2

For my two little miracles: My children, Bridget Haewon Kim and Shamus Joomin Kim.

For my biggest source of strength: My wife, Elizabeth McConville Kim.

For my biggest supporters: My parents, Dr. Chin Goo and In Sook Kim, and my brother, Charles Kim.

3
4
Copyright © 2014 by SAGE Publications, Inc.

All rights reserved. No part of this book may be reproduced or utilized in any form or by any means, electronic or mechanical, including
photocopying, recording, or by any information storage and retrieval system, without permission in writing from the publisher.

Printed in the United States of America

Library of Congress Cataloging-in-Publication Data

Solution-focused brief therapy : a multicultural approach / [edited by] Johnny S. Kim, PhD, University of Denver.

pages cm

ISBN 978-1-4522-5667-2 (pbk. : alk. paper) — ISBN 978-1-4833-1229-3 (web pdf) 1. Solution-focused brief therapy—Cross-cultural
studies. 2. Cultural psychiatry. 3. Cultural competence. I. Kim, Johnny S., editor of compilation.

RC489.S65S66 2014

616.89′147—dc23 2013016891

This book is printed on acid-free paper.

13 14 15 16 17 10 9 8 7 6 5 4 3 2 1

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FOR INFORMATION:

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6
 Contents
Preface

Acknowledgments

About the Editor

7
Chapter 1. Solution-Focused Brief Therapy and Cultural Competency
Johnny S. Kim

8
Chapter 2. Solution-Focused Therapy Treatment Manual for Working With Individuals
Terry S. Trepper, Eric E. McCollum, Peter De Jong, Harry Korman, Wallace Gingerich, Cynthia
Franklin

9
Chapter 3. Does Solution-Focused Brief Therapy Work?
Cynthia Franklin, Katherine L. Montgomery

10
Chapter 4. Solution-Focused Approach With Asian American Clients
Johnny S. Kim, Jun Sung Hong, Cindy Sangalang

11
Chapter 5. Solution-Focused Approach With African American Clients
Diane Bigler

12
Chapter 6. Solution-Focused Approach With Hispanic and Latino Clients
Peter Lehmann, Catheleen Jordan, Damaris Mosharef

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Chapter 7. Solution-Focused Approach With American Indian Clients
Sara Blakeslee, Sara A. Smock Jordan

14
Chapter 8. Solution-Focused Approach With Asian Immigrant Clients
Rowena Fong, Britt Urban

15
Chapter 9. Solution-Focused Approach With Multicultural Families
Jung Jin Choi, Robin Akdeniz

16
Chapter 10. Solution-Focused Approach With LGBTQ Clients
Sara A. Smock Jordan

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Chapter 11. Solution-Focused Approach With Clients With Disabilities
Adam S. Froerer, Ednalice Pagan-Romney

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Chapter 12. Solution-Focused Approach With Economically Poor Clients
Brandy R. Maynard, Michael S. Kelly

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Chapter 13. Solution-Focused Approach With Spiritual or Religious Clients
Michael S. Kelly, Brandy R. Maynard

Index

20
 Preface

W hen I was a doctoral student in the social work program at the University of Texas at Austin, I was
fortunate enough to work as a graduate research assistant for Cynthia Franklin and Cal Streeter on a
solution-focused alternative high school research project. A main reason why, I believe, I got the job was
because I had been trained in solution-focused brief therapy (SFBT) as a clinical social worker in Seattle,
Washington, and I used it in my work as a school social worker. Through this research project, I got a chance
to meet two of the main developers, Insoo Kim Berg and Steve de Shazer, as they were friends with Cynthia
and were also involved in the research project as consultants and trainers.

I remember it was during this time that Insoo did a training for the school staff on our research project and
shared a particular story about her early years as a social worker conducting a family therapy session with a
Caucasian family. There was conflict between the parents and the teenage child, and Insoo was working with
them to explore their family relationship problems. But being a Korean immigrant, Insoo was confused about
the disciplining style of the parents. The parents informed Insoo that they had to ground their child for
disobeying them, but Insoo had no idea what grounding meant in relation to parental discipline. She knew
grounding literally meant to crush or pound but knew that was not what the parents meant (or at least hoped
that was not what they meant), so she asked for clarification. The parents explained that when their child
disobeyed them, they punished their child by making the child stay in the house. Unfortunately, this
explanation puzzled Insoo even more because in Korean culture, it is considered an honor to be in the house
spending time with your family, and many times children are expected to live with and take care of their aging
parents. Insoo was confused by the idea that to punish the child, the parents forced the child to stay in the
house with the parents. This parenting technique seemed incongruous to Insoo, who was coming from a
Korean perspective. This story came to my mind when I started to think about what area in SFBT is lacking.

There is a gap for social workers, psychologists, marriage and family therapists, and master’s-level
counselors who are looking for a book that provides clinical applications of SFBT from a multicultural
perspective and that contains concrete and tangible tools and intervention strategies. To date, no book and
very few articles have been written about how to use SFBT with minority clients, which is an important topic
in the United States and abroad. This book is an attempt to fill that void by offering several chapters devoted
to common issues prevalent in specific minority groups, especially regarding common risk and protective
factors particular to that group, and by showing ways to integrate this knowledge with SFBT techniques to
help your clients.

This edited book is intended for both students and clinicians interested in learning about SFBT and
incorporating a multicultural perspective in working with their clients. This book is set up so that it can be
used as a textbook in clinical courses as well as a training guide for current practitioners interested in
expanding their clinical skills with their minority clients. Chapter 1 provides a history of the development and

21
influences on SFBT as well as a discussion about why incorporating a multicultural approach is needed in
clinical practice. A unique feature of Chapter 1 is the introduction of a new theory of change not found in
other solution-focused books. Although most practitioners tend to focus on the specific techniques of a
therapy model, it is also important to understand how and why the techniques work and to bring this
explanation into the clinical process with the client.

Unlike other solution-focused books currently available, this book incorporates the recently developed
SFBT Treatment Manual, which was created to address treatment fidelity issues and to make sure clinicians
really are doing SFBT. Chapter 2 provides the details on the specific model and techniques based on the
Treatment Manual endorsed and written by the Solution-Focused Brief Therapy Association. Chapter 3
provides a review of the empirical support and discussion around whether SFBT works. This chapter will
review the efficacy of SFBT, describing the numerous studies conducted both domestically and
internationally.

Chapters 4 through 13 expand on the SFBT model described in Chapter 2 by describing how to use SFBT
specifically with minority clients, with an emphasis on specific, concrete questions and techniques for students
and clinicians. The case examples are written as short transcripts of a session dialogue, which the reader can
follow along with to see the interactions between the clinician and the client. The chapters close with
conclusion sections that summarize and highlight key points, provide resources for further learning, and
include discussion questions.

It is worth noting that although we talk about diversity and cultural competency in solution-focused
practice, this book is not set up to be a book on diversity and is not intended to cover all the minority groups
and their cultures and values. There is tremendous variability in each of us and in our clients, and it is
impossible to create a book that can address every possible difference and experience. Furthermore, although
the SFBT Treatment Manual was created for treatment fidelity and adherence, SFBT is flexible enough to
adjust to the needs and strengths of the individual client and clinician. It is my hope that the case examples
and discussion questions in the chapters will help further stimulate conversation in the classroom and will
facilitate learning.

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 Acknowledgments

T his book could not have been created without the help of all the contributing authors, many of whom
are colleagues as well as friends. I would especially like to thank Cynthia Franklin for hiring me when I
was a doctoral student and helping to set a path for me to write this book. I would also like to thank my
publisher Kassie Graves for her support and helping me make this book come to fruition. My thanks to the
following reviewers who offered valuable feedback and suggestions for the structure and content of this book:
Nicole Knickmeyer (Austin Peay State University), J.J. Choi (Kyonggi University, Korea), Christine Sacco-
Bene (Barry University), Lynne Kellner (Fitchburg State University), Michael O’Melia (St. Ambrose
University), Deborah Barlieb (Kutztown University of Pennsylvania), Duane Bidwell (Claremont Mckenna
College), and Barbara Early (Catholic University of America).

A special thanks to my family: Sulki; Nate; Abby; and the McConville, Zhang, Zankel, and McGaugh
families for their support and encouragement. Lastly, I’d like to thank the many solution-focused clinicians,
students, researchers, and clients around the world who continue to do the good work Insoo and Steve started
more than 30 years ago.

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 About the Editor

Dr. Johnny S. Kim is an Associate Professor at the University of Denver Graduate School of Social Work. He
received his master’s degree in social work from Boston College, PhD in social work from the University of
Texas at Austin, and was a Council on Social Work Education Minority Clinical Fellow. Dr. Kim’s research
focuses on evaluating school-based interventions, solution-focused brief therapy, meta-analysis, and evidence-
based practice. Prior to his doctoral studies, Dr. Kim worked as a school social worker and case manager for
community mental health agencies in Seattle.

24
 1
Solution-Focused Brief Therapy and
Cultural Competency
Johnny S. Kim

Introduction

NASA’s Space Pen Dilemma1

When the United States’ National Aeronautics and Space Administration (NASA) first started sending
astronauts into outer space, it quickly realized that a ballpoint pen didn’t work. To solve this problem,
NASA scientists spent years and about a million dollars to develop a pen that could write in zero gravity,
upside down, on almost any surface, and at temperatures ranging from below freezing to 300 degrees
Celsius.

During this same time, the Russians were also sending their cosmonauts into outer space and therefore
faced a similar dilemma. Their solution to the problem . . . was to use a pencil.

The appeal of solution-focused brief therapy reminds me of the NASA space pen joke described above.
Although this story is notfactually accurate (the United States did use a pencil in the beginning, and the space
pen was developed independently by Paul Fisher who received no NASA funding2), the punch line still
resonates. There is something to be said about a simple, practical solution to a problem versus a time-
consuming and complicated one. Over the past three decades, solution-focused brief therapy (SFBT) has
become a popular therapeutic model for clinicians and professional counseling schools in part because of the
model’s strengths-based focus and simplicity. For example, building on Saleebey’s (1992) summary of
strengths-based assumptions and principles, De Jong and Miller (1995) make a case for how SFBT can
advance social work’s tradition of using strengths-based principles by incorporating various SFBT techniques
and assumptions.

This chapter begins by providing an overview of SFBT and its history. It describes how SFBT was
developed inductively from a multidisciplinary team of clinicians working at the Mental Research Institute in
the 1970s. Later, the Brief Family Therapy Center was created in the 1980s by de Shazer and Kim Berg, and
this led to the rise in popularity of SFBT among many clinicians. Recently, SFBT training, research, and
networking continues through the founding of the Solution-Focused Brief Therapy Association (SFBTA) in
the 2000s. In addition, the theoretical framework for how SFBT works will be discussed. The chapter will
conclude with a discussion on the importance of incorporating a multicultural approach to using SFBT with
minority clients.

25
What Is SFBT?
Before we can discuss the origins of SFBT, it would be useful to provide a quick overview of the core
components of the therapy model and its appeal. More specific details of the intervention techniques will be
discussed in Chapter 2 and expanded upon with specific clients in Chapters 4–13. Many of the early writings
on the SFBT model and techniques were introduced in books and peer-reviewed articles written by several of
the developers, but over the past several years, efforts have been made to manualize the therapy model to
distinguish it from other similar therapy interventions.

In 1997, de Shazer and Kim Berg took one of the first steps to manualize SFBT by publishing an article
identifying four characteristics that must be featured during the first interview. Although there is no set order
to these features, they are necessary if the clinician is to be doing solution-focused therapy. The four
characteristics necessary are as follows:

1. The therapist must ask the “miracle question.”

2. Scaling questions must be asked at least once.
3. Toward the end of the interview, the therapist must take a break.
4. After the break, the therapist gives the client a set of compliments and sometimes suggestions or
homework tasks.

Gingerich and Eisengart (2000) further operationalized SFBT in their systematic review of all the outcome
studies by including only studies that contained the four characteristics listed above, along with searching for
presession change, setting goals for the client, and searching for exceptions to the problem. Prior to the
development of the treatment manual discussed in Chapter 2, these were considered the core techniques
necessary in SFBT.

Most solution-focused interviews occur during the traditional 50–75-minute session. The structure of the
interview is divided into three parts. The first part, which usually lasts 5–10 minutes, is spent making small
talk with the client to find out a little bit about the client’s life. The second part of the session, which takes up
the bulk of the time—around 40 minutes—is spent discussing the problem, looking for exceptions, and
formulating goals. The final part of the therapy session, which lasts around 5–10 minutes, involves giving the
client a set of compliments, homework, and determining whether to meet again.

Historical Background
Originating in the early 1980s at the Brief Family Therapy Center (BFTC) in Milwaukee, Wisconsin, SFBT
was developed inductively by Steve de Shazer (1988), Insoo Kim Berg (1994), and colleagues (Berg & De
Jong, 1996; Berg & Miller, 1992; Cade & O’Hanlon, 1993; Lipchik, 2002; Murphy, 1996) who wanted to
study effective therapeutic techniques and to determine what worked in therapy sessions. They used one-way
mirrors to observe each other’s techniques and would consult with the team behind the mirror during the
therapy session. The mental health team at BFTC was interested in looking for instances when the problem
was not occurring in the client’s life and collaborating with the client on developing goals (de Shazer, 1985).

26
Over the past 20 years, many people such as Bill O’Hanlon, Ron Kral, Eve Lipchik, Yvonne Dolan, and Scott
Miller have studied and trained with Steve de Shazer and Insoo Kim Berg at BFTC and have contributed to
the development of the model (Hawkes, Marsh, & Wilgosh, 1998). The SFBT model has been applied to a
wide range of problems, such as psychiatric disorders, alcohol abuse, crisis-oriented youth services, and
school-related behavior problems (Franklin, Biever, Moore, Clemons, & Scamardo, 2001).

The origins of the development of SFBT can be traced back to de Shazer and colleagues (Fisch, Weakland,
& Segal, 1983; Watzlawick, Weakland, & Fisch, 1974) at the Brief Therapy Center of the Mental Research
Institute (MRI) during the late 1970s. The brief therapy approach at MRI tried to resolve a client’s problem
in a shorter amount of time (within a 10-session limit), as opposed to the traditionally longer psychodynamic
therapeutic approaches. The rationale for this session-limited approach gained traction because earlier studies
(Garfield, 1978; Gurman, 1981; Koss, 1979) showed clients stayed in therapy an average of 6–10 sessions
regardless of the clinician’s plans or modality (de Shazer, 1985). However, brief therapy, as viewed by de
Shazer and his colleagues at MRI, went beyond just fewer therapy sessions. They believed clients wanted to be
freed from their problems as quickly as possible; therefore, it was the clinician’s ethical duty to make the most
use of that limited contact. Because the practitioners at MRI believed in shorter number of sessions for the
clients’ sakes, the focus of the counseling sessions was not on trying to understand the root cause of the
problem. Instead, the emphasis was to find effective ways of thinking about the problem and practical ways of
dealing with it (Furman & Ahola, 1994).

In 1975, de Shazer began working on a more comprehensive model of brief therapy by including the client
and family members in developing problem constructions (de Shazer, 1985). By 1978, de Shazer left MRI and
with a core group of colleagues (Insoo Kim Berg, Elam Nunnally, Eve Lipchik, and Alex Molnar) started
BFTC (de Shazer, 1985). SFBT, the model, began to develop in 1980 and was given that name by 1982 (de
Shazer & Berg, 1997). This group of clinical practitioners (along with future team members Wallace
Gingerich, Scott Miller, and Michele Weiner-Davis) continued to explore what worked in counseling sessions
through consultations and experimentations with different techniques. What evolved through these sessions
was an understanding and belief that doing something different in a problematic situation can be enough to
inspire positive change to help satisfy the client (de Shazer, 1985). The BFTC team eventually began shifting
its focus from figuring out how to solve problems to identifying solutions and how to get there with the client.
Diverging from their work at MRI, de Shazer and colleagues at BFTC made a conscious effort to focus on
solutions instead of problems when working with clients. In further developing the solution-focused model,
specific techniques such as miracle and exception questions were developed to aid in identifying solutions.

It has been more than 30 years since the SFBT model was introduced, and it has continued to evolve and
grow. Prior to the deaths of Steve de Shazer (1940–2005) and Insoo Kim Berg (1934–2007), the North
American solution-focused community created SFBTA in 2002, which continues to hold its annual
conferences throughout the United States and Canada. Along with the conferences that offer workshops and
presentations for clinicians and researchers, SFBTA continues to promote SFBT by providing training
resources, promoting and advancing research in the therapy model, and continuing the work that Insoo and
Steve started.

27
Antecedents and Influences
Although SFBT has distinguished itself from other forms of brief therapy with its solution talk, the
solution-focused model has had many influences during its development. One of the earliest influences on
Steve de Shazer and the SFBT model was Milton Erickson and his pioneering work in brief therapy in the
mid-1950s. While at MRI, de Shazer would study Erickson’s approach and techniques of brief hypnotherapy
to help figure out what clinicians do that is effective. For example, two key components of brief therapy de
Shazer learned from Erickson, which were later incorporated into SFBT, were (1) using what the client brings
to the counseling session and (2) not trying to find or correct any causative underlying psychological disorders
(de Shazer, 1985). These two components became key assumptions in the SFBT model of recognizing the
strength and resources of each client and focusing on the present and future since the past cannot be changed.

Milton Erickson’s crystal-ball technique and hypnosis methods also influenced Steve de Shazer in his
development of the SFBT model. Erickson developed the crystal-ball technique in 1954 to enable clients,
who are in a hypnotic trance, to see into the future where the complaint is gone. De Shazer expands on
Erickson’s work by using this technique in a way that allows clients to construct their own solution (de Shazer,
1985). The first two steps of de Shazer’s crystal-ball method teach the client to notice his or her own behavior
as well as the behaviors of others and to recall times of success in the client’s life, again focusing on his or her
own behavior as well as the behaviors of others. The third step transports the client into the future all the
while remembering the successful resolution of the problem. The fourth step asks the client to remember how
the problem was solved, the client’s reaction, and the reaction of others.

The use of hypnotic trance was varied and has evolved throughout the years in SFBT. de Shazer describes
hypnosis as more of a “focused attention” that is part of the interaction between the hypnotist and client.
Rather than the traditional trance induction, the solution-focused clinician and client are paying close
attention to what the other is saying (de Shazer, 1985). These crystal-ball techniques would evolve into some
of the major building blocks of SFBT, mainly looking for exceptions (successes) and focusing on solutions
rather than problems.

Earlier works by Minuchin’s structural family therapy, strategic family therapy, and Milan’s systemic family
therapy also contributed to the development of solution-focused therapy (Hawkes et al., 1998). All three
family therapies were developed in the 1970s and also were influenced by Milton Erickson’s brief therapy
model. The idea of assigning tasks to help create change in a client was an important advancement for family
therapy, which later influenced the development of SFBT.

The use of tasks in structural family therapy helps clients learn new ways of relating to one another by
moving them beyond their ordinary experiences with each other. Minuchin believed there was a family
hierarchy where each subsystem (i.e., grandparent, parent, children) of the family had authority according to
its place on the hierarchy. He theorized that problems in families occurred when these subsystems experienced
distortion or became too rigid. A healthy family and its members, Minuchin believed, had clear boundaries in
their family hierarchy, and tasks were used to help family members learn these boundaries (Hawkes et al.,
1998).

Strategic family therapy was developed by a group of clinicians from MRI where de Shazer worked.

28
Strategic family clinicians focused on solving a client’s problem by examining the interactions clients had with
other involved party members such as family or friends. Once the clinician had an understanding of the
problem and of all those involved, tasks were used to change the usual way problems were handled. For
example, a parent might be given a task to compliment their child for good behavior as opposed to their usual
methods (grounding, hitting, yelling, etc.) of punishing their child for bad behavior (Hawkes et al., 1998;
Watzlawick et al., 1974). Furthermore, paradoxical tasks were sometimes used by the clinician or when
families were considered “stuck” and change was not occurring. The rationale for these paradoxical tasks, such
as encouraging a wife who constantly needs reassurances from her husband to become more dependent on
him, was to push the client into one extreme direction so that they would want to go toward the desired
direction (Hawkes et al., 1998).

Evolving from the structural and strategic models, systemic family therapy expanded on Minuchin’s family
focus by including individuals, couples, and families. Systemic family clinicians incorporated how other
members within the client’s social network viewed the problem as well as incorporated social institutions (e.g.,
school, church, work), ethnicity, and gender influences on the problem. For systemic family clinicians, tasks
are not as important for the therapy session as they are for structural or strategic models. There is more of an
emphasis in messages, which examined the families’ different understanding of the problem and discussed each
member’s interpretation. Messages were used to question the meaning of the client’s problem (Hawkes et al.,
1998).

Similar to structural family therapy and strategic family therapy, SFBT encourages clients to do something
different that may help them move beyond their traditional approach to solving the problem to help create
small changes. The use of tasks allows clinicians to break up patterns of unsuccessful attempts by a client to
solve her problem by shifting her approach to resolving the problem. Besides tasks, the systemic family
therapy model’s openness in letting clients define problems and the respectful attitude of the clinician
influenced the SFBT clinician’s approach to working with clients.

Starting with Erickson’s brief therapy model, SFBT has been influenced by many aspects of structural,
strategic, and systemic therapy models. However, according to Lethem (2002), the SFBT currently aligns
itself more under the metatheory of social constructionism, which asserts that individual constructs are shaped
entirely through conversations with others. Granvold (1996) defines metatheory as “a related group of theories
sharing assumptions and assertions” (p. 345). Falling under the metatheory umbrella of social constructionism
along with SFBT are Saleebey’s strengths perspective model, Brower and Nurius’s cognitive ecological model,
and White and Epston’s narrative therapy model. Although each of these therapy models has different
techniques to use with clients, they all share the same underlying assumption of the client’s construction of
reality (Franklin, 1998).

Theory of Change in SFBT

Social Constructionism
The metatheory social constructionism has been a major influence on the theoretical philosophies of SFBT

29
(Berg & De Jong, 1996; Franklin, 1998). Unlike scientific positivism, which believes in an objective truth or
reality, social constructionism contends reality is socially or psychologically constructed by the individual. It is
the interaction with and observations of other people that allow individuals to formulate their ideas of what is
real (Franklin, 1998), with change occurring through the development of new meaning constructions (Berg &
De Jong, 1996).

SFBT falls under the social constructionism metatheory because of its philosophy and belief that language
is used to construct reality for the client (Franklin, 1998). In SFBT, the clinician uses language and Socratic
questioning to co-construct goals with the client and works collaboratively to resolve the problem by using the
client’s strengths. The goals define what clients want different in their lives, and resources are identified to
help meet these goals (Berg & De Jong, 1996). This mindset is in line with social constructionism and is a
major contributor to SFBT (Lipchik, 2002).

Clinicians using SFBT pay special attention to the words the client uses to describe his or her problem all
the while respecting the client’s definitions of reality. SFBT and social constructionism believe that the client
is the expert in his or her own meanings since the client has detailed knowledge of his or her own perceptions,
definitions of reality, and experiences related to the problem (Berg & De Jong, 1996). The clinician works
with the client in co-constructing goals and creates change in the client by helping the client identify successes
and solutions that can be used to resolve the problem.

SFBT is different from many other therapies in that the clinician makes no claim to be the expert. It is a
different way of thinking about the helping process. The attitude in SFBT is one of great respect for the client
and the belief that the client is the expert in resolving the problem. It is not the role of the clinician to
interpret meaning about the problem or even attempt to solve the problem for the client (Berg & De Jong,
1996). Clinicians believe that clients have the knowledge, strength, skills, and insights to solve their own
problems.

Several assumptions made in SFBT that are very important to this therapy stem from the influences of brief
therapy and social constructionism. The first one is that Every Client Is Unique. This is taken from a
constructionist model and leads to the belief that the solution should be particular to the individual client. The
second assumption is that Clients Have the Inherent Strength and Resources to Help Themselves. By focusing on
the client’s strengths rather than the client’s problems, change will occur more rapidly. The third assumption
is Change Is Constant and Inevitable; A Small Change Can Lead to Bigger Changes. In a situation where the
client feels stuck or overwhelmed, making a small step toward the goal can generate hope and lead to bigger
changes. The final assumption is One Can’t Change the Past so One Should Concentrate on the Present and Future.
It is not necessary to analyze past actions that resulted in the problem to find a solution to the problem.
Clinicians and clients work right away to co-construct goals and look for ways that the solution is already
occurring in his or her life (Lipchik, 2002).

In addition, Lethem (2002) cites George, Iveson, and Ratner’s (2000) summary of six additional
assumptions that solution-focused clinicians should also maintain: (1) understanding the cause of the problem
is not necessary to find its resolution; (2) knowing where the client wants to get to is key to successful therapy;
(3) however fixed the problem pattern seems to be, there are always times when the client is already doing

30
some solution-building; (4) problems do not represent underlying pathology or deficits; (5) clinicians must
discover ways in which clients are able to cooperate with therapy; and (6) the concept of resistance is
considered unbeneficial. These assumptions, along with an emphasis on solutions, help provide the theoretical
framework for SFBT and help differentiate SFBT from other therapy models.

SFBT requires that the client and the clinician co-construct changes and goals to help resolve the client’s
problem. The clinician role is described as leading from one step behind, with the client being the expert and
dictating how the problem is perceived (Cantwell & Holmes, 1994). The active role the clinician takes lies in
the Socraticquestions he or she asks to help the client look at the situation from a different perspective and to
look for clues where the solution is already occurring in the client’s life (Franklin & Jordan, 1999).

Broaden-and-Build Theory of Positive Emotions

Visser and Schlundt Bodien (2009) set out to provide evidence for de Shazer’s assertion that clients are able
to find solutions to problems and start solution-building conversations when clients are able to describe their
positive behaviors and expect positive changes to occur. The article by Visser and Schlundt Bodien (2009)
offers an adjusted conceptual model illustrating how positive behaviors and positive expectations, elicited from
subtle interventions, interact with each other and lead to solution-building conversations inherent in SFBT.
Of the many different theories and research reviewed in their article to support positive behaviors and
expectations in SFBT, the broaden-and-build theory of positive emotions by Fredrickson (1998) provides the
most compelling evidence for explaining how SFBT works.

Positive emotions (e.g., joy, happiness, hope, trust, love) have become a very popular topic for researchers in
psychology with the growth of the positive psychology movement (Linley, Joseph, Harrington, & Wood,
2006). Similar to the strengths perspective shift in social work in 1982 (Kim, 2008; Saleebey, 2006),
psychology, in 1998, started to focus its attention to the assets and positive resources that clients have rather
than their pathological deficits (Seligman, 1999). Positive emotions theory argues that positive emotions are
not simply the absence of negative emotions (e.g., anger, sadness, frustration, hopelessness) or just a “good
feeling” a client has but rather can serve a therapeutic value in clinical practice (Fitzpatrick & Stalikas, 2008a).
Most of the research and discussion in clinical practice viewed positive emotions as a desired outcome (i.e., I
want to be happy again) and neglected the possibility of positive emotions serving as a vehicle for therapeutic
change (Fitzpatrick & Stalikas, 2008b). One popular theory on positive emotions that identifies and
recognizes the generative role of positive emotions is the broaden-and-build theory of positive emotions by
Fredrickson (1998).

Emerging out of the recognition that positive emotions were neglected in psychology research on emotions
in theory building and hypothesis testing, Fredrickson (1998) sought to examine what role positive emotions
play in individuals’ momentary thought-action repertoires and how this might guide specific interventions to
improve psychological well-being. To help test the broaden-and-build theory, Fredrickson and colleagues
conducted several laboratory studies that found support for the broadening of thought-action repertoires,
undoing of lingering negative emotions, increasing resiliency, and improving psychological well-being (see
Fredrickson, 2001, for review). Since its introduction, the broaden-and-build theory of positive emotions has
developed strong empirical support for its claim that positive emotions can help generate change in clients

31
(Garland et al., 2010).

Under the broaden-and-build theory, positive emotions elicit thought-action repertoires that are broad,
flexible, and receptive to new thoughts and actions while negative emotions elicit thought-action repertoires
that are limited, rigid, and less receptive. The broadening aspect of this theory posits that after a person
experiences a positive feeling, they are more open and more receptive. As Fitzpatrick and Stalikas (2008b)
state, “In an open state, they feel the urge to contemplate new ideas, develop alternative solutions to problems,
reinterpret their situations, reflect on behaviors, and initiate new courses of action and creative endeavors” (pp.
139). This is the key step in helping clients do something different, an idea touted in SFBT.

In addition to broadening, this theory also posits that positive emotions help build durable resources that
can be drawn upon for future use. Although positive emotions may be brief and fleeting, they have lasting
positive effects on an individual ability to function (Garland et al., 2010). Experiencing and accruing positive
emotions helps increase a client’s personal resources and helps people transform themselves into more creative,
resilient, and knowledgeable individuals (Fredrickson, 2004). Also, because positive and negative emotions are
opposites in a continuum, an individual cannot experience both simultaneously. Therefore, it’s this
incompatibility between positive and negative emotions’ thought-action repertoires that helps to explain how
interventions building positive emotions can help change an individual’s negative emotions (Fredrickson,
2000). Furthermore, one of the key aspects of positive emotions is the possibility of them negating or even
reversing negative emotions, which often narrows an individual’s thought-action range (Fredrickson, 2001).
Therefore, clients who experience positive emotions work toward change by replacing negative perspectives
that limit their thoughts and behaviors (Fitzpatrick & Stalikas, 2008b).

Another aspect noted in the broaden-and-build theory of positive emotions is the idea that there is an
upward spiral process that is set in motion as clients continue to experience positive emotions. This is counter
to the downward spiral path that can be activated by negative emotions and that is often seen in clients who
are experiencing emotional and psychological distress. It is common for clients experiencing psychological
problems like depression or anxiety to dwell on negative thoughts and beliefs about themselves or a particular
situation, which then leads to dysfunctional behaviors and further perpetuating a downward spiral of
psychopathology (Garland et al., 2010). With positive emotions, the opposite can occur, where upward spirals
of positive emotions help clients build enduring resources of new thoughts, perspectives, and options
(Fitzpatrick & Stalikas, 2008b). To counteract the negative emotions clients have, a greater number of
positive emotions must be experienced by a client. Research on this suggests that a minimum 3-to-1 ratio of
positive emotions experienced to negative emotions is necessary to help generate sustained positive changes
and undo the impact of negative distress (Garland et al., 2010).

In an effort to apply the broaden-and-build theory of positive emotions to clinical practice, Fredrickson
(2000) hypothesized that interventions that help build or reinforce positive emotions can help treat typical
problems rooted in negative emotions like anxiety, depression, and aggression. SFBT incorporates specific
techniques and questioning that can help create these positive emotions that will enhance client’s emotional,
behavioral, and social resources (Fitzpatrick & Stalikas, 2008b; Visser & Schlundt Bodien, 2009). Fredrickson
(2004) states, “Typically, emotions begin with an individual’s assessment of the personal meaning of some
antecedent event: what Lazarus (1991) called the person-environment relationship, or adaptational encounter”

32
(p. 1368). SFBT centers on identifying and magnifying what clients are doing well in relations to solving their
own problems. The premise of SFBT begins by setting the stage that the clinician will observe not what the
clients are doing wrong but rather what they are doing well, which can help create positive emotions for the
clients. Another example involves using compliments, which are an important part of working with students
and can be used to build positive emotions (Fitzpatrick & Stalikas, 2008b). The tone and approach in SFBT
is positive and focuses on clients’ strengths.

Why Consider a Multicultural Approach With SFBT?

Very little has been written about cultural competency in SFBT. Many professional organizations like social
work, psychology, counseling, and marriage and family therapy stress the importance of being a culturally
competent clinician, but this conversation has not been stressed in the writings of SFBT. In fact, key
developers such as Peter de Jong and Insoo Kim Berg (2008) have actually noted this fact but maintained a
stance that is contrary to many clinical books and professional schools, which stresses the importance of
recognizing cultural diversity and ways in which discrimination and oppression impact our clients. Many
solution-focused clinicians have noted their reservations with cultural competent practice and argue that
because the therapy model aligns with a social constructionism, stressing cultural competency is not required.
Concerns have been raised by De Jong and Berg (2008) and others in general around cultural competency
training (Abrams & Moio, 2009; Dean, 2001), that cultural competency practice can still reinforce
assumptions around stereotyping and the fallacy of knowing everything about a particular race, culture, or
minority group. Because of these concerns, solution-focused clinicians advocate for more of a not knowing
approach, which is central to SFBT, and many solution-focused clinicians downplay the current trend of
being a culturally competent clinician.

Although these arguments and concerns are important considerations, my belief is that there are ways to
incorporate a multicultural approach to working with minority clients while staying true to SFBT ideals as
well as the current emphasis on cultural competency stressed in academic and professional schools. For
example, SFBT stresses collaboration in the counseling sessions and flattens the inherent hierarchy that often
exists with the clinician being the expert and the client needing “fixing.” A multicultural approach also
emphasizes collaboration and respect with minority clients. It can also help foster positive relationships with a
minority client because the focus is placed on tailoring the conversation around the client’s particular situation
and his perspective. When a clinician can demonstrate empathy and genuine curiosity about how clients may
have experienced and overcome discrimination with the questions asked in the counseling session, a client is
more likely to feel validated and to feel like an integral part of the counseling session (Blundo, 2001).

By understanding and incorporating a minority client’s ethnic or cultural values and experiences, a solution-
focused clinician can further help build a collaborative relationship by lessening the burden placed on minority
clients who often have to retell and explain their stories. A culturally competent clinician is cognizant that
many minority clients experience barriers that members of the dominant society do not and can demonstrate it
by specifically asking questions about common experiences shared by a particular minority group. When a
clinician does not take the time to learn and ask about the various forms of discrimination and barriers unique
to minority clients, a minority client is burdened with the task of educating and explaining their experiences,

33
which can be frustrating and time consuming. Now imagine if a minority client has to do this with every
clinician she works with and how discouraging that could be. Although a culturally competent clinician may
not know all the ways that minority clients were marginalized, minority clients might relate better to a
clinician who recognizes that discrimination may be a part of the client’s experience and who asks questions
about how those experiences may have impacted the client’s current situation. This approach is also still in line
with the SFBT value that proposes clients are the experts and their perspectives are valid rather than assuming
their beliefs need to be changed or re-evaluated.

Finally, incorporating a multicultural approach can also enhance a clinician’s confidence in working with
diverse clients. Although SFBT encourages a not knowing approach to working with clients, Insoo Kim Berg
and others have also talked about leading from one step behind when working with clients (Cantwell & Holmes,
1994; De Jong & Berg, 2008). Unlike other problem-focused models of psychotherapy that direct the
clinician to structure the counseling session, the leading from one step behind approach in SFBT encourages
clinicians to gently guide clients to their own solutions to problems through Socratic questioning. Therefore,
having some ideas about areas of risk and protective factors unique to minority clients that might arise can
help a solution-focused clinician to lead from one step behind and ask questions that might be missed. A
culturally competent solution-focused clinician can still let the client be the expert in providing his unique
experiences and information about himself and his situation but also guide a session by asking questions
around common ethnic and cultural values and experiences.

There are opportunities to structure a session around solution-building conversations that build on a
minority client’s unique cultural strengths and experiences that can lead to solutions to the problem. Given the
increase in popularity of SFBT and the increase in minority clients seeking counseling services, incorporating
a multicultural approach to SFBT can help reduce the risk of cross-cultural misinterpretation and help
facilitate a more positive counseling experience for all parties involved (Bowie, Hall, & Johnson, 2011). It is
my hope that this book can offer suggestions for integrating cultural considerations into solution-focused
techniques and start a conversation about what this might look like.

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Process, 39, 477–496.
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Budman (Ed.), Forms of brief therapy (pp. 415–462). New York: Guilford.
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professionals. Boston: Butterworth Heinemann.
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ed., Vol. 4, pp. 177–181). Washington, DC: NASW Press.
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Clinical Psychology, 47, 210–121.
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(possible) future. The Journal of Positive Psychology, 1, 3–16.
Lipchik, E. (2002). Beyond technique in solution focused therapy. New York: Guilford.
Murphy, J. (1996). Solution-focused brief therapy in the school. In S. Miller, M. Hubble, & B. Duncan
(Eds.), Handbook of solution-focused brief therapy (pp. 184–204). San Francisco: Jossey-Bass.
Saleebey, D. (1992). The strengths perspective in social work practice. New York: Longman.
Saleebey, D. (2006). The strengths perspective in social work practice (4th ed.). Boston: Allyn and Bacon.
Seligman, M. E. P (1999). The president’s address. American Psychologist, 54, 559–562.
Visser, C., & Schlundt Bodien, G. (2009). Supporting clients’ solution building process by subtly eliciting
positive behavior descriptions and expectations of beneficial change. InterAction, 1, 9–25.
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resolution. New York: Norton.

1. http://www.snopes.com/business/genious.spacepen.asp

2. http://history nasa.gov/spacepen.html

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 2
Solution-Focused Therapy Treatment
Manual for Working With Individuals*
Terry S. Trepper, Eric E. McCollum, Peter De Jong, Harry Korman,
Wallace Gingerich, Cynthia Franklin

T he purpose of this Treatment Manual is to offer an overview to the general structure of solution-focused
brief therapy (SFBT). This manual will follow the standardized format and include each of the
components recommended by Carroll and Nuro (1997). The following sections are included: (a) overview,
description, and rationale of SFBT; (b) goals and goal setting in SFBT; (c) how SFBT is contrasted with
other treatments; (d) specific active ingredients and therapist behaviors in SFBT; (e) nature of the client-
therapist relationship in SFBT; (f) format; (g) session format and content; (h) compatibility with adjunctive
therapies; (i) target population; (j) meeting needs of special populations; (k) therapist characteristics and
requirements; (l) therapist training; and (m) supervision.

Overview, Description, and Rationale

SFBT group treatment is based on more than 20 years of theoretical development, clinical practice, and
empirical research (e.g., Berg, 1994; Berg & Miller, 1992; De Jong & Berg, 2008; de Shazer, Berg, et
al.,1986; de Shazer, Dolan, et al., 2006). SFBT is different in many ways from traditional approaches to
treatment. It is a competency-based model, which minimizes emphasis on past failings and problems and
instead focuses on clients’ strengths and previous successes. There is a focus on working from the client’s
understandings of his concern/situation and what the client might want different. The basic tenets that
inform SFBT are as follows:

• It is based on solution-building rather than problem-solving.

• The therapeutic focus should be on the client’s desired future rather than on past problems or current
conflicts.
• Clients are encouraged to increase the frequency of current useful behaviors.
• No problem happens all the time. There are exceptions—that is, times when the problem could have
happened but didn’t—that can be used by the client and therapist to co-construct solutions.
• Therapists help clients find alternatives to current undesired patterns of behavior, cognition, and
interaction that are within the clients’ repertoire or can be co-constructed by therapists and clients as
such.
• Differing from skill-building and behavior therapy interventions, the model assumes that solution
behaviors already exist for clients.

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 • It is asserted that small increments of change lead to large increments of change.
• Clients’ solutions are not necessarily directly related to any identified problem by either the client or the
therapist.
• The conversational skills required of the therapist to invite the client to build solutions are different from
those needed to diagnose and treat client problems.

SFBT differs from traditional treatment in that traditional treatment focuses on exploring problematic
feelings, cognitions, behaviors, and/or interaction, providing interpretations, confrontation, and client
education (Corey, 1985). In contrast, SFBT helps clients develop a desired vision of the future wherein the
problem is solved, and helps them explore and amplify related client exceptions, strengths, and resources to
co-construct a client-specific pathway to making the vision a reality. Thus, each client finds her own way to a
solution based on her emerging definitions of goals, strategies, strengths, and resources. Even in cases where
the client uses outside resources to create solutions, it is the client who takes the lead in defining the nature of
those resources and how they would be useful.

Solution-Focused Therapeutic Process

SFBT uses the same process regardless of the concern that the individual client brings to therapy. SFBT is
an approach that focuses on how clients change rather than one that focuses on diagnosing and treating
problems. As such, it uses a language of change. The signature questions used in solution-focused interviews
are intended to set up a therapeutic process wherein practitioners listen for and absorb clients’ words and
meanings (regarding what is important to clients, what they want, and related successes), then formulate and
ask the next question by connecting to clients’ key words and phrases. Therapists then continue to listen and
absorb as clients again answer from their frames of reference and once again formulate and ask the next
question by similarly connecting to the client’s responses. It is through this continuing process of listening,
absorbing, connecting, and client responding that practitioners and clients together co-construct new and
altered meanings that build toward solutions. Communication researchers McGee, Del Vento, and Bavelas
(2005) describe this process as creating new common ground between practitioners and clients in which
questions that contain embedded assumptions of client competence and expertise set in motion a conversation
in which clients participate in discovering and constructing themselves as persons of ability with positive
qualities who are in the process of creating a more satisfying life. Examples of this therapeutic process are
given later when the questions used in SFBT are presented.

General Ingredients of SFBT

Most psychotherapy, SFBT included, consists of conversations. In SFBT, there are three main general
ingredients to these conversations. First, there are the overall topics. SFBT conversations are centered on
client concerns; who and what are important to the clients; a vision of a preferred future; clients’ exceptions,
strengths, and resources related to that vision; scaling of clients’ motivational level and confidence in finding
solutions; and ongoing scaling of clients’ progress toward reaching the preferred future. Second, as indicated
in the previous section, solution-focused conversations involve a therapeutic process of co-constructing altered
or new meanings in clients. This process is set in motion largely by therapists asking solution-focused

38
questions about the topics of conversation identified in the previous paragraph and connecting to and building
from the resulting meanings expressed by clients. Third, therapists use a number of specific responding and
questioning techniques that invite clients to co-construct a vision of a preferred future and draw on their past
successes, strengths, and resources to make that vision a reality.

Goal Setting and Subsequent Therapy

The setting of specific, concrete, and realistic goals is an important component of SFBT. Goals1 are
formulated and amplified through solution-focused conversation about what clients want different in the
future. Consequently, in SFBT, clients set the goals. Once a beginning formulation is in place, therapy
focuses on exceptions related to goals, regularly scaling how close clients are to their goals or a solution, and
co-constructing useful next steps to reaching their preferred futures. Goals in SFBT are desired emotions,
cognitions, behaviors, and interactions in different contexts (areas of the client’s life).

How SFBT Is Contrasted With Other Treatments

SFBT is most similar to competency-based, resiliency-oriented models, such as some of the components of
motivational enhancement interviewing (Miller & Rollnick, 2002; Miller, Zweben, DiClemente, &
Rychtarik, 1994). There are also some similarities between SFBT and cognitive behavioral therapy, although
the latter model has the therapist assigning changes and tasks while SFBT therapists encourage clients to do
more of their own previous exception behavior or test behaviors that are part of the client’s description of her
goal. SFBT also has some similarities to Narrative Therapy (e.g., Freedman & Combs, 1996) in that both
take a nonpathology stance, are client-focused, and work to create new realities as part of the approach. SFBT
is most dissimilar in terms of underlying philosophy and assumptions with any approach that requires
“working through” or intensive focus on a problem to resolve it, or any approach that is primarily focused on
the past rather than the present or future.

Specific Active Ingredients

Some of the major active ingredients in SFBT include (a) developing a cooperative therapeutic alliance with
the client; (b) creating a solution-versus-problem focus; (c) setting of measurable changeable goals; (d)
focusing on the future through future-oriented questions and discussions; (e) scaling the ongoing attainment
of the goals to get the client’s evaluation of the progress made; and (f) focusing the conversation on exceptions
to the client’s problems, especially those exceptions related to what the client wants different, and encouraging
him to do more of what he did to make the exceptions happen.

Nature of the Client-Therapist Relationship

With SFBT, the therapist is seen as a collaborator and consultant, there to help clients achieve their goals.
With SFBT, clients do more of the talking, and what they talk about is considered the cornerstone of the
resolution of their complaints. Usually, SFBT therapists will use more indirect methods such as the use of

39
extensive questioning about previous solutions and exceptions. In SFBT, the client is the expert and the
practitioner takes a stance of “not knowing” and of “leading from one step behind” through solution-focused
questioning and responding.

Format and Session Structure

Much of the following is taken from de Shazer and colleagues (2006).

Main Interventions

A positive, collegial, solution-focused stance. One of the most important aspects of SFBT is the general tenor and
stance that is taken by the therapist. The overall attitude is positive, respectful, and hopeful. There is a general
assumption that people are strongly resilient and continuously use this to make changes. Further, there is a
strong belief that most people have the strength, wisdom, and experience to effect change. What other models
view as “resistance” is generally seen as (a) people’s natural protective mechanisms or realistic desire to be
cautious and go slowly or (b) a therapist error, that is, an intervention that does not fit the clients’ situation.
All of these make for sessions that tend to feel collegial rather than hierarchical (although as noted earlier,
SFBT therapists do “lead from behind”) and that feel cooperative rather than adversarial.

Looking for previous solutions. SFBT therapists have learned that most people have previously solved many
problems. This may have been at another time, another place, or in another situation. The problem may have
also come back. The key is that the person had solved her problem, even if for a short time.

Looking for exceptions. Even when clients do not have a previous solution that can be repeated, most people
have recent examples of exceptions to their problem. An exception is thought of as a time when a problem
could have occurred but did not. The difference between a previous solution and an exception is small but
significant. A previous solution is something that clients have tried on their own that has worked, but for
some reason they have not continued this successful solution and probably forgot about it. An exception is
something that happens instead of the problem, with or without the client’s intention or maybe even
understanding.

Questions versus directives or interpretations. Questions are an important communication element of all models
of therapy. Therapists use questions often with all approaches while taking history, when checking in at the
beginning of a session, or when finding out how a homework assignment went. SFBT therapists, however,
make “questions” the primary communication and intervention tool. SFBT therapists tend to make no
interpretations, and they very rarely directly challenge or confront a client.

Present- and future-focused questions versus past-oriented focus. The questions that are asked by SFBT therapists
are almost always focused on the present or on the future, and the focus is almost exclusively on what the
client wants to have happen in his life or on what of this that is already happening. This reflects the basic
belief that problems are best solved by focusing on what is already working and how clients would like their
lives to be rather than focusing on the past and the origin of problems.

40
Compliments. Compliments are another essential part of SFBT. Validating what clients are already doing well
and acknowledging how difficult their problems are encourage the client to change while giving the message
that the therapist has been listening (i.e., understands) and cares (Berg & Dolan, 2001). Compliments in
therapy sessions can help to punctuate what the client is doing that is working.

Gentle nudging to do more of what is working. Once SFBT therapists have created a positive frame through
compliments and then discovered some previous solutions and exceptions to the problem, they gently nudge
clients to do more of what has previously worked or to try changes clients have brought up that they would
like to try—frequently called “an experiment.” It is rare for an SFBT therapist to make a suggestion or
assignment that is not based on the client’s previous solutions or exceptions. It is always best if change ideas
and assignments emanate from the client at least indirectly during the conversation rather than from the
therapist because these behaviors are familiar to them.

Specific Interventions

Presession change. At the beginning or early in the first therapy session, SFBT therapists typically ask, “What
changes have you noticed that have happened or started to happen since you called to make the appointment
for this session?” This question has three possible answers. First, they may say that nothing has happened. In
this case, the therapist simply goes on and begins the session by asking something like: “How can I be helpful
to you today?” or “What would need to happen today to make this a really useful session?” or “How would
your best friend notice if that this session was helpful to you?” or “What needs to be different in your life after
this session for you to be able to say that it was a good idea you came in and talked with me?”

The second possible answer is that things have started to change or get better. In this case, the therapist
asks many questions about the changes that have started, requesting a lot of detail. This starts the process of
“solution-talk,” emphasizing the client’s strengths and resiliencies from the beginning, and allows the therapist
to ask, “So, if these changes were to continue in this direction, would this be what you would like?” thus
offering the beginning of a concrete and positive goal.

The third possible answer is that things are about the same. The therapist might be able to ask something
like “Is this unusual, that things have not gotten worse?” or “How have you all managed to keep things from
getting worse?” These questions may lead to information about previous solutions and exceptions and may
move them into a solution-talk mode.

Solution-focused goals. Like many models of psychotherapy, clear, concrete, and specific goals are an
important component of SFBT. Whenever possible, the therapist tries to elicit smaller goals rather than larger
once. More important, clients are encouraged to frame their goals as the presence of a solution rather than the
absence of a problem. For example, it is better to have as a goal “We want our son to talk nicer to us”—which
would need to be described in greater detail—rather than “We would like our child to not curse at us.” Also, if
a goal is described in terms of its solution, it can be more easily scaled (see later).2

Miracle question. Some clients have difficulty articulating any goal at all, much less a solution-focused goal.
The miracle question is a way to ask for a client’s goal in a way that communicates respect for the immensity

41
of the problem and at the same time that leads to the client’s coming up with smaller, more manageable goals.
It is also a way for many clients to do a “virtual rehearsal” of their preferred future.

The precise language of the intervention may vary, but the basic wording is, “I am going to ask you a rather
strange question. [pause] The strange question is this: [pause] After we talk, you will go back to your work
[home, school], and you will do whatever you need to do the rest of today, such as taking care of the children,
cooking dinner, watching TV, giving the children a bath, and so on. It will become time to go to bed.
Everybody in your household is quiet, and you are sleeping in peace. In the middle of the night, a miracle
happens and the problem that prompted you to talk to me today is solved! But because this happens while you
are sleeping, you have no way of knowing that there was an overnight miracle that solved the problem. [pause]
So, when you wake up tomorrow morning, what might be the small change that will make you say to yourself,
‘Wow, something must have happened—the problem is gone!’” (Berg & Dolan, 2001, p. 7).

Clients have a number of reactions to the question. They may seem puzzled. They may say they don’t
understand the question or that they “don’t know.” They may smile. Usually, however, given enough time to
ponder it and with persistence on the part of the therapist, they start to come up with some things that would
be different when their problem is solved. Here is an example of how a couple, both former drug dealers with
several years of previous contact with therapists and social workers, who said they wanted “social services out
of our lives,” began to answer the miracle question. Insoo Kim Berg is the interviewer. Besides being a good
example of how clients begin answering the miracle question, these excerpts illustrate solution-focused co-
construction between therapist and clients where altered or new meanings build as the therapist formulates
next questions and responses based on the clients’ previous answers and words—here about what will be
different when the miracle happens:

Berg: (Finishing the miracle question with . . . ) So when you wake up tomorrow morning,
what will be the first small clue to you . . . “whoa, something is different.”
Dad: You mean everything’s gone: the kids . . . everything?
Mom: No, no.
Berg: The problem is gone.
Dad: It never happened?
Mom: The problem happened but it’s all better.
Berg: It’s all handled now.
Mom: To tell you the truth, I probably don’t know how . . . we’re waiting. I mean, we’re
waiting on that day. We’re waiting on that day when there is just nobody.
Berg: Nobody. No social service in your life.
Mom: Yeah.
Berg: How would you, when you sort of come out of sleep in the morning, and you look
around and see, what will let you know . . . “wow, today is different, a different day
today, something is different, something happened.”
Dad: The gut feeling. The inside feeling. The monkey off the back so to speak.

42
Berg: OK.
Dad: When I had a drug problem . . . , I guess it’s a lot of the time the same feeling.
When I had a drug problem I always was searching, and just always something, I never
felt good about it. You know.
Berg: (Connecting to client words and meanings, ignoring the “complaint statements” and
choosing one part of the client’s message that is connected with what he wants to feel
differently) So, after this miracle tonight, when the miracle happens, the problems are
all solved, what would be different in your gut feeling?
Dad: Maybe I’d feel a little lighter, a little easier to move . . . not having to, ah, answer for
my every movement.
Mom: Uh-huh. Being able to make decisions as husband and wife. As parents of kids.
Without having to wonder, “Did we make the right decision or are we going to be
judged on that decision?”
Berg: Oh.
Mom: I mean, this is what we feel is best, but when we have to answer our decision to
somebody else . . .
Dad: Yeah, I mean “try it this way,” or “try it that way,” well, I mean, it’s natural to learn a
lot of those things on your own, I mean . . . I mean, you fail and you get back up and
you try it another way.
Berg: So you would like to make the decision just the two of you, you were saying, “Hmm,
this makes sense, let’s do it this way” without worrying: “Is someone going to look over
our shoulder or not.”
Mom & Dad: Right.
Mom: And whether we agree or whether we disagree. To have somebody, have somebody
taking sides, you know, what is his point, what is my point, and then trying to explain
to us, well . . .
Dad: [Referring to social services] It was always having a mediator, I mean, . . .
Mom: Yeah, there’s always somebody to mediate.
Berg: So the mediator will be gone. Will be out of your life.
Mom & Dad: Right.
Berg: [Connecting again to client words/meanings; accepting and building] OK. All right.
All right. So suppose, suppose all these mediators are out of your life, including me.
What would be different between the two of you? [Silence]
Dad: [Sighs]
Mom: Everything. Like I said, being able to look at each other as husband and wife and know
that if we have, if we agree on something, that that is our decision, and that’s the way
it’s going to be. If we disagree on something, it’s a decision that, I mean, that’s

43
 something we have to work out between us, and we don’t have to worry what that third
person’s opinion is going to be, and I don’t have to have a third person saying, “Yes,
well, I agree, the way Keith decided it was right,” which makes me feel even more
belittled.
Berg: All right. So, you two will make decisions regarding your family. What to do about the
kids, what to do about the money, going to do whatever, right?
Mom: Right.
Berg: Suppose you were able to do that without second-guessing. What would be different
between the two of you . . . that will let you know, “Wow! This is different! We are
making our own decisions.”
Mom: A lot of tension gone I think. . . .

And so forth.

What clients are able to co-construct with the therapist in answer to the miracle question can usually be
taken as the goals of therapy. With a detailed description of how they would like their lives to be, clients often
can turn more easily to building enhanced meanings about exceptions and past solution behaviors that can be
useful in realizing their preferred futures.

In therapy with couples or families or work groups, the miracle question can be asked to individuals or the
group as a whole. If asked to individual members, each one would give his or her response to the miracle
question, and others might react to it. If the question is asked to the family, work group, or couple as a whole,
members may “work on” their miracle together. The SFBT therapist, in trying to maintain a collaborative
stance among family members, punctuates similar goals and supportive statements among family members.

Scaling questions. Whether the client gives specific goals directly or through the miracle question, an
important next intervention in SFBT is to have the client evaluate his own progress. The therapist asks the
Miracle Question’s Scale: From 0–10 or from 1–10, where 0 means when the initial appointment was
arranged and 10 means the day after the miracle, where are things now? For example, with a couple where
better communication is their goal:

Therapist: What I want to do now is scale the problem and the goal. Let’s say a 1 is as bad as the
problem ever could be, you never talk, only fight, or avoid all the time. And let’s say a
10 is where you talk all the time, with perfect communication, never have a fight ever.
Husband: That is pretty unrealistic.
T: That would be the ideal. So where would you two say it was for you at its worst?
Maybe right before you came in to see me.
Wife: It was pretty bad . . . I don’t know . . . I’d say a 2 or a 3.
H: Yeah, I’d say a 2.
T: OK. [writing] . . . a 2–3 for you, and a 2 for you. Now, tell me what you would be
satisfied with when therapy is over and successful?

44
W: I’d be happy with an 8.
H: Well, of course I’d like a 10, but that is unrealistic. Yeah, I’d agree, an 8 would be
good.
T: What would you say it is right now?
W: I would say it is a little better, because he is coming here with me, and I see that he is
trying . . . I’d say maybe a 4?
H: Well, that’s nice to hear. I wouldn’t have thought she’d put it that high. I would say it
is a 5.
T: OK., a 4 for you, a 5 for you. And you both want it to be an 8 for therapy to be
successful, right?

There are three major components of this intervention. First, it is an assessment device. That is, when used
each session, the therapist and the clients have an ongoing measurement of the clients’ progress. Second, it
makes it clear that the clients’ evaluation is more important than the therapist’s. Third, it is a powerful
intervention in and of itself, because it focuses the dialogue on previous solutions and exceptions and
punctuates new changes as they occur. Like the changes made before the first session, here are three things
that can happen between each session: (a) things can get better, (b) things can stay the same, or (c) things can
get worse.

If the scale goes up, the therapist gets long descriptions and details as to what is different and better and
how they were able to make the changes. The therapist may compliment the clients during the session for
progress made or/and he may comment on the changes in summary of the session. This supports and
solidifies the changes and leads to the obvious nudge to “do more of the same.” If things “stay the same,”
again, the clients can be complimented on maintaining their changes or for not letting things get worse. “How
did you keep it from going down?” the therapist might ask. It is interesting how often that will lead to a
description of changes that they have made, in which case again the therapist can compliment and support
and encourage more of that change.

T: Mary, last week you were a 4 on the scale of good communications. I am wondering
where you are this week?
W: [Pause] I’d say a 5.
T: A 5! Wow! Really, in just one week.
W: Yes, I think we communicated better this week.
T: How did you communicate better this week?
W: Well, I think it was Rich. He seemed to try to listen to me more this week.
T: That’s great. Can you give me an example of when he listened to you more?
W: Well, yes, yesterday for example. He usually calls me once a day at work, and . . .
T: Sorry to interrupt, but did you say he calls you once a day? At work?
W: Yes

45
T: I’m just a little surprised, because not all husbands call their wives every day.
W: He has always done that.
T: Is that something you like? That you wouldn’t want him to change?
W: Yes, for sure.
T: Sorry, go on, you were telling me about yesterday when he called.
W: Well, usually it is kind of a quick call. But I told him about some problems I was
having, and he listened for a long time, seemed to care, gave me some good ideas. That
was nice.
T: So that was an example of how you would like it to be, where you can talk about
something, a problem, and he listens and gives good ideas? Support?
W: Yes.
T: Rich, did you know that Mary liked your calling her and listening to her? That that
made you two move up the scale, to her?
H: Yeah, I guess so. I have really been trying this week.
T: That’s great. What else have you done to try to make the communication better this
week?

This example shows how going over the scale with the couple served as a vehicle for finding the clients’
progress. The therapist gathered more and more information about the small changes that the clients made on
their own using the differences on the scale to generate questions. This naturally led to the therapist’s
suggesting that the couple continue to do the things that are working, in this case for the husband to continue
his calling her and his continuing to engage in the active listening that she found so helpful.

Constructing solutions and exceptions. The SFBT therapist spends most of the session listening attentively for
talk about previous solutions, exceptions, and goals. When these come out, the therapist punctuates them with
enthusiasm and support. The therapist then works to keep the solution-talk in the forefront. This, of course,
requires a whole range of different skills from those used in traditional problem-focused therapies. Whereas
the problem-focused therapist is concerned about missing signs of what has caused or is maintaining a
problem, the SFBT therapist is concerned about missing signs of progress and solutions.

Mother: She always just ignores me, acts like I’m not there, comes home from school, just runs
into her room. Who knows what she is doing in there.
Daughter: You say we fight all the time, so I just go in my room so we don’t fight.
M: See? She admits she just tries to avoid me. I don’t know why she can’t just come home
and talk to me a little about school or something, like she used to.
T: Wait a second, when did she “used to”? Anita, when did you use to come home and tell
your mom about school?
D: I did that a lot, last semester I did.
T: Can you give me an example of the last time you did that?

46
M: I can tell you, it was last week actually. She was all excited about her science project
getting chosen.
T: Tell me more, what day was that . . . ?
M: I think last Wednesday.
T: And she came home . . .
M: She came home all excited.
T: What were you doing?
M: I think the usual, I was getting dinner ready. And she came in all excited, and I asked
her what was up, and she told me her science project was chosen for the display at
school.
T: Wow, that is quite an honor.
M: It is.
T: So then what happened?
M: Well, we talked about it, she told me all about it.
T: Anita, do you remember this?
D: Sure, it was only last week. I was pretty happy.
T: And would you say that this was a nice talk, a nice talk between you two?
D: Sure. That’s what I mean; I don’t always go in my room.
T: Was there anything different about that time, last week, that made it easier to talk to
each other?
M: Well, she was excited.
D: My mom listened, wasn’t doing anything else.
T: Wow, this is a great example. Thank you. Let me ask this: If it were like that more
often, where Anita talked to you about things that were interesting and important to
her, and where, Mom, you listened to her completely without doing other things, is
that what you two mean by better communication?
D: Yeah, exactly.
M: Yes.

In this example, the therapist did a number of things. First, she listened carefully for an exception to the
problem, a time when the problem could have happened but did not. Second, she punctuated that exception
by repeating it, emphasizing it, getting more details about it, and congratulating them on it. Third, she
connected the exception to their goal (or miracle) by asking the question, “If this exception were to occur
more often, would your goal be reached?”

Coping questions. If a client reports that the problem is not better, the therapist may sometimes ask coping
questions such as, “How have you managed to prevent it from getting worse? “ or “This sounds hard—How
are you managing to cope with this to the degree that you are?”

47
 Taking a break and reconvening. Many models of family therapy have encouraged therapists to take a break
toward the end of the session. Usually this involves a conversation between the therapist and a team of
colleagues or a supervision team who have been watching the session and who give feedback and suggestions
to the therapist. In SFBT, therapists are also encouraged to take a break near the session end. If there is a
team, they give the therapist feedback, a list of compliments for the family, and some suggestions for
interventions based on the client’s strengths, previous solutions, or exceptions. If there is not a team available,
the therapist will still take a break to collect his or her thoughts, and then come up with compliments and
ideas for possible experiments. When the therapist returns to the session, he or she can offer the family
compliments.

T: I just wanted to tell you, the team was really impressed with you two this week. They
wanted me to tell you that, Mom, they thought you really seem to care a lot about your
daughter. It is really hard to be a mom, and you seem so focused and clear about how
much you love her and how you want to help her. They were impressed that you came
to session today, in spite of work and having a sick child at home. Anita, the team also
wanted to compliment you on your commitment to making the family better. They
wanted me to tell you how bright and articulate they think you are, and what a good
“scientist” you are! Yes, that you seem to be really aware of what small, little things that
happen in your family that might make a difference . . . That is what scientists do, they
observe things that seem to change things, no matter how small. Anyway, they were
impressed with you two a lot!
D: [Seeming pleased] Wow, thanks!

Experiments and homework assignments. Although many models of psychotherapy use intersession homework
assignments to solidify changes begun during therapy, most of the time the homework is assigned by the
therapist. In SFBT, therapists frequently end the session by suggesting a possible experiment for the client to
try between sessions if they so choose. These experiments are based on something the client is already doing
(exceptions), thinking, feeling, and so on that is heading them in the direction of their goal. Alternately,
homework is sometimes designed by the client. Both follow the basic philosophy that what emanates from the
client is better than if it were to come from the therapist. This is true for a number of reasons. First, what is
usually suggested by the client, directly or indirectly, is familiar. One of the main reasons homework is not
accomplished in other models is that it is foreign to the family, thus it takes more thinking and work to
accomplish (usually thought of as “resistance”). Second, the clients usually assign themselves either more of
what has worked already for them (a previous solution) or something they really want to do. In both cases, the
homework is more tied to their own goals and solutions. Third, when a client makes his or her own
homework assignment, it reduces the natural tendency for clients to “resist” outside intervention, no matter
how good the intention. Although SFBT does not focus on resistance (in fact, it sees this phenomenon as a
natural, protective process that people use to move slowly and cautiously into change rather than as evidence
of psychopathology), certainly, when clients initiate their own homework, there is a greater likelihood of
success.

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T: Before we end today, I would like for you two to think about a homework assignment.
If you were to give yourselves a homework assignment this week, what would it be?
D: Maybe that we talk more?
T: Can you tell me more?
D: Well, that I try to talk to her more when I come home from school. And that she stops
what she is doing and listens.
T: I like that. You know why? Because it is what you two were starting to do last week.
Mom, what do you think? Is that a good homework assignment?
M: Yeah, that’s good.
T: So let’s make this clear. Anita will try to talk to you more when she comes home from
school. And you will put down what you are doing, if you can, and listen and talk to
her about what she is talking to you about. Anything else? Anything you want to add?
M: No, that’s good. I just need to stop what I was doing; I think that is important to listen
to her.
T: Well that sure seemed to work for you two last week. Okay, so that’s the assignment.
We’ll see how it went next time.

A couple of points should be emphasized here: First, the mother and daughter were asked to make their
own assignment rather than have one imposed on them by the therapist. Second, what they assigned
themselves flowed naturally from their previous solution and exceptions from the week before. This is very
common and is encouraged by SFBT therapists. However, even if the client suggested an assignment that was
not based on solutions and exceptions to the problem, the therapist would most likely support it. What is
preeminent is that the assignments come from the client.

In cases where the client has not been able to form a clear goal, the therapist may propose that the client
thinks about how he wants things to be by, for instance, using the FFST (formula first session task; de Shazer,
1985, 1992).

Ideas around what the therapist thinks might be useful for the client to observe may (and will often) be
given with the end-of-session message. These will have something to do with what the client described in the
miracle.

So, what is better, even a little bit, since last time we meet? At the start of each session after the first, the therapist will
usually ask about progress, about what has been better during the interval. Many clients will report that there have
been some noticeable improvements. The therapist will help the client describe these changes in as much
detail as possible. Of course, some clients will report that things have remained the same or have gotten worse.
This will lead the therapist to explore how the clients have maintained things without things getting worse;
or, if worse, what did the client do to prevent things from getting much worse. Whatever the client has done
to prevent things from worsening is then the focus and a source for compliments and perhaps for an
experiment since whatever they did they should continue doing. During the session, usually after there has
been a lot of talk about what is better, the therapist will ask the client about how she would now rate herself

49
on the progress (toward solution) scale. Of course, when the rating is higher than the previous session’s, the
therapist will compliment this progress and help the client figure out how she will maintain the improvement.

At some point during the session—possibly at the beginning, perhaps later in the session—the therapist
will check, frequently indirectly, on how the assignment went. If the client did the assignment and it
“worked”—that is, it helped her move toward her goals—the therapist will compliment the client. If the client
did not do the assignment, the therapist usually drops it or asks what the client did instead that was better.

One difference between SFBT and other homework-driven models, such as cognitive behavioral therapy, is
that the homework itself is not required for change per se, so not completing an assignment is not addressed.
It is assumed if the client does not complete an assignment that (a) something realistic got in the way of its
completion, such as work or illness; (b) the client did not find the assignment useful; or (c) it was basically not
relevant during the interval between sessions. In any case, there is no fault assigned. If the client did the
assignment but things did not improve or got worse, the therapist handles this in the same way he or she
would when problems stay the same or get worse in general.

Compatibility With Adjunctive Therapies

SFBT can easily be used as an addendum to other therapies. One of the original and primary tenets of SFBT
—“If something is working, do more of it”—suggests that therapists should encourage their clients to
continue with other therapies and approaches that are helpful. For example, clients are encouraged to (a)
continue to take prescribed medication, (b) stay in self-help groups if it is helping them to achieve their goals,
or (c) begin or continue family therapy. Finally, it is a misconception that SFBT is philosophically opposed to
traditional substance abuse treatments. Just the opposite is true. If a client is in traditional treatment, or has
been in the past and it has helped, he or she is encouraged to continue doing what is working. As such, SFBT
could be used in addition to or as a component of a comprehensive treatment program.

Target Populations
SFBT has been found clinically to be helpful in treatment programs in the United States for adolescent and
adult outpatients (Pichot & Dolan, 2003) and as an adjunct to more intensive inpatient treatment in Europe.
SFBT is being used to treat the entire range of clinical disorders and is also being used in educational and
business settings. Meta-analysis and systematic reviews of experimental and quasi-experimental studies
indicate that SFBT is a promising intervention for youth with externalizing behavior problems and those with
school and academic problems, showing medium to large effect sizes (Kim, in press; Kim & Franklin, 1997).

Meeting the Needs of Special Populations

Although SFBT may be useful as the primary treatment mode for many individuals in outpatient therapy,
those with severe psychiatric, medical problems, or unstable living situations will most likely need additional
medical, psychological, and social services. In those situations, SFBT may be part of a more comprehensive
treatment program.

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Therapist Characteristics and Requirements
SFBT therapists should posses the requisite training and certification in mental health discipline and
specialized training in SFBT. The ideal SFBT therapist would possess (a) a minimum of a master’s degree in
a counseling discipline such as counseling, social work, marriage and family therapy, psychology, or psychiatry
and (b) formal training and supervision in SFBT, through either a university class or a series of workshops and
training. Therapists who seem to embrace and excel as solution-focused therapists have these characteristics:
(a) are warm and friendly; (b) are naturally positive and supportive (often are told they “see the good in
people”); (c) are open minded and flexible to new ideas; (d) are excellent listeners, especially the ability to
listen for clients’ previous solutions embedded in “problem-talk”; and (e) are tenacious and patient.

Therapist Training
Therapists who meet the above requirements should receive formal training and supervision in SFBT. A brief
outline of such a training program would include the following:

1. History and philosophy of SFBT

2. Basic tenets of SFBT
3. Session format and structure of SFBT
4. Video examples of “Masters” of SFBT
5. Format of SFBT
6. Video examples of SFBT
7. Role-playing
8. Practice with video feedback
9. Training with video feedback

Therapists can be considered trained when they achieve an 85% adherence and competency rating using
standardized adherence and competency rating scales. There should also be subjective evaluations by the
trainers as to therapists’ overall ability to function reliably and capably as solution-focused therapists.

Supervision
SFBT therapists should be supervised live whenever possible. One of the most common problems is the
therapist slipping back into “problem-talk.” It is far better for the therapist-in-training to receive concurrent
feedback, through telephone call-in for example, so that this can be corrected immediately. “Solution-talk” is
far more likely to become natural and accommodated by therapists when given immediate feedback, especially
early in training. The other advantage to live supervision, of course, is that there is a second set of “clinical
eyes,” which also will benefit the clients, especially more difficult cases. When live supervision is not possible,
then videotape supervision is the best alternative, since the movement and body language of the group is
relevant to the feedback that the supervisor will want to give the therapist. Adherence and competency scales

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should be used as an adjunct to supervision to focus the supervision on balancing both the quantity of
interventions (adherence) and the quality (competency) and allow for more immediate remediation.

REFERENCES
Berg, I. K. (1994). Family-based services: A solution-focused approach. New York: Norton.
Berg, I. K., & Dolan, Y. (2001). Tales of solutions: A collection of hope-inspiring stories. New York: Norton.
Berg, I. K., & Miller, S. D. (1992). Working with the problem drinker: A solution-oriented approach. New York:
Norton.
Carroll, K. M., & Nuro, K. F. (1997). The use and development of treatment manuals. In K. M. Carroll
(Ed.), Improving compliance with alcoholism treatment (pp. 53–72). Bethesda, MD: National Institute on
Alcohol Abuse and Alcoholism.
Corey, G. (1985). Theory and practice of group counseling (2nd ed.). Monterey, CA: Brooks/Cole.
De Jong, P., & Berg, I. K. (2008). Interviewing for solutions (3rd ed.). Belmont, CA: Thomson Brooks/Cole.
de Shazer, S. (1985). Keys to solution in brief therapy. New York: Norton.
de Shazer, S. (1992). Patterns of brief family therapy. New York: Guilford.
de Shazer, S., Berg, I. K., Lipchik, E., Nunnally, E., Molnar, A., Gingerich, W., & Weiner-Davis, M.
(1986). Brief therapy: Focused solution development. Family Process, 25(2), 207–221.
de Shazer, S., Dolan, Y. M., Korman, H., Trepper, T. S., McCollum, E. E., & Berg, I. K. (2006). More than
miracles: The state of the art of solution focused therapy. New York: Haworth Press.
Freedman, J., & Combs, G. (1996). Narrative therapy: The social construction of preferred realities. New York:
Norton.
Kim, J. S. (in press). Examining the effectiveness of solution-focused grief therapy: a meta-analysis. Research
on Social Practice.
Kim, J. S. & Franklin, C. (1997) Solution-focused brief therapy in schools: A review of the literature.
(Manuscript submitted for publication).
Kim, J. S. (2008). Examining the effectiveness of solution-focused brief therapy: A meta-analysis. Research on
Social Work Practice, 18, 107–116.
Kim, J. S., & Franklin, C. (2009). Solution-focused brief therapy in schools: A review of the literature.
Children and Youth Services Review, 31, 464–470.
McGee, D. R., Del Vento, A., & Bavelas, J. B. (2005). An interactional model of questions as therapeutic
interventions. Journal of Marital and Family Therapy, 31, 371–384.
Miller, W. R., & Rollnick, S. (2002). Motivational interviewing: Preparing people for change (2nd ed.). New
York: Guilford.
Miller, W. R., Zweben, A., DiClemente, C. C., & Rychtarik, R. G. (1994). Motivational enhancement therapy
manual: A clinical research guide for therapists treating individuals with alcohol abuse and dependence (NIH
Publication No. 94–3723). Rockville, MD: National Institute on Alcohol Abuse and Alcoholism.
Pichot, T., & Dolan, Y. (2003). Solution-focused brief therapy: Its effective use in agency settings. New York:
Haworth.

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* © Copyright 2013 SFBTA.

1. Goals in SFBT are desired emotions, cognitions, behaviors, and interactions in different contexts (areas of the client's life).

2. Goals connect emotion, cognition, behavior, and interaction. So if the client says, “I don’t want to feel depressed,” the therapist will start
eliciting goals by asking how the client will notice when things become better, and the client might answer, “I’d feel better. I’d be more calm and
relaxed.” The therapist might then ask in what area of the client’s life he will start noticing if he felt more calm and relaxed, and the client might
answer, “When I am getting the children ready to go to school.” The client will then be asked what the children will notice about him that says
that he is more calm and relaxed, and how the children will behave differently when they are noticing this. The conversation might then move
on to what differences this will make in other areas of the client’s life, like the relationship with the partner or/and at work. The therapist will
try to create descriptions of cognition, emotion, behavior, and interaction in several different contexts (parts of the client’s life) with people in
these contexts. This is an important part of SFBT—connecting descriptions of both desired and undesired cognitions, emotions, behavior, and
interactions with each other in contexts where they make sense.

Source: T. Trepper et al. (Eds.), (2012). Solution-focused brief therapy: From practice to evidence-informed practice. New York: Oxford
University Press. (pp. 20–36). © Copyright 2013 SFBTA

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 3
Does Solution-Focused Brief Therapy
Work?
Cynthia Franklin, Katherine L. Montgomery

Introduction
Solution-focused brief therapy (SFBT) was birthed out of the spirit of systematic observations and a desire to
discover the most effective and efficient therapeutic methods for helping clients to change in brief therapy.
Past research studies on SFBT demonstrate this approach has promise as an effective intervention, and
outcome research on SFBT using experimental designs has also advanced over the past 10 years. Despite the
growth, there is a dearth of literature that describes the effectiveness of SFBT with different ethnic
populations. This chapter reviews the efficacy of SFBT, describing the numerous studies conducted both
domestically and internationally. The extent to which SFBT has been used and evaluated with ethnic minority
clients, as well as the effectiveness of SFBT with ethnic minority groups, will be reviewed. Finally, this
chapter will also discuss the treatment problems, settings, and populations in which SFBT has proven to be
most effective.

SFBT Research

History and Foundation of SFBT Research

SFBT emerged out of a strong research foundation and process that mirrors the evidence-based approach
in how knowledge is developed. SFBT originally evolved out of the family systems therapy; during the time
SFBT was being developed, the dominant therapeutic approaches were largely problem focused, and many
therapists used a psychodynamic theoretical approach (Lipchik, 2002). Family systems approaches to therapy
challenged the theoretical notions of traditional therapies by offering new ways to conceptualize and to create
an effective therapeutic change process, and SFBT also provided new methods for helping clients solve their
problems. The founders of SFBT were a group of practitioners and researchers who were guided by the
question: What works in brief therapy? This question became a focus of their clinical investigations that led to
the development of SFBT. This group of practitioner/researchers also shared a desire first to understand the
extent to which existing components of therapeutic approaches were responsible for positive change for the
client and, second, to understand how the change process could occur earlier in the therapeutic relationship
(Lipchik, Derks, LaCourt, & Nunnally, 2012).

To explore the possibilities of change occurring earlier in the therapeutic process, the team experimented
with brief family therapy (BFT). Then, they worked to develop the theory and therapeutic change techniques

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by repeatedly testing their ideas through observations of clinical interviews, and they corroborated their
findings with additional clinical interviews and observations of therapy sessions. The ideas the team
discovered were further compared with current theoretical perspectives in the field of family therapy, and they
contributed new ideas for how to improve the therapeutic change process with clients. The approach taken by
the founders of SFBT was similar to qualitative designs that allow theoretical constructs to emerge out of
observations and interview data (Charmaz, 2006). In attempts to conceptually and theoretically define BFT,
the therapists, for example, were collecting data by watching each other behind a one-way mirror to
understand what worked and what needed to be changed as they developed this new approach (Lipchik et al.,
2012). They also conducted follow-up interviews with clients that examined the extent to which the brief
therapy was helping clients reach their goals.

Over time, the founders of SFBT discovered that the focus on solutions, rather than problems, seemed to
be a critical component in the brief therapy process, and the team began to publish the therapeutic change
techniques that they had discovered (de Shazer, 1985; de Shazer et al., 1986). Thus, SFBT was birthed out of
the reciprocal relationship between observed therapeutic sessions, client feedback, and the conceptual
conversations that followed (see Lipchik et al., 2012, for a detailed history). From this history, SFBT quickly
emerged into a therapeutic approach that is now being used in many different countries across the world, and
more systematic attempts to evaluate the outcomes of SFBT also have emerged.

Preliminary Studies of SFBT

Even though SFBT was initially created through an approach similar to qualitative research, more rigorous
experimental research was slower to emerge. Perhaps this is because SFBT was created in a clinical field
setting and not in a university or research setting. In 1994, a psychiatrist in the United Kingdom, Dr. Alasdair
Macdonald, sought to compile all of the published research on SFBT and found only eight studies. Three of
the studies were from the Brief Family Therapy Center (BFTC) in Milwaukee, two were from England, and
one study was published from each of the following areas: Germany, Spain, and California. Each of these
studies reported on the naturalistic follow-up data of clinical populations, and results ranged from 66% to 86%
improvement.

The first three published studies were conducted by de Shazer and colleagues (1985, 1986, 1991) at the
BFTC. Reporting on the six-month follow-up results of 28 cases, de Shazer (1985) found that 82% (N = 23)
of the cases had improved, and 39% (N = 11) had resolved their identified problem after an average of five
sessions. The following year, de Shazer and colleagues (1986) published the results of follow-up telephone
calls with approximately 400 cases over a five-year period at the BFTC. They found that 72% of the cases
reported improvement after an average of six sessions. The final study published by de Shazer (1991) reported
on the results of 29 cases who had received SFBT. After receiving an average of 4.6 sessions, 86% of the cases
reported at an 18-month follow-up that they had either resolved their identified problem or made substantial
progress (de Shazer, 1991).

George and colleagues (1990) reported the results of six-month follow-up phone calls with 62 cases that
received SFBT at their London clinic. They found that in 66% (N = 41) of the cases, both the therapist and
the clients interviewed were satisfied with the outcome (George, Iveson, & Ratner, 1990).

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 Perez-Grande (1991) reported on the results of 97 cases, 25% of whom were youth, who had received
SFBT in a family clinic in Salamanca, Spain. Seventy-one percent of participants described that they felt
better after receiving SFBT (with an average of five sessions). In addition, researchers were able to recruit 81
clients to participate in follow-up (between 6 to 35 months follow-up depending on the participant)
interviews. Thirteen percent of follow-up participants reported that they had relapsed; however, 38% reported
that improvement had not only been sustained, but they had noticed additional improvements (Perez-Grande,
1991).

The next study found was conducted by Burr (1993) in Germany. Among youth referred to a Northern
Germany child psychiatry clinic, 55 clients who had received SFBT were recruited to participate in a nine-
month (average) follow-up survey (Burr, 1993). Of the 34 participants that responded, 77% (N = 26)
indicated that that they improved.

Having used a family systems approach that was based on solution-focused principles to impact learning
and behavioral problems among elementary students in California, Morrison and colleagues (1993) reported
on the results of their study with 30 children (six of which were receiving special education services).
Researchers found that 77% (N = 23) revealed improvements; however, seven children relapsed over time.

The final study compiled by Macdonald was the first published report of SFBT with adults seeking
psychiatric care (1994). Approximately one year after receiving intervention, 70% (N = 29) of the individuals
or families reported continued improvements. The researcher also found that among clients who reported
having four or more years of sustained problems, there were fewer reported improvements. In addition, he also
found that there were no differences in the benefits for participants from varying socioeconomic statuses
(Macdonald, 1994).

Despite the limitations of the samples and designs, each of these early pretest-posttest design studies
offered important first steps in understanding the empirical impact of SFBT with various clinical populations.
Overall, approximately 70% or more of the participants in each study reported initial improvements after
receiving SFBT. Although they offered preliminary promise, stronger studies with more rigorous research
designs were needed before researchers and practitioners could speak to the efficacy of SFBT with various
populations.

Overall Effectiveness of SFBT

Over the past decade, the advancements in SFBT outcome research led Kim and colleagues (2010) to
conclude that SFBT is a practice based on evidence that deserves further consideration for its efficacy and
effectiveness. Even though therapies are often evaluated for their state of current evidence, evidence-based
practice is a process for how practitioners may decide the most effective intervention(s) for a client problem
(and effectively apply using the best clinical judgment and expertise) and how the identified intervention(s)
can be matched to a client’s values. To execute this process, practitioners are encouraged to examine
therapeutic approaches that are based on research evidence and applicability to their clients. This is why the
research basis of SFBT is so important. When practitioners follow an evidence-based practice approach, they
will seek to use approaches that have enough evidence from research studies to justify their use with the

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specific clients and problems that they treat. Issues, such as effectiveness with those from ethnically diverse
backgrounds and particular problem areas, must be considered as well as the potential fit with a client’s
preferences.

To ease the burden on practitioners and to help them quickly and efficiently identify evidence-based
practices, there is a trend for experts to examine therapeutic interventions based on their research evidence and
an overall estimate of effect (such as an effect size or another ranking that offers some type of conclusion
about their evidence-based standing). For example, systematic reviews and meta-analyses may be conducted
that examine experimental design studies, the actual rigor of those studies, and the outcomes achieved.
Policymakers, research funders, and federal agencies have also conducted their own reviews that have resulted
in therapies being evaluated and labeled as “evidence-based.” Although there are many weaknesses to this type
of therapeutic evaluation approach, it is very important for a therapy to meet the evidence-based criteria that
has been specified by different evaluators. The good news is that SFBT has been examined by systematic
reviews and federal agencies and has enough research support to be considered a “promising practice” that
deserves further evaluation. Specifically, SFBT was evaluated by the Office of Juvenile Justice and
Delinquency Prevention and declared a promising practice. In addition, it has also recently been reviewed by
the Substance Abuse and Mental Health Services Administration and has been added to its National Registry
for Evidence-based Practices (see Gingerich, Kim, Stams, & Macdonald, 2012, and Kim, 2008, for reviews).
The following section examines in more detail the systematic reviews on SFBT and some of the critiques of
this approach for application with ethnically diverse clients.

Figure 3.1 The Hierarchy of Research

As previously mentioned, when interpreting how efficacious a particular intervention is, researchers

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examine the results of existing studies, and, in line with the evidence-based practice model, the best evidence
with the strongest research designs must be appraised with a critical eye. To critically identify and evaluate the
strongest and most comprehensive evidence-base, the hierarchy of research is a pragmatic tool that can be
used (see Figure 3.1). As is illustrated, meta-analyses are considered to be at the top of the research hierarchy.
The purpose of a meta-analysis is to systematically collect data from multiple studies that answer a specific
research question (e.g., how effective is SFBT?) and offer a quantitative number that statistically illustrates
how effective a particular variable (e.g., receipt of solution-focused therapy) is on identified outcomes (e.g.,
internalizing behaviors of clients in therapy; Littell, Corcoran, & Pallai, 2008). Even though meta-analysis is
considered to be at the top of hierarchy and an acceptable way to evaluate therapies, it is not independent of
the other research methods but rather dependent on the quality of the studies that are available for the
analysis. The phrase “garbage in is garbage out” has often been used to express this critique of meta-analysis.
We will see how limitations in research designs may limit the interpretations of meta-analyses that have been
done on SFBT and how small samples used in studies also may limit our conclusions about the effectiveness
of this approach with ethnic minority populations.

Meta-Analytic Reviews of SFBT

Meta-Analysis Published in 2006
The first meta-analytic review of SFBT was conducted by Dutch researchers in 2006 with the aim of
investigating the quantitative evidence that existed on the impact of SFBT with various populations (Stams,
Dekovic, Buist, & De Vries, 2006). Stams and colleagues (2006) primarily used computerized databases when
they searched for studies to include in their meta-analytic review: Medline, PsycINFO, and ERIC. They
searched these databases with various combinations of the following terms: solution-focused therapy, SFBT,
therapy, solution, and intervention. To be included in the meta-analysis initially, studies had to have been
published articles or dissertations. In addition, Stams and colleagues included studies that were mentioned in
the published manuscripts, such as book chapters, other articles, and the qualitative review that was conducted
by Gingerich and Eisengart in 2000.

For a study to meet inclusion criteria, the author(s) had to define the treatment being studied as SFBT. No
additional inclusion criteria were used to determine how SFBT was delivered. Stams and colleagues (2006)
included a variety of study designs in their meta-analysis, ranging from experimental and quasi-experimental
designs to one-group designs that only reported posttest measurement data.

Twenty-one studies met inclusion criteria, and the authors reported on the results of 1,421 participants who
had received SFBT. Stams and colleagues (2006) calculated a “fail-safe N” number to investigate whether a
publication bias or file-drawer problem existed. This method estimates the number of unpublished studies
necessary to impact statistically significant effects that were included in the study (Durlak & Lipsey, 1991).
Through calculating the fail-safe number, Stams and colleagues (2006) were able to determine that there was
likely not a file-drawer effect occurring that could have impacted the results of their meta-analysis.

Stams and colleagues reported a Cohen’s d statistic (Cohen, 1988) when they offered the quantitative effect
that had occurred in the reviewed articles. When interpreting Cohen’s d, researchers generally interpret d =

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.20 to be a small effect size, d = .50 to be a medium effect size, and d = .80 or higher to be a large effect size.
The pooled effect size that Stams and colleagues (2006) reported using the random effects model was d = .37
(95% confidence interval [CI], 19 < d < .55), p < .001 (Z = 3.94), indicating that those who had received
SFBT reported outcomes that had a small to near medium effect (Cohen, 1988). Researchers, however, found
the sample of studies to be heterogeneous (Q [20] = 63.87, p < .001). This means that the overall effect size
calculated was not an appropriate indicator necessary to describe the effect of SFBT with the included
participants. To address the heterogeneity problem, the researchers ran a series of analyses of variance to
identify moderators that accounted for the differences across studies’ effect sizes.

The moderator analyses results are shown in Table 3.1. One of the more substantial implications from the
table is that, when compared with a group of participants who received no treatment, those participants who
received SFBT were found to have a statistically significant medium effect size (d = 0.57, p < .01). The
researchers also looked at studies that offered an evidence-based treatment to the control group; the effect was
very small (d = .16) and not statistically significant. These findings indicate that those participants who receive
SFBT reported positive outcomes; however, it may not be any better than alternative evidence-based
treatments. These results, however, are often typical of other therapy research that has indicated that different
approaches may achieve similar results. As a younger therapy, it may even be interpreted as an important
finding for SFBT, because SFBT is shown to be as effective as other well-researched therapies and may also
achieve the same results with fewer numbers of sessions. The moderator analysis further highlighted that
studies published prior to 2000 did not produce as strong effects (d = .29, p < .001) as those published after
2000 (d = .87, p < .001). In addition, there were specific populations that benefited more from receiving
SFBT: adults (d = .87, p < .001), clients who received services while being institutionalized (d = .60, p < .001),
participants with externalizing problems (d = .61, p < .001), those participants who received SFBT in a group
format (d = .59, p < .001), and participants who received six weeks or less of SFBT (d = .46, p < .001). These
researchers, however, did not include an analysis of ethnic group differences. Perhaps this is because their
study samples were too small or did not provide enough variation to warrant this analysis.

Table 3.1 Stams and Colleagues (2006) Meta-Analysis Moderator Results

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Adapted from Gingerich and colleagues (2012). *p<0.05; **p<0.01; ***p<0.001

Stams and colleagues (2006) also found that the research design moderated the level of efficacy. The weaker
designed studies seemed to produce larger effect sizes. For example, studies with no control group had a much
larger overall effect (d = .84, p < .001) when compared with the experimental and quasi-experimental designs
(d = .25, p < .01). In addition, studies that were defined as “weak” had a stronger effect on outcomes (d = .47, p
< .01) than those that were defined as “strong” research designs (d = .30, p < .001).

This meta-analytic review was the first of its kind to quantitatively assess the efficacy of SFBT. Stams and
colleagues reported on important findings where efficacy was moderated by demographic characteristics, types
of problems, ways in which SFBT was delivered, and type of research design. Stams and colleagues (2006)
concluded that although SFBT was not more effective than standard problem-focused therapy, it does seem
to be effective with a variety of populations. Researchers also concluded that SFBT did have a positive effect
over shorter periods than did standard problem-focused therapy.

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Meta-Analysis Published in 2008
In 2008, a second meta-analytic review of SFBT was published that specifically examined outcomes
associated with externalizing behavior problems, internalizing behavior problems, and familial or relationship
problems (Kim, 2008). Kim created more specific inclusion criteria than the previous meta-analysis, including
studies that incorporated only one of the following SFBT techniques identified by de Shazer and Berg (1997):
(a) use of the miracle question; (b) scaling questions; (c) the therapist taking a break at the end of the
interview; or (d) after the therapist’s break, the client was given a set of compliments, possible suggestions,
and/or homework tasks. Kim (2008) also required that the study be a stronger research design, only including
studies that were experimental and quasi-experimental designs. Lastly, studies published in journal articles
between 1988 and 2005, as well as studies reported in both published and unpublished dissertations, were
included in this meta-analytic review.

Twenty-two studies met inclusion criteria for Kim’s (2008) review and, as aforementioned, outcomes were
grouped in three categories: (a) externalizing behavior problems, (b) internalizing behavior problems, and (c)
familial and relationship problems. Some publications were included in more than one of the three identified
outcome domains because they investigated the efficacy of SFBT with several outcomes (Franklin, Moore, &
Hopson, 2008; Huang, 2001; Marinaccio, 2001; Seagram, 1997; Triantafillou, 2002).

Kim (2008) found that nine studies investigated the impact of SFBT on outcomes associated with
externalizing behavior problems. Externalizing behavioral problems include variables such as hyperactivity,
conduct problems, and aggression. The majority of these studies were conducted with children and
adolescents (N = 6), and the remainder were conducted with couples, mothers, teachers, and people who are
elderly. Different from the large effect found in Stams and colleagues’ study (2006), Kim’s (2008) results
revealed a small and nonstatistically significant overall effect size (d = .13, not significant [n.s.]; Cohen, 1988).
This effect indicates that there was little difference between those who received SFBT and the participants in
control groups. As seen, however, in Table 3.2, individual effect sizes varied substantially. It may be possible
that SFBT has more of an effect with more specific populations. The numbers of studies included in the
meta-analysis, however, did not make it statistically possible for the researcher to investigate differences in
sample characteristics that might account for these large differences. This also means that this study was not
able to investigate important differences in outcomes based on moderators like race that might help
researchers better evaluate the effectiveness of SFBT with different ethnic minority populations.

Table 3.2 Kim (2008) Meta-Analysis Results

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Adapted from Gingerich, Kim, Stams, and Macdonald (2012).

Twelve studies included in Kim’s (2008) review measured the impact of SFBT on internalizing behavior
problem outcomes (see Table 3.2). Internalizing problems generally include outcomes such as depression,
anxiety, self-concept, and self-esteem problems. Samples included ranged from children and adolescents (N =
7), one sample of which was composed of adolescent offenders, to couples (N = 1), adults (N = 1), college
students (N = 1), and psychiatric patients (N = 1). With a wide range of effect size outcomes (−.46 to 1.18),
the combined effect size estimate investigating the efficacy of SFBT with internalizing behavior outcomes
revealed a statistically significant small effect (d = .26, p < .05).

Finally, Kim (2008) reported the effects from eight studies that investigated SFBT with familial and/or
relationship associated outcomes. This domain reported on results with much fewer child and adolescent
specific populations. Two studies specifically reported on their results with couples. In addition, studies
included samples of families (N = 2), couples (N = 2), adults (N = 1), children (N = 1), and orthopedic patients
(N = 1). Effect sizes in this domain also varied substantially (from −.56 to 1.23), offering an overall small but
positive effect (d = .26, n.s.).

Many participants receiving SFBT reported positive effects regarding externalizing, internalizing, and

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familial/relationship problems. However, of the three domains explored in Kim’s (2008) meta-analytic review,
only studies that reported on outcomes associated with internalizing behavior problems revealed a statistically
significant overall effect size. In other words, the overall treatment effect on internalizing behavior problem
outcomes can be attributed to receiving SFBT. Additional research needs to be conducted to determine if
SFBT influences externalizing behavior problems and family and relationship problems.

In his article, Kim (2008) offers possible explanations regarding the interpretation of the results of his
analysis. He highlighted two primary issues that could have affected the overall effects sizes: dissertations and
treatment fidelity. Previous researchers have noted that there can be substantial differences between
dissertations and published journal articles (e.g., Carlberg & Walberg, 1984). In Kim’s (2008) review, he
explained that of all included dissertation studies (N = 11), only two revealed a medium (d = .56) or large
effect (d = 1.18) size. The rest of the dissertation effect sizes were either small or revealed negative treatment
effects. In contrast, the published studies reported a more evenly distributed variety of effect sizes (four with
large to nearing large, three medium, and four small treatment effect sizes). The large number of small and
negative treatment effect sizes reported in these dissertations may likely have influenced the overall effect sizes
in Kim’s (2008) meta-analysis.

Kim (2008) also highlighted that treatment fidelity (the degree to which the treatment was delivered as it
was originally intended) could explain the lower effect sizes as well. To deliver treatment with fidelity, it is
important that clinicians receive adequate training prior to the beginning of the study. Only three dissertation
studies reported that clinicians received six or more hours of SFBT training, and in six dissertation studies, the
author reported clinicians receiving little or no SFBT training prior to delivering the intervention.

Kim (2008) also found that the amount of training received prior to the delivery of the intervention was an
issue in several of the published studies. In fact, in seven of the published studies, researchers reported that
clinicians had received little to no SFBT training prior to implementing the intervention. Only in four
published studies did researchers report that clinicians received a minimum of 20 hours of training. Kim
explained that it was possible that the amount of training received impacted effect sizes. For example, the
clinicians in two studies who received a two- to four-day SFBT training served clients who reported having
outcomes with nearly large effect sizes (d = .70 and d = .74). Interestingly, however, in the two studies where
substantial SFBT training (20 hours in one study and eight weeks of training in the other) was offered, no
difference was found between the treatment and control groups (meaning the effect size was zero). Kim
(2008) suggests that these differences in training may be impacting treatment fidelity. SFBT has often been
considered simple to implement because of the simplistic nature of the techniques; however, for clinicians to
become proficient at delivering SFBT, much training and practice is needed (c.f., Franklin, Trepper,
Gingerich, & McCollum, 2012). Additional research is needed to determine the extent to which variation in
the type of publication (e.g., dissertations and published journal articles), amount of training, and treatment
fidelity impact outcomes after receiving SFBT.

Recent Studies
After the aforementioned reviews were published, some additional important studies investigating the
efficacy of SFBT impacting client outcomes have been conducted (see Table 3.3; c.f., Cepukiene & Pakrosnis,

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2010; Daki & Savage, 2010; Knekt & Lindfors, 2004; Knekt et al., 2008a, 2008b; Shin, 2009; Smock et al.,
2008). The first study was a quasi-experimental design that was conducted by Cepukiene and Pakrosnis
(2010) with 92 adolescents in foster care homes in Lithuania. The 46 youth in the treatment group received
one session of SFBT for five weeks, and the 46 youth in the control group received no treatment.
Posttreatment results revealed that participants had significantly decreased their behavioral problems when
compared with the control group. Control group participants reported no significant changes (Cepukiene &
Pakrosnis, 2010).

Daki and Savage also published results in 2010 on an RCT study with 14 children in Canada who had
reading difficulties. Students were randomized either into an SFBT group or an academic homework support
group. Although both groups revealed improvement in several areas, those in the SFBT group had a very large
and higher overall eta-squared effect size (.20) compared with the control group (.09). Specifically, those in
the treatment group showed improvement in attitudes toward school and teachers, listening comprehension,
and reading fluency, and a reduction in anxiety while the control group participants showed gains in
phonological awareness and spelling skills relative to the intervention group (Daki & Savage, 2010).

The third study also used an RCT design to investigate the efficacy of SFBT with 326 participants (Knekt
et al., 2008a, 2008b; Knekt & Lindfors, 2004). More specifically, researchers compared the impact of SFBT
with control groups that received evidence-based practices (short-term psychodynamic psychotherapy and
long-term psychodynamic therapy) with clients who had been diagnosed with depression and anxiety
disorders. Researchers found a reduction in both depression and anxiety symptoms for all three groups at
three-year follow-up. They explained that the brief interventions (SFBT and short-term psychodynamic
psychotherapy) impacted outcomes more quickly, but over time, participants in the long-term therapy group
reported gains similar to those in the brief groups (Knekt et al., 2008a, 2008b; Knekt & Lindfors, 2004). In
addition, they found that although the brief interventions resulted in faster treatment outcomes (in Year 1),
the long-term treatment not only revealed comparable treatment effects with the brief participants in Year 2
but also revealed that gains from the long-term group exceeded the treatment effect gains from the short-term
groups.

Table 3.3 Recent SFBT Studies

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 In another study conducted with 40 youth on probation in Korea, Shin (2009) reported on the comparison
of 20 youth randomly assigned to SFBT to 20 youth randomly assigned to receive six 45-minute individual
supportive therapy sessions. Those in the SFBT group received six two-hour sessions over the course of one
week. Shin (2009) reported that those in the treatment group had significant increases in social adjustment
and significant decreases in aggressive behavior. Conversely, those in the control group reported decreases in
social adjustment and significant increases in aggressive behavior.

Smock and colleagues (2008) reported on the results of an RCT with 38 adults who qualified as having
level 1 substance-use problems (people who are diagnosed with level 1 substance-use problems usually are said
to need outpatient treatment with no more than nine hours of treatment each week). No statistical differences
were found between the SFBT group and the control group on the Beck Depression Inventory or Outcome
Questionnaire measures. However, participants in the treatment group who received solution-focused group
therapy reported statistically significant medium effect-size improvements on the two outcome measures when
comparing pretest and posttest differences. In addition, the control group received an alternative treatment
(an adaptation of the Hazelden model) and revealed no statistically significant treatment effects when
comparing pretest and posttest differences (Smock et al., 2008). Smock’s sample consisted of Caucasians
(45%), African Americans (29%), Hispanics (21%), and Native Americans (5%).

Single Case Design Studies

Not all research on SFBT lends itself to review and synthesis with meta-analysis. This type of research,
although very important to evidence-based practice, only summarized some of the studies on SFBT. Several
single case studies, for example, have been conducted on SFBT, and these studies have been important in
laying an empirical foundation for this approach. These types of studies also have potential to show how

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SFBT might work with clients from different ethnic backgrounds. Single-case designs are case studies that
use repeated measures prior to the intervention or program being introduced in the baseline phase to serve as a
control. Then, the repeated measures are obtained after the intervention to assess any changes that occurred
shortly after the intervention (Rubin & Babbie, 2010). These types of research designs often rely on visual
inspection of data and, even though they may not be included in meta-analysis, are useful for evaluating
therapy approaches, especially in practice settings.

Recently, Kim (2012) reviewed eight of these single case studies using a method called percent of
nonoverlapping data that allows researchers to look quantitatively at the outcomes of single case studies. Seven
of the single case studies reviewed by Kim provided ethnic information. Descriptions of the mean percentages
of ethnicity of study participants were as follows: Caucasian (mean = 74.2%), followed by African American
(mean = 65.5%), and Hispanic (mean = 62.0%). None of the studies included any Asian Americans, Native
Americans, or an “other” category for ethnicity. These percentages suggest that although Caucasians were the
highest percentage, African Americans and Hispanics were also treated with SFBT in these single case
studies.

In Kim’s single case review, studies were grouped and discussed based on internalizing, externalizing, and
relationship outcomes. The results from the studies showed mixed outcomes for behavioral and relationship
outcomes, and Kim further cautioned that more rigorous outcome studies should be conducted before any
definitive conclusions can be offered. These studies, however, provide an empirical foundation for practice
evaluations of SFBT, and practitioners are encouraged to use single case designs when evaluating their own
practices. It appears that more attention to the use of single case designs in SFBT practice evaluations of
ethnic groups is certainly needed, especially evaluations of Asians and Native Americans who are absent from
these studies.

Efficacy of SFBT With Ethnic Minority Populations

Very few authors have attended to the topic of the cultural groundedness or efficacy of SFBT with ethnic
minority populations (e.g., African American and Hispanic), although there is considerably more literature
that addresses SFBT with Asian American populations (Lee & Mejelde-Mosse, 2004; Miller, Yang, & Chen,
1997; Tetsuro, 2002). There appears to be a robust literature on the use of SFBT in international literature
within Mainland China, Taiwan, Hong Kong, and Japan (e.g., Hsu, 2009; 2011; Mishima, 2012; Xu, 2010;
Yang, Dayu, & Yulin, 2001; Yang, Xuanwen, & Yingping, 2005; Yeung, 1999). The lack of English
translations appears to have impeded the knowledge of SFBT literature in Asian countries from being known
to American audiences. For example, Dr. Weisu Hsu, a professor from Normal University in Taiwan, has
been a major trainer and proponent of SFBT and has also helped to publish the use of this approach with
Asian populations in English (e.g., Hsu & Wang, 2011). It is most interesting that the literature on using
SFBT with Asian groups far outnumbers literature describing SFBT practices specific to any other ethnic
groups. Proponents for use of SFBT with Asian groups suggest that SFBT is very appropriate for use with
Asian populations, because of the action-oriented and logical way in which it is structured. It also focuses on
strengths instead of pathology, and this lack of “pathologizing” is believed to help Asian clients address,

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instead of deny, their problems. SFBT also offers simple solutions that are most appealing and helps Asian
clients honor group cohesion and family piety. Authors have also addressed cultural adaptions needed to use
with Asian groups, such as modification of the miracle question and compliments given.

It is not known why the culturally grounded literature on Asian populations outnumbers discussion of
applications with other ethnic groups. The application of SFBT to Asian populations may be because one of
the developers, Insoo Kim Berg, was South Korean and also traveled extensively as a clinical trainer in Asian
countries. The fact that literature is much more sparse about the effectiveness of SFBT with other ethnic
minority populations, however, appears to be inconsistent with broad applications of SFBT in different
countries and settings (such as schools, child welfare, psychiatric clinics, and prisons), because ethnic minority
groups are known to predominate populations in such institutional settings. It is possible that the lack of
specific literature on culture groundedness may because SFBT views culture as being integral to language,
cognition, and social interactions, which SFBT specifically addresses in its mechanisms of change. SFBT
takes a more client-centered view of therapeutic relationships, for example, and suggests that therapists should
take a “not knowing” stance and begin where the client is, thus adapting themselves to each client’s preferred
beliefs and ways of communicating. So instead of assuming that a therapist should have some prior knowledge
of culture and adapt the therapy based on a prescribed cultural lens, therapists allow clients to guide them
regarding their preferred ways of behaving and adapt themselves accordingly. This ideology may make cultural
adaptations seem less necessary to those involved in the therapy process, because cultural groundedness and
respect for human diversity are integrally part of the relationship process of the therapy. In addition, the
indelible belief is that all humans share many common human struggles, strengths, and positive attributes and
are able to find their own solutions.

Despite the approach of SFBT toward clients, recent therapy literature (e.g., Holleran-Steiker, 2008) has
given substantial attention to the concept of culturally grounded interventions in evidence-based practice.
More specifically, researchers have called into question the extent to which identified “evidence-based
practices” translate to and are in fact efficacious with minority populations. As researchers continue to
examine the efficacy of SFBT, it also is important to examine the extent to which SFBT is efficacious with
minority populations. To this end, Corcoran (2000) specifically talks about applying SFBT with ethnic
minority clients, and her conceptual framework may prove to be helpful in understanding how SFBT may be
effective with these populations. She highlights that several of the assumptions associated with SFBT have
conceptual overlap with cultural norms held by African American and Hispanic populations. For example, a
key assumption in SFBT is that an individual’s behavior is heavily influenced by external context, and
behavior cannot simply be defined by an individual’s personal characteristics (c.f., Durrant, 1995). Solution-
focused therapists operating with this assumption often draw from the familial context in understanding and
interpreting behavior. A respect for and closeness in the family system is a common cultural norm for many
ethnic minority populations (e.g., Forehand & Kotchick, 1996; Hines & Boyd-Franklin, 1996). Corcoran
(2000) highlights how several other assumptions have similar overlap with the cultural norms of minority
populations (e.g., inevitable cooperation, client-formulated goals, focus on behavior and perception rather
than feelings, emphasis on the future instead of the past, and prioritizing solutions rather than problems).

Although several main assumptions of SFBT have overlap with the cultural values of ethnic minority

67
populations, it is important to examine the empirical evidence from SFBT studies. Table 3.4 highlights the
racial demographic characteristics of the populations from the studies discussed in this chapter. (It is
important to note, however, that several studies did not include the racial demographics in the narrative of
their study; thus, the number of studies included in the table is much smaller than the number of studies
described in this chapter.)

Table 3.4 Ethnicity of Included Studies*

* Note: This table includes only the studies that specifically identified the ethnic demographic characteristics of their sample.

Overall, most of the people who received SFBT were Caucasian (71.7%), followed by African American
(12.3%) and Hispanic (12.3%). Although at first glance these numbers might look as though people who are
Caucasian are being disproportionately served, they actually are fairly close to the U.S. population proportions
(and most of the studies included in the table were conducted in the United States). According to the 2010
U.S. Census, 72% of the total population is Caucasian, 12% is Black or African American, 16% is Hispanic,
5% is Asian, and 0.9% is Native American (U.S. Census Bureau, 2010). Although these numbers closely
mirror the proportion of the U.S. population, it is difficult to make inferences on the efficacy of SFBT with
minority populations because the sample-size numbers included in the studies are very small. Another
interesting observation from the studies is that Asian groups have not been targeted or studied very much,
even though SFBT literature indicates that SFBT may be effective with Asian Americans and groups from
diverse Asian countries.

68
 It is also important to note studies that primarily focus on ethnic minority populations. One of the fastest
growing ethnic minority groups in the United States is the Hispanic population and, as noted, Corcoran
(2000) suggests that SFBT may work well with Hispanic groups. Some studies, such as the one conducted by
Franklin and colleagues (2007) and three studies conducted and reviewed by Harris and Franklin (2008), used
SFBT in a school setting with a high percentage of ethnic minority clients, primarily Hispanics, who were at
high risk of dropping out of high school. These showed that SFBT might be adaptable and effective with
Hispanic youth. These studies, however, will need to be replicated with larger and more rigorous designs
before we can conclude that SFBT works with this population. In addition, Springer and colleagues (2000)
conducted an SFBT study that specifically targeted ethnic minority populations. Additional studies such as
this one are needed that specifically focus on a sample of people who represent a minority group.

Conclusion
The current chapter reviewed the efficacy of SFBT, describing the numerous studies conducted both
domestically and internationally, with a specific focus on SFBT with ethnic minority populations. Research
into the efficacy of SFBT has been growing over the past 10 years, and SFBT has been increasingly
recognized as a promising therapy that is based on evidence. Applications of the therapy have been very broad,
making it difficult to pinpoint a particular problem area within which the therapy may be most effective.
There has been a considerable amount of mixed (both positive and negative) findings for children and
adolescents with internalizing and externalizing problems, as well as mixed outcomes for adults with
substance-use and mental health problems. Surprisingly, there is a dearth of literature that specifically
addresses the cultural groundedness of SFBT and its effective use with different ethnic groups. It appears that
the need for cultural adaptations or increased cultural groundedness has not been a part of the mainstream
conversations between SFBT authors or researchers, especially not in the United States, where these
conversations are usually most prevalent. Neither has the effectiveness of SFBT with specific ethnic groups
been a major focus of existing studies, with only a few exceptions of studies that focused specifically on the
effectiveness of SFBT with ethnic minority groups (e.g., Franklin et al., 2007; Harris & Franklin, 2008;
Springer et al., 2000). This lack of focus on cultural groundedness of SFBT appears out of step with recent
therapy literature that suggests that practitioners and researchers should give considerable focus to cultural
adaptations of evidence-based practices.

Although it is not known why SFBT does not focus very much on cultural groundedness, proponents
believe that the unique ways in which SFBT focuses on therapeutic change and client relationships may
already be responding to these concerns for cultural adaptations. It is also feasible that adherents to SFBT
assume that SFBT therapists’ collaborative and client-centered approach to the therapy relationship would
automatically privilege each client’s unique way of relating regardless of ethnicity or culture, thus making it
less necessary to be concerned about racial and cultural differences in the therapeutic change process.

This chapter further analyzed the samples of several outcome studies that were conducted in United States,
and the samples from SFBT studies appear to closely mirror the ethnic representations similar to the U.S.
Census. This finding suggests that SFBT is possibly applicable to different ethnic groups. The therapy studies

69
are mostly being conducted with Caucasians, but African Americans and Hispanics also are receiving SFBT
in these studies. To a lesser extent, Asians and Native Americans have also been a part of some studies. The
samples of these studies, however, are very small, and reviews of the literature have not been able to
specifically address the results of different studies with ethnic minority populations. So at this point, the
research has not specifically addressed outcomes across different ethnic minority groups. Rather, we know
only that the therapy has been studied with different ethnic groups in the samples. The wide variation in
effect sizes across the different studies would certainly suggest that this type of research on the influence of
race on outcomes is needed.

The most robust literature on the use of SFBT with ethnic groups addresses the perceived effectiveness of
SFBT with Asian Americans and the effective use of SFBT in diverse Asian countries. As discussed, there
appears to be a large literature base in Taiwan, Hong Kong, and Mainland China, as well as studies in Japan.
Until more of this international literature is translated into English, it will not be possible to know the extent
of the outcome studies that might exist on Asian populations and the actual effectiveness of SFBT with
Asians. One finding that is apparent from outcome studies on SFBT is that Asians have not been the focus of
intervention in the studies reviewed. There appears to be strong belief among many different authors,
however, that SFBT is an appropriate therapy for Asian clients, and this needs to be investigated in future
research into the effectiveness of SFBT.

FURTHER LEARNING
Solution Land: http://www.solutionland.com A website from Japan that provides training and resources on
SFBT.

DISCUSSION QUESTIONS
1. How has meta-analysis been used to evaluate the effectiveness of SFBT?
2. What are the major limitations to outcome studies on SFBT as they relate to ethnic minority groups?
3. How is it that solution-focused authors and researchers have not focused much on the effectiveness of
SFBT with different ethnic groups?
4. Discuss some of key features of SFBT that might make it a good therapy for ethnic minority groups.

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 4
Solution-Focused Approach With Asian
American Clients
Johnny S. Kim, Jun Sung Hong, Cindy Sangalang

Historical Background
According to the most recent U.S. Census Bureau, Asian American, or Asian Pacific American, is defined as a
person with national origin in East Asia (China, Japan, Mongolia, North and South Korea, Taiwan), South
Asia (Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, Sri Lanka), and Southeast Asia (Cambodia,
Indonesia, Laos, Malaysia, Myanmar, the Philippines, Thailand, Vietnam). Recognized as the fastest growing
population, Asian Americans encompass 4.8% of the U.S. population while people who identify as Asian
combined with at least one other race comprise 5.6% (Humes, Jones, & Ramirez, 2011). Because of the small
Asian American population, Asian Americans have frequently been lumped into a single racial category.
However, each Asian American ethnic group has common as well as unique cultural characteristics, which are
influenced by religious beliefs (mainly derived from Buddhism, Confucianism, Hinduism, and Taoism), as
well as historical and social processes. Some common Asian cultural values include collectivist-orientation,
social harmony, filial piety and moral obligation to the family, and saving face.

In addition to cultural characteristics, each group has a different history of migration to the United States.
The first major wave of Chinese immigrants to the United States began in the 19th century, which consisted
of single men who arrived as laborers on the transcontinental railroad. Three years later, the Burlingame
Treaty was ratified, which facilitated immigration, resulting in the influx of Chinese immigrants. During
1850s and 1860s, the rate of Chinese immigration increased dramatically, from 41,397 in 1850 to 64,301 in
1860 (Wong, 1995). They also worked as cheap laborers in the mining industry while experiencing racial
discrimination, as their presence was dubbed as “yellow peril” (Black, 1963). Prejudice and discrimination
against Chinese laborers led to the repeal of the Burlingame Treaty (Briggs, 2001) and the passage of anti-
immigration laws, such as the Chinese Exclusion Act of 1882 and antimiscegenation laws.

Japanese emigration to the United States began when a small number of fishermen reached the United
States by drifting to work on sugar plantations in Hawaii (Murayama, 1991). Railroads in particular recruited
issei (i.e., first-generation immigrants) from Hawaii and Japan. Widespread perceptions of “unassimilability”
of the Japanese immigrants and fear of “Asian invasion” by American labor unions, interest groups, and
politicians heightened anti-Japanese sentiments, as the immigrants began to settle in the Pacific Northwest.
In 1907, the Gentlemen’s Agreement was enacted by President Theodore Roosevelt, which convinced Japan
to halt the flow of laborers to the United States (Inui, 1925; Kurashige, 2002). Western states also sought to
discourage Japanese settlement by enacting alien land acts, which prohibited immigrants from purchasing and

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owning land.

The period from 1924 to 1952 marked a time of Asian exclusion (Daniels, 1974). In 1924, the Immigration
Act, or Johnson-Reed Act, enacted by the federal government, limited the number of immigrants from any
country to 2% of its immigrants already in the United States in 1890. The 1924 bill was supported by
members of Congress, who openly lamented that foreigners represented a threat to the fabric of American
society (LeMay 2006). During the first year of the act, the rate of immigration declined by more than 50%,
and approximately 75% of the immigrants admitted were from northern and western Europe (Koven &
Gotzke, 2010).

It was not until 1952 when significant changes were made in the Immigration Act. In 1952, the Congress
enacted the McCarran-Walter Act of 1952, which eliminated race as a barrier to immigration, and in 1964,
Congress passed the Immigration and Naturalization Act of 1965, which abolished the national origins quota,
and Congress established two criteria for immigration: (1) family unification and (2) occupational skills
(DeSipio & de la Garza, 1998), which significantly increased the number of immigrants from Asia and Latin
America. Asians with special occupational skills benefited from the Immigration and Naturalization Act.
After being admitted to the United States, they used their citizenship rights to secure entry of relatives (Koven
& Gotzke, 2010). The passage of the Immigration and Naturalization Act and the naturalization of Southeast
Asian refugees in the 1970s resulted in a major change in American demographics. From 1970 to 1980, the
Asian American population increased by 143 percent (Suzuki, 1988), and from less than 1% in 1970 to 3% of
the entire population by the 1990 census (Lee & Fernandez, 1998). Today, Asian Americans are recognized
as the fastest growing, multiethnic population in the United States.

Asian American Values

As previously noted, the Asian American population comprises a multitude of groups with various national
and ethnic origins, histories of settlement, and modes of migration to the United States. Despite the vast
diversity among Asian Americans, cross-cultural analyses have identified common values underlying many
Asian ethnic and cultural groups. These values include a collectivist orientation that emphasizes
interdependence, a relational sense of self, and social norms and structures rooted in the centrality of family
(Markus & Kitayama, 1991; Triandis, McCusker, & Hui, 1990; Yee, DeBaryshe, Yuen, Kim, & McCubbin,
2007). Such characteristics are neither exclusively nor universally applicable to all Americans of Asian descent
yet may provide some utility in guiding cultural explanations driving group differences in behavior and
psychological processes. Accordingly, the modification or melding of these values with other cultural
influences varies and depends on a host of individual, family, social, and environmental factors (e.g.,
personality traits, acculturation and generational level, length of stay in the United States).

Collectivist Orientation
Asian Americans are generally described as having a collectivist cultural orientation. Collectivism is
typically contrasted with Western individualism, which emphasizes autonomy, individuality, and personal
freedom (Oyserman, Coon, & Kemmelmeier, 2002). Individualism has shaped the foundation of the
dominant American ethos, exemplified by the United States Declaration of Independence, which valorizes

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individual freedom and happiness. In contrast, collectivist cultures are characterized by interdependence on
others and the importance of group needs over individual interests (Hofstede, 1980). For Asian Americans,
the family is the primary social unit, and an individual is often perceived as a reflection of his or her family
(Kim, Atkinson, & Umemoto, 2001). Hence, the experience of shame and “loss of face” (i.e. diminished self-
worth and perceived moral character) are experienced and informed by the larger family rather than the
individual alone (Kim et al., 2001; Gong, Gage, & Tacata, 2003). For example, research has shown that Asian
Americans often prefer to keep information about problems within the family rather than seek support from
formal counseling services (Leong & Lau, 2001). Moreover, value is placed on group harmony and cohesion.
This is in large part because of the notion that one’s well-being is tied to a sense of belonging and
connectedness with others.

Interdependent Sense of Self

Individuals with roots in Asian cultures tend to embrace a sense of self that is relationally defined. That is,
in contrast to the individualistic perspective in which a person’s sense of self is viewed as independent and
unique from others, a collectivist perspective underscores how a person’s sense of self is fundamentally linked
to others and defined in the context of social relationships (Markus & Kitayama, 1991). More specifically, an
individual’s identity is often intertwined with his or her role within and contribution to the family. In practice,
this is often expressed by following familial and social expectations, considering the needs of family members
before one’s own needs, and retaining a sense of unity within the family or larger group (Kim, Yang,
Atkinson, Wolfe, & Hong, 1999). This notion of the interdependent sense of self also has consequences for
various psychological processes, such as emotional expression and coping. For example, many Asian
Americans place value on indirect expression and emotion-regulation to preserve group harmony and not
burden others with their problems (Taylor et al., 2004). Instead, problems are often resolved through
individual coping and emotional restraint to prevent shame or loss of face. In addition, collectivist norms
discourage individuals from sharing information or opinions that conflict with the group (McLaughlin &
Braun, 1998). The preservation of harmonious interdependence governs interpersonal relationships and social
interactions since there is greater value placed on the ability to blend in with the group (Markus & Kitayama,
1991).

Familism
The centrality of family is a cornerstone of cultural values for Asian Americans (Yee et al., 2007). For many
Asian Americans, the well-being and priorities of one’s family often take precedence over one’s own needs,
and decisions are often considered with regard to their effects on the family (McLaughlin & Braun, 1998).
Family structures are often hierarchical, emphasizing respect and duty to one’s parents and elders (Uba, 1994).
Moreover, a strong sense of family obligation is instilled at a young age and carries throughout one’s adult life
(Fuligni, Tseng, & Lam, 1999). The notion of filial piety, or deference to one’s parents, remains a salient
aspect of many Asian American families (Kim, Atkinson, & Yang, 1999). For example, adult children are
often expected to serve as caretakers for their elderly parents. In fact, in traditional or immigrant Asian
families it is not uncommon for multiple generations to live in one household (Yee et al., 2007). Family
conflict can be particularly stressful for Asian Americans, particularly between parents and their children. This

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is common within Asian immigrant families in which language barriers and cultural clashes can occur when
children acculturate more rapidly to American culture than their parents (Ying & Han, 2007).

Clinical Issues for Asian Americans

Racial Microaggression
Ethnic minorities have experienced many forms of racism and discrimination in American society for
hundreds of years. Asian Americans are a group that has experienced overt racial discrimination and
prejudices yet their experiences seem to be overshadowed when compared with other ethnic minority groups
like African Americans and Latino/Hispanic Americans. Like many ethnic minority groups, Asian Americans
were denied citizenship, forbidden to own property, forced into internment camps, and discriminated against
for their accent and limited-English-speaking ability (Sue, Bucceri, Lin, Nadal, & Torino, 2009). The
cumulative effects of racial discrimination have been connected to increase in mental health problems, such as
depression, anxiety, low self-esteem, and physiological problems, such as heart disease, pain, and respiratory
illness (Yoo, Gee, & Takeuchi, 2009). Furthermore, researchers are recognizing that encounters with
discrimination can lead to illness because of the stress associated with discrimination (Myers, Lewis, &
Parker-Dominguez, 2003).

Although overt forms of racism and discrimination are still prevalent in today’s society, a more subtle form
of racial discrimination continues to grow and has become a new form of racism known as racial
microaggression. Sue and colleagues (2009) explain, “Simply stated, microaggressions are brief, everyday
exchanges that send denigrating messages to people of color because they belong to a racial minority group.
These exchanges are so pervasive and automatic in daily interactions that they are often dismissed and glossed
over as being innocuous” (p. 88). What’s different about this form of subtle discrimination is that individuals
of the dominant society may not be consciously aware that their comments and behaviors often reflect the
negative attitudes and feelings they have toward racial and ethnic minorities, and they also may be unaware
how these microaggressions are interpreted by and adversely affect the minority individual. Qualitative
research (Nadal, Escobar, Prado, David, & Haynes, 2011; Sue et al., 2009) on Asian American
microaggression identified six themes that are particular to this group, which will be useful for clinicians:

Treated as foreigners in one’s own land (e.g., making fun of Asian accents);
Treated as second-class citizens (e.g., receiving substandard services compared with whites);
Minimizing or trivializing ethnic differences among Asian American groups (e.g., statements about all
Asians looking alike);
Exoticizing Asian women and emasculating Asian men (e.g., Asian women being viewed as submissive
and hypersexualized or Filipino men looking feminine and gay);
Pathologizing Asian cultural values and behaviors (e.g., eating rice for breakfast is considered weird);
Invisibility (e.g., instances where Asian Americans felt overlooked or left out).

The underlying messages being sent to Asian Americans with these racial microaggressions are that you are
not part of the mainstream American society. As Wang, Leu, and Shoda (2011) argue, “This is consistent

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with research by Branscombe and her colleagues suggesting that being reminded of one’s lower status in
society may be responsible for negative emotions in general” (p. 1667). There is some disagreement around
whether comments or behaviors could be misinterpreted or may have nothing to do with the ethnicity of
Asian Americans. Arguments have been noted that these innocuous situations may not be distinguishable
from affronts that all individuals experience, irrespective of race or ethnicity (Schacht, 2008). This viewpoint
dismisses the emotional impact Asian Americans and other minorities experience based on their interpretation
of even harmless situations (e.g., being overlooked by servers at a restaurant or bar) or comments that weren’t
intended to be offensive (e.g., being asked why you don’t have an Asian accent). It further burdens the Asian
American individual by questioning whether their race or ethnicity plays a role for these events or comments,
which nonminority individuals oftentimes do not have to consider, and research supports this notion (Wang
et al., 2011). Another series of studies by Devos and Banaji (2005) further illustrates this point because they
discovered white Americans associated Asian Americans and African Americans (to a lesser degree) with
being less American than white Americans. The article further found that the definition of American identity
is equated with being white. Devos and Banaji (2005) found “the propensity to equate American with white
cannot easily be overridden and is sometimes completely dissociated from conscious beliefs or knowledge
about ethnic–national associations” (p. 463).

Model Minority Myth

Historically, the Asian American group has been thought of as the model minority group who did not access
various governmental programs. The model minority label suggests that Asian Americans are more
academically and financially successful than other minority groups because of their cultural values of hard
work, perseverance, and close family ties. The implications of viewing Asian Americans as the model minority
has led people to use this group as proof that the American dream is colorblind and achievable with hard
work. Yoo, Burrola, and Steger (2010) explain, “The model minority image was used to discredit the protest
and demands for social justice and silence critics of the systematic practice of racism in the United States” (p.
114).

Although it may be true that Asian Americans on average are achieving academic and financial success,
there is a problem of overgeneralizing to the larger Asian American subgroups and failing to recognize the
heterogeneity among the different Asian countries. This stereotype and fallacy has also led to the term model
minority, which is usually applied to Asian Americans. Because of this myth, clinicians, policymakers, and
researchers have focused their attention on other minority groups and not paid much attention to the Asian
American population. Currently more research has shed light onto the ways Asian Americans are
discriminated against and the negative impact on them. For example, Yoo and colleagues (2009) found that
language and racial discrimination was significantly associated with numerous chronic health conditions
among Asian American immigrants. Gee and colleagues (2007) further cite previous studies that found an
association between Asian Americans who experienced racial discrimination and depressive symptoms, poor
mental health, and substance misuse.

Despite the tremendous increase in the Asian population, little research has been done addressing the needs
and concerns of this group when compared with other minority groups. This lack of research has also limited

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the information clinicians have to practice cultural-sensitive counseling and presented a very general and
homogeneous approach to working with the Asian Americans population. For example, research indicates
that Asian American youth experience the same rate of mental health problems as white youth but have
higher rates of unmet mental health needs than white youth and are among the least to use mental health
services (Li & Seidman, 2010). Along with the risk factors and clinical problems described previously, more
research is needed to look into the protective factors and strengths of Asian Americans.

Strengths and Protective Factors

As mentioned earlier, Asian Americans are more academically and financially successful that other minority
groups in the United States (Jacob, Gray, & Johnson, in press). For Asian American youth, research studies
(Koh, Shao, & Wang, 2009) have shown strong self-motivation, especially around academic achievement and
that could serve as a source of strength. Solution-focused clinicians may be able to tap into the numerous
strengths and protective factors that may contribute to this achievement. Spirituality is important to many
Asian Americans and another source of strength when dealing with problems or life challenges. When it
comes to seeking help for mental health concerns, Asian Americans are more likely to seek out informal
support such as family members, ministers, or indigenous healers rather than mental health clinicians or
medical doctors. Possible reasons for this include embarrassment or loss of face for the Asian American client
and their family, lack of health insurance, lower English proficiency and higher perceived discrimination by
the Asian American client, and being a recent immigrant (Spencer, Chen, Gee, Fabian, & Takeuchi, 2010).

It’s also important to understand the different ways Asian Americans use social support. Asian American
males are more likely to experience racism, but women are more likely to use support-seeking coping strategies
(Liang, Alvarez, Juang, & Liang, 2009). In addition, not all social-support seeking strategies may be useful to
the Asian American client and in some cases, may be more burdensome. Although many Western cultures
encourage the use of social support as an opportunity to further discuss problems or seek advice, this may not
be the most effective strategy for Asian Americans because of concerns around shame and saving face. Kim,
Sherman, and Taylor (2008) explain that a collectivist culture may encourage Asian Americans to be more
cautious in sharing problems with family, friends, or colleagues because they don’t want to overburden their
social networks, which then leads Asian Americans to seek less explicit social support than other ethnic
groups. They recommend Asian Americans use implicit social support, which involves obtaining emotional
support without disclosing or discussing a problem. This form of support is more culturally sensitive than the
more common explicit social support used in Western cultures. Asian Americans can still benefit from being
around others and engaged in various social activities without the pressure to disclose sensitive information to
family or friends until they are ready. Implicit social support can be beneficial for Asian Americans because
they gain comfort through the awareness of being around others rather than through the use of a support
network (Kim et al., 2008).

On a related note, another important protective factor involves informal social support from family and
church for Asian Americans. Some research has suggested that family affection in Asian American families
can serve as a potential protective factor, especially for families where the children were born or mostly raised
in the United States, which can lead to differences in Asian value gap (Ahn, Kim, & Park, 2008). Solution-

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focused clinicians should look for times when family members responded with appropriate responses such as
praise for getting good grades or empathy when dealing with failures (Park, Vo, & Tsong, 2009).
Unfortunately, a lot of Asian American parents use shaming tactics and criticize their children as a way to deal
with conflict or family problems. Furthermore, Asians value emotional restraint, which might limit family
members’ willingness to use appropriate affectionate communication. Although more traditional Asian
American family members may be hesitant to use verbal or physical affectionate communication, they may be
more willing to show their affection through supportive behaviors, such as paying for academic tutoring (Park,
Vo, & Tsong, 2009).

Case Example
In this case example, we’ll present Abby Kim who is a 16-year-old second-generation Korean American
female whose parents emigrated from Korea 18 years ago. Abby has a brother who is two years older and
attends the same urban, public high school she does. Abby’s parents have limited English-speaking ability and
have tried to instill the Korean values of discipline, hard work, and respect for elders in their children. Abby
was referred to the school social worker, Mr. Chris Dougherty, because she has been struggling in her classes
and her teachers are concerned that she is depressed and feeling overwhelmed in school. At the first session,
the school social worker worked to establish a collaborative relationship and understand Abby’s view of the
problem and any potential multicultural concerns.

Collaborative Relationship

Mr. Dougherty: Hi Abby, thanks for seeing me today. I know your teachers have expressed some
concern for you but I wanted to hear from you what you think the problem is and how
you think I might be able to help.
Abby: I don’t know if you can. I just feel overwhelmed by everything and feel like things are
just continuing to spiral out of control. I don’t care about school anymore because I
don’t fit in and I’m always arguing with my parents. I just don’t see how it’s going to
get better.
Mr. Dougherty: Well, I can’t promise you anything other than you don’t have to solve this yourself, and
I’ll do what I can to help and support you because it sounds like there is a lot going on
with you both at school and at home.
Mr. Dougherty: When you say you don’t care about school anymore because you don’t fit in, what sorts
of experiences or interactions make you believe that?
Abby: Well, it’s so stupid. But these girls have been making fun of me because I’m not smart
in math and they’ll say stuff like, “Aren’t all Chinese people suppose to be good at
math!” and they’ll start laughing at me. I mean, I’m not even Chinese but they’re right
because I am stupid in math.
Mr. Dougherty: That must have upset you quite a bit hearing those stereotypes and also those students
not knowing the differences between the different Asian countries. What was your

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 reaction after they made those comments?
Abby: I corrected them and told them that I was Korean and that it’s a myth that all Asians
are super smart in math.

In this dialogue exchange, the therapeutic relationship is enhanced by letting Abby tell Mr. Chris
Dougherty what she thinks the problem is rather than just going by what the teacher believes the problem is
for Abby. It’s very easy to forget to ask the client her or his perspective, which is an important theoretical
component of solution-focused brief therapy. By asking early on what Abby thinks the problem is, Mr.
Dougherty begins the session by focusing on the present and sets the stage to join with the client on the
problem in a more collaborative style rather than a one-up power relationship where Mr. Dougherty is viewed
as the expert. In addition, letting Abby describe what she thinks to be the issue allows her to become the
expert about her situation and provides an opportunity for the clinician to validate her opinions and further
establish a collaborative relationship. Also, by asking Abby how she thinks that Mr. Dougherty can help, he
continues the emphasis on Abby’s perspective of the meeting as well as tries to get Abby to think about a
hopeful future.

The clinician who is familiar with Asian values might explore whether there is conflict that Abby might be
experiencing with the need to be more assertive in American schools and with her non-Asian peers and with
her ethnic values taught by her first-generation parents. This can help the clinician further develop a
relationship with Abby and also help understand her perspective on her problems in more complex details
when examined through a multicultural lens. There is also an opportunity to use the SFBT technique of
complimenting to elicit a positive emotion and continue to be supportive of the client.

Complimenting and Relationship Questions

Mr. Dougherty: Good for you! It sounds like you know how to speak up for yourself. Is it easy for you
to be assertive and correct racial stereotypes about Asian Americans?
Abby: Well, I think it depends. Sometimes I feel really angry when people make fun of me for
my Asian looks and I’m able to speak up. But when it’s a group of people making fun
of your eyes or your accent, it’s hard to stand up for myself and then I just get sad and
depressed. I just can’t stand up for myself and I stop caring about things like school.
Mr. Dougherty: What would your parents say about how you handled this situation and you being
assertive?
Abby: I’m not sure they understand or would like me getting angry and talking back like that.
They raised me to be a good Korean daughter, which means I have to be respectful to
others and not show my emotions. I think they are afraid that I’ll get in trouble in
school or get into a fight and then I won’t be able to go to a good college.
Mr. Dougherty: Well, what’s different for you living here in America as opposed to your parents
growing up in Korea?
Abby: I think about the fact that my parents never had to deal with being so different.
Mr. Dougherty: Could you tell me more about that?

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Abby: Because my mom and dad grew up in Korea where everyone looked like them, they
never experienced the constant racism or stereotypes that I have to here. I struggle with
fitting in and also trying to be the perfect person my parents expect me to be.
Mr. Dougherty: Is that why you said or think that you are stupid in math? Because you’re struggling
with the stereotypes of Asians being really good in math and your parents’ expectations
for high academic standards?
Abby: I guess I never thought of it that way but yeah, that’s exactly what I’m struggling with.
It just gets me feeling hopeless that I can’t do it!
Mr. Dougherty: I’m curious—would your teachers say you are bad at math?
Abby: Probably not.
Mr. Dougherty: What would your math teacher say about your abilities in math?
Abby: He’d probably say I’m good at it and that I get B’s and A’s on my math tests.
Mr. Dougherty: So what do you make of this?
Abby: I guess I’m not as bad in math class as I think and I shouldn’t let the stereotype
convince me otherwise. I don’t have to be perfect and can feel confident in myself.
Mr. Dougherty: Kind of like when you stood up for yourself against those girls who teased you about
being bad at math?
Abby: Yeah, exactly.

In the dialogue exchange, the school social worker raises a question about possible cultural differences
between the student and her family. Relationship questions were asked to help Abby see how other important
people in her life might view the problem. Ultimately, by using Socratic questioning, the clinician helps Abby
to see that her conclusions about her being bad at math and being perfect are not accurate or necessarily
helpful. The focus is also on pointing out her successes, which allows her to view herself differently prior to
the session and shifts her beliefs about herself in a more positive light.

There are several assumptions made in SFBT that are very important to this therapy. The first one is that
Every Client Is Unique. This is taken from a constructivist model and leads to the belief that the solution
should be particular to the unique client. The second assumption is that Clients Have the Inherent Strength and
Resources to Help Themselves. By focusing on the client’s strengths rather than problems, change will occur
more rapidly. The third assumption is Change Is Constant and Inevitable; a Small Change Can Lead to Bigger
Changes. In a situation where the client feels stuck or overwhelmed, making a small step toward the goal can
generate hope and lead to bigger changes. The final assumption is One Can’t Change the Past So One Should
Concentrate on the Present and Future. It is not necessary to analyze past actions that resulted in the problem to
find a solution to the problem. Therapists and clients work right away to co-construct goals and look for ways
that the solution is already occurring in their life (Lipchik, 2002).

As the session progresses, Mr. Dougherty uses scaling questions to shift the conversation toward identifying
solutions to the problem and future goals.

Scaling Questions

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Mr. Dougherty: So can I ask you on a scale of 1 to 10, how depressed do you feel now about school and
your math classes, where 1 is absolutely hopeless and 10 is everything is perfect?
Abby: Ummm, probably a 7.
Mr. Dougherty: What makes it a 7 for you?
Abby: Well, I guess I feel like I’m not as bad in my math class as I thought and it was just
those girls teasing me that made me feel like I was a failure.
Mr. Dougherty: Wow that is great self-awareness! Can you give me an example of what it would take
for you to move the scale up to say an 8 or even a 9?
Abby: I don’t know . . .
Mr. Dougherty: What would tell you that you are an 8. What would you be doing that would let you
know that things are a little bit better for you than right now?
Abby: Well, I guess I’d have to do better in my math class for it to be an 8 or 9.
Mr. Dougherty: So how could you do that? What would you be doing differently to get better grades?
Abby: I’d probably have to work on my doing my homework earlier that I have been.
Mr. Dougherty: Could you explain to me what would be different in terms of how you approach doing
your homework when you’re getting better grades?
Abby: Right now I wait until the night before to do my homework and rush to get it done.
And lately I haven’t been able to complete all of it because we’ve been covering harder
materials, so I think I need to start doing my homework earlier in case I get stuck.
Mr. Dougherty: And if you get stuck, what could you do then to finish your homework?
Abby: I could ask my brother who’s older and really good in math for help.
Mr. Dougherty: Those are excellent ideas!

Scaling questions in this case example are used to quantify how Abby feels about her situation and allow
Mr. Dougherty to help Abby identify therapeutic goals. By asking what it would take to move up a few points
on the scale, Mr. Dougherty invites Abby to name specific behaviors and actions needed to improve her
feelings and situation. This solution-building approach to using the scaling questions is particularly useful
when clients provide vague or general responses to solutions and goals (Kiser, Peircy, & Lipchik, 1993). Also
in this case example, Abby responded with a score that is pretty favorable, so it lets Mr. Dougherty and Abby
know that the situation may not be as dire as the teachers or even the student believes it to be. The solution-
building conversation concludes by identifying potential barriers to accomplishing homework assignments and
identifying specific steps Abby can take when getting stuck.

Exception Question

Mr. Dougherty: So I’d like to ask you a question about a comment you made earlier about feeling like
you don’t fit in at school. Can you think of a time when you didn’t feel like you were
different or felt like you fit in?
Abby: Probably when I went to this weeklong summer camp for Korean American kids last

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 summer.
Mr. Dougherty: Could you tell me how this camp experience helped you feel like you fit in?
Abby: Well, Camp Conifer was started so that other kids like me can meet up with other kids
who were born in the U.S. but look Korean. It gave me an opportunity to make a lot of
new friends from all over southern California and it was a relief because it made being
Asian irrelevant.
Mr. Dougherty: What was different about that time?
Abby: It was really the first time I felt like I was surrounded by other kids who look and act
like me. At my current school, there aren’t many Asians kids, but at Camp Conifer, I
wasn’t alone or felt different. For once, I felt like I fit in and didn’t have to explain or
make apologies about the food I ate or the behaviors of my parents.
Mr. Dougherty: Great! If I asked your camp counselor what they noticed about you at that time, what
do you think they would say you were doing that was different?
Abby: They’d say I was more talkative and social. I probably laughed a lot more and appeared
more relax. I was more willing to start conversations with people I didn’t know.

As discussed earlier, the solution-focused clinicians do not view themselves to be the experts in clients’
problems and therefore don’t need to have the answers. However, this does not mean that the solution-
focused clinician takes a passive role throughout the therapy session. In actuality, the clinician’s role is
described as leading from one step behind (Cantwell & Holmes, 1994). Instead of being the leader of the session
and dictating where the client goes, solution-focused clinicians walk side by side with the client. The active
role the clinician takes lies in the Socratic questions he or she asks to help the client look at the situation from
a different perspective and to look for clues where the solution is already occurring in the client’s life.

So, in the previous example, the clinician uses the exception question to let Abby identify the possible
solutions to not fitting in by looking at it from a different perspective and one that focuses on cultural identity
issues faced by many second-generation Asian Americans. The exception question allowed Abby to see that
there were times in her life where her problem of “not fitting in” didn’t exist and to see this problem from a
different perspective in terms of how she views herself. The solution-building conversation ends by asking for
examples of what Abby was doing differently at Camp Conifer when she felt like she fit in, which can then be
used to identify specific behaviors and thoughts that are more positive.

Solution-Focused Goals or Homework

Mr. Dougherty: Abby, I like to see you again next week but before we meet, I want to give you a
homework assignment. Would you be willing to give it a try?
Abby: Sure, I guess so.
Mr. Dougherty: Great. So between now and the next time we meet, I want you to observe the times
when you’re not feeling so different. And during those times, try to notice what you’re
doing to make that happen. Do you think this is something you can do for next week?

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 The social worker concluded the session by suggesting a homework assignment, an observation task, in
which Abby tries to notice solutions in her day. This solution-focus technique is useful in helping clients learn
how to pay attention to what is happening in their life that they want to have continue and describing that at
the next meeting. They may also be asked to pay attention to times when the problem is less intense or less in
duration. If Abby was not open to this suggestion or seemed confused by it, the solution-focused clinician
could have explored, collaboratively, other homework assignments whereby Abby continues to try to notice
times where she stands up for herself or when she does well on a test or assignment in her math class, allowing
Abby to define what “doing well” looks like.

Summary
This chapter highlights the heterogeneity of Asian Americans and some of the common values they share
along with challenges they face. Although there may be commonalities in terms of the values Asian
Americans share, it is important to recognize that individual Asian American groups may differ in terms of
how strongly they adhere to specific cultural values (Kim, Yang, Atkinson, Wolfe, & Hong, 1999). Solution-
focused clinicians should be aware of impact of microaggression and model minority stereotypes, which are
especially relevant to Asian Americans, to further develop a therapeutic alliance. In addition, the protective
factors and strengths of Asian Americans can also be used to help identify future solutions to problems in
Asian American clients and the different ways social support can be tailored with this ethnic group.

FURTHER LEARNING

Websites
Asian American Health Resources

http://asianamericanhealth.nlm.nih.gov/

Asian American History, Demographics, & Issues

http://www.asian-nation.org/index.shtml

White House Initiative on Asian Americans and Pacific Islanders

http://www.whitehouse.gov/aapi

Books

Asian Americans: Personality Patterns, Identity, and Mental Health by Laura Uba (1994). New York: Guilford
Press.
Social Work Practice with the Asian American Elderly by Namkee Choi (2002). Binghamton, New York:
Haworth.
Working With the Asian Americans: A Guide for Clinicians by Evelyn Lee (1997). New York: Guildford Press.

Videos

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 Asian American Films

http://www.asianamericanfilm.com/

Asian American Video Resource List

http://www.lib.berkeley.edu/MRC/AsianAmvid.html

DISCUSSION QUESTIONS
1. How could you incorporate exception questions with Abby around her older brother or other Asian
American friends around stereotypes?
2. How could you have used the miracle question on this case if the client was stuck with finding a solution?
3. What would you do differently if this client was reluctant to talk with you or was an involuntary client?
4. What other homework assignments might you suggest and why?

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 5
Solution-Focused Approach With African
American Clients
Diane Bigler

Introduction
Many clinicians explore ways to instill hope and possibility in clients that they are working with. When a
clinician is working with African American clients, there is a greater need to incorporate cultural
understandings with therapeutic approaches that will allow African American clients to feel encouraged,
supported, and ultimately understood. Before the professional can begin to take a solution-focused therapeutic
stance with an African American client, there should be a process by which the professional understands the
culture of the African American person and population.

Historical Background
According to the U.S. Census Bureau, African Americans composed 12.6 percent of the U.S. population in
2010 (U.S. Census Bureau, 2011). African Americans have experienced a rich history in this country that
began before the 19th century. African Americans have contributed through fighting in several wars,
including the War of Independence, World War I, World War II, the Korean War, the Vietnam War, Desert
Storm, Operation Iraqi Freedom, and the War on Terror. The African American population has also
participated in the Civil Rights Movement of the 1950s as well as the Black Liberation Movement of the
1960s. Through protesting, overcoming legalized segregation, and developing more abilities to advocate for
rights, African Americans have experienced advances in education, housing, and careers.

One of the primary challenges for the African American community in the past quarter century has been
the stunting of the population growth for African American men ages 15–24 because of homicide, suicide,
and substance abuse (Baker & Bell, 1999). This challenge has presented the African American community
with a disturbing and daunting task; that is, how to maximize the potential of the young African American
male and minimize the risk of violence, drug addiction, gang involvement, and incarceration.

The urban core is home to roughly 60 percent of African Americans, and this can sometimes present the
additional challenge with almost 25 percent of the African American urban core population living in poverty
(Baker & Bell, 1999). Clinicians are often called upon by social services organizations, the courts, hospitals,
and community mental health centers to provide services to residents of the urban core who could be affected
by poverty.

In addition to poverty rates for this population, health problems for the African American community are

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increasing. Rates of hypertension, diabetes, heart disease, and obesity are rising as African Americans struggle
to acquire affordable health care (Das, Olfson, McCurtis, & Weissman, 2006). There are additional health
maintenance challenges for this community, which can range from limited access to health education and
resources, to lack of health insurance, and to discrimination by medical providers, clinics, and hospitals (Das
et al., 2006).

As this population experiences a compromised ability to access health care, there is also a frequent barrier
for African American individuals to receive proper mental health care treatment in the United States. A high
crime neighborhood where an African American individual resides is generally challenged in providing
affordable, accessible mental health services. There are several mental health disorders of concern within the
African American population, some of which include posttraumatic stress disorder, substance use, depression,
anxiety disorders, and schizophrenia (Baker & Bell, 1999). Left untreated, many African Americans
struggling with mental illness descend into a world of hopelessness and despair.

Culture, Values, and Beliefs

Although the mental health community largely perceives itself as having awareness of African American
culture and values, one can rarely overeducate on the inherent ways in which any cultural group should be
viewed according to their beliefs and values. Unfortunately, there is occurrence for a well-meaning helping
professional equipped with education, practice experience, and an intrinsic desire to serve to inadvertently
offend or shut down an African American client because of a lack of appropriate cultural awareness and
sensitivity.

One cannot overstate the importance of understanding how a culture’s values help or hinder a person’s
ability to receive intervention and support from a mental health professional. For instance, the professional
who is likely equipped with interventions that could on the surface bring about success and positive client
outcomes could increase the likelihood of positive client outcomes if he attends to the client’s culture and
belief system first before intervention is initiated.

Within the African American culture, there are distinct values that are integral parts of understanding the
African American individual as well as the larger systems of family and community. Strong kinship bonds
prevail in many families, where aunts, nephews, cousins, and other nonimmediate family members are just as
closely regarded and protected as immediate family members (Newsome & Kelly, 2004). Understanding the
importance of kinship bonds can help the clinician to consider accessing kinship supports as an aid to
treatment for the individual or family.

A strong religious orientation is also frequently present in African American individuals. Older, more
religious African Americans have reported the use of prayer as a way of coping with mental health issues
(Newsome & Kelly, 2004). There is belief in the connection between this value and the aforementioned
kinship bond value; that is, that the strongly bonded extended family experiences religious practices together
on a regular basis. This shared familial experience solidifies the notion within the African American
community that there is strength to be garnered from two fundamental sources: family and religion.
Continuing along this theme, African Americans use the informal support networks of family, church, and

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community to assist with acquisition of basic needs, when there is a death, and when a troubled youth of the
community needs rallying, prayer, and mentoring.

Since kinship relationships are so central in the African American community, the elderly members are
often highly respected and revered. A wise grandmother or auntie is cared for, protected, and sought out for
wisdom. Along with community pastors and religious leaders, the elderly members of the community are
regarded as the “beacons of light” for many who may be struggling with poverty, parenting, or health
problems (Baker & Bell, 1999).

Although the members of an African American community readily embrace each other, they are less eager
to embrace or accept outside individuals, especially government or professional individuals. Sometimes, the
negative perception of “the system” within the African American community prevents mental health
professionals in particular from intervening on behalf of individuals within the African American community.
In fairness, racism and discrimination are still forces that weave their way into the lives of many African
Americans. Therefore, as perception of discrimination by some African Americans exists, this perception can
sometimes be validated by outside individuals who may be well meaning but ill equipped in cultural
sensitivity. Mental health attitudes of African Americans are largely influenced by the psychological,
psychiatric, and social work communities offering a measure of cultural sensitivity and awareness.

The abilities of African Americans to express their personal styles and talents through dress, music, food,
and art lend strengths to the culture itself and to the larger culture of the United States. The ability for
“outsiders” to recognize and respect these personal styles and talents is of benefit in the development of
African American cultural awareness and sensitivity.

A strong sense of personal pride is often present in the African American person. In addition, higher levels
of pride are very strong within the culture (Thompson, Bazile, & Akbar, 2004). For example, the African
American young male will often have immeasurable pride for the female members of his family. The church
community will revel in the accomplishments of a church member, and a celebration party will be planned and
held with great enthusiasm.

In addition to some of the values and protective factors of African Americans outlined previously, one that
certainly will seem useful with a solution-focused approach is resourcefulness. Through their experiences of
racial discrimination, community violence, and poverty challenges, African Americans have developed an
inherent ability to draw on resources, strengths, and solutions to challenges that they have faced. A sense of
competence can help the African American individual, family, or community solve a problem effectively or
find a solution to a challenge. Empowerment involves discovering this inherent power within people and
identifying, facilitating, or creating contexts in which people can gain influence over decisions that affect their
lives. Talents and skills that are related to the resourcefulness of African Americans can include self-reliance,
self-sufficiency, and the ability to cope with crises.

Communication takes many forms in human culture. As with other cultures, the African American culture
and its individuals often assess whether to accept someone outside of their culture based on what
communication style and pattern is presented to them. Showing respect through tone of voice and choice of
words is key. Avoiding constant prolonged eye contact can avoid the perception of an African American

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individual feeling threatened or dominated. Sometimes, an African American who is seeking mental health
services may elect to bring a community or religious leader to the appointment for support (Das et al., 2006).
This practice should not be discouraged, and the support person should be welcomed as part of the client’s
support network.

Avoiding the use of street language or slang is recommended. One area in which the professional may seek
guidance from the client is in how the client would like to be addressed. Believing that an African American
client finds it acceptable to be addressed by their first name is assumptive. Asking the client, “How would you
like to be addressed?” or “What name would you prefer I call you?” is respectable and appropriate, especially
for elder African Americans.

Perceptions of Mental Health Services

African Americans have been identified as a group that uses mental health services inconsistently (Kessler et
al., 1994; Sue & Sue, 1990). Reasons for this include many variables addressed earlier in the chapter, with
economics standing out as a primary reason for service inconsistency

The National Black Survey, which examined African American help-seeking behaviors for mental and
emotional distress, is the most comprehensive study of help seeking in the African American community.
Conducted in 1986, study findings indicate that only 22% of African Americans expressed a preference for an
African American therapist (Thompson et al., 2004). These data allude to the possibility that non–African
American therapists can quite possibly be considered by an African American individual. In a study of client
mistrust and premature termination from counseling, it is suggested that African Americans who rated their
mistrust as high were more likely to terminate therapy prematurely. What this suggests is that there is
sufficient potential for all therapists to build an alliance with an African American client based on cultural
sensitivity and practice.

Focus groups conducted in the latter part of 2000 examined African Americans’ perceptions of the
following: cultural barriers, mistrust, and stigma associated with seeking and receiving psychotherapy
(Thompson et al., 2004). Focus group participants reported some frustration at the disparity of black
therapists versus white therapists, and that they would have a much harder time relating to a white therapist.
However, participants also reported that if a therapist made a sincere effort to understand African American
clients, the client would participate in finding common ground. Participants expressed concern that therapists
lack an adequate knowledge of African American life and struggle to accept and understand the African
American individual.

What is also noteworthy is that participants discussed the importance and value therapies that focus on the
provision of tools and strategies rather than on insight oriented approaches. As this chapter progresses toward
exploring the application of solution-focused brief therapy (SFBT) with African Americans, it is of
appropriate timing to provide this response from a focus group participant who was addressing strategies for
working with white therapists:

I found out that it really doesn’t matter [seeing a white therapist].

A lot of them let you solve your own problems.

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 Actually in therapy, you are solving your own problems (Thompson et al., 2004, p. 24).

Research by Thompson and colleagues (2004) indicates that participants with psychotherapy experience
often avoided discussion of their experiences with poverty, paying bills, racism, neighborhood violence and
trauma, and family life because of fears that the therapist would not understand these areas of their lives.

What the focus group findings indicate is that there is a need for the therapeutic community to educate the
African American community on the willingness and abilities of mental health professionals to learn more
about the lives of African Americans. Although this study revealed that African Americans who participated
were not generally negative toward seeking mental health services, they did, however, hold attitudes and
beliefs that negatively affected actual treatment seeking. Participants noted that stigma, cost, and knowledge
of available sources affected treatment seeking. Participants were also concerned that therapists’ stereotypes
affected therapists’ attitudes toward and treatment of African Americans.

Of interest in understanding the perception that African Americans develop when they are first seeking
services include the presence or lack of ethnic reading material in the waiting area, diversity of the office
artwork, and ethnic minorities who work for the therapist or agency (Heron, Twomey, Jacobs, & Kaslow,
1997).

Clinical Issues for African Americans

Addiction continues to be one of society’s most challenging and complex problems. The link between mental
health disorders and substance use is noteworthy. At least 50 percent of people seeking substance abuse
support have a co-occurring mental health disorder (McCann, 2012). Substance use has a particular impact on
the African American culture, from increased domestic and community violence and poverty, to child abuse
and neglect, to health-related problems. Roughly one third of all inpatient admissions for substance abuse
treatment are African Americans.

There are a number of variables related to sociocultural factors in substance abuse. One of those variables in
the African American community is spirituality as a means of overcoming adversity and crises. Research has
shown that integration of culturally specific factors such as spirituality into treatment of substance abuse is
consistently associated with better outcomes and lower rates of relapse (Baker & Bell, 1999). It has been well
documented that spirituality and religion are key sources of strength and tenacity for African Americans. The
results of a recent study on spirituality among African American women in recovery from substance abuse
revealed that spirituality—a key component of African personality and culture—had a significant correlation
with positive mental health outcomes for these clients (Baker & Bell, 1999).

As of 2009, the U.S. Census Bureau reported that more than 7.8 million children are residing in a
grandparent-headed household (U.S. Census Bureau, 2011). This figure has increased from 4.5 million
children in 2000. Approximately 20 percent of these children have neither parent present, and a grandparent
is responsible for their basic needs. Twenty-four percent of African American children are being raised by a
grandparent. Although many African American families and communities rely on extended family for support
and care of the children, more African American grandmothers are becoming caregivers for their

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grandchildren when the parents are unable or unwilling to provide care. Legal issues, relationships with
biological parents, and financial stressors are all significant factors in how a grandparent experiences and copes
with raising their grandchild (Newsome & Kelly, 2004). Kinship care of children does have its strengths, one
being that a grandparent can often provide a nurturing and supportive environment for their African
American grandchild. Elements of additional kin relatives assisting the grandparent are beneficial as well as
more grandparents becoming increasingly involved in their grandchildren’s educational and extracurricular
pursuits.

Kinship care is a staple, especially in the African American community. It has been occurring since
enslavement when Africanparents and their descendants were sold and separated from their children.
Relatives and others took the children into their households and cared for them. However, one must examine
the current sociological elements that present grandparents and other relatives raising kinship children with
unique challenges as compared with past years. These challenges can range from childhood mental health
disorders, youth drug experimentation and drug use, and lack of resources and support for grandparents.
Sometimes, a grandparent is merely left with the responsibility of care for a grandchild with no legal authority
given by the biological parent. Grandparents raising grandchildren are often searching for solutions to some of
the challenges that they face when caring for their grandchildren.

Another major problem in the African American community is domestic violence. In a national survey, 29
percent of African American women and 12 percent of African American men reported at least one instance
of violence from an intimate partner (Tjaden & Thoennes, 2000). In recent years, a promising effort to
support African American victims of domestic violence has been created by several African American
churches that have been trained in appropriate ways to receive people who are experiencing intimate partner
violence.

The Institute on Domestic Violence in the African American Community (IDVAAC) is an organization
focused on the unique circumstances of African Americans as they face issues related to domestic violence,
including intimate partner violence, child abuse, elder maltreatment, and community violence. IDVAAC’s
mission is to enhance society’s understanding of and ability to end violence in the African American
community. IDVAAC was formed in 1993, when a group of scholars and practitioners informally met to
discuss the plight of the African American community in the area of domestic violence. The group ultimately
agreed that the “one-size-fits-all” approach to domestic violence services being provided in mainstream
communities would not suffice for African Americans, who disproportionately experience stressors that can
create conditions that lead to violence in the home.

Limited community support and negative perceptions by relatives and friends can prevent some African
American women from disclosing stories of intimate partner abuse. The stigma of being a victimized African
American woman can be a hindrance to help-seeking. For example, the fear of being labeled, ridiculed,
criticized, and belittled by family and friends for being in an abusive relationship can make some African
American women hesitant to broach the topic in their networks. The community may deny that domestic
violence is a problem among its families. In fact, there may be a “political gag order,” which is a self- and
community-imposed silence to avoid reinforcing negative stereotypes about the African American community
(Datillio, 1998). As a result, there may be a scarcity of services and resources in the African American

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community. It is emotionally difficult for African American women to free themselves from violent
relationships if they risk losing community support or being ostracized by relatives and neighbors.

SFBT With African Americans

Individuals who are struggling with untreated mental health or psychosocial issues often identify their
world as “problem-saturated.” That is, their cognition directs them to identify with the emotions of
hopelessness, discouragement, and judgment. Clinicians are ever seeking ways to increase engagement in
services with the most vulnerable of our populations; and, as such, are charged with determining interventions
and approaches that will increase the likelihood that an individual will experience growth.

As the African American community continues to thrive and struggle all at the same time, the solution-
focused community eagerly offers its approach to clinicians who are working with members of this minority
culture. If one pauses for a moment and considers how African Americans have been therapeutically treated
previously, there is a multitude of approaches, theories, and techniques that have been used.

SFBT uses a language of change. The process by which the clinician engages the client is one that is curious,
empathic, and gentle. The perceptions that some African Americans have of psychotherapy have been less
than positive, and therefore, we must look for more appropriate and culturally sensitive methods to assist this
culture. SFBT is conversation based, which can potentially allow the African American client to feel heard,
valued, and talked to rather than talked at. Basing therapeutic interaction with an African American client on
“respectful curiosity” promotes a spirit of openness and trust between clinician and client.

One of the clinician’s first steps is to empathically join with the client through asking coping questions. For
example, consider the following scenario as an example of this skill:

Randall is a 21-year-old father of a 4-year-old son named Derek. You are seeing Randall for a scheduled in-home therapy visit. When you
arrive, Randall informs you that his girlfriend and Derek’s mother, Beth, left the family five days ago. You gently reply, “That sounds very
stressful. How have you been coping the past several days?”

Coping questions convey the clinicians understanding of the hardships currently involved. These types of
questions also elicit strengths and resources, which are crucial in forming a solution-focused alliance with the
client and encouraging movement forward.

Randall answers that he has been taking care of Derek with the help of his aunt and grandmother. He also
states that he has been going for a run each morning to “get rid of stress” while his grandmother feeds Derek
breakfast. The information that Randall has shared here is quite helpful for the clinician on many levels. One,
it informs the clinician of what natural supports this family has. Two, it conveys that Randall has a coping
skill of exercise (running) to manage stress. Third, and most importantly, it demonstrates that Randall is a
capable, caring father despite the significant stress he has experienced this week.

How would non-solution-oriented approaches seek to respond to Randall? Most would launch into an
exploration of more about the problem; that is, wanting details and possible motivations for why Beth has left
the family. Some clinicians may assess that Randall is in need of immediate skill-building and could try to
continue intervention with teaching Randall coping skills and addressing any parenting concerns. Although it
is fair to say that these responses do have merit, there is weight in understanding how a solution-oriented

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approach provides the clinician with a different route to consider. We now know that Randall has natural
supports (aunt and grandmother) and that he has identified and used a coping skill (exercising). How might
we then use this information to continue our work with Randall?

Through exploration of solution-building conversations, we notice one technique that could also be useful
as we continue our conversation with Randall. Compliments seek to validate what the client is already doing
well. Beyond that, compliments recognize and acknowledge the difficulties that someone is facing. As
perceptions of helping professionals by African Americans is understood, we can find experiences where the
African American individual has not been the recipient of compliments by helping professionals that they
have had contact with. Often, these interactions for many African Americans fall into three categories:
businesslike, neutral, or negative. Providing compliments to an African American client can be particularly
aligning for the therapeutic relationship. As critical to the client’s well-being is the process of complimenting,
which leads to encouragement by the clinician to clients that they are capable of change. Moreover, the
messages of understanding and listening are conveyed to the client who is likely feeling overwhelmed,
frustrated, and hopeless.

Take Randall for instance. We can hypothesize that the past five days have been especially difficult for him.
He may be receiving loving and positive support from his aunt and grandmother. He may be releasing some
stress and coping with the recent family circumstances by exercising. But we do not know if Randall has been
praised for the things that he has been doing right, and as clinicians, we would have the ability to do this.
Take, for example, some possible compliments that the solution-focused clinician could provide to Randall:

Example one: “Randall, I really admire how you have sought out family support to help care for Derek.”
Example two: “It sounds to me like you have been doing a really great job of keeping things together.”
Example three: “You are very resourceful by the ways that you have problem-solved with this situation.”
Example four: “I am glad to hear that you have been able to set aside time to take care of yourself and hope
you can continue to do that.”

In example one, we see the clinician identify a specific behavior that Randall has engaged in that has
resulted in the client solving part of the problem—in this case, who can help care for Derek. In example two,
the clinician is seen reinforcing the general observation that Randall is handling this situation well. Example
three provides us with a technique to attribute Randall with a positive attribute; in this case, the clinician views
Randall as “resourceful” and tells him so. Finally, example four combines the expression of a specific behavior
that Randall has engaged in (self-care through exercising) with encouragement toward the client to continue
this behavior. This type of compliment can illuminate for the client what is working and to encourage the
client to keep doing it.

Complimenting an African American client can be an exercise in authenticity and a validation of a cultural
value within this community: the endurance of suffering. Clearly, methods and solutions have been created for
generations within the African American culture that have allowed these individuals to sustain themselves and
thrive amid challenges, adversity, and oppression.

When exploring how solution-focused approaches can be of particular benefit to minority cultures, it is

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crucial to recognize the role of the clinician within this framework. The clinician is seen as the collaborator or
consultant. This differs from traditional approaches in two primary ways. One, in traditional treatment the
clinician is viewed as the expert. As a general rule, experts usually possess and emit a sense of power. Two,
traditionally oriented treatment seeks to create goals for the client. The solution-focused clinician hired by the
client helps the client achieve the client’s goals (Berg, 1994).

Attending to the African American client’s “world view” is essential when using a solution-focused
framework. Attempting to understand the hopes, goals, and visions of an African American seeking treatment
allows the clinician to assess which direction the client wishes to pursue. Empowerment is a concept that
African Americans have often struggled to attain, largely because of societal and institutional viewpoints and
practices. Problem saturation, that is, the overwhelming presence and reminders to African Americans of their
physical, financial, environmental, social, and psychological problems, is common. Presuppositional language is
another solution-focused approach that refers to the clinician’s attempts at encouraging exploration of a
preferred future versus problems that exist right now (De Jong & Berg, 2002). Following is an example of a
clinician using presuppositional language on the case study of Lenora.

Case Example

Lenora is a 53-year-old African American woman who was widowed a year ago. Her husband died suddenly at home while Lenora was at
work. Lenora has received grief counseling at the local community mental health center and has recently been referred by her primary care
physician to Todd, a licensed clinician in private practice. Lenora’s doctor has concerns that her grief has now progressed to clinical
depression, as Lenora presents with difficulty eating, bathing, and leaving her apartment. Lenora has recently begun isolating herself from
family and friends. She reports that no one understands her pain and that she does not have a reason to get out of bed. Lenora’s support
system consists of her sister, adult daughter, and pastor at her church. Lenora has not been to church in four months but does state that
she misses seeing her pastor.

Todd, the clinician, is now preparing to meet with Lenora for the initial assessment appointment. He
realizes that his approach will need to be one of validation, empathy, and encouragement. Todd believes that a
solution-focused approach may be the best way not only to engage Lenora but also to provide her with some
hope and encouragement. During the initial session with Lenora, Todd uses presuppositional language to
elicit a preferred future from Lenora.

Clinician: Lenora, I understand from what you have told me that life is really difficult right now.
Lenora: Yes it is.
C: I am wondering if we could take a moment and imagine something. Would that be
okay?
L: I guess.
C: Good. I would like you to imagine how you wish your life was instead of how it is now.
Can you tell me one thing that you would hope would be different?
L: Not really, because things won’t be different.
C: It’s really understandable that you would feel that way. Depression can leave a person
feeling hopeless about their future. Even though you don’t think anything would be
different, what do you wish was different?

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L: I wish that I could go to church again.
C: You wish you could go to church again. Okay [writing it down]. That’s good.
L: But, I don’t think I’ll ever be able to go to church again.
C: I certainly understand how you could feel that way. How would your life be even a little
bit different if you were going to church?
L: I don’t know. I guess I would see some of my old friends and the pastor.
C: Your pastor is an important person in your life, isn’t he?
L: Yeah, he is. He gives me hope sometimes, but then it goes away.
C: What does he give you hope about?
L: That maybe I can be okay.

In this script, we see the clinician, Todd, engaging Lenora in exploring how she imagines her life being
different in some way. Todd validates Lenora’s feelings and reflects back some of her statements. One thing
that is noteworthy is how Todd acknowledges Lenora’s statement “I don’t think I’ll ever be able to go to
church again,” but he does not explore why she feels this way. This is an important solution-focused
distinction. That is, the clinician can validate this feeling, but the reason why Lenora feels this way is not as
important as the question that Todd asks her following his validating statement. Todd wonders aloud how she
imagines her life would be different (even a little) by going to church. If the solution-focused clinician hopes
to move the client toward solutions, he must use techniques that allow the client to explore possibilities.

It is important for the clinician in this case, Todd, to use methods that explore Lenora’s natural and cultural
supports. For many African Americans, this effort by a clinician increases the client’s feelings of being
culturally understood and validated.

Stigmatization and pathology-centered care has statistically prevented the African American client from
viewing therapy as beneficial or benign. Eliciting a preferred future from an African American client is critical
to building a therapeutic relationship that is centered on garnering strengths and moving forward with
possibilities and instilling hope.

Scaling techniques, which are common in solution-focused work, allow the clinician to assess the client’s
progress through concrete measurement (Berg, 1994). It should also be noted that this technique empowers
clients in realizing that their assessment is more important than the therapist’s assessment. As was discussed
earlier in the chapter, the perception of some African Americans that clinicians view themselves as the
“experts” of the client’s life is seen as a barrier to African Americans seeking out mental health treatment.
Scaling techniques can elicit coping strategies, supports, and resources that the client is using to survive.
Clinicians that work with African Americans who experience a wide variety of challenges, from poverty, to
domestic violence, to mental illness, can benefit from introducing scaling as a means to discover a client’s
inherent coping behaviors. The case example picks up with the clinician using the scaling technique with
Lenora.

C: Lenora, I would like to introduce scaling to you as a way for us to look at the
depression a little more closely. Would that be all right?

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L: Yes.
C: Okay. We’re going to use a 1 to mean the problem is no longer here and a 10 is as bad
as the problem can ever get.
L: My depression will always be here.
C: Well, I can see how it could feel that way to you. If I could just get you to imagine for a
moment that a 1 is the ideal, kind of like a “dream” that the problem is not here. How
does that sound?
L: Okay, I guess.
C: On that scale of 1 to 10, where would you say you are with the depression right now?
L: Oh, it’s a 10 right now. I am so miserable.
C: A 10, okay [writing down]. Now, let me ask you to think of a time that you remember
when the depression was not a 10.
C: Oh, I don’t know if it’s ever been less than a 10. Let’s see [pauses], it was maybe an 8
last week. I think it was last Wednesday that it was a little less bad, about an 8.
C: So, last Wednesday, it was about an 8 [writing down]. Now if you could think for a
moment about what was different last Wednesday. What sticks out in your mind as
happening that day?
L: Gosh, nothing really. I just sat around the house and didn’t do much.
C: Did you have contact with anyone? Any visitors or phone calls?
L: Actually my neighbor Charlotte had baked me a cake and I returned her cake pan to
her that day. We talked for a few minutes.
C: Good. How was your conversation with Charlotte?
L: It was really nice. She is a lovely person and very kind to me. She understands that I
have hard times.
C: So Charlotte is somebody who understands you and treats you nicely?
L: Yes. I remember I smiled a few times when we were talking.
C: You smiled? Is that something that you don’t do very much?
L: Yeah. There’s nothing to smile about.
C: But talking to Charlotte made you smile?
L: Yeah she did [smiles].
C: Did you do anything differently after your visit with Charlotte?
L: I went home and took a bath. I hadn’t taken a bath in about a week.
C: You took care of yourself.
L: I suppose so.
C: So by visiting with Charlotte, it helped you feel more positive and you were able to do
something to take care of yourself. It sounds like those behaviors helped the depression

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 to be an 8 instead of a 10.
L: I guess so. I never thought of it that way. I had forgotten about what last Wednesday
was like until we talked about it just now.

It is generally difficult for clients to examine their depression. One significant but sometimes easily missed
SFBT technique that Todd implemented was externalizing Lenora’s depression. Instead of referring to
depression as “your depression,” he titles it “the depression” so that he can model to Lenora that the
depression that she is suffering from is a part of her but not all of her. This is a critical step that clinicians can
take when working with African Americans, as the general stigmatization process that many African
Americans experience is overidentification with their mental disorders. Externalization on the part of the
clinician is particularly useful when working with different cultures.

We are introduced to the concept of scaling in this scenario by Todd providing Lenora with a scale model
by which she can assess her depression. As Lenora provides a numerical assessment, Todd prompts her to
explore recent times when the depression was less. Although Lenora is able to identify this, she initially
struggles with identifying reasons why the depression may have been lower. This is a common struggle for
clients who have not been prompted to explore why things have been less difficult at different times in their
lives. Most traditional psychotherapy models focus on alleviation of symptoms through introduction of new
techniques and intervention, rather than using the client’s past experiences as opportunities for change
(Trepper et al., 2010). This search for past solutions can be particularly effective with the African American
client, who is often resourceful and resilient in handling life’s challenges.

Lenora has now been able to identify a specific factor that was present on a day when the depression was at
an 8 versus a 10. A connection with a friend that day served to lessen the pain and intensity of the depression
for Lenora. One of the most significant ways that a clinician can explore solutions with the African American
client is to understand the deep meaningfulness of natural supports. In the African American community,
members are often strengthened and maintained by family, friends, a church community, and neighborhood
members. Exploring solutions for African Americans allows the clinician to consider these meaningful cultural
connections when developing a treatment approach.

We see Todd, the clinician, continuing his reflective statement with Lenora in this scenario as well as the
first one. One important piece of information gathered in the scaling conversation is that Lenora’s contact
with her friend Charlotte prompted her to engage in an act of self-care (bathing), which had been a challenge
for Lenora lately. In solution-focused work, the clinician reflects back the positive behavior to the client and
allows the client to reflect on the connection between a possible solution and positive behavior. Specifically
with Lenora, the goal is to begin the process of helping her connect positive meaningful connections (i.e., her
visit with Charlotte) to being able to engage in self-care (i.e., taking a bath) as solutions to managing the
depression that she is experiencing.

Summary
This chapter has addressed the historical background of African Americans as well as explored how racial and

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cultural differences in both African American clients and mental health professionals have impacted the
perception of mental health in the African American community. Environmental, generational, social, and
educational challenges have made it difficult for some African Americans to be understood and valued by the
mental health and psychiatric community. Clinical issues such as depression, addiction, and domestic violence
have challenged clinicians to develop culturally sensitive and sound approaches to addressing these clinical
issues within the African American community. Value and cultural considerations that are crucial to the
African American client were presented, along with ways to incorporate these considerations in clinical
practice. Clinicians who work with African Americans will find that solution-focused therapy provides a
wealth of opportunity for fostering a positive, strengths-based relationship with clients.

Through examining the case studies of Randall and Lenora, specific solution-focused methods were
introduced that allow the reader to have concrete examples of solution-focused therapy in action with African
American individuals. Consideration was given to discussing how specific cultural elements present in Randall
and Lenora’s lives can be valued by the solution-focused clinician.

FURTHER LEARNING
There are a variety of materials and resources available to individuals interested in learning more about
solution-focused work with African Americans. Please refer to the following resources to expand your
knowledge.

Berg, I. K. Irreconcilable differences: A solution-focused approach to marital therapy. One hour, 32 minutes. Order
through www.psychotherapy.net
Black Mental Health Alliance for Education and Consultation Inc.–Advocacy for African American mental
health services. Includes community education, training, consultation, and mental health referrals.
www.blackmentalhealth.com; 410-338-2642
Black Mental Health Net. Includes provider directory and mental health library.
www.blackmentalhealthnet.com
Institute on Domestic Violence in the African American Community. www.idvaac.org; 877-NIDDAAC
Moore Campbell, B. (2006). 72 hour hold. Anchor. Description: A fictional tale of an African American
mother grappling with her teenage daughter’s mental illness and the inadequate mental health system that
she encounters.
National Alliance on Mental Illness–Multicultural Action Center. Provides fact sheets, videos, and additional
resources focused on mental health care and challenges in the African American community.
www.nami.org
National Organization for People of Color Against Suicide. Promotes life-affirming strategies for people of
color to decrease life-threatening behaviors. www.nopcas.org; 202-549-6039
The Substance Abuse and Mental Health Services Administration. “Stories that Heal” features videos of
African Americans living with mental health problems. www.storiesthatheal.samhsa.gov
U.S. Department of Health and Human Services–The Office of Minority Health. Provides information and
statistics on mental health and African Americans, cultural competency, and health topics.

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 www.minorityhealth.hhs.gov; 800-444-6472
Williams, T. M. (2008). Black pain: It just looks like we’re not hurting Simon & Schuster. Description: A
ground-breaking book about depression in the black community.

DISCUSSION QUESTIONS
1. What challenges do African Americans face in your community with regard to mental health services?
2. In what ways do you think an African American client would respond to solution-focused techniques?
3. How could Lenora’s clinician Todd help her develop a solution-focused treatment plan to address the
depression she is experiencing? What would be an example of a solution-focused treatment goal for
Lenora?
4. How could solution-focused techniques be used if working with an African American struggling with
domestic violence?
5. How will you incorporate solution-focused principles into your work with African American clients?

REFERENCES
Baker, F. M., & Bell, C. C. (1999). Issues in the psychiatric treatment of African Americans. Psychiatric
Services, 50(3), 362–368.
Berg, I. K. (1994). Family-based services: A solution-focused approach. New York: Norton.
Das, A. K., Olfson, M., McCurtis, H., & Weissman, M. (2006). Depression in African Americans: Breaking
barriers to detection and treatment. The Journal of Family Practice, 55(1), 30–39.
Datillio, F. M. (1998). Case studies in couple and family therapy: Systemic and cognitive perspectives. New York:
Guilford.
De Jong, P., & Berg, I. K. (2002). Interviewing for solutions (Vol. 2). Pacific Grove, CA: Brooks/Cole.
Heron, R., Twomey, H., Jacobs, D., & Kaslow, N. (1997). Culturally competent interventions for abused and
suicidal African American women. Psychotherapy, 34, 410–424.
Kessler, R., McGonagle, K., Zhao, S., Nelson, C., Hughes, M., Eshleman, S., . . . Kendler K. S. (1994).
Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: Results from
the National Comorbidity Survey. Archives of General Psychiatry, 51, 8–19.
McCann, S. (2012). What is co-morbidity? Retrieved from http://www.anonymousone.com/faq203.htm.
Newsome, W. S., & Kelly, M. (2004). Grandparents raising grandchildren: A solution-focused brief therapy
approach in school settings. Social Work with Groups, 27(4), 65–84.
Sue, D. W., & Sue, D. (1990). Counseling the culturally different: Theory and practice (2nd ed.). New York:
Wiley.
Sue, S., Fujino, D. C., Hu, L., Takeuchi, D. T., & Zane, N. (1991). Community mental health services for
ethnic minority groups: A test of the cultural responsiveness hypothesis. Journal of Consulting and Clinical
Psychology, 59, 533-540.
Thompson, V. L. S., Bazile, A., & Akbar, M. (2004). African Americans’ perceptions of psychotherapy and
psychotherapists. Professional Psychology: Research and Practice, 35, 19–26.

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Tjaden, P., & Thoennes, N. (2000). Full report of the prevalence, incidence, and consequences of violence against
women. Washington, DC: National Institute of Justice and the Centers for Disease Control and
Prevention.
Trepper, T. S., McCollum, E. E., De Jong, P., Korman, H., Gingerich, W., & Franklin, C. (2010). Solution-
focused therapy treatment manual for working with individuals. Retrieved from
http://sfbta.org/researchDownloads.html.
U.S. Census Bureau. (2011). Living arrangements of children: 2009. Washington, DC: Author. Retrieved from
http://www.census.gov/prod/2011pubs/p70-126.pdf.

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 6
Solution-Focused Approach With
Hispanic and Latino Clients
Peter Lehmann, Catheleen Jordan, Damaris Mosharef

S olution-focused brief therapy (SFBT) is an approach that attempts to change peoples’ lives in the shortest
possible time. That is, change comes from the identification of two sources; by first asking clients about
their preferred future and second by detailing the skills and resources they already have (Ratner, George, &
Iveson, 2012). In its most creative period of development during the 1980s and 1990s, SFBT developed as a
model that could be applicable to all clients who presented with a host of needs. Beginning more than 20
years ago, Steve de Shazar and Insoo Kim Berg and others authored a number of texts including Keys to
Solutions in Brief Therapy (1985), Family Preservation (1991), and Working With the Problem Drinker: A
Solution Focused Approach (1992) to name a few. Since then, SFBT has become a prominent global model of
practice with a solid base of evidence (see Franklin, Trepper, Gingerich, & McCollum, 2012, for a review)
embedded in a number techniques, including the use of compliments, scaling and miracle questions, exception
building, and so forth. The process is facilitator-driven, generating hopefulness and optimism by looking at
strengths, resources, and competencies (e.g., Berg, 1994; Berg & Miller, 1992; de Shazar et al., 2007).

We argue that SFBT is also a healing practice that can be the focus for change among diverse cultures, long
known to have proportionately higher rates of mental health issues compared with the general population
(e.g., Barrio et al., 2003; Randall, Sobsey, & Parrila, 2001; Sue, 2003; U.S. Surgeon General, 2001). Given
that SFBT is grounded in language—how clients use words and how meaning is framed (de Shazar, 1994)—a
cultural context thus becomes a frame of reference. This frame of reference provides a perspective for
understanding any person’s ways of being, behavior, thought, emotion, and interrelatedness that must be
congruent with clients’ cultural beliefs to be effective (Benish, Quintana, & Wampold, 2011; Frank & Frank,
1993). Thus, it might be argued that SFBT is a model of practice that has the capacity to expand therapeutic
effectiveness to multiple ethnic minority groups, an argument long called on in the psychotherapy literature
(Wrenn, 1962). Indeed, there is now a growing body of literature detailing the work of SFBT with Hispanic
and Latino populations (e.g., Beyebach et al., 2000; Corcoran, 2000; Froeschle, Smith, & Ricard, 2007;
Harris & Franklin, 2009; Seidel & Hedley, 2008; Thompson, Bender, Windsor, & Flynn, 2009; Tucker &
Trevin~o, 2011; Zamarripa, 2009). Considering these advances, SFBT may be seen as a culturally adaptive
form of psychotherapy, one in which interventions can be congruent with the clients’ values, contexts, and
world views (Bernal, Jimenez-Chafey, & Domenech Rodríguez, 2009).

This chapter expands the utility of SFBT within a cultural context toward an application of use with
Spanish-speaking populations. We begin with a historical overview of Latino and Hispanic groups. For the
purposes of this chapter, we follow the writings of Quintana (1998) who argued that ethnic labels such as

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Latino, Hispanic, Spanish, Mexican American, and so on have very different meanings depending on a
number of different factors such as age, country of origin, and acculturation. Thus, we use Hispanic and
Latino interchangeably. In recognition of the differences between these populations, we summarize two
sections that may help solution-focused clinicians appreciate the cultural uniqueness common to these
populations but also differentiate some of the protective/risk factors presented by clients. A specific case
example is included. The chapter ends with a compendium of resources that may be useful for the solution-
focused practitioners.

Background: Overview of Hispanic and Latino Populations

Conventional Spanish-speaking populations represent the fastest growing ethnic groups in the United States.
According to the 2010 Census (U.S. Census Bureau, 2012), 308.7 million people resided in the United States,
of which 50.5 million, or 16 percent of the total population, were of Hispanic or Latino origin. Thus, the
Hispanic population has increased by 15.2 million between 2000 and 2010, accounting for more than half of
the 27.3 million increase in the total U.S population. Gallo and colleagues (2009) have stated that by 2050,
Hispanic-speaking populations will compose 30% of the population living in the United States.

This amalgamation of people, while considered Spanish, represents a broad collage of heterogeneous ethnic
groups who typically designate themselves as Hispanics, Mexican Americans, Latinos, Hispanos, Central
Americans, and South Americans, to name a few (Gomez-Diaz, 2001). In fact, almost two decades ago
Castex (1998) wrote that Hispanic and Latino clients can come from as many as 26 different nations. Among
them, she suggested there are significant differences in language, socioeconomic status, customs, and values
and that within individual countries there is quite often a great deal of diversity.

The Pew Research Center reports (2012) that within the continental United States, Hispanic subgroups
also differ in their states, regions, and counties of geographic concentration. Mexicans, Salvadorans, and
Guatemalans are largely concentrated in the western states while Cubans, Colombians, Hondurans, and
Peruvians are largely concentrated in the South. The largest numbers of Puerto Ricans, Dominicans, and
Ecuadorians are in the Northeast. The nation’s Cuban population is mostly concentrated in the southeast.
Nearly half (48%) live in one county—Miami-Dade County in Florida. Miami-Dade County is also home to
the nation’s largest Colombian, Honduran, and Peruvian communities.

For Mexicans, Salvadorans, and Guatemalans, Los Angeles County in California contains each group’s
largest community. Los Angeles County alone contains 9% of the nation’s Hispanic population. Bronx
County in New York contains the largest Puerto Rican and Dominican populations, and Queens County in
New York contains the largest Ecuadorian population.

Cultural Experiences of Hispanic/Latino Populations

Although the differences between the Hispanic and Latino populations seem to embody multiple countries
of origin and ethnic practices that are unique within their own right, we argue that these groups share some
elements of a shared culture, that is, a common set of beliefs, norms, and values to name a few. At the same
time, we caution that each client’s unique culture must first be analyzed according to the sociopolitical context

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(e.g., histories and patterns of migration, the histories of wars/oppression within countries of origin, social
class, race) in which these cultures have evolved (McGoldrick et al., 2005). In this section, we present an
overview of these shared elements. As such, they represent some broad and not hard-and-fast protective
qualities that may be found among Latino and Spanish-speaking populations. Understanding the uniqueness
of these elements may be explained by the dual process of acculturation, or adapting to the host mainstream
culture, and enculturation, or the adoption of specific values, beliefs, and behaviors of that specific ethnic group
(Gonzales, Fabrett, & Knight, 2009). Sensitivity toward these differences is a task for solution-focused
practitioners who are encouraged to enquire about distinctions and uniqueness about each. References for
some of the shared elements below have been taken from U.S. Department of Health and Human Services
(2003), Ready, Knight, and Chang Chung, (2006), Taylor, Lopez, Martinez Hamar, and Velasco (2012),
Hispanic Culture online (2012), and Gallo and colleagues (2009).

Language Dominance. Latinos’ Spanish proficiency differs by nativity; second- and third-generation
Latinos speak less Spanish than their ancestors although there is a strong consensus that knowledge of the
language will be important for succeeding generations. It has long been acknowledged that language erosion
as a source of cultural heritage can be conflictual for many Latino families in the United States (Bernal &
Knight, 1993). Conversely, retaining Spanish as a family-first language has been found to buffer the stressors
involved with adapting to a new country (Alegria et al., 2007; Vega et al., 1998)

The Work Ethic. Hispanics more than the general public appear to believe in the efficacy of hard work.
This characteristic is seen as a sign for getting ahead and being successful in their new country. A 2000
analysis of census data (Hernandez, 2006) found that 93% of children whose fathers were present in the home
had worked during the previous year.

Religion, Mind, Body, and Spirit. Overall, Hispanics have a strong religious affiliation and believe it to be
an important and critical part of their life. One’s faith in the Hispanic culture has been identified as a factor
that can be a protective buffer from stressors that impact family life (Jarvis, Kirmayer, Weinfeld, & Lasry,
2005). The notion of espiritu or spirit is used synergistically to combine with mind and body. The culture
emphasizes faith in the saints and patrons of certain causes, where praying, lighting candles, and believing in
the Spirit of God are fairly common practices. Given the importance of religion, the church stands out as one
of the most important community organization for Hispanics, providing a natural and important link to
others in the community (see Gallo, et al., 2009, for a summary of the relationship between religion and
physical/mental well-being among Hispanic populations).

Gender Roles. Gender roles in the Latino culture have typically suggested a configuration of male
dominance (machismo) and female submissiveness (marianismo) behaviors within this population. Machismo is
seen as behavior male-dominant and characterized by patriarchal authority and dominance (Galanti, 2003).
Marianismo is characterized by female passivity, dependence, self-sacrifice, and placing family needs first. It
has long been associated with adoration of the Virgin Mary (Nieto-Gomez, 1974), one who remains a virgin
until marriage and who invests devotion, loyalty, and nurturance to the family. Although these terms have
long been part of the cultural landscape, they are clearly not well understood, and there is little information
that they represent or are accepted in totality by the Hispanic/Latino community (Humara, 1999; Sobralske,
2006; Sussman Getrich et al., 2012). Further, these terms may have more impact depending on immigration,

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ethnic subgroup, and acculturation status.

To amplify the emerging difference, Falicov (2010) has argued that notions of machismo have been steeped
in pathology and historical lore, representing an overgeneralization of a cultural grand narrative or
“comprehensive knowledge about a topic” (p. 310) that is no longer applicable. In its place the author has
suggested that we now have cultures of ‘‘masculinities’’ in which each man expresses his maleness in a unique
way, as a blend of mainstream cultural expectations along with alternative features or behaviors (Brod, 1987;
Gutmann, 2003). Similarly, Preto (2005) has stated that Latinos can be characterized by personalism, a form
of individualism that values the inner qualities of people that make them unique.

Finally, the role of gender has been diverted from marianismo by the recent Latina feminist psychology
movement (Hurtado & Cervantez, 2009). Essentially, the authors write that this recent perspective privileges
the lived experience of Hispanic women in embodying culture and language. Thus, it is understood that
context (language, national or regional backgrounds, social class, sexuality, etc.) will impact behavior.

La Familia (Family). The importance of family in the lives of the Hispanic culture is significant and may
include a long line of connections to extended family (aunts, uncles, cousin, grandparents) all playing a
supportive role. A theme of interdependence among immediate and/or extended family members may be
common where traditions are passed on with great enthusiasm. Some of the recent literature has also found
the existence of egalitarianism and joint decision-making between husband and wife in areas of child-rearing
or household decisions (Baca Zinn, 1982; Coltrane, Parke, & Adams, 2004; Cromwell & Ruiz, 1979).
Finally, there is some evidence that ties strong family and values to positive outcomes with, for example,
protection for negative peers (German, Gonzales, & Dumka, 2009), acculturation (Dumka, Roosa, &
Jackson, 1997), coping with chronic stress (Rodriguez, Mira, Paez, & Myers, 2007), and caregiver assistance
with the elderly (Losada et al., 2006).

The Importance of Traditional Medicine. Within the Hispanic community, there is an extensive practice
of traditional medicine carried out by curanderas, espiritistas, or healers. In urbanized settings, this tradition
has been carried on in part by Hispanic pharmacists, familiar with both traditional treatments as well as
modern prescription medicines such as antibiotics. Hispanics may combine traditional medicine with other
approaches.

Confianza (Trust). Trust is considered an especially important attribute of most Latinos; however, levels of
distrust are highest among foreign-born and first- and second-generation individuals. It appears that by the
third generation, levels of distrust are lower.

Respeto (Respect). The traditional patriarchal family of the Latino includes appropriate deferential
treatment based on age, sex, social position, and authority. Older adults are afforded more respect from family
and community members. At times, and out of deference to the professionals, Latinos may not express doubt
or disagreement with information or may be reluctant to ask questions.

Personalismo (Quality of Personal Relationships) and Simpatia (Pleasant Relationships). The quality of
personal relationships is important, and Hispanics expect practitioners to take a personal interest in them as
humans where one is seen as warm and friendly. Professional relationships can be very important to Hispanic
clients engendering a commitment to treatment and the continuity of care/therapy they receive.

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Risk and Protective Clinical Factors Specific to the Hispanic/Latino Population
Collectively, there is some evidence Hispanic and Latino populations experience disproportionately more
social and mental health disadvantages than the general population (Tienda & Mitchell, 2006). However,
apart from the aggregate, it is now clear there will be differences within various ethnic subgroups. The present
section details a risk and protective framework for solution-focused therapists. As such, a visual guide found in
a syndemic model is highlighted.

It is well known that the Hispanic and Latino populations represent the largest foreign-born ethnic group
currently in the United States (Gallo et al., 2009). Consequently, the problems of immigration and
subsequent acculturation are common to this group. Immigration experiences can be quite stressful. The
problem of being undocumented may also be particularly problematic given the threat of exposure, arrest, and
deportation. In addition to language barriers, families relocate to new environments, must reestablish
networks, and often find themselves in low-paying jobs and poor living conditions that may be markedly
poorer than other groups (e.g., Finch & Vega, 2003; Pérez & Fortuna, 2005). General and ethnic-specific
discrimination is also an added stressor (Brondolo et al., 2005). These kinds of ongoing issues and demands
may produce relational conflicts around values or family roles that may have been congruent in the country of
origin but are no longer functional in the new country (Hernandez & McGoldrick, 1999). Within the mental
health field, researchers have found that some of the existing disparities noted previously do result in
maladaptive behaviors. Thus, it may be helpful for solution-focused therapists working with these populations
to have a structure for addressing any number of mental health issues that may be presented. A guide for
balancing risk and protective behaviors is summarized later.

A Syndemic Continuum
Among the host of maladaptive responses to disparity, Hispanics more than other minorities and Caucasian
populations report higher rates of binge drinking (Substance Abuse and Mental Health Services
Administration, 2009), more interpersonal relationship violence (Caetano, Field, Ramisetty-Mikler, &
McGrath, 2005), suicidal ideation among females (Krishnan, Hilbert, & VanLeeuwen, 2001) and higher rates
of AIDS (Kaiser Family Foundation, 2009). In the last 15 years, similar behaviors have been found among
disadvantaged populations (Singer, 1994) and in the interim these cluster behaviors have been termed SAVA
(Sexual Abuse, Violence, AIDS). Singer (2009) has placed these multiple health problems under what has
become known as a syndemic model. The term, widely used in the health field, is seen as the interaction of
two or more diseases/afflictions that increases the negative consequences on a population. In recognition of
this problem in the Hispanic and Latino population, González-Guarda, Florom-Smith, and Thomas (2011)
have conceptualized a risk-protective syndemic continuum that may be helpful toward understanding the
current population.

Figure 6.1 presents an adapted visual overview of a syndemic continuum solution-focused clinicians may
find useful when working with some Hispanic populations. González-Guarda, Florom-Smith, and Thomas
(2011) have highlighted this perspective as a tightly interwoven and synergistic condition that is rooted in and
may be part of the Hispanic and Latino population. In their original work, a cluster of specific behaviors and
conditions were included around the inner syndemic cross to represent some of the Hispanic and Latino

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disparities. However, the reader will note that a cluster of behaviors and conditions surrounding the inner
cross are absent, thus allowing each case or circumstance to be configured differently. So for example, one
might find a host of potential conditions, including, health/illness, mental health, economic, divorce, and
acculturation in addition to the original SAVA responses identified earlier. The relationships between these
conditions and their concentric circles are represented by intersecting lines that point to the core of the model.
Each of the circles can be considered within a risk-protective framework, thus acting as a buffer or barrier to
well-being or good health.

Figure 6.1 A Syndemic Model of Potential Responses Useful for Work With Hispanic Populations
(Reprinted with permission.)

Source: González-Guarda, Florom-Smith, and Thomas. (2011).

Knowledge and adaptation of a syndemic process may have applicability for the solution-focused clinician
on a number of fronts. First, the template provides the practitioner with a visual representation of four
resource or strength areas that are likely to be at the heart of much of the therapeutic conversation. In
addition, these areas could operate as coping mechanisms as well as part of a unique worldview perspective
that represents each client. Next, each of these circles should be seen as multiple reference points for
developing solution-focused questions and interventions with the client that bring together the concern and
one or more resources in the environment. Third and last, a syndemic model for working with Hispanic
populations may provide a therapeutic overview for differentiating between ethnic subgroups, cognizant that
again, there are likely to be a host of differences/strengths/competencies and risks among the many Hispanic
cultures and subgroups.

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 The following case highlights a summary example of SFBT with a Hispanic family. As follows, there were
any number of multiple syndemic issues interacting with this family, including health, aggression, deportation,
and parental abandonment. Each issue is systemically related within a risk/protective continuum, consequently
providing the therapist with a structure to use her skills toward moving forward with the family.

Case Example: Background

Federico is a 15-year-old Hispanic male referred to a university mental health center by the local school
district for counseling regarding aggressive behavior issues. Federico was born in Mexico and immigrated to
the United States at the age of 7. He and his three siblings (one older brother, one younger brother, and a
younger sister) live with their mother, Carmelita, an undocumented, non-English speaker, diagnosed with
type 2 diabetes, who struggles to provide for her children and reports living in constant fear of being deported.
Carmelita admits being desperate for help resolving the ongoing conflicts involving her son. She discloses the
greatest concern as the potential of Federico’s aggressive behavior resulting in deportation. Though technically
Federico is the client, both agree that Carmelita is a key player in the conflict resolution and therefore should
join the sessions. As a result, sessions were predominantly in Spanish, with the exception of moments needed
by Federico to process without mother’s awareness.

In the first session, Federico reports Carmelita’s treatment of him as the problem. Per his reporting,
Carmelita hates him because he is the spitting image of his father. He abandoned her and their four children
to raise the children of another woman without regard to the resulting lack and harm. Federico shares feeling
deeply hurt, angry, and unable to bare the rejection and mistreatment he receives while watching his mother
lovingly relating with his older brother as if he were a gift from God. Federico concludes that his aggressive
behavior is the natural consequence of the relational condition between him and his mom, like a volcano that,
when under great pressure, explodes. Carmelita denies Federico’s accusations, though she admits verbalizing
the resemblance between Federico and his dad, demonstrating for the clinician how she says it (facial
expression showing disgust, voice inflection demonstrating frustration), seemingly unaware of how she looks
and sounds as she says it. Carmelita denies any feelings of hate or anger toward her ex-husband or her son,
stating that as a Catholic she is not allowed to hate or hold a grudge against anyone. To do so, she says, would
place her in danger of God’s wrath, and he might hurt her or one of her children, and she just can’t risk that.
Carmelita firmly declares undifferentiated love for each of her children, no exceptions.

The clinician recaps what she has understood each to say to confirm understanding. Both Federico and
Carmelita verify feeling heard and understood. The clinician ends the first session with a homework
assignment designed by the clients.

Homework

Clinician: Would you agree that there is a difference in the way you perceive the current
situation?
Federico: Yes, that’s the problem; she doesn’t admit her part in this.
Carmelita: [Smiles and says], We see things differently alright.

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Clinician: Would feeling understood be helpful?
Federico: Of course it would! I think I would be less angry if she would just admit her anger,
hate, and mistreatment of me!
Carmelita: Maybe; it should.
Clinician: What could help you see each other’s perspective a bit better?
Federico: She just needs to look at herself in the mirror to realize how angry and mean she looks
when she is telling me how I’m just like my dad.
Clinician: Carmelita, would you be willing to practice saying what you say to Federico about his
resemblance to his dad in front of a mirror to get a better understanding of what
Federico might be seeing and sensing when you say those things to him?
Carmelita: Yes, that’s fine. I can do that.
Clinician: Carmelita, what would you like Federico to have more clarity about regarding your
perspective?
Carmelita: I need him to give me credit for the ways I show him that I love him, the sacrifices I
make.
Clinician: Federico, would you be willing to take time to notice mom’s acts of kindness and love,
keeping a record of the good things you catch her doing for you this week?
Federico: There won’t be any, but sure I’ll look.
Clinician: Do you think that should be your homework assignment for this week?
Clients: Sure, that would be fine.
Clinician: Fine then, see you next week.

Miracle Question
To gain further understanding of Federico’s perspective on his situation, who and what is important to him,
and what he may want to change, the clinician introduces the miracle question. Asking Federico to provide as
much detail as he can about how things would be different if a miracle occurred, while he was sleeping, that
resolved everything bringing him to therapy. Thus, a goal statement is established. Federico admits that as a
Catholic, he believes in miracles but continues by saying that his problem, the anger that eats him up inside,
can never go away, “Nunca, de ninguna manera” (“Never, no way, no how”). The clinician acknowledges his
position and uses his faith to encourage him to dream.

Clinician: If you chose to give yourself permission to imagine that it is possible, in agreement
with the Catholic part of you that believes in miracles, after all, a miracle by definition
is the occurrence of those things that are impossible, what would that be like?
Federico: Mama and I would be playful with each other, laugh and be silly a lot.
Clinician: And how would that impact you?
Federico: Well, I would be happy more often, and it’s impossible to be happy and angry at the

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 same time, so I guess I would be less aggressive.
Clinician: And if you were less aggressive, how would that impact you?
Federico: Well, if I am less aggressive, my chances of doing well in school might increase because
I would spend less time in correctional suspension, which means I would be in class
more often. That might help me feel less lost and more confident in class and might
keep me from falling behind as much on homework and class assignments.
Clinician: Would doing well in school be helpful?
Federico: Of course, if I do well in school I might get a scholarship to go to college, so I can get a
good job to support Mama. You know she is sick, and soon may be unable to work. As
an undocumented person, she can’t receive assistance from the government. My
schooling is one of Mama’s greatest concerns—that and us getting deported. She nags
me about it all the time. My brother does well in school, and she is always bragging
about him. Maybe it would cause her to brag about me.
Clinician: What does it mean if Mama brags about you?
Federico: That I make her proud and that she loves me.
Clinician: How does knowing she loves you help?
Federico: Well, when I feel loved by her, I am more caring and gentle with her, more patient. I
don’t get angry as easily. I am nicer to my brothers and sister and to people in general.
Clinician: Can they tell?
Federico: Sure!
Clinician: How do you know they can tell?
Federico: They are happier around me; they laugh more and fight less, like me I guess.

Scaling
Early on, and throughout the counseling process, scaling questions assisted Federico, Carmelita, and the
clinician in identifying with clarity and relevant information. The information was then used to assess what if
any progress is being made, what evidence of change exists, what motivates change, and other helpful clues.
One significant measure occurred at the beginning of the very first session. Federico was asked to indicate on
a scale of 1 to 10 how counseling could impact his current concerns, 1 signifying no help and 10 signifying
great help. Federico circled 2. He explains that he comes to counseling because his school and Mama insisted
on it, but he cannot see how talking about the problem can solve anything. This scaling question provided
great insight into his expectation of what counseling would be like and how it would affect him.

Another important measure took place at the beginning of session two to measure the homework’s success.
He was to consider on a scale from 1 to 10, 1 signifying zero success and 10 indicating total success, how
successful the homework assignment was in helping him obtain his desired goal. Federico indicated a 5.

Clinician: How can you tell you are at a 5 and not a 4 or a 6, Federico?
Federico: Well, I say 5 because Mama admits that the image in the mirror appears angry, mean,

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 and disgusted, so she can see why I might reach the conclusion that she is angry at me
when she says that to me. That admission is more than I expected, but she still denies
feeling angry and hateful towards me or my dad, so I can’t say that the homework was a
total success. Maybe it took us halfway there, that’s why I say 5. It’s not a 6 because at a
6 I would feel more hopeful than a 5. I am not that hopeful that Mama will admit the
anger and hate she has toward me for looking like my father, and I am not hopeful that
she can ever stop seeing him when she looks at me, so she can’t stop hating me.
Clinician: How would you know you were feeling more hopeful?
Federico: When I feel hopeful, I have more energy to spend on doing helpful things. I don’t have
to be told a lot of times to do something, like clean up or do my homework. I just do it
with a better attitude.
Clinician: So if your mom saw you doing your chores without an attitude, doing your homework
without being told, and doing other helpful things after being asked only one time,
where would you be on the scale?
Federico: Probably a 7 or 8.
Clinician: Wow, what would you look like at a 9 or 10?
Federico: I would probably never be a 10. A 10 is perfection. I cannot be perfect, a 9 maybe. At a
9, I would be energetic, happy, and friendly, even with my brothers and sister, and
especially with my mom. I would be more peaceful too, less of a complainer, not hyper
or impatient. I would have a good sense of humor and take things easy, not so serious
about things. I don’t know what else. I don’t know if I could ever be a 9. At a 9, I
would not feel rejected.
Clinician: If you did not feel rejected, what would you feel?
Federico: I don’t know, accepted—loved maybe.
Clinician: When you feel accepted and loved, what do you do more of?
Federico: Accepting. I accept that we are poor, don’t have a good car, don’t have a good father,
don’t have a healthy mother, are not legal here, and can easily be deported any time,
but we are still OK. We can still survive. We can still triumph. That’s how I feel when
I feel accepted and loved, the world doesn’t get small for me, I can still hope, dream.
But when I feel rejected, I think my mom hates me. I get angry at all those things,
super mad, and I want to hurt somebody, even myself and my mom, not really my
mom, but I know I do hurt her in those times. I guess part of me wants to hurt her and
part of me doesn’t. I want to quit trying to succeed.

Compliments
The clinician compliments Federico and Carmelita on their great effort, recognizing how challenging the
process can be. She emphasizes their demonstration of commitment to each other and the relationship,
notably in their follow-through in doing their homework, attending sessions, participating while in session,

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and so on. She commends Federico for thanking his mother for the special meal and points out that he went
beyond his assignment, which only called him to notice the things she did. She compliments Carmelita for
acknowledging that the image in the mirror seems as angry as her son has been describing, which by her
reporting is a very scary thing for her, considering what she shared about the potential punishment from God.
Later in the process, she points to her courage for verbalizing her hurt and anger and for apologizing to her
son, acknowledging the potential discomfort this new process embraced. Complimenting continues all the
way through counseling, pointing out specific achievements, efforts, and change.

Exception Question
The exception question followed nicely. Federico was invited by the therapist to remember when he had
experienced what he described.

Clinician: I’m curious, have you ever responded with patience instead of aggression to a situation
that could have called for aggression?
Federico: Uh, I don’t know, maybe.
Clinician: When?
Federico: Well yesterday, Mama was kind of grouchy, and normally that’s enough to make me
angry because it makes me feel like she hates me, and when I think she hates me, it
makes me mad. For some reason, yesterday I just found it funny, and instead of getting
angry and mean, I motivated my little brother and sister to join me in cleaning up what
she was complaining about.
Clinician: Wow, how were you able to do that?
Federico: I don’t know, I guess I just knew she was just tired and not feeling well. I guess the
thought that she hates me didn’t enter my mind yesterday for some weird reason.
Clinician: How is that possible?
Federico: I hate to admit it since I denied that coming here could be helpful, but I think coming
here has helped me understand my mother better, and she has changed too. She is
being more affectionate, less critical. She doesn’t tell me that I’m like my father much
anymore. I mean sometimes she does, but it’s not as mean as before, or maybe I just
don’t notice it as much.
Clinician: Wow, that’s awesome! Can you think of any other time when you could have
responded with aggression but didn’t?
Federico: Well, my brother made me mad this morning, and I felt like punching him in the face,
but I just left the house and walked to school instead. I’m not saying I didn’t feel
aggressive, because I did, but I didn’t punch him in the face like I wanted to. That
counts right?
Clinician: It sure does. How did you do that?
Federico: I guess I just don’t want to make my mom upset so early. You know she is sick, and the

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 doctor told her getting upset makes things worse.
Clinician: Sounds like you really care about your mom. You are a good son.
Federico: Yeah, of course.

Case Summary
From beginning to end the client is invited to guide the process, to be the expert. Permission is sought before
implementing any strategy. In so doing, as the clinician asks the questions, the client depicts his culture and
values. In this case, the value of family and collectivistic mindset of many Hispanic families is evident in the
descriptions of Federico’s healthier self. The strong Catholic influence also often found in Hispanic families is
evident. Respecting their faith and religious convictions is essential to communicate respect and develop trust.
In working with Carmelita, the clinician respected her religious convictions, without shying away from
questions that could highlight potential contradictions assist in resolving inner conflict. Carmelita began with
the thought that to keep herself and her children safe she must deny her true feelings of anger. Yet in the
process, she discovered that if she could see the anger in the mirror, God who sees everything could see it in
her heart, and he would help her to let it go if she confessed it and repented. In doing so, she was able to
genuinely address mistakes made with Federico and ask for his forgiveness, which resulted in great healing for
Federico and the family as a whole. Through the process, he discovered personal and family strengths: humor,
hope, faith, and hard work. In the end, Federico gained clarity about what he truly values more than money.

Summary
SFBT work is respectful of individual choice, deeply honoring self-determination. This is no different when
working with diverse cultures and, consequently, the present chapter has attempted to highlight a growing
literature that supports the use of brief approaches with Hispanic and Latino populations. An understanding
of what Hispanic or Latino is may not be as straightforward as once considered; however, an effort has been
made to identify potential commonalities between these populations. Through the use of an adapted syndemic
model, SFBT practitioners may support clients’ unique values surrounding symptoms, their course, and
possible intervention options. More so, a case example demonstrating both SFBT and the syndemic model
supports some congruence between a client’s worldview and how these positions may be woven into SFBT
practice.

FURTHER LEARNING

Association of Hispanic Mental Health Professionals: http://www.ahmhp.org/home

Center for Mexican American Studies: http://www.utexas.edu/cola/centers/cmas

Center for Puerto Rican Studies: http://centropr.hunter.cuny.edu

The Committee for Hispanic Children and Families: http://www.chcfinc.org

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Hispanic National Bar Association: http://www.hnba.com

Hispanic Radio Network: http://www.hcnmedia.com

Hispanic Surf: http://www.hispanicsurf.com

National Alliance for Hispanic Health: http://www.hispanichealth.org

National Hispania Leadership Institute: http://www.nhli.org

National Latino Behavioral Health Association: http://www.nlbha.org/index.php

DISCUSSION QUESTIONS
1. Hispanic and Latino populations have some shared cultural elements; discuss some of these that a social
worker might find helpful to know.
2. What is meant by a syndemic model? Using the diagram of Potential Syndemic Conditions, describe a
Hispanic family you have seen in a clinical setting or a family you know.
3. Using the above family case example, describe some solution-focused techniques that might be helpful.
4. In considering what you’ve learned from the chapter, how are Hispanic family values and beliefs different
(if they are) from other cultural group values and beliefs?

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28, 1–11.

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 7
Solution-Focused Approach With
American Indian Clients
Sara Blakeslee, Sara A. Smock Jordan

Historical Background
There are currently 566 federally recognized American Indian tribes in the United States (U.S. Department of
the Interior, Bureau of Indian Affairs, 2012) with a high degree of heterogeneity across tribes and with each
tribe embracing a specific culture. Data from the 2010 U.S. Census reveal 5.2 million Americans identify
themselves as American Indian or Alaskan native, or a combination of other ancestry. Of this total, 2.9
million identified as American Indian or Alaskan native alone (Norris, Vines, & Hoeffel, 2012). American
Indians have always had a special and at times reverent relationship to the land, and the Bureau of Indian
Affairs (2012) reports there are approximately 326 federally administered reservations in the Unites States).
Although there is great intertribal diversity, when describing or discussing American Indians in the context of
therapy, it is important to avoid the dangerous process of “ethnic glossing” (Trimble, 1991). Tribes should be
acknowledged as having specific languages, customs, religions, and structures (Sutton & Broken Nose, 1996),
regardless of how homogenous they might appear.

Values of American Indians

American Indians have faced a cultural genocide since explorers from the Old World colonized America. This
process of systematic “deculturation” and government-sanctioned genocide has had deleterious effects on the
native population (Hooper, 1991; Tafoya & Del Vecchio, 2005). In order to conquer and eradicate American
Indians, early European explorers viewed them as “uncivilized” and as savages (Tafoya & Del Vecchio, 2005),
thereby making it easier to dehumanize the indigenous tribes and subject them to disease (Grandbois, 2005),
warfare (Tafoya & Del Vecchio, 2005), and forced assimilation (La Due, 1994). This assimilation continued
into modern Western society as Christian groups sanctioned the kidnapping of children so they might be
shipped to boarding schools, where they were often beaten and emotionally abused (Grandbois, 2005; Tafoya
& Del Vecchio, 2005). Despite the cultural genocide that has threatened to eradicate the values and customs
of American Indians, some common cultural features can inform solution-focused brief therapy (SFBT) work.

Spirituality
Because of the influence of Christian missionaries and cultural genocide that has been occurring for
centuries, many American Indians have a unique fusion of spirituality and religiosity. Coyhis (2000) asserts

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that being able to draw from both native and modern religions is a factor in recovery, specifically in recovery
from addictions and substance abuse. Despite the significant amounts of diversity among American Indian
tribes, most regard nature in a reverent manner. Specifically, “animals, plants, mountains, and bodies of water
are considered sacred” (Brucker & Perry, 1998, p. 313) to American Indians. Furthermore, American Indians
espouse a broad and inclusive view of all forms of life. The term “lifeworld” refers to “all aspects of being”
(Duran, Duran, Yellow Horse Brave Heart, & Yellow Horse-Davis, 1998, p. 343) and is an underlying
cultural nuance that differs from Western thought.

Community Versus Individualism

There are several distinctions between American Indian and Western cultures that inform how individuals
in those societies relate to their environments and, more specifically, how they view and respond to therapy.
One of those distinctions is the reliance on the individual versus the community for well-being. American
Indian culture is characterized by a focus on the circularity of relationships in contrast to the majority culture
that emphasizes linearity (Grandbois, 2005). The connectedness of these human relationships is important,
but no area of the lifeworld should be ignored. This balance and harmony in the social, mental, physical, and
spiritual aspects leads to wellness (Cross, 1997). Therefore, health is only achieved when there is a balance
between the inner and outer forces of the lifeworld (Cross, 1997). For example, in American Indian culture,
sharing resources is linked to self-worth (Lewis & Ho, 1975), and it is through this mechanism that respect is
gained (Attneave, 1982; Wise & Miller, 1983).

Brucker and Perry (1998) state that, “the American Indian perspective on the exchange of goods and the
importance of sharing is very different from the typical Western value of accumulating wealth” (p. 314).
When American Indian communities engage in this act of community, they are contributing not only to the
whole health of the individual but also to the harmony and balance of the larger community.

Family Structure/Tribal Structure

There are vast differences between tribes in terms of kinship networks and family structures. Many
American Indians consider extended relatives a part of the nuclear family (Napoliello & Sweet, 1992), and
there is often a lack of distinction between family members and tribal members (Sutton & Broken Nose,
1996; Wise & Miller, 1983). In some traditional American Indian families, it is not uncommon for three
generations to be involved in daily activities together (Attneave, 1982). This structure supports the assertion
by many scholars that therapy intervention occurs on all levels of the system (Evans-Campbell, 2008; Brucker
& Perry, 1998; Tafoya, 1989) and should also include medicine people or other tribal elders and healers as the
family wishes. Duran and Duran (1995) explain that family interventions are required when working in the
Native community and further assert the following:

[O]nce the therapist is aware of some of the . . . historical issues, she/he can begin to implement some of the available strategies available
from the Western camp. Therapies involving communications . . . and other systemic approaches can be quite effective if the therapist has
knowledge and also validates some of the historical issues that have had a profound intergenerational effect on the Native American
family. (p. 158)

Time

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 American Indians perceive the temporal sequence of days and hours as being coordinated by nature.
Therefore, they do not conceptualize appointments in the same manner as European Americans, and
punctuality is not as important as it may be to Western clients (Brucker & Perry, 1998). Culturally competent
clinicians will understand this cultural knowledge and integrate it into treatment rather than viewing the client
as disrespectful or uninterested in therapy. SFBT therapists who make use of the Vision Question or other
interventions of a temporal nature should understand that viewing the future is a Western way of viewing time
and that interventions may need to be adapted.

Communication
Tafoya (1989) presents several considerations for a culturally competent therapist to keep in mind when
working with an American Indian population. For example, many American Indians avoid eye contact as a
sign of respect (Brucker & Perry, 1998; Tafoya, 1989) and take longer pauses between sentences than
European Americans. In addition, American Indian clients may expect the therapist to take a more directive
approach in therapy (Dauphinais, Dauphinais, & Rowe, 1981; Tafoya, 1989). There is little empirical
evidence to suggest that American Indian therapists or healers are more effective than are those from a
different culture. However, given the history of oppression by Westerners, a certain level of mistrust can exist
toward white professionals (Trimble & Medicine, 1993). SFBT is a natural fit for this population, given its
emphasis on the inherent strengths of the client and the collaborative nature in which conversation occurs.

Clinical Issues for American Indians

Despite the heterogeneity that exists across tribes, many native people share a cumulative sense of trauma
surrounding not only their history of oppression and colonization but also around their contemporary
challenges (Brave Heart, Chase, Elkins, & Altschul, 2011). These collective emotional and psychological
woundings have been conceptualized as historical trauma (Brave Heart, 1998; 2003). These events responsible
for the historical trauma also have contemporary correlates and ramifications, known as the “soul wound”
(Duran et al., 1998, p. 341). As a result of these soul wounds, Native people have historically turned toward
what Duran and colleagues (1998) label “anesthetic self-intervention,” including drug and alcohol use and
abuse, intimate partner and domestic violence, and suicide (p. 346). As a result, the historical trauma extends
throughout the life span in a multigenerational way (Duran et al., 1998) and manifests in these presenting
problems.

Substance Abuse
Alcohol abuse and dependence have been issues for Native Americans since the early settlers introduced
alcohol to America. Historical accounts indicate alcohol was introduced as a means of plying natives in order
to steal land during treaty negotiations. After the introduction of alcohol into the culture, the Natives then
used it as a way to cope with the invading European settlers and the subsequent losses of land and cultural
genocide that ensued. Furthermore, biologically, Native Americans have a different process for metabolizing
alcohol that has resulted in them being more susceptible to alcoholism and its consequences (Mancall, 1995;
Moore & Smock, n.d.). In modern times, binge alcohol use (typically five drinks for men and four drinks for

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women per two-hour period) among American Indian adults is 30.6% compared with 11.2% of the national
average, and 18% are in need of treatment for alcohol or illicit drug use (Substance Abuse and Mental Health
Services Administration, Office of Applied Studies, 2010).

SFBT has been shown to be an effective and efficacious treatment for substance abuse (Smock et al., 2008).
In addition, several SFBT books have been written on applying the model to substance abuse treatment (Berg
& Miller, 1992; Berg & Reuss, 1997; Pichot & Dolan, 2003; Pichot & Smock, 2009). Although several books
and peer-reviewed articles have been written on using SFBT with people who abuse substances, there is still a
lack of material on using SFBT with Native Americans. However, given the effectiveness of SFBT across
diverse populations and its sensitivity to culture, this model is very appropriate to use with Native Americans
in substance abuse treatment.

Intimate Partner and Family Violence

“Research on the prevalence of domestic violence in American Indian culture suggests that battery and
abuse occur more frequently in this population than in the dominant culture” (Brucker & Perry, 1998, p. 310).
This surge in violence is best explained by the internalized oppression model (Duran et al., 1998; Freire,
1970). Assimilation and acculturation have taken their toll on the American Indian culture such that to
survive, natives have been forced to adopt the Western views of their culture while struggling to maintain a
sense of their heritage. This process is what Poupart (2003) refers to a double consciousness. In this process,
American Indians simultaneously accept and reject the Western stereotypes about them as at once being true
and false. For individuals to remain silent about this internalized oppression is another way in which the
dominant culture perpetuates the disempowerment of the other.

Through the process of colonization, the dominant culture infused the American Indian culture with the
concept of violence that was not previously accepted in tribal ways of being. Prior to the colonization by
Europeans, women, children, and elders were treated as honored members of the tribal community, and any
act of violence was not only committed against them but also against the spiritual world (Poupart, 2003). Over
time, violence in the American Indian community has become a way of expressing the isomorphic dissonance
that exists between the forces of the dominant culture over the subjugated one.

Poverty and Unemployment

According to current census data, poverty rates for American Indians and Alaskan Natives are two times
higher than the national average, with some tribal groups feeling this oppression more than others
(http://www.bia.gov/cs/groups/public/documents/text/idc-001819.pdf). The population is also
demographically younger than the majority culture, with almost one third of natives being under the age of 18
(http://www.bia.gov/cs/groups/public/documents/text/idc-001819.pdf). The literature cites a causal link
between living in poverty and having fewer opportunities for education and employment. Because of
educational discrepancies between natives and the majority culture, many young people fall behind in key
content areas such as math or science. This in turn can lead to higher dropout rates compared with the
majority culture (National Center for Educational Statistics, 2012) and fewer employment opportunities,
except for those jobs with a low wage. Many times the lack of employment opportunities is related to the

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geographical position of the tribal community; those in rural areas are often forced to decide between
remaining on the reservation or leaving to seek employment that offers a higher wage.

Depression and Suicide

In a 2005 study investigating health disparities among American Indians, Beals and colleagues found that
the most common diagnoses were alcohol dependence, posttraumatic stress disorder, and major depressive
episode. Along with high rates of depression, Napoli (1999) reports that “suicide rates for American Indian
males are twice that of other racial groups and the rates increase with age more dramatically than those of
other groups” (p. 26). Further, Brucker and Perry (1998) have found suicide to be the leading cause of death
for American Indian adolescents. Risk factors for suicide among the American Indian adolescent population
are “depression, hopelessness, alcohol and drug use, and family dysfunction” (Brucker & Perry, 1998, p. 311).

Duran and Duran (1995) along with Duran and colleagues (1998) link suicide rates to the complex
interplay between centuries of colonialism, loss of culture, and historical trauma, saying

The features associated . . . include depression, suicidal ideation and behavior, guilt and concern about betraying the ancestors for being
excluded from the suffering, as well as obligation for survivor parents, identification with parental suffering and a compulsion to
compensate for the genocidal legacy, persecutory and intrusive Holocaust. (Duran et al., 1998, p. 342)

Furthermore, the unresolved intergenerational trauma is cumulative, “thus compounding the subsequent
health problems of the community” (Duran et al., 1998, p. 342; Solomon, Kotler, & Mikulincer, 1988). One
instance of suicide can have lasting effects on the community not only because of the present and future
trauma resulting from the loss, but also because the loss is a tangible manifestation of the historical trauma
and injustice perpetrated against the tribal groups.

Strengths and Protective Factors

Many of the cultural features described earlier are also sources of agency and protective factors for American
Indians. In addition, Attneave (1982) describes the potential opportunities and satisfaction that exist when
working with families that have survived the atrocities of the American Indian displacement and ensuing
cultural genocide. A focus on American Indian religious practices enables individuals and families to draw
from traditional sources of guidance and comfort. The emphasis on community, family, and the wisdom of
the elder members of the tribe also offers a source of healing for presenting problems, which American
Indians might also consider spiritual in nature. Also, the view that all living things are connected in the
lifeworld brings with it a sense of attachment that coincides with a holistic, systemic method of addressing the
presenting problem either individually or relationally.

Using SFBT With American Indians

The literature on barriers to treatment for the American Indian population is clear: The predominant reasons
for early termination or underutilization are linked to the lack of culturally appropriate interventions and
culturally competent providers (LaFromboise, 1993). However, given the inclusivity of the tribe and family
members in the family structure, Brucker and Perry (1998) assert that family therapy may be much more

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natural to American Indians than individual therapy. Further, within the discipline of systemic therapy, SFBT
is an appropriate, culturally sensitive approach.

Before mentioning the case example and the specific interventions of SFBT adapted for American Indians,
it is important to discuss the foundation of this model. SFBT is an inductively created approach that is based
on co-construction. Co-construction in the SFBT therapeutic process is what happens between the therapist
and the client, the therapeutic dialogue (McKergow & Korman, 2009). Research from psycholinguistics
breaks down this process even more by labeling each speaker, listener, and their interaction. The speaker
delivers information to the listener who then responds verbally or with facial expressions and/or gestures
(Clark 1996; Clark & Schaefer, 1987). The “speaker” can be either the therapist or the client at any given
time, overlapping as the dialogue occurs. This process of co-construction occurs with alternating and
overlapping speaker and listener roles in a three-step fashion called grounding (DeJong & Berg, 2013). Recent
therapeutic dialogue research has illustrated this three-step grounding co-construction process in SFBT
(Bavelas, DeJong, Smock, & Korman, 2011).

All of this is to say that SFBT is not just a set of interventions that the therapist does during session. Earlier
articles, chapters, and books have focused on SFBT interventions and have not stressed enough the
importance of co-construction as the base for SFBT. It is possible that therapists can use SFBT interventions
without doing SFBT. Solution building (DeJong, & Berg, 2013; Smock, McCollum, & Stevenson, 2010) is
the co-construction process specific to SFBT. All therapists co-construct, but SFBT co-construction is unique
because we solution-build instead of problem-solve. The words we choose to use, the questions we ask, and
what we decide to paraphrase or not from the client’s language are all part of solution building (Bavelas et al.,
2011; McGee, 1999; McGee, Del Vento, & Bavelas, 2005). For a more exhaustive read of solution building,
see DeJong and Berg (2013) and Smock and colleagues (2010).

Case Example
Mika (45) and Matt (50) are a married couple that has recently moved from a rural reservation to an urban
area about two hours away. They have a son, Takoda, who is 15. Since the move a few months ago, Matt and
Mika report feeling disconnected from each other and the community. They feel their relationship with
Takoda, who now prefers to be called “Tate,” is also slipping. The couple is referred to you through an
employee assistance program at Mika’s job. Her supervisor is concerned about her frequent absences and poor
job performance. When pressed, Mika explains these absences as stemming from sleep loss caused by frequent
fighting between her and Matt at home. There have also been several tribal events at the reservation that she
has taken sick time to attend. Mika is reluctant to engage in therapy but does so out of fear of losing her job.
As Matt has not secured employment yet, the family relies on her for their sole source of income. The couple
presents to you without Takoda for the intake session. Matt is quiet and does not easily engage; however,
Mika warms up toward the end of the first session.

Therapist: I’m wondering what would need to happen during our meeting today so that being
here was helpful.

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Mika: Well, my boss said that we needed to come. I am the only one working right now and
we are afraid that I will lose my job if we don’t come.
Matt: [Nods]
Therapist: Hmm. So just being here is helpful for Mika’s job?
Mika: Yes.
Therapist: [Nods and pauses] Keeping your job is important.
Mika: [Nods]
Therapist: So besides coming today, what other expectations does your job have?
Mika: Well I don’t get much time off and I have to take sick leave if we need to go back to
our tribe for an event. [Therapist nods.] I have missed several days and that is why they
sent me here. I wish we had never left.
Therapist: It sounds like you are trying really hard to keep your job for your family and stay
connected to your tribe at the same time. Sounds difficult.
Mika: It is. And our son Takoda is losing his heritage already; his school is trying to make
him think like white people  . . . no offense.
Therapist: Oh, none taken. I can’t imagine how difficult things must be since you left your tribe.
Tell me a little bit about your son.
Mika: He is 15 and really wants to fit in at school  . . . so much so that he wants to be called
Tate now. [Therapist nods.] It is really a slap in our face because his name has special
significance in our tribe.
Therapist: Wow. It sounds like you both are going through a lot. How have you been coping?
Mika: Well not very well. We have been fighting a lot.
Therapist: And has fighting been interfering with your job?
Mika: Yes.
Therapist: So the fighting and taking time off work to visit your tribe are why your boss asked you
to come and talk to me?
Mika: Yes.
Therapist: And it must be difficult to talk to a white therapist who isn’t from your tribe.
Mika: Yes, very hard. I mean, you seem really nice, but it is still hard.
Therapist: Of course it is. How might I be helpful given that I am not American Indian?
Mika: Well, if you were to give a positive report to my boss that would be helpful.
Therapist: What would that look like?
Mika: Well, it would just be you telling my boss that I’m not crazy and I’m a good worker.
Therapist: So telling your boss that you are a good worker and you aren’t crazy would help.
Mika: Yes and maybe fighting less.
Therapist: So what difference would fighting less make on your job?

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Mika: If we fought less, I wouldn’t be coming in late for work.
Therapist: So your boss would notice you fighting less?
Mika: Oh, yes.
Therapist: And she would get off your back some about missing work?
Mika: Yes. She would think I am a good worker. Which means I would keep my job and be
able to feed my family.
Therapist: So if you weren’t fighting as much, how would you be instead?
Mika: Sleeping more and spending more time with Takoda. Things would be better.
Therapist: What else would you both be doing if you weren’t fighting as much?
Mika: We would talk more about our tribal traditions. This would help to make us feel more
at home.
Therapist: [Nods] So sleeping, getting to work, spending more time with Takoda and talking
about your tribal traditions  . . . more of those things would be happening. Do you
mind if I ask a strange question? It is helpful for me.
Mika: Sure.
Therapist: Thanks. OK, well let’s suppose that the two of you leave here and do your regular
routine. And at some point you find yourself going to sleep. And during the middle of
your sleep something shifts, an elder or an animal appeared in a vision and they let you
know that the problems you have been talking about today are no longer a problem.
Your boss sees you as a good worker, you are able to spend time with Takoda, and you
are sleeping more and have more time to talk about your tribe. But you don’t know that
an elder or animal appeared to fix things because you are asleep. So you wake up
tomorrow to start your day but things are different. What are the first things you would
notice that are different?
Mika: Well, Matt and I would wake up in the same bed. When we fight, he usually sleeps on
the couch.
Matt: [Nods]
Therapist: What else would you notice?
Mika: Matt would do some morning chanting with Takoda that he hasn’t done since we
moved.
Therapist: [Nods] What else?
Mika: Takoda would wake up on time and join us for tea.
Mika: And we would walk Takoda to school before I had to go to work. Things would just be
as good as they could possibly be while living outside of our tribe.
Therapist: So on a scale from 1 to 10, where 10 is things being as good as they can be while living
outside of the tribe and 1 was furthest from that, where would both of you be on the
scale right now?

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Mika: Well, I think a 5.
Therapist: A 5. What are you doing at a 5 that shows that you are working toward your goal?
Mika: Well, we came here today. That was a big step.
Therapist: [Nods]. Yes. What else are you doing?
Mika: Wanting to spending more time with Takoda.
Therapist: And you Matt?
Matt: [Matt is silent.]
Therapist: That’s okay. Is it okay to go with a 5?
Matt: [Nods]
Therapist: So what would it take to move from a 5 to a 6? What would you be doing or thinking
differently that would let you know you are at a 6.
Mika: Well, probably wanting to come back here again.
Therapist: That would let you know if you were a 6 if you wanted to come back here.
Mika: [Nods]

LATER IN THE SESSION

Therapist: I would like to share with you some compliments I have noticed during our time
together today. First, I appreciate you coming to talk to me today. I know it wasn’t
easy. I think you are both wise for being cautious about sharing things with others.
And even though it was hard, you found the strength to come today. Mika you were
willing to do whatever it takes to keep your job for your family [Mika nods]. I can tell
that both of you are committed to Takoda and his experience of his tribal culture. And
the strength it takes both of you to be away from your tribe and your dedication to be
there at rituals and ceremonies.
Matt and Mika: [Nod]
Therapist: So between now and the next time we meet, I would like for you to plan to spend some
time together, whether that is just enjoying each other’s company or spending time
with Takoda. And hopefully you’ll find the time and space to discuss those things that
are most helpful to you.
Mika: OK. That sounds good.
Matt: [Nods]
Therapist: Thank you again for speaking with me today.

SFBT Techniques
The next sections will discuss how SFBT interventions can be worded specifically to be culturally appropriate
for American Indians. Even though SFBT is not focused on techniques, several components of SFBT (i.e.,

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goal setting, miracle question, scaling question, homework) aid in maintaining solution-building co-
construction.

Goal Setting
In SFBT, setting a workable goal(s) is important. However, it is important to be mindful of how “goals” are
viewed in the American Indian culture. In European societies, as well as other cultures, people describe
themselves by what they are “doing.” For instance, when European, Asian, or African Americans meet
someone for the first time, they usually describe themselves by what they do for a living (i.e., I’m a professor).
For American Indians, one’s focus is on “being,” not doing (Ho, 1987). In the previous case example, the
therapist begins by saying, “I’m wondering what would need to happen during our meeting today so that
being here was helpful.” Sometimes the therapist will open a session by saying, “What can we do here today
that would be helpful”. Given American Indian’s time orientation to being not doing, it is important for SFBT
therapists to use language that reflects this. Another instance of using being not doing occurred when the
therapist said, “So if you weren’t fighting as much, how would you be instead?” A lot of times the therapist
would say, “So if you weren’t fighting as much, what would you be doing instead?” Unlike other approaches
that have more “cookie-cutter” phrasing of techniques, SFBT allows for adjustment in linguistic phrasing.

Vision Question
SFBT uses the miracle question as a way to help clients describe what their lives would look like if their
problem were gone. Many small adaptations to the phrasing of the miracle have been changed to be more
culturally appropriate. For instance, in nonreligious or Eastern cultures, the term “miracle” can have a
Christian undertone, and so “something shifts” or “you have received a blessing” may be used instead. In the
American Indian culture, it would be more appropriate to ask a “vision question” and inquire about having a
“vision of an elder or an animal” instead of asking the “miracle question.” Regardless of what the question is
called, it is important to convey that something unusual and significant happened (i.e., a miracle or an elder
vision). As always, it is important to remember the five elements of the miracle question: The change must be
of some significance to the client (unlikely to happen naturally); the “miracle” or in this case “vision” must be
defined; it has the element of immediacy (“tonight while you are sleeping”); the client must be unaware that
the miracle (or vision) occurred; and the client is to discover the clues that the “miracle” or “vision” has
occurred (Pichot & Dolan, 2003; Pichot & Smock, 2009). All of these elements of the miracle question can
be slightly adjusted for the American Indian culture.

Scaling
Scaling is another important tool in SFBT. Its purpose is to gain a clearer idea of small changes that will
lead to their preferred future. A therapist can ask different types of scaling questions (goal, confidence, etc.).
When asking a scaling question about the client’s goal, it is important that the “workable” goal has been
defined. In the case example above, the therapist asks, “So on a scale from 1 to 10, where 10 is things being as
good as they can be while living outside of the tribe and 1 was furthest from that, where would both of you be
on the scale right now?” Although knowing what a 10 looks like is essential, sometimes it is helpful to say,

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“And 1 is furthest from that” because the opposite of their goal is really only understood by the client. In
SFBT, we ask detailed questions about the goal but not about the other end, so it is acceptable to say that 1 is
“furthest” from their goal. The other important detail about the phrasing of this question is that the therapist
said, “Where would both of you be on the scale” not “What would both of you be doing.” As previously
mentioned, the American Indian culture is oriented toward being not doing. Adapting scaling questions to be
culturally sensitive is not a major shift, but it involves making minor adjustments in lexical choice (i.e., the
purposeful selection of phrases and words that may affect the listener; van Dijk, 1983).

Homework
Homework in SFBT is different from other approaches. Some practitioners allow the clients to come up
with their own homework (Pichot & Dolan, 2003) where others will nudge based off of what the client has
said is already working or their own suggested changes to try (de Shazer et al., 2007). Since American Indians
expect their therapists to be more directive (Dauphinais, Dauphinais, & Rowe, 1981; Tafoya, 1989), it makes
sense for a SFBT therapist to assign clients homework instead of having them create their own. For example,
the therapist in the case example said, “So between now and the next time we meet, I would like for you to
plan to spend some time together, whether that is just enjoying each other’s company or spending time with
Takoda.” This presentation of homework is more directive than saying, “So what would be helpful for you to
do between now and the next time we meet to move you closer to your goal?” Although both homework
assignments come from the client, the former is more directive.

Summary
Despite the myriad differences between American Indian tribes, focusing on their strengths and common
cultural features can inform the SFBT therapist in her or his use of the model. Attachment to the lifeworld,
indirect communication styles, and a focus on a collectivist culture (Brave Heart et al., 2011) are just a few of
the features that may aid the therapist in developing what Attneave (1982) describes as a “creative therapeutic
alliance” that enables the therapist to “untangle the knots” within a family (p. 82).

FURTHER LEARNING
The following are additional resources that may be helpful when using SFBT with American Indians:

Berg, I. K., & Dolan, Y. (2001). Tales of solutions: a collection of hope-inspiring stories. New York: Norton.
Berg, I. K., & Miller, S. (1992). Working with the problem drinker: A solution focused approach. New York:
Norton.
Fiske, H. (1997). Fundamentals of suicide prevention: A course manual. Toronto: Legal Profession Assistance
Conference, Canadian Bar Association.
Fiske, H. (1997). Solution-focused brief therapy in suicide prevention. Proceedings, American Association of
Suicidology Annual Conference, Memphis, TN.
Fiske, H. (1998). Applications of solution-focused brief therapy in suicide prevention. In. D. deLeo, A.

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 Schmidtke, & R. Diekstra (Eds.), Suicide prevention: A holistic approach. Dordrecht, the Netherlands:
Kluwer.
Fiske, H. (1998). Working with parents of suicidal adolescents. Proceedings, American Association of
Suicidology Annual Conference, Washington, DC
Fiske, H. (2004). Eliciting and utilizing suicidal callers’ reasons for living. Proceedings, American Association
of Suicidology Annual Conference, 37.
Fiske, H. (2004). Living with a suicidal person: What families can do. Proceedings, Irish Association of
Suicidology Annual Conference.
Fiske, H. (2005). Five small group exercises for experiential learning of SFBT. Journal of Family Psychotherapy,
16(1/2) [Special issue on solution-focused training], 155–158. Published simultaneously in Nelson, T.
(Ed.) (2005), Education and training in solution-focused brief therapy. Binghamton, NY: Haworth.
Fiske, H. (2008). Solution-focused training: The medium and the message. In T. Nelson & F. Thomas
(Eds.), Solution-focused applications. Binghamton, NY: Haworth.

DISCUSSION QUESTIONS
1. How might a SFBT therapist engage in a therapeutic conversation about oppression and colonization
without engaging in problem-talk?
2. What statement or question would be the most helpful to use at the beginning of the next session?
3. What are some cultural features of American Indians that should be considered when engaging in solution
building and co-construction with clients?
4. What are the five elements of the vision question? How are those adaptable to the American Indian
culture?
5. How might a non–American Indian therapist approach an American Indian client using the tenets of
SFBT?

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Guilford.
Bavelas, J., DeJong, P., Smock, S. A., & Korman, H. (2011, November). Can we really see co-construction
happening? Workshop at the 9th annual conference of Solution-Focused Practices, Bakersfield, CA.
Beals, J., Novins, D., Whitesell, N., Spicer, P., Mitchell, C., Manson, S., & AI-SUPERPFP Team. (2005).
Prevalence of mental disorders & utilization of mental health services in two American Indian reservation
populations: Mental health disparities in a national context. American Journal of Psychiatry, 12, 117–130.
Berg, I. K. (1995). Solution-focused brief therapy with substance abusers: In A. M. Washton (Ed.),
Psychotherapy and substance abuse: A practitioner’s handbook (pp. 223–242). New York: Guilford.
Berg, I. K., & Miller, S. D. (1992). Working with the problem drinker: A solution-focused approach. New York:
Norton.

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Berg, I. K., & Reuss, N. (1995). Solutions step-by-step: A substance abuse treatment. New York: Guilford.
Brave Heart, M. Y. H. (1998). The return to the sacred path: Healing the historical trauma response among
the Lakota. Smith College Studies in Social Work, 68, 287–305.
Brave Heart, M. Y. H. (2003). The historical trauma response among Natives and its relationship with
substance abuse: A Lakota illustration. Journal of Psychoactive Drugs, 35(1), 7–13.
Brave Heart, M. Y. H., Chase, J., Elkins, J., & Altschul, D. B. (2011). Historical trauma among indigenous
peoples of the Americas: Concepts, research, and clinical considerations. Journal of Psychoactive Drugs, 43,
282–290.
Brucker, P. S., & Perry, B. J. (1998). American Indians: Presenting concerns and considerations for family
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perceptions of counselor effectiveness. Counselor Education and Supervision, 21, 72–80.
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de Shazer, S., Dolan, Y., Korman, H., Trepper, T. S., McCollum, E. E., & Berg, I. K. (2007). More than
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American Indian Soul Wound. In Y. Danieli, (Ed.), International handbook of multigenerational legacies of
trauma (pp. 341–354). New York: Plenum Press.
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Freire, P. (1970). Pedagogy of the oppressed. New York: The Continuum International Publishing Group.
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Ho, M. K. (1987). Family therapy with ethnic minorities. Newbury Park, CA: Sage.
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330.
La Due, R. (1994). Coyote returns: Twenty sweats does not an Indian expert make, bringing ethics alive.
Feminist Ethics in Psychotherapy Practice, 15(1), 93–111.
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Lewis, R.G., & Ho, M.K. (1975). Social work with Native Americans. Social Work, 20(5), 379-382.
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countertransference implications. Psychoanalytic Social Work, 6(1), 25–47.
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NSDUH report: Substance use among American Indian or Alaska Native adults. Rockville, MD: Author.
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Giordano, & J. Pearce (Eds.), Ethnicity and family therapy (2nd ed., pp. 31–44). New York: Guilford.
Tafoya, N., & Del Vecchio, A. (2005). Back to the future: An examination of the Native American holocaust.
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New York: Guilford.
Tafoya, T. (1989). Circles and cedar: Native Americans and family therapy. Journal of Psychotherapy and the
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International Journal of the Addictions, 25(2A), 149–170.
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334–361). New York: Brunner/Mazel.

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 8
Solution-Focused Approach With Asian
Immigrant Clients
Rowena Fong, Britt Urban

T he Asian population in the United States is the fastest growing racial group (U.S. Census Bureau,
2012). There are 14.7 million “single-race” Asians living in the United States. When Asians of multi-
race backgrounds are included, the number of Asians reaches 17.3 million, constituting 5.6% of the total U.S.
population (U.S. Census Bureau, 2012). This number has jumped dramatically since the last census in 2000,
when Asians (single-race and multirace Asians combined) totaled 11.9 million.

People of Chinese heritage make up the largest group of Asians in the United States, at 3.3 million people.
If those who have partial Chinese heritage are also included, the number is even greater, at 4 million. Filipinos
and Asian Indians follow closely in numbers after the Chinese as the second- and third-largest groups of
Asians in the United States. There are 3.4 million people of (at least partial) Filipino descent in the United
States, and 3.2 million people of (at least partial) Asian Indian background. However, when looking at these
groups in terms of “single-race” status, the numbers shift and Asian Indians become the larger group of the
two, at 2.8 million people, while Filipinos total 2.6 million (U.S. Census Bureau, 2012). Other significant
Asian populations include people of (at least partial) Vietnamese, Korean, and Japanese heritage, at 1.8
million, 1.7 million, and 1.3 million people, respectively.

According to the U.S. Office of Management and Budget (OMB), which provides the basis for the U.S.
Census Bureau’s race classification, Asian is defined as people “having origins in any of the original peoples of
the East Asia, Southeast Asia, or the Indian subcontinent, including, for example, Cambodia, China, India,
Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam” (U.S. Census Bureau, 2012,
p. 3). However, based on the sheer number of Asian countries and cultures that exist, it is clear that being
Asian cannot be defined so easily. Asia encompasses a diverse array of cultures, languages, religions, values,
norms, and traditions. There are many cultural nuances between Asian subgroups that often get overlooked
and replaced by broad generalizations. This can become problematic when trying to provide culturally
competent mental health services to individuals of Asian background. It is also important to know about the
challenging historical background and contexts related to migration journeys of Asian immigrant populations
currently living in the United States.

Historical Background: Asian Immigration to the United States

Each Asian group has a unique immigration history to the United States. The Chinese started coming to the
United States en masse in the mid-1800s during the California Gold Rush. In search of wealth, many

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Chinese immigrants flocked to the United States, and between 1850 and 1860, the Chinese immigrant
population had grown enormously, from just 758 to more than 35,000 (U.S. Census Bureau, 1999). It
continued to expand for decades after that, because of the growing need for laborers in mines, on post–Civil
War rebuilding efforts, and for the building of railroads (Cohen, 1984; Daniels, 1988).

As the Chinese population grew, anti-immigrant sentiment toward the Chinese did as well. This eventually
led to the Chinese Exclusion Act of 1882, which banned all immigration of Chinese workers “for a period of
ten years and barred all Chinese immigrants from naturalized citizenship” (Lee, 2002, p. 36) and eventually
expanded to include all Chinese people, with very few exceptions. This exclusion of the Chinese continued for
many more decades and was finally repealed in 1943. However, this did not change the lasting impact this
discriminatory legislation has had on Chinese Americans.

The Chinese American community has one of the higher rates of poverty of the many Asian subgroups,
with 13.4% of the Chinese American population living in poverty (U.S. Census Bureau, 2007). At the same
time, the median household income for Chinese American families was $57,433, which is higher than the
median income of white households but still lower than Asian Indian and Filipino median income (U.S.
Census Bureau, 2007).

Asian Indians are more educated than all other Asian subgroups (U.S. Department of Education, 2010). In
fact, Asian Indians are “more highly educated than the overall U.S. population” (Farver, Narang, & Bhadha,
2002, p. 340), with 80% of Asian Indian adults achieving at least a bachelor’s degree (Aud, Fox, &
KewalRamani, 2010). Asian Indian immigrants also come to the United States with greater fluency in English
and a better understanding of Western culture than many other Asian subgroups This is thought to have a
great deal to do with British influence in India because of its historical colonization of India (Farver, Narang,
& Bhadha, 2002). As would be expected, because they are more educated, Asian Indians also tend to be of a
higher socioeconomic class than many other Asian subgroups. In 2010, for example, the median income for
Asian Indians was $90,711 (U.S. Census Bureau, 2012). In contrast, the median income in 2010 for all
single-race Asians in the U.S. was $67,022 (U.S. Census Bureau, 2012).

The Vietnamese have a very unique immigration history to the United States, which, in turn, has led to a
very different set of socioeconomic and educational circumstances for this group. Many Vietnamese people
came to the United States as refugees following the Vietnam War in 1975. This first wave of Vietnamese was
fleeing the Communist regime that remained in Vietnam and tended to be of a more educated and higher
class (Ngo & Lee, 2007). However, later waves of Vietnamese immigrants who came to the United States
were generally less educated and of lower socioeconomic status (Ngo & Lee, 2007).

The Vietnamese are now the largest group of Southeast Asians in the United States (U.S. Census Bureau,
2012). Although the Vietnamese have higher educational attainment and socioeconomic level than all other
Southeast Asian subgroups (Ngo & Lee, 2007), their median household income is still well below that of
white, Asian Indian, Chinese, Filipino, and Japanese Americans (U.S. Census Bureau, 2007). In addition, the
Vietnamese community in the United States has high rates of poverty, at 14% of their population, trailing
only Korean Americans, whose poverty rate is 14.9%. And another fact about the Vietnamese population:
“38% of Vietnamese Americans do not have a high school diploma and only 19.5% hold a Bachelor’s degree”

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(Ngo & Lee, p. 419).

Cultural Values as Strengths and Protective Factors

Cultural values are expressions of important norms and attitudes in a society, reflecting acceptable and
nonacceptable behaviors based on traditional values within an ethnic culture (Fong, 2004). Cultural values as
they are supported by ethnic communities reflect what holds an ethnic community of people together.
Cultural values in home or motherland environments allow immigrants to survive. Transferring to new
environments, such as the United States, might be stressful to Asian immigrants, especially if ethnic cultural
values clash with Western American values (Fong & Furuto, 2001). It is important to clinicians to know and
understand cultural values of Asian clients, particularly when the cultural values can be part of the cultural
contexts for shaping solution-focused therapy techniques to be used with Asian immigrant clients.

Chinese Cultural Values

Many Chinese cultural values and beliefs are based on the spiritual philosophies of Confucianism,
Buddhism, and Taoism. One major belief in Chinese society is that of filial piety. Filial piety is the Confucian
belief in honoring and respecting one’s parents and ancestors as well as “ensuring the continuity of the family
line, and in general conducting oneself so as to bring honor and avoid disgrace to one’s family name” (Ho,
Xie, Liang, & Zeng, 2012, p. 41). The status of the family determines one’s relationship to others and to
society itself.

Modesty is also highly valued in Chinese culture. This stems from Confucian thought that being modest
brings the opportunity for greater achievement while being arrogant “leads to loss” (Hui-Chen Huang &
Gove, 2012, p. 11). This belief accounts for the tendency of many people of Chinese background to take more
responsibility for personal failures and problems while interpreting positive personal outcomes as coming from
external sources, not their own attributes (Leung, 2010). It also takes the focus off the individual, which
reinforces another Chinese cultural belief: that the group is more important than the individual. Chinese
culture is historically collectivist, and the family is especially central (Hui-Chen Huang & Gove, 2012). This
connects back to the ideal of filial piety, in which one mustn’t bring shame to the family and must behave in a
way that brings honor.

Confucian thought also emphasizes individual morality. One way to exhibit one’s benevolence and
simultaneously ensure the family’s integrity is through academic achievement. Historically, the Chinese have
placed greatest value on those who contribute to the good of the community. Those who are educated will
become influential in society, which explains why scholars have come to be associated with “high social class,
leadership and high moral character” (Hui-Chen Huang & Gove, 2012, p. 10) in Chinese culture.

As far as family structure, the Chinese family is male-dominated. Women are considered to have a lower
social status than men (Agbayani, 2004) and must obey the family patriarchs (their husbands and fathers) as a
display of positive regard and devotion to the family. Children must also show immense respect for their
parents and elders, highlighting the authoritarian structure of the family but also illustrating how being a
“filial son or daughter . . . is the essential first step toward being socialized to be an acceptable member of
society” (Ho et al., 2012, p. 40).

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Asian Indian Cultural Values
Traditional Asian Indian culture values the group over the individual, as in Chinese culture. The family’s
welfare and status is most important, which means family matters should be intensely guarded and kept
private. The family includes not only the nuclear family, as in Western culture, but also the larger, extended
family. There is a reliance on this extended family for support, financially, emotionally, and in many other
regards.

The family is structured in a patriarchal fashion, in which the men in the family make the decisions and
these decisions are to be obeyed. Women are traditionally dependent on men in the family (Farver, Narang &
Bhadha, 2002), whether it is within her family of origin or later in her marriage. In addition, it has been well
documented that the pressure to maintain family cohesiveness is often greater for women than for men, as
there is the “frequent expectation that [women] accede to familial demands, often on behalf of their male
counterparts” (Masood, Okazaki, & Takeuchi, 2009, p. 272).

Children in Asian Indian families are cherished because of the great value placed on family connections and
the high expectations of what the children will later contribute to the family. While girls and boys are raised
along traditional gender lines, all children are expected to be well-behaved and to preserve and advance the
family’s social standing with their accomplishments and successes, including academically (Farver, Narang, &
Bhadha, 2002).

Religion and social class also play are part in Asian Indian cultural values. As stated, identity for Asian
Indians is determined by “religion, social class, language and a state in India,” (Farver, Narang, & Bhadha,
2002, p. 340).

Vietnamese Cultural Values

Vietnamese culture is similar to the other groups described earlier in that the family and community are
most important, and they are a source of strength and support for individuals. The family has a hierarchal
structure, with children having a great sense of respect for elders and feeling an obligation to take care of older
family members (Ngo & Lee, 2007). The expectation that family is of greatest importance also translates into
a cultural standard of achievement for one’s family, whether through education, professional success, or
general benevolence (D’Andrade, 2008). Vietnamese families “regard [their] education . . . as an investment
in the future” (Ngo & Lee, 2007, p. 424) and implement tactics to ensure that their children succeed.

Clinical Considerations for Asian Clients

Because of the cultural differences and unique backgrounds of different Asian groups, it is also important to
recognize the distinct set of clinical issues that these clients may face. The clinical problems for Asian
immigrant clients will, again, vary by subgroup. Recently arrived immigrants, for example, may face
adjustment issues related to orienting to a new country, way of life, and societal structure. For example, an
Asian Indian male client who has immigrated for employment or educational purposes and has a middle-class
or upper middle-class background may not experience the same stressors as a female Chinese immigrant
seeking a doctorate degree. A female Chinese immigrant faces different challenges than does a middle-class
Indian male because of her gender and role expectation in family life.

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 In Asian cultures, valuing the family is a high priority. It is common that the family or community is
prioritized over the individual in Asian cultures. It is also common that the family reputation is guarded and
that one’s personal conduct should be regulated to ensure that the family name is not tarnished. These family-
focused values manifest themselves in certain typical behaviors, including “conformity to norms, emotional
self-control, family recognition through achievement, and humility” (Hall, Hong, Zane, & Meyer, 2011, p.
216) as well as privacy regarding family problems.

Thus, clinical considerations need to be made when an individual Asian client seeks help but tries to explain
the kinds of pressure that he or she feels from the family. Also, patriarchy rules many Asian cultures, which
places women in a lower status. Asian immigrant women may find themselves in a double bind not only to
honor their families and conduct themselves according to their possibly lowered female status but also to
assert themselves as they learn to acculturate in their social environments in their job places in order to excel
and be rewarded for outstanding performance. Acculturation issues will be a common problem, however, for
many Asian immigrants. Navigating new systems, language, cultural values and norms, and daily life will
present challenges.

In addition to clinical concerns, there are nonclinical problems that should not be overlooked in the clinical
setting, including discrimination and oppression. There is a long history of racism in the United States and an
enduring anti-immigrant sentiment. Non-Caucasian immigrants are likely to face racism and discrimination
in the health care, employment, and academic systems. Clinicians must recognize how these problems impact
clients’ perspectives and self-concepts. In addition, there must be an understanding by providers that there
may be some distrust of the people who work in these systems, based on past negative experiences.

In addition, many immigrant clients are coming to the United States to seek economic opportunities that
will improve their lives. Financial barriers related to transportation, ability to pay for services, and availability
of time to dedicate to therapy are all important things to remember when working with this clientele. What
may be seen as “noncompliance” may actually have a completely different meaning behind it, like inability to
take time off work.

Although individuals and subgroups will differ, it is vital that service providers recognize how the Western
framework for providing mental health services may be at odds with some Asian cultural values and norms,
which will allow clinicians to more effectively work with this Asian immigrant population.

Case Example: Background Information

A 26-year-old female Chinese immigrant, Mei Li, immigrated to the United States one year ago. She arrived
with her husband and two young children. Mei Li was born and raised in a small village in Guangdong,
China. She speaks Cantonese. In her village, the conditions were meager and difficult. She did not have
adequate access to medical care Her family was very poor and relied on farming to survive. She was able to get
a basic education and reached the 10th grade. However, she had to stop attending school because of financial
needs of her family and her father’s ailing health. She got married at the age of 19 to a man from a
neighboring village. Her family and village practice Christianity, and their religious faith is a strength in the
community, helping them through difficult and stressful times.

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 Mei Li came to the United States not knowing English and having only basic education. Her past work
experience includes selling food at the local market. She is unfamiliar with U.S. culture, customs, and way of
life. She has begun English language classes and has found a job washing dishes in a retirement home, with
the help of people at the Chinese church she goes to.

After one year of being in the United States, Mei Li starts to show somatic symptoms of anxiety and
depression, but these are not easily identified by a Western clinician, Dr. Laura Smith. Mei Li’s husband, Tai
Ming, expects her to cook food for the family and take care of the children, but she now has the added
responsibility of working full time. Her traditional role in Chinese culture is to be deferential to her husband
and his wishes and to remain in the home to take care of the children and household affairs. Mei Li is
becoming overwhelmed by the many new roles and the expectations she faces in America. She is confused and
saddened by the conflicting cultures that she faces at home and in her work life. She is also feeling lonely and
misses her country, her culture, and much of her extended family that she left behind in China.

Solution-Focused Brief Therapy Techniques Used

Mei Li came to seek physical health services after first consulting with her Asian community’s natural
acupuncture healer, Mr. Wei Chin. However, Mr. Chin also works closely with the Chinese church where the
pastor, Reverend Wong, heard how depressed Mei Li was getting and finally referred Mei Li to get mental
health services, in conjunction with ongoing natural healing methods.

The primary techniques used to assist Mei Li in her solution-focused brief therapy (SFBT) sessions were
(1) present- and future-focused goal setting, (2) finding exceptions, and (3) homework assignments. The
primary issues Mei Li wanted to focus on were (1) her feelings of being overwhelmed by navigating two
cultures and (2) the grief and loss she is going through.

Transcript of a Session

Clinician: So, Mei Li, you have talked a lot about the challenge of adapting to being in the
United States. This is a really broad definition of the problem you are facing. I’d like to
look more in depth at the problems that you encounter on a daily basis with regard to
cultural adaptation. Tell me about the specific day-to-day challenges that you are
having.
Mei Li: Well, today I got up at 4 a.m. in the morning. I had to make dinner so that it would be
waiting for my husband when he gets home at 4 p.m. I also had to prepare food for the
children and get them ready for school. I walked them to their bus and then had to
walk to my own bus stop. My bus ride to work is one hour. Then I work an eight-hour
shift. I come home and have to get the children bathed and clean the house.
C: What would you like to see happen at home instead? [GOAL SETTING
TECHNIQUE]
Mei Li: Well, normally we have a lot more people in our home to help with the chores and take

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 care of the kids. Normally the family supports each other. Here, in the U.S., I feel so
much pressure to do it all. My husband helps with the kids when he can but he works
two jobs and when he is home, he must sleep. Normally, we just have our whole family
and community to support us. I feel so alone here.
C: So, you would like to feel that sense of connection and support that family normally
provides in your home country.
Mei Li: Yes. But my family is all in China still. My brother and sister-in-law will come in two
years but now I don’t have much support.
C: Tell me about the people you do have here in the U.S.
Mei Li: It is just me and my husband, and our children. We used to go to church with other
Chinese people and they gave us some help and support, especially when we first got
here. But there are always needs all over the community, so I don’t want to ask for help
all the time.
C: OK, so you have your husband and sometimes you have had help from the church.
Mei Li: Yes.
C: Tell me about other Chinese families that you know here.
Mei Li: Well, there are many Chinese here. But they are not family. We all have our own jobs
and apartments, and I do not see them too much.
C: Have there been times since you have come to the U.S. when you have felt supported
and less worried? (FINDING EXCEPTION TECHNIQUE)
Mei Li: Yes. When we used to go to the church with other Chinese families. But we moved to
a different apartment, so now I don’t see them anymore because the church is too far.
C: Well, then we know that there is a way for you to feel less lonely in the U.S. because
you have felt connected with people here before. There seems to be a transportation
barrier that is stopping you from staying connected though.
Mei Li: Yes. Transportation and my work schedule.
C: So, we have determined that you would feel less worried and lonely if you were able to
see other Chinese families for connection and support. Now, we must find out what
the possibilities are for making that happen.
Mei Li: I don’t know the route to the church and I am scared of getting lost in the city.
C: OK. But you know how to ride the bus to work. How has that been for you?
Mei Li: Well, at first it was scary also but a lady from my work helped me figure it out. So,
then I was able to do it on my own.
C: What would you think about talking with this same woman at work or someone else at
work that you are comfortable with in order to find the bus route to the church?
Mei Li: I can do that.
C: Great! That is wonderful that you have already figured out one possible solution to this

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 problem! Are there other ways you have coped with loneliness and sadness since being
here in the U.S.? (FINDING EXCEPTION TECHNIQUE)
Mei Li: Well, I am always happy when I am with my children.
C: Of course. That makes sense. And what do you like to do with them?
Mei Li: When I have time, we go to the park that is by our apartments. We play.
C: That sounds really nice. How often do you get to do that?
Mei Li: Well, lately because I have not been feeling very well, we don’t go very much. I feel too
sad and don’t even want to leave the house.
C: But if you did go, you think it would help?
Mei Li: Yes. I do.
C: OK. Well, for this session, we have found out that you are very lonely and miss your
home country. This makes you sad. You also feel a lot of stress because of the new
culture that you are living in. Learning a new language, working full time, and figuring
out your new surroundings adds to your stress while you try to maintain your own
values and beliefs. But we have also discovered that you have found ways in the past to
feel less lonely and to cope well with this new life. Having a bigger “family” to support
you would be ideal. Getting help and support from your coworker in order to re-
establish your relationship with the church would be a good start. So, for this week,
how do feel about doing two homework assignments: (1) ask your coworker to sit down
with you at lunch and discuss the possible bus routes from your apartment to your
church and (2) go to the park with your children once a week.
(HOMEWORKASSIGNMENTS TECHNIQUE)
Mei Li: I can do that.
C: What day will you go to the park?
Mei Li: On Sunday. My day off.
C: When will you talk to your coworker?
Mei Li: She works the same shift with me on Wednesday.
C: Great! I’m so happy that you have figured out ways to help improve your situation.
Now let’s schedule our next session...

Case Summary—Culture values play a major role in understanding Asian immigrant clients. The clinician
was respectful of Mei Li’s Asian cultural values of valuing children and family and yet was not dismissive or
disapproving of her traditional wife expectations to handle job, children, and family without possible help
from her husband.

The clinician used techniques of finding the exception, goal setting, and homework assignments. Solution-
focused therapy was targeted toward understanding and finding the exceptions, the way it used to be before
Mei Li became depressed and overwhelmed. The clinician helped her see that the solution was to find a way
to help Mei Li get back into a regular routine of attending Chinese church, which gave her a lot of emotional

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and spiritual support. The clinician helped Mei Li set up the goal for what she wanted to see happen in her
home life and what kinds of changes needed to be made by using homework assignments to get to that goal of
spending more time with her children and going to Chinese church more regularly. In the end, Mei Li had
more hope of how she might change her situation rather than remaining in the current one which was making
her depressed and anxious.

Summary
SFBT used with Asian immigrants needs to take into consideration the cultural values that reflect the norms
and attitudes of that ethnic population. Accepting where the client is at is very important because he or she
may be ensconced in traditional family values that define roles and acceptable behaviors and attitudes. SFBT
clinicians need to have knowledge of and respect for traditional cultural values as they may represent strengths
and protective factors in culturally competent social work practice.

FURTHER LEARNING
Asian Community Mental Health Services: www.acmhs.org
National South Asian Mental Health Resources: www.chaicounselors.org/resources/links#national
Delgado, M., Jones, K., & Rohani, M. (2005). Social work practice with refugee and immigrant youth. Boston:
Allyn and Bacon.
Fernando, M., & Congress. E. (Eds.). (2009). Social work with immigrant and refugees: Legal issues, clinical
skills, and advocacy. New York: Springer.
Fong, R. (Ed.). (2004). Culturally competent practice with immigrant and refugee children and families. New
York: Guilford.
Fong, R., & Furuto, S. (Eds.) (2001). Culturally competent practice: Skills, interventions, and evaluations.
Boston: Allyn and Bacon.
Lum, D. (2011). (Ed.). Culturally competent practice: A framework for understanding diverse groups and social
justice. Belmont, CA: Brooks/Cole.

DISCUSSION QUESTIONS
1. What do you do to determine the diversity within the Asian immigrant population?
2. What role do cultural values play in Asian immigrant populations?
3. How would you use cultural values as strengths or protective factors in the development of SFBT
techniques?

REFERENCES
Agbayani-Siewert, P. (2004). Assumptions of Asian American similarity: The case of Filipino and Chinese
American students. Social Work, 49(1), 39–51.

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Aud, S., Fox, M., & KewalRamani, A. (2010). Status and trends in the education of racial and ethnic groups
(NCES Publication No. 2010-015). U.S. Department of Education, National Center for Education
Statistics. Washington, DC: U.S. Government Printing Office.
Cheung, S. (2001). Problem-solving and solution-focused therapy for Chinese: Recent developments. Asian
Journal of Counseling, 8(2), 111–128.
Chun, K. M., & Akutsu, P. D. (2007). Assessing Asian American family acculturation in clinical settings:
Guidelines and recommendations for mental health professionals. Handbook of mental health and
acculturation in Asian American families. Totowa, NJ: Humana Press.
Cohen, L. (1984). Chinese in the post-Civil War South: A people without a history. Baton Rouge: Louisiana State
University Press.
D’Andrade, R. (2008). A study of personal and cultural values. New York: Palgrave Macmillan.
Daniels, R. (1988). Asian America: Chinese and Japanese in the United States since 1850. Seattle: University of
Washington Press.
Farver, J., Narang, S., & Bhadha, B. (2002). East meets west: Ethnic identity, acculturation, and conflict in
Asian Indian families. Journal of Family Psychology, 16(3), 338–350.
Fong, R. (Ed.) (2004). Culturally competent practice with immigrant and refugee children and families. New York:
Guilford.
Fong, R., & Furuto, S. (Eds.) (2001). Culturally competent practice: Skills, interventions, and evaluations.
Boston: Allyn and Bacon.
Griner, D., & Smith, T. (2006). Culturally adapted mental health interventions: A meta-analytic review.
Psychotherapy: Theory, Research, Practice, Training, 43(4), 531–548.
Hall, G., Hong, J., Zane, N., & Meyer, O. (2011). Culturally competent treatments for Asian Americans:
The relevance of mindfulness and acceptance-based psychotherapies. Clinical Psychology: Science and Practice,
18(3), 215–231.
Ho, D., Xie, W., Liang, X., & Zeng, L. (2012). Filial piety and traditional Chinese values: A study of high
and mass cultures. Psychology of Children Journal, 1, 40–55.
Hui-Chen Huang, G., & Gove, M. (2012). Confucianism and Chinese families: Values and practices in
education. International Journal of Humanities and Social Science, 2(3), 10–14.
Kim, B., Atkinson, D., & Umemoto, D. (2001). Asian cultural values and the counseling process: Current
knowledge and directions for future research. The Counseling Psychologist, 29(4), 570–603.
Lee, E. (2002). The Chinese exclusion example: Race, immigration, and American gatekeeping, 1882-1924.
Journal of American Ethnic History, 21(3), 36–62.
Leung, K. (2010). Beliefs in Chinese culture. In M. H. Bond (Ed.), Oxford handbook of Chinese psychology (pp.
211–240). New York: Oxford University Press.
Masood, N., Okazaki, S., & Takeuchi, D. (2009). Gender, family, and community correlates of mental health
in South Asian Americans. Cultural Diversity and Ethnic Minority Psychology, 15(3), 265–274.
Ngo, B., & Lee, S. (2007). Complicating the image of model minority success: A review of Southeast Asian
American education. Review of Educational Research, 77(4), 415–453.
U.S. Census Bureau. (1999). Table 4. Region and country or area of birth of the foreign-born population,
with geographic detail shown in decennial census publications of 1930 or earlier: 1850 to 1930 and 1960 to

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 1990. Retrieved from http://www.census.gov/population/www/documentation/twps0029/tab04.html.
U.S. Census Bureau. (2007). The American community—Asians: 2004. Washington, DC: U.S. Department of
Commerce.
U.S. Census Bureau. (2012). The Asian population: 2010. Washington, DC: U.S. Department of Commerce.

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 9
Solution-Focused Approach With
Multicultural Families
Jung Jin Choi, Robin Akdeniz

“All counseling is multicultural in nature.”

(Speight, Myers, Cox, & Highlen, 1991, p. 31)

Introduction
Evidence has been documented that solution-focused brief therapy (SFBT) works for many forms of issues
and populations (Corcoran & Pillai, 2009; Gingerich, Kim, Stams, & MacDonald, 2012; Kim, 2008; Kim &
Franklin, 2009). Although SFBT has been used with and for multicultural families, the literature is
insufficient in reporting on both the rationale and on the process of using it. In this chapter, we aim to
demonstrate how a solution-building approach can be applied to multicultural families, one of the fastest
growing populations in the United States. While expanding the SFBT techniques and questions presented in
Chapter 2 to various issues that are unique to this diverse group, we present background information about
multicultural families, including demographics, definitions, historic contexts, and risk/protective factors that
are reported in the literature. Finally, a case example, developed from personal experience, will be used to
illustrate various conflicts and strengths of multicultural families, and the use of SFBT techniques specific to
this population.

Multicultural Families: The Background

Marriage in the United States across both racial and ethnic lines is on a steep rise (Wang, 2012). With the
increase in contact between individuals because of immigration, technology, and international travel comes the
opportunity to form intimate intercultural relationships (Bustamante, Nelson, Henriksen, & Monakes, 2011).
Presently, many pressures are imposed on the clinician, including the uneasiness and misperception that can
form around issues of religion, culture, race, and class combined with time pressures that are commonly and
most recently imposed by managed care (Crohn, 1998). A consequence of these pressures is increased
emphasis on the client’s “presenting problems,” making it difficult for the clinician to pay attention to the
strengths, resources, and resiliencies that their clients bring to therapy (Saleebey, 2009). Given this emphasis,
it has become more difficult for clinicians to broaden their framework of understanding regarding their clients
(Lee, 2003). It is essential, however, for clinicians to understand multicultural families and their conflicts in a
larger context, both socially and historically. Knowing the evolution of multiculturalism in a historic context
would allow the clinician to see their clients through a broader and more balanced perspective (Fong, 2005;
Greene & Lee, 2011; Lee, 2003). Before we discuss this issue any further, it is necessary to define several

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terms that are often used interchangeably throughout the literature without being clarified.

Definitions
While multiracial clients are individuals of two or more racial backgrounds, multiethnic clients are individuals
of two or more ethnic backgrounds (Fong, 2005). Both multiracial and multiethnic clients are generally from
marriages that are interracial and interethnic; however, the issues they seek treatment for can also be found in
families who have adopted children internationally and trans-racially. Intermarriage or marrying out, according
to Wang (2012), are terms used to describe marriages between interethnic partners (e.g., between a Hispanic
and non-Hispanic person) as well as marriages between interracial partners (such as white, black, Asian,
American Indian, etc.). In contrast, intramarriage or marrying in refer to marriages in which individuals marry
within the same race or ethnicity (Wang, 2012).

The use of the term intercultural refers to the point of interaction between individuals of different cultures
(Bustamante et al., 2011). This can be seen in an endless array of combinations such as black and white
(mixed races), Chinese and American (mixed nationalities), and Jewish and Catholic (mixed religions), to
name just a few possible examples. Accordingly, intimate intercultural relationships or intercultural couples are
“committed, loving relationships between two people who identify with different cultural groups because they
represented at least two nationalities, races, or religions” (Bustamante et al., 2011, p. 154). To understand
intercultural couples, it is essential to first understand the meaning of culture, a word that has been defined in
numerous ways. Culture, according to Greene and Lee (2011), is a combined pattern of behavior that
incorporates the beliefs, customs, values, institutions, methods of communication, thoughts, and actions of a
particular group as it pertains to race, ethnicity, or religion. Bustamante and colleagues (2011) consider culture
as a system of meaning that is learned and used by the members of that particular cultural group to enable
them to make sense of one another and their world. It also develops and nurtures the members’ common
identity and promotes a sense of their shared community. Culture is historical, therefore transmitted across
generations (Lee & Mjedle-Mossey, 2004). Often compared with an iceberg, culture has the deeper layers
hidden from view (which are one’s beliefs, values, and traditions), with the uppermost layers the part of the
iceberg that can be seen (including one’s artifacts and both verbal and nonverbal behaviors; Bustamante et al.,
2011). Each one of us embodies both the hidden and exposed layers as a cultural iceberg.

Changing Demographics in Historic Contexts

Throughout most of U.S. history, the majority of states had antimiscegenation laws, which deemed it illegal
for whites to marry nonwhites (Wang, 2012). Antimiscegenation laws developed as a result of “societal
attitudes about white supremacy and theories and myths about racial mixings” (Fong, 2005, p. 150). They
were created to protect “whiteness” and influenced social policy. Dating back to the colonial period, the
discrimination and exploitation of blacks and Native Americans was “based on racial hierarchal inequities…
imposed on persons of color because of the belief that one race was superior to others” (p. 150). The laws were
established as interracial relationships were viewed as major threats to the economic, social, and political
statuses of white society. It was only 1967 when the landmark U.S. Supreme Court case: Loving v. Virginia,
made antimiscegenation laws unconstitutional in the 16 remaining states (Wang, 2012).

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 Intermarriage in the United States is on the rise, and this noted at a time when fewer people are getting
married, and those currently married are at an all-time low (Wang, 2012). Intermarriage rates in 2010
composed 15% of all new marriages (those who have been married within 12 months of the survey date)
compared with 6.7% in 1980. The breakdown in ethnicity for all newlyweds in 2010 who “married out” was
“9% of whites, 17% of blacks, 26% of Hispanics, and 28% of Asians” (Wang, 2012, p. 1). The gender patterns
of newlyweds who married out revealed black males accounted for 24% compared with 9% of black females.
Within the Asian population, however, males accounted for 17% of those who married out compared with
36% of Asian females. No gender differences were noted with white and Hispanic populations. Intermarriage
rates of those who were native-born (in the United States) compared with immigrants were also reported.
Among Asians, 37.5% of those who were native-born intermarried contrasted with 24.4% of immigrants.
Among Hispanics, intermarriage was reported to be 36.2% among native-born compared with 14.2% of those
who were immigrants.

Public acceptance of intermarriage has continuously changed. The Pew Research Center report (Wang,
2012) identified that of the 35% of the population who stated that a member of their family was intermarried,
63% of them reported they were okay with it compared with only 33% in 1986. Although 43% stated that
intermarriage is a change for the better, 11% stated it was a change for the worse (also, younger adults looked
more favorably upon it compared with older adults, 69% vs. 28%). Those who were college educated were
most likely to think positively about intermarriage. Of all races examined, blacks were more likely than other
races to accept intermarriages in family members.

Common Challenges and Risk Factors

There are many variables that affect the multiracial client, including race, religion, gender, ability, and
sexual orientation, which intersect at the micro, mezzo, and macro levels (Fong, 2005). In this section, we
review common risk factors that influence multiracial clients at various levels of clients’ lives.

Research identified a few major factors that contribute to shaping a multiracial individual’s cultural identity
(Bustamante et al., 2011; Fong, 2005; Jackson, 2009; Kim, 1998; McClurg, 2004; Sullivan & Cottone, 2006;
Zens, 2011). On the macro level, the stressors inherent in interracial and intercultural marriages include
stereotyping, negative societal reactions, sexism, and racism. Fong (2005) noted that as with many minority
groups, multiracial people have suffered indignities as well, such as discrimination and oppression. This,
according to Fong, is largely due to the societal attitude that supports the concept of a racial hierarchy and the
laws, policies, and racist attitudes that target people of color and interracial marriage, which may be the reason
for multiracial clients to seek therapy. The personal experiences of discrimination and racism and the racial
climate of the community and school all have significant influence on the development of identity (Jackson,
2009). Racial and ethnic identity development is all too often influenced by racism within society, and as
biracial adolescents become more aware of their biracial heritage, this becomes more obvious to them
(McClurg, 2004).

At the mezzo level, multiracial people may experience issues related to family, friends, and neighbors,
including decreased support from friends and family opposition (Fong, 2005; Zens, 2011). Multiracial youth
may experience conflicts regarding the selection of one ethnicity over another, or may choose both or all

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ethnicities, which subsequently may create discord within the family members’ reactions to this choice (Zens,
2011). Extended family relationships were also considered a primary stressor and included experiences of
marginalization, definitions of family connections, and perceptions of family subsystems and prioritization
(Bustamante et al., 2011). Conflict within a family can develop from differences in worldviews, within
families as well as between generations, leading to cultural dissonance (Lee & Mjelde-Mossey, 2004). At the
same time, to Mexican immigrants in the United States, the single greatest stressor noted is the loss of the
extended family, which as a strong cultural value, encompasses the importance of both the family and the
extended family (Yznaga, 2008). Indeed, diversity exists within families and between generations as it does
between different ethnic groups (Lee & Mjelde-Mossey, 2004).

In working with multiracial people at the micro level, the “terminology of ‘what do you call yourself’ is an
ongoing battle” (Fong, 2005, p. 160), as clients struggle “with self-validation, have a great need to have pride
to be empowered, and struggle with questions about self-esteem” (p. 160). Although many couples in same-
culture relationships experience stressors, intercultural couples may experience increased difficulties because of
cultural differences in values and worldviews that might intensify the stressors (Bustamante et al., 2011;
Crohn, 1998; Heller & Wood, 2000). The stressor of childrearing practices and parenting, for example, stems
from the cultural environments in which the individuals grow up and relates to expectations about how
children should be raised and the accepted methods of discipline, which also can be influenced by the stressors
that exist at the mezzo and macro levels. Time orientation was also found to be a stressor, related to how one
occupies time, promptness, spontaneity, and procrastination. A common stressor, gender role expectations in
couples, was noted to relate to the differences between cultures (i.e., male-dominated cultures, who is the
primary child caretaker, who performs which household chores, etc.). Crohn (1998) stated that cross-cultural
couples commonly enter therapy when an event occurs in the life cycle that upsets cultural differences within
the relationship that have been denied. This, in turn, results in conflict within the relationship caused by the
resurfacing of cultural loyalties. However, conflict still arises because the need to belong, as Maslow (1954)
argued, does not vanish.

Strengths and Protective Factors

Saleebey (2009) argued that clinicians often fall short in building on client strengths. He suggested that the
formula is rather simple: “Rally clients’ interests, capacities, motivations, resources, and emotions in the work
of reaching their hopes and dreams, help them find pathways to those goals, and the payoff may be an
enhanced quality of life for them” (p. 1). Specific to working with multiracial clients, identifying their
strengths and learning to use these strengths in the development of solutions will assist them to be empowered
(Fong, 2005).

As discussed earlier, no one is free from culture and therefore, in working with multiracial people at the
macro level, the culture itself should be viewed in the context of inherent strengths. A cultural strength that is
seen in many cultural groups, including African Americans, Asian Americans, and Hispanic Americans, is the
collectivist orientation of many cultural groups (Greene & Lee, 2011; Lee, 2003). The families and
communities in these cultural groups willingly provide assistance, support, and resources to individuals and
families facing adversity. Most of these collectivist cultures are considered “high context cultures in which

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people pay great attention to the surrounding context of an event to define the appropriateness of one’s
behaviors” (Greene & Lee, 2011, p. 186). This serves to reinforce behaviors, as well as sanction those that
require change. A strong external predictor regarding the happiness of interracial marriage, according to Zens
(2011), is community support. Lee and Mjelde-Mossey (2004) also suggested that within East Asian cultures,
the cultural value of being pragmatic and instrumental may be useful in the therapeutic setting. East Asian
families commonly “expect quick assessment and prompt intervention” (p. 502), hence, therapy with this
population should be “goal-oriented, focus on the present and future, and emphasize small and achievable
changes with clear indicators of progress” (p. 502). Also, many cultures have particular ways in which they
address adversity, providing strength and assistance to groups and individuals of that culture (Greene & Lee,
2011; Lee, 2003). Among African Americans, prayer has been noted to be the utmost coping response that is
used in times of difficulty (Lee, 2003). Spirituality and religion have played an important role in mental health
with various ethnic and racial groups (Canda & Furman, 2010; Lee, 2003; Greene & Lee, 2011). Also, A Bill
of Rights for Racially Mixed People (Root, 1996, p. 7, see Appendix) that illustrates the rights multiracial and
multiethnic clients are entitled to can be added to the list of strengths. Although the Bill exemplifies the
rights multiracial people deserve to have at micro levels, we believe they should be seen as an asset to exist at
macro levels as well, as they represent and remind us of the basic needs of human beings in a broad sense.

Although many advantages to being multicultural were identified (Bustamante et al., 2011, Fong, 2005;
McClurg, 2004), at the mezzo levels, multicultural people, for example, may experience opportunities to relate
to people in the cultures of both their parents (Fong, 2005). Similarly, McClurg (2004) indicated that the
parents of biracial children are able to provide assistance in the development of pride by recognizing the
differences between the two heritages and acknowledging these differences. In addition, marriages can be
enriched by both religious and ethnic differences and similarities, which can also test the growth of intimacy
within the marriage. For intramarried couples, their shared religious and ethnic culture can offer a deeper level
of understanding, resulting in a high level of intimacy that evolved from this connection, as the basis for
commencing their intimacy process (Heller & Wood, 2000). Bustamante and colleagues (2011) noted that
couples either maintain a balanced or an unbalanced perspective of their cultural differences and similarities,
defining balanced intercultural couples as “those who integrate such cultural differences, rather than deny them
or distort them” (p. 155). Heller and Wood (2000) concluded that both intramarried and intermarried couples
“achieve comparable levels of intimacy…partially explained by the convergent pathways taken by the two
groups as they traverse religious and ethnic landscapes to arrive on common ground” (p. 250).

Bustamante and colleagues (2011) found that intercultural couples use myriad coping strategies, at the micro
levels, that seem to reduce the strength of their conflicts. Gender role flexibility was noted to offset issues
relating to differences in gender role expectations, a critical element being communication about expectations
and responsibilities. Humor about differences to “de-emphasize or ‘lighten-up’ differences” (p. 160) was used
to reduce tension in situations that were potentially stressful, including the use of cultural stereotypes as the
basis of some of the humor. Cultural deference, which refers to one partner deferring more toward the other’s
culture, was found to be another critical coping skill. Making the decision to acculturate and assimilate was
noted to aid in the adaptation of cultural differences. As well, recognition of similarities stresses resemblances
the couple may share in their values. Couples have been noted to use cultural reframing, whereby “they

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normalized various cultural stressors experienced by creating a new set of values or by creating new
frameworks for interacting that blended, expanded, or transformed cultural perspectives within their unique
relationships” (p. 160). Lastly, having a general appreciation for other cultures is an essential coping strategy
for the intercultural couple, as well as for all multicultural clients and families. Having an interest in other
cultures and valuing exposure to cultures different from one’s own are important elements of general cultural
appreciation. In a study of the cultural adjustment of international couples during the periods of courtship and
early marriage, Zens (2011) identified resiliency factors that were key to maintaining relationships that
included creating meaning from adversity, having a positive outlook, being flexible, being connected, and
having social and economic resources. Adversity was considered to be an expected challenge that couples and
families grew and learned from.

Changing Lenses: From Deficit Oriented to Solution-Building

According to Lee and Mjelde-Mossey (2004), “Most helping professions in the United States are saturated
with practice approaches that are based upon a deficit or pathology perspective” (p. 501). This is further
compounded by the tendency of those in the majority culture to devalue those in the minority. Lee (2003)
suggested that clinicians who use the “diagnosis and treatment” model most often have a proclivity toward
establishing and continuing this prevailing dialogue. The traditional assumption about therapy is that experts
define how other people ought to be, as therapy is a matter of instruction or manipulation by clinicians with
expert knowledge (Hoffman, 1990). Alienation of the client can result from the devaluation of a client’s expert
knowledge by such a hierarchal therapeutic relationship, without this ever being the intention of the clinician.
Devaluation by the dominant society marginalizes the status of culturally different clients, placing these clients
at a “higher risk for internalizing a deficit view of self and constructing a sense of self in which they feel
personally inadequate, incompetent, and powerless” (Greene & Lee, 2011, p. 188). Traditional approaches
that use a deficit perspective can amplify these feelings, further disempowering them. The goal of therapy
with multicultural families should be movement from dominance and subordination toward collaboration and
cooperation (Kim, 1998).

The increasing recognition of SFBT reflects the need to build cooperative relationships with clients about
what they want and to emphasize their strengths as the foundation of solutions to problems (De Jong & Berg,
2013; Saleebey, 2009). SFBT has helped practitioners overcome the conventional problem-solving framework
on human issues. Berg and De Jong (1996) defined SFBT as solution-building conversations. SFBT
practitioners co-construct new and more useful meanings with their clients through the dialogue that is led by
the clients and uses the clients’ present life resources and images of future goals (Dolan, 1991).

Central to a solution-building approach is that all people, regardless of their level of functioning, have
strengths, resources, and competencies though they may not be using them, may be underusing them, or may
have forgotten they have them (Berg & Miller, 1992; Greene & Lee, 2011; Saleebey, 2009). The strengths
perspective assumes that “every individual, group, family, and community has strengths” (Saleebey, 2009, p.
15) and “all people are capable of continued growth and change” (Lee, 2003, p. 387). A major focus in therapy
with multicultural families is to assist in the identification, expansion, and utilization of these strengths within
the client’s cultural context. Therefore, use of a solution-focused approach with multicultural families is

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“consistent with the concepts of multiple worldviews, empowerment, and a strengths perspective” (Greene &
Lee, 2011; Lee & Mjelde-Mossey, p. 503).

Since an extensive discussion on SFBT is provided in Chapter 2 and throughout this book, we will now
briefly discuss several aspects of SFBT that need to be emphasized for furthering our case study that follows.
SFBT is best known for its concrete practice techniques that invite clients to build solutions (De Jong & Berg,
2013). These techniques include miracle, exception finding, coping, relationship, and scaling questions. The
use of these future- and strengths-oriented questions are excellent tools to help the multicultural family be
able to identify strengths and resources that otherwise would be unnoticed (Lee & Mjelde-Mossey, 2004).

The miracle question can, at times, be difficult to comprehend and respond to for some cultures. In these
instances, the use of future-oriented outcome questions can achieve the same purpose, especially if cultural
beliefs and practices are employed in the wording of the questions (De Jong & Berg, 2013; de Shazer, Dolan,
Korman, Trepper, McCollum, & Berg, 2007; Lee & Mjelde-Mossey, 2004). For an East Asian elder, an
example of this might be (Lee & Mjelde-Mossey, 2004): “If I see you and your family two months from now
and your family can deal with these issues in a better way, how will I know that your family is different?” For
an example of how to incorporate cultural beliefs into the question (Lee & Mjelde-Mossey, 2004), we might
ask: “If your ancestor heard your prayer, how would your family be different than what you are describing to
me?” Outcome questions such as a miracle question focus on the identification of “small, observable, and
concrete behaviors that are indicators of small changes” (de Shazer, 1985; Greene & Lee, 2011, p. 189; Lee,
2003, p. 390). The use of the word “miracle” may be a difficult concept for some cultures to imagine,
therefore, we might ask a question such as: “In a perfect world, what would you like to see happen?” A follow-
up question regarding the observation of small and observable behaviors might ask the client to identify what
that change might look like and be as concrete as: “How would you prefer to be greeted by your grandchildren
when they enter the house?”

Exception finding questions are asked to identify times when the problems are not happening or are less
severe for the purpose of identifying existing solutions or developing the foundations of new solutions. They
also aim to provide the clues to the solutions, as “there are always times when clients are able to handle their
life situations in a more satisfying way or in a different manner” (Lee, Greene, & Rheinscheld, 1999, cited in
Greene & Lee, 2011, p. 184).

Coping questions are designed to assist the client to pay attention to times when they are able to cope with
their problems and notice what they are doing at these times when they are coping successfully (Lee, 2003).
They are most often used to help clients who feel they have no control over their issue and feel helpless in
being able to find a solution.

Relationship questions are another form of evaluative questioning (Greene & Lee, 2011) wherein clients are
invited to look at their situations and possible solutions through the perspectives of people important to them.
Clients are asked to imagine how significant others might possibly react to their situation and to the changes
they may employ to solve their problem. This type of question serves the purpose of defining the problem
within the client’s social context, thereby providing them with more than one indicator of change and
enabling them to develop a greater ability to see what their future may look like within the context of the real

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life (Lee, 2003).

Scaling questions quantify a client’s perceptions and can be used to measure progress, to help set goals for the
following session, and to plan for changes in behaviors (planning for solutions) that will enable them to move
up the scale (De Jong & Berg, 2013).

In the treatment of intercultural couples, Bustamante and colleagues (2011) indicated that the clinician
would be able to skillfully facilitate the couple in “uncovering undiscovered narrative about the couple’s
cultural issues” (p. 162) by taking a stance of curiosity and a not-knowing approach. To open new ways of
dialogue, many social constructionists have adopted what Goolishian and Anderson (1992, p. 13) have called
“a not-knowing position” that entails a general attitude or stance in which the clinician’s actions communicate
an abundant, genuine curiosity. Similarly, SFBT also emphasizes the importance of the not-knowing posture
in which the practitioner learns how to put clients into the position of being the experts of their lives (De Jong
& Berg, 2013). In therapy, a practitioner is in a difficult position to know the significance of the client’s
perceptions and explanations before the client speaks. It is important for practitioners to set aside their own
frames of reference as much as possible by taking the not-knowing position. The position fosters human
dignity by inviting clients to be experts about themselves and their lives (De Jong & Berg, 2013; Goolishian &
Anderson, 1992). The “not-knowing” stance permits the practitioner to “enter into the client’s subjective
experiences of her life situations and collaboratively engage in a solution-building process that is viable and
responsive to her cultural context” (Anderson & Goolishan, 1992, cited in Greene & Lee, 2011, p. 184). The
families, in SFBT, are honored as the “knowers” of their experience. They are the experts of their own
experiences and are central as the decision makers.

A Case Study
Our original plan was to incorporate an actual case study from one of our clinical practices to demonstrate the
use of a solution-focused framework with multicultural families. However, we have decided to take an
unconventional approach for this section and use some creative license that we thought might provoke greater
analysis, thought, and insight for the reader. In the following, we share a personal story of a courtship, and the
ensuing intercultural, interfaith marriage, which began 32 years ago between a 23-year-old American/Jewish
female and a 25-year-old Turkish/Muslim male. As the female of this married couple and coauthor of this
chapter, I (Robin Akdeniz) have chosen to share some of the challenges, protective factors, and coping
strategies experienced at various points in the life course and to discuss the resolution of these issues using
treatment techniques practiced in SFBT. Although writing the chapter resonated with my own personal
experience, I first had the chance to see many of my past conflicts and times of stress more clearly when I took
a training for SFBT. After learning about a variety of traditional treatment methods in my professional
education that historically view issues through a problem-oriented lens, the opportunity to examine the
conflicts and issues that created stress could now be perceived differently as I was able to identify the strengths
and resilient factors that empowered us as a couple to manage our conflicts and thrive.

As the “client,” the fictional name of Sarah shall be used. Sarah has scheduled appointments to see a
solution-focused clinician for counseling at three different timeframes representing different stages in the life

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course perspective:

Timeframe #1: Sarah is 23 years old.

Sarah and her fiancé, Ali, have been engaged for 10 months and have both been “on a high from the
excitement,” until the past few weeks, when Sarah stated she has experienced a lot of stress, and feels upset
and overwhelmed. Sarah stated Ali’s family lives in Turkey and her family lives in New York. Sarah stated
that approximately one month ago, her family made an engagement party, for which her mother-in-law (to
be), Azize, traveled from Turkey. Azize was invited to stay at Sarah’s parents’ home for the duration of her
stay in the United States. The first evening there, after the dinner they had in her honor, Azize presented
Sarah with gifts and proceeded to drape her in gold jewelry (necklaces, bracelets, rings, earrings), much to the
delight and surprise of the American family (including Sarah). This, it was soon understood, was a tradition of
their family’s Turkish culture. More gifts followed, for Sarah and for her parents, including handwoven
tablecloths and other special handcrafted items. The engagement party two days later was reported to be a
great success for all, with much jubilation and celebration.

A week later, Sarah’s father asked her and Ali (in the presence of Azize) how much longer Azize plans to
stay in their home. According to Ali’s cultural code, this was rude and ungracious behavior. Although Azize
did not understand the language, she understood what was being communicated and arranged to leave their
house and stay with her other son. This incident was reported to have caused Sarah (and Ali) a great deal of
stress.

Two weeks ago, Sarah stated her parents advised them that they plan to underwrite their upcoming
wedding but expect the groom’s family to assume responsibility for the flowers, music, and photographer,
according to their American tradition. Sarah stated Ali’s family believed they had already happily and willingly
fulfilled their responsibility for the wedding. Sarah stated she is feeling a high amount of pressure from her
family about their wedding arrangements and is not able to sleep through the night, waking up two or three
times during the night with feelings of panic.

Had this author sought counseling and had the opportunity to speak with a solution-focused clinician, the
following SFBT questions might have been asked of her to empower her to be able to develop goals for
herself, identify strengths and resources that may go unnoticed by the client, and seek solutions to her issues:

• Miracle question: “A miracle happens while you’re in sleeping, and the miracle makes the problems that
brought you here disappear. But this happens while you’re sleeping so you can’t know it happened. How
do you and people close to you discover this miracle happened?” (de Shazer et al., 2007, p. 38)
• Exception question: Are there any times you can think of recently when you feel that the miracle already
happened, even just a little bit? Are there times when you haven’t been feeling overwhelmed; when you
were feeling calm and in control? If so, tell me more about that time. What was different about the way
you handled that situation?
• Scaling question: On a scale of 0–10 with 0 being very anxious and panicked and 10 being the state of the
miracle, where would you put yourself on the scale right now? What do you think you can do in the
coming week to bring yourself up the scale to the next number?

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 • Coping question: How are you able to endure and even survive these stressful days? How are you able to
get up in the morning and go to work?
• Relationship question: What do you think your mother-in-law might suggest you do in this situation?
What would your grandmother suggest?

Postscript
The real-life solution we sought to this problem was that, as a couple, we decided to pay for the parts of the
wedding my family considered as the “groom’s responsibility.” Although we found our own solution, the result
might have been more positive had we viewed our issues through a solution-focused lens incorporating a
multicultural perspective. Our solution, although it served its purpose, was a surface solution. Finding a
superficial solution can be useful at times; however, in this case, much anxiety and stress was experienced and
resentments and negative feelings between family members were formed. Greater understanding of us as an
intercultural couple would have included the use of collaboration with both of our families, the identification
of the similarities between our cultures, the incorporation of humor, the use of cultural deference, and
assistance with culturally reframing our lives together as a new construct.

Timeframe #2: Sarah is 25 years old.

Sarah and Ali have been married for eight months. Sarah stated she was very happy with their wedding and
honeymoon and their move to a new apartment, and both are satisfied in their respective jobs. Sarah stated
that in general, she is very content but described times over the past eight months that are of concern to her,
most notably when there is a conflict or difficulty that she is preoccupied with and for which she wants to seek
resolution in collaboration with Ali. Sarah stated she usually introduces a subject, followed by Ali expressing
his opinion about it. Sarah then frequently tries to continue the conversation in order for the solution to
reflect her desired outcome. Ali, in response to this, becomes silent and ceases communication, which Sarah
describes as “shutting down” and withdrawing, resulting in increased frustration and leading to Sarah
resorting to pleading and crying. Sarah stated she does not know how to improve their communication and
would like to prevent this pattern from continuing.

The approach of a “not-knowing” stance would be essential to learn about styles of communication and
expression of emotion and how these styles are specific to their cultural contexts. As this is an issue about
communication between two individuals, the recommendation would be to have both Sarah and Ali attend
therapy sessions together. Questions that could be asked of both Sarah and Ali:

• Presession change question: Have you noticed any differences since you contacted me last week?
• Exception questions: Tell me about the times when you are speaking to each other and you consider your
communication effective. How are those conversations different from the ones you consider difficult?
What do you think you do differently at these times?
• Indirect compliments: You are both sitting here together right now. Tell me…how are you able to interact
so nicely right now? You told me before about the nice dinner you made together last night and enjoyed.
How did you do that?
• Scaling questions: On a scale of 0–10, with 10 being you would do anything to overcome this

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 communication issue and 0 being you don’t think you will do anything: (To both Sarah and Ali) Where
would you put yourself today?
• Relationship questions: (To Sarah) What do you think your sister would say if she saw you speaking
calmly to Ali about a difficult subject? (To Ali) What do you think your best friend in Turkey, who
communicates well with you, would say when he listens to your issues with Sarah?

Postscript
Communication issues are a well-documented source of conflict for married couples. Specific to this case,
the expression of emotions and moods as well as both verbal and nonverbal communication styles would be
better assessed and improved if viewed through a multicultural lens. My style of mood expression and
communication was greatly influenced by my American/Jewish culture, characterized by high verbal
communication and high emotional expression. As well, my husband’s mood expression and communication
style was influenced by his Turkish culture. While I was accustomed to loud and emotional verbal exchanges
with family, my husband was not. When I traveled to Turkey and spent time with his family, I was surprised
to observe their more controlled and reserved demeanor, lower volume when speaking, desire to minimize
confrontation and conflict, and longer periods of silence (that was comfortable for them, but not for me).
Other cultural issues that would have been beneficial to explore, such as boundaries (physical and emotional),
privacy, and level of involvement of extended family, would have honored our differences and improved our
mutual respect.

Timeframe #3: Sarah is 34 years old.

Sarah and Ali have been married for nine years. Beginning in their second year of marriage, Sarah suffered
a miscarriage, the first of a series of major disappointments over an eight-year period, as they attempted to
accomplish their dream of having a family. Sarah and Ali, both physically and emotionally exhausted after
years of highs and lows, are trying to figure out what their options are in order to solve their issue. They are
considering medical interventions, such as in vitro fertilization, and also are considering adoption alternatives.

The concept of the client as “expert” is a critical stance to assume as a clinician for Sarah and Ali. A married
couple now for nine years, they are honored as the knowers of their experiences and are central as the decision
makers. Sarah has made an appointment for herself for the first session. Questions that could be asked of
Sarah:

• Clarifying the client’s goals: “What are your hopes in coming here? If coming here turns out to be a really
good idea what differences will you notice in your life? What will be the first signs that things are
improving?” (O’Connell, 2005, p. 46)
• Coping questions: How have you been able to recover from each disappointment? What sorts of things
have helped you and Ali?
• Scaling questions: On a scale of 0–10, with 0 being the lowest you have felt about this situation and 10
being happy and fulfilled, where would you say you are on the scale today? What do you think you can
do to bring yourself up to the next number on the scale?
• Relationship questions: How would Ali say you are handling this stressful time? How do you think your

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 mother would respond if you told her about your thoughts regarding adoption? How about your mother-
in-law?

Postscript
For approximately nine years, my husband and I experienced an inordinate amount of stress in our pursuit
of creating a family, from the “highs” of temporarily successful pregnancies to the “lows” of grief, loss, and
heartbreak. From the cultural perspective of my husband’s family, I was the one who was assumed to have the
“problem” as I was not successful in maintaining a pregnancy to term. My husband’s family and extended
family, in his largely patriarchal male-dominated culture, initially reacted by expressing disappointment and
then offered their own solutions. They cited examples of other male family members who divorced their
wives, remarried, and successfully had children. Another suggestion was that we might have to concede and
have a life without children, as they cited examples of family members who accepted this destiny. Their
inclination was to attribute our situation to fate, although my husband did not agree with this explanation.

My family’s reaction was sympathetic and concerned but disappointed. We explored medical alternatives
and enrolled in an in vitro program and concurrently spent time researching both domestic and international
adoptions. My family was wary of the adoption route and voiced concern over committing to something that
was an unknown, therefore, something one could not trust. In time, my husband and I made the decision not
to pursue in vitro and explore the adoption route in greater depth. We realized we wanted to be parents, first
and foremost. Both families were committed to our plan and to our surprise, we received considerable, albeit
guarded support. One year later, it was my husband’s parents who located a possible infant for us in Turkey.
As soon as the phone call came, we traveled to Turkey, and, a few months later, returned with our daughter.
This solution that we sought together as a couple was so gratifying that we followed the same route three
years later to adopt our second daughter.

An Analysis and Conclusion

As a multicultural couple, Sarah and Ali have experienced several of the challenges discussed earlier in this
chapter. As well, they have demonstrated strengths, protective factors, and resiliencies that have enabled them
to overcome their issues and seek meaningful and effective solutions. Regarding risk factors of multicultural
families, in the case of Sarah and Ali, marginalization and devaluation of the minority culture (Turkish
culture) by the majority culture (American) was identified. As evidenced by the engagement and wedding
scenario, the cultural traditions and patterns of behavior were both misunderstood and misinterpreted because
they were viewed according to the American culture’s value system. In addition, greater emphasis was put on
cultural differences rather than on similarities. Differences in styles of communication, both verbal and
nonverbal, and expression of mood were evident, most notably in the second scenario. The presence of some
negative family reactions added to the couple’s challenges. Gender role expectations in a largely male-
dominated society arose and created additional stress for the couple.

To overcome these risk factors and create harmony within their relationship, a large number of strengths
and protective factors have been identified and exhibited. To begin with, they shared both values and

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worldviews. They were able to identify their similarities and formulate a shared core value system (i.e., their
desire to have a family despite the importance placed on having a biological child). They also had societal
reactions that were positive, consisting of a strong social support network of friends and family. They
incorporated humor about their differences into their relationship, thereby lightening up potentially stressful
situations. Cultural deference, deferring more toward one culture than the other was demonstrated by Ali’s
deferment to Sarah’s cultural heritage by agreeing to have all the rituals of a Jewish wedding incorporated into
their ceremony, even though his preference was to have a secular wedding.

Sarah and Ali committed themselves to the decision to acculturate and assimilate depending upon which
country they were in. For the majority of their marriage, Ali has acculturated and assimilated into American
culture. When they visit Turkey, by learning the Turkish language, customs, and rituals, Sarah has thus made
the effort to acculturate and assimilate to Turkish culture. Similarly, they have a general appreciation for other
cultures, considered to be an essential coping strategy of intercultural couples. They both have an abundant
interest in each other’s cultures and consider the exposure they have had to cultures different from their own
to be an important shared value.

Cultural reframing led to the creation of a new framework for interacting in order to normalize the stressors
within their distinctive relationship. The development of their unique family is an example of this coping skill,
as they blended, expanded, and transformed their cultural viewpoints to reflect their customs, values, and
behaviors. Sarah and Ali also demonstrated resilient factors throughout their marriage as they created
meaning from adversity, maintained a positive outlook, and remained flexible and connected to others. Sarah
and Ali perceive their intercultural relationship to be advantageous and consider it one of enrichment that has
enabled them to grow, develop, and learn in ways that would not have been possible had they been involved in
a same culture relationship.

The solution-focused clinician, in working with multicultural families in general and this couple in
particular, assumes the “not-knowing posture” to learn the resources, strengths, resiliencies, and protective
factors of the couple. Assumptions are not made, as the clinician leads from one step behind, listening
carefully to understand the meaning to the client. Change, according to the strengths perspective, is not only
possible, but is inevitable, and all people are capable of continued growth and change. In the case example,
Ali’s family eventually made a total shift in their belief about what constitutes a family, demonstrating how
small increments of change will lead to larger ones, and change in one part of a system can lead to changes in
other parts. Placing emphasis on how each family member can contribute rather than focusing on who is
responsible for the conflict will foster solution building, which would have been helpful to Sarah and Ali in
scenario #1. A miracle question would have been extremely helpful in assisting Sarah to start to establish goals
for herself in her newly committed relationship, in which she was eager to build a strong and cohesive family.
Asking this question might have given Sarah permission to think about possibilities, giving her a future focus,
and to think in relation to establishing shorter-term goals. Complimenting Sarah and Ali would have
acknowledged how difficult and overwhelming their issues must have been, thereby validating what they are
doing well and providing them with the encouragement to continue. This would have sent an important
message to the couple that the clinician is listening to them, understands, and cares.

In conclusion, a solution-focused approach would have provided Sarah and Ali with a new paradigm of

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possibilities, hope, and respect as it values and integrates clients’ worldviews in the process, a cornerstone of
culturally competent practice for multicultural families. Working with multicultural families in therapy can be
rife with both enriching and challenging moments, but ultimately it is a gratifying experience that leads to a
greater scope of understanding for the individuals, couples, and family members that seek our assistance, as
well as for the clinician privileged to work with and learn from multicultural families.

Exercise
To further enrich the discussion about this case, think about how you could incorporate the husband and
other significant family members into couple and/or family counseling:

a. Develop exception, coping, scaling, and relationship questions to pose to the husband and to other family
members (Sarah’s mother, father, Azize, Ali’s father) to facilitate resolution of these issues.
b. How might your sessions be different if this was couple or family counseling rather than individual
counseling?
c. Practice developing a cultural genogram, first for each individual client and then for them together as a
couple, as a tool to assist them in the task of cultural reframing.
d. The husband, being from a more collectivist culture, may be wary of therapeutic involvement. How could
you provide credibility, expertise and structure to diminish his anxiety and demonstrate professional
competence?
e. What issues might be important to consider for adopted children in the case example? What if they were
biological?

APPENDIX

A Bill of Rights for Racially Mixed People by Root (1996, p. 7).

1. I have the right not to justify my existence in this world.

2. I have the right not to keep the races separate within me.
3. I have the right not to be responsible for people’s discomfort with my physical ambiguity.
4. I have the right not to justify my ethnic legitimacy.
5. I have the right to identify myself differently than strangers expect me to identify myself.
6. I have the right to identify myself differently than how my parents identify me.
7. I have the right to identify myself differently than my brothers and sisters.
8. I have the right to identify myself differently in different situations.
9. I have the right to create a vocabulary to communicate about being multiracial.
10. I have the right to change my identity over my lifetime—and more than once.
11. I have the right to have loyalties and identify with more than one group of people.
12. I have the right to freely choose whom I befriend and love.

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 10
Solution-Focused Approach With
LGBTQ Clients
Sara A. Smock Jordan

Definitions
Lesbian, gay, bisexual, transgender, queer, questioning, intersex, and ally or asexual (LGBTQQIA) includes
the full spectrum of individuals who are sexual and/or gender minorities. Most literature uses “LGBT” and is
not fully inclusive of intersex persons, pansexuals, those who are still questioning, or those who prefer the label
queer. Sexuality and gender are distinct spectrums, not directly correlated with one another. For example, a
person can be very feminine and be attracted to women (lesbian) or can feel like a man trapped in a woman’s
body (transsexual) and sexually attracted to both men and women (bisexual). When working with sexual, sex,
and gender minorities, it is important to begin by understanding how clients may identify.

Gays and lesbians are individuals that are attracted to the same sex. These terms are more culturally
sensitive than using “homosexual,” which has a “clinical” or “disorder” connotation. Bisexuals are individuals
that are attracted to both sexes. For bisexuals, sexual attraction is about being attracted to a person regardless
of biological sex. The term pansexual is different from bisexual in that these individuals are attracted to people
regardless of sex or gender identity (Long & Grote, 2012). An example of a pansexual might be someone who
is attracted to men, women, transsexuals (male to female or female to male), or any combination of sex or
gender identity.

“Transgender” is an umbrella term used to describe transsexuals, cross-dressers, intersex, performers, and
gender bender/adrogynes. Transsexuals are what most people think of when they hear the word transgender.
Transsexuals are individuals that feel like they are either a woman trapped in a man’s body or a man trapped in
a woman’s body. Not all transsexuals go through the entire process of getting sexual reassignment surgery but
may dress as the opposite sex or choose to make minor physical changes that resemble the opposite sex.
Cross-dressers are comfortable with their sex at birth but may occasionally dress as the opposite sex. A
stereotype of cross-dressers is that they are gay men; however, most cross-dressers happen to be straight men.
An intersex person, formally referred to as a hermaphrodite, is someone who has both sex organs. Intersex
individuals used to be assigned a gender by their parents and raised as that gender from birth, but more
recently, parents are sometimes given the option to allow the child to choose their gender when they become
old enough. Some put an “I” in LGBTQQIA to set intersex individuals apart from transgendered individuals
given their unique experience while others include intersex people under the transgender umbrella. Performers
are individuals that dress as the opposite sex for entertainment purposes. Some performers are gay or
transsexual and some are not. Gender benders/androgynes do not fit into the other transgender categories.

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They may be effeminate men (more recently referred to as metrosexual) or “butch” women. Again, it is
important to remember that gender identity and sexual attraction are two distinct things.

Queer is a term that used to be considered derogatory but has more recently been “taken back” by
individuals who don’t fit into society’s definition of sex and gender. Queer individuals take pride in being
outside of the box. A gender queer might be a very masculine man with a beard who chooses to wear dresses,
high heels, and makeup. Queer, queer theory, and gender queer are just some terms used to describe
individuals that proudly refuse to fit into societal stereotypes of sex and gender.

The “A” in LGBTQQIA can stand for ally or asexual. Asexuals are individuals who don’t have sexual
attraction to anyone and are often left out of the LGBT literature. One major myth about asexuals is that they
don’t have sex. Sexual attraction and sexual behavior are two different things; lots of people have sex with
people they aren’t attracted to. Asexuals are capable and may choose to have sex although they do not possess
sexual attraction. An asexual person might come to therapy because their lack of sexual attraction is affecting
their interpersonal relationships.

Throughout this chapter, the author will use LGBTQ to describe sexual and gender minorities. However,
keep in mind that the application of solution-focused brief therapy (SFBT) is meant for all individuals
regardless of the sexual or gender identity.

Historical Background
Over the years, the LGBTQ community has had to face a great deal of discrimination and hate from society,
as well as from mental health professionals. For example, a recent study found that LGB clients who lived in
states that banned gay marriage had a significantly greater occurrence of Diagnostic and Statistical Manual of
Mental Disorders (DSM) diagnoses than those who lived in gay marriage states (Hatzenbuehler, McLaughlin,
Keyes, & Hasin, 2010). In addition, 20% of sexual minorities have experienced a hate crime (Herek, 2009).

The term “homosexual” was entirely removed from the DSM in 1986, less than 20 years ago. Up until that
point, the mental health community labeled nonstraight individuals with a mental disorder. Just before
homosexuality was omitted, gender identity disorder was added in 1980. The labels for gender identity have
changed from DSM-III to DSM-IV but still remain as a diagnosable mental disorder.

Heterosexist and Heteronormative

Discrimination, bias, and hatred toward LGBTQ individuals and couples have many forms. Furthermore,
anti-LGBTQ attitudes from society affect sexual and gender minorities, their children, and their partners. In
addition, homophobia and internalized homophobia continue to create fear and unwanted anguish in both
straight and gay individuals. Thus, the stress of being a sexual and/or gender minority contributes to higher
rates of mental health needs (Giammattei & Green, 2012; Goodman, 2005; Lewis, Derlega, Brown, & Rose,
2009; Meyer, 2003).

Clinicians are not excluded from possessing prejudices and discriminating against nonstraight clients.
Heteronomative clinicians and counselors have developed approaches called “reorientation” therapy, which

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aims at altering one’s sexual orientation, to “cure” LGB individuals. Serovich, Grafsky, and Gangamma
(2012) completed a review of reorientation therapies and found that the studies in their review were “severely
compromised in scope and quality” (p. 435). Regardless of its “effectiveness,” the ethical and moral issues
surrounding this type of approach show that heteronormative clinicians are trying to fix LGB individuals. In
fact, one of the most damaging experiences that LGBTQ clients can have is a clinician with heterosexist,
heteronormative, and/or heterocentric biases (Henke, Carlson, & McGeorge, 2009; Israel, Gorcheva, Burnes,
& Walther, 2008; McGeorge & Carlson, 2011). Training and supervision of SFBT clinicians is a good place
to explore any heterosexist and/or heteronormative biases, and several (Marek, Sandifer, Beach, Coward, &
Protinsky, 1994; Thomas, 1994; Wetchler, 1990) have developed models of SFBT supervision that include an
educational component.

Given that SFBT is an approach that uses the client’s goals for treatment, what should a clinician do if a
client wants to change sexual orientation? In 2009, the American Psychological Association rejected the use of
reparative therapy and suggested offering acceptance and support without “imposing a specific sexual
orientation identity outcome” (p. 17). So how does a SFBT clinician fight heteronormative and/or
heterosexist biases while allowing the client to work on the goal of fixing his or her sexuality? It really comes
down to helping the client to set a workable goal. In SFBT, a workable goal is described as the following: It
must be challenging and perceived by the client as involving hard work, it is important to the client, it has
meaning and is realistic, it is concrete, it is small, and there are exceptions to the problem (Berg & Miller,
1992; de Shazer, 1991). By definition, a client expressing that her goal is to change her sexual orientation fits
some of the criteria for a workable goal but not all of them. Changing one’s sexual orientation is not
considered by most as “realistic.” In addition, a problem is defined by nature that a solution exists (de Shazer,
1988, 1991, 1993), but life circumstances like losing your arm or having your parent just die can’t be changed
(J. Simon, personal communication, 2006). Sexual orientation is another life situation that is not a problem,
but coping and dealing with the discrimination of one’s sexual orientation can have a solution. Asking the
client what they would like life to look like, being an LGB individual, would help produce a workable goal.
For instance, here is a SFBT dialogue example that addresses this issue:

Clinician: So how can I be helpful to you today?

Tom: I am really hoping that you can help me not be gay anymore. My
church says it is wrong, and I just want to be normal.
Clinician: So you want to be normal.
Tom: Yes
Clinician: So what would you be doing if you were a normal man?
Tom: Well I wouldn’t be attracted to men.
Clinician: And what else?
Tom: I would want to get married and fit in.
Clinician: What else would you be doing if you were fitting in?
Tom: I would be having kids, taking them to ball games, you know, the

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 normal life.
Clinician: So let me make sure I have this correct. You are gay and your church
says it is wrong and you just want to be normal….get married…have
children…fit in. Right?
Tom: Yes.
Clinician: So being gay is something you wish you weren’t, but you can still see
yourself having a normal life where you fit in?
Tom: Yes.
Clinician: So as a gay man who wants to fit in, what would be the first step in a
normal life for you?
Tom: Well I guess if I dated a woman, I would start to fit in more.
Clinician: And somehow being gay and dating a woman would move you closer
to fitting in. What else would be part of fitting in? Would you be
happier if you fit in?
Tom: Yes, I want to be normal and happy, and I think I could be happier if I
fit in even if I am attracted to men.

In this example, Tom presents with wanting to “not be gay anymore.” The SFBT clinician was able to stay
within the model, acknowledge Tom’s wish, and move him toward creating a workable goal. Possible options
for continuing the dialogue in a solution-focused manner would be for the clinician to say “So when you are
happy, what are you doing?” or “So if you ‘fit in,’ how would that be helpful for you?” or “And what else would
you be doing if you ‘fit in’?” These options allow the conversation to focus on the details of where the client
wants to be when he is happier and fitting in. The “problem” is dealing with the emotions, stigma, and so on
associated with being gay. In turn, the solution for Tom lies in living a normal life and fitting in.

Transgender
Although transgendered individuals are included in the same category as sexual minorities, gender variance
includes several different types, each possessing their own unique issues. From gender benders to transsexuals,
transgendered individuals can face everyday situations like choosing which restroom to use to the long process
of gender reassignment surgery. Even clinicians educated in gay and lesbian issues may be ignorant of
transgendered ones. Common things like knowing how to refer to your client and larger issues like
understanding the transitioning process are important to understand when using SFBT with this population.

What if a client is transgender and wants to transition to the other sex? This is a different situation than
changing sexual orientation (mentioned earlier). It is possible to transition to the other sex, and an SFBT
clinician can help a client work toward his workable goals to accomplish his desired future.

Clinical and Nonclinical Issues for LGBTQ

Coming-Out Process

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 One issue that LGBTQ individuals may come to therapy for is help in the coming-out process. Although
society’s view of gay, lesbian, bi, and queer people has become more accepting, discovering one’s own sexual
identity, as well as coming out to friends and family, is psychologically, emotionally, and socially often
difficult. The possibility of negative responses from friends and family can be a frightening experience
(Johnston & Jenkins, 2004).

Using SFBT with clients in the coming-out process offers many opportunities. One to specifically highlight
is the use of exceptions. If a client has already come out to at least one person in her life, the clinician can
highlight this exception and talk about the courage, confidence, and wisdom it took to disclose. Then the
clinician can talk about what other resources are needed to come out to more people if that is the desire of the
client. It is important to note that it should always be the client’s goal to come out, not the clinician’s. Other
approaches may encourage or discourage clients to come out to family and friends, but SFBT follows the
client’s lead. If it is the miracle or goal, then the client and clinician will co-construct what would make it
more likely for coming out to occur.

Substance Abuse
Although it is hard to pinpoint an exact prevalence rate of substance abuse and dependence in LGBTQ
individuals, most studies conclude higher rates in this community (Anderson, 2009). Several factors are
hypothesized as attributing to a higher prevalence of substance use disorders in this community. First, the
stress from internalized homo/bi/transphobia puts LGBTQ individuals at a greater risk for substance use
disorders. Second, interpsychie experiences like “coming out” and societal discrimination and harassment
specific to LGBTQ individuals increases the likelihood as well. In addition, the most common social forum
for LGBTQ individuals to meet each other is in clubs and bars, an environment of alcohol and illicit drug
use/abuse (Anderson, 2009). These and other factors contribute to greater risk of developing a substance use
disorder.

Many articles and books have been written on using SFBT with substance abusers (Berg, & Miller, 1992;
Berg & Reuss, 1995), and research shows its effectiveness (Smock et al., 2008). SFBT substance abuse
treatment can occur in an individual format or in a group setting. SFBT group formats are available for
working with substance abusers (Pichot & Dolan, 2003; Pichot & Smock, 2009) and other marginalized
populations like those living with HIV/AIDS (Froerer, Smock, & Seedall, 2009).

Depression and Suicide

Sexual and gender identity often occur in adolescence. Studies have found that LGB or questioning
teenagers are more likely to abuse drugs and alcohol, suffer from symptoms of depression, and consider or
attempt suicide (Grossman & Kerner, 1998; Magruder & Waldner, 1999; Peters, 1997). As individuals come
out about their sexual orientation, those that are more “out” tend to report fewer symptoms of depression and
anxiety (Jordan & Deluty, 1998; Lewis Derlega, Berndt, Morris, & Rose, 2001; Mohr & Fassinger, 2003) and
greater psychological well-being and quality of life (Halpin & Allen 2004; LaSala 2000; Monroe 2001; Savin-
Williams 2001). Less depression only seems to hold true if LGB individuals have positive views of being gay,
lesbian, or bisexual (Rosario, Hunter, Maguen, Gwadz, & Smith, 2001). For others, being gay, lesbian, or

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bisexual and the coming-out process include isolation, loneliness, and depression (Beattie, 2004). Thus, as an
SFBT clinician, it is important to be aware that depression and suicidal ideation are possible presenting
problems for LGB clients.

Strengths and Protective Factors

Transgendered Individuals
Several resiliency traits are present in gender-variant individuals: evolving a self-generated definition of self,
embracing self-worth, awareness of oppression, connection with a supportive community, and cultivating
hope for the future (Singh & Hays, 2011). These strengths are helpful in co-constructing their preferred
future. They also can be highlighted and complimented when clients display these in session. Asking the
miracle question of a transsexual client may also be easier than asking nontrans clients because they are more
likely to think about what it would be like if they woke up tomorrow and were living as the opposite sex.

Sexual Minority Couples

Research has found several strengths in LGBT couples. More autonomous and intimate relationships have
been reported (Kurdek, 1998) as well as being more upbeat, humorous, affectionate, and positive during and
after conflict with their partner than heterosexual couples. In addition, lesbian and gay individuals are more
likely than heterosexual individuals to consider their ex-lovers as close friends (Patterson, 1994). These
strengths are important to keep in mind when providing compliments to clients at the end of the session.
Compliments are always based off what the client mentions in session, but being aware of cultural strengths
may be helpful.

Case Example: Coming Out to Parents

Cory is a 24-year-old male who has been struggling with coming out to his parents about his sexual
orientation. Recently he has sought therapy to work on talking to his parents. The following is a solution-
focused conversation with Cory about how he would like things to be different.

Clinician: What will we need to talk about today that would let you know that it
was worth coming here today?
Corey: Well, I have been struggling with how to tell my family that I am gay.
I have come out to my friends but just can’t bring myself to talk to my
parents about it.
Clinician: So you have already come out to your friends? How did you do that?
Corey: It wasn’t easy…
Clinician: Doesn’t sound easy at all. How did you do it?
Corey: Well, I came out to my friends one at a time. It would just come up in
conversation about who I am seeing or comments my friends would

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 say about women when we would hang out.
Clinician: So when the conversation about seeing someone or comments about
women would come up, you would use that opportunity to disclose
that you are gay?
Corey: Yeah [pause], it was harder to open up to some friends than others. I
do have one lesbian friend Lacy. [Pause] She was she easiest to talk to.
In fact, she was the first person I told and she encouraged me to share
with others when I was ready.
Clinician: It sounds like talking to Lacy was very helpful.
Corey: [Nods] Yeah it really was. I have always looked up to Lacy because she
is very open about, her sexuality so once I told her and she supported
my coming out of the closet, I wanted to work on it. [Clinician nods.]
It is just that I am going to visit my parents soon and really want to
have the courage to tell them. I think it would be a big relief for me,
but I am really nervous about what they will say. They have some
pretty conservative views [pause], especially my dad.
Clinician: So having the courage to tell your parents, this would make a
difference in your life?
Corey: Absolutely!
Clinician: [Nods] Yes. Hmm. Ok, is it all right if I ask you a strange question?
Corey: Sure, I guess.
Clinician: It just makes it easier for me to be helpful.
Corey: [Nods]
Clinician: Okay, let’s suppose you leave here and go about your usual day. At
some point, you find yourself going to bed and drifting off to sleep.
[Client nods] And while you are asleep, something shifts and a miracle
happens. [Client nods] The miracle is that the problem that brought
you here today is solved [client nods], but all of this has happened
while you were sleeping [pause] so you don’t know it has occurred,
right?
Corey: [Nods]
Clinician: So when you wake up tomorrow, what is the first sign that would let
you know a miracle happened [pause] since you were sleeping and
don’t know the miracle happened?
Corey: Hmm. I’m not really sure. [Clinician just waits] I guess I wouldn’t be
worrying when I woke up.
Clinician: You wouldn’t be worrying.

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Corey: [Nods]
Clinician: So if you were not worrying when you first woke up, what would you
be doing instead?
Corey: Well [pause] I guess I would get out of bed when the alarm goes off.
[Clinician nods] I usually have trouble getting out of bed.
Clinician: Getting out of bed. What else would you notice?
Corey: I would probably feel like my true self, without any worries on my
mind [pause] comfortable in my own skin.
Clinician: [Nods] Yes. So when you are feeling like your true self, comfortable,
who might be the first person to notice this?
Corey: [Laughs] Well probably my dog. [Clinician smiles] He likes to sleep at
the foot of my bed.
Clinician: What’s your dog’s name?
Corey: Rex.
Clinician: So Rex would notice you being yourself. So what would Rex notice
you doing when you are being yourself?
Corey: [Smiles and laughs] He would see me get out of bed and take him for
a walk. That would make him very happy.
Clinician: [Smiles] I bet that would make him happy.

A BIT LATER….

Clinician: So let’s say on a scale from 1 to 10 that a 10 represents you being

yourself, totally comfortable with yourself just like the day after the
miracle and 1 being furthest from that. Where would you put yourself
on this scale today?
Corey: [Pause] Well…I don’t know.
Clinician: That’s OK. It sometimes takes a bit to think about this.
Corey: Well, right now I would probably be at a 4.
Clinician: A 4. [Nods]
Corey: I would be a 4 because I really want to be myself and be totally out
with everyone, but the thought of telling my dad scares me so much.
Clinician: [Nods] Yes, it sounds like a very difficult conversation to have with
your dad.
Corey: He is very critical of gays, and I worry that he will treat me different,
that he won’t want to spend time with me anymore.
Clinician: So what would it look like to be a 4.5 or 5? What would be different?
Corey: I think I would have a specific plan for talking to my parents.

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Clinician: A specific plan. What would that look like?
Corey: Well, I would rehearse over and over what I would say to my parents
and would know what I would do if they flipped out.
Clinician: So a good plan with a worst-case scenario built in.
Corey: [Smiles and laughs]
Clinician: I always take a break in session to gather some thoughts. I will return
in a few minutes.
Corey: OK.

AFTER THE BREAK

Clinician: I have gathered my thoughts about some compliments that I have for
you.
First, I want to thank you for sharing with me today. You are going
through a difficult struggle with telling your family that you are gay
[client nods] and are able to share it with a stranger [clinician points to
self]. That takes a lot of courage. [Client nods] It also takes a lot of
courage to plan a conversation with your parents.
Corey: Yes.
Clinician: You also seem very determined to want to be yourself. You have
already come out to your friends, which I am sure wasn’t easy.
Corey: Yeah.
Clinician: But you found the strength to do it. You had the wisdom to start
talking about being gay to Lacy first. [Client nods] This is very
impressive.
Corey: [Smiles]
Clinician: So I am wondering about something. What would you need to do
between now and the next time we meet to move you closer to your
goal?
Corey: Well, I would have come up with my specific plan. I think I should
write it out and bring it to my next session.
Clinician: Sounds like this will be useful.
Corey: Yes. [Smiles]

Solution Building Co-Construction

In the previous case example, many techniques were used. However, it is important to talk about the
essence of the SFBT model: solution building co-construction. Co-construction occurs in all therapy
approaches and is observable through a sequence of “reciprocal influence” called grounding (Bavelas, De Jong,

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Korman, & Smock Jordan, 2012). Grounding is a moment by moment interactional communication process
where the speaker and listener negotiate a mutual understanding (Clark, 1996; Clark & Schaefer, 1987,
1989). Co-construction and grounding are unique in SFBT because the process in which a SFBT clinician
selects words (i.e., lexical choice), asks questions, and restates the client’s language is solution building in
nature (Bavelas, De Jong, Smock, & Korman, 2011; DeJong, Bavelas, & Smock Jordan, 2012; McGee, 1999;
McGee, Del Vento, & Bavelas, 2005).

So what is solution building? SFBT literature has stated the following as components of solution building:
clearly identifying the solution, increasing the client’s awareness of exceptions to the problem, and the client
developing a hope in the future (Berg & Dolan, 2001; De Jong & Berg, 2008; Smock, McCollum, &
Stevenson, 2010). However, until Smock and colleagues’ development of the Solution Building Inventory
(SBI), which was developed to statistically analyze the factors of solution building, no formal study existed on
solution building. Solution building was found to be a one-dimensional construct, including identifying
solutions, exceptions, and hope (Smock et al., 2008). Smock (2007) continued quantitative validation of
solution building by testing the SBI on a clinical population. The results found that the SBI is a reliable
measure of solution building in a clinical population.

Although the statistical constructs of solution building have been identified, the process of solution-
building communication needed to be evaluated. In the late 1990s, Bavelas and her team began using their
methodology, microanalysis of dialogue, to study the detailed moment by moment observable communication
sequences that make solution building co-construction unique (Bavelas et al., 2012). Microanalysis of dialogue
research shows the following details about the process of solution-building co-construction: clinicians use
more positive words than negative (Smock, Froerer, & Bavelas, 2008; Smock, Bavelas, Froerer, Korman, &
De Jong, 2010); clinicians use more of the client’s own words (Bavelas & DeJong, 2008); the content of the
clinicians’ formulations (i.e., echoing, paraphrasing, summarizing what the other person has said) are more
likely to be positive than negative; clinicians more often preserve more of the client’s positive language than
the clients’ negative language (Froerer, 2009); clinicians preserve a significantly higher proportion of the
client’s exact words (adding significantly fewer of the clinician’s interpretations in their formulations; (Bavelas
& DeJong, 2008); and questions and formulations stated by the clinician are primarily positive (Tomorri &
Bavelas, 2007). All of these detailed studies provide insight into the process of solution building co-
construction.

Interventions
Within the process of solution building are specific questions and interventions that aid in identifying the
solution, increasing the client’s awareness of exceptions to the problem and developing a hope in the future.
These interventions are not to be used in a rigid format but should flow out of leading the client to articulate
the steps that will lead them to the desired future.

During this first part of the session, the clinician gets the client to state his goal. From the very first
question, “What will we need to talk about today that would let you know that it was worth coming here
today?” the client responds with his goal. It should be noted that clients don’t always state their workable goal
in the first few utterances of a session. Although most individuals can state why they are seeking therapy, not

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all of them clearly state a workable goal immediately. They may respond by saying, “I am depressed all of the
time.” This statement describes a state of being that is not desirable but doesn’t articulate what the client
would like to happen when he is not depressed. Other models of therapy take clients down the path of being
depressed instead of asking questions that bring clients to describe what they would like their lives to look
like. This difference in focus is considered solution building.

The clinician also takes the opportunity to highlight the client’s exceptions (times when they have been
successful in doing or thinking the things they want to). After the client says, “I have come out to my friends
but just can’t bring myself to talk to my parents about it,” the clinician follows by asking, “So you have already
come out to your friends? How do you do that?” The clinician acknowledges that Cory has already come out
to his friends and asks about the resources he possessed to do that. Cory then responds by saying, “It wasn’t
easy,” and the clinician confirms the difficulty by saying, “Doesn’t sound easy at all.” As previous mentioned,
one key aspect of a workable goal is that it is challenging. Also, the clinician makes sure the other elements of
a useful goal are in place (see previous explanation of workable goals). “(I) really want to have the courage to
tell them. I think it would be a big relief for me” shows that the goal is meaningful to the client and realistic.
“I have been struggling with how to tell my family that I am gay” shows that the goal is concrete. Talking to
his parents is a small, but difficult, task and coming out to his friend is evidence that an exception has
occurred. “But just can’t bring myself to talk to my parents about it” lets the clinician know that this goal
involves hard work.

Once there is a clearly defined goal, the clinician is free to ask the miracle question. Sometimes this occurs
during the first session and sometimes it doesn’t. Some clients begin with well-defined workable goals while
others take some time. De Shazer (1985) provides an option when clients seem highly motivated but are not
able to define a workable goal:

I am so impressed with how hard you have worked on your problem and how clearly you can describe to me the things you have tried so
far to make things better. I can understand why you would be discouraged and frustrated right now. I also agree with you that this is a very
stubborn problem. Because this is such a stubborn problem, I suggest that, between now and the next time we meet, when the problem
happens, you “do something different”…no matter how strange or weird or off-the-wall what you do might seem. The only important
thing is that whatever you decide to do, you need to do something different.

The key to remember is a well-defined workable goal must be in place before the miracle question is asked.
After the miracle question was asked to Cory, he responded by saying, “Hmm. I’m not really sure.” The
clinician just waits after his response to give him a chance to think about his answer more. Cory then says, “I
guess I wouldn’t be worrying when I woke up.” Since the goal is to find out the positive things they will be
doing instead of the unwanted behaviors (like worrying), the clinician asks, “So if you were not worrying when
you first woke up, what would you be doing instead?” Cory answers by saying, “Well [pause] I guess I would
get out of bed when the alarm goes off.” This response is a concrete observable difference that Cory would
notice, which is a goal of asking the miracle question. Gathering a detailed description of life without the
problem will aid in the solution-building process.

The clinician uses a scaling question to get a clearer picture of the steps that will lead to the client’s
preferred future. There are different types of scaling questions that a clinician can ask (goal, confidence, etc.).
In this example, the clinician asked, “So let’s say on a scale from 1 to 10 that a 10 represents you being

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yourself, totally comfortable with yourself just like the day after the miracle and 1 being furthest from that.
Where would you put yourself on this scale today?” Cory answered this question by stating, “Well…I don’t
know.” It is not uncommon for clients to initially answer with “I don’t know.” One way to respond is to say
what the clinician said in this example, “That’s ok. It sometimes takes a bit to think about this.” This gives the
client permission to take as long as needed to answer the question yet doesn’t let the client off the hook. If a
client continues to struggle, the clinician is asking the wrong question and is not following the client. Another
way to handle the “I don’t know” response is to ask the client what others would notice. The clinician can say,
“Where would your best friend say you are on the scale?”

After the session break, it is customary for the clinician to give the client compliments based on what the
client has said they are doing well, are proud of, or like about themselves. Compliments are not based on what
the clinician thinks is the client’s strength but what the client thinks are his strengths. Then, the clinician
gives the client an assignment. In the previous example, the clinician asks, “What would you need to do
between now and the next time we meet to move you closer to your goal?” This question allows the client to
come up with his own homework.

Summary
So how is solution building a useful approach for the LGBTQ population? First, given the strengths, issues,
and barriers to treatment that LGBTQ individuals and couples face, using an approach that emphasizes the
client’s resources is helpful. Second, it is important to use an approach that focuses on the client’s needs and
issues (Giammattei & Green, 2012), the exact perspective that SFBT takes by seeing the client as the expert
of themselves. Finally, the co-construction process of solution building uses more positive words and more of
the clients’ positive and exact words, which is empowering. Solution building co-construction offers each
client hope while highlighting the positive things they are already doing.

FURTHER LEARNING
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York: Routledge.
Buhrke, R. A. (1989). Incorporating lesbian and gay issues into counselor training: A resource guide. Journal
of Counseling & Development, 68(1), 77–80.
de Shazer, S., Dolan, Y., Korman, H., Trepper, T., McCollum, E. E., & Berg, I. K. (2007). More than
miracles: The state of the art of solution-focused brief therapy. New York: Haworth.
Fiske, H. (2003). Treating transgendered clients: Suicide risk. Proceedings, American Association of
Suicidology Annual Conference, 36.
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 and lesbian adjustment issues. Journal of Mental Health Counseling, 16(2), 163–173.
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 11
Solution-Focused Approach With Clients
With Disabilities
Adam S. Froerer, Ednalice Pagan-Romney

Introduction
The Americans with Disabilities Act (ADA) of 2008 defines disability as a physical or mental impairment
that significantly limits a major life activity, or having a record of such impairment, or being regarded as
having such impairment because of an actual or perceived physical or mental impairment. Some disabilities are
relatively limited in duration; others can extend across a lifetime. Disabilities include physical, mental, and
sensory difficulties that affect an individual’s ability to engage in daily activities (U.S. Department of Health
and Human Services, 2005). In 2010, the U.S. Census (U.S. Census Bureau, 2010) reported that roughly 57
million individuals (18.7%) had a disability in the United States and that approximately 38 million of these
individuals had severe disabilities. About 9% (5 million) of disabled individuals were 14 years old or younger;
39% (22 million) were 15 to 20 years old; 18% (10 million) were between the ages of 21 and 64; and the
remaining 34% (19 million) of the individuals with disabilities were 65 years of age or older.

It is also important to note that individuals who are low income and racial minorities are more likely than
others to experience chronic illnesses and to have less than optimal outcomes because of these chronic illnesses
than individuals from higher income categories or nonminority individuals (Alter et al., 2006; Dalstra et al.,
2005). Despite this disparity, medical or health concerns are not limited to one particular group of people but
rather can cross all demographic lines.

Persons with disabilities often experience discrimination or oppressions because of their physical or mental
states (APA, 2012). Attitudes toward impairments are the results of social constructions, and many abled and
disabled people tend to reject individuals who have physical disabilities (Rosenblum & Travis, 2008). These
rejections come from ideal beliefs of physical attractiveness and “the perfect body” held by many in society.
Individuals who do not have “the perfect body” may feel inadequate, have low self-esteem, or be depressed.
People with disabilities may also face psychological distress because of the social implications of their
impairment. Huijgevoort (2002) explains that individuals with disabilities are undervalued and are often seen
to fill the lowest position in society. This situation occurs because disabilities have contributed to an individual
being unable to compete at the same level with an individual without a disability. Society’s rejection of these
individuals may create feelings of inadequacy to develop social relationships with the nondisabled population.

Clinical Issues for Clients With Disabilities

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Individuals with disabilities can be impacted by or deal with any issue or problem that nondisabled individuals
can deal with. It is important to note that managing a disability may or may not be related to why individuals,
couples, or families choose to seek counseling. It would be a mistake for clinicians working with disabled
individuals or their family members to assume that a client’s disability or illness is the reason the client(s)
is/are presenting for therapy. Instead, clinicians should take time to work collaboratively with their clients to
understand what the client would like to get out of therapy or how therapy might be helpful, regardless of
their ability status. This is just one of many reasons why solution-focused brief therapy (SFBT) is a good fit
for clients with disabilities as a therapeutic modality.

In addition to dealing with the traditional issues that nondisabled individuals manage, disabled individuals
may encounter added stress or challenges related to their disability or illness. Following is a list of potential
clinical issues that may be unique to this population. This list is not exhaustive but may provide clinicians with
ideas about issues disabled individuals may encounter.

• Discrimination or prejudice from abled individuals or other disabled individuals

• Physical discomfort
• Emotional stress/discomfort (i.e., depression, anxiety, etc.)
• Disrupted or changed relationships
• Potential impact on sex life
• Loss of life plans/Development of new life plans
• Anticipatory loss (Rolland, 1994)
• The need for help in preparing for future development of the illness
• Changing roles within the family
• Managing new or ongoing medical needs and multiple doctor visits
• Addressing religious or spiritual impacts of illness or disability
• Potential change in job status because of illness or disability
• Change or loss of identity
• Challenges in relating to others
• Difficulty in asking for help when needed

When considering the clinical issues that disabled individuals may have, it is important to remember the
uniqueness of each client and meet them where they are. One way this can be done is by considering the
variations within disabilities or illnesses. Rolland (1994) mentioned that illnesses and/or disabilities can
subjectively be mapped using four criteria and that this mapping may help orient clinicians working with this
population. Rolland suggests considering (1) the onset of the illness (acute vs. gradual), (2) the course of the
illness (progressive vs. constant vs. relapsing), (3) the outcome (nonfatal vs. shortened life span or sudden
death vs. fatal), and (4) incapacitation (none vs. mild vs. moderate vs. severe). Understandably, variations
within this typology may impact a client’s perspective about their illness or disability as well as their perception
of therapy, the clinical issues they would like to address in therapy, and what their goals are in relation to
therapy and their disability. In addition, variations among clients’ typology should impact the language an
SFBT clinician uses in collaborating with their clients. For example, the questions and formulations SFBT
clinicians use with their clients will differ if they are working with a client with a progressive disability

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(worsening over time) versus a constant stabilized disability (unchanging over time). In addition, this typology
helps provide a framework for understanding the client’s preferred future or details the client mentions within
their future, solution-focused goal. Having an understanding of this typology will aid the clinician in meeting
their clients where they are.

Some factors that have shown to impact recovery from illness or disease are socioeconomic status (SES) and
ability to change behavior. SES and membership in a minority group are frequently cited as sources of
disparities. Mwachofi and Broyles (2008) indicated that individuals with lower SES tend to experience higher
disability rates than those with higher SES. Compared with whites, members of minority groups experience
poorer health status and greater disability (Institute of Medicine, 2002). A clinician working with a disabled
population would do well to assess other diversity factors that might intersect with a client’s disability. SFBT
clinicians are particularly suited for this role, given the individualized nature of the co-constructed
conversation. Specific tools and techniques to manage this will be detailed later in the chapter.

Focusing on behavior change for individuals with disabilities has also been shown to be an effective strategy
to prevent further morbidity and mortality. Clinicians in medical rehabilitation settings likely have a higher
chance to help disabled individuals learn how to improve their health behaviors and maintain behavior
changes after discharge (Schwarzer, Lippke, & Luszczynska, 2011). However, by focusing on a client’s
preferred future, strengths, and resources, any clinician can help a client change his behavior.

According to the American Psychological Association (APA, 2012), disability is a biopsychosocial

construct that reflects a dynamic interaction of individuals with their various environments. Thus, mental
health professionals may enhance the therapeutic interaction by collaborating with clients who have
disabilities and the systems that affect them (APA, 2012). One evidence-based approach that can be used
effectively with individuals with disabilities is SFBT.

Solution-Focused Brief Therapy

SFBT is a therapeutic practice that is characterized more as a pragmatic approach rather than a theoretical
approach to therapy (de Shazer et al., 2007). The major guidelines for the model may impact the way therapy
looks significantly when working with individuals with disabilities. In the following section, some of the major
tenets of the model (de Shazer et al., 2007) will be reviewed, with specific attention to the implications for
working with individuals with disabilities.

If it isn’t broken, don’t fix it. SFBT is known for attending only to the areas the client mentions as a concern
and co-constructing a conversation that is helpful for the client. It is not the job of the clinician to intervene
somewhere that the client has not directed. This may be particularly true for clients with disabilities. A
clinician should not assume that simply because a client has a disability that this is the reason they are
presenting for therapy. Generally, the client will mention if the disability is linked to the presenting problem.
However, given that individuals with disabilities have continually been marginalized within many cultures,
some of the onus may fall to the clinician to mention the disability to convey acceptance of the client and to
show understanding for their unique challenges and the possibility that they have experienced discrimination
or oppression. There is a risk that a SFBT clinician could become “solution-forced” and perpetuate oppression

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of disabled clients by insinuating that talking about their disability is not relevant to the solution but is instead
considered problem-talk. SFBT clinicians cannot risk overlooking what may be a defining aspect of a client’s
life by ignoring the client’s disability. The SFBT clinicians will generally address these areas in a tentative way
with the client to give the client an opportunity to discuss whether her disability status is contributing to her
presenting problem for therapy. Following are some examples of possible approaches:

Example 1: Clinician (talking with a visually impaired client): Given what you have told me so far about feeling misunderstood, I’m
wondering how you have managed to cope, particularly with the added stress of your visual status.

Asking the coping question can provide clients with the opportunity to discuss difficult aspects of their
lives, as well as how they have managed to deal with these challenges. Inherent in their coping is an account of
their problem. However, by focusing on the coping aspect, clients are able to recognize their strengths and
abilities and stay true to the solution-focused model.

Example 2: Clinician (talking with a client with a learning disability): What things might you have to be thoughtful about, given your
learning disability, as you think about moving to a six on your scale?

This question allows clients to maintain a future focus while discussing the real impact their disability may
have on moving toward their preferred future.

The solution is not necessarily directly related to the problem. This may be particularly true for clients with
disabilities. For clients whose disability or illness is the presenting problem, their solution (or what their
preferred future will look like) may need to include the reality that the disability or illness will never change or
be cured. Their solution, or what will make a difference to them, will most likely be something other than, “I
will be cured.” Examples of alternative solutions that are unrelated to the problem of a disability may include
things like:

• “I am getting along with my partner better.”

• “I find my job satisfying and fulfilling.”
• “I’m taking time to do things just for me.”
• “I get enough sleep at night.”

In addition, clinicians need to be careful not to assume that a client’s disability or illness needs to change in
order for the client to feel that therapy has been useful. Again, clients may present with any number of
presenting problems, and their solutions may have nothing to do with their disability status.

No problem happens all of the time; there are always exceptions that can be utilized. (de Shazer et al., 2007). This is
important to mention, particularly with clients with disabilities, because it can happen that these individuals
may suffer from tunnel vision and only see how their disabilities are negatively impacting their lives. Helping
clients to look for exceptions, or times when they are coping better, or when their disabilities are not getting in
the way of their success, is important for engendering hope and co-constructing a preferred future. By
identifying exceptions to the problem, clients will be able to more fully take stock of their strengths and
abilities.

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Strengths and Protective Factors
From a SFBT perspective, the client is considered the expert of their life; this is particularly true for clients
with disabilities (Roeden, Bannink, Maaskant, & Curfs, 2009). There is no way for the clinician to know
what life has been like for clients, what struggles or challenges they have faced or overcome, or how clients
have managed to cope with their illness or disability. The SFBT clinician takes the stance that disabled
clients, like all clients, have the competence and resources they need to be successful or to make needed
changes (Roeden et al., 2009). In addition, any past successes mentioned by the client can be considered
exceptions or ideas that might be useful again.

An inherent strength within clients with illnesses or disabilities is that they have each successfully coped
with their conditions to some degree. Perhaps an individual is not satisfied with his level of coping, but the
fact that he has shown up for counseling is an indication that he has effectively coped in some way. It is
important for the SFBT clinicians to acknowledge and highlight this coping and question the client about
what has made this level of coping manageable. Following is an example of a SFBT clinician talking with a
client diagnosed with multiple sclerosis about coping:

Clinician: Given all of this discomfort and pain you’re experiencing, how have you
managed to cope so far?
Client: I don’t know. I don’t feel like I’m coping very well.
Clinician: Are there times when you cope better than other times?
Client: I suppose if my kids are coming over, I put on a tough face for them. I don’t
want them to think I’m not doing well. I don’t want them to worry.
Clinician: So, if your kids are coming over you are able to cope better. Focus on
something other than the pain?
Client: I guess so, I hadn’t really thought about it like that before. I still feel the
pain when they are around, but I guess I just have more of my attention on
something else. It’s not like it goes away, I just seem to manage a little
better.

Another strength for this population is that many clients with disabilities have learned to juggle the several
components of care. Possible areas of strength may include the following:

• Maneuvering the medical professionals and appointments

• Navigating insurance or third-party payment providers
• Accessing support groups or therapy services
• Communicating their needs to employers or schools
• Garnering support from family members and friends
• Incorporating self-care activities into their lives

Another aspect that can be a strength for many individuals is knowing when enough is enough. They are
aware of their limits and how to manage with those limits. Discussing their access to outside resources and

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how they have advocated for themselves can be useful. Using SFBT techniques to help identify small steps
they have taken, and can continue to take, can help lead to their preferred future.

Techniques and Case Examples

Miracle Question
The miracle question is a way to help clients articulate what their preferred future might look like (Trepper
et al., 2010). When working with clients with disabilities or clients who have chronic or terminal illnesses, it is
important for clinicians to remember that the client’s condition(s) may not change or may not be curable.
Sometimes clinicians and clients misunderstand the intent of the miracle question and interpret it to mean
that once the miracle has taken place, the client’s disability or condition would be gone or cured. Despite the
fact that some medical conditions may never change, or may even worsen over time, the miracle question can
be a useful tool to use to help clients articulate what their desired future will look like, despite the ongoing
presence of their illness or disability. Clinicians should carefully word the miracle question to incorporate the
client’s language regarding their preferred future while making it clear that they are not magically removing a
real, unchangeable condition for the client. By using the language of the client and by ensuring that the client
understands that the miracle may be present, despite the presence of the problem, the clinician also helps the
client know that they are not minimizing the potential pain or impact of the client’s disability or illness.

The following case example will illustrate how the miracle question might be used with a client diagnosed
with leukemia who recently relapsed for the second time after a short stage of remission. The client is
enduring ongoing chemotherapy treatment and will continue this treatment for at least two more years.

Clinician: [Concluding the miracle question with…] So tomorrow if you woke

up and knew that you were going to “live your life to the fullest” and
that “you weren’t going to sweat the little stuff” [both things the client
mentioned earlier in the session], what would be the first hint to you
that would let you know that this shift had taken place during the
night?
Client: Do you mean that I didn’t have cancer anymore?
Clinician: No, you still had cancer, but you were able to “live your life to the
fullest” and that “you weren’t going to sweat the small stuff,” even
though your cancer status hadn’t changed.
Client: Well, I guess that I wouldn’t be so mad all of the time.
Clinician: You wouldn’t be so mad all of the time. What might you be feeling
instead?
Client: I guess I wouldn’t focus all of my energy on having cancer. I guess I
would cherish the opportunity to spend time with my partner and my
kids.
Clinician: So if this shift had taken place overnight, you would notice that you

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 felt happy to have the time to spend with your partner and your kids.
How would they notice that you were feeling happy to spend time
with them?

In the case example, the clinician clarified that the miracle was not that the client’s cancer was cured, but
rather encouraged the client to think about how life might be different if a miracle took place and the client
was “living their life to the fullest” with cancer.

Relationship Questions
Relationship questions can also be useful with disabled clients because it may be difficult for them to
identify a preferred future or any exception to the problem given their current situation or disabled state.
Relationship questions ask the client to think about how others might react if something were to change
about the situation. In the following section, Steve de Shazer talks with a client who was recently in a car
accident that resulted in him being paralyzed from the waist down and confined to a wheelchair. The client is
relatively hopeless about things getting any better. De Shazer (Solution-Focused Brief Therapy, 2008) uses a
series of relationship questions to highlight how the client’s mother would know that attending therapy was
helpful.

de Shazer: So, uh, how do you think your mother, perhaps, or your best friend
would know that your coming here today (maybe not just today, but
your coming here to see us), it turns out to be in some way useful, how
would your mother know this?
Client: Umm, That’s a hard question.
de Shazer: Yeah, umm, they pay me to ask the hard questions.
Client: Yeah. Umm, maybe, maybe if I said good morning to her or hi or
something like that in the morning.
de Shazer: Um hmm. That would be a surprise to her?
Client: Yeah, yeah. Probably, yeah.
de Shazer: Okay, and, uh, what would she do, do you think? How would she
react?
Client: Uh, well she’s, my mom can be overly emotional, so maybe she might
even cry or go overboard with it.
de Shazer: Somehow overboard?
Client: Um hmm.
de Shazer: And if she goes overboard somehow, how are you going to react to
that?

Steve de Shazer continually follows up with the client to create a clear picture of how his mother might
react if coming to therapy was useful for the client. Getting this detailed account, through relationship
questions, from what the client thinks his mother might notice, allowed the client to answer the question with

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something other than “I don’t know” and to provide rich details the client might notice going forward.

Coping Questions
Coping questions are used by SFBT clinicians to show understanding of the client’s difficult situations or
lack of progress or to show empathy for the client without creating a situation where the session dialogue
becomes bogged down by problem-talk. Coping questions allow clients an opportunity to evaluate their own
strengths and resources within a difficult situation and help them recognize, even in the face of a real
challenge, they are not completely helpless.

Following, a case example is used to show how coping questions can be used with clients with disabilities.
Jamie, a 36-year-old woman, presented for therapy because she had been experiencing depression and feelings
of worthlessness for approximately eight months. Jamie commented that her depression began after a recent
surgery and was exacerbated because she was passed over for a job position she applied for. Jamie is paralyzed
from the waist down and experiences slow speech patterns because of needing a ventilator to assist her in
breathing. Jamie commented that the spokesperson for the company she applied to informed her that she did
not get the job because they did not believe she would be able to complete the required tasks of the position
without abundant assistance from her coworkers. Although the company spokesperson did not overtly
comment on Jamie’s ability status, Jamie was confident that she did not get the job because of her disability.

Jamie: I don’t know why I even bother anymore. I am so sick of being turned
down. No one is ever going to be interested in giving someone like me
a job. Why does this keep happening to me?
Clinician: I can tell this is really disappointing for you. It sounds like you have
been down this road several times before. How have you managed to
keep your head up in the face of these disappointments and being
dismissed?
Jamie: I don’t think I have kept my head up. I just keep getting more and
more depressed. I’m so tired of this!
Clinician: This is really getting to you. Something that really stands out to me is
that you’ve kept going multiple times, despite feeling depressed and
being overlooked; what is it about you that allows you to push through
the depression? How is it that you have continued to cope, even a
little, with these feelings of depression?
Jamie: I don’t think I have a choice. If something bad happens or if someone
is dismissive I just have to keep going; what else can I do?
Clinician: You just persevere. You just keep going.
Jamie: Yeah. I just find myself pushing through.
Clinician: I’m impressed that you push through. I think others might have given
up by now. How have you managed to just keep pushing through?
What is it about you that has made that possible?

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 This example highlights that at times the clinician may need to ask a coping question multiple times,
perhaps in different ways. Continuing to focus on how the client has coped with her challenges allowed the
client to begin shifting her language from problem-talk to solution-building language. This example
highlights that the client has been coping, at least a little, and has not given up completely. It is important to
note that the clinician could easily have focused on the potential discrimination the client experienced or the
depression that resulted from being turned down. The clinician focused instead on how the client has been
coping with these issues; these coping questions help amplify possible ways the client might proceed. These
coping questions could be followed up with exception questions to keep the solution-building conversation
going. It might also be important to acknowledge the discrimination or oppression and talk with clients about
ways they would like to cope with these things going forward as well as what has worked for them in the past
when dealing with discrimination.

Exception Questions
A client with a learning disability is talking with a clinician about his inability to concentrate during school.

Client: I just can’t do well in school. I’m always distracted and I can’t
concentrate. I just feel stupid all the time.
Clinician: Can you tell me about a time recently where you were able to
concentrate a little better than usual?
Client: I can’t remember a time like that.
Clinician: You can’t remember. Has your teacher ever mentioned that you were
paying attention during class?
Client: Sometimes.
Clinician: That has happened before? What did you do to make her say that?

In this example, the therapist asks about times when the client was able to concentrate, despite his learning
disability. The client, after some effort by the therapist, was able to identify exceptions to his problem by
telling the therapist about times when his teacher complimented him on paying attention during class. From
this point, the therapist could continue to solution build with the client by getting a detailed description about
what the client was doing during these exception times. The therapist could further collaborate with the client
by asking scaling questions.

Scaling Questions
Mario was a 10-year old boy who was in a head-on car accident, which resulted in him being trapped inside
of his car with his leg pinned in place and crushed for almost one hour before the paramedics were able to free
him and rush him to a nearby hospital. Mario, suffering from an acute disability, was referred to a SFBT
clinician who served as part of a multidisciplinary team for pediatric patients within a hospital setting. The
clinician met Mario on his third day in the hospital and one day after he had major surgery on his leg. Mario
was in a full lower-body cast that left only his toes exposed. In addition, Mario’s injured leg was supported by
several large metal pins that protruded through the cast. Mario was referred to the clinician because of

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significant anxiety about having his leg touched and therefore experiencing pain. Mario’s anxiety was also
prevalent when he heard medical sirens on ambulances or police vehicles, since these reminded Mario of being
trapped in his car during the accident and hearing similar sirens at that time. The medical staff reported that
Mario was uncontrollable because of this anxiety and that their attempts at providing adequate medical
treatment were being thwarted by his behavioral outbursts during his panic.

Clinician: Mario, it sounds like you have been through a lot lately. Can you tell
me what has been helpful for you since you got here to the hospital?
Mario: My grandpa.
Clinician: Having your grandpa here is helpful. What does your grandpa do that
is so helpful?
Mario: He talks to me and tells me funny jokes.
Clinician: What else does you grandpa do that is helpful?
Mario: When I get scared, he holds my hand and tells the doctors not to
touch my leg too much.
Clinician: If I asked you to tell me how helpful it was for your grandpa to hold
your hand what would you tell me?
Mario: Really helpful.
Clinician: Let me ask you in another way, think about a number 1 through 10.
Let’s say that 10 is the most helpful that anyone could be, maybe 5 was
only kind of helpful, 3 wasn’t very helpful, and 1 was not helpful at all.
What number would you say having your grandpa here has been? You
can pick any number between 1 and 10.
Mario: I think 10.
Clinician: 10 really? You’re very lucky. Is there anything else that has happened
here at the hospital that you would say is as helpful as your grandpa?
Mario: No.
Clinician: Is there anything that helps you as much as an 8?

This example shows how the scaling question can be modified when working with a child. In this example,
the clinician provided a little more information about the numbers so that the client, who is only 10 years old,
would understand what the clinician was asking. It should also be noted that the scaling question was not
altered much given the disabled status of this client. This example illustrates that using the clients’ language
and meeting clients where they are is more important than overtly focusing on the disability or illness. SFBT
is an approach that uses the strengths and abilities of a client to co-construct a preferred future for the client.

Summary
Although some modifications may be needed when working with individuals with disabilities, SFBT is an

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ideal approach to use with this population. Relying on the client, as the expert, and meeting the client where
they are by using their unique language, allows the client and clinician to work together in a meaningful way
to build solutions. SFBT clinicians should trust that the model will work and use the approach to help
disabled and nondisabled clients move toward their desired future.

FURTHER LEARNING

Books:

Doing Something Different: Solution-Focused Brief Therapy Practices edited by Thorana S. Nelson (2010)
This book has three specific chapters that are related to using SFBT with clients with disabilities or chronic
illnesses, which are: (1) Chapter 25, Extreme Listening: Taught by People With Asperger’s Syndrome by Vicky
Bliss, (2) Chapter 31, Diabetes Education and Support Group: A Different Conversation by Tommie V. Boyd
and Yulia Watters, and (3) Chapter 51, Psychiatry Should Be a Parenthesis in People’s Lives by Harry Korman.

Families, Illness, & Disability: An Integrated Treatment Model by John S. Rolland, M.D. (1994)
This book provides a comprehensive overview of clinical issues encountered by clients with disabilities as
well as assessment guidelines and treatment approaches to use with this population.

Living Beyond Loss: Death in the Family (2nd ed.) edited by Froma Walsh and Monica McGoldrick (2004)
This book gives valuable insight into working with clients dealing with death and loss, an element of
clinical care that is often closely related to disability and illness.

What Psychotherapists Should Know About Disability by Rhoda Olkin (1999)

This book provides a comprehensive consideration of the issues related to disability and what therapists
should consider when working with this population.

Articles:

“Creativity and Solution-Focused Counseling for a Child With Chronic Illness” by Rebecca K. Frels, Elsa
Soto Leggett, and Patricia S. Larocca from the Journal of Creativity in Mental Health (2009)
“Solution-Focused Brief Therapy With Persons With Intellectual Disabilities” by John M. Roeden, Fredrike
P. Bannink, Marian A. Maaskant, and Leopold M. G. Curfs from the Journal of Policy and Practice in
Intellectual Disabilities (2009)

Videos:

Dying Well with Insoo Kim Berg. In this video, Berg works with a woman diagnosed with HIV/AIDS who is
approaching the end of her life (Available through www.sfbta.org).
I Want to Want To with Steve de Shazer. de Shazer works with a man confined to a wheelchair (Available
through www.sfbta.org).

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Websites:
The following websites offer information and resources as well as references to other websites for
individuals with disabilities.

http://www.disability.gov
http://www.findingdulcinea.com/guides/Health/Physical-Disabilities.pg_0.html

DISCUSSION QUESTIONS
The following is a list of questions that could be used by SFBT instructors or trainers to help teach others to
use SFBT with clients with disabilities:

1. What thoughts or feelings do you have when working with clients with physical or mental disorders?
2. What thoughts or feelings do you have when working with clients with chronic or terminal illnesses?
3. How do you manage these thoughts or feelings?
4. Do you think SFBT can work for people with disabilities or chronic/terminal illness? Why/why not?
5. How might you balance focusing on the future while not ignoring the past or current pain that
individuals with disabilities have faced, either because of their disability/illness or because of
discrimination or oppression they have suffered due to their disability/illness?
6. What are the areas of strength or competence you see in your clients with disabilities? What other
possible strengths or competencies might other individuals with disabilities have? How could you draw
on those strengths in your therapy?

REFERENCES
Alter, D. A., Chang, A., Austin, P.C., Mustart, C., Iron, K., Williams, J. L., et al. (2006). Socioeconomic
status and mortality after acute myocardial infarction. Annals of Internal Medicine, 144, 82–93.
American Psychological Association. (2012). Guidelines for assessment of and intervention with persons with
disabilities. American Psychologist, 67(1), 43–62. doi: 10.1037/a0025892
Americans With Disabilities Act (ADA) Amendments Act of 2008, Pub. L. No. 110–325, 42 U.S.C.A. §
12101.
Dalstra, J. A., Kunst, A. E., Borrell, C., Breeze, E., Cambois, E., Costa, G., . . . Mackenbach J. P. (2005).
Socioeconomic differences in the prevalence of common chronic diseases: An overview of eight European
countries. International Journal of Epidemiology, 34, 316–326.
de Shazer, S. Dolan, Y., Korman, H., Trepper, T., McCollum, E., & Berg, I. K. (2007). More than miracles:
The state of the art of solution-focused brief therapy. New York: Routledge.
Frels, R. K., Leggett, E. S., & Larocca, P. S. (2009). Creativity and solution-focused counseling for a child
with chronic illness in Journal of Creativity in Mental Health, 4, 308–319.
Huijgevoort van, T. (2002). Coping with a visual impairment through self-investigation. Journal of Visual
Impairment & Blindness, 96(11) 783–795.

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Institute of Medicine. (2002). Unequal treatment confronting racial and ethnic disparities in healthcare.
Washington, DC: National Academy Press.
Mwachofi, A. K., & Broyles, R. (2008). Is minority status a more consistent predictor of disability than
socioeconomic status? Journal of Disability Policy Studies, 19(1), 34–43. doi: 10.1177/1044207308315275
Nelson, T. S. (Ed). (2010). Doing something different: Solution-focused brief therapy practices. New York:
Routledge.
Roeden, J. M., Bannink, F. P., Maaskant, M. A., & Curfs, L. M. G. (2009). Solution-focused brief therapy
with persons with intellectual disabilities. Journal of Policy and Practice in Intellectual Disabilities, 6(4), 253–
259.
Rolland, J. S. (1994). Families, illness, & disability: An integrated treatment model. New York: Basic Books.
Rosenblum, K. E., & Travis, T. M. C. (2008). The meaning of difference: American construction of race, sex and
gender, social class, sexual orientation, and disability. New York: McGraw-Hill.
Schwarzer, R., Lippke, S., & Luszczynska, A. (2011). Mechanisms of health behavior change in persons with
chronic illness or disability: The health action process approach (HAPA). Rehabilitation Psychology, 56(3),
161–170. doi: 10.1037/a0024509
Solution-Focused Brief Therapy. (2008a). Dying well. Retrieved from http://www.sfbta.org/dvds.html.
Solution-Focused Brief Therapy. (2008b). I want to want to. Retrieved from http://sfbta.org/dvds.html.
Trepper, T. S., McCollum, E. E., De Jong, P., Korman, H., Gingerich, W., & Franklin, C. (2010). Solution-
focused therapy treatment manual for working with individuals. Retrieved from http://sfbta.org/research.html.
U.S. Census Bureau. (2010). Census 2010 Profile America Facts for Features 20th Anniversary of Americans with
Disabilities Act: July 26. Retrieved from
http://www.census.gov/newsroom/releases/archives/facts_for_features_special_editions/cb10-ff13.html.
U.S. Department of Health and Human Services. (2005). The surgeon general’s call to action to improve the
health and wellness of persons with disabilities. Retrieved from
http://www.surgeongeneral.gov/library/disabilities/.
Walsh, F., & McGoldrick, M. (Eds.). (2004). Living beyond loss: Death in the family (2nd ed.). New York:
Norton.

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 12
Solution-Focused Approach With
Economically Poor Clients
Brandy R. Maynard, Michael S. Kelly

M ore than 46 million people live below the poverty line in the United States, the largest number since
poverty estimates were published 52 years ago (DeNavas-Walt, Proctor, & Smith, 2011). The rates of
poverty, as defined by income thresholds determined by the Office of Management and Budget, have been on
the rise for the past three consecutive years, from 12.5 percent in 2007 to 15.1 percent in 2010. The great
recession of this decade has contributed to widening income inequality and a growing perception that specific
groups (young, non-college-educated men, older working Americans who aren’t yet eligible for Social Security
or Medicare, single mothers) are suffering heavily through this economic downturn and may come to form a
new “underclass” in the coming decade (Tavernise, 2011). Although poverty can affect anyone, the incidence
of poverty is particularly pronounced for children, who experience poverty disproportionally from adults, and
African American, Hispanic, and Native American minority groups, who experience poverty disproportionally
from white, non-Hispanics (DeNavas-Walt et al., 2011). Poverty is not only a prevalent problem in the
United States, but it is a significant social and health issue, linked to myriad social, emotional, behavioral, and
health problems for those living at or near the poverty line for any length of time.

Solution-focused brief therapy (SFBT) is particularly relevant and potentially helpful for clients living in
poverty. From the beginning, SFBT focused on helping clients living in various marginalized communities
(i.e., people who were homeless, people dealing with severe mental illness, people with significant substance
abuse histories), with many, if not most of those clients, living in poverty (Dolan, 2012). More so than many
other therapy approaches that formed around university settings or upper-middle-class client populations,
SFBT was founded at the Brief Family Therapy Center (BFTC) in Milwaukee, largely as an “inner-city
outpatient clinic” (Dolan, 2012). Because of the poor, urban community context in which SFBT was born,
SFBT evolved as an approach that responded to the needs of poor people and sought to identify and build
upon the strengths and possibilities of clients living in poverty.

Clinical Issues for Economically Poor Clients

Research across several decades has established a strong correlation between poverty and mental, emotional,
and behavioral health problems among adults as well as children and youth (Yoshikawa, Aber, & Beardslee,
2012). A review by Neugebauer, Dohrenwend, and Dohrenwend (1980) found psychopathology was at least
two and a half times more prevalent in the lowest social class. More recent studies and reviews of research
have also documented higher prevalence of mental health and substance use disorders in low-income groups
compared with higher income groups across the lifespan (Bassuk, Buckner, Perloff, & Bassuk, 1998; Evans,

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2004; Lorant, Deliege, Eaton, Robert, Philippot, & Ansseau, 2003). As research into the effects of poverty on
mental health has become more sophisticated, greater light is being shed on the causal, mediating, and
moderating processes of the effects of poverty on mental health outcomes. Poverty has been shown to
negatively impact mental health both directly and through mediated pathways (Yoshikawa et al., 2012).
Moreover, as economically poor clients are more likely to be exposed to multiple adverse social and physical
environmental conditions across the ecology, cumulative risk exposure over time has been recognized as a
significant contributor to poverty’s negative impact on mental and behavioral health (Evans, 2004). It is clear
from the growing body of research that poverty plays a significant role in the behavioral, emotional, and
mental health outcomes of children and adults, although a role that is complex and dynamic.

Research on the effects of poverty on the emotional, behavioral, and mental health of children and
adolescents paints a complex but compelling picture of poverty’s negative effects on the mental health of
children and adolescents. Poverty has been linked with depression and suicide risk, anxiety, antisocial and
withdrawn behaviors, social adjustment, and externalizing behaviors to name a few (Dashiff, DiMicco, Myers,
& Sheppard, 2009; Gilman, Kawachi, Fitzmaurice, & Buka, 2003). These negative outcomes occur through
various pathways such as poverty affecting parents’ stress and mental health, parenting behaviors or family
relational processes, which then in turn affects the emotional and behavioral outcomes of children and youth.
Poverty can also impact child and youth outcomes through institutional mechanisms, such as neighborhood
disadvantage, lower quality of neighborhood schools in high-poverty areas, relational characteristics among
neighbors and lack of opportunities in poorer neighborhoods to provide activities that support positive youth
development (Sampson, Morenoff, & Gannon-Rowley, 2002; Small & McDermott, 2006). It is clear that
poverty negatively impacts the mental, emotional, and behavioral health of children and adolescents. The
pathways through which this affect occurs, however, is complex and dynamic, often mediated through parent,
family, neighborhood, school, and other environmental and relational risks to which children and youth in
poverty are multiply and disproportionately exposed.

The association between poverty and mental health problems and poorer prognosis for adults is also well
established (Lorant et al., 2003). In a meta-analysis examining socioeconomic inequalities of depression,
Lorant and colleagues found that low-socioeconomic status individuals were almost twice as likely to be
depressed as more economically advantaged individuals. Bassuk and colleagues (1998) found that low-income
women had higher lifetime and current rates of major depression, substance use, and posttraumatic stress
disorder (PTSD). Research examining the association between poverty and mental health problems in adults
suggests multiple pathways through which poverty impacts mental health. Poverty is strongly associated with
increased stress on individuals and families; financial, parenting, and child care problems; role
conflict/performance; lack of social support; and use of poorer coping strategies (Belle, 1990), which in turn
impact mental health and well-being. Like children, adults living in poverty are exposed to multiple and daily
psychosocial stressors across their ecology, which affects their mental health both directly and indirectly
through mediating pathways.

The clinical issues with which economically poor clients may present, such as depression and anxiety, may
occur more frequently in individuals who are economically poor, but their mental health issues may not differ
diagnostically from those who are more economically advantaged. Nevertheless, clients living in poverty do

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bring particular life experiences and individual, relational, and contextual risk factors that are less common in
the lives of economically advantaged clients. Furthermore, the underlying causal and mediating factors as well
as the daily experiences of people living in poverty differ significantly from those who have greater economic
means, which can profoundly shape their access to mental health treatment as well as the goals and techniques
applied to their unique problems and experiences (Gonzalez, 2005). Therefore, interventions with
economically poor clients need to address not only the mental health symptomatology but also issues and
stressors related to poverty that may be causing, mediating, or exacerbating their mental health symptoms.

A number of interventions and psychotherapies, such as cognitive-behavioral therapy and interpersonal

psychotherapy, have demonstrated effectiveness in treating many of the more common mental health
problems (i.e., depression, anxiety, PTSD, externalizing behaviors in children) that individuals in poverty are
more likely to experience. For children and youth, interventions to prevent or treat mental and behavioral
health problems often target risk factors or mediating mechanisms, whether explicitly or implicitly, that link
poverty to mental health problems (Yoshikawa et al., 2012). In a review by Yoshikawa and colleagues (2012),
the authors concluded that interventions targeting mediating mechanisms related to poverty, if effective, could
have a positive impact on mental, emotional, and behavioral health of children, but there is less evidence that
those interventions affect family poverty itself. The World Health Organization (WHO, 2004) also
concluded that interventions that successfully address poverty could be expected to positively impact mental
health.

Although there are a number of interventions that have demonstrated effectiveness in preventing and
reducing mental health symptomatology in adults and children, fewer studies examine the intervention
specifically with participants who are experiencing poverty or assess differential effects between participants
who are in poverty versus more economically advantaged participants. Thus it is less clear which interventions
work better than others to improve mental, emotional, and/or behavioral health outcomes with clients
experiencing poverty. Research strongly suggests, however, that mental health problems can be prevented and
treated by addressing poverty and the environmental and relational mechanisms resulting from poverty that
are impacting clients’ mental health.

Nonclinical Problems and Issues

As noted earlier, persons living in poverty are at greater risk of developing clinical problems; however, those
living in poverty also disproportionally face nonclinical problems and issues that may or may not be linked in
some way to mental or behavioral health problems. The nonclinical problems and issues faced by clients living
in poverty are varied, with poor clients often facing multiple nonclinical problems. Moreover, the nonclinical
problems and issues more commonly faced by poor clients may also contribute to having less access to quality
mental health treatment and social support (Gonzalez, 2005).

Economically poor children and adults are exposed to more severe and chronic stress and risks than those
not living in poverty (Evans, 2004). Sources of acute and chronic stressors, risks, or events to which poor
persons are disproportionally exposed include poor nutrition and food insecurity, community and family
violence, job insecurity, homelessness, unsafe and unstable housing, family disruption, and health problems
(Belle, 1990; Evans, 2004; Lantz, House, Lepkowski, Williams, Mero, & Chen, 1998; Yoshikawa et al.,

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2012). In addition, children living in poverty are less likely to experience quality learning environments at
home or school and are more likely to experience inconsistent and harsher discipline (Yoshikawa et al., 2012).
Although poor clients are more likely to experience any one of these risks and stressors than those more
economically advantaged, the cumulative effects of multiple risks experienced by those living in poverty is
likely most detrimental to their well-being (Evans, 2004).

Although poor clients are more likely to experience both clinical and nonclinical problems and issues, they
are less likely to have access to health and mental health services, less likely to seek care, and also more likely
to end treatment earlier than those more economically advantaged (Gonzalez, 2005). Poverty also limits access
to material and community resources as well as social supports (Belle, 1990; Yoshikawa et al., 2012). Poor
clients are not only more likely to be exposed to risk and stress but also less likely to have access to the means
or supports to cope with the multiple stressors they experience.

Strengths and Protective Factors

In some ways, the risk and resilience literature was conceived largely to address how people living in states
of deprivation and disadvantage might be supported by protective factors to survive and thrive despite strong
odds against their success. This literature, although far from definitive on the topic, at least established that
people living in poverty can (and do) manage to overcome their day-to-day difficulties and even change their
socioeconomic life circumstances for themselves and their families (Garmezy, 1993; Kumpfer, 1999).

The tendency to talk about people living in poverty as “others” and to objectify their lives in ways that most
policymakers and politicians would never dream of doing with other demographic groups necessarily
complicates any careful read of the risk and resilience literature related to clients living in poverty. Although
liberals can fairly be accused of talking about “the poor” as a monolithic group facing insurmountable societal
and structural disadvantages, conservatives tend to reject ideas about “the poor” as a collective group
altogether, preferring instead to focus on individual factors (often pathological ones rooted in culture or
psychological dysfunction) that contribute to a person remaining in poverty. As with any group that is
caricatured and objectified like poor people are in the United States, the truth is much more complicated and,
indeed, is beyond the scope of this chapter. However, a few important points stand out from the literature
that fit nicely within a conceptual framework of using SFBT to assist clients dealing with poverty, and they
are outlined here:

Clients in poverty want to change their lives and often possess personal, family, and community strengths
that can be mobilized by SFBT to help them make these changes.
Clients in poverty have hope as they look toward the future and can be assisted to increase their sense of
hope with SFBT.
Clients in poverty can see exceptions too, and no matter how dire their circumstances, clients in poverty still
see exceptions in the midst of their situations, and skilled SFBT clinicians can help those clients identify
how these exceptions can be marshaled into becoming “small changes” that grow into larger changes for the
client.

When applying SFBT ideas and techniques to reinforce and build client strengths, and when applying the

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risk and resilience literature to working with clients in poverty, it is important for clinicians to understand how
specific SFBT ideas and techniques (like questions about miracles, exceptions, and future goals) do (or don’t)
work for specific clients who are struggling with poverty. The goal in doing SFBT with clients in poverty is to
create new pathways for clients to solve their own challenges based on the strengths and resources that the
client has identified as being able to be employed. There is, we believe, a risk that clinicians may overdo the
social constructionist side of SFBT with clients in poverty and allow the conversation to enter a zone where
client’s real poverty struggles are diminished and an alternative future is emphasized at the expense of helping
clients identify concrete, practical steps they can take to ameliorate their problems. We will say more about
this risk related to SFBT practice with clients in poverty in the case examples that follow as well as in our
concluding chapter summary.

Case Examples
In this chapter, we will provide an in-depth case example of a single mother, Tonya Williams (TW), and her
multiproblem family situation (names and identifying information have been changed). As will become clear
from the case description that follows, Tonya is a person living in poverty who is trying to help herself and her
family navigate a number of significant personal and systemic barriers in terms of employment, housing,
domestic violence, and substance abuse issues as well schooling and health care for her children. We will first
describe Tonya’s background and then demonstrate how a range of SFBT interventions can be employed to
help Tonya create the conditions to make the changes she wants to make in her situation.

Tonya is a 25-year-old Caucasian woman who comes to her local community mental health center
(CMHC) for counseling for depression. She is a single mother of three boys, ages 3, 6, and 7, each of whom
has a different father. The two oldest boys have neurological complications and learning problems at school
related to Tonya having drunk heavily while she was pregnant with them. The two boys are now in
elementary school, and both have individualized education plans (IEPs) for other health impairment (OHI).
Tonya sought treatment at the CMHC because she has recently relapsed into binge drinking after staying
sober for five years. She told the therapist that she believes she started drinking again because the father of her
youngest son, Tommy, recently become involved again in their lives after leaving them two years ago (she and
Tommy’s dad were never married). Although Tommy and the other boys are excited to see him, the stress
caused by his drinking and violent outbursts are causing her to seek refuge in whiskey again.

Tonya works part time as a cashier at a local big-box store but recently was put on probation after arguing
with her supervisor about her limited hours. Her car was recently stolen, and she is relying on neighbors for
help getting to work. Her mother lives nearby and has been helpful taking care of the boys on nights when
Tonya has to work. In addition to getting low-cost therapy services at the CMHC, Tonya has worked at the
center with her case manager to get her sons psychiatric/neurological treatment through Medicaid, and she
was happy to finally qualify for a public assistance apartment big enough to accommodate her family. What
follows are examples of how in-session solution-building conversations using various SFBT techniques might
work with a client like Tonya, starting with the assessment of presession change.

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Presession Change

Mike Kelly (MK): Hello Tonya, I’m Mike, thanks for coming to meet with me today.
TW: You’re welcome. I appreciate you being able to get me an appointment scheduled so
quickly. That was great.
MK: I know that we have a lot to discuss based on what you shared on your intake form
about your kids and your work situation. Before that, I wanted to ask what changes
have you noticed that have happened or started to happen since you called to make the
appointment for our session?
TW: Hmmm…not much, same old same old. [Pauses] Actually, now that you mention it, I
have noticed that things are a little better at home this past week.
MK: Really, that’s great. What has been better at home this past week?
TW: I don’t know…just the kids, the kids and me, we’re getting along a little better I think.
MK: When you say getting along better, what do you mean? If I could have seen you guys at
home before, what would have been different this past week?
TW: Oh, you wouldn’t want to see my boys when they’re crazy. I tell my girlfriend that
those times I wish I could just send ‘em back to the stork, have him come and take ’em
back! [Laughs] No, lately they’ve been just doing more to help in the new apartment. I
think they’re excited that with our new place, that they all get more space in their
bedroom, and they’ve been playing better with each other, too.
MK: So if these changes for your boys were to continue in this direction, would this be what
you would like to see going forward?
TW: Totally. My boys are good boys (mostly), and I need them to know that this new
apartment is a really special thing for us and that we need to take good care of it. We
waited a long time to get this place.
MK: Since you moved in, what have you noticed about how you’ve changed?
TW: Huh, well, I know that this was on the form I filled out, but you know my drinking,
right…? Well, for some reason, I just don’t want to get drunk in this new place. I went
out after work a few days ago for beers, but I haven’t even brought any whiskey into the
house yet.
MK: That sounds like a big change—how were you able to do that?
TW: I’m not sure…maybe I’m like the boys too. Maybe I’m so excited about the new place
that I don’t want us to screw it up by me getting wasted and doing something stupid.
The landlord doesn’t live in the building, but he’s around all the time and I guess I
don’t want to piss him off.

From the outset, it’s clear that there are significant changes happening in Tonya’s life, even since she made
the appointment last week to come in for therapy. SFBT clinicians are keen to start with finding out how any
presession changes may be under way and to start there if the client identifies anything she thinks is positive.

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It’s very common, as Tonya shows in this excerpt, for clients to not expect this conversation at the start of
therapy. Typically, clients expect therapists to focus on (1) the client’s presenting problem and (2) some
background, often family and psychiatric history. In the case of Tonya and her family, those two topics could
have easily consumed the bulk of the first session. Instead, the SFBT clinician here chose to work first on
learning about what Tonya saw changing in her life already since deciding to seek therapy. Her responses—
about her children’s behavior changes and her decreased drinking—opened up myriad possibilities for goal
setting in this session and future sessions.

Scaling Question
This next excerpt comes later in the first session after more discussion about goal setting for Tonya.

MK: So I want to ask you, are we on track for the two goals you want to work on here?
TW: I think so, though I gotta say they sound pretty overwhelming, too. You said we could
work on my taking charge of our new place in terms of getting the boys to listen and
behave, which is gonna be tough, and then we talked about whether I could keep my
drinking under control for the next week…
MK: I agree that those are both important goals; would you like to focus on them both, or
just pick one to start with?
TW: No, I think we have to talk about me and the boys, together and separate. Things have
to change.
MK: OK, so let’s start with the boys first. If we were to talk next week and you told me
things had kept on getting better with them and how they behave at home, what would
you be telling me about?
TW: Hmmm…well the two biggest things are picking up around the house and listening to
directions the first time I tell them to do something. They are terrible at both of those
things, at least they used to be.
MK: OK, so right now, with the improvement you’ve seen moving into your new place,
where would you rate them on a scale of 1 to 10, with 10 being close to perfect and 1
being not very well behaved at all?
TW: Definitely a 5 for picking up, they’re better but the house still gets so damn messy, you
know?
MK: OK, and how about the following directions one?
TW: Oh hell…a 3, maybe. Maybe!
MK: All right, so if we talked soon, and you told me that the boys had moved from a 5 in
cleaning up and a 3 in listening, to maybe a 7 in cleaning up and a 5 in listening, would
that be progress in your opinion?
TW: Totally. I mean, they are little boys after all. If I had the house mostly cleaned up each
day, at least the TV room and their room, I wouldn’t get so upset.

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MK: So having those two rooms picked up each day, mostly, would look like a 7 to you?
TW: Yeah, and they actually do a lot of it now even before I tell them. My oldest has these
baseball cards and he likes to spread them out, but then he wants to pick them up and
store ’em, too before his brothers mess them up. Once he starts picking them up, his
younger brothers tend to join in.
MK: And what about listening moving up to a 5 from a 3, what would that look like to you?
TW: Well first of all, I wouldn’t have to say something more than, I don’t know, two or
three times. And I wouldn’t have to get up and go over and do it myself, or even yell at
them. I hate it when I yell at them.

As with the presession change, the key to this sequence is to help Tonya set goals that are manageable and
possible, particularly early in therapy. By identifying two specific behaviors that her sons struggle with at
home, it’s possible to then assess how well she can delineate the specific behaviors she wants to see changed
while also privileging her view of the problem over some external authority such as a child-welfare worker,
caseworker, or the clinician. Despite concerns that clients might be too “black-and-white” with this exercise,
it’s been our experience that clients, once they understand the scale, are actually very quick to give a specific
and clear number that fits how they perceive the problem. And although Tonya’s “3” and “5” are themselves
not scientific data points to measure progress, they are nonetheless highly useful clinical data points that can
help groundwork with clients who tend to struggle with getting started on seemingly overwhelming problems.
Having the scale established from Tonya’s perspective also enables the clinician to revisit progress that Tonya
herself has identified as meaningful to her, making it in our experience more likely that she will remember the
goals she has set and work harder to maintain the gains that she sees taking place.

Miracle Question
This next excerpt comes from the fifth session, after Tonya had begun to see herself more positively as
being able to manage her new apartment and her boys’ behavior. This conversation was inspired in part by her
disclosure in this session that despite being able to stay “sober” in her new apartment for six weeks now, she
was starting to anticipate that her drinking might start up again when her ex-boyfriend (Tommy’s dad was
came back in town after a few months away working on a construction job out of state. He called her the
previous evening and told her that he “missed” her, was wanting to get back together, and was ready to change
for her and “for the boys.” Tonya’s initial reaction: “He’s horny and once he gets that from me, it’ll be back to
the same drinking and fighting. I’m sick of it!”

MK: So Tonya, I can tell you that you’re feeling pretty concerned about Tommy’s dad
coming back to town. Maybe this is just a coincidence, but I can’t help but notice that a
lot of these great changes that you and the boys have made have happened mostly
while he was away. Are you worried about what his coming back will do to what you’ve
been working to change?
TW: [Tearing up] I just…I can’t do it anymore. I know he’s Tommy’s daddy and all, and I
love him, but he’s bad for me. I can’t have him in our new place. I know what will

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 happen. He’ll come in with presents for the boys, they’ll jump all over him, and then
after they go to bed, he’ll want to toast his return with me and then it’ll be all over.
MK: What do you mean by “all over?”
TW: We’ll finish a bottle of whiskey together and then he’ll want to get with me and it’ll be
fine for a few days, but then he’ll start his ways, picking on me, yelling at the boys
even…he can’t hold his liquor like I can.
MK: Is that when he became violent before with you and the kids?
TW: Yeah, and I’m worried for the boys but also for the landlord finding out about it and
giving us a hard time. Plus, if I start drinking again—oh, Lord.
MK: So when is he coming back?
TW: Next week—haven’t even told him where our new place is yet. I have this fantasy of
just keeping it from him, but then I know he would find out and it would get even
worse. Plus, the boys love him and I want him to have a relationship with them.
MK: OK, I can hear how important it is that we figure out how to get a handle on how
you’re going to manage all these changes. I want to ask you to think about something
with me, maybe something that might sound a little random or crazy at first, can I ask
you about it?
TW: Sure, it can’t be any crazier than the rest of my life already is [laughing]!
MK: OK, I want you to think about all the complicated stuff we just talked about with
Tommy’s dad, his coming back, how you think it will go, etc., and I want you to
imagine that after we’re done here tonight, you put the boys to bed, and go to sleep.
Meanwhile, in the middle of the night, a miracle happens, and the problems we’ve
been talking about are solved. Only, and this is the crazy part, you don’t know that the
problems have been solved, and you get up and start your day like it was like any other
day. What do you think would be the first sign of a small change that would tip you off
to say, “Wow, something happened—my problem is gone!”
TW: I don’t believe in miracles, that’s just romance novel fantasy [laughing].
MK: I told you it was crazy [laughing, too]…can you tell me what you would see as different
in your life?
TW: I can tell you I would notice something different on that new calendar I put next to the
fridge.
MK: What would you notice?
TW: I can’t believe I’m saying this…I would notice that we had a schedule for when my ex
was going to take the boys out, AWAY from me, and when we might all meet up in a
park or something for me to play with them with him.
MK: Why would that be the first thing you’d notice?
TW: Because it would mean that I had gotten the guts up to tell him that if he wants to be

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 part of the boys’ life, it can’t be here, it can’t be with me, I can’t be his girlfriend
anymore.
MK: That sounds like what you really want for your boys and for yourself.
TW: Yeah. I guess the other thing I would notice on that calendar was a time for me to
start…I don’t know, doing something for ME.

Asking the miracle question involves being ready for a wide range of responses (or no response at all—some
clients, like Tonya, are ambivalent about whether miracles even exist and may dispute the question outright).
In this case, a seemingly chronic and unchangeable situation involving Tonya feeling overpowered by her
feelings for her ex and her sexual and drinking behavior with him became instead a clear and concrete goal:
helping Tonya find a way to set boundaries for her ex to be involved with her boys but not with her. The
image of the calendar also was significant to us as it indicated that Tonya was working hard to organize her
new life in her new apartment and her efforts to manage a chronically disruptive and destructive relationship
with her ex-boyfriend.

Solution-Focused Goals and Homework

In thinking about how to work on goals and homework with clients living in poverty, it is useful to return
to the premise we developed earlier. We are referring specifically to how hard it can be sometimes to “see”
poor clients with their own individuality and strengths while not applying stereotypical, politicized, and
objectified constructs. We say this here because homework with poor clients, while possibly more complicated
by multiproblem situations, should reflect the same kinds of work we might do with clients who aren’t in
poverty. Our clients in poverty often, if anything, have to be more organized and more resourceful in setting
goals and carrying out homework tasks because they are often working with multiple agencies and have fewer
resources and community supports.

It is also helpful here to look at how well the task-centered approach, developed over the last 40 years, can
be integrated with SFBT (Kelly, 2008). We believe that task-centered approaches can help clients in poverty
focus on specific tasks they want to accomplish when they have to balance multiple stressors and time
demands. Above all, we think that what matters most in giving homework with clients living in poverty is that
we empower clients to set their own goals and construct the homework that will help the clients achieve those
goals. Approaching clients as collaborative and empowered agents of their own change increases clients’
engagement and investment in treatment. Moreover, this perspective provides potential solutions and
experiences for clients that likely differ dramatically from how they have likely experienced other agencies or
interventions.

Conclusion and Summary

Research across several decades has firmly established a strong link between poverty and mental, emotional,
and behavioral health problems. The impact of poverty on mental, emotional, and behavioral health problems
is complex and often mediated through a number of environmental and individual factors. Moreover, the lack
of resources and supports not only increases the risks of persons living in poverty but also limits their ability to

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access quality mental health care. Interventions targeting symptoms as well as the life stressors that contribute
to the mental, emotional, and behavioral health problems can be effective in the prevention and treatment of
mental, emotional, and behavioral health disorders for those living in poverty.

This chapter has argued that SFBT is a model that is particularly relevant and can be used effectively with
persons living in poverty. Because SFBT is present/future focused and problems and goals are created jointly
between the client and therapist, SFBT provides opportunities for clients to be empowered and start making
decisions and changes in their lives, which is not often experienced by those living in poverty. By focusing on
using and building client strengths and resources, clients can mobilize and employ natural resources rather
than continuing to rely and depend on formal resources that often limit their power and choices. Also, because
the problems experienced by those living in poverty are daily stressors that cumulate to contribute to mental
health problems, the practical strategies of SFBT can be used to begin ameliorating current stressors in
smaller steps that can provide opportunities for clients to feel successful and empowered. These smaller
successes can then be used as evidence of “exceptions” that can then be used to further advance their progress
toward achieving larger goals.

From our counseling experiences, we have found solution-focused counseling to be an effective and relevant
model for working with persons who are experiencing poverty. Although solution-focused models have been
applied and found to be effective with various problems, there is unfortunately a lack of specific empirical
evidence of the effects of SFBT for persons living in poverty. We recommend future studies of SFBT to
examine effects with persons living in poverty, both in terms of reducing specific symptoms and reducing life
stressors that may be contributing to the mental, emotional, or behavioral health problems and symptoms.

FURTHER LEARNING

Substance Abuse and Mental Health Services Administration (SAMHSA)

SAMHSA is an agency of the U.S. Department of Health and Human Services created to focus attention,
programs, and funding on improving the lives of people with or at risk for mental health and substance abuse
disorders. SAMHSA provides a wealth of information, resources, and publications and provides a searchable,
online registry of more than 240 interventions in the National Registry of Effective Programs and Services.

http://www.samhsa.gov/

World Health Organization (WHO)

The WHO is the directing and coordinating authority for health within the United Nations system. It is
responsible for providing leadership on global health matters, shaping the health research agenda, setting
norms and standards, articulating evidence-based policy options, providing technical support to countries, and
monitoring and assessing health trends. The WHO has produced policy briefs and information sheets related
to mental health and poverty that can be found at:
http://www.who.int/mental_health/policy/development/en/.

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National Center for Children in Poverty (NCCP)
The NCCP is one of the nation’s leading public policy centers dedicated to promoting the economic
security, health, and well-being of America’s low-income families and children. The NCCP provides
resources, information, and publications related to poverty and children, with specific resources related to
mental health and children in poverty.

http://www.nccp.org/topics/mentalhealth.html

ACKNOWLEDGMENTS
The authors would like to acknowledge the Meadows Center for Preventing Educational Risk and the
Institute of Education Sciences grant R324B080008 for providing support. The manuscript content does not
necessarily represent the positions or policies of the funding agencies.

DISCUSSION QUESTIONS
1. Clients in poverty struggle with a range of problems that put them in a seeming state of constant
crisis. Think of a client you know who is living in poverty and detail how you would decide where to start
with them, using the SFBT ideas in this chapter.
2. Despite the emphasis on SFBT ideas being client-centered and concretely linked to specific client goals, it
is possible for a practitioner who is inexperienced using SFBT techniques like the Miracle Question to
create a misleading sense of what SFBT is for clients who are struggling with day-to-day
survival. Discuss how you would manage this tension in your own work e.g. would you ask the Miracle
Question to your clients living in poverty?
3. Thinking of clients you’ve worked with, what are some strengths you’ve noted that appear to be in some
ways related to their experience of living in poverty?
4. This chapter argues that the future-focused and goal-oriented nature of SFBT makes it practical and
potentially effective for clients living in poverty. Critics of SFBT would counter that doing so ignores the
“root causes” of poverty and will only be a band-aid to persistent and chronic problems. How do you view
this debate, thinking of the clients you serve?

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 13
Solution-Focused Approach With
Spiritual or Religious Clients
Michael S. Kelly, Brandy R. Maynard

T his chapter will focus on solution-focused brief therapy (SFBT) practice with clients who self-identify as
spiritual and/or religious. Anyone reading this chapter might understandably ask why this chapter needs
to exist in this volume at all: After all, aren’t spiritual/religious people found in all demographic groups in the
United States? What is so “special” about these clients? We believe that this chapter is necessary because the
field of mental health has struggled to fully account for the ways that religion and spirituality impact clients
and has often either ignored client’s religious beliefs or practices or viewed them as potential barriers to
successful treatment outcomes. In addition, we believe that the principles and techniques of SFBT can be
quite compatible with a variety of these clients’ problems and issues.

Historical Background
The field of mental health is only beginning to acknowledge something any casual student of American
history knows: namely, how important religious liberty has been to the founding and ongoing development of
the United States. This historical fact remains true over 200 years later, with many Americans continuing to
view their faith tradition and related religious practices as a central component of their identity as Americans.
Recent surveys have continued to note that despite seemingly steep declines in religious beliefs and practices
in most industrialized democracies, Americans continue to profess a belief in God and to engage in regular
religious practices like prayer and church attendance (Gallup, 2011; Pew Forum on Religion and Public Life,
2007). According to a recent Gallup Poll, 81% of respondents in the United States reported that religion was
fairly or very important in their lives (Gallup, 2011). A sizable (though smaller) number of Americans tell
survey researchers they reject organized religion but consider themselves to be “spiritual,” favoring the notion
of a “higher power” or spiritual force that is instrumental in affecting their lives.

Religion has historically played an important role in mental health care, with religious institutions
providing much of the mental health care prior to the 19th century (Koenig, 2009). In the 19th century,
however, religion began to be associated with hysteria and neurosis; religious experiences were pathologized by
antireligious intellectuals, such as Charcot and Freud, who had a strong influence on how religion and
religious persons were viewed in the medical and mental health communities (Moreira-Almeida, Neto, &
Koenig, 2006). Studies conducted during the 1950s and 1960s painted a negative picture of the religious
believes, portraying them as distressed, unintelligent, anxious, and symptomatic (Bergin, 1983). Over the past
two decades, however, rigorous research has begun to accumulate in the medical and psychological,
psychiatric, and mental health fields painting a much different picture of religious involvement and mental

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health (Moreira-Almeida et al., 2006). Attitudes toward religiosity and spirituality have been gradually
changing as a result of this large body of research that generally shows positive associations between
religiosity/spirituality and mental health and well-being. This chapter will offer additional details on what we
know about the connection between spiritual/religious beliefs and mental health, as well as numerous ways
that SFBT ideas can be integrated into helping clients who identify as spiritual or religious.

Clinical Issues for Spiritual or Religious Clients

Although there are no clinical problems and issues specific to religious and spiritual clients, spirituality and
religion have been implicated in both contributing to and protecting against mental health problems. Over the
past two decades, the relationship between spirituality and religion with mental and behavioral health has
received increased attention. Hundreds of studies have examined the relationship between religion and mental
health and several large reviews and meta-analyses have been conducted to synthesize this body of research to
try to understand the relationship and mechanisms that may mediate the relationship between
religiosity/spirituality and mental health.

Reviews of research examining the relationship between religion and mental health have found religiosity
and spirituality to be generally associated with lower levels or rates of mental health problems (Hackney &
Sanders, 2003; Koenig, 2009; Wong, Rew, & Slaikeu, 2006). In a review of more than 100 studies examining
the relationship between religion and depression, lower rates and fewer depressive symptoms and fewer
suicides were associated with those who were more religious or spiritual (Koenig, 2009). Of the 93
observational studies in Koenig’s review, only four found a negative association between depression and
religion. Likewise, in a systematic review and meta-analysis of 147 studies examining the relationship between
religiousness and depressive symptoms, a modest but robust association was found between religiousness and
lower levels of depressive symptoms (Smith, McCullough, & Poll, 2003). Smith and colleagues found no
variation in the association by age, gender, or ethnic group, but they did find a stronger association for people
under severe life stress than for those with minimal life stress. Although much of the research in this area is
composed of cross-sectional studies, some longitudinal studies have also found that greater religiousness at
baseline predicted fewer depressive symptoms later (Koenig, 2009).

The relationships between religiosity and spirituality with anxiety and substance abuse have also been found
to be generally positively correlated. In Koenig’s review of 69 observational studies examining the relationship
between anxiety and religiosity, 35 studies found significantly less anxiety or fear among those who were more
religious, 24 found no association and 10 found greater anxiety. In a review of 138 studies examining the
relationship between substance use and religion, significantly less substance use and abuse was found among
the more religious in 90% of the studies (Koenig, 2009). This protective relationship has been identified in
reference to the use and abuse of a wide variety of illicit substances, including tobacco, alcohol, marijuana,
cocaine, and hallucinogens (Hodge, Marsiglia, & Nieri, 2011; Salas-Wright, Vaughn, Hodge, & Perron,
2012). Researchers have also identified religiosity as a factor that can serve to attenuate the relationship
between key individual and community-level risk factors and the use and abuse of illicit substances (Bahr &
Hoffman, 2008; Desmond, Soper, & Kraus, 2011; Fowler, Ahmed, Tompset, Jozefowicz-Simbeni, & Toro,
2008).

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 Research on religiosity/spirituality, as it relates to mental and behavioral health, has begun to move from
examining and describing simple relationships between variables to examining variability in relationships on
various factors and mediating and underlying factors. The relationship between religiosity/spirituality and
mental health has been found to vary on the degree to which religion/spirituality is integrated into one’s life,
demographic characteristics (e.g., age, ethnicity, gender, and socioeconomic status), form of religion, and how
religiosity/spirituality and mental health are defined and measured. Some mechanisms by which religion may
affect mental and behavioral health include social support, cognitive mechanisms, values, belief systems and
worldview, and religious practices such as prayer (Baetz & Toews, 2009). For example, positive correlations
between religiosity and mental health have been found to be mediated, at least in part, by social support and
social activity. Thus religiosity has been found to positively impact one’s level of social support and activity,
which, in turn, is linked to lower depression. Religiosity has also been found to be indirectly related to
substance abuse by means of social-developmental factors in adolescents, such as pro/antisocial bonding and
beliefs about the use of illicit substances (Johnson et al., 2008; Salas-Wright, Vaughn, & Maynard, 2012). For
example, recent studies have found religiosity to be associated with factors such as prosocial beliefs and
prosocial bonding, which, in turn, are negatively associated with adolescent substance use (Johnson et al.,
2008). Although sources of variability and various mechanisms have been identified, research in this area is
still very young and much has yet to be explored. It is likely the mechanisms by which religiosity/spirituality
mediate or impact mental health outcomes is complex and multidimensional and may be moderated by
additional factors as well (Baetz & Toews, 2009).

Although much of the more recent research examining the relationship between religiosity/spirituality and
mental health is generally positive, religion can have a negative impact on psychological well-being and mental
health. Religiosity has been found to increase levels of anxiety and fear, enhance feelings of guilt, reinforce
neurotic tendencies, and be a source of internal and interpersonal strain and conflict (Exline, 2002; Koenig,
2009). Whether religion and spirituality is a source of comfort and strength or a detriment to mental health
and psychosocial well-being, it is clear that religiosity and spirituality play a role in people’s lives that has the
potential to impact their mental and emotional health, either directly or indirectly.

Some research suggests that integrating religiosity and spirituality into counseling could be beneficial to
address mental health problems and needs. Studies have shown that the effects of spiritual interventions or
spiritually modified or accommodative counseling interventions can be more effective or similarly effective
compared to standard approaches (Hodge, 2006; McCullough, 1999; Smith, Bartz, & Richards, 2007). Being
aware of and sensitive to clients’ religious and spiritual beliefs and activities is important when working with
spiritual and religious clients. Moreover, integrating a client’s spirituality or religion in counseling may be
beneficial, particularly when used within a framework, like solution-focused brief therapy (SFBT), that builds
on clients’ strengths and resources. Some scholars have begun to describe how SFBT and religious beliefs can
interact successfully (Frederick, 2008; Guterman & Leite, 2006), though, to our knowledge, no empirical
research exists demonstrating how SFBT and religion work together to improve mental health outcomes.

Strengths and Protective Factors

Religion and spirituality have long been recognized as a source of strength, and evidence continues to

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accumulate on the protective aspects of religion and spirituality. As discussed earlier, religiosity and spirituality
have been positively linked to better mental health and psychosocial well-being. Although religiosity in
general has been found to be protective for substance use and abuse, various components of religiosity—such
as religious service attendance, religious salience, and private prayer or devotion—have also been identified as
important stand-alone protective factors (Longest & Vaisey, 2008; Marsiglia et al., 2005; Miller, Davies, &
Greenwald, 2000). Religion and spirituality can serve as a source of social support and connections to a
community of people thus helping to meet a persons need to belong; provide healthy and positive ways of
coping with life stressors; provide a sense of comfort, meaning and purpose during difficult times; and
promote a more positive worldview and prosocial behaviors (Exline, 2002; Pargament, 2002).

Case Examples
The following case examples are composites of cases from the clinical practice history of the first author and
are intended to illustrate how various techniques of SFBT, namely the miracle question, presession change
and scaling questions, and solution-focused goals and homework, can be used with religious and/or spiritual
clients. These examples describe clients who self-identified as religious and spiritually oriented (indeed, in a
few cases, the clients told me that they came to my private practice because they had been referred by another
friend who said that I was “comfortable” working with clients who were religious).

Miracle Question
The Willards (Pete and Alice) sought therapy as parents to manage their adolescent daughter’s bipolar
disorder. Their 17-year-old daughter, Maddie, had been diagnosed with bipolar disorder two years prior.
Although Maddie’s symptoms were being fairly well managed through medication prescribed by her
consulting psychiatrist and Maddie’s own individual therapy, Mr. and Mrs. Willard reported feeling that they
were still struggling to understand and manage their own feelings about Maddie’s condition. Moreover, they
were having difficulties setting reasonable limits for Maddie’s behavior at home and were being challenged in
helping her begin the process of thinking about life after high school. Several friends in their church had
suggested that they seek their own counseling, and their pastor had referred them to me, saying that I “worked
well with very challenging cases.”

The Willards described the strain that Maddie’s bipolar symptoms placed on them as parents. Alice Willard
said that she had developed sleeping problems and was taking medicine for anxiety symptoms. She added that
she had always had a history of anxiety but that her symptoms had accelerated when Maddie started showing
her bipolar symptoms four years ago. Maddie became prone to staying out late with friends and losing track of
where she was unless her parents texted her reminders of when she needed to be home. Alice found the whole
process of waiting for Maddie to come home (and worrying about what might be happening to her) extremely
stressful. Pete said that his wife’s worry had made him frustrated, as “she worries but then she just shuts down,
and I have to pick up the pieces after whatever argument she gets into with Maddie.” Pete explained that his
contracting business was suffering, as he had to constantly field calls from both Maddie and his wife about
“the latest fight of the day…I’m sick of it. I’ve got a wife who worries too much and a daughter that can’t

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decide if she’s up or down every day!” This case picks up roughly in the middle of the first session after
introductions and discussion around what brought them into counseling:

Michael Kelly (MK): I appreciate you both sharing with me how challenging it’s been to manage Maddie’s
behavior at home and in the community. I can also hear that your experiences of
parenting Maddie together have been challenging at times, though you do both
describe trying to work together as a team.
Pete Willard (PW, We try, we try.
husband of Alice):
Alice Willard (AW, But it’s hard. I wish we could work together better. I wish I was better with Maddie.
wife of Pete):
MK: It’s funny you mention wanting that Alice because I was thinking it might be helpful to
think about how you both and Maddie might be able to be happier at home together
with some changes in how you all do things.
AW: Changes, like your telling us about something we’re doing wrong now?
MK: Not really. I’m more interested in talking to you about what you imagine your life
would be like without your problems with Maddie. I want you to both imagine that
after we finish up tonight, you go home and get ready for the next day. You go to sleep
and while you’re sleeping a miracle happens.
PW: A miracle? Huh? You mean like we have like a visit from an angel or some kind of
religious revelation?
MK: I wasn’t thinking of a specific angel that comes to visit you, but if it helps you imagine
it, you can try to imagine that overnight God works a miracle in your lives, and when
you wake up your problems with Maddie are solved.
AW: Hallelujah! [both laugh]
MK: What I’m curious about is not the details of how the miracle happened, but what you
would you both notice first the next morning? What would be the first small change
that you would notice that would make you say, “What a blessing—our problems with
Maddie are solved!”
PW: [Long pause] You know I’ve prayed on this for a long time, asking not for a miracle
with our family but something for me. More like something that I would be able to do.
Well, I know one thing that would change for me right away. I would be a lot more
patient and loving with Alice and Maddie. I would make more of an effort to support
both of them than I do now.
AW: What do you mean? [acting genuinely surprised]
PW: I—I act sometimes like it’s just you two that are the problem, but I’m not perfect
either. I get short with you and I sometimes think I make your anxiety worse by
snapping at you.

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AW: I know that you are trying, Pete. It’s just hard for all of us, including Maddie. She’s
such a good kid and I wish I didn’t worry so much.
MK: How about you Alice? What would be the first thing you noticed was different after
the miracle happened?
AW: I wouldn’t want to go sit in my room and cry as much [laughing]. I would be able to do
one other thing first, too—I would be able to accept that Maddie is bipolar. I know it
sounds stupid, but I’ve been fighting accepting that this is who she is for so long, still
hoping that maybe somehow she’ll snap out of it somehow or the medication will just
make it all go away.
PW: [Looking at his wife and then the therapist] When we pray before bedtime, we pray
every night for Maddie.
MK: Alice, how would you know you had started to accept Maddie? What would be the first
few signs that you had started to do this?
AW: I would wake up each day and the first things I would do is think of the fact that I
LOVE my daughter and that I am SO PROUD of all the things she’s done despite her
mental illness. I would thank God for her and for my wonderful and loving husband
and then get up and start making her favorite breakfast, her blueberry pancakes. Most
days I don’t do any of that—I just lay there and think of how hard things are.
MK: You both talked a bit about each other in your discussion of my question about a
miracle. What would you notice that was different about the other parent? What would
you notice was different about Pete, Alice?
AW: Hmmm…I rely on Pete so much, and he’s so good with handling Maddie’s mood
swings, I was kind of surprised when he said he would be more loving. If anything, I
think I’m the one who needs to be more patient with him.
PW: And, see, I feel the opposite. Even though I complain about it, I think that both
Maddie and Alice have both gotten a lot better in handling (both of their) mood
swings [both laugh at Pete comparing Alice and Maddie]. I just want them to be able
to slow down and take things more one day at a time…. Maddie is our special girl and
we will need to be able to be there for her through all her teenage years [moves closer
to Alice, picks up her hand in his].

Asking the miracle question elicited many interesting responses from Pete and Alice. They both heard the
question in therapeutic and religious terms, recognizing that they believed in miracles (and even prayed for
them) but also honoring my request to think of the first signs of how the miracle would be revealed rather
than some ultimately religious revelation or gift. Interestingly, neither of them wished for what could have
arguably been the most “miraculous” thing of all—that Maddie be cured of her mental illness. Rather, they
chose to focus on things that they would do and perceive differently themselves. They also were able to
quickly translate the miracle question into actions that they might actually take together and separately,
allowing me to assess their readiness for making changes with some potentially overwhelming issues related to

213
their own marriage and Maddie’s functioning. As what often happens with asking the miracle question, both
Pete and Alice were able to begin to articulate aspects of progress with Maddie that had already begun—that
is, presession changes that I was able to build on in this session and subsequent work with the family.

Presession Change and Scaling Questions

Angie Rodriguez is a 55-year-old widowed Hispanic woman who came to therapy seeking help for
depression and anxiety. Her husband Jose died of a heart attack last year, and she has continued to struggle
with her loss and the impact of his death on their three young-adult children. She works full time as a nurse
and is a very active member of her church, serving on a variety of committees and working in the church’s
weekly homeless shelter program. She was attending a bereavement group at her church and came to seek
additional counseling at the recommendation of a friend in the group.

MK: So Angie, how can I be of help to you?

Angie Rodriguez My friend said that getting some counseling would help, and I have to say making the
(AR): call to come see you, that I felt better somehow after we spoke on the phone to make
this appointment.
MK: I’m so glad to meet you. Can you let me know more about what you meant a minute
ago when you said that you “felt better somehow” after we talked on the phone last
week to set up this meeting?
AR: Huh, I don’t know, I guess it just made me feel a sense of relief. I was starting to feel a
little closed in with my continuing in that group at my church…
MK: The bereavement group?
AR: Yeah, that one. Now don’t get me wrong, I still have my bad days, but a lot of the
widows in that group are just somewhere different than I am right now with how I feel
about Jose’s death.
MK: Where would you say you are right now? Do you notice yourself having different
feelings of loss and sadness related to your husband’s passing?
AR: I do, I can really say that now. I used to get angry when I heard people describe a lost
loved one as “being in a better place” like heaven, but now I don’t know…
MK: Now do you think of Jose more in that way than you did before?
AR: I guess that that’s true, I’ve never heard anybody say it to me that way before. And I get
why the other women in our group are still angry (and God knows I miss my Jose), but
I have to say that as hard as things are, I have my days where I can actually handle
things without him, you know? I mean I’ve always been able to do my work and take
care of my kids, but now I just feel more…okay with things sometime. Isn’t that
strange? [starts to cry] Like I know that I’ll be all right and that Jose is in a better place,
and we will be together again someday.
MK: This feeling you have sometimes now, you called it feeling “okay.” If you had to say

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 how often you feel that way, would you say you feel it a few times a day, almost all day
some days, or just once in a while?
AR: I think I’ve just started to notice this lately—I almost catch myself not feeling sad
about Jose and laughing, or just feeling that, you know “okay” feeling again [crying
some more]. Is this crazy?
MK: Not at all, it’s very normal to start to feel your sense of loss change over time. It doesn’t
mean you don’t still miss and love your husband or that you’ll ever forget your time
with him.
AR: I was starting to feel guilty about that. I mean I see our kids, and in all their own ways
they are just stuck still. And the women in my group, too—maybe they’ll feel
differently soon, but sometimes I would go to our group and come home feeling even
sadder than when I came to church that night.
MK: If you had to put a number on how stuck you feel these days, with 1 being not very
stuck most days and 10 being feeling very stuck most of the time, where you would say
you find yourselves at these days?
AR: You ask interesting questions; my friend told me you were interesting [laughing]! I’m
not sure, let me see…maybe I’m at a 4 or 5 most days. When I was really low I was at a
7 or 8, just having trouble getting through the day.
MK: That helps me understand how much progress you have already made—do you see how
that could be? What do you think you did that helped you move from a 7 to a 5 most
days?
AR: I think I’ve just let my love of Jose and my trust in God take care of me more…to stop
feeling so lost and tired and hopeless and let go, and let God take care of me more.
MK: What do you think you would be doing differently if you came in a few weeks from
now and told me that you felt more like a 3 in terms of being stuck?
AR: I would be talking more like we’ve just been talking today. I would be feeling less guilty
for feeling “okay” sometimes and probably stop going to the group at my church as
often if it keeps making me sad.

The combination of presession change and scaling questions made for a very dynamic initial few minutes
with Angie. Given her presenting issues, I could have easily spent time drawing on a rich history of her view
of the problem and could have felt justified in doing so, given the enormity of her loss. At the same time,
Angie gave me a sense from the beginning that she had begun to notice feeling different since making the
appointment, and that led to her description of feeling “okay” more often and her conflicted feelings about
how she should continue to feel in grieving for her late husband. The scaling questions again elicited
fascinating perspectives from Angie: She had already begun to engage in some informal scaling herself,
thinking about how her sense of feeling “stuck” had shifted over time and how it differed from what she saw
in her kids and the other women in her bereavement group. In both cases, the presession change and the
scaling questions, I was able to return to those crucial components of Angie’s view of her grieving process to

215
encourage her to trust her own process and (importantly for Angie and for many clients like her) to trust God
to be with her as she grieved for her husband.

Solution-Focused Goals or Homework

For us, one of the most exciting aspects of doing this work with religious and spiritually oriented clients is
the many ways that homework can organically emerge from this client population. Many times
spiritual/religious clients would bring study bibles or other religious texts into sessions with us and would
share with us how they prayed on specific passages or ideas, often every day between sessions. In addition,
when encouraged to look for exceptions to the problems they faced, these clients could often turn to
something they had read or heard in church or in fellowship with other family or friends. Although it is
certainly not a given that religious/spiritual involvement increases positive emotion for all the clients we
served, many times we were told by clients that their faith helped organize their lives, helped them set positive
goals, and became a strong resource moving forward.

Conclusion and Summary

As we stated in the introduction to this chapter, we are pleased to have a chance to show ways that SFBT can
be successfully adapted to working with clients who are religious or spiritually oriented. In this chapter, we
have shared some key ideas for further discussion and reflection:

The fields of mental health have been slow to acknowledge the importance of integrating mental health
treatments within clients’ religious/spiritual frameworks;
Recent research has started to establish that for many clients, their religious and/or spiritual beliefs increase
their overall mental health and well-being and stand as significant resources that all therapists (SFBT
clinicians and those who practice other treatment modalities) should explore fully with their clients;
Not all clients experience their religious or spiritual experiences as protective factors, making it perhaps even
more urgent that clinicians learn how to assess the impact of religion and spirituality on a client’s well-
being;
SFBT, with its focus on the future and increasing client focus on change already under way, is well-suited
to many religious and spiritual frameworks;
Examples of work with clients using the SFBT concepts of the miracle question, presession change and
scaling questions, and solution-focused goals or homework underline the utility of SFBT as an approach
with religious or spiritually oriented clients.

FURTHER LEARNING

Gallup Organization

www.gallup.com

This longstanding public-opinion organization has been measuring what Americans do (and don’t) believe

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about a range of topics for more than 70 years, including personal religious beliefs and practices.

U.S. Religious Landscape Survey

http://religions.pewforum.org

This site collects a wide range of interesting data about Americans and their religious, spiritual, political, and
cultural attitudes, based on 35,000 interviews with American adults.

DISCUSSION QUESTIONS
1. How might you respond if a spiritual or religious client said they were waiting for God to help solve their
problems or make their situation better (divine intervention)?
2. Think of the clients you typically serve: since much of what SFBT practitioners do involves looking for
client strengths, what are some potential strengths religion and spirituality might provide to your clients?
3. Building off of question #1, give some examples of SFBT questions you would ask clients to elicit their
strengths related to religion and spirituality?
4. Not all clients experience religious and spiritual beliefs as a source of strength. In fact, some clients may
actually feel harmed by organized religion. As a SFBT practitioner, how would you incorporate these
issues into your work with a client who believes they've been actively damaged by their experiences with
organized religion?
5. How might you respond if a spiritual or religious client said they were waiting for God to help solve their
problems or make their situation better(divine intervention)?

ACKNOWLEDGMENTS
The authors would like to acknowledge the Meadows Center for Preventing Educational Risk and the
Institute of Education Sciences grant R324B080008 for providing support. The manuscript content does not
necessarily represent the positions or policies of the funding agencies.

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 Index

Aber, J. L., 181, 193

see also Yoshikawa, H.
Abrams, L. S., 10, 11
Acculturation, 90, 146
Adams, J. F., 41 (table), 51
Adams, M., 92, 102
Androgynes, 151
Affectionate communication, 62
African American clients
case study, 81–85
clinical issues, 77–78
cultural values and beliefs system, 73–75, 138
domestic violence, 78
historical perspective, 72–73
kinship care, 77–78
mental health services use, 75–76
research background, 47, 48 (table), 48–49, 50
solution-focused brief therapy (SFBT) approach, 78–85
strengths and protective factors, 75
substance abuse, 77
Agbayani-Siewert, P., 125, 132
Aguilar-Gaxiola, S., 105
see also Vega, W. A.
Ahmed, S. R., 196, 205
Ahn, A. J., 62, 69
Ahola, T., 3, 12
AI-SUPERPFP Team, 119
see also Beals, J.
Akbar, M., 75, 87
see also Thompson, V. L. S.
Akutsu, P. D., 132
Alcohol abuse, 109
Alderte, E., 105
see also Vega, W. A.

220
Alegria, M., 91, 102
Allen, M. W., 155, 164
Ally individuals, 151
Altschul, D. B., 109, 119
see also Brave Heart, M. Y. H.
Alvarez, A. N., 61, 70
American Indian clients
case study, 112–116
clinical issues, 109–110
communication strategies, 108–109
community versus individualism, 107–108
cultural values and beliefs system, 106–107
depression, 110–111
domestic violence, 110
family structure/tribal structure, 108
historical perspective, 106
poverty, 110
research background, 48 (table), 49, 50
solution-focused brief therapy (SFBT) approach, 111–112
spirituality, 107
strengths and protective factors, 111
substance abuse, 109
suicide, 110–111
time perception, 108
unemployment, 110
American Psychological Association (APA), 152, 163, 167, 169, 178
Americans with Disabilities Act (ADA), 166, 178
Anderson, H., 141, 149
Anderson, S. C., 155, 163
Ansseau, M., 181, 193
see also Lorant, V.
Anti-immigration laws, 56, 123
Anti-miscegenation laws, 56, 135
Anxiety disorders, 196
APA Task Force on Appropriate Therapeutic Responses to Sexual Orientation, 163
Arguelles, W., 103
see also Gallo, L. C.
Asexual individuals, 151
Asian American clients
case study, 62–68

221
 clinical issues, 58–62
collectivist orientation, 57, 125
familism, 58, 124–125
historical perspective, 55–56
interdependent sense of self, 57–58
model minority myth, 60–61
racial microaggression, 58–60
research background, 46, 48 (table), 49, 50
strengths and protective factors, 61–62
value system, 57–58, 124–125
Asian Community Mental Health Services, 131
Asian immigrant clients
case study, 127–131
clinical issues, 126–127
cultural values and beliefs system, 124–126
demographic characteristics, 122–123
historical perspective, 123–124
solution-focused brief therapy (SFBT) approach, 128–131
strengths and protective factors, 124–126
Asian Indian population, 122, 123–124
Assimilation, 107, 146
Atkinson, D. R., 57, 58, 68, 70, 132
see also Kim, B. S. K.
Attneave, C., 107, 108, 111, 117, 119
Aud, S., 123, 132

Babbie, E., 45, 53

Baca Zinn, M., 92, 102
Baetz, M., 196, 204
Bahr, S. J., 196, 204
Baker, F. M., 73, 77, 86
Balanced intercultural relationships, 138
Banaji, M. R., 60, 69
Bannink, F. P., 170, 177, 179
see also Roeden, J. M.
Barrio, C., 88, 102
Bartz, J., 197, 205
Bassuk, E. L., 181, 182, 192
Bassuk, S. S., 181, 192
see also Bassuk, E. L.

222
Bavelas, J. B., 16, 31, 112, 119, 120, 159, 160, 163, 165
Bazile, A., 75, 87
see also Thompson, V. L. S.
Beach, A., 152, 164
Beals, J., 110, 119
Beardslee, W. R., 181, 193
see also Yoshikawa, H.
Beattie, K., 155, 163
Behavioral health issues, 181–183, 196
Bell, C. C., 73, 77, 86
Belle, D., 182, 183, 192
Bender, K., 89, 105
Benish, S. G., 89, 102
Berg, I. K., 2, 3, 4, 6, 7, 10, 11, 12, 14, 15, 20, 31, 40, 46, 51, 81, 82, 86, 88, 102, 103, 109, 112, 118, 119,
139, 140, 141, 148, 152, 155, 159, 162, 163, 164, 177, 178
see also de Shazer, S.
Bergin, A. E., 195, 204
Bernal, G., 102
Bernal, M., 89, 90, 102
Berndt, A., 155, 164
Bernstein, A. C., 162
Beyebach, M., 89, 102
Bhadba, B., 123, 124, 125, 126, 132
Biever, J. L., 3, 12
Bill of Rights for Racially Mixed People, A (Root), 138, 148
Binge drinking, 93, 109
Binger, J. J., 162
Biracial population, 136, 138
see also Multicultural families
Bisexuals, 150
Black, I., 56, 69
Black Mental Health Alliance for Education and Consultation Inc., 86
Black Mental Health Net, 86
Bliss, V., 177
Blundo, R., 10, 12
Borrell, C., 178
see also Dalstra, J. A.
Bowie, S. L., 11, 12
Boyd-Franklin, N., 47, 52
Boyd, T. V., 177

223
Bozeman, B. N., 41 (table), 48 (table), 51
Braun, K. L., 58, 70
Brave Heart, M. Y. H., 109, 117, 119
Break-taking strategy, 2, 26–27
Breeze, E., 178
see also Dalstra, J. A.
Brief family therapy (BFT), 33
Brief Family Therapy Center (BFTC), 3, 34, 181
Briggs, V. M., Jr., 56, 69
Broaden-and-build theory of positive emotions, 8–10
Brod, H., 91, 102
Broken Nose, M. A., 106, 108, 120
Brondolo, E., 93, 102
Bronx County, New York, 90
Brown, D., 152, 164
Broyles, R., 168, 178
Brucker, P. S., 107, 108, 110, 111, 112, 119
Bucceri, J. M., 59, 71
see also Sue, D. W.
Buckner, J. C., 181, 192
see also Bassuk, E. L.
Buhrke, R. A., 162
Buist, K., 37, 53
see also Stams, G. J. J. M.
Buka, S. L., 181, 193
Bureau of Indian Affairs, 106, 121
Burlingame Treaty, 56
Burnes, T. R., 152, 164
Burrola, K. S., 60, 71
see also Yoo, H. C.
Burr, W., 34, 51
Bustamante, R. M., 134, 135, 136, 137, 138, 141, 148

Cade, B., 3, 12
Caetano, R., 93, 102
Cain, H., 41 (table), 48 (table), 51
Cambois, E., 178
see also Dalstra, J. A.
Canda, E. R., 138, 148
Canino, G., 102

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 see also Alegria, M.
Cantwell, P., 7, 11, 12, 67, 69
Cao, Z., 102
see also Alegria, M.
Caraveo-Anduaga, H., 105
see also Vega, W. A.
Cardin, S. A., 51
see also Conoley, C. W.
Carlberg, C. G., 51
Carlson, T. S., 152, 164, 165
Carroll, K. M., 14, 31
Castex, G. M., 89, 102
Catalano, R., 105
see also Vega, W. A.
Caucasian population, 48 (table), 48–49, 50
Cepukiene, V., 43, 44 (table), 51
Cervantez, K., 91, 103
Chang Chung, S. C., 90, 104
Charmaz, K., 33, 51
Chase, J., 109, 119
see also Brave Heart, M. Y. H.
Chen, J., 61, 69, 71, 183, 193
see also Gee, G. C.
Chen, M., 46, 53
Cheung, S., 132
Chinese Exclusion Act (1882), 56, 123
Chinese population, 55–56, 122, 123, 124–125
Choi, N., 68
Chun, K. M., 132
Clark, H. H., 112, 159, 163
Clemons, D., 3, 12
Clients with disabilities
case study, 171–176
characteristics, 166–167
clinical issues, 167–169
solution-focused brief therapy (SFBT) approach, 169–176
strengths and protective factors, 170–171
Coakley, V, 102
see also Brondolo, E.
Cockburn, J. T., 41 (table), 51

225
Cockburn, O. J., 41 (table), 51
Co-construction process, 112, 159–160
Cognitive-behavioral therapy, 182
Cohen, J., 37, 40, 51
Cohen, L., 123, 132
Cohen’s d statistic, 37, 38–39 (table)
Collaborative relationships, 62–63
Collectivism, 57, 125, 137
Collegiality, 17–18
Coltrane, S., 92, 102
Combs, G., 17, 31
Coming-out process, 154, 156–159
Complementing questions, 63–65
Compliments
African American clients, 79–80
American Indian clients, 115–116
characteristics and functional role, 2, 18
Hispanic and Latino clients, 99
lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) clients, 159
multicultural families, 144
Confianza, 91
Confucian beliefs, 124–125
Congress, E., 131
Conoley, C. W., 48 (table), 51
Conversations, 16
Cook, D. R., 41 (table), 51
Coon, H. M., 57, 70
Coping questions
African American clients, 79
characteristics and functional role, 26
clients with disabilities, 173–175
multicultural families, 140, 143, 145
Coping strategies, 138–139
Corcoran, J., 36, 47, 48 (table), 49, 51, 53, 89, 102, 133, 148
Corey, G., 15, 31
Costa, G., 178
see also Dalstra, J. A.
Cottone, R. R., 136, 149
Coward, R. L., 152, 164
Cox, C. I., 133, 149

226
Coyhis, D., 107, 119
Craig, M. C., 51
see also Conoley, C. W.
Crohn, J., 134, 137, 148
Cromwell, R. E., 92, 102
Crosbie-Burnett, M., 163
Cross-cultural relationships, 134–139
Cross-dressers, 151
Cross, T., 107, 119
Crystal-ball technique, 4–5
Cultural competency, 1–3
Cultural deference, 138, 143, 146
Cultural genocide, 106–107
Cultural norms and values, 46–47, 49–50
Culture, definition of, 134–135
Curfs, L. M. G., 170, 177, 179
see also Roeden, J. M.

Daki, J., 43, 44 (table), 51

Dalstra, J. A., 166, 178
D’Andrade, R., 126, 132
Daniels, R., 56, 69, 123, 132
Das, A. K., 73, 75, 86
Dashiff, C., 181, 192
Datillio, F. M., 78, 86
Dauphinais, L., 108, 117, 119
Dauphinais, P., 108, 117, 119
David, E. J. R., 59, 70
Davies, M., 197, 205
Dayu, Y., 46, 54
Dean, R. G., 10, 12
DeBaryshe, B. D., 57, 71
see also Yee, B. W. K.
De Jong, P., 2, 3, 6, 7, 10, 11, 12, 14, 31, 86, 87, 112, 119, 139, 140, 141, 148, 159, 160, 163, 164, 165,
179
see also Bavelas, J. B.; Trepper, T.
Dekovic, M., 37, 53
see also Stams, G. J. J. M.
de la Garza, R. O., 56, 69
Delgado, M., 131

227
Deliege, D., 181, 193
see also Lorant, V.
Deluty, R. H., 155, 164
Del Vecchio, A., 107, 121
Del Vento, A., 16, 31, 112, 120, 159, 165
de Miguel, J., 102
see also Beyebach, M.
DeNavas-Walt, C., 180, 192
Depression, 81–85, 110–111, 155, 182, 195–196
Derks, J., 33, 53
see also Lipchik, E.
Derlega, V. J., 152, 155, 164
de Shazer, S., 2, 3, 4–5, 12, 15, 17, 28, 31, 33, 34, 40, 51, 88, 103, 117, 119, 140, 143, 148, 152, 153, 161,
162, 164, 169, 170, 173, 177, 178
DeSipio, L., 56, 69
Desmond, S. A., 196, 205
de Vega, M., 102
see also Beyebach, M.
DeVos, T., 60, 69
De Vries, L., 37, 53
see also Stams, G. J. J. M.
Diagnostic and Statistical Manual of Mental Disorders (DSM), 151–152
DiClemente, C. C., 16, 31
DiMicco, W., 181, 192
Disabled clients
see Clients with disabilities
Discrimination
African Americans, 74
Asian Americans, 56, 58–60, 123, 127
clients with disabilities, 167
lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) clients, 151–153
multicultural families, 136
Dohrenwend, B. P, 181, 193
Dohrenwend, B. S., 181, 193
Dolan, Y., 3, 12, 15, 20, 29, 31, 103, 109, 117, 118, 119, 120, 139, 140, 148, 155, 159, 162, 163, 165, 178,
181, 192
see also de Shazer, S.
Domenech Rodríguez, M. M., 89, 102
Domestic violence, 78, 110
Dominguez., G., 53

228
 see also Morrison, J. A.
Dumka, L. E., 92, 103
Dunagan, M. S., 58, 71
Duran, B., 107, 108, 111, 119, 120
see also Duran, E.
Duran, E., 107, 108, 109, 110, 111, 119, 120
Durlak, J. A., 37, 51
Durrant, M., 47, 51

Eakes, G., 41 (table), 48 (table), 51

Eaton, W., 181, 193
see also Lorant, V.
Economically poor clients
case study, 185–191
clinical issues, 181–183
demographic characteristics, 180
nonclinical problems and issues, 183
solution-focused brief therapy (SFBT) approach, 180–181, 190–191
strengths and protective factors, 183–184
Eisengart, S., 2, 13, 37, 52
Elkins, J., 109, 119
see also Brave Heart, M. Y. H.
Emotional health issues, 181–183
Emotional restraint, 62
Empowerment, 81
Enculturation, 90
Erickson, Milton, 4–5
Escobar, K. M. V., 59, 70
Eshleman, S., 87
see also Kessler, R.
Espinosa de los Monteros, K., 103
see also Gallo, L. C.
Ethnic glossing, 106
Ethnic minority populations, 46–49, 48 (table), 50, 88–89
see also Multicultural families; specific minority population
Evans-Campbell, T., 108, 120
Evans, G. W., 181, 183, 193
Exception-finding questions
Asian American clients, 67
Asian immigrant clients, 129–130

229
 characteristics and functional role, 18, 25–26
clients with disabilities, 175
Hispanic and Latino clients, 99–100
multicultural families, 140, 143, 144
Exclusion policies and legislation, 56
Exline, J. J., 197, 205
Experiments, 27–28
Extended family, 92, 125, 136
Externalizing behavior outcomes, 40, 41 (table), 84

Fabian, C. G., 61, 71

Fabrett, F. C., 90, 103
Faith, 91
Falicov, C. J., 91, 103
Family, importance of, 91, 124–126
Family systems therapy, 32–33
Family violence
see Domestic violence
Farver, J., 123, 124, 125, 126, 132
Fassinger, R. E., 155, 165
Fernandez, M., 56, 70
Fernando, M., 131
Field, C. A., 93, 102
File-drawer effect, 37
Filial piety, 124–125
Filipino population, 122
Finch, B. K., 93, 103
Fisch, R., 3, 12, 13
see also Watzlawick, P.
Fisher, Paul, 1
Fiske, H., 118, 162
Fitzmaurice, G. M., 181, 193
Fitzpatrick, M. R., 8, 9, 10, 12
Florom-Smith, A. L., 93, 103
Flynn, P. M., 89, 105
Fong, R., 124, 131, 132, 134, 135, 136–137, 138, 149
Forced assimilation, 107
Ford, V. E., 162
Forehand, R., 47, 51
Formula first session task (FFST), 28

230
Fortuna, L., 93, 104
Fowler, P. J., 196, 205
Fox, M., 123, 132
Frank, J. B., 89, 103
Frank, J. D., 89, 103
Franklin, C., 3, 6, 8, 12, 29, 31, 40, 41 (table), 43, 48 (table), 49, 52, 87, 88, 89, 103, 133, 149, 179
see also Trepper, T.
Frederick, T. V., 197, 205
Fredrickson, B. L., 8, 9–10, 12
Freedman, J., 17, 31
Freire, P., 110, 120
Frels, R. K., 177, 178
Froerer, A. S., 155, 160, 164, 165
Froeschle, J. G., 89, 103
Fujino, D. C., 87
Fuligni, A. J., 58, 69
Furman, B., 3, 12
Furman, L. D., 138, 148
Furuto, S., 124, 131, 132

Gage, S. L., 57, 69

Galanti, G. A., 91, 103
Gallardo-Cooper, M. I., 41 (table), 48 (table), 52
Gallo, L. C., 89, 90, 91, 92, 103
Gallup, 195, 205
Gangamma, R., 152, 165
Gannon-Rowley, T., 181, 193
Garcia, P., 102
see also Barrio, C.
Garcia Preto, N., 91, 103, 104
see also McGoldrick, M.
Garfield, S., 3, 12
Garland, E. L., 8, 9, 12
Garmezy, N., 184, 193
Gay community
see Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) clients
Gee, G. C., 59, 60, 61, 69, 71
Geil, M., 52
Gender benders, 151
Gender roles, 91, 125, 137, 138, 146

231
Genocide, 106–107
Gensterblum, A. E., 52
Gentlemen’s Agreement (1907), 56
Gentle nudges, 18
George, E., 7, 13, 34, 52, 88, 104
German, M., 92, 103
Giammattei, S. V., 152, 162, 164
Gilman, S. E., 181, 193
Gingerich, W., 2, 4, 13, 31, 35, 37, 38–39 (table), 41 (table), 43, 52, 87, 88, 103, 133, 149, 179
see also Trepper, T.
Giordano, J., 104
see also McGoldrick, M.
Gluth, D. R., 163
Goals and goal-setting formulation
American Indian clients, 116
Asian immigrant clients, 128–129
characteristics and functional role, 16, 19
economically poor clients, 187–188
lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) clients, 152–154, 161
multicultural families, 145
spiritual/religious clients, 203
Gomez., D., 53
see also Morrison, J. A.
Gomez-Diaz, L., 89, 103
Gong, F., 57, 69
Gonzales, N. A., 90, 92, 103
González-Guarda, R. M., 93, 103
Gonzalez, M. J., 182, 183, 193
Goodman, M., 152, 164
Goolishian, H. A., 141, 149
Gorcheva, R., 152, 164
Gordon, T., 102
see also Brondolo, E.
Gotzke, F., 56, 70
Gove, M., 125, 132
Grafsky, E. L., 152, 165
Graham, J. M., 51
see also Conoley, C. W.
Grandbois, D., 107, 120
Grandparent-headed households, 77–78

232
Granvold, D. K., 6, 13
Gray, B., 61, 70
Greene, G. J., 134, 137, 138, 139, 140, 141, 149
Green, R. J., 152, 162, 164
Greenwald, S., 197, 205
Griner, D., 132
Grossman, A. H., 155, 164
Grote, J., 150, 164
Grounding strategy, 159
Gurman, A., 3, 13
Guterman, J. T., 197, 205
Gutmann, M., 91, 103
Gwadz, M., 155, 165

Hackney, C. H., 195, 205

Hall, G., 126, 132
Hall, J. C., 11, 12
Halpin, S. A., 155, 164
Hanjorgiris, W. F., 163
Han, M., 58, 71
Harkanen, T., 52
see also Knekt, P.
Harrington, S., 8, 13
Harris, M. B., 49, 52, 89, 103
Hasin, D. S., 152, 164
Hatzenbuehler, M., L., 151, 164
Hawkes, D., 3, 5, 6, 13
Hawthorne, W., 102
see also Barrio, C.
Haynes, K., 59, 70
Hays, D. G., 155, 165
Hedley, D., 89, 104
Helitzer, A. L., 104
see also Sussman Getrich, C. M.
Heller, P. E., 137, 138, 149
Henke, T., 152, 164
Henriksen, R. C., 134, 148
see also Bustamante, R. M.
Herek, G. M., 152, 164
Hermaphrodites, 151

233
Hernandez, C., 102
see also Beyebach, M.
Hernandez, D., 91, 103
Hernandez, M., 103
Heron, R., 76, 86
Heteronormativity, 152
Heterosexism, 152
Hierarchy of research, 36–37
Highlen, P., S., 133, 149
Hilbert, J. C., 93, 104
Hines, P., 47, 52
Hispanic and Latino clients
case study, 95–101
cultural values and beliefs system, 90–92
demographic characteristics, 89–90
research background, 47, 48 (table), 48–49, 50
risk and protective factors, 92–93
substance abuse, 93
syndemic continuum model, 93–95, 94 (figure)
Hispanic Culture Online, 90, 103
Ho, D., 125, 132
Hodge, D. R., 196, 197, 205
Hoeffel, E. M., 106, 120
Hoffman, D. L., 104
see also Sussman Getrich, C. M.
Hoffman, J. P., 196, 204
Hoffman, L., 139, 149
Hofstede, G., 57, 69
Holleran-Steiker, L. K., 47, 52
Holmes, S., 7, 11, 12, 67, 69
Holtby, M. E., 163
Homework tasks
American Indian clients, 117–118
Asian American clients, 67–68
Asian immigrant clients, 130
characteristics and functional role, 2, 27–29
economically poor clients, 190–191
Hispanic and Latino clients, 96
spiritual/religious clients, 203
Ho, M. K., 107, 116, 120

234
Homophobia, 152
Homosexuality
see Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) clients
Hong, J., 126, 132
Hong, S., 58, 68, 70
Hooper, K., 107, 120
Hopson, L., 40, 52
Hough, R. L., 102
see also Barrio, C.
House, J. S., 183, 193
Hsu, W., 46, 52
Huang, M., 40, 41 (table), 52
Hughes, M., 87
see also Kessler, R.
Hui, C. H., 57, 71
Hui-Chen Huang, G., 125, 132
Huijgevoort, T. van, 167, 178
Hu, L., 87
Humara, M., 91, 103
Humes, K. R., 55, 69
Humor, 138, 143, 146
Hunter, J., 155, 163, 165
Hurtado, A., 91, 103
Hypnosis, 4, 5

Immigration, 55–56
Immigration Act (1924), 56
Immigration and Naturalization Act (1965), 56
Indirect compliments, 144
Individualism versus collectivism, 57, 107–108, 125, 137
Ingersoll-Dayton, B., 41 (table), 48 (table), 52
Institute of Medicine, 168, 178
Institute on Domestic Violence in the African American Community (IDVAAC), 78, 86
Integrity, 125
Intercultural relationships, 134–139
Intermarriage, 134–139
Internalizing behavior outcomes, 40, 41 (table), 42
Interpersonal psychotherapy, 182
Interracial/interethnic relationships, 134–139
Intersexual individuals, 151

235
Intervention strategies, 160–162
Intimate intercultural relationships, 134–139
Intimate partner violence
see Domestic violence
Intramarriage, 134–139
Inui, K. S., 56, 69
Israel, T., 152, 164
Iveson, C., 7, 13, 34, 52, 88, 104
see also George, E.
Izal, M., 104
see also Losada, A.

Jackson, D., 136

Jackson, K. F., 136, 149
Jackson, K. M., 92, 103
Jacob, J., 61, 70
Jacobs, D., 76, 86
Jacobsen, R. B., 41 (table), 54
Japanese population, 56
Jarcho, J., 58, 71
Jarvis, E., 91, 104
Jenkins, D., 154, 164
Jeste, D. V., 102
see also Barrio, C.
Jimenez-Chafey, M. I., 89, 102
Johnson, A., 61, 70
Johnson, D. P., 12
see also Garland, E. L.
Johnson, O. J., 11, 12
Johnson-Reed Act (1924), 56
Johnson, T., 196, 205
Johnston, L., 154, 164
Jones, K., 131
Jones, N. A., 55, 69
Jordan, C., 8, 12
Jordan, K. M., 155, 164
Joseph, S., 8, 13
Jozefowicz-Simbeni, D. M. H., 196, 205
Juang, L. P., 61, 70
Jurich, J. A., 41 (table), 51

236
Kaiser Family Foundation, 93, 104
Kaslow, N., 76, 86
Kawachi, I., 181, 193
Kelley, L., 48 (table), 53
Kelly, K. P., 102
see also Brondolo, E.
Kelly, M., 74, 77, 87
Kelly, M. S., 190, 193
Kelsinki Psychotherapy Study Group, 52
see also Knekt, P.
Kemmelmeier, M., 57, 70
Kendler, K. S., 87
see also Kessler, R.
Kerner, M. S., 155, 164
Kessler, R., 75, 87
KewalRamani, A., 123, 132
Keyes, K. M., 152, 164
Kim, B. C., 136, 139, 149
Kim, B. S. K., 57, 58, 62, 68, 69, 70, 132
Kim, H. S., 58, 61, 70, 71
Kim, J. S., 8, 13, 29, 31, 35, 40, 41 (table), 42–43, 45–46, 52, 133, 149
Kim, S. Y., 57, 71
see also Yee, B. W. K.
Kinship bonds, 74, 77–78, 108
Kirmayer, L., 91, 104
Kiselica, M. S., 163
Kiser, D. J., 66, 70
Kitayama, S., 57, 58, 70
Knekt, P., 43, 44, 44 (table), 52
Knight, B. G., 104
see also Losada, A.
Knight, G. P., 90, 102, 103
Knight, R., 90, 104
Koenig, H. G., 194, 195, 196, 197, 205
see also Moreira-Almeida, A.
Koh, J. B. K., 61, 70
Kolody, B., 105
see also Vega, W. A.
Korman, H., 12, 31, 87, 103, 112, 119, 140, 148, 159, 160, 162, 163, 165, 177, 178, 179
see also Bavelas, J. B.; de Shazer, S.; Trepper, T.

237
Koss, M., 3, 13
Kotchick, B. A., 47, 51
Kotler, M., 111, 120
Koven, S. G., 56, 70
Kral, R., 3
Kraus, R., 196, 205
Kring, A. M., 12
see also Garland, E. L.
Krishnan, S. P., 93, 104
Kristeller, J., 205
see also Johnson, T.
Kulis, S., 205
see also Marsiglia, F. F.
Kumpfer, K. L., 184, 193
Kunst, A. E., 178
see also Dalstra, J. A.
Kurashige, L., 56, 70
Kurdek, L. A., 156, 164

LaCourt, M., 33, 53

see also Lipchik, E.
La Due, R., 107, 120
LaFromboise, T. D., 111, 120
Lam, M., 58, 69
Language dominance, 90–91
Language use, 6–7, 88–89
Lantz, P. M., 183, 193
Larocca, P. S., 177, 178
LaSala, M. C., 155, 163, 164
Lasry, J., 91, 104
Latino Americans
see Hispanic and Latino clients
Lau, A. S. L., 57, 70
“Leading from one step behind” approach, 7–8, 11
Lee, E., 68, 123, 132
Lee, M. Y., 46, 53, 134, 135, 136, 137, 138, 139, 140, 141, 149
Lee, S., 124, 126, 132
Lee, S. M., 56, 70
Leggett, E. S., 41 (table), 53, 177, 178
Leite, N., 197, 205

238
LeMay, M. C., 56, 70
Lena, D., 53
see also Morrison, J. A.
Leong, F. T. L., 57, 70
Lepkowski, J. M., 183, 193
Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) clients
case study, 156–159
clinical and nonclinical issues, 154–155
coming-out process, 154, 156–159
definitions, 150–151
depression, 155
historical perspective, 151–154
solution-focused brief therapy (SFBT) approach, 156–162
strengths and protective factors, 155–156
substance abuse, 155
suicide, 155
Lethem, J., 6, 7, 13
Leu, J., 59, 71
see also Wang, J.
Leung, K., 125, 132
Levy, E., 102
see also Brondolo, E.
Lewis, R. G., 107, 120
Lewis, R. J., 152, 155, 164
Lewis, T. T., 59, 70
Liang, C. T. H., 61, 70
Liang, M. X., 61, 70
Liang, X., 125, 132
see also Ho, D.
Li, H., 61, 70
Lin, A. E., 59, 71
see also Sue, D. W.
Lindfors, O., 43, 44, 52
see also Knekt, P.
Linley, P. A., 8, 13
Lipchik, E., 3, 4, 6, 13, 31, 33, 51, 53, 65, 66, 70
Lippke, S., 168, 179
Lipsey, M. W., 37, 51
Littell, J. H., 36, 53
Littrell, J. M., 48 (table), 53

239
Longest, K. C., 197, 205
Long, J., 150, 164
Lopez, M. H., 90, 104
Lorant, V., 181, 182, 193
Losada, A., 92, 104
Los Angeles County, California, 90
Loving v. Virginia (1967), 135
Lum, D., 131
Luszczynska, A., 168, 179
Lynch, C., 41 (table), 53
see also Springer, D. W.

Maaskant, M. A., 170, 177, 179

see also Roeden, J. M.
Macdonald, A. J., 33, 34, 35, 41 (table), 52, 53, 133, 149
Machismo, 91
MacIntyre, M., 41 (table), 54
Mackenbach, J. P., 178
see also Dalstra, J. A.
Magruder, B., 155, 164
Maguen, S., 155, 165
Main interventions, 17–18
Malia, J. A., 53
see also Littrell, J. M.
Mancall, P., 109, 120
Manson, S., 119
see also Beals, J.
Marek, L. I., 152, 164
Marianismo, 91
Marinaccio, B. C., 40, 41 (table), 53
Markowski, M., 41 (table), 48 (table), 51
Markus, H. R., 57, 58, 70
Márquez, M., 104
see also Losada, A.
Marrying out/marrying in, 134–136
Marsh, T. I., 3, 13
see also Hawkes, D.
Marsiglia, F. F., 196, 197, 205
Martinez Hamar, J., 90, 104
Masood, N., 125, 132

240
Maynard, B. R., 196, 205
McCann, S., 77, 87
McCarran-Walter Act (1952), 56
McClurg, L., 136, 138, 149
McCollum, E. E., 31, 43, 52, 53, 87, 88, 103, 112, 119, 120, 140, 148, 159, 162, 165, 178, 179
see also de Shazer, S.; Smock, S.; Trepper, T.
McCubbin, H. I., 57, 71
McCullough, M. E., 196, 197, 205
McCurtis, H., 73, 86
see also Das, A. K.
McCusker, C., 57, 71
McDermott, M., 181, 193
McGee, D. R., 16, 31, 112, 120, 159, 165
McGeorge, C. R., 152, 164, 165
McGoldrick, M., 90, 103, 104, 177, 179
McGonagle, K., 87
see also Kessler, R.
McGrath, C., 93, 102
McLaughlin, K. A., 152, 164
McLaughlin, L. A., 58, 70
Medicine, B., 109, 121
Medicine, traditional, 91
Mental health issues, 181–183, 194–197
Mental Research Institute (MRI), 3
Mero, R. P., 183, 193
Meta-analytic reviews, 37–43, 38–39 (table), 41 (table)
Metatheory concepts, 6
Metrosexuals, 151
Meyer, I. H., 152, 165
Meyer, O., 126, 132
Meyer, P. S., 12
see also Garland, E. L.
Miami-Dade County, Florida, 90
Microaggression, racial, 58–60
Microanalysis of communication in solution-focused brief therapy (workshop), 165
Microanalysis of dialogue, 160
Mikulincer, M., 111, 120
Miller, G., 46, 53
Miller, L., 197, 205
Miller, N. B., 107, 108, 121

241
Miller, S. D., 2, 3, 4, 12, 14, 31, 88, 102, 109, 118, 119, 139, 148, 152, 155, 163
Miller, W. R., 16, 31
Minority clients, 10–11, 46–49, 48 (table), 50
Minuchin, S., 5
Mira, C. B., 92, 104
Miracle questions
American Indian clients, 117
characteristics and functional role, 2, 19–22
clients with disabilities, 171–172
economically poor clients, 188–190
Hispanic and Latino clients, 96–97
lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) clients, 157, 161
multicultural families, 140, 142–143
spiritual/religious clients, 198–201
Mishima, N., 46, 53
Mitchell, C., 119
see also Beals, J.
Mitchell, F., 92, 105
Mitchell, V., 163
Mjelde-Mossey, L. A., 46, 53, 135, 136, 137, 139, 140, 149
Model minority myth, 60–61
Modesty, 125
Mohr, J. J., 155, 165
Moio, J. A., 10, 11
Molnar, A., 4, 31, 51
Monakes, S., 134, 148
see also Bustamante, R. M.
Monroe, E. J., 155, 165
Montorio, I., 104
see also Losada, A.
Moore, A., 109, 120
Moore Campbell, B., 86
Moore, K., 3, 12, 40, 52
Morality, 125
Moreira-Almeida, A., 194, 195, 205
Morejon, A., 102
see also Beyebach, M.
Morenoff, J. D., 181, 193
Morris, L., 155, 164
Morrison, J. A., 34, 53

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Multicultural approach, 10–11, 46–47, 49–50, 88–89
Multicultural families
background information, 134
case study, 141–147
definitions, 134–135
demographic characteristics, 135–136
risk factors and challenges, 136–137
solution-focused brief therapy (SFBT) approach, 133, 139–147
strengths and protective factors, 137–139, 146
Multirace Asians, 122
Mulvaney-Day, N., 102
see also Alegria, M.
Murayama, Y., 56, 70
Murphy, J., 3, 13
Mwachofi, A. K., 168, 178
Myers, B., 181, 192
Myers, H. F., 59, 70, 92, 104
Myers, L. J., 133, 149

Nadal, K. L., 59, 70, 71

see also Sue, D. W.
Napoliello, A. L., 108, 120
Napoli, M., 111, 120
Narang, S., 123, 124, 125, 126, 132
National Aeronautics and Space Administration (NASA), 1
National Alliance on Mental Illness–Multicultural Action Center, 86
National Black Survey, 75–76
National Center for Children in Poverty (NCCP), 192
National Center for Educational Statistics, 110, 120
National Center for Health Statistics, 104
National Organization for People of Color Against Suicide, 86
National South Asian Mental Health Resources, 131
Native American population, 48 (table), 49, 50
see also American Indian clients
Negative emotions, 9
Nelson, C., 87
see also Kessler, R.
Nelson, J. A., 134, 148
see also Bustamante, R. M.
Nelson, T. S., 48 (table), 53, 177, 178

243
Neto, F. L., 194, 205
see also Moreira-Almeida, A.
Neugebauer, D. D., 181, 193
Neu, T., 51
see also Conoley, C. W.
Newsome, S., 41 (table), 48 (table), 53
Newsome, W. S., 74, 77, 87
Ngo, B., 124, 126, 132
Nieri, T., 196, 205
see also Marsiglia, F. F.
Nieto-Gomez, A., 91, 104
Norris, T., 106, 120
Novins, D., 119
see also Beals, J.
Nunnally, E., 4, 31, 33, 51, 53
see also Lipchik, E.
Nuro, K. F., 14, 31

O’Connell, B., 145, 149

O’Hanlon, W. H., 3, 12
Okazaki, S., 125, 132
Olfson, M., 73, 86
see also Das, A. K.
Olivos, K., 53
see also Morrison, J. A.
Olkin, R., 177
O’Pry, A., 51
see also Conoley, C. W.
Oyserman, D., 57, 70

Paez, N. D., 92, 104

Pakrosnis, R., 43, 44 (table), 51
Pansexuals, 150
Paradoxical tasks, 5
Pargament, K. I., 197, 205
Parke, R. D., 92, 102
Parker-Dominguez, T., 59, 70
Parker, R. I., 51
see also Conoley, C. W.
Park, Y. S., 62, 69, 70
Parrila, R., 88, 104

244
Parsai, M., 205
see also Marsiglia, F. F.
Patterson, C. J., 156, 165
Penedo, F. J., 103
see also Gallo, L. C.
Penn, D. L., 12
see also Garland, E. L.
Perez-Grande, M. D., 34, 53
Pérez, M. C., 93, 104
Perloff, J. N., 181, 192
see also Bassuk, E. L.
Perron, B. E., 196, 205
Perry, B. J., 107, 108, 110, 111, 112, 119
Personalismo, 91
Peters, A. J., 155, 165
Pew Forum on Religion and Public Life, 195, 205
Pew Research Center, 90, 104, 135
Philippot, P., 181, 193
see also Lorant, V.
Pichot, T., 29, 31, 109, 117, 120, 155, 165
Pierce, K., 53, 165
see also Smock, S.
Piercy, F. P., 41 (table), 51, 66, 70
Pillai, V., 36, 53, 133, 148
Poll, J., 196, 205
Polo, A., 102
see also Alegria, M.
Positive emotions theory, 8–10
Posttraumatic stress disorder (PTSD), 182
Potoczniak, D., 163
Poupart, L. M., 110, 120
Poverty rates, 110, 123, 124, 180
see also Economically poor clients
Prado, G. T., 59, 70
Presession change, 19, 144, 185–187, 201–202
Prest, L. A., 41 (table), 54
Presuppositional language, 81–82
Previous solutions, 18, 25–26
Problem-focused therapy, 25
Problem saturation, 81

245
Proctor B. D., 180, 192
see also DeNavas-Walt, C.
Protinsky, H. O., 152, 164
Pryce, J., 41 (table), 52
see also Ingersoll-Dayton, B.

Queens County, New York, 90

Queer individuals, 151
Questioning strategies, 18
Quintana, S., 89, 102, 104

Racial microaggression, 58–60

Racism
African Americans, 74
Asian Americans, 58–60, 123, 127
multicultural families, 136
Railroad construction, 55–56
Ramirez, R. R., 55, 69
Ramisetty-Mikler, S., 93, 102
Randall, W., 88, 104
Ratner, H., 7, 13, 34, 52, 88, 104
see also George, E.
Ray, R., 53, 165
see also Smock, S.
Ready, T., 90, 104
Recent efficacy studies, 43–45, 44 (table)
Relationship questions
Asian American clients, 63–65
clients with disabilities, 173
multicultural families, 140–141, 143, 144, 145
Relationships, 91
Religious beliefs, 91, 107, 124–125, 138, 194–195
see also Spiritual/religious clients
Reorientation therapies, 152–154
Research background
early therapy approaches, 32–33
evidence-based reviews, 35–37
hierarchical structure, 36 (figure), 36–37
meta-analytic reviews, 37–43, 38–39 (table), 41 (table)
preliminary pretest-posttest design studies, 33–35
recent efficacy studies, 43–45, 44 (table)

246
 single case design studies, 45–46
Respect/Respeto, 91
Reuss, N., 109, 119, 155, 163
Rew, L., 195, 205
Reynolds, A. L., 163
Rhyne, A., 104
see also Sussman Getrich, C. M.
Ricard, R., 89, 103
Richards, S., 197, 205
Robert, A., 181, 193
see also Lorant, V.
Robert, L., 104
see also Sussman Getrich, C. M.
Robinson Shurgot, G., 104
see also Losada, A.
Rodriguez, N., 92, 104
Roeden, J. M., 170, 177, 179
Rohani, M., 131
Rolland, J. S., 167, 168, 177, 179
Rollnick, S., 16, 31
Roosa, M. W., 92, 103
Roosevelt, Theodore, 56
Root, M., 138, 148, 149
Rosario, M., 155, 163, 165
Rosenblum, K. E., 167, 179
Rose, S., 152, 155, 164
Rowe, W., 108, 117, 119
Rubin, A., 41 (table), 45, 53
see also Springer, D. W.
Ruiz, M. A., 104
see also Losada, A.
Ruiz, R. A., 92, 102
Rychtarik, R. G., 16, 31

Salas-Wright, C. P., 196, 205

Saleebey, D., 2, 6, 8, 13, 134, 137, 139, 149
Saltzburg, N., 163
Sampson, R. J., 181, 193
Sanchez, M. S., 102
see also Beyebach, M.

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Sanchez, T. D., 104
see also Sussman Getrich, C. M.
Sanders, G. S., 195, 205
Sandifer, D. M., 152, 164
Savage, R., 43, 44 (table), 51
SAVA (Sexual Abuse, Violence, AIDS), 93–94
Saving face, 61
Savin-Williams, R. C., 155, 165
Scaling questions
African American clients, 82–85
American Indian clients, 115, 117
Asian American clients, 65–66
characteristics and functional role, 2, 22–24
clients with disabilities, 175–176
economically poor clients, 187–188
Hispanic and Latino clients, 98–99
lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) clients, 158, 161–162
multicultural families, 141, 143, 144, 145
spiritual/religious clients, 201–202
Scamardo, M., 3, 12
Schacht, T. E., 60, 70
Schaefer, E. F., 112, 159, 163
Schlundt Bodien, G., 8, 9, 13
Schrimshaw, E. W., 163
Schroepfer, T., 41 (table), 52
see also Ingersoll-Dayton, B.
Schwarzer, R., 168, 179
Seagram, B. M. C., 40, 41 (table), 53
Seedall, R., 155, 164
Segal, L., 3, 12
Seidel, A., 89, 104
Seidman, L., 61, 70
Seligman, M. E. P., 8, 13
Serovich, J. M., 152, 165
Sexual minority couples, 156
SFBT, CBT, and MI (workshop), 163
Shame, 61, 125
Shao, Y., 61, 70
Sheets, V., 205
see also Johnson, T.

248
Sheppard, K., 181, 192
Sherman, D. K., 58, 61, 70, 71
see also Kim, H. S.
Shin, S., 43, 44 (table), 45, 53
Shoda, Y., 59, 71
see also Wang, J.
Simon, J., 153
Simpatia, 91
Singer, M., 93, 104
Singh, A., 155, 165
Single case design studies, 45–46
Single-race Asians, 122
Slaikeu, K. D., 195, 205
Small, M. L., 181, 193
Smith, J. C., 180, 192
see also DeNavas-Walt, C.
Smith, R., 155, 165
Smith, R. L., 89, 103
Smith, T., 132
Smith, T. B., 196, 197, 205
Smock Jordan, S., 159, 163
see also Bavelas, J. B.
Smock, S., 43, 44 (table), 45, 48 (table), 52, 53, 109, 112, 117, 119, 120, 155, 159, 160, 163, 164, 165
see also Bavelas, J. B.
Sobralske, M., 91, 104
Sobsey, D., 88, 104
Social constructionism, 6–8
Social support networks, 61–62, 75, 84–85, 146
Socratic questioning approach, 6, 7–8
Solares, V., 104
see also Sussman Getrich, C. M.
Solomon, Z., 111, 120
Solution Building Inventory (SBI), 159–160
Solution-Focused Brief Therapy, 173, 179
Solution-Focused Brief Therapy Association (SFBTA), 2
Solution-focused brief therapy (SFBT)
African American clients, 72–85
American Indian clients, 106–118
antecedents, 4–6
Asian American clients, 55–68

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 Asian immigrant clients, 122–131
basic concepts and characteristics, 2–3, 88–89
clients with disabilities, 166–177
co-construction strategy, 112, 159–160
economically poor clients, 180–191
effectiveness, 34–50
ethnic minority populations, 46–49, 48 (table), 50, 88–89
goals and goal-setting, 116, 128–129
Hispanic and Latino clients, 88–101
historical background, 3–6
influencing factors, 4–6
key assumptions, 7
lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) clients, 150–162
meta-analytic reviews, 37–43, 38–39 (table), 41 (table)
multicultural approach, 10–11, 46–47, 49–50, 88–89
multicultural families, 133–147
recent efficacy studies, 43–45, 44 (table)
research background, 32–35
single case design studies, 45–46
spiritual/religious clients, 194–204
theories of change, 6–10
Treatment Manual, 14–30
Somlai, A. M., 104
Soper, S. E., 196, 205
Space pen dilemma, 1
Specific interventions, 19–29
Speight, S. L., 133, 149
Spencer, M., 61, 69, 71
see also Gee, G. C.
Spicer, P., 119
see also Beals, J.
Spirituality, 107, 138
Spiritual/religious clients
case studies, 197–203
clinical issues, 195–197
historical perspective, 194–195
solution-focused brief therapy (SFBT) approach, 197–204
strengths and protective factors, 197
Springer, D. W., 41 (table), 48 (table), 49, 53
Stalikas, A., 8, 9, 10, 12

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Stams, G. J. J. M., 35, 37, 38–39 (table), 39–40, 41 (table), 52, 53, 133, 149
Steger, M. F., 60, 71
see also Yoo, H. C.
Stevens, E., 104
Stevenson, M., 112, 120, 159, 165
see also Smock, S.
Strategic family therapy, 5
Streeter, C. L., 41 (table), 52
Structural family therapy, 5
Substance abuse, 77, 93, 109, 155, 182, 196
Substance Abuse and Mental Health Services Administration, 86, 93, 104, 109, 120, 192
Sue, D., 75, 87
Sue, D. W., 59, 71, 75, 87
Sue, S., 87, 88, 104
Suicide/suicide rates, 110–111, 155
Sullivan, C., 136, 149
Sundman, P., 41 (table), 53
Sundstrom, S. M., 41 (table), 53
Sussman Getrich, C. M., 91, 104
Sutton, C. T., 106, 108, 120
Suzuki, B., 56, 71
Swanson, M., 41 (table), 48 (table), 51
Sweet, E. S., 108, 120
Syndemic continuum model, 93–95, 94 (figure)
Systemic family therapy, 5–6

Tacata, L. A., 57, 69

Tafoya, N., 107, 121
Tafoya, T., 108
1989, 120
Takagi, K., 58, 71
Takeuchi, D. T., 59, 61, 69, 71, 87, 125, 132
see also Gee, G. C.
Tavernise, S., 180, 193
Taylor, P., 90, 104
Taylor, S. E., 58, 61, 70, 71
see also Kim, H. S.
Tetsuro, O., 46, 53
Theories of change
broaden-and-build theory of positive emotions, 8–10

251
 social constructionism, 6–8
Therapist training, 30, 42–43
Thoennes, N., 78, 87
Thomas, F. N., 41 (table), 51, 152, 165
Thomas, T., 93, 103
Thompson, S., 102
see also Brondolo, E.
Thompson, S. J., 89, 105
Thompson, V. L. S., 75, 76, 87
Tienda, M., 92, 105
Tjaden, P., 78, 87
Tobin, J. N., 102
see also Brondolo, E.
Toews, J., 196, 204
Tomorri, C., 160, 165
Tompsett, C. J., 196, 205
Torino, G. C., 59, 71
see also Sue, D. W.
Toro, P. A., 196, 205
Torres, M., 102
see also Alegria, M.
Traditional medicine, 91
Transexuals, 150–151
Transgendered individuals, 150–151, 154, 155–156
Travis, T. M. C., 167, 179
Treatment Manual
active ingredients, 17
basic principles, 14–15
client-therapist relationship, 17
compatibility with adjunctive therapies, 29
conversation ingredients, 16
goals and goal-setting formulation, 16, 19
main interventions, 17–18
rationale, 15–16
session format and structure, 17–29
special populations, 29
specific interventions, 19–29
supervision, 30
target populations, 29
therapeutic process, 15–16

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 therapist characteristics and requirements, 29–30
therapist training, 30
treatment comparison studies, 16–17
Trepper, T., 12, 31, 43, 52, 53, 87, 88, 103, 119, 140, 148, 162, 165, 171, 178, 179
see also de Shazer, S.; Smock, S.
Treviño, A. L., 89, 105
Triandis, H. C., 57, 71
Triantafillou, N., 40, 41 (table), 53
Trimble, J. E., 106, 109, 121
Tripodi, S. J., 41 (table), 52
Trust, 91
Tseng, V, 58, 69
Tsong, Y., 62, 70
Tucker, N., 89, 105
Twomey, H., 76, 86

Uba, L., 58, 68, 71

Umemoto, D., 57, 70, 132
see also Kim, B. S. K.
Unemployment, 110
U.S. Census Bureau, 49, 54, 55, 72, 77, 87, 89, 105, 122, 123, 124, 132, 166, 179
U.S. Department of Education, 123
U.S. Department of Health and Human Services, 85, 90, 104, 105, 166, 179
U.S. Department of the Interior, Bureau of Indian Affairs, 106, 121
U.S. Office of Management and Budget (OMB), 122
U.S. Surgeon General, 88, 105

Vaisey, S., 197, 205

Validation, 82
Valikoski, M., 52
see also Knekt, P.
Vanderwood, M., 53
see also Littrell, J. M.
van Dijk, T. A., 117, 121
van Huijgevoort, T., 167, 178
VanLeeuwen, D., 93, 104
Vaughan, M. D., 163
Vaughn, M. G., 196, 205
Vega, W. A., 91, 93, 105
Velasco, G., 90, 104
Vietnamese population, 124, 126

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Villalba, J. A., 41 (table), 54
Vines, P. L., 106, 120
Virtala, E., 52
see also Knekt, P.
Vision questions, 117
Visser, C., 8, 9, 13
Vo, L. P., 62, 70

Waehler, C. A., 163

Walberg, H. J., 51
Waldner, L. K., 155, 164
Walsh, F., 177, 179
Walsh, S., 41 (table), 48 (table), 51
Walther, W. A., 152, 164
Wampold, B. E., 89, 102
Wang, C. D. C., 46, 52
Wang, J., 59, 60, 71
Wang, Q., 61, 70
Wang, W., 134, 135, 149
Warner, R. M., 104
see also Sussman Getrich, C. M.
Watson, C., 41 (table), 54
Watters, Y., 177
Watzlawick, P., 3, 5, 13
Weakland, J., 3, 12, 13
see also Watzlawick, P.
Wechtler, J. L., 53
see also Smock, S.
Weiner-Davis, M., 4, 31, 51
Weinfeld, M., 91, 104
Weissman, M., 73, 86
see also Das, A. K.
Wetchler, J., 152, 162, 165
Wettersten, K. B., 41 (table), 48 (table), 54
Wetzel, B. E., 41 (table), 54
Whitesell, N., 119
see also Beals, J.
Wilgosh, R., 3, 13
see also Hawkes, D.
Williams. D. R., 183, 193

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Williams, T. M., 86
Windsor, L. C., 89, 105
Wise, F., 107, 108, 121
Wolfe, M. M., 58, 68, 70
Wong, M. G., 56, 71
Wong, Y. J., 195, 205
Wood, A. M., 8, 13
Wood, B., 137, 138, 149
Work ethic, 91
World Health Organization (WHO), 182, 192, 193
Wrenn, C. G., 89, 105

Xie, W., 125, 132

see also Ho, D.
Xuanwen, L., 46, 54
Xu, H., 46, 54

Yamada, A. M., 102

see also Barrio, C.
Yang, B., 46, 54
Yang, J., 46, 53, 54
Yang, P. H., 58, 68, 70
Yee, B. W. K., 57, 58, 71
Yellow Horse Brave Heart, M., 107, 120
see also Duran, E.
Yellow Horse-Davis, S., 107, 120
see also Duran, E.
Yellow peril, 56
Yeung, K. C., 46, 54
Yingping, Z., 46, 54
Ying, Y.-W, 58, 71
Yip, T., 69
see also Gee, G. C.
Yoo, H. C., 59, 60, 71
Yoshikawa, H., 181, 182, 183, 193
Yuen, S., 57, 71
see also Yee, B. W. K.
Yulin, L., 46, 54
Yznaga, S. D., 136, 149

Zamarripa, M., 89, 105

255
Zane, N., 87, 126, 132
Zeng, L., 125, 132
see also Ho, D.
Zens, M. G., 136, 137, 139, 149
Zhao, S., 87
see also Kessler, R.
Zimmerman, T. S., 41 (table), 54
Zweben, A., 16, 31

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