Monday 18th August 2014
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How brief is brief?

1. “As brief as possible and not one session longer!”

This was the saying of one of the founders of the solution focused approach, Steve de Shazer. While the research shows that on average clients in solution focused brief therapy attend for 3 or 4 sessions, this is only an average. The modal number of sessions is 1, meaning that more clients attend only once than any other number of sessions. However, there are other clients who attend for 20 or more sessions, sometimes over years, and this affects the overall average.

Research shows that the average number of sessions that clients attend is between 8 and 12 for all models of therapy. Why solution focused should require less isn’t clear. One possible clue is that in the solution focused approach the therapist is likely to ask the client when they want to return and usually the gaps between sessions is longer than it is for other approaches.

de Shazer’s argument was that therapy should not be tied to a particular number of sessions. Each meeting should be treated as if it could be the last; clients are asked where they have reached on their scale and are asked if they want a further session. If they are making progress and want to meet again, then they should be allowed the opportunity to do so, but if they aren’t progressing then the therapist should question the point of continuing to meet.

Researchers at the University of Salamanca have found that if a client isn’t making progress by the 3rd session, then it is highly unlikely that they will make progress after, say, the 6th session. They recommended discussing with the client possible alternatives, such as a different approach or different therapist.

2. So what if the client asks “how long will this take?”

Solution focus depends for its outcome on the client’s report of progress and so it is impossible for the therapist to be definite about how long it will take for that particular person. All they can do is refer to the research that shows that the therapy will usually take less than 5 sessions and add that that is only an average. One could say “the average is less than 5 and that means that while some people come only once or twice, others might decide to come 10 or 20 times”.

3. Agency requirements

The reality for many agencies is that clients are offered a fixed number of sessions, or, in some cases, number of weeks or months of work.

de Shazer argued that if a client knows in advance that they are going to get, say, 6 sessions then they are unlikely to work as hard at change and might not make much progress until the 5th session. Anecdotal evidence from many practitioners we have spoken to over the years tends to confirm this view!

A further difficulty is that there are those clients who have had their allotted number of sessions and still request more meetings to help them do even better. One team we worked with who offered families 12 weeks of work were sometimes faced with the problem of re-referrals in the 13th week. Counsellors we know who are faced with clients wanting more than their allotted 6 sessions are sometimes able to negotiate for a certain percentage of their clients to receive more sessions.

Those practitioners who work in agencies that define how many sessions clients should receive will have to adapt their approach to fit this demand. For example, if a client is making early progress, then subsequent sessions could focus on how they can maintain their progress, or the therapist and client can agree to “bank” the last few sessions for the client to “draw on” should they require them later.

It is advisable that the therapist keep it clear from the outset that there are a fixed number of sessions. At the start of the first meeting, for example, the client could be asked “what are your best hopes from our 6 sessions?” and then each session is focused on the progress towards this possibly more limited aim. If the client isn’t making sufficient progress and will require further work afterwards then options for this (including onward referral) would need to be discussed.

4. What if the client asks for ongoing support?

Some clients might be making progress and request more and more sessions even though the practitioner is ready to end! Another scenario is where the client isn’t making progress and when they are offered to be referred on elsewhere they insist that they still want to see the same therapist.

While there is no simple answer here, and what the therapist will do will be influenced by agency policy, it is helpful to bear in mind the outcome orientation of solution focused practice. At the outset of the work the client is asked what they are hoping to achieve from the work and this is not likely to have been the wish for “continuous support”. So the client would need to be reminded of the “contract” that was agreed at the outset, and if this has been achieved or, conversely, is not being achieved, then the therapist should discuss this with them.

5. What about staying brief in statutory work?

Where a client is required to work with an agency (for example, under a supervision order or where there are child safety concerns) then the “contract” for the work cannot be as client-defined as it is in standard solution focused work. The client might achieve their own hopes from the work and still have to attend for sessions because the worker requires them to, especially if the agency has other goals that they wish to see the client accomplish. There are also situations where the worker and client can agree that the work is effectively finished and yet the court order (or time to the next case conference etc) still needs to be seen through, in which case it would be advisable to have short meetings focused on eliciting what the client is doing to maintain progress and deal with setbacks.

6. Conclusion

While it comes as a surprise to some people that brief practitioners don’t usually set a fixed number of sessions, this is because research shows that clients will attend for few sessions anyway and so the solution focused approach has been designed specifically to capitalise on the preference of clients for a brief engagement.

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