“Life can only be understood by looking backward; but it must be lived looking forward”
Søren Kierkegaard

Suppose you are hungry and decide to go eat at a restaurant. After you have waited a while, you are invited to take a seat. The waiter starts asking you questions about your hunger: How severe is your hunger? Why are you hungry? How long have you been hungry? Have you been this hungry before? What role has your hunger played in your life and your family?  What disadvantages and perhaps advantages does it have for you?
After getting even hungrier, the waiter wants you to fill out some questionnaires about hunger (and other issues the waiter considers important). And after all this, you are served a dinner that you did not choose yourself, but rather one that the waiter claims is good for you and has helped hungry visitors in the past. What do you suppose the chances are that you will leave this restaurant satisfied?

The solution-focused approach
Fortunately, a work method for synthesis no longer needs to be devised: it already exists! The solution-focused approach looks forward to what might be created instead of backwards to what is already there (and needs repairing). It is a competency-based approach, with as little emphasis as possible on failures and problems in the past and present, and as much emphasis as possible on competences, (past) successes and exceptions (moments when the problem or complaint could have arisen, but somehow did not).

When building solutions, clients are seen as experts in their own lives. They are invited to think differently, describe their preferred future, notice positive differences and make progress. Their possibilities, competences and context are used optimally. Research has shown that the solution-focused approach takes less time than the problem-focused approach [1] – and is therefore more cost-effective -, the autonomy of patients is better guaranteed, and fewer burnout complaints are reported by practitioners [2].

Solution-focused professionals always search for openings in conversations even if the subjects that are being discussed are steeped in problems. People almost always tell enough on both the problem and solutions side. These openings can be about what they want differently, exceptions, competences and resources, and who or what can be useful in taking next steps. These solutions do not even have to be related to the problems. They are encouraged to find out what works (better) and to do more of it. Improvement is often the result of shifting focus from dissatisfaction with the current situation to a positive goal; and by taking steps in that direction. This process of shifting attention consists of three steps:

1. Acknowledging the problem: “This must be hard for you.”
2. Suggesting a wish to change: “Do I understand that you would like that to be different?”
3. Asking about the preferred future: “How would you like it to be different?”

Two basic assumptions
Constructing solutions is different from solving problems. It helps us develop a vision for a better future and in discovering what competencies and resources we can use to make that vision a reality. The solution-focused approach consists of the pragmatic application of a number of principles, which can best be described as finding the direct route to what works.

The two basic assumptions are:

1. If something works (better), do more of it.
2. If something doesn’t work, stop and do something else.

The solution-focused approach is intrinsically pragmatic; it revolves around finding what works for this person, at this moment, in this context. The emphasis is on constructing solutions as a counterbalance to the traditional emphasis on analyzing problems. For example, if we look at solution-focused brief therapy, it differs from other forms of psychotherapy in two important ways:

1. Many forms of therapy, like cognitive behavioral therapy or psychoanalytic therapy, have an explicit theory about the origin and perpetuation of problems. Solution-focused therapy has no assumptions about how people develop problems. De Shazer, one of the founders of solution-focused brief therapy, is reported to have said: “Shit happens.”
2. Many forms of therapy assume that knowledge about the origin of problems is necessary to help people get better: they are based on the medical analytical model. Solution-focused therapy is based on the synthesis paradigm, where the (causes of) problems tell us nothing about how we can be useful to our clients.

Asking solution-focused questions forms the basis of the solution-focused approach. They invite clients to discover their own expertise and use it optimally. Solution-focused questions can be about goal formulation, exceptions to the problem or complaints and about competences and resources. Scaling questions are used to simplify complex matters, determine the purpose of the consultation, find out what works and to define progress. They may also indicate how much motivation, hope or confidence the client/patient has that he will achieve his goal.

GP: ‘The consultation is more easygoing and more fun. It’s less heavy. And that can make you very happy. Patients frequently make progress. It is often effective.’

The solution-focused approach does not claim that it can solve problems or can be a cure for complaints and disorders. However, it does claim that it can be helpful to clients in realizing their preferred future, a process in which classifying or diagnosing problems is often irrelevant. When they have realized their preferred future, their problems, complaints and worries might or might not have disappeared.

The solution-focused approach complements the medical model for reducing or eliminating undesirable behavior, complaint or problems. The solution-focused model revolves around starting or expanding desired behavior. It is goal-oriented and future-oriented, short-term and practical, it focuses on achieving concrete results, is lighthearted and positive in tone and atmosphere, and energy-saving for professionals.

Some SF assumptions are:

• It is not necessary to know the cause or perpetuating factors of a problem/complaint in order to be able to solve it.
• Quick change or solution of the problem is possible.
• Focus on solutions and possibilities instead of on pathology.
• Invite the client/patient to take action.
• Look for, and encourage, small positive changes.

The term ‘solution’ suggests that there is a problem. Because this is not always the case, some authors prefer to speak of ‘preferences’ and ‘possibilities’. In short: the solution-focused approach is about designing an outcome that was not there before. De Bono, whose ideas we discussed in Chapter 17, became known for his term ‘thinking outside the box’. He stated the following about designing an outcome:

“With design there is a sense of purpose and a sense of fit. Problem analysis is always looking back at what is already there; design is always looking forward at what might be created. We need to design outcomes. I do not even like saying design “solutions” because this implies that there is a problem. Even when we cannot find a cause, or, after finding it, cannot remove it, we can always attempt to design an outcome.”

A short history
The solution-focused approach was developed in the 1980s by De Shazer, Berg and colleagues at the Brief Family Therapy Center in Milwaukee, USA. They built their ideas on the findings of Gregory Bateson [3] and Watzlawick, Weakland and Fisch [4], who assumed that the attempted solution often perpetuated the problem and did not solve it, and that understanding the origin of the problem was not (always) necessary. Steve de Shazer formulated several tenets regarding a solution-focused approach [5].

• The class of problems does not belong to the class of solutions. Analyzing problems is not necessary to find solutions, but analyzing solutions is (for example: “What have you already done that was useful?”).
• The client is the expert. He defines his goal and the way to achieve it. De Shazer assumes that problems are ‘platform tickets’ (tickets you needed to use to access a train platform). They help the client through the entrance, but do not determine which train he takes or where he gets off. Where someone wants to go is not determined by the starting point.
• If it’s not broken, don’t fix it. Do not interfere with what’s going well in the client’s perception.
• If something works (better), do more of it. Even if it is different from what was expected.
• If something doesn’t work, stop and do something else. More of the same leads to nothing.

SF practice
Steve de Shazer [6] regarded the solution-focused approach as a tap on the shoulder. The professional does not have to push or pull, but always stands one step behind the client and looks in the same direction (to the preferred future of the client). A tap on the shoulder helps to focus attention on the preferred future. This attitude is called leading from one step behind. Solution-focused questions are those taps on the shoulder. The attitude of the solution-focused professional is sometimes called the ‘attitude of not knowing’: he asks questions inviting the client to discover and use his own expertise and competencies. These questions can be divided into six types:

1. The question about change before the first session (pre-treatment change)

What has changed since you made this appointment? Two-thirds of clients report some progress since making the appointment [7]. They are then asked, “How did you manage to do that?” and “How can you make that happen more often?” This is in line with the assumption that everything is changing and that the point is not to see if change is taking place but when change takes happens.

2. The question about the goal

“What is your goal in coming here?” Or: “What would you like to have accomplished by the end of this session/sessions in order to conclude that it has been useful?” Or, “How will we know we can stop meeting like this?” (This was the opening question by De Shazer). Or ask: “What do you want instead of the problem?” or: “What are your best hopes? And suppose all your best hopes are met, what will be different?”
The miracle question is another possibility: “Suppose you are sleeping tonight and a miracle happens. The miracle is that the problem that brought you here has been solved (sufficiently). But you don’t know, because you were asleep. What will be the first thing you will notice tomorrow morning that will tell you that the miracle has happened? What will be different tomorrow? What will you be doing differently? And how else will you notice during the day that the miracle has happened? How will others know that the miracle has happened? How will they react differently?”
Other goal formulating questions: “When can we stop seeing each other?” and “How are you going to celebrate when you don’t have to come here anymore?”

3. The question: ‘What else?’

Asking for details is important: “What exactly does that look like?” “Suppose that happens, what would you be doing differently? What else? And what else?” It is important to keep inviting to think about anything that resembles a success, resource, or something the client values ​​about himself. The question also implies that there is more and that the client only has to discover what this is.

4. The question about exceptions

“When is/was a small part of the miracle already present?” Or: “When is/was something of the preferred future already noticeable? How did you notice? What was different? How did you do that?” Questions about moments when the problem is less or not there, or when the problem is not a problem (for a while) can also be asked: “What is different about those moments?”
An alternative question is to ask for the moment when the client succeeds to deal with the problem differently or better, in situations where the problem is there. Clients often overlook these moments when the problem is less or not there, because in their opinion the problem is always there
Ludwig Wittgenstein stated “The aspects of things that are most important for us are hidden because of their simplicity and familiarity (one is unable to notice something – because it is always before one’s eyes).” There is no need to dig to find exceptions: they are on the surface, but clients (still) overlook them and do not (yet) see these differences as a ‘difference that makes a difference’.

5. Scaling questions

Scaling questions focus on progress, motivation, hope and/or confidence. They can be asked when the goal has been formulated or when exceptions have been sought. Sometimes it is good to first ask the client if he is familiar with the use of scaling and then explain what a scaling question is.
A commonly used scaling question is, “If the miracle (or ideal situation) is a 10, and 0 is the opposite, where do you want to end up on that scale? What will be a realistic goal? And where on the scale do you put your current situation? How come it is not lower than it is? What’s in that number? What else? And what does a higher number look like? What will you be doing differently then? How can you get a point higher? What or who might be useful in achieving this?” The ideal 10 is often neither attainable nor necessary: ​​most clients are pleased with a 7 or 8. Think about it: how often do you give your own situation a 10?

6. The question about competences

Everyone has competences, however bleak their situation may be. Competency-based questions are: “How exactly did you do that?” “How do you manage to…?” “How do you cope?” “How come it’s not worse?” It’s important to look at all small, positive details that invite clients to tell a success story about themselves.

That being said: a combination of a problem-focused and a solution-focused approach – of analysis and synthesis – might also be possible (Chapter 2).

Research an publications
The solution-focused approach is applied everywhere. Not only in (mental) healthcare, but also in education, organizations and teams, the judiciary, journalism and sports. There is a large body of literature on solution-focused brief therapy. This concerns therapy in psychiatry [13] [14] [15] with a variety of problems such as alcohol abuse [8] and post-traumatic stress disorder [9] [10], [11], [12].
There are publications about solution-focused conversations with ‘therapy veterans’ [16], [17], [18], children and adolescents [19], [20], [21], the elderly [22], in group therapy [23], people with intellectual disabilities [24], management and coaching [25], [26], in organizations [27], leadership [28], remedial teaching [29], mediation [30], restorative justice [31], general practice [32], supervision and peer supervision [33] and positive cognitive behavioral therapy [34].

Manager: “The solution-focused approach adds something to the toolkit I need to run an organization. It is useful when conversing with customers, but also in managing the team. It gives you a certain joy.”