Psychotherapy: Theory, Research, Practice, Training 2006, Vol. 43, No. 1, 1–12
Copyright 2006 by the American Psychological Association 0033-3204/06/$12.00 DOI: 10.1037/0033-3204.43.1.1
PERSON-CENTERED THERAPY AND SOLUTION-FOCUSED BRIEF THERAPY: AN INTEGRATION OF PRESENT AND FUTURE AWARENESS LISA M. CEPEDA AND DONNA S. DAVENPORT Texas A&M University
The authors propose an integration of person-centered therapy, with its focus on the here and now of client awareness of self, and solution-focused therapy, with its future-oriented techniques that also raise awareness of client potentials. Although the two theories hold different assumptions regarding the therapist’s role in facilitating client change, it is suggested that solutionfocused techniques are often compatible for use within a person-centered approach. Further, solution-focused activities may facilitate the journey of becoming self-aware within the personcentered tradition. This article reviews the two theories, clarifying the similarities and differences. To illustrate the potential integration of the approaches, several types of solution-focused strategies are offered through a clinical example. Keywords: person-centered, solutionfocused, theory integration, psychotherapy
Lisa M. Cepeda and Donna S. Davenport, Counseling Psychology Program, Department of Educational Psychology, Texas A&M University, College Station. We thank Antonio Cepeda-Benito for reading several versions of the current manuscript and providing excellent constructive feedback. Correspondence regarding this article should be addressed to Lisa M. Cepeda, Department of Educational Psychology, Texas A&M University, College Station, TX 77843-4225. E-mail:
[email protected]
Over the last 30 years, most psychotherapists have self-identified as eclectic/integrative in their theoretical orientation (Norcross, Hedges, & Castle, 2002; Norcross, Prochasca & Farber, 1993). Integration psychotherapy is motivated by dissatisfaction with single-school approaches or a desire to look across and beyond school boundaries (Goldfried, Pachankis, & Bell, 2005). The availability of different theoretical approaches allows therapists to tailor their interventions to their clients’ individual needs by selecting and integrating specific techniques (van Kessel & Lietaer, 1995). Thus, therapists look to explore how different ways of thinking about psychotherapy and change may combine to improve treatment outcomes (Goldfried et al., 2005). Practical reasons also motivate therapists to integrate theoretical orientations. Managed health care andeconomic and contextual constraints lure therapists away from long-term psychotherapy approaches. These pragmatic limitations often result in the modifications and adjustments to psychotherapy aimed at reducing the length of treatment and measuring change in a concrete and readily quantifiable manner (Goldfried et al., 2005). However, therapists also express concern over the idea that therapeutic gain can be achieved by molding psychotherapy to pragmatism. Whereas proponents of brief therapy interventions emphasize the importance of being practical in effecting short-term, positive change, experiential therapists are concerned that brief therapies do not take sufficient time to assess the affective inner world of the client (Jaison, 2002). Rather than taking an either-or approach, the present authors propose that the process of integrating different approaches can be achieved to attain pragmatic gains while accessing the client’s inner world and without losing theoretical congruity (see also Jaison, 2002). We will present how Person-Centered (PC; Rogers, 1980) and Solution-Focused (SF; De Jong & Berg, 2002) theories and techniques can be integrated and applied to a real-world therapy case. After a brief summary of both the-
1
Cepeda and Davenport ories, a clinical example of how the integration of these approaches may take place will be presented. Our hope is that ideas suggested here will enhance therapists’ creative thinking about further use of PC therapy by actively inspiring an awakening of the client’s potential self through the use of SF techniques. Carl Rogers’ person-centered therapy has made immeasurable contributions to the fields of counseling and psychotherapy (James & Gilliland, 2003). Rogers’ views of the human potential and the role of the therapist as being a listener that is supportive, accepting, and caring became a welcomed alternative to Freudian psychoanalysis and directive behaviorism (Rogers & Kinget, 1962; Raskin, 1948; Seligman, 2001). Rogers’ ideas have found wide appeal because they explain “basic aspects of the way in which the person’s own capacity for change can be released and ways in which relationships can foster or defeat such self-directed change” (Rogers, 1980, p.50). Rogers was responsible for demonstrating that the therapist’s delivery of genuineness, empathy, and acceptance within the therapeutic relationship is the most important tool for client change (Corey, 2001; Kramer, 1995). Moreover, this ideal of the therapeutic relationship has been generally incorporated by most approaches (Watkins & Goodyear, 1984). Solution-focused (SF) therapy began in the 1980s with the research and writings of Steve de Shazer, Insoo Kim Berg, and their colleagues (for a review, see De Jong & Berg, 2002). Therapists using a SF approach de-emphasize the past in favor of behavior change that promotes the attainment of the person’s wants and goals. Rather than spending time seeking to understand the causes of a problem, SF therapists spend their energies increasing their clients’ hope and fostering in them an expectancy of change (Bozeman, 2000). Like Rogerians, SF therapists work to increase their clients’ awareness (Norum, 2000). Rather than enhancing complete self-awareness, SF therapists selectively focus on their clients’ strengths and on what is working in their lives.
and behaviors. Therapists help clients by facilitating here and now experiences within the therapeutic relationship that create the opportunity for clients to become aware of their true feelings (de Haas, 1980; Lehmann, 1974; Rogers, 1961). Rogers posits that this awareness of self can only become actualized, grow, and change through an interpersonal relationship that is safe, accepting, and caring (Schmid, 2002). This is the goal of therapy: to create the conditions that will encourage clients toward self-actualization, to become their most real and richest being (Brodley, 1986). In order to facilitate change, the therapist must fully receive the client and the client must experience being fully received, an experience which includes the sense of being understood and accepted empathically (Rogers, 1961). This approach rests on three main conditions deemed necessary for personal client growth and change: genuineness or congruence, empathy, and warmth or unconditional positive regard (Rogers, 1967). The relationship of person-centered therapy allows clients to become aware and to fully accept themselves as they are—including imperfections and dysfunctions. This client awareness exposes the gap between the real and ideal self and serves to motivate the individual toward narrowing the gap. Clients then use this relationship to generalize to the outside world (de Haas, 1980; Swildens, 1977) and to become more open to experiences (Rogers, 1961). The therapist and the client perceive this change as the client becomes able to see reality without distorting it to fit a preconceived, defensive structure. The assumption is that clients go from a rigid belief system to one of process and change, with an enhanced interest for exploring new possibilities. Clients may become less invested in their public images and more interested in understanding how they are and in becoming their true selves. Thus, change occurs because the client is motivated to actualize; not only is there no need to encourage change, this theory suggests that “pushing” the client to make changes can actually be detrimental.
Theoretical Assumptions and Key Elements of Person-Centered Therapy
Theoretical Assumptions and Key Elements of Solution-Focused Therapy
Person-centered therapy rests on the assumption that the practicing therapist can help clients overcome the negative effects that some past experiences have had on their attitudes, feelings,
Steve de Shazer, Insoo Kim Berg, Bill O’Hanlon, and Michelle Weiner-Davis are the names most closely associated to the origins of solution-focused therapy (De Jong & Berg, 2002;
2
Blending Person-Centered and Solution-Focused Therapies Seligman, 2001). These authors maintain that solutions are possible without an in-depth assessment of the nature of the problems for which clients seek help (De Jong & Berg, 2002). Rather than assuming a necessary connection between a problem and its solution, SF therapy focuses on the client’s strengths. The assumption is that working with the client’s resources is more constructive than working with the client’s deficits (Berg & Reuss, 1998). The emphasis is on the future instead of the past, on solutions rather than problems, and on client strengths, not deficiencies (Murphy, 1997). Several authors offer a number of underlying assumptions and directives to guide therapists’ adoption of the solution-focused model (De Jong & Berg, 2002; Walter & Peller, 1992). Among the most important assumptions are the following: ● ● ●
● ●
If it doesn’t work, do something different, and if it works, do more of it. Clients have the strengths and resources to change. Clients’ problems are seen as roadblocks resulting from limited recognition of alternatives and not as symptoms of underlying pathology. A small change in any aspect of a problem can initiate a solution. Focusing on future possibilities and solutions enhances change, as does cooperation.
Proponents of SF therapy insist that the clients are the experts of their own lives. To communicate this, therapists set aside their worldviews in order to be in a state of curiosity and desire that can be informed by the client (Berg & Reuss, 1998). Murphy (1997) calls this stance adopting the “ambassador perspective.” This approach is similar to Rogers’ concept of empathy— getting inside the client’s world (Lipchick, 2002). In addition to being curious, the practitioner of the ambassador perspective is tentative instead of absolute. To help establish a relationship, the therapist tries to match the client’s language and position. To facilitate the focus on the future and to communicate hope, the therapist speaks using presuppositional language, which communicates a positive expectation for change and faith in the client’s ability to bring about the change that will improve his or her own life (Sarti, 2003). It is important to cooperate with the client’s position, which refers both to the client’s theory about a problem and its solution and to the client’s “customership”; that is, his or her motiva-
tion and commitment to resolve the problem (Fisch, Weakland, & Segal, 1982). In a customertype relationship, clients acknowledge the problem and want to do something about it. In a visitor-type relationship, conversely, clients are not very interested in seeing things change or in doing anything about the problem (Fisch et al., 1982). Complainants acknowledge that there is a problem, but they are unwilling to do anything about it. Regardless of the initial customership, therapists must remain unswerving in their dedication and respect for their clients, thus shaping their clients’ attitudes toward the customer viewpoint. Therapists also rely on homework tasks that accommodate the client’s unique views with regards to their unique solutions, but with the intention that each task will move clients forward toward their goal (Greene, Lee, Mentzer, Pinnell, & Niles, 1998). The beginning of solution talk starts with the end in mind. The client describes at the onset of counseling what he or she wants. This is called goal negotiation (Berg & De Jong, 1996). Effective goals should be specific, small, positive, and most importantly, meaningful (Murphy, 1997). Well-formed goals need to be described as the presence of something positive rather than the absence of something negative. Therapists encourage clients to “describe how they will know when the problem is solved” (De Jong & Berg, 2002, p. 80). To achieve this presence of positive behavior, therapists ask for specific details about who will be doing what-to-whom-when-andwhere after the problem is solved (Murphy, 1997). Therapists also help clients identify sources of support within their relationships by asking how significant others can be of help in building solutions and how they will react when the solutions substitute the problem. Pulling from the strengths and talents of the client’s significant others gives the client a real-life view of the solutions’ impact (Santa Rita, 1998). A well-known strategy of SF therapy is the Miracle Question, which invites clients to think about unlimited possibilities. Insoo Kim Berg sets the stage for her clients’ creative answers using a dramatic voice to create a lightness that evokes possibility within the session, thus inviting the client’s imagination. Suppose that, while you are sleeping tonight, a miracle happens. The miracle is that the problem, which brought you here today, is solved. Only you don’t know that it is solved because you are asleep. What difference will you notice tomorrow
3
Cepeda and Davenport morning that will tell you that a miracle has happened? What else will you notice? (De Jong & Berg, 2002, p. 85).
Clients are encouraged to think big and paint a picture of a time when the problem will no longer be there. It is important to establish a connection between the miracle and the here and now through behavioral descriptions. Berg uses wellformed questions to make this connection. “You say that the miracle is that you’d feel better. When you feel better, what might others notice different about you that would tell them that you feel better? What might you do different when you feel better? What else?” And this example: “You say that the miracle is that you’d weigh 50 pounds less. OK, what will be different in your life when you lose that first pound?” (De Jong & Berg, 2002, p.290). Exception Finding (Molnar & de Shazer, 1987) consists of asking clients about times when the problem was absent or less noticeable. Identifying exceptions to the problem focuses clients on success and the realization that they already have begun to build their own solutions. Transferring what works in one situation to another is a simple, effective solution (Nelson, 1998). Clients are encouraged simply to do the exception more frequently (Murphy, 1997). Scaling helps clients put their observations, impressions, and predictions on a measurable scale from 1 to 10. Scaling helps clients see complex aspects of their life in a more concrete and comprehensible form. Scaling questions can be used to access a variety of perceptions from self-esteem to investment in change to progress in goal achievement (De Jong & Berg, 2002). Scaling helps clients detect and appreciate solution building in small increments. This tool also is used to motivate clients to move forward and to envision what type of effort will be needed to achieve small gains. Small and concrete goals are defined as the client describes what will happen as she or he moves up from one number to another on the scale. Building on the Person-Centered Approach Boy and Pine (1999) posited that there are two phases to PC therapy. Phase I consists of the creation of a therapeutic relationship that will foster the client’s innate drive toward selfactualization and growth. The techniques or behaviors of the therapist in Phase I coincide with the delivery of the core ingredients of PC therapy.
4
Adhering to Rogers’ propositions, Boy and Pine (1999) conceptualize Phase I as the means to foster autonomy and encourage clients to explore their inner choices rather than to rely on others for direction or evaluation. Once clients begin to engage fully in the therapeutic process and exhibit signs of a stronger internal locus of control and a willingness to grow, the therapist should move to Phase II. This phase moves into an experiential and eclectic process that allows therapists to respond more directly to the individual needs of their clients. Phase I is thus conceptualized as setting the background for effective, honest, open communication and accurate identification of client needs, whereas Phase II consists of finding and implementing the procedures that the therapist and client find most suitable and congruent with the needs of the client. Phase II stretches the boundaries of classical Rogerian therapy. Therapists move into Phase II with the addition of other therapeutic approaches and techniques that widen the client’s road in the journey to self-actualization. Similarly, Bohart and Tallman (1996) suggested that within a PC approach, clients can use an array of approaches and procedures in different ways: Because the client who uses the technique is a whole person, the client may be able to approach his or her problems from a multiplicity of productive directions, gaining insight into the unconscious (psychodynamic), exploring feelings and values (humanistic), practicing skills (behavioral), or changing cognitions (cognitive). It is the whole person—the active client— who takes these various part processes and uses them in his or her self-growth (p. 19).
This concept of Phase I/Phase II, offers the potential for PC therapy to be integrated with other approaches. Even clients that achieve a high level of awareness and motivation to change and genuinely seek to be congruent may find difficulties in attaining their goals in an expeditious way that “works” in their family and cultural contexts. That is, some clients come to therapy not only with both behavioral deficits and maladaptive behaviors, but also with very specific contextual problems that get in the way of moving forward (e.g., not knowing how to respond assertively to an overdomineering spouse). Solution-focused therapy provides a series of techniques that help clients establish and find ways of achieving concrete goals (Lethem, 2002). To the extent that the goals set within the solution-focused approach can be congruent with the self-actualizing goals of person-centered therapy and with the therapeu-
Blending Person-Centered and Solution-Focused Therapies tic relationship already established, this approach is congruent with a Phase I/Phase II model of person-centered therapy. Without losing sight of the theories’ specific tenets, we propose to blend PC and SF therapy in a theoretically congruent manner. Similarly but independently1, Jaison (2002) presented a convincing integration of an experiential psychotherapy approach, Focusing Oriented Therapy (FOT; Gendlin, 1996), and a brief therapy approach, Solution Oriented Brief Therapy (SOBT; O’Hanlon & Weiner-Davis, 1989), to create an integrated, new orientation, Solution Oriented Focusing Therapy (SOFT). Jaison (2002) recommended that therapists become fluid in the languages of the experiential and solution-focused approaches and then let their intuition guide them in switching languages within and across sessions, as needed. Unlike Jaison (2002), we propose a more structured method to the integration of both therapies by adopting Boy and Pine’s (1999) Phase I/Phase II model. That is, we encourage therapists to draw heavily from Rogerian techniques during Phase I, and then move to make use of SF techniques during Phase II of psychotherapy. Differences and Similarities Between the Theories and Suggested Resolutions The challenge before us is to integrate the Rogerian approach, where the therapist is generally nondirective and the therapeutic goal is not easily quantifiable, with the brief-therapy modality of Solution-Focused therapy, where directiveness is expected and the goal is to change concrete, easily observable behaviors. The therapist’s focus for how to accommodate client change is assumed also to differ greatly between PC and SF therapy. The PC therapist focuses on here and now experiences within the therapeutic relationship to help the client become aware of his or her true self. It is assumed that as clients feel accepted within the therapeutic relationship, they are then able to accept themselves and change. In contrast, the SF therapist facilitates client change through solution talk. To envision and create small, attainable goals, the SF therapist directs the client toward envisioning a future without the problem. Then, by using the client’s resources and strengths, the therapist works in cooperation to reach that hopeful future in small steps. PC therapy envisions change as possible
through acceptance of self. The PC therapist facilitates change through communicating acceptance and respect to the client and by remaining nondirective. The SF therapist, in contrast, facilitates change by encouraging clients to envision a problemless future and make the appropriate changes. In theory, a successful integration of the two theories would combine the potential benefits of both approaches, increasing awareness and acceptance of the self to enhance long-lasting change and congruence, while accelerating the process of change and increasing the client’s confidence in his or her ability to cope and resolve problems. In PC therapy, the goal is to create the conditions that will encourage self-actualization, to create an environment that will help the client narrow the gap between real self and ideal self. These internal changes to a client’s perception and acceptance of themselves in the here and now are seen as a necessary step before the client can motivate to change. In contrast, the goals of SF therapy are clear and specific and are brought about by action, by doing something the client knows how to do and that works. While SF therapy focuses on the future and PC therapy focuses on the here and now, both approaches concentrate on the self. SF therapy concentrates on the ideal vision of the clients and their dreams, on how to make parts of those dreams come true in very concrete ways. PC therapy concentrates on accepting the client as is, so that clients can self-actualize and become closer to their ideal self. Thus, although different on the surface, in essence, both approaches share their focus on the self, the objective of changing the self, and the strengths of the self (Jaison, 2002). Praising and complimenting the client is viewed differently by these two theories. Rogerian therapists believe that clients reach selfaffirmation through being accepted, not praised, by their therapist. Praise is seen as risky, in that it can lead the client to rely on the therapist’s point of view, rather than his or her own. SF therapists, conversely, advocate complimenting and praising 1 We were unaware of Bala Jaison’s work until a reviewer pointed us in that direction. Although the two papers defend the integration of seemingly disparate theoretical approaches and overlap considerably at a conceptual level, differences between the two works exist with regard to the specific theories that are integrated, as well as the specific recommendations and structure offered to achieve the integration.
5
Cepeda and Davenport the client in order to buoy and remind the client of his or her strengths. The two perspectives can be at least partially integrated by having therapists ask the client about feelings of self-worth and pride before acknowledging their own feelings for the client, thereby avoiding the client’s problem of saying what will please the therapist. For example, if the client achieves a goal, the therapist may say, “Was that difficult to do? Are you feeling proud of yourself?” If the client assents, then the therapist may reinforce this selfperception by saying something like, “And no wonder! That seems like an important change for you to make! And you’re saying it worked!” A similar use of praise is the naming of a client strength that has become obvious during therapy—resiliency, for example. Naming the strength, as long is it is done congruently and not as false praise, can serve to bolster the client’s self-image while remaining true to the PC approach. Although there are some differences between the two theories on the issue of therapist selfdisclosure, we do not believe these differences are great. Rogers (1967) indicated late in life that if he had it to do over again, he would have included more congruent self-disclosure (called “immediacy” by his followers, Truax, Carkhuff, and Egan) in his therapeutic style. Rogers explains his tendencies toward sharing his feelings with the client: “I am quite certain even before I stopped carrying individual counseling cases, I was doing more and more of what I would call confrontation, e.g., confrontation of the other person with my feelings. . .” (Landreth, 1984). Note the similarity to the SF approach: “We do not recommend that you tell clients about your own experiences. The notion behind solution building is that the first place, and usually the only necessary place, to look for solutions is within the client’s frame of reference and past experiences. However, that does not mean you ought never to reveal to clients what is on your mind. Sometimes it is important to tell clients what you are thinking, e.g., if you notice a contradiction in what the client says, you might observe and inquire: ‘Earlier, you said things were pretty good between you and your mom. Just now, you said you are sick of her. I’m confused. Can you explain to me how those two fit together?’ ” (Berg & De Jong, 1996, p. 32–33).
Self-disclosure does not mean telling your clients that, for instance, you too broke curfew as a teenager or you too were sexually abused (Berg & De Jong, 1996). The issue of providing suggestions is approached somewhat differently in the two thera-
6
peutic approaches. Traditional person-centered therapists do not offer suggestions for behavioral change because it is again seen as a technique that tends to foster dependency. In the SF approach, while it is preferable for clients to be able to generalize solutions from another situation to the current problem area, or to arrive at possible solutions for themselves, it is allowable for the SF therapist to tentatively offer a behavioral suggestion. While this is, indeed, different from the person-centered counselor’s approach (Brodley, 1986), if the suggestion is provided tentatively, as an experiment to try rather than a guaranteed solution, the risk of dependency is reduced. Integration of PC and SF therapy should not be difficult because the two theories share at least four important assumptions. First, the ultimate goal of PC therapy (to provide the proper environment in which the client is motivated to selfactualize, to grow, to become all that he or she can become) is also central to SF therapy. As self-actualization is the goal for all persons, regardless of “normality,” it logically follows that the ultimate goal of all humanistic psychotherapy approaches, including SF therapy, is to facilitate progress for those whose progress has been blocked or interrupted (Patterson & Hidore, 1997). Second, both approaches are humanistic in nature in that they emphasize the whole person, and share the belief that people are trustworthy, resourceful, and able to make constructive changes and live effective and productive lives (Cain, 1987). This positive view of human nature implies that people have an inherent capacity to move away from maladjustment and toward psychological health (De Jong & Berg, 2002; Rogers, 1961). Therapists in both approaches thus place the primary responsibility on the client; they share the belief that people have the resources they need to solve their problems. A third tenet that is shared by both SF and PC therapy involves the role of the therapist; both theories take a phenomenological approach. Therapists in both traditions attempt to understand the client’s internal frame of reference (how the client perceives himself or herself and the world). Neither therapist assumes more knowledge than the client but rather accepts that the client is the expert. The fourth important commonality is the view that life is change and change is inevitable. Both approaches attempt to facilitate change through client-chosen direc-
Blending Person-Centered and Solution-Focused Therapies tions. The client is seen as the one who generates what is possible and who contributes the movement that actualizes this client-driven potential (Corey, 2001). An advantage of PC and SF therapy is their emphasis on understanding the client’s internal frame of reference, and working from the position of not knowing more than the client. This characteristic gives PC and SF therapy the flexibility to work with human diversity. As each client is a composite of several dimensions of diversity (class, ethnicity, gender, physical ability/disability, sexual orientation, race, religion, and so forth), and the therapist has no way of knowing ahead of time how these may interact within any particular client, the willingness to learn about the client from the client is a necessary condition to becoming a culturally sensitive counselor (Negy, 2004). Whereas knowledge about the histories, customs, preferences, and patterns of diverse groups, as well as the therapist’s increased self-awareness on class, racial, gender, and other learned biases contribute to culturally sensitive practices (Sue & Sue, 2003), sensitive therapists recognize individual diversity (Negy, 2000). Integration of PC and SF Therapy: A Case Study Building on the work of Boy and Pine’s (1999), we posit that the techniques of SF therapy (De Jong & Berg, 2002) can be incorporated as enhancing elements of their PC, Phase II approach. In order to maintain theoretical integrity, the combination of PC and SF therapy should comply with two requirements. First, SF techniques need to be implemented so that they complement and work congruently within the theoretical framework of the person-centered approach; that is, Rogers’ relationship qualities of congruence, empathy, and unconditional positive regard must be maintained. This means not diminishing the human therapeutic relationship and not taking the control away from the client. Second, prior to implementing SF techniques, the therapist needs to be able to recognize whether the client has already began to engage fully in the therapeutic process, the goal of Phase I. In Rogers’ “Seven Stages of Process,” he explains how a therapist can perceive the client’s personality changes. In stages four and five, the client, now feeling understood, welcomed, and received,
shows a freer flow of feelings along with a loosening of the way experiences are construed. In addition, there is an increased ownership-of-self feelings and “a desire to be these, to be the ‘real me’ ” (Rogers, 1961, p.141). Attention to these client processes will provide a basis for initiating the use of SF techniques. The following case description is based on the work of the first author, a doctoral student in a counseling psychology program. The client’s name and her identifying information have been modified to protect confidentiality. Background. Marı´a, a woman in her mid 40s, was born and raised in a small town in Mexico. Marı´a’s physician referred her for therapy to receive treatment for depression. Her treatment goals included increasing her understanding of her physical ailments and exploring why she was not as happy as she remembered being. She also wished for a closer connection with her husband and her daughter. Marı´a reported loving her husband of 20 years, but she also complained of his lack of warmth and his disinterest in her. They communicated very little and lived following very traditional roles. Marı´a’s 16-year-old daughter from her current husband was also depressed and Marı´a felt estranged from her. Marı´a described herself as a devout Catholic and saw her role and wifely functions as in line with the Bible. At the time of treatment, she worked for the ranch owners of the farm where they had lived for the past 18 years. Marı´a presented as depressed and anxious and quite preoccupied with her poor health. She complained of severe headaches, heart palpitations, and painful arthritis in both hands. She reported not being the happy, full-of-energy person that she used to be. She would easily forget the content of conversations and reported never confiding her intimate thoughts with anyone for fear of gossip. Therapy process: Phase I. My initial concern in therapy was to focus on understanding Marı´a from her internal frame of reference. She was very distressed and anxious, which seemed to both make her want to change and to motivate her to work toward her desired changes. Using a person-centered framework, I trusted in her ability to find her own way and believed that she had within herself the necessary resources for personal growth. Thus, I encouraged Marı´a to speak about the person she was and the woman she desired to become. I strove to create an atmo-
7
Cepeda and Davenport sphere of safety and freedom that would encourage Marı´a to explore all her sides. I attempted to understand what it would be like to live in Mar´ıa’s world. Through nods, facial expressions, and empathic reflections I conveyed to her my acceptance of her and my understanding. The early sessions focused on an unraveling of her pain. Marı´a said she had never before disclosed secret truths about herself. She was now spilling out her secrets slowly and laboriously, as if the Mexico that claimed her soul wished to keep the secrets on the other side of the border. In an early session, Marı´a talked about her childhood labors of ironing, needlework, and cleaning. For 35 years she had been doing manual labor without rest. I suggested that she was tired from years of too much work and she nodded, a nod that seemed both to acknowledge my reflection and communicate a soothing from being understood. A few sessions later, she went from a mere nod to openly verbalizing a corner of that truth. She was tired but she felt the strength to accept the fact that she was tired. She disclosed feelings of wanting to sit down during the day and not wanting to follow her husband’s orders. I reflected that she desired to rest during the day when others still asked so much of her. She nodded, and her Spanish flowed in the freedom and warmth of our relationship. Her feelings of exhaustion continued to resurface from time to time. My congruence with my inner and outer self with Marı´a was central to empowering the therapeutic relationship. What I felt as Marı´a told her story was genuine, and how I expressed my real feelings matched my inner experience. I openly expressed my thoughts, reactions, and attitudes within our sessions. In our eighth session, Marı´a shared her feeling of being trapped doing ranch labor and being manipulated by her ranch owner. She said she was allowed to leave the ranch only on rare occasions and only after asking permission. She dreamed of doing work other than being the nursemaid, cleaning lady, and cook for the ranch owners. However, Marı´a had been warned authoritatively and without question that they would take her home away from her if she dared to look elsewhere. Here I felt her feelings of powerlessness. I reflected her delicate and difficult position and her feelings of frustration at having to tolerate the unfair treatment. Twelve sessions later, Marı´a revisited this theme. She
8
told me the ranch owner had withdrawn her permission to come to therapy. Her boss had told Marı´a that she wasn’t depressed and that she was wasting her money. Obviously, Marı´a did not yield to the farm owner’s pressure and came to therapy in spite of its now being forbidden. Although she confided she feared what her husband would say to her when he got wind of her conversation with the rancher, I saw a Marı´a filled with more of herself. Her smile seemed brighter; she walked straighter; she talked with a determination that was more in line with the core of her. Refusing to obey her boss had heightened her sense of self-esteem and had partially lifted the depression. Therapy process: Phase II. At this point, using some of the techniques offered by the solution-focused approach seemed indicated. It was clear that our therapeutic relationship was a safe haven for Marı´a. Therapy was the place where she could tell of her pain without feeling guilty for being a bad daughter, sister, or wife. By being accepted, she had the courage to look within and to accept herself. She had gained confidence in herself and found the drive to do things differently on her own. In revealing that she felt good but still feared her husband’s reaction she communicated she understood she still had a way to go. Nonetheless, her body language told me she knew what direction she wanted to take. It became clear that Marı´a was becoming increasingly actualized. She was more open to experience, had more trust in herself, and had more of an internal source of evaluation (Corey, 2001). Thus an important advantage of using the PC approach was achieved, a goal that most likely would translate into long-term gains and would promote generalization to the outside world. The advantages of SF therapy would now build on a solid base of internalized selfacceptance, a gain not emphasized by the SF approach. Marı´a was at a point where she was ready to work toward concrete goals. Her self-trust and self-acceptance were evident through her attempts at making changes in her relationships with both the ranch owner and her husband. At the same time she had no experience being assertive, and learning such skills was important to increase her chances of success. She also needed support and encouragement to keep gaining ground toward her goals. I could assist her in the development of a good plan and in keeping her
Blending Person-Centered and Solution-Focused Therapies hopes high. What follows is a paraphrased transcript of how Session 20 went. Within parentheses I explain why the techniques of SF therapy are employed. Lisa: Marı´a, I want to know if you are proud of yourself with your show of strength and spirit when you talked to the ranch owner? (I know that it is more important for Marı´a to acknowledge being proud of herself than for me to offer her praise which might reinforce her tendency to seek my approval and distance her from strengthening her own internal source of evaluation.) Maria: I do feel sort of happy with myself. Yes, it felt good to tell the ranch owner that I was coming here no matter what she said! With my husband, I would like to tell him too! I know I haven’t heard the end of this. Lisa: Fantastic that you feel happy with your communication successes! Now Marı´a, I have a different kind of a question for you. On a scale from 1–10, with 1 being you want to keep all your thoughts, opinions, and feelings to yourself when talking with your husband and 10 being you want to share your heart and mind with him, where are you today? (Here I introduce a scaling question to help focus Marı´a’s perception of the communication problem and to find out how motivated she is to work toward solutions.) Marı´a: I guess I’d be a 6 today. I’m a little afraid of what he’s going to say to me, but it makes me feel good to stick up for myself. Lisa: Caramba! A 6! Tell me, Marı´a, what will be different when you are at a 7? (Marı´a’s 6 indicates a customer-type relationship in that she seems motivated by her selfacceptance and wants to be her own protector. I encourage her to imagine what will be different when she is a 7, which begins goal negotiation talk. This is different from traditional person-centered therapy in that I am offering more guidance in helping the client perceive future possibilities.) Marı´a: I won’t be waiting for him to start in on me! I’ll bring up the issue myself! Lisa: Wow! How will you do that? How will you make that happen? (Here I use presuppositional language promoting hope for a future that could exist without the old problem. The question also directs Marı´a to think ahead and develop a well-thought-out plan that may have better chances of success than behavior solely ruled by emotion. Moreover by taking the impulsivity out of her emotionally driven assertiveness she will feel more in control.) Marı´a: Well, what I’ll do is this, I’ll just bring it up when I’m getting his dinner ready and he’s sitting down at the table. Lisa: So when you are at a 7, Marı´a, you will just initiate the conversation yourself right before dinner? Is there a time in the past when you can remember starting the conversation like this? (Here, I introduce the exception. I want to find out if there are certain topics and or time of day when it is easier for Marı´a to initiate talk with her husband. The exception may also be a time when Marı´a felt more congruent with her ideal self and where the gap between real Marı´a and ideal Marı´a became narrower.)
Marı´a: Oh yes! Just the other day I told him I was sitting down to watch my program on the TV and I told him I was tired and deserved to sit down! Lisa: So already you manage to start the conversation and tell him how you feel about something. Do you feel proud of yourself for your strength and determination to care for yourself? (Again, I choose to praise her indirectly—more in line with PC therapy—to continue to strengthen her awareness of emotion and to encourage her internal source of evaluation.) Maria: Yes, I actually do feel proud. (I ask Marı´a to compliment herself for her solution attempts and finding the exception to her old unassertive problem.) Lisa: Now Marı´a, I have a strange question for you. You need to use your wonderful imagination with this one. Suppose that tonight there is a miracle while you are sleeping and this problem is solved. You are sleeping so you can’t tell that the miracle has happened until you wake up. When you get up, what will be different that tells you that your problem is gone? (I use the miracle question to allow Marı´a to imagine her world without this problem. This is similar to asking her to imagine her being her ideal self.) Marı´a: For goodness sake! I would wake up feeling rested and full of energy for the day. I guess I would just say what’s on my mind and feel good about it. I would also not care so much what he said back to me. Maybe he would be kinder. Lisa: You will wake up rested and full of energy and you’ll just say what’s on your mind! What else? (I use more presuppositional language suggesting hope for the miracle. I ask “what else” to encourage Marı´a to keep dreaming. The more concrete the miracle, the easier it is to create goals and begin with small steps.) Marı´a: I guess I won’t be keeping everything inside me like I usually do. My chest might not feel so filled with loneliness. Lisa: Great! So you won’t be keeping everything inside of you and this will help you feel less filled with loneliness. I wonder, Marı´a, how will your husband know the miracle has happened? (The relationship question elicits what significant others can contribute to the miracle along with how they will be affected by Marı´a’s behavior changes. This type of exercise may lead to an expectancy of what ideal relationships are like.) Marı´a: Juan? Hmm. He will like that I have more energy in the morning and I think he might start treating me nicer, with more respect. Lisa: Fantastic! Juan will like your morning energy and he’ll be kinder and show you more respect! How will your daughter know that the miracle has happened? Marı´a: Hmm. She will like seeing me up in the morning smiling. She will talk to me more, I think. (Here I reiterate all the steps of Marı´a’s miracle day using presuppositions. I then bridge the futuristic day with the present to see if there are more exceptions happening already.) Lisa: Marı´a, now tell me if any part of this miracle day is already happening.
9
Cepeda and Davenport Marı´a: Let’s see. I wake up every morning to make my daughter’s lunch. Lisa: Wow! So already you just wake up and make her lunch! You’ve already made progress without even really trying! Okay, now I want to change gears. What small part of the miracle day will you work on this next week to help you get to number 7? (Here I am encouraging Marı´a to work on a small goal for the next week. Reaching self-actualization is a desirable goal, but one that surely requires patience and time. By translating the path to self-actualization into smaller but more attainable achievements, I help the client avoid discouragement and stay motivated.) Marı´a: Goodness. I guess I will say more from the morning on. I can smile more and just say how I feel. If I don’t feel well, I’ll say that too. If I need help with the breakfast, I’ll say that too. (Marı´a is building her own solutions here. At first she seemed only motivated to stick up for herself, but now after envisioning the miracle day, her eyes are lit up with more hopefulness, more determination and motivation upon seeing a future where she wakes up smiling, speaking her heart and mind, and receiving respect and kindness in return. Also, her plan is more likely to work because her behavior will be less likely to provoke a negative reaction from her husband.) Lisa: Marı´a, are you delighted with yourself at how enthusiastic you seem when you envision your miracle day? Marı´a: Actually, I am happy with these thoughts. Lisa: So, smiling more and sharing what’s on your mind from the early morning on will help you feel less lonely and more hopeful in your relationships with Juan and your daughter, Rosa? Marı´a: I think that’s right. My loneliness gets worse as the day gets longer. I keep so much inside me that my chest aches. Lisa: Marı´a, I am thinking about all the things we have shared today. First, I want to tell you how I’m glad you’ve shared how impressed you are with your own determination and strength. I can see that even between the two of us you speak your feelings more freely, not waiting for me to ask. I notice that you respect yourself for your hard work in sticking up for yourself and in your recent successes at expressing your feelings to your ranch owner and to your husband! You have also shared your realization of having such a big heart and a genuine kindness. You can see how your family will benefit as you share more of yourself with them. You have told me how you see a future without the problem of keeping everything inside of you. I see you very hopeful that you will make your miracle day come true. I see how you inspire yourself by how hard you are willing to work in order to make this day happen. I can also see that you are already doing things to make this day happen. You work hard in session, opening your heart and mind to me. I like your idea of smiling more and sharing your opinions and emotions with both Juan and Rosa from the start of the day. Knowing that you have already expressed yourself to Juan and Rosa before, sounds like you will just need to expand on what you already know how to do! (I conclude by reminding Marı´a of her own positive feelings toward herself, in addition to the caring she has for her family, her imagination, determination and strength.)
10
Marı´a glows while she listens to the summary of her strengths and self-love. She seems undaunted with the prospect of beginning to work daily with specific new behaviors that will facilitate her miracle day. I deliver the feedback to Marı´a authentically and with empathy, observing her present reactions. Our therapeutic relationship is strong at this point and I feel confident that the timing of the integration of solutionfocused techniques is optimal. A 10-month follow up session reconfirmed that Marı´a had made important internal gains, as suggested by her positive self-concept and self-efficacy, and maintained her motivation and resolve to implement behavioral solutions to her parenting challenges. Her demeanor and self-report indicated a substantial alleviation of her depressive presentation. Moreover, she felt more at peace with herself and less guilty.
Conclusion Marı´a, through weeks of person-centered therapy, (acceptance, unconditional caring, and affirmation) arrived at an optimum point of selfacceptance. She felt my nonjudgmental acceptance of her and from the positive regard, which I communicated to her, she was able to accept and love herself. The therapeutic relationship was a source of healing for Marı´a. As she felt fully understood and accepted empathically, the conditions were right to further encourage Marı´a toward change. As she felt received and loved in the therapeutic relationship, she was at a moment where she could then begin to reorganize her personality in such a way as to cope better with life. The SF techniques employed to help Marı´a accomplish change were an addition to the techniques of PC therapy (listening, accepting, respecting, understanding, responding, and being present for the client). The merging of the SF techniques within PC therapy allowed for a concrete, attainable vision which Marı´a grasped to further her self-discovery and growth. The proposed approach may not be appropriate for all clients and circumstances. For example, the client who comes from a cultural understanding of therapy as brief and action oriented, along with the notion of “doctor knows best,” may become frustrated with the PC approach of Phase I and perceive the therapist as “leading one step from behind.” Clients may enter therapy with a clear idea of “homework” or task between sessions, and may have well-defined problems and concerns that are in need of immediate and concrete answers. These clients might not want to spend time exploring their inner self, strengthening their self-concept, or deepening their awareness of emotions, but may want just quick solutions to their problems. Although from a PC
Blending Person-Centered and Solution-Focused Therapies perspective, long-lasting and generalizable gains cannot be obtained unless clients have the courage to face all aspects of the self, these clients may leave treatment early if they do not perceive that therapy will help them. For these clients an SF approach from the get go might be more appropriate, albeit less potentially useful, than the integration of PC and SF therapy. Possible problems to this integrative approach may arrive from lack of mastery in the integration of PC and SF, particularly by maintaining an overly rigid adherence to PC and SF techniques during Phase I and Phase II, respectively, as well as through failure to assess accurately the client’s level of readiness for internal and external growth. Given that the therapist’s genuineness determines the power of the therapeutic relationship (Corey, 2001), the transition from Phase I to Phase II should consist in moving progressively from the passive and nondirective style of PC to the directive mode of SF therapy. Here we depart somewhat from Jaison’s (2002) recommendations, which say that therapists should jump between the experiential and the SF approaches within and across sessions, as therapists deem necessary. However, we agree with Jaison (2002) in that PC and SF techniques can be given in doses and that the therapist can reassess and adjust dosages as necessary. Identifying the point at which therapists decide to move from Phase I to Phase II is very important. Given that the purpose of blending the two approaches is to augment the potential benefits of SF therapy by capitalizing on the establishment of a solid therapeutic alliance and the selfactualization gains brought about by PC therapy, therapists should wait for clear signs of Phase I progress before moving to Phase II and diving into SF techniques. This caution also departs from Bela Jaison’s recommendation, which advises that the therapist trust his or her intuition in knowing when to change approaches and provides the general guideline of changing between techniques whenever the therapist feels that the client is stuck. In brief, the present thesis proposes that creating solutions for a less problematic tomorrow affords the client various concrete options for more self-directed change. SF techniques widen the road of the client’s journey of self-acceptance and awareness of real self— encompassing the client’s dreams, perfect days, and ideal self. The integration of SF techniques in Phase II of PC
therapy facilitates the transfer of learning from the therapeutic relationship to relationships with clients’ significant others in the outside world. SF techniques may offer the clients tangible evidence that they are indeed on the road to becoming the person of their dreams, their ideal self. Employing SF techniques within the PC therapy framework should increase awareness and acceptance of the self to achieve long-lasting change and congruence. References BERG, I. K., & DE JONG, P. (1996). Solution-building conversations: Co-constructing a sense of competence with clients. Families in Society, 77, 376 –391. BERG, I. K., & REUSS, N. H. (1998). Solutions step by step: A substance abuse treatment manual. New York: Norton. BOHART, A. C., & TALLMAN, K. (1996). The active client: Therapy as self-help. Journal of Humanistic Psychology, 36(3), 7–30. BOY, A. V., & PINE, G. J. (1999). A Person-centered foundation for counseling and psychotherapy (2nd ed.). Springfield, IL: Thomas Books. BOZEMAN, B. N. (2000). The efficacy of solution-focused therapy techniques on perceptions of hope in clients with depressive symptoms. Dissertation Abstracts International, 61, 1117. BRODLEY, B. T. (1986, September). Client-centered therapy—What is it? What is it not? Paper presented at the First Annual Meeting of the Association for the Development of the Person-Centered Approach, Chicago, IL. CAIN, D. J. (1987). Carl Rogers’ life in review. PersonCentered Review, 2(4), 476 –506. COREY, G. (2001). Theory and practice of counseling and psychotherapy (6th ed.). Belmont, CA: Wadsworth. DE HAAS, O. (1980). An attempt at definition of Rogerian psychotherapy. Tijdschrift voor Psychotherapie, 6, 179 – 197. DE JONG, P., & BERG, I. K. (2002). Interviewing for solutions (2nd ed.). Pacific Grove, CA: Brooks/Cole. FISCH, R., WEAKLAND, J. H., & SEGAL, L. (1982). The tactics of change: Doing therapy briefly. San Francisco: Jossey-Bass. GENDLIN, E. T. (1996). Focusing-oriented psychotherapy. New York: Guilford. GOLDFRIED, M. R., PACHANKIS, J. E., & BELL, A. C. (2005). A history of psychotherapy integration. In J. C. Norcross & M. R. Goldfried (Eds.), Handbook of psychotherapy integration (2nd ed., pp. 24 – 60). London: Oxford University Press. GREENE, G. J., LEE, M. Y., MENTZER, R. A., PINNELL, S. R., & NILES, D. (1998). Miracles, dreams, and empowerment: A brief therapy practice note. Families in Society, 79, 395–399. JAISON, B. (2002). Integrating experiential and brief therapy models: A guide for clinicians. In J. C. Watson, R. N. Goldmann, N. Rhonda, & M. S. Warner (Eds.), Client-centered and experiential psychotherapy in the
11
Cepeda and Davenport 21st century: Advances in theory, research, and practice (pp. 356 –368). Ross-on-Wye, UK: PCCS Books. JAMES, R. J., & GILLILAND, B. E. (2003). Counseling and Psychotherapy (5th ed.). Boston: Pearson Education, Inc. KRAMER, R. (1995). The birth of client-centered therapy: Carl Rogers, Otto Rank, and “the beyond.” [Special Issue]. Journal of Humanistic Psychology. 35(4), 54 – 110. LANDRETH, G. L. (1984). Encountering Carl Rogers: His views on facilitating groups. Personnel and Guidance Journal, 62, 323–326. LEHMANN, B. W. (1974). The search for identity: A Rogerian approach. Nederlands Tijdschrift voor de Psychologie en haar Grensgebieden, 29, 385–398. LETHEM, J. (2002). Brief solution focused therapy. Child and Adolescent Mental Health, 7, 189 –192. LIPCHICK, E. (2002). Beyond technique in solutionfocused therapy: Working with emotions and the therapeutic relationship. New York: Guilford Press. MOLNAR, A., & DE SHAZER, S. (1987). Solution-focused therapy: Toward the identification of therapeutic tasks. Journal of Marital and Family Therapy, 13, 349 –358. MURPHY, J. J. (1997). Solution-focused counseling in middle and high schools. Alexandria, VA: American Counseling Association. NEGY, C. (2000). Limitations of the multicultural approach to psychotherapy with diverse clients. In I. Cue´llar, & F. A. Paniagua (Eds.), Handbook of multicultural mental health (pp. 439 – 453). San Diego, CA: Academic Press, Inc. NEGY, C. (2004). Conceptual and practical considerations for effective therapy. In C. Negy (Ed.), Cross-cultural psychotherapy: Toward a critical understanding of diverse clients (pp. 3–22). Reno, NV: Bent Tree Press. NELSON, V. (1998). Notice the difference. Journal of Family Psychotherapy, 9(1), 81– 84. NORCROSS, J. C., HEDGES, M., & CASTLE, P. H. (2002). Psychologists conducting psychotherapy in 2001: A study of the Division 29 membership. Psychotherapy: Theory, Research, Practice, Training, 39, 97–102. NORCROSS, J. C., PROCHASCA, J. O., & FARBER, J. A. (1993). Psychologists conducting psychotherapy: New findings and historical comparisons on the psychotherapy division membership. Psychotherapy: Theory/ Research /Practice/Training, 30, 692– 697. NORUM, D. (2000). Mindful solutions: A journey of awareness. Journal of Systemic Therapies, 19, 16 –19. O’HANLON, W. H., & WEINER-DAVIS, M. (1989). In search of solutions: A new direction in psychotherapy. New York: Norton. PATTERSON, C. H., & HIDORE, S. C. (1997). Successful
12
psychotherapy: A caring, loving relationship. Northvale, NJ: Jason Aronson Inc. RASKIN, N. J. (1948). The development of nondirective therapy. Consulting Psychology, 12, 92–110. ROGERS, C. R. (1961). On becoming a person. Boston: Houghton Mifflin. ROGERS, C. R. (1967). The conditions of change from a client-centered viewpoint. In B. Berenson & R. Carkhuff (Eds.), Sources of gain in counseling and psychotherapy (pp. 71– 85). New York: Holt, Rinehart, & Winston. ROGERS, C. R. (1980). A Way of Being. Boston: Houghton Mifflin. ROGERS, C. R., & KINGET, G. M. (1962). Psychotherapy and human relations: Theory and practice of nondirective therapy/Psychotherapie et relations humaines: Theorie et practique de la therapie nondirective. Oxford, UK: Publications Universitaires. SANTA RITA, E. (1998). What do you do after asking the miracle question in solution-focused therapy? Family Therapy, 25, 189 –195. SARTI, J. P. (2003). A hermeneutic interpretation of solution-focused therapy: The interweaving of historical time and theory. Dissertation Abstracts International, 64, 2404. SCHMID, P. F. (2002, July). The unavoidable we in therapy. Invited statement at the Counseling and Psychotherapy Colloquium of the Carl Rogers Symposium ‘Honoring 100 Years of Carl Rogers. His Life. Our Work. A Global Vision.’ San Diego, CA. SELIGMAN, L. (2001). Systems, strategies, and skills of counseling and psychotherapy. Upper Saddle River, NJ: Prentice Hall. SUE, D. W., & SUE, D. (2003). Counseling the culturally diverse: Theory and practice (4th ed.). New York: John Wiley & Sons, Inc. SWILDENS, H. (1977). Controversies within Rogerian therapy: The therapeutic relationship. Tijdschrift voor Psychotherapie, 3, 249 –252. VAN KESSEL, W., & LIETAER, G. (1998). Interpersonal processes. In L. S. Greenberg & J. C. Watson (Eds.), Handbook of experiential psychotherapy (pp. 155–177). New York: Guilford Press. VARGAS, L. A., & KOSS-CHIOINO, J. D. (Eds.). (1992). Working with culture: Psychotherapeutic interventions with ethnic minorities. San Francisco: Jossey-Bass. WALTER, J. L., & PELLER, J. E. (1992). Becoming solution-focused in brief therapy. New York: Brunner/ Mazel. WATKINS, C. E., JR., & GOODYEAR, R. K. (1984). Reflections on client-centered therapy. Counselor Education and Supervision, 23, 178 –186.
