Karen:

I'm wondering about times when you have had the opportunity to observe therapy sessions (your own or those of other therapists) and what you would say appears to be “happening” in the conversation that you would like to have more fully described so it could be available to therapists across the many models and approaches?

Eve:

I think there are two things that might be happening:

First, that the therapist is not connecting with the client from the client's point of view. Research indicates that the therapeutic relationship contributes more to change than any other factors. Therefore, the therapist's first priority should be good connection with the client/s. I would define “good” connection as the client feeling that the therapist understand what the client/s is trying to say and feeling accepted. This requires listening carefully, clarifying what one thinks one is hearing, and being aware of the process, not only the words that are being said. I believe that the emphasis on language in post-modern approaches has the potential for being misunderstood as referring to words only. When language is taken to mean verbal and nonverbal communication there is less danger of misunderstanding.

  Of course, that brings in the issue of emotions, which have actually been eschewed in some brief therapies, and certainly not a focus in any of the systemic or postmodern ones. Clients usually describe their problems in terms of “feelings” and in order to forge a good connection with them we must acknowledge and respect their feelings. Having a conversation with clients in terms of their feelings does not rule out brief, focused treatment because clients tend to drift toward behavioral answers on their own. For example, if we were to reflect back to a client how anxious he/she is feeling, and how difficult that must be, and then ask “ At times when you are just a little bit less anxious, what is different?” it is very likely that the answer will be a behavioral one, or one that can easily be translated into behavioral terms that are observable and measurable (e.g. “I am exercising” or “I am not home alone”)

Secondly, I think the therapist may be focusing more on how to be true to their particular model or approach than on what is going on between him/her and the client/s. We all want to do the best we can and it is natural to want to apply our tools, our theoretical assumptions and techniques. We seem to forget that our person is a tool as well.   The tools work best in the context of a good therapeutic relationship. Too often I observe therapists asking a miracle question, or a scaling question out of context and clients revert back to whatever they wanted to tell the therapist before the question was asked.   When that happens the client is saying something important that we must listen to.   Neuroscientific research is beginning to offer us a lot of interesting information about the state of the body and mind when we are feeling safe and understood, as opposed to upset and defensive. There is evidence that all the neural networks in the brain light up under those conditions, that is, they are active and open to making new connections (change).   In keeping with strength based thinking that implies that in a safe environment clients may find solutions using their own resources even without our particular theories or techniques. I always think of Erickson's teachings about how to circumvent resistance in that regard, or about the “yes set.”   We assumed that when clients nod assent while hearing the compliments at the end of the session they relax, and are thereby more likely to take in the rest of the intervention message and use it.  

I am not saying that because relationship is so important we don't need a theoretical base or techniques. I am saying we need both, but that it is useful to remember that our relationship with clients is as important as our knowledge about a particular way of doing therapy.

Karen:

I share your apparent enthusiasm for listening being a first priority.   Can you describe more about the “listening” which you prefer most:   1) What kind of listening, can you name it   (eg. “curious listening” or “not-knowing listening” or “attentive listening”….), and, 2)   Listening for what   (eg. for stories, for meaning, for exceptions….)?

Eve:

Your questions makes me aware that I used the word “listening” too   loosely in my first answer.   Let me be more specific. In my book I discriminated between “listening to” and   “hearing” clients.   I think of   “hearing” as a more passive process than “listening.”   In the former one lets all the words being said run through one's head   just   to understand content;   the latter is a parallel process of paying attention for the purpose of intervening. For example, a client may be telling a story about her anxiety, and that she does not experience herself as getting better.   I hear the story on one hand, while monitoring it for small differences or exceptions to offer hope to the client about change that she is not aware of. “Listening” is therefore dependent on theoretical assumptions. In this case   “Nothing is all negative” or “A small change can lead to bigger changes” would point the way.   I also “observe” the client's reaction for process. How has she responded to a suggested task? How does she respond when a change or exception is pointed out to her?   I am beginning to think that the phrase “paying attention to clients” would better describe what I loosely called “listening.”

Language is an interdependent action, and meaning is co-constructed. There can be no clear boundary drawn between therapist and client. However, the therapist, as a paid professional, has a role to fulfill in relation to clients that requires some self-reflection.   “Paying attention” to understand what clients think, feel, want, and how they respond is one aspect of that role. Choosing a response to what is experienced in relation to the client is an equally important part of that role. I call the process of monitoring my own experience of my conversation with clients, and how to choose my responses, “dual track thinking.” I imagine that there are two tracks running through my head. One track registers my observations about the client and the other one my own reactions to what I observe. Those reactions include my honest feelings about the clients as well as myself.   For example,   I might be working with a single mother who describes her situation as not being able to control her children and I notice that I am thinking she is negligent and self-absorbed.   If I am unaware of these judgements I will surely say and do things that will hinder a good therapeutic relationship, and therefore, a solution. If, on the other hand, I am open to my judgmental attitude I can use my dual track thinking (inner conversation) to ask myself how else I could think about this mother so that the chances for motivating her to be more attentive to the children are as good as possible. I could scroll though my assumptions and see which offer me a change in attitude, or I might try to think of a reframe for her self-absorption. For example, I might remember that she was a foster child that was moved many times during her childhood and adolescence and think of her as “needy.”   I think of her children as “needy” of her attention. The mother can probably relate to what it means to want attention and love.   Consequently, I might choose to engage her in her neediness with empathy about how hard it is to be a parent and find time for oneself, as well; how well she feels she is doing and get her to describe the positives; what she “needs” to feel better;   what she thinks the kids “need.” On the last point I would ask her what she remembers needing the most when she was a child and what she wants to give her kids in the future.   I would hope that this approach would forge a connection in which she would eventually do something different in relation to her children.

So in answer to what type of listening I do, I would say that depends on the inner conversation I am having with myself about what I am observing about the clients and myself. I might notice that I am not clear about what a client is saying and that prompts me to ask about meaning. I may have the experience of wanting to ask a question and notice I feel uncertain about it.   During that inner conversation with myself in I may realize that the question I want to ask has more to do with satisfying my own curiosity than helping the client find a solution. Whenever I recognize that I am stuck either because the client is not feeling progress, or because I do not know what to ask next, my inner conversations direct me to look to the client for the direction, which means to take a “not knowing” position.

Karen

Eve, thank you so much for your thorough and thoughtful reply.   It really helps to clarify for me your ideas about listening.   I would like now to shift to explore something else that you wrote in your recent paper.    On page 5 of “Uncovering MRI Roots in Solution-Focused Therapy, you wrote:   “Change occurs through language when recognition of exceptions and existing and potential strengths create new actions.”   This has me wondering two things:   First, how would you describe what you mean by “strengths”?   Second, What sort of questions/conversation do you have with people that assist in building a connection between these “strengths” and the possible use of them in relation to creating solutions?  

Eve:

The short answer for how “strengths” are used for solutions is that the search for, and emphasis on “strengths” is an attitude on the part of the therapist which affects the clients' attitude in a manner that leads to solutions. The therapist's attitude manifests itself in the therapeutic relationship in many ways. I shall talk about a few of them below.

The more detailed answer is that I think of people's “strengths” or “resources” in general terms, as well as very specific to a particular client.   In the general sense, “strengths” are qualities or capabilities that are generally valued in our society, such as honesty, reliability, caring, personal responsibility, a good work ethic, loyalty, etc. In the personal sense   I think of “strengths” as the qualities people value for themselves but think they lack, such as the ability to be happy, to have control, to appreciate themselves, and many others.

My experience has been that most people who come to see me tend to be focused more on deficiencies in themselves and their life than on positives. In the course of our conversation I listen very carefully for the opportunity to highlight any small exceptions and/or strengths to produce what Bateson called “news of difference.” For example, a client, who works in a managerial position and has come about some job stress, may tell me that he started at his firm fifteen years ago in the mailroom. I would not want to miss the opportunity to make a comment like “Your employer must think highly of you” or “Well, that says a lot about what your employer must think about your capabilities.”   In his present frame of mind about the work situation he may not be conscious of the fact that he must have earned the respect of his employer all these years. If our conversation can heighten his awareness of this positive fact this could be the   “small change that can lead to a bigger change.” I am not suggesting that one such remark will make the whole difference, although I have been amazed at times at the power of slightly changed perception to lead to surprising changes. Offering responses in conversation that bring qualities that are generally appreciated in our society   into clients' awareness is part of building solutions. That is equally true of exceptions, of course.

On the level of more individual strengths, to use them for solutions one first has to understand what the client really wants from coming to therapy. “What will be different when you will feel that you don't have to come here anymore?” The answer will differ with each person and therefore the strength or resource one listens for has to fit the client's particular needs. So, if a client wants to leave therapy feeling she will have control over outbursts of anger than I would want to highlight anything she mentions in our conversations that hints at control over anger. For example, if the client should say something like “I spoke to my sister again last night and she really made me mad. I just had to get off the phone quickly before I blasted her.” If this is a first session the response would be “Is that different?”   If she says it is, then the next questions would be “How did you find the control to hang up before you blasted her?   The client's answer may give her information about herself that she was not conscious of at this time and lead to more hope and confidence for the future. If this conversation with the sister were reported in a later session then the response could be “how did you make the decision to control yourself?,” suggesting that she can make choices about how to behave.  

One of the most useful ways to use strengths for solutions is to ask clients early on, when they have clarified what they want from therapy, if they have ever had a similar problem and how they handled it in the past. It is quite surprising how often people forget that they already possess the skills they need for a solution.

Of course, another way of thinking about   strengths and solutions is in terms of emotions. There are more emotional systems in the brain than cognitive ones. That is why it is so easy to become upset in an instant, but so hard for us to reason ourselves out of being upset. When our emotions have overpowered our rational thinking we feel stuck and unable to solve our problems. The strengths and exceptions the solution-focused therapist finds and reflects calm the emotions (reduce anxiety) and allow for more cognitive input, which opens options for different thinking, feeling and acting.

So, to sum up, one uses strengths for solutions by looking for them and reflecting them back to clients, and also by asking clients to check whether they don't already have what they need.

Karen

Eve, I really like your position about strengths, in that you see “looking for strengths” as an attitude on the part of the therapist versus a technique, which then allows for the “strengths attitude” to show up all through the therapy conversations.  

I have really enjoyed our e-mail conversation, and your enthusiastic answers to my questions.   Was there anything else that you would really like to comment on, or perhaps was there a question that you wished I had asked?

Eve:

I, too, have enjoyed being challenged by your questions. I never tire of contemplating the theoretical and practical aspects of what I call Solution-focused Therapy. I always learn something from it even after so many years of thinking about it.   Since every contact with every client is a unique experience we should never really allow ourselves to think that we know all we have to know to be helpful. I think that is why I emphasize the philosophy and theoretical assumptions of Solution-focused Therapy rather than the techniques. The techniques are very effective, but can be very seductive. If they make us feel that they, rather than we drive solutions,   that can greatly curtail our ability to interact with clients productively.   Your comment above in regard to strengths, that it is an attitude that pervades the therapeutic conversation, really sums up what I was trying to say throughout this whole interview.   Thank you!

Karen

Thank you so much,   Eve.