the therapist as an expert on client’s life). This is connected particularly with the principles of cooperation, honoring individuality, and growing of solutions mentioned above.
In terms of a solution-oriented approach, two main forms of “knowledge” or “expertise” are distinguished: expertise on content and expertise on process (Berg & Miller, 1992; De Jong & Berg, 2012; de Shazer et al., 2007; Guterman, 2014). While process refers to what therapists do to facilitate change (e.g., methods, techniques), content refers to the objects of change in any given clinical theory (Guterman, 2014). Content-related expertise thus refers to the life of the client and meanings of life events etc. Clients can describe different problem situations (fear of the dark, relationship problems, eating disorders, etc.), they can mention different professional or “folk” classifications of problems (e.g., depression, low self-esteem, lack of communication, anorexia), or various professional concepts (system, boundaries, cognitive scheme, self-actualization, projection, etc.); or they can describe various previous attempts to solve the situation (e.g., “I tried to reprogram the thinking,” “I practiced meditation”). In all these areas, therapists can also think of many things based on their own experience, the experience of their other clients, professional literature, etc. All these ideas can be classified as expertise on content, led by the question “what?”, when exploring topics that the client somehow mentions.
Another type of expertise is process-related expertise, which is connected with asking “how?”. In this case, the therapist’s knowledge concerns how to conduct a helping conversation. This knowledge is again based on expertise, training and experience with clients, and each therapeutic or counseling approach offers its own systems of knowledge on how to lead the process of change in consultation. In SFBT, process expertise mainly involves how to join the clients and develop cooperation (a therapeutic relationship) with them; how to collaboratively set direction of their work together with clients (a preferred future); and how to help the client use the resources available to move towards his/her desired change (De Jong & Berg, 2012).
The way in which therapists handle their expertise in content and process has a great influence on the course of cooperation with clients. The above-mentioned attitude of “not-knowing” or “constructive curiosity” referred to the therapist’s ability to put aside his/her knowledge of content (content expertise) in order to enhance local “knowledge” formed together with the client, including his or her unique resources.
During close observing of SFBT therapeutic sessions one can notice that SFBT therapists usually occupy a certain “conversational position”Footnote 1, in which they try to lead the client’s ability to develop a solution with as little therapist’s content expertise as possible. Narrative therapy author Michael White distinguishes the four positions of a therapist in a conversation, according to whether he/she has an influence and is at the “center” of therapy or is “de-centred” (White & Morgan, 2006). I put it in the simple scheme inspired by this typology and White’s own scheme (see Fig. 1). This scheme may be useful for reflecting on the therapist’s position and particularly reflecting on content and process expertise of therapist.
Therapist’s positions (based on White & Morgan (2006))
Presented scheme clearly shows that the therapists should move in the upper half of the scheme, i.e., in the area where they have some influence. If therapists had no influence on the conversation and the process of change, it would be useless for the client to go to them for consultations. If the therapists find themself in a situation during the conversation where they have no influence on the process of change (i.e., they don’t contribute to the desired change at all), they should reflect on this fact and take some steps to make themselves again beneficial for the client. Routine outcome monitoring or feedback from clients play a crucial role here as well as supervision and deliberate practice of therapists (Miller et al., 2020; Prescott et al., 2017).
The second dimension of White’s scheme shows whether the therapist is in a central or decentralized position in the process of change. If the therapist is in the imaginary “center” of therapy, then he/she is the main actor of change. The therapist’s experience and knowledge are also privileged in this position, while the fact that the client is an expert on their life is neglected and their “voice” is less audible (Anderson, 1997; Peller & Walter, 2000; White & Morgan, 2006). This position corresponds to a certain cultural image of psychotherapy: the therapist is often perceived as an expert on how to arrange change and how to conduct “the right intervention” (whether in the form of advice, questions, interpretations, or other techniques), and as the most important factor in the process of change. If the intervention “does not work,” the therapist remains at the center, but at the same time loses influence and may be held accountable and blamed for failure. If, on the contrary, the intervention of the therapist occupying a central position is effective, the therapist becomes the main “hero” in the process of change. However, this is associated with the fact that the client automatically takes the position of someone who is not competent, someone who has a deficit and needs support. Client’s knowledge is neglected as well in such case. In this context, it is interesting that psychotherapy research shows the vital importance of client resources and client participation in the process of change; thus, the therapist should strive to make the client the main “hero” of therapy not himself (Duncan et al., 2004, 2010).
The preferred position of a therapist using SFBT is (similarly to the narrative approach) in the quadrant of influence associated with decentralization, where the main “hero” of the whole process is the client, whose role in the change process is emphasized more than the therapist’s. Therefore, SFBT usually places great importance on expertise regarding the process, which is knowledge of procedures and conversational tools and the ways how to contextualize them to the sessions so that they allow the clients to develop the change they want and be the main figures of this change. Content-related expertise can very easily place a therapist at the center of events (due to their “knowledge”) and weaken the client’s competencies. By contrast, expertise in the process allows the therapist to find creative ways to enable the client’s unique way of creating change (Lipchik, 2018).
These ideas suggest it may be inadmissible in SFBT to have or show any content-related expertise. However, such a view is too simplified. In general, while SFBT prefers expertise to the process for the reasons given above, this does not mean that SFBT therapists should never come up with their own ideas and inspirations, or that they should not appear in a central position for a moment (de Shazer et al., 2007). Lipchik states: “I do not think we should provide information up front until we have tried to help clients find their own solutions. But when it seems evident that we have information clients lack, it can be offered in a respectful manner that allows for choices” (Lipchik, 2018, p. 86). Two complementary skills are essential in SFBT in this respect: the skill of being curious and not-knowing, as well as the skill of raising the therapist’s content ideas in respectful and useful ways, and with good timing. Paradoxically, trying to give up content-related expertise in some contexts may be a sign of the therapist’s insufficient flexibility and low levels of SFBT skills - similar to offering content-related expertise in a context where pure process expertise would be more useful.
In the following part of the article the focus will be on the ways of working with content-related expertise of not only the therapist, but also of various other people involved, in accordance with the principles of SFBT. This especially involves efforts to provide an individual approach, effectiveness (including the central position of the client in the change process), and process expertise (i.e., how to consult so that different perspectives can be utilized in conversations).
Playful ways of introducing different “voices” into conversation (Peller & Walter, 2000) can help to overcome the dilemma of content/process related to the expertise of the therapist. Conversation can be enriched by different perspectives including client’s own perspective as well as therapist’s perspective. There might be presented various perspectives like special “menu” for the client who can choose what makes sense to him or her (see case example 1).
Case Example 1: How should I feel?
I worked with a 25-year-old client who has been released from a psychiatric hospital after several years of hospitalization and has been working on getting back to “normal”. There have already been partial improvements (he got back to his studies on university, renewed some important relationships etc.), but in spite of that, at the third meeting he revisited the past and things he used to do that he is now retrospectively ashamed of.
C: How should I feel about what I have done?
T: (surprised) How should you feel about what you have done?
C: I mean…… should I feel ashamed or not?
T: Do you need to come with some reason or explanation or clarification or something else? (C continuously nods) Uhm… suppose You will get the explanation or clarification you need, what difference will it make?
C: Well, I somehow need to accept myself… I need to accept the fact that I did it ……well, I don’t know…that’s hard….
T: Let me do a little experiment… if we could ask someone whose perspective you value, who would it be?
C: A psychologist from the mental hospital.
T: If we could ask her this question - how should you feel about what you have done - what would she tell you?
C: I think she would tell me that I had experienced some trauma and that I wasn’t coping well.
T: And what is that like for you? What does that perspective bring to you with regard to accept yourself and accept the fact that you did it?
C: It sucks, but it’s like bearable….
T: And is there anyone else whose perspective you might find useful?
(we explored two more perspectives, one of his mother and one of his friend from hospital, then I asked if he would like to invite other perspectives)
C: Well… I’d be interested in some expert opinions.
T: Hmm, some experts might say that you have some genetic defect or some imbalance in your brain that just broke out in you at some point and it had to be managed somehow with pills and therapy and all that you’ve been through… does that make any sense? (C nods) Other equally reputable experts might say that you did it because at a certain stage in your life you were under a lot of stress, a lot of strain and your weak psyche couldn’t take it and the whole thing broke down and you were in a state where you couldn’t control your actions… (C nods continuously). And still some other experts would suggest a lot of different explanations including me. Would you like to hear my perspective?
C: (with lots of interest) Yeah, yeah, sure.
T: I would tell you for myself that I was very impressed that you came out of the worst of it (C: (surprised) Yeah? ), because I see a huge amount of work behind your progress, behind being on that scale at 6.5… you know you were at 0 half a year ago… so for me, when you ask me my opinion, I notice a lot of what you’ve done for yourself and I think that those things in that past that you’re ashamed of are part of your story, even if it doesn’t make you happy, of course… (C: Right), but there are other parts to the story that you seem to have stood up well to… your story is much more rich, it contains part which makes you ashamed but it also contains part which perhaps is worth to make you proud about yourself, about the work you have done….
C: Hmmm…yeah well….
T: When I offered various possible answers to your question, did it bring anything useful for you with regard to accept yourself and the fact that you did it all?
C: Well… it is hard to say now, it is not about saying yes or no to this… I guess it’s more important for me now to focus on getting back to normal and not to let anything like this happen again….
The “Pie of Inspiration” Model
SFBT therapist mainly tries to highlight the client’s resources, which are manifested, for example, in exceptions, changes between sessions, coping, confidence in change, or “small talk” (De Jong & Berg, 2012; de Shazer, 1985). All of these areas examine the client’s expertise in content, i.e., his/her knowledge related to their own life. The therapist, in the position of a process-related expert, offers such procedural elements, so that the clients can discover and develop these things in conversation and connect them to their preferred directions. The resources that the client has gained in this way in the past are the simplest and most empowering way to move forward. On the other hand, the client also has the resources to obtain new resources (new knowledge, skills, experience, motivation, etc.). Hence, these are not resources that are directly suitable for moving towards what clients want (preferred future), but resources that can be used so that they can learn something new. This means that the clients are not limited to what they already know, but can also draw from what they do not know yet, but are able to learn.
Tomasz Switek (personal communication) brought this question to my attention years ago. Taking advantage of his example in a slightly modified version, we can imagine a man who wants to climb Mt. Everest. The most valuable and easiest to use resources will be those based on his own experience (for instance, he can walk, climb, he knows how to use climbing equipment, he can keep his balance, he can work in a low-oxygen environment, he can handle sudden changes in temperature, he can read maps, he has money to path, has developed the strength of his arms and legs, and can speak different languages, etc.). In addition, the climber can obtain other resources, such as information from someone who has been in the Himalayas, or from professional publications; skills from professional courses and training, etc. Here the client must use his resources (contacts, money, ability to find information, etc.) in order to learn these new things and then use them as his own resources when he will climb the mountain.
Applying this metaphor to therapy we can say that situations that clients describe as a problems can usually also be described as “stuck” situations (Watzlawick et al., 1974), where clients themselves are unable to engage their resources either directly to create change (a solution), or to create the new resources they need to progress towards solution (de Shazer, 1991). Therefore, clients come for a consultation with the therapist to obtain these new resources and move on. Thanks to the “ripple effect”, i.e., the spreading of changes in systems (de Shazer, 1985), it is usually enough to use resources that are already available but not yet used, to achieve at least a small shift toward the preferred future, and the whole learning or resource spiral will start again. This is the most common process of change in SFBT consultations. In some cases, it may be appropriate to focus on the targeted acquisition of new resources that the client needs to develop but does not yet have available, and perhaps has no idea about them. In such cases, the resources they have at their disposal (money, time, current skills, motivation, etc.) can be used to create resources that they have not yet acquired (e.g., new skills). In such cases, the content-oriented expertise can help guide the client in a useful direction.
To find out where to look for “knowledge” directed to the client’s resources (content-related expertise) and where to find inspiration, I created a simple model, called the “Pie of Inspiration.” The model is partly inspired by the “Data situations circle” developed by Tomasz Switek (Switek, 2014). I chose the name “Pie of Inspiration” not only because of the shape of the scheme (see Fig. 2 below), but also because the best, like pies, is hidden in the middle; but the outer “crust,” also has its significance. This model can help therapists decide how to work with different types of knowledge and skills.
The Pie of Inspiration contains several levels (proceed from the inside out, numbers correspond with the numbers in the the Fig. 2):
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1)
Client’s experience. Direct client experience in which resources have manifested themselves (most often in the form of various forms of exceptions); this is something “evidence-based” (it has already happened and he/she has observed it), and resources can be directly sought within this experience.Footnote 2 This method is the most empowering for the client and offers the most natural connection of resources with the preferred future; therefore, it is most often used in SFBT.
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2)
Experience of significant others with the client. This is an experience (again in the form of various types of exceptions) that was captured by significant persons in the client’s environment. Again these are empirically verified situations, but can also be situations that the client overlooked and someone else noticed. If they are confirmed by the client, then they can serve as a reminder and be as empowering as the previous option. However, if the client does not identify with them, it will be more difficult to use them in the process of change.
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3)
Experience of the therapist with the client. These are situations that the therapist had the opportunity to observe directly, particularly during a session. Again there are exceptions that can be perceived as empirically verified, and a similar rule applies as with the previous variant: if accepted by the client, they can be very empowering; if not, they are of rather limited importance in the process of change.
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4)
Verified expertise. This is expertise that is carefully validated by research, mostly with people who resemble a client (research in the field of so-called “positive psychology” is especially useful in terms of finding resources (Snyder & Lopez, 2002). The advantage is that these ideas can lead the therapist and the client to areas where they would not think of looking for resources at all. The disadvantage is that this is generalized (global) knowledge based on research by people other than the client, and therefore cannot be completely relied on. It is questionable whether these ideas fit the client’s unique situation, and also the client’s motivation to try these ideas may be lower. Ideas of this type are most often provided by the therapist, but they can also come from the client or some important person around him.
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5)
Personal experiences of significant others. If a person close to the client has been through something similar, their experience of resources may be inspiring for the client and his/her situation. However, again this is an indirect inspiration, and given that it is verified by the personal experience of one individual, it is less likely to be relevant to the client than experience verified by more people (see the previous point).
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6)
Personal experiences of other clients. This is the experience of exceptions by other people who have some features in common with the client (e.g., in group therapy, from a self-help group, etc.). There is a very indirect link to the client’s life, but these experiences can point out interesting areas to look for resources.
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7)
The therapist’s own experience. If the therapist him/herself can offer something similar from their own life that is relevant to what the client is dealing with, it is also possible to point out potential resources in this way. However, this is a very indirect area, and focusing on their own experience can complicate the therapist’s attitude of therapeutic curiosity and constructive listening.
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8)
Verified hearsay experience. These are the stories of people who have tried to achieve similar changes as the client, which either the client or the therapist knows from hearsay, indirectly. These stories are valuable in that they still contain empirically validated experiences that can help to direct resources; however, the credibility of the stories is lower because it is not possible to accurately verify all their facts (which may have changed during the narration), or to ask questions. And this area is also very indirect.
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9)
Client’s (unverified) ideas. These are the client’s ideas regarding where resources could be found and what might work, but these ideas have not yet been verified in practice (there is no direct observation it works). Because these are the ideas of a client who knows the subtle nuances of his/her life, they can be relatively more likely to work; and most importantly, the client may be more likely to experiment with them than with someone else’s ideas. But we have to bear in mind there is no even anecdotical evidence of usefulness of those ideas.
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10)
Therapist’s (unverified) ideas. These are the therapist’s ideas which have not yet been empirically verified. However, thanks to the therapist’s knowledge of the client or topic, they may point to an interesting possibility for seeking resources. Limitations are similar to previous one.
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11)
Other clients’ (unverified) ideas. These are ideas of other clients (e.g., from a therapeutic group), which have not yet been empirically verified. However, thanks to their knowledge of the client or topic, they may point to an interesting place to look for resources.
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12)
(Unverified) ideas of significant others. These are the ideas of important people around the client, and again they are largely assumptions that are not based on any empirical experience. Moreover, they are ideas from people who know the client’s problem and potential resources less well than people with similar problems, and know therapeutic strategies mostly less than the therapist. Furthermore, these people can be the initiators of therapy, and clients then have the least motivation to try these ideas. Last but not least, it is often the case that these ideas have been tried before starting therapy and led to no success. These are all reasons why they these ideas are listed in penultimate place.
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13)
Stories, rumors, and thoughts. Various fiction stories, films, quotes, aphorisms, fables and other culturally shared ideas can be a source of inspiration, albeit a very indirect one.
There are many playful ways to work with the Pie of Inspiration. Basically, therapists should follow a few principles:
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Focus on resources. The model is focused only on searching for resources, not for eliciting explanations, views on problems, etc. Resources plays crucial role in the process of change in all psychotherapies (Duncan et al., 2010; Flückiger et al., 2009), and SFBT particularly pays very close attention to resources and their utilization in therapy (De Jong & Berg, 2012; de Shazer et al., 2007). The model allows client and therapist to search for available resources as well as potential ones (Flückiger et al., 2009). Suggestions and between sessions experiments (De Jong & Berg, 2012) can serve in developing new resources or activating available resources.
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Focus on different areas. Different areas (levels of the pie) can be explored with circular questions (e.g., “What would your mother say you have accomplished lately?”, “Do you know from experience anyone who has had a similar problem?”, etc.), or by offering one’s own perspective (“Would you be interested in any of my research ideas on this?”). In addition, various forms of experiments (De Jong & Berg, 2012) in which the client gathers different ideas from different areas can be very useful (e.g., collecting different perspectives). On the other hand, there is no need to address all areas of the model in each case, sometimes less is better and effectiveness or parsimony principle is to be applied (de Shazer et al., 2007).
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Always offer more alternatives. When offering or collecting ideas, it seems useful to us to always offer more alternatives than one (which implies there is only one correct answer) or two (which creates the dilemma of “either/or”). Hence, there should be at least three alternatives, which are not evaluated in advance.
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Let the client choose. Although some alternatives may seem better to the therapist than others, it is useful to let the client assess their suitability for his/her situation and, if necessary, choose what they want to try.
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Timing. When applying the therapist’s knowledge and ideas, it is important to work with timing as well. In particular, sharing one’s own ideas too early can unnecessarily weaken the client’s competence and creativity.
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Tentativity. The therapist’s ideas should be presented, if possible, in such a way that the client can relatively easily reject them if they are not relevant (de Shazer et al., 2007; Thomas & Nelson, 2007). This can sometimes be in contrast to the fact that clients may perceive the therapist as an “expert” or “authority.” It can be very tempting for a therapist to take on this role, but the risk must be considered that this will limit the client’s central position in the change process.
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Prefer indirectness. When therapist offers their own ideas and knowledge, I recommend prioritizing indirect options that maintain the therapist’s decentralized position and are easier to reject — such as reflective teams (Johnson et al., 1997), support groups, stories and anecdotes (BoVee-Akyurek et al., 2020), brainstormings (Furman & Ahola, 1992), etc.
Case Example 2: The Trembling Hand
At a long-term psychotherapy training session with about 15 participants, I was conducting a consultation with a client of about 50 years of age who complains of hand problems. I asked the participants in the training to form three teams and agreed with them and the client that one of them would be a reflective team (Johnson et al., 1997; Peller & Walter, 2000) and that the other two teams would be assigned a task during the consultation, depending on what emerged. The client described that he had worked in an automobile light manufacturing plant all his life. Two years ago, however, he developed severe tremors and progressively numbness in both hands. The client underwent various medical examinations, various forms of treatment, rehabilitation and spa stays. One hand has improved over time, so that he can perform normal tasks with it, but the other hand is not improving, it often shakes uncontrollably and the client cannot hold anything in it (for example, he is able to grasp a cup of tea in it, but is unable to carry it from the kitchen to the living room). He has consulted leading medical experts on hands in our country, but only one of them stated that he had already encountered one similar case, the others were not at all sure. As the doctors were at a loss, they concluded that the problem was “psychosomatic” and sent the client for therapy. Later in the session, he responded to questions focused on his preferred future by saying that he would like some ideas on what to do to make the hand work. When I explored what difference would it make if he got some good ideas, he responded by saying that he could find another job (he could not go back to manufacturing), that he could go on trips with his wife and children (he really liked to visit various historical sites and also enjoyed going to wellness centers with his family), and that he could take up swimming in the pool. During the consultation, we explored instances of the preferred future (situations where some of what he would like to see happen at least a little bit), things that have worked well in healing the other hand, what help the client cope, moments where the client does something helpful for his still ailing hand, and his confidence in change. I then went back to the trainees divided into teams, and together with the client we asked a second team to reflect on anything they had picked up that had worked for the client, and a third team to focus on various ideas of what else the client could try. I then asked the first team - reflecting team - for their reflections and offered the client to listen to the conversation of the team and if anything struck a chord, he could make a note of it or refer back to it on the recording (the consultation was recorded on the client’s mobile phone with his permission) and if anything was heard that wasn’t relevant, he could simply put it aside. When the team had finished, I asked the client if he felt like going back to something that was said and developing it in some way or if he would prefer the input of another team. The client took some notes and asked for another team to investigate what was already working. After this team finished their input, I asked again if there was anything he wanted to return to or if he wanted to continue straight on with a third team. The client asked for a third team, which offered various ideas, mostly based on what had died during the consultation or during previous reflections. I then asked the client again if there was anything he wanted to return to, if he had found any interesting inspirations. The client responded by saying that he felt he had heard many different ideas and that he would like to go back and think about it later. For example, he mentioned that he was approached with the idea of attending a few sessions of couples therapy where the clients would be him and his trembling hand. He was also surprised by one team’s observation that his hand visibly calmed down during the session as he described how much he enjoyed sightseeing with his family. He was also intrigued by the idea of approaching the doctor, who was the only one who had encountered a case similar to the client’s, to ask him if anything had helped the other patient. We ended the session with a conversation about what other perspectives the client would like to have, and the client made a small list of where he could find other interesting ideas. At the end of the session, he reported that he had not expected to get such a variety of interesting perspectives and that he had other ideas of what to try and where to possibly get even more inspiring perspectives, and that he believed that some of this would move him forward. It was agreed that if he needed another session he could book again, with the client stating that if he did book any further sessions, he would definitely welcome the three teams presence again.
In the above case, the Pie of inspiration model was used rather implicitly. Most space was devoted to the client’s experience (instances, confidence in change, coping), but there were also perceived changes in the session (calming of the hand tremor in some parts of the consultation) or ideas for using potential resources (e.g. a doctor who had already encountered a similar case, couples therapy with a trembling hand).
Another example of more explicit and structured practical work with different layers of the Pie of inspiration can be the “Klondike exercise,” which was adapted for working with children. Klondike is the name of a gold mining site and, figuratively speaking, refers to the possibility of getting rich quick. As part of the activity, therapist can invite the child and parents to play for a gold deposit, and tell stories about gold diggers and how difficult it is to find a gold deposit, how easy it is to overlook it, and how important it is to quickly capture and start mining… Then therapist can prepare a large paper (A3 or larger) and simple cards (cut paper into A5) with questions on different areas (e.g., “What do you think you have already done well?”, “What does your mother think that worked for you well?”, “What would your friend X say, what are you good at?”, “Do you know someone who solved something like you? What helped him? What would he advise you?”, “What is written in wise books about overcoming similar problems?”, etc.). I find it useful to create questions together with clients, in a tailor-made language and one that they understand. It is also worth considering whether to keep questions more general (“What are you good at?”) or more narrowly focused (“What are you good at in relation to what we are working on here?”). Some questions can be answered during a session (those that involve other people can be examined circularly); others the child can take home and find answers with the support of parents or other supporters (they can ask friends at school, relatives, teachers, therapists or other professionals who work with them, they can also search the Internet, use appropriate social networks, etc.). From all the question and answer cards, therapist and client can then compile a map of the site. Let the child paint the background and then glue the sheets of paper to the place of their choice on the big paper. Then they can focus on some area that the client chooses, and test in practice whether it was gold-bearing or not (i.e., whether the idea worked).
In Conclusion
Given the pitfalls and benefits of the therapists sharing their own knowledge and demonstrating their expertise on the content, I would like to conclude by offering some guidelines for communicating the therapist’s own ideas to the client in SFBT:
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Think about what benefits it brings to communicate your idea to a client and if those benefits outweigh continuing conversation with constructive curiosity stance.
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If you have a reflecting team (Johnson et al., 1997), let the ideas be sounded there, rather than in consultation with the therapist.
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When you decide to share your ideas, consider timing (when to share them) and always ask the client if they would like to hear your ideas.
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Be as concise as possible.
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Be constructive. When you talk about your ideas, focus on strengthening the client’s resources and offer something interesting and stimulating, such as new perspectives, indirect suggestions (BoVee-Akyurek et al., 2020), or constructive ideas.
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Open more possibilities. It is useful when the idea is not in the style of “this is the only right way to look at the situation or how to deal with it,” but rather that “it is possible to see it this way or another.” If you decide to offer your idea, don’t offer just one (suggesting there is only one right answer) or two (an either/or dilemma), but at least three.
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Take care to emphasize that this is your idea, and that it does not have to fit into the client’s situation at all.
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Try to present your idea as something that is on the same level as other ideas, not somehow better or more correct than the others due to the fact that you’re a professional therapist.
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Try to invite more perspectives or “voices” deliberately.
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Return to the client’s experience as soon as possible and ask how he/she sees it, then build on their perspective and their own ideas.
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If you have already shared your ideas in one consultation, consider sharing them for the second time, with a double caution and a third use with triples, etc. If you have exceeded number five, carefully consider whether you are still taking a solution-focused approach: you may find yourself doing something completely different! If this happens, congratulate yourself on being able to reflect on this, and decide how you want to proceed further.
Notes
Although the term „evidence-based“ perhaps associate modernist view of “objectivity” and “truth”, the term is used here in the sense of something which was observed or experienced. This kind of evidence plays important role in SFBT. Without it there makes no sense to do more of what works (de Shazer et al., 2007), or to offer (evidence-based) compliments (Ratner et al., 2012).
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Zatloukal, L. The Pie of Inspiration: Positioning the Therapist’s and Client’s Knowledge in Solution-Focused Brief Therapy. Contemp Fam Ther 46, 87–99 (2024). https://doi.org/10.1007/s10591-023-09663-y
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DOI: https://doi.org/10.1007/s10591-023-09663-y