Integrative Brief Solution-Focused Therapy. A Provisional Roadmap

-INTEGRATIVE BRIEF SOLUTION -FOCUSED THERAPY-
INTEGRATIVE BRIEF SOLUTION-FOCUSED

THERAPY: A PROVISIONAL ROADMAP 1
Mark Beyebach PhD

Master en Terapia Sistémica.
Universidad Pontificia de Salamanca
C/Compañia, 5
37002 Salamanca
(Spain)
mark.beyebach@upsa.es
1En (Selekman M. y Geyerhofer S.) Beyond Solution-Focused Brief Therapy: International Perspectives.
Chicago: Zeig y Tucker (en prensa).
1
The integration movement constitutes one of the most important trends in the field of psychotherapy
(Bergin & Garfield, 1994). Although it includes a great variety of approaches and a diversity of
methodologies (cfr. Goldfried, 1991; Norcross & Newman, 1992), they could in general be
described as the quest to systematically develop psychotherapeutic procedures that make the most
of current, successful models and techniques of psychotherapy, crossing theoretical boundaries in
order to include what works best. Therefore we could say (admittedly a little bit tongue-in-cheek)
that psychotherapy integration is basically a solution-focused approach!
In this paper, I will describe the solution-focused, integrative practice that my team and I have been
developing in Salamanca, Spain, over the last fifteen years2 . In the opening section, I will describe
the context in which our practice is based, and how this practice has been evolving over time in
order to become more comprehensive. In the second section, I will present our ideas about
integration within a solution-focused framework (De Shazer, 1982, 1985, 1988; de Shazer et al.,
1986). In the following three sections, I will discuss the three different criteria I use for model
integration. Finally, I will close out the chapter sharing my concerns about the limitations and
shortcomings of using an integrative approach.
THE EVOLUTION OF AN INTEGRATIVE SOLUTION-FOCUSED

PRACTICE IN SALAMANCA
The main context where my colleagues and I work is a clinical center located in the Psychology
Department of the Universidad Pontificia de Salamanca, Spain, where a two-year postgraduate
program in solution-focused brief family therapy is run. In this center, treatment is free, with clients
referred to us by former clients, doctors, psychologists, psychiatrists, and social workers. Most of
our clients are "voluntary" (not mandated) clients. They present for a wide variety of reasons,
including complaints of depression, of anxiety, marital and family problems, eating disorders,
addictions, and major psychiatric disorders. Around 40% of the clients consult for a problem
presented by a child or adolescent. In this setting, the sessions are conducted by one of the trainers
in around 60% of the cases, and in around 40%, by one of the trainees, always under supervision
by the rest of the training group. Trainees are post-graduate level psychologists and before
conducting therapy have participated for at least one year in an intensive Solution-Focused Therapy
training program. The average number of sessions is below five (X= 4.7), and around three-
quarters of our cases appear to be successful at follow-up (Beyebach, Rodríguez Sánchez, Arribas
de Miguel, Herrero de Vega, Hernández and Rodríguez Morejón, 2000)
In our case, to introduce other techniques into the solution-focused model was not really a
deliberate decision, but more or less something my team and I stumbled upon. Once we had been
introduced to solution-focused therapy in the late 1980s (De Shazer, 1982, 1985, 1988; de Shazer
2 The Salamanca team has included different people over this period of time. Early brief therapy
practitioners in Salamanca were Jose Luis Rodríguez Arias, Maria Dolores Grande and Fernando de la
Cueva. Angel Altuna and Rafael Piqueras were also involved in the introduction of solution -focused
ideas. Alberto Rodríguez Morejón and I worked together for the best of ten years, both in private practice
and at the university, and Jose María Rodríguez de Castro joined us during two years also. Nowadays the
team includes Margarita Herrero de Vega and me, along with the trainees of the program.
2
et al., 1986), and after a period of certainly radical "purism" (Beyebach & Morejón, 1997), we
found ourselves doing a number of "different" things that seemed not to fit in with the solution-
focused model, and that moved us in the direction of a more eclectic practice. At first, we saw this
as a weakness, as an undue departure from the solution-focused model but, after some time
struggling intellectually and clinically with the idea, we decided that these "departures" could be seen,
not as a problem, but as a solution, as they were adding to our practice. The next step was to label
these departures, this eclectic practice, as integration, to start thinking about it in the context of the
vast literature on integration in psychotherapy, and to order our ideas by writing about them
(Beyebach & Rodríguez Morejón, 1999).
In this process of reflection my colleagues and I found out that, for us, to depart from the "pure"
solution-focused approach meant that the likelihood of taking certain therapeutic directions was
higher in certain situations and cases. This meant as a therapist to take the responsibility for
following certain shortcuts, for narrowing down the number of alternatives under certain
circumstances, which made us a bit unconfortable, as it seemed at odds with the proverbial "non-
expert" stance that any good-intentioned solution-focused therapist was supposed to endorse. Also,
"integration" meant to work more on the "problem side" of our clients´ predicaments. And even
worse, it even sometimes meant to work harder as a therapist: by giving more advice, by being
more directive, or even by taking more of an "expert" role. And this also created some uneasyness.
As to when we would be more likely to use non-solution-focused techniques, we realized that this
was the case when solution-focused techniques were not helping to produce (rapid) enough
changes, or when they seemed not to fit with the position or wishes of our clients. But we also
became aware that sometimes, even though the solution-focused approach seemed to be fitting, and
even though it might have worked, we simply chose to follow alternative courses of action, courses
of action that for certain cases or types of clinical situations seemed to us to hold a greater promise
of success. This third reason for integration seemed to be especially at odds with the solution-
focused premises: we were following more our maps than those of our clients.
As systematizing and theorizing is a good way of coping with uneasyness and uncertainty, we started
to develop some guidelines that would help us to clarify our clinical practice, training and research
projects. In other words, we tried to move from eclecticism to integration, from haphazard practice
to a more systematic and detailed approach. This chapter is one of the results of this ongoing effort,
and is necessarily provisional and tentative.
I will begin this chapter by examining what techniques or models my colleagues and I like to
integrate with the base solution-focused model, and in what ways we pursue these therapeutic
options. In the next three sections, I will explore in more depth three different forms of integration
that we use. First, I will discuss integration as a therapeutic response when the solution-focused is
not working. Second, in clinical situations where from the beginning of treatment we decide to use
non-solution-focused techniques as guided by our clients unique needs. A third possibility we
consider, is to integrate non-solution-focused techiques as shortcuts under certain circunstances. In
the fourth section of this paper I will discuss both clinical situations and types of cases that in my
view merit the use of these shortcuts. Finally, I will raise some questions about our integrative
approach and discuss the shortcomings and limitations my colleagues and I have identified.
3
In any case, I would like to make clear that the approach I am presenting here has been developed
on the basis of clinical experience and theoretical reflection only 3 . Although in this process we are
also doing some research to ground specific aspects of our work (Beyebach and Escudero
Carranza, 1997; Beyebach et al., 1996; Beyebach et al., 2000), unfortunately it is far from coming
close to empirically-based integration as proposed by distinguished researchers in the field
(Goldstein, 1991; Shoham & Rohrbaugh, 1996).
TECHNICAL INTEGRATION IN A SOLUTION-FOCUSED

FRAMEWORK
Norcross and Newman (1992) distinguish three different approaches towards psychotherapy
integration. Theoretical integration combines principles and practices from two or more "pure"
psychotherapy models in an overarching framework that translates into clear treatment procedures.
This implies an effort to reconcile or combine different theoretical assumptions. Technical integration
can be described as importing and exporting from one therapeutic approach to another certain
therapeutic techniques "that work". And the common factors approach seeks to identify the
elements that contribute to positive outcomes across different therapy models.
In our practice, my colleagues and I do not pretend to integrate models or approaches of

psychotherapy (theoretical integration), but simply to enhance the range and effect of our therapy by
introducing some different techniques in our basic theoretical and clinical framework (technical
integration). More specifically, we include certain non-solution-focused techniques within a
constructionist (Gergen, 1985), solution-focused (de Shazer, 1982, 1985, 1988, 1991, 1994)
framework. Of course, importing certain therapeutic procedures might put the epistemological
integrity of the base model in jeopardy, as it might inadvertedly lead to the adoption of different
premises or of a different therapeutic position vis a vis the client (Lazarus & Messer, 1991). This is
one of the reasons why we preferently (although not exclusively) use techniques that come from
fields historically and conceptually linked to solution-focused therapy: systemic therapies (Minuchin,
1974; Navarro, 1992; Penn, 1982; Slevini-Palazzoli et al., 1978; Tomm, 1987), strategic therapies
(Fisch et al., 1982; Haley, 1976; Weakland, 1983) and narrative approaches (White, 1995; White
and Epston, 1989).
My colleagues and I also keep our fundamental solution-focused premises and our basic solution-
focused approach towards our cients: one based on respecting their world view and language, on
believing and eliciting their resources, and on actively creating conditions for cooperation and fit. On
a more abstract level, the basic idea is still to keep as simple and as much focused on the solution
(as opposed to the problem) side as possible 4 .
3 The ideas presented here have been developing over the years through discussions and collaboration
with colleagues in Salamanca and the feedback from our clients. There are also a number of therapists who
have visited our program and have shared their experience and their wisdom. I am especially grateful to
Steve de Shazer, Eero Riikonen and Sara Vataja, Michael Hjerth and Anders Claeson from FKC Stockholm,
Luc Isebaert, Chris Iveson from BTP London, Greg Smith, Marcelo Pakman, Ben Furman and last but not
least, Matthew Selekman.
4 I would like to acknowledge that, although in this paper I am focusing only on why and when to
integrate, I consider it equally important to be clear about when and why not to integrate. I think that it is
a very interesting endeavour to try and stick to the basics of the solution -focused approach even in t he
face of difficult clinical situations, as for instance the Milwauke (De Shazer, 1994) and the London (George
et al., 1999) teams do.
4
Therefore, our basic therapeutic scheme is to start any case with a deliberate effort at relationship -
building, trying to work out a collaborative therapeutic project with the clients and to clarify their
goals for the therapy or for the session. Here we are very likely to use the Miracle Question (de
Shazer, 1988). Once this is done, and we have a certain sense of what the clients want from us, the
simplest choice is to keep on the solution-focused track: pretreatment change questions, exception
and scaling questions, etc. (de Shazer, 1985, 1988, 1991, 1994; de Shazer et al., 1986;
O´Hanlon and Weiner-Davis, 1989).
The other option for us is to use, within this framework, some other, non-solution-focused practices,
be it externalization of the problem (White, 1995; White and Epston, 1989), some MRI problem
pattern interventions (Fisch et al., 1982; Watzlawick et al., 1982; Weakland, 1983), or any other
procedure. However, even in this case, we always go back, as soon as possible, to the solution-
focused basics: as soon as there are some changes, we consolidate client gains and use "positive
blaming" (Kowalski and Kral, 1988). Throughout therapy, and even before returning to the use of
solution-focused techniques in response to client improvements or resources, we are very likely to
use scaling questions (de Shazer & Berg, 1992), which we have found extremely useful. Our
sessions are usually take one hour in lenght, and following the conversation with our clients, there is
an intersession break after which the therapists delivers some compliments and if appropriate some
tasks. The decision on what kind of tasks to propose to clients is also basically solution-focused,
maximizing the likelihood of fit by taking into account the relationship type pattern created between
the therapist and the client (cfr. De Shazer 1988) and in relationship to a particular goal (Tohn &
Oshlag, 1995): visitor, complainant, or customer.
Elsewhere (Beyebach & Rodríguez Morejón, 1999) my colleagues and I have discussed our use of
metaphors and stories, of solution-focused externalization, of working with our clients personal
qualities and with their explanatory frameworks ("why" questions), the use of circular questions
(Penn, 1992; Tomm, 1987), "go slow" messages (Fisch et al., 1982) and relapse prevention.
Although we see these as examples of integration, for the purposes of this paper I will focus on the
use of techniques that more clearly depart from the solution-focused approach and even from the
brief therapy tradition. I will do this in the next three sessions, where I will try to spell out more
clearly the three different types of "integration maps" we use.
GETTING MORE COMPLEX WHEN SOLUTION-FOCUSED

THERAPY IS NOT WORKING: SEQUENTIAL INTEGRATION
Alejandra´s story is an example of what I like to call "sequential integration", i.e., the introduction of
non-solution-focused techniques when the solution-focused base model seems not to be working,
or to be working too slowly.
Alejandra, aged 10, was brought into therapy by her worried parents, who presented a
rather unusual complaint: their daughter was working too much at school and at home.
My first reaction was to crack a joke about introducing this family to all the other
families we work with where the situation is the opposite: parents in despair about their
lazy, not-at-all-working kids. But then the parents made the seriousness of the situation
5
clear: Alejandra would spend almost all of her time in front of her textbooks or doing
homework (even during this conversation she had her books on her lap!). If the books
were taken away from her by her parents, she would become more tense and anxious,
would eat very little and could hardly sleep. In fact, she looked tired, and totally
exhausted.
It was easy to find out what the parents wanted out of therapy, and also to transform that
into small, positive and concrete goals. However, Alejandra made clear that she had no
interest whatsoever in therapy or in any changes. She simply wanted to study more, to
work harder, and not to be there, in our office, wasting her time by talking with me "and
those stupid guys behind the glass". I continued the session by unsuccessfully exploring
exceptions and recent improvements. On the progress scale, things were at their worst, so
I focused on specifying the first small signs that would tell them that things had finally
improved one step. After the break, the team complimented Alejandra and her parents,
and asked the parents to keep track of any moments where any small parts of the miracle
would be taking place.
In the second session, two weeks later, things had not improved. I was told by the mother
that the father could not come, and that over the last two weeks there had been almost no
"good moments". In a number of occasions, the father had lost his patience and punished
Alejandra in order to make her "come to reason", which had ony contributed to making
the situation more tense. Alejandra´s tutor also had a long conversation with her to
persuade her to work less hard (she was already getting the best marks she possibly
could), and the parents were thinking of consulting a psychiatrist so as to get some
medication for their daughter´s "obsession". Alejandra did not quite understand why
everybody was so worried.
After some attempts at solution talk, the team decided to shift gears. We started to think
more in M.R.I. terms, and chose to address the interactional pattern that we construed as
maintaining the problem. After the break, I com plimented Alejandra again, and then
spoke with her mother alone. I told her that there was a radical "cure" for her daughter´s
"obsession", that it was extremely effective, but that it would involve a lot of courage on
her part and that of her husband. I explained how, in our view, the more she and her
husband tried to talk her daughter into not working, the more Alejandra would work or
think of her homework assignments, and how this again prompted the parents to insist
more, which again strengthened their daughter´s determination. The mother agreed. So I
suggested that the way to break this cycle was that she and her husband stop their
unsuccessful attempts at helping Alejandra, and that instead, they begin to encourage her
to study more . They could, of course, do some interesting activities with Andrés,
Alejandra´s yuonger brother, close to where Alejandra was doing her homwork
assignments. But they were not to invite her to join, as they usually did. Moreover, if
Alejandra showed some signs of wanting to join them, they would have to ask her to first
make sure her homework was really done.
The mother could see the logic of our suggestion, but she was hesitant to take such an
extreme step. She also wanted to discuss it with her husband first. I joined her in that
position by pointing out how our suggestion would only work if it was carried out by her
and her husband together as a team, and if they were determined enough to keep on that
6
track for at least one week. We agreed to have another session just with her husband and
her, to discuss the "plan" in detail.
The third session was not very long. I discussed with the parents how they could change
their logical and "normal", but unfortunately unsuccessful response to their daughter. We
analyzed in detail how they could both resist the temptation to ask Alejandra to stop
studying. We also brainstormed ideas on how to carry out interesting activities close to
Alejandra and how to again resist the temptation to invite her to join them. After some 30
minutes, both were determined to carry out the plan, to take note of any positive reaction
by Alejandra, and to stick to it at least for two weeks.
The fourth session was very different from the previous three. A dramatic change had
taken place. Once Alejandra´s parents had started to insist on her studying more, she had
begun to lose interest in her homework. As she had begun to work much less, she had
started to join her mother and Andrés in some of their games. Of course, her parents had
reacted by reminding her that maybe she should work harder, but Alejandra had not
followed their advice. She had started to enjoy again some of her usual leisure activities,
looked already much better, and even gave me her first smile!
We spent the rest of the session exploring what this "new life" was like, what Alejandra
and her parents were doing differently, and what plans they had for the next month. Back
on the solution-focused track, we simply had the family talk about their changes, and kept
doing that in the fifth session, which was the last one. At follow-up two years later,
Alejandra was still doing fine. She was still a good student, but in what her mother had
described as a much more "reasonable and healthy" way.
In cases like Alejandra´s, when the solution-focused strategy seems not to be working, the first thing
we do is to re-examine our client´s and our own goals, asking ourselves what the clients want
(Hjerth, 1997). Sometimes this re-examination leads us to reposition ourselves within the solution-
focused model; maybe we had been leaving someone or something out, maybe we need to
renegotiate goals, or we are simply working in the wrong direction. However, if we are confident
enough that we do have a shared therapeutic project and that the goals are achievable , small and
specific, and even so we are making no progress, then we believe it is time to introduce some
different techniques.
There are a number therapeutic procedures my colleagues and I usually consider introducing, usually
moving from the more simple, straightforward interventions to increasingly complex ones:
* Small problem-pattern modifications (O´Hanlon & Weiner-Davis, 1989; De Shazer, 1982).
* Externalization of the problem (White, 1995; White and Epston, 1989).
*Interventions designed to interrupt the problem -maintaining attempted solutions, usually

involving a quite radical shift in the basic interactional pattern (Fisch et al., 1982; Shoham &
Rohrbaugh, 1997).5
5 In our experience, a great number of solution-focused practitioners integrate solution -focused, strategic
and/or narrative techniques (cfr. for instance Dykes & Neville, 2000; Saggese & Foley, 2000; Shilts &
7
* Use of a reflecting team format (Andersen, 1987) so as to allow different constructions to

emerge and new meanings to be created.
* Psychoeducational interventions (Anderson et al., 1986; Berkowitz et al., 1984; González

et al., 1987), directed at providing a cognitive framework that helps reframing and changing
interactions around the problem.
*Structural interventions (Minuchin, 1974; Minuchin & Fishman, 1981), aimed at re-
organizing the family system.
What kind of technique we import in any given case depends of course on the particulars of that
case and on the position of our clients. However, there are certain guidelines that inform our
decision-making process. They are as follows:
* We try to stick to the idea of staying as simple as possible. Therefore, if a small change in
part of the problem pattern could be enough, we will not try to reverse the whole attempted
solutions system. Or, if we can produce enough change by interrupting the main client attempted
solution, we will not go for a broader re-organization of the family system. In fact, the techniques
listed above are ordered in what can be seen as an order of increasing complexity.
*We will tend to go from the simpler to the more complex progressively. Only if one type of
intervention proves not to be working, we will move on to the next , more complex one.
*We will use interventions that allow us to maintain an epistemologically coherent position in
therapy: for us, it would not make sense to, for instance, start by doing solution-focused therapy
(a constructivist, non-normative model, where the therapist tries to adopt a non-expert position),
move on to structural family therapy interventions (a realist, normative model, with the therapist
in the role of an expert), then use a reflecting team format (again constructivist and non-
normative, diluting expertness in a multiplicity of voices), and finally take on some
psychoeducational ideas (again normative).
Of course, one delicate decision is whether change is or not happening, and if it is or not going "fast
enough". We often face this dilemma: should we keep on the solution-focused track, or is it time to
start doing something different? To a great extent, this depends on our clients´ judgement: if they
don´t see changes, or if they perceive that things are moving too slow, then we will agree with them
that no changes are happening, or that they are occuring too slowly. Therefore, the best way to find
out is by asking the clients directly: "Do you feel we are going at the right pace?"; "Are things moving
in the right direction for you? Is the situation improving enough?"). However, this is not the sole
criterion for us. Sometimes clients are satisfied with how things are going, but we are not. And at
times, the opposite may occur.
There are at least two bits of information we take into account in making our own judgement about
the pace of changes. One is the potential risk of the situation: be it risk for violence, for medical
complications, suicide, or even further involvement with mental health professionals and the resulting
Reiter, 2000; Selekman, 1993, 1997), probably because these three approaches share basic therapeutic
assumptions about the process of change and the role of clients resources.
8
risk of iatrogenic effects. In the case of Alejandra, we did not only take into account the rapidly
increasing desperation and hopelessness of her parents, but also the risk of medicalization.
The other type of information my colleagues and I are more or less aware of is the type, duration,
and seriousness of the problem we are dealing with. Although it is difficult to spell out clear
guidelines in this respect, we are likely to, for example, not get too impatient if we are already in the
6th session and with only small changes occuring with a client that has been suffering from anorexia
for five years; but are likely to feel uncomfortable about having used 6 sessions progressing slowly
with a client who presented with a recently developed anxiety problem with open spaces. Another
example: we would be more likely to expect fast changes occuring with the parents of a rebellious
child than in a case where we are seeing a socially isolated, chronically unemployed elderly person.
In any case, we wish to see some progress, even small. If clients open the session stating that things
are the same or worse, we will spend some time trying to deconstruct this no-change frame and to
locate some exceptions (de Shazer, 1988), but, as a rule of thumb, if things stay the same over more
than two sessions in a row, we shift gears 6 . The following case is an example of this type of
sequential integration.
Rocío, aged 16, and Damián, 12, came in with their parents Rosa and Nacho. Rocío had
been in treatment for what had been diagnosed as "anorexia" for two years, but things
had not improved, and she was still eating little and vomiting at least twice a day. Rocío
was medically controlled, but had dropped out of the psychological treatments she had
started. In despair, her mother had decided to seek some different professional help.
In the first session, we spent some time clarifying what exactly the family wanted from us,
and what they wished us to do differently from the other professionals they had been
involved with. Rocío stated that she wanted to find her way "out of anorexia", but that
she thought it would be very difficult, "almost impossible". She also explained that group
therapy had not worked for her, and that she thought that having some conjoint family
sessions would help her more. Of the psychologists that she had met before, the only one
she saw as having been helpful was one who had been "hard" on her, and had not limited
herself to listening and agreeing. The mother and the father added that they wanted help
for the whole family, as the past two years had strained them so much. Damián was even
more direct, and blunty stated that he wanted us to prevent Rocío from dying.
As the family reported that no pretreatment changes had occurred with their situation, I
asked the Miracle Question, and the conversation kept on that track for almost half an
hour. The family, including Rocío, was very good in giving a detailed account of all what
they wanted to be different including both changes in Rocío´s behavior (she would eat
more, stop vomitting, go out again with her friends, concentrate more on her studies
instead of ruminating about food, etc.); and in the behavior of the whole family (there
would be dialogue and laughter instead of yelling and shouting, they would go out
6 An interesting study recently conducted in Stockholm suggests that clients´ reports of lack of progress
at the outset of the session "should be taken seriously and not be subjected to any therapeutic maneuver
aimed at `reframing´, `re -storying´ , or `re-constructing´ the time between sessions as a success (...)
Reports of lack of change likely signal the need to alter treatment to maintain the relationship and increase
the chances of success" (Reuterlov et al., 2000, pp. 114).
9
together again for excursions, they would ressume contact with neighbours and
friends....). At the end of the session, I posed a progress scaling question (de Shazer &
Berg, 1992): "On a scale from 1 to 10, where 1 stands for when things were at their worst,
and 10 stands for the Miracle has happened, where would you put yourselves today?".
Although the answers looked promising (Damián:1; Rocío: 3; Rosa: 3; Nacho:2), there
was no time for further discussion.
After the break, I presented the compliments of the team and asked the famil y members to
secretly pretend that the miracle had happened (De Shazer, 1991), two days per week and
secretly, and try to guess what days the others were pretending.
In the second session, some parts of the miracle had happened indeed: the family members
felt more relaxed, there had been less fights around food and vomiting, and there had
been more conversations between them and more "good moments" instead. I amplified
the changes and tried to understand how they had achieved them. Nacho had made an
effort to avoid useless arguments with his daughter about food, and the mother had been
able to "forget about the problem" for some moments. Rocío stated that she had been
thinking about the eating issue, and that she really wanted to be "normal" again. She als o
wanted her family to be happy again. Damián said that his sister had been "lovely" with
him most of the days, and that this had made it easier for him to "behave well". There
were no changes as far as food or vomiting were concerned, but Rocío expressed her
willingness to do something about it. On the scale, Rocío and her parents rated the
situation at a "4". Damián even went up to a "6". After the break, I complimented
everybody about their changes and encouraged them to keep on doing what was useful. I
also expressed our curiosity about the new changes they might report in our next session.
However, in the third session there was nothing new. As Rocío had kept eating too little
and vomiting twice a day, the changes in the family interaction had backslided. The
general mood was worse, and Damián had even refused to come to the session. After
talking with the family together, the team decided to change gears: I would see Rocío
separately and try externalization of the problem (White & Epston, 1989). In the
conversation with her, Rocío expressed her wish to defeat "anorexia", but also her doubts
about whether that was or not possible. We discussed how the "voice of anorexia" used to
demoralize her, and after the break asked her to pay attention to any occas ion when she
was able to disregard "the voice" or to counter its arguments. We encouraged the parents
not to give up and to watch for any positive changes in Rocío´s eating behavior.
In the fourth session, things had improved again, and on the scale were finally rated
above "5" 7 . Rocío had found herself bleeding from the throat one day and that had scared
her to death. The medical consequences of the vomiting (which she was well aware of
after the group psychotherapy she had been attending) had become much more evident
for her, and she had stopped it for some days. The parents were very happy with these
developments, but also afraid that Rocío would go "back to anorexia" as soon as her fear
had disappeared. After discussing in detail how Rocío had been able not to vomit for three
days in a row, we identified several helpful things: Rocío and her mother would go for a
walk after lunch, Rocío would play with her brother instead of brooding about her weight,
7 In the Spanish school system, a "5" is the minimum mark for a "pass" grade.
10
and the father would encourage her to go on and keep talking in a "soft voice". Rocío was
finding more convincing arguments to defeat the "voice of anorexia", and also improving
the relationship with her friends. After that, I worked on the confidence scale ("On a scale
from 0 to 10, where 10 stands for you have all the confidence in the world that you will be
able to continue with these changes, and 0 stands for you have no confidence at all, where
would you put yourself today?" "What would you notice different if you where one point
higher?") and we identified some ways to keep the changes going. After the break, I
complimented everybody on the progress they were making, asked them to continue with
their changes, and to pay attention to how they overcame the "bad moments" that might
lie ahead.
Over the next two sessions, we kept on having conjoint conversations with the whole
family, but taking some time alone with Rocío to discuss ways of fighting back against
anorexia. Rocío and her family were able to keep the changes going, although she never
did have more than three "vomit-free" days in a row.
In the seventh session, it became clear that, although Rocío was engaging more and more
in social activities, felt happpier and more relaxed, and was even eating "normally", the
vomiting pattern persisted: after one or two days without vomiting, Rocío´s fear of getting
fat would get too strong and she would "have to" vomit again some days. Her parents
and Damián were reacting and contributing positively to Rocío´s changes, but worried
about the risks that vomiting posed. The team had a long discussion, and we finally
decided that we had to change gears again, as the changes at the family level were not
translating into changes in the eating-vomiting pattern. Also, it did not look as it was
simply a matter of time, since the situation in general had improved, it was now easier for
Rocío to keep the vomiting behavior. In other words, we had a strong suspicion that we
were becoming part of the problem, not of the solution. Therefore, we decided to work
more from a structural perspective. We would put the parents in charge of their daughter
until Rocio was ready to change (Minuchin, 1974; Haley, 1976)
We discussed the situation with the family and it was agreed that Rocío needed some more
"intensive" help in order to prevent the vomiting, by doing the following: the mother
would stay with her daughter at least two hours after lunch and after dinner to make sure
that she resisted the urge to vomit. Damián would extend the surveillance to the way to
school, and Nacho would be in charge of comforting his wife when he came home. Rocío,
after some hesitation, accepted the plan. We encouraged the family to go on with their
plan, and also asked Rocío to write down the arguments of anorexia and her own
arguments against anorexia, and to notice on what occasions hers became stronger. We
also discussed possible difficulties that might arise and the strategies anorexia might use
to prevent the famiy from working as a team.
The following weeks were quite rocky. After the initial acceptance of her mother´s
surveillance, Rocío started to react against it. Suddenly, she became aware of how bad she
felt when she could not vomit. We worked with her to help her identify again the tricks
and traps of anorexia, and with her parents to keep their strong grip on anorexia, while
being kind to Rocío. Then, about one month after the start of the "plan", things began to
go more smoothly again.
11
We decided to continue using this strategy for awhile. In our subsequent sessions together,
we worked with the parents alone on how they could keep their strength and not drain
their resources, followed the ideas about working with families of chronically ill people
(González et al., 1987; Rolland, 1987). This involved discussing how Nacho could look
more after his wife and also bringing in some members of the extended family to provide
respite periods for Rosa. With Rocío, we began to discuss how she would know that the
time was ripe for her family´s surveillance to loosen up, and also what her future would
look like once she finally decided to let go of the vomiting.
After some sessions, Rocío had almost completely stopped vomiting. Now the task was to
go back to a situation were she herself could be in control of her eating and of her not
vomiting. This involved to gradually "leave her alone" for some lunches, then for lunch
and dinner one day, then two days, and so forth.
In our fourteenth session, almost one year after the beginning of therapy with us, things
had finally changed enough to be rated at a 8 on the scale by both Rocío, the mother and
the father. By Damian, they were rated higher at a 9.5. Vomiting still happened once in a
while, but now it served as a reminder that for some time Rocio should stay on guard, as a
way to strenghten her determination. We reviewed with the family the video of their first
session, and it became evident that most goals of their goals had been reached and that
now they were a "different family".
We kept on scheduling some follow-up sessions, six and twelve months later, to make sure
that the family could successfully manage possible relapses. Things continued to improve
steadily. Now Rocio was vomit-free, no longer concerned with her weight or with food,
and planning to study psychology. She thought that the bad time that she had had with
anorexia would help her be a good child psychologist. We asked her to become our
consultant, and to write a letter explaining how she had defeated anorexia, and we
secured her permission to use it with other girls who were experiencing similar difficulties.
This case illustrates how difficult it may become to find the right pace in the integration of different
therapeutic procedures. Working with Rocío and her family, we constantly faced the dilemma of
becoming too intrusive versus staying too passive in face of the vomiting problem. After starting on a
purely solution-focused basis, relying on the cooperation with Rocío, we finally took sides with
Rocío´s parents and adopted a strategy borrowed from structural family therapy, where Rocío had
less of a say. One might wonder if it would have been more efficient to use a structural strategy from
the very beginning. But then, it could also be speculated that beginning with a solution-focused
approach created an adequate context of cooperation where the more intrusive approach was later
more easily accepted. The truth is, we can not know.
The case also provides an example of working out a balance between interventions aimed at the
interpersonal, family level and interventions on a more intrapersonal, cognitive level with Rocío. And
finally, as I will discuss below, working with an eating disorder case created some further
complications, as the medical risks had to be taken into account.
12
INTEGRATION AS A WAY OF IMPROVING FIT WITH OUR

CLIENTS.
In our practice, the introduction of non-solution-focused techniques does not mean that things are
necessarily going bad or too slowly. There are times when from the first session on we use
therapeutic procedures that are not solution-focused, because we think that in this way we adjust
better to our clients´ views. On these occasions we do of course negotiate the therapeutic contract,
work on goals, use scales, and so on in the usual solution-focused manner, but also introduce other
elements. Although this possibility can present itself in all kind of cases and situations, there are three
types of situations where my colleagues and I are more likely to depart from the solution-focused
road:
1. Sometimes we meet clients who very clearly demand from us "expert advice". They do not
want us to help them figure out what might work best (our usual, solution-focused approach),
but want us to tell them. Of course, this is a rather common situation, probably linked to the
medical model that is so pervasive in our culture8 . In most cases we are able to renegotiate the
therapeutic contract and are eventually successful in avoiding the "advice giving role", but in other
cases the only way we find to cooperate with our clients is precisely to accept the role they want
us to play. In that instance, we are more likey to use non-solution-focused techniques, like for
instance psychoeducation, behavior modifcation techniques, and so on.
Jesús, 15, and his mother came to see us because he was doing badly at school, which
created a lot of tension between Jesús and his parents. Both Jesús and his mother wanted
some help to change this situation. The mother asked us for some advice on how to handle
her child, and Jesús wanted some "study techniques" so that he could concentrate better
and be more efficient in preparing for his exams. The Miracle Question helped to clarify
what Jesús felt his mother could do to help him: instead of being on his back all the time,
she would keep at a distance and offer help only on his request; she would also stop going
to talk to the teachers almost every month, which Jesús felt embarassed about. As for the
"study techniques", the negotiation of goals and the discussion of exceptions did not help
to work out a good "recipe"; indeed, it became evident that both the mother and the son
wanted us to teach Jesús the "right way" to concentrate and prepare for his exams
efficiently. So we made a separate appointment and one member of the team, who
happened to be an education counselor, provided some advice and suggested some
exercises. In our therapy sessions, I would ask him what difference the new techniques
were making, what effect this had on the rest of his days, what his mother was noticing
different, and so on.
A related reason for assuming a more directive role as an expert is that sometimes our clients are
very confused and what they want is some "outside" clarity. Again, a possible approach would be
to help them achieve some clarity about their goals, about what to do, and so on, but if the
situation is really chaotic we feel it pays off to provide some clarity ourselves, as the following
case illlustrates:
Jaime and Elena, aged 43 and 39, came to us asking for advice on how to communicate to
their 6- and 10-year children their decision to get a divorce. I explored their thoughts
8 And aggravated by the university context we work in.
13
about this by asking the following solution-focused questions: "What is your hope of the
best possible outcome of this conversation with your children?"; "How would you like the
conversation to procede?" "How did you succeed in the past, when you had to tell them
something difficult?". The couple had great difficulty answering my questions. They had
too many doubts and fears and wanted to have a clear guideline about how to behave.
Therefore, I took a break and consulted with the team. We decided to explain to the couple
the ideas developed by psychiatrist Gerald Caplan as to how to communicate to children
about this type of parental decision (Caplan, 1980). I gave them each a handout
summarizing these ideas and discussed with them how to implement them. They came back
reporting that it all had gone well and that their children had accepted the breakup of the
family with surprising ease. We had some more sessions with the family in order to help
them to adjust to their new situation.
2. A common experience of most solution-focused therapists is that, more often than not, at the
beginning of therapy clients seem to be much more interested in explaining the details of the
problem rather than in exploring goals or exceptions. This is why the successful co-construction
of a solution-focused conversation requires a certain level of technical skill, self-discipline and
persistence (de Shazer, 1994). Sometimes, this includes opening some space so that the client
can tell the problem story and feels listened to.
There are occasions, however, when our clients seem to feel that this is not enough, and very
clearly demand to tell us in detail and in length their problem (hi)story. This is very common in
cases where clients have been subject to a history of violence or abuse. On other occasions, it is
simply that clients have a very clear agenda that includes telling their problem story in detail. We
have found that on these occasions, the therapist´s insistence on introducing a solution-focused
view is likely to strain the therapeutic relationship and to diminish fit. This is why in these cases
we prefer to honour these stories and listen respectful to them. Sometimes, this is solution-
focused listening, but on other occasions it is simply that: listening to the clients, giving support,
showing empathy and respect. The following case example illustrates these points:
Eusebio was in a way a special client. He was in the last year of his psychology studies,
and had a clear idea of what a "good therapy" involved: a detailed account of the history
of the problem and specific information of its causes so as to evaluate correctly and
develop the "right" therapeutic interventions. So when I asked him in our first meeting
how we could help him best, he told me that he wanted to overcome his panic attacks, and
that for this purpose he had brought a detailed list of the most important dates in the
evolution of this problem. He wanted us to listen to his account and then we could go on to
look for specific solutions. I decided to follow his advice and I spend the whole first session
listening to the history of the problem. In the final message, the team and I complimented
him on the accuracy of his perceptions and his great ability for insight and self-
observation, and gave him the Formula First Session Task (De Shazer, 1985). In the
second session, I felt that it was okay to go back to using solution talk with him. I began
the interview by asking him: "What´s better?" and pursuing this line of questioning the
remainder of the session. The rest of the sessions were straighforward and solution-
focused, and it was easy to involve Eusebio as a co-therapist who would use his knowledge
of psychology to "heal himself". In the sixth session we decided to end therapy, as Eusebio
felt that he had enough control over his anxiety and was not having any panic attacks. We
had two more follow-ups on Eusebio´s request.
14
Another good therapeutic option to talk about problems in a useful way is to externalize the
problem (White and Epston, 1989; White, 1995). In this way, we meet the demand of the family
to discuss the problem but at the same time create new options and pave the way for exploring
exceptions ("unique outcomes"). This can be especially useful in working with child-presented
problems, as it enables both the parents and child to participate in the conversation (Dykes and
Neville, 2000). In any case, the information gathered in the process of listening to the problem
story may provide ideas for problem pattern interventions and reframes.
3. It also happens that clients explicitly demand from therapy some understanding of their
problems, to know why something has happened or is happening to them. Here again, our first
reaction is to test if we can keep the solution-focused track, by asking questinos like: "Okay, you
would like to understand the roots of your problems. Would it be okay with you if we first help
you to solve them, and then go back and try to understand them?"; "If you had to choose
between understanding the problems, but not solving them, and solving them but without ever
knowing why they happened in the first place, which would you prefer?" (Hjerth, 1997); "Imagine
that you fully understood the causes of these problems that have been plaguing you. What
difference would that make for you?". However, there are times when clients really want to
understand more than to solve or overcome something. In these cases, we could still work
solution-focused, but we think that cooperation will be easier if we adjust to our clients´ views.
One useful thing to do is to work more in a narrative way, where the talk about values, personal
qualities, and meanings in general is more likely to help our clients. One can also explore in detail
the explanations that the clients have given themselves by asking "why" questions (Furman and
Ahola, 1992). Another option is to gather some historical information first and to offer one or
several possible explanations for the problem situation; depending on the position of the client, we
may either give an "expert verdict" or use the reflecting team format (Andersen, 1987).
Sometimes we simply refer the case to a psychodynamically oriented colleague.
Cecilia, 21, came to therapy because she wanted "to put things in their place". For a few
years, she had had a number of what she called "strange" experiences (including some
drug abuse, problems with friends, a fallout with her girlfriend), and although she now felt
she was "back to normal", wanted to make sense of what had happened to her. This
included understanding why it had happened to her in the first place. This lead us to
pursuing a more narrative approach (White and Epston, 1989), where we explored the
meaning that various past incidents had had forCecilia, what they told her about her
weaknesses and strengths as a person, what she had learned from these experiences, and
so on.
In all of these situations, it can be argued that we are not "really" integrating anything, as our
approach is indeed still solution-focused; after all, what we are trying to do is to cooperate with our
clients and work from within their framework, which is certainly a solution-focused way of doing
therapy. However, I think it is useful to conceptualize these practices as something different from
solution-focused therapy (De Shazer, 1985, 1988, 1991, 1994); otherwise, we would end up
stating that any respectful or even any good therapy is solution-focused (Beyebach y
Morejón,1999)!
15
NON-SOLUTION-FOCUSED "SHORTCUTS".
So far, I have discussed situations where our departure from the solution-focused model occurs in
response to the feedback from clients: related to how therapy is progressing (sequential integration)
or to what would enhance cooperation (integration to improve fit). There are also, however, some
situations where our decision to integrate non-solution-focused practices is taken almost a priori,
on the basis of what kind of situation or of problem the clients are presenting.
Here, sometimes even before starting the first interview, we are likely to consider certain lines of
action more than others. In others words, I acknowlegde that in these cases we use some "preferred
shortcuts". Some of them have been simply followed by us over the years and have left some traces
on the grass that invite us to go that way again; others have been created by decades of
psychotherapy practice and research: so many therapists and researchers before us have taken
these paths, that they are clearly visible on our way down the hill of the problem.
First, I will present some clinical situations where I feel some non-solution-focused are appropriate.
Then I will discuss how certain types of presented problem invite us to take some shortcuts also.
"Shortcuts" in certain clinical situations
Only one party is coming
There are rather common clinical situations such as the following: maybe the mother comes
complaining about the communication problems with her daughter, who refuses to attend; or the
relatives of a person with a severe psychiatric diagnosis come to consult about how to treat him
or her; or the parents, involved in a terrible fight with their teenage child, are unable to get him to
the session. Quite often, this implies that the people who present in the session establish a
complainant type relationship with us (de Shazer, 1988), perceiving that it is the absent member
who "has the problem".
Although the empirical evidence is unclear, we feel that we usually have more therapeutic options
if we can include in therapy, at least at some moments, all the participants who comprise the
problem-determined (or solution-determined) system (Anderson and Goolishian, 1988).
Therefore, we are likely to put forth some effort to include the non-attending person in the next
session. This might involve a very straightforward discussion with the relatives about how to invite
him/her, some tasks around this issue, or even an invitation letter (White and Epston, 1989).
Of course, in many occasions we are not successful in engaging the absent member. Here, it is
very useful to follow solution-focused ideas about how to work in complainant-type therapeutic
relationships (de Shazer, 1988). In many cases, focusing on goals and exceptions and giving
observation tasks makes a big enough difference. However, we are also likely to make an effort
to get our clients into doing something different about the problem, and this usually involves
suggesting some problem-pattern interruption tasks (O´Hanlon & Weiner-Davis, 1989; De
Shazer, 1982). In other words, we are more likely to use problem-focused interventions, and to
use them earlier, in clinical situations when we are doing "family therapy with individuals"
(Weakland, 1983).
Working with visitors
16
In many cases, the situation is the opposite, the person described by others as the problem is in
the session with us, but does not really perceive having a problem. Maybe the adolescent has
been forced to come in by his parents, or s/he is under the threat of suspension from school, or
the family has been put under pressure by their social worker; or someone has been court-
ordered to undergo therapy (something that is starting to become quite common in Spain also).
Here again, the solution-focused model provides a very useful framework to deal with these
situations. Therefore, we also like to think in terms of a visitor-type relationship (De Shazer,
1988), and to remain in a therapeutic stance that fits best with our client. Furthermore, we like to
conceptualize this as a triadic relationship, including the therapist, the client and a given goal
(Tohn and Oshlag, 1995). In this way, we keep more open to other goals the client might indeed
want to go for.
However, my colleagues and I also have found that sometimes it can be useful to resort to other
approaches in order to move the therapeutic system into a more complainant-type or even
customer-type relationship. Here, we are finding the ideas of "motivational interviewing"
procedures (Miller and Rollnick, 1991) to be very useful. In our practice, this means exploring
more about the problem with the client, and working more on what these authors call client
"ambivalence". Working with ambivalence often means for us explicitly to explore with the clients
the pros and cons of change, but from a very neutral position, trying to avoid at any price to be
perceived as pushing towards change. In this process, we may use the Miracle Question (De
Shazer, 1988) together with the "nightmare question" (Berg & Reuss, 1998) in order to draw
distinctions; or ask clients to work on "decisionalbalances" (Miller & Rollnick, 1991); or project
themselves into different futures at different points in time. Often, this leads very naturally into the
"go slow" or the "dangers of improvement" stance so typical of M.R.I. therapists (Fisch et al.,
1982). In some rare cases, we might even use a full-blown paradoxical prescription not to
change, moving more towards the paradoxical stance described by the early Milan therapists
(Selvini-Palazzoli et al., 1978).
Crisis situations
Sometimes the situation is very volatile or even dangerous, that is, there is a serious risk for
suicide or violence; there are clear signs of an impending psychotic crisis; time is running out fast
before a legal or academic decision is taken; or the family are facing any other type of acute
crisis. Once more, we share the view that in these situations the therapist can successfully keep a
solution-focused stance (Booker, 1996), and that maybe especially in times of acute crisis it is
useful to avoid automatically taking the position of a "Rambo-therapist" that comes in and
"straightens it all out". However, we also think that here sometimes more traditional alternatives
are necessary, like for example to provide the social network of the suicidal person with clear
guidelines for surveillance and support, to design an escape plan for the person at risk of
violence, or to actively persuade the client to consult a psychiatrist.
Previous treatments
Over the last years, an increasing number of our clients have come to consult with us after having
had a number of previous psychotherapeutic or psychiatric treatments, and often while in therapy
17
with one or more other professionals. Again, we see these situations as an invitation, not to
depart from the solution-focused model, but to add a few pieces to the base model.
Here, we think it is important to make some time in the first session to explore how previous
treatments went. And for us it is important both to explore what helped (useful clues for solutions)
and what did not . This allows us to find better ways to cooperate with our clients, and also gives
as some indications as to what pathways to pursue and which ones to avoid with them. Also, we
like to ask explicitly what message the person got from previous professionals, as sometimes
these messages ("You are a hopeless case"; "Your problems all go back to the relationship with
your mother"; "If you had raised this kid properly, he would not be into drugs now") have a
strong influence on how our clients perceive their situation and its possible (or impossible)
solutions.
If clients not only had passed treatment before, but are currently in treatment, we make a special
effort to clarify what precisely they want from us , and to make clear what our role is in the
situation. Also, we are likely to invite our clients, maybe at a later point in therapy, to think about
how their lives will be once they get rid of all the professionals (including us) who are messing
around in their lives. Once improvements occur, we will also promote that credit is shared with all
the helpers involved (Furman & Ahola, 1992; Selekman, 1993, 1997).
"Shortcuts" for types of problems
This is probably the issue where our practice is more at odds with radical solution-focused thinking.
After all, from the solution-focused perspective, problems and solutions are not logically connected
(de Shazer, 1991), which in clinical practice should translate into starting any new therapy with a
"beginners mind" (Selekman, 1993). From this point of view, there is no reason why any specific
type of clinical problem should call for any specific type of intervention9 .
In my opinion, this is a very useful premise, that helps remind us as therapists that the person is
always more than the problem (George et al., 1998), and to keep on listening carefully to our
clients and not just to our pre-conceived theories about them (Duncan and Miller, 2000). But I
believe that this respectful stance should not lead us to ignore the admittedly fragmentary knowledge
that decades of psychotherapy research have brought forth (Bergin and Garfield, 1994). On the
contrary, I think that it is in the best interest of our clients that the therapists who are working with
them are aware of and can use at least part of this knowledge.
For instance, when we help clients who are worried about problems with a high degree of self-
referentiality (stuttering, tics, insomnia....), where it is likely that any deliberate efforts to diminish
the problem will indeed enhance self-consciousness of it and therefore increase it (Shoham and
Rorhbaugh, 1997), we tend to use symptom prescription, in our view the most effective way to
address these situations (Orlinsky et al., 1994). In cases where the biological aspect is predominant
(eating disorders, psychosis, etc.) we are likely to slow down the pace of our intervention. And, as
9 But it also should be taken into account that in fact there is a growing number of solution-focused
literature on working with specific problem populations (Berg & Miller, 1992: Berg & Reuss, 1997; Dolan,
1991; Selekman,1993, 1997) and that, in the related M.R.I. field, Giorgio Nardone is working very
systematically towards developing specific interventions for specific problems (Nardone & W atzlawick,
1990).
18
discussed before, situations with a more immediate risk of danger will call for more expedient
approaches.
Besides that, there are a number of more or less well-defined problems that in my view merit that
we add different concepts and techniques to our usual solution-focused approach. In all of these
cases there are some non-solution-focused techniques that can be successfully used, but there are
also some theoretical and practical challenges that invite us to enlarge our frame of reference.
Therefore, for each of the following types of problems I will briefly discuss how we adapt our
conceptual framework, what techniques we import, and what "themes" we have found useful in
therapeutic conversations10 . It must be stressed that in all of them, our basic way of thinking is still
solution-focused, and that we still use the solution-focused miracle question, work on exceptions, on
scales, and so on.
It should also be taken into account that I am adopting the position of a "general practitioner
therapist", ready to do therapy with a variety of problems and client populations. However, it could
be argued that, if a therapist faces a case of, for instance, schizophrenia or of anorexia she/he should
not spend a lot of time thinking about integration, but better refer the case as soon as possible to a
specialized unit (for instance, a well designed psychoeducational program for schizophrenic patients;
support groups for physically ill youngsters and their families; multidisciplinary units specializing in
treating severe anorexia, etc.)
I do not agree fully with that position. On the one hand, because it is not always possible, as there
are not always specialized units or teams available, at least in Spain. Secondly, it is not always
necessary; Pierre Beumont, for instance, one of the great specialist in anorexia, contends that eating
disorder cases should be treated by (trained) general medical practitioners, leaving only severe
cases for specialized, multidisciplinary teams (Touyz & Beumont, 1999). And, thirdly, in my view,
too much specialization in one problem or "pathology" carries the risk of generating potentialy
problem-maintaining professional patterns, sometimes even producing real self-perpetuating
professional lobbies.
In any case, none of my recommendations should be taken as a design for a good-for-all therapy,
but more as a way to enhance cooperation with other professionals and approaches (that, as
mentioned above, are likely to be involved anyway). For each of these situations, I will present my
thoughts on how they invite my colleagues and me to enlarge the conceptual model, on what
techniques can be useful, and on what conversational "themes" we find potentially fruitful.
Family violence
Working with families or couples where violence is present poses a big challenge for any
practitioner, who might even feel in these cases that there is simply no place for psychotherapy. I
also think that, while working with the victims of present or past abuse lends itself very easily to
solution-focused work (Dolan, 1991), working in a conjoint format including the offender can be a
different story, in part because "bad will" does not fit in easily into the humanistic, positive premises
of the solution-focused approach. However, I think that conjoint, solution-focused therapy is not
only possible (Lipchik & Kubicki, 1996; Lethem, 1994), but often necessary, provided that some
10 I would like to acknowledge the influence of Pepe Navarro (Navarro, 1992), who has introduced me to
and discussed many of these ideas.
19
issues are thoroughly taken into account. We systematically include three basic considerations in
approaching these situations:
1. "Protection before therapy", meaning that very basic things like safety plans, contact with
police and other self-defense procedures take priority over any "psychotherapeutic" intervention.
We like the idea that, in the same way as the offender has to take responsibility for the violence
(Jenkins, 1990), the victim has the responsibility for protecting herself (Lethem, 1994).
2.We also keep in mind that the victims of violence are likely to be in a position of fear and
threat that inhibits their cognitive functioning and makes rational-decision making more difficult.
We do not see this as a justification to make decisions for our endangered clients ("good
intentioned saviors" usually end up quite frustrated), but as a reminder that we will have to be
very clear and maybe at times more directive than in other cases.
3. Finally, we also include the legal system into our consideration, in the same way as we would
include the school system in working with children or teenagers that have problems in that
context.
On the technical side, when my colleagues and I work with a couple or a family where physical
violence occurs,we systematically provide some space for individual interviews with the victims so
as to make sure that they have some "safe space" to voice their concerns. Also, we start therapy
focusing on the problem of violence. Here, we are likely to work out a non-agression contract, to
develop escape plans, and to intervene on the violence sequence in order to introduce stop
mechanisms like time out (Perrone & Nannini, 1997).
With couples, and once the responsibility-protection dyad has been worked on, we often try to
move the conversation to the trust / fear dilemma, in order to help the couple rebuild the
interpersonal trust that violence has eroded. Working with families where the son or daughter is
beating or otherwise attacking his/her parents11, my colleages and I usually discuss with the parents
how they can resist the "blackmailing trap", or how they could make the final sacrifice for their
offspring, for instance taking the courageous big step of going to the police.
Eating disorders
Eating disorders (anorexia, bulimia, and a wide range of problems inbetween) are also likely to
provide formidable challenges to any therapist. Here, I think the solution-focused framework has to
be enlarged to take into account the biological aspects of these problems. For instance, the
solution-focused premise that "small changes are enough" as they will lead to other changes, is not
very useful in situations where the biology of the client may put heavy constraints on her response to
changes, or even to her ability to change in the first place.
Therefore, I think that in any case of anorexia or bulimia, if the client is not being followed-up
medically, the therapist has the duty to refer her to a medical doctor so as to check their physical
health and take appropriate measures (which might include hospitalization if the medical risk is too
big). It is simply too dangerous to have a medically uncontrolled, eating disordered person in
psychotherapy.
11 Something that, by the way, we are finding more and more often in our office.
20
On the technical side, and especially working with ematiated anorectics, my team and I like to
provide the client with as many options and choices as possible, and here again solution-focused
techniques provide excellent leverage, but we also take the weight problem into account, even
though our client may not have any concerns about this at all. This does not mean that we have to
spend all of our sessions discussing food (on the contrary, I think it is very important to avoid the
"food talk" trap), but it does mean that changes in other areas (friends, family, college...) are
welcomed but are only "good enough" if they also translate into weight gain 12.
My colleagues and I also find that the ideas of the "motivational interview" (Miller & Rollnick, 1991)
are useful in helping eating disordered clients make the decision to change, and often externalize "the
voice of bulimia" or "the voice of anorexia" (White & Epston, 1989) so as to create some space
between the client and her eating disordered identity. Here, "becoming independent" from anorexia,
from the "weight dictatorship", from the "tyranny of slenderness" and so on can be powerful themes
for therapeutic conversations. We also routinely discuss the risks of relapsing, which often ocrcurs
with these cases (Brownell and Fairburn,1995; Garner & Garfinkel, 1993).
Alcohol and drug abuse
In these cases, that traditionally are considered "difficult", we find the solution-focused approach
especially useful (Berg & Miller 1992; Berg & Reuss, 1997), as it opens a whole new range of
possibilities in a field that for many years has been caught up in a rather confrontative and blaming
stance. However, we believe that the potential complications created by medical and biological
aspects should be fully taken into account and as in the case of eating disorders medical help should
be ensured.
Technically, we find that in most cases it is not necessary to depart from solutio n-focused therapy-
as-usual. Working with individuals, the conversation topic of "resisting the temptation to (take drugs,
drink)" (De Shazer, 1988) is frequently useful, as is the issue of rebuilding trust when we see the
family or the couple. Here, we have found Antabuse contracts very useful, not only as a way of
helping the problem drinker to control himself, but especially as a way of marking "visible" signs of
improvement that promote interpersonal trust. In any case, we make a special effort to include close
relatives into treatment (in the case of adult clients, especially the spouse), as there is considerable
empirical evidence that it increases the likelihood of a successful outcome (Alexander, Holtzworth-
Munroe and Jameson, 1994). We also usually put relapse prevention on the agenda to address with
clients once they have made progress.
Physical illnes in the family
Quite often, families present with a physically ill member, either as the main concern of the family
(for instance, an adolescent depressed after amputation of a leg following a car accident), or as an
element that complicates a situation for which help is requested (for instance, parents consulting for
the temper-tantrums of a child, brother of a mentally handicapped girl). Here the situation is different
than in marital therapy, as we do have very clear and useful models on the impact that physical
illness, especially chronic illness, has on the family (Rolland, 1987; González, Steinglass and Reiss,
1987).
12 For severely ematiated patients, the "protection before therapy" position discussed for violence
problems translates into "feeding before therapy".
21
Therefore, and even if the chronic illness is not the main complaint of the family, we like to take into
account this conceptual framework. It helps us to redefine and normalize the experiences of the
family (for instance, jealousy of a healthy brother; feelings of exhaustion and guilt on the part of the
caretakers; social isolation of the family), to be watchful of the possible difficulties of the primary
caretaker (who is at risk of developing psychological problems); and to actively promote social
support for the family and especially for the primary caretaker. It also requires that we sometimes
mediate between the family and the medical system, where difficulties and problems are likely, and
that we have a broader look on how the situation may evolve as family and illness move along their
evolutionary cycle (Rolland, 1987).
And again, externalizing conversations (White and Epston, 1989) might be useful, especially
discussions on how to "put illness in its place" (González et. al., 1987). This is an approach that is
starting to have good empirical support and that in our experience makes a lot of sense for
physically ill persons and their families.
Psychosis
Psychoses, and specifically schizophrenia, is one of the few problem areas where research really
supports the effectiveness of family therapy. Over the last two decades, a great number of teams
have been documenting the effectiveness of psychoeducational family therapy in cases of
schizophrenia (Anderson et al., 1986; Falloon et al. , 1984; Leff et al., 1985) and, again, I think it
would be unwise to ignore the information that has been gained from these studies. Although
psychoeducational programs are complex, multidimensional and multidisciplinary, there are a
number of elements that in the absence of specialized teams to which to refer the case a solution-
focused practitioner may wish to take into account.
One important aspect is the role of maintenance neuroleptic medication in reducing the risk of
relapse. Here, in co-operation with the psychiatrist, my team and I will promote an informed
decision-making around the issue, and are likely to support the taking of the medication on the part
of the schizophrenic youngster. The other element that research on relapse in schizophrenia (and
more generally, in other conditions like depression, anorexia or drug addiction) has shown to be of
the utmost importance is what has been labeled "Expressed Emotion" (Leff and Vaughn, 1985;
Vaughn & Leff, 1976), which is also a strong predictor of relapse. The practical implication is that
we also encourage, even though it might not be a priority of the family, the reduction of hostile and
critical remarks as well as of the possible overinvolvement with the patient. Sometimes, this includes
the provision of psychoeducational information on the condition, although we prefer to leave this to
the psychiatrist or medical doctor.
The metaphor of "putting the illness in its place" is also very useful in these cases, both for the patient
and for his/her family, who we also routinely try to get involved into the treatment process.
Phobias, fears and other monsters
Phobias are probably the best-researched disorders in psychotherapy, and exposure to the phobic
stimulus (with and without cognitive intervention) is probably the best supported type of intervention
(Bergin and Garfield, 1994). This is why my colleagues and I like to take it into account in working
with phobic patients. This does not mean that we necessarily apply a behavioral exposure program,
22
but that we will be ready to highlight and promote any instances where the client, instead of avoiding
the phobic situation, confronts it. In other words, the information on exposure procedures helps as
to decide what exceptions are more relevant: maybe the phobic teenager felt quite good the day she
decided to stay at home instead of going to the mall, but that other occasion when she did go to the
mall and was able to cope with her anxiety will be much more useful as an exception.
We have found scaling questions (De Shazer and Berg, 1992) and percentage questions, White and
Epston, 1989) especially useful in finding out how much control over their lives the clients have and
how much they want to regain, and also to discuss their readiness to face the phobic situation, their
confidence in coping with anxiety and so on.
LIMITATIONS OF OUR APPROACH
The risks of integration in solution-focused practice
Elsewhere (Beyebach and Rodrígue Morejón, 1999) my colleagues and I have discussed in detail
the challenges that in our view integration poses for solution-focused practice. Let me briefly
mention that importing non-solution-focused techniques may change the position of the therapist,
and more specifically make it difficult to adopt the "not knowing stance" (de Shazer, 1994, Hjerth,
1995) so typical of this approach. Also, it may promote a narrower focus on problems as opposed
to solutions and promote "diagnostic thinking". This, in turn, leads easily to the therapist´s "working
too hard", something which most solution-focused colleagues would object too, but which we only
see as a problem if it in turn it leads the clients to "work less hard".
In our view, these risks can be countered by using the non-solution-focused techniques in what we
consider a solution-focused way (Beyebach & Rodríguez Morejón, 1999), which for us means:
1. To stick to the criterion of simplicity as discussed above which helps us to avoid getting
exceedingly complex.
2. To use non-solution-focused techniques in the same respectful way as any solution-focused

practice: maximizing fit, listening to the client, proposing instead of imposing, and so on.
3. Downplaying the therapist´s expertise when using non-solution-focused techniques, for instance
by presenting them simply as something that other clients have developed and/or found useful.
Furthermore, the therapist may choose to highlight certain aspects of the client´s report that are in
keeping with the intervention he has planned. For instance, the client may describe various
different exceptions, and the therapist may choose to emphasize those that according to an MRI
analysis of the problem-maintaining pattern he thinks have more potential of bringing about lasting
change. In this way, she/he will not have to present this as an intervention developed by him/her
or the team, but can simply ask the client to "do it more".
4. To maintain an open mind and avoid seeing the imported task or technique as the only possible
/ useful one.
5. To get back to the solution-focused track as soon as possible, for instance by amplifying
changes and positively blaming the client as soon as there are any improvements. Although the use
of directive interventions makes it usually less easy to share credit with the client, some
23
questioning about the effect and consequences of the changes will usually assist in finding some
other improvements for which the clients can be positively blamed.
Shortcomings of our integration proposal
As I explained in the introduction to this chapter, the ideas elaborated here are only one outcome of
my colleagues and my ongoing reflection process on integration in solution-focused therapy.
Therefore, it should be taken simply as a provisional map that we are developing and finding useful
in our context and for our clinical, training and research purposes, and that it might not be useful at
all for therapists or researchers working in a different setting. There are some additional caveats I
would like to discuss briefly:
1. Of course, our decision-making process in therapy is not by far as clear-cut and precise as it
might look in the description I have provided here. More often that not, we find ourselves using
techniques or asking questions that seem to simply "pop up" out of the blue, and not as an outcome
of a rational decision process. They are in part a reaction to our clients, and in part the result of
personal and clinical experiences and training, but the processes by which they "come alive" are
quite undeliberate. However, I think that even so it is worthwhile to try and put forward an ordered
description of our procedures and to formulate certain rules. On the one hand, because it provides
hypotheses that can be empirically tested, and because it facilitates accountability and training. And
on the other hand, because paradoxically it helps us to resist the "black hole effect" that problems
usually have; we wish to discipline ourselves to stay solution-focused, but to be able to do that
(without being rigid) we also have to be clear on when to allow ourselves not to be solution-
focused!
2. The approach I am suggesting here has no empirical evidence to support it, except some very
preliminary outcome follow-ups (Beyebach et al., 1996. 1997, 2000). My colleagues and I have
initiated some new process-outcome research projects on our integration procedures13, but it is
unlikely that a general approach such as the one we are proposing here can ever be adequately
tested as a whole. Furthermore, we are not happy at all with the results we are getting in some
situations, especially in working with couples, and also in cases of severe eating disorders. And, to
make matters worse, most of the building blocks of our integrative practice, including narrative
methods, MRI techniques and of course also the very solution-focused model on which we base
our work have yet to document their efficacy and effectiveness for specific clinical populations. This,
in the light of the great deal of sound and rigorous research on psychotherapy integration that is
being carried out worlwide, and taking into account the increasing popularity of empirically validated
treatments (EVTs), is another reason to take this chapter with a great deal of caution.
3. Although it might look reasonable to import a technique that has proven successful in some other
context and therapeutic model, one should bear in mind that any given technique, developed in a
particular context and under certain theoretical premises, is probably transformed into a different
technique when used under different circumstances (Lazarus & Messer, 1991; Shoham &
Rohrbaugh, 1996). In other words, psychoeducation is likely to have a different effect if delivered in
a psychiatric unit as part of a complex multifamily program, than if delivered by a solution-focused
13 One of the specific questions we are examining empirically is whether or not changing gears in a stuck
case situation really helps to make a positive outcome more likely, or if on the contrary starting to use
non -solution-focused techniques has no effect or maybe even makes the outcome worse.
24
therapist working with one family. Or the metaphor of "putting the illness in its place" might be
received very differently by a family who hears it from their main medical doctor in a big clinic than
from a solution-focused psychologist in a small private practice.
4. Finally, I have to admit that our descriptions on when we integrate are very broad, as we are
focusing only on macrolevel variables. My team and I try to take into account not only problem
type, but also the clinical presentation and the overall stance of our clients, but if we want to really
optimize clie nt-technique fit, we will have to look at even more specific client attributes, especially
relational ones, that hold great promise for improving client /therapy match (Rohrbaugh & Shoham,
1996). Here, solution-focused practices are very useful, as so much emphasis is put on adapting to
the clients stance and language, but this subtle adjustment process is still far from being well
understood and researched.
CONCLUSIONS
In this paper I have presented our current thinking about introducing non-solution-focused
techniques and procedures into a solution-focused therapeutic framework. My colleagues and I feel
that in this way we take advantage of the developments in other systemic and/or brief therapy
methods, as well as of some of the knowledge accumulated in the fields of individual and family
psychotherapy over the years. Although we believe that in this way we are paying a better service to
our clients, we need more theoretical refinement and detailed research to support our claims.
Our idea is to keep a basically solution-focused format, using goal negotiation, work on exceptions
and on scales, tasks and compliments in the usual solution-focused way, and to introduce certain
elements only if we think that they will allow us to be more effective or to achieve a better fit with
our clients. Our failures have taught us that we will have to look closer at possible moderating
variables, and that we have to keep on learning from those cases where we are not successful. In
this process, we hope to keep an open mind to the teachings of our colleagues and our clients.
ACKNOWLEDGEMENTS
I would like to thank Matthew Selekman, who not only invited me to contribute this chapter, but
also reviewed my manuscript carefully and showed endless patience in correcting all kinds of
grammatical errors and in making useful stylistic suggestions to make the text legible.
25
REFERENCES
Alexander, J.F., Holtzworth-Munroe, A. & Jameson, P. (1994). The process and outcome of
marital and family therapy: research review and evaluation. In (A.E. Bergin and S.L. Garfield,
eds.) Handbook of Psychotherapy and Behavior Change (4th edition). New York: Wiley,
595-630.
Anderson, H. and Goolishian, H.A. (1988). Human systems as linguistic systems: Preliminary and
evolving ideas about the impications for clinical theory. Family Process, 27, 371-393.
Anderson, C.M., Reiss, D.J. and Hogarty, G.E. (1986). Schizophrenia and the family . New
York: Guilford.
Andersen, T.(1987) The reflecting team: dialogue and metalogue in clinical work. Family Process,
26, 415-428.
Berg, I.K. and Reuss, N.H. (1998). Solutions step by step. A substance abuse treatment
manual. New York: Norton.
Bergin A.E. and Garfield S.L. (1994). Handbook of Psychotherapy and Behavior Change (4th
edition). New York: Wiley.
Berkowitz, R., Eberlin-Friess, R. Kuipers, L. & Leff, J. (1984). Educating relatives about
schizophrenia. Schizophrenia Bulletin, 10, 418-429.
Beyebach M. and Rodríguez Morejón A. (1997). Lösungsorientierte Therapie in Spanien: die

Erfahrungen der Salamanca-Gruppe. In (W. Eberling, ed.) Kurzgefasst -zum Stand der
lösungsorientierten Kurzzeittherapie in Europa. Dortmund (Germany): Borgman, 252-277.
Beyebach, M. and Escudero Carranza, V. (1997). Therapeutic interaction and dropout: measuring
relational communication in solution-focused therapy. Journal of Family Therapy, 19, 173-212.
Beyebach, M.and Rodríguez Morejón, A., (1999). Some thoughts on integration in Solution-
focused therapy. Journal of Systemic Therapies, 18, 24-42.
Beyebach M., Rodríguez Morejón A., Palenzuela D.L. and Rodríguez-Arias J.L. (1996). Research
on the process of solution-focused therapy. In (S.D. Miller, M.A. Hubble and B.L. Duncan,
eds.) Handbook of Solution-focused Brief Therapy. San Francisco: Jossey Bass, 299-334.
Beyebach M., Rodríguez Sánchez M.S, Arribas de Miguel J., Herrero de Vega M., Hernández C.
and Rodríguez Morejón, A., (2000). Outcome of solution-focused therapy at a university family
therapy center. Journal of Systemic Therapies, 19, 116-128.
Booker, J. (1996). Solution-focused hospital diversion: treatment of first choice. In (S.D. Miller,
M.A. Hubble and B.L. Duncan, eds.) Handbook of Solution-focused Brief Therapy. San
Francisco: Jossey Bass, 205-227.
Brownell, K..D. and Fairburn, C.G. (1995). Eating disorders and obesity. New York: Guilford.
26
Butler, W.R. and Powers, K.V. (1996). Solution-focused grief therapy. In (S.D. Miller, M.A.
Hubble and B.L. Duncan, eds.) Handbook of Solution-focused Brief Therapy. San Francisco:
Jossey Bass.
de Shazer, S. (1982). Patterns of brief family therapy. New York: Norton.
de Shazer, S. (1985). Keys to solution in brief therapy. New York: Norton.
de Shazer, S. (1988). Clues. Investigating solutions in brief therapy. New York: Norton.
de Shazer, S.. (1991). Putting difference to work. New York: Norton.
de Shazer, S.. (1994). Words were originally magic. New York: Norton.
de Shazer, S. and Berg, I.K. (1992). Doing therapy: a post-structural re-vision. Journal of Marital
and Family Therapy, 18, 71-81.
de Shazer, S., Berg I.K., Lipchik, E., Nunnally, E., Molnar, A., Gingerich, W., and Weiner-Davis,
M. (1986). Brief therapy: Focused solution development. Family Process, 25, 207-221.
Dykes, M.A.& Neville K.E.(2000). Taming Trouble and other tales: Using externalized characters
in solution-focused therapy. Journal of Systemic Therapies, 19, 74-81.
Dolan, I. (1991). Resolving sexual abuse. New York: Norton.
Duncan B.L. & Miller, S.D. (2000). The heroic client. Doing client-directed, outcome-informed
therapy. San Francisco: Jossey-Bass.
Falloon, I.R.H., Boyd, J.L. & McGill,C. (1984). Family Care of Schizophrenia. A problem-
solving approach to the treatment of mental illness. New York: Guilford.
Fisch, R., Weakland, J. H., & Segal L. (1982). The tactics of change. Doing therapy briefly.
San Francisco: Jossey-Bass.
Furman B. & Ahola T. (1992). Solution talk: Hosting therapeutic conversations. New York:
Norton.
Garner, D.M. & Garfinkel, P.E. (1993). Handbook of treatment for eating disorders (2nd
edition). New York: Guilford.
George E., Iveson,C., and Ratner, H. (1998). Solution focused brief therapy: Course notes.
London: Brief Therapy Practice.
George E., Iveson,C., and Ratner, H. (1999). Problem to solution. Brief therapy with individuals
and families. Revised and expanded edition. London: Brief Therapy Press.
Gergen, K (1985). The social constructionist movement in modern psychology. American

Psychologist, 40, 266-275.
27
Goldfried, M.R.(1991). Research issues in psychotherapy integration. Journal of Psychotherapy

integration, 1, 5-25.
González, S., Steinglass, P. and Reiss, D. (1987). Family centered interventions for people with
chronic disabilities. Washington: George Washington University.
Haley J. (1976). Problem-soving therapy: New strategies for effective family therapy. San
Francisco: Jossey-Bass.
Hjerth, M. (1997). Workshop presented in Salamanca, Spain.
Hollon, S.D. and Beck, A.T. (1994). Cognitive and cognitive-behavioral therapies. In (A.E. Bergin
and S.L. Garfield, eds.) Handbook of Psychotherapy and Behavior Change (4th edition).
New York: Wiley, 428-466.
Hudson, P.& O´Hanlon W.H. (1991). Rewriting love stories: Brief marital therapy. New York:
Norton.
Jenkins, A. (1990). Invitations to responsibility: The therapeutic engagement of men who are
violent and abusive. Adelaide: The Dulwich Centre Publications.
Lazarus, A.A. and Messer, S.B. (1991). Does chaos prevail? An exchange on technical eclecticism
and assimilative integration. Journal of Psychotherapy Integration, 2, 143-158.
Leff, J., Kuipers, L., Ber kowithz, R. and Sturgeon, D. (1985). A controlled trial of social
intervention in the families of schizophrenic patients: two-year follow-up. British Journal of
Psychiatry, 146, 594-600.
Leff, J. and Vaughn, C. (1985). Expressed emotion in families: iIs significance for mental
illness. New York: Guilford.
Lethem, J. (1994). Moved to tears, moved to action: Solution focused brief therapy with
women and children. London: Brief Therapy Press.
Lipchik, E. and Kubicki, A.D. (1996). In (S.D. Miller, M.A. Hub ble and B.L. Duncan, eds.)
Handbook of Solution-focused Brief Therapy. San Francisco: Jossey Bass, 65-98.
Miller, W.R. and Rollnick, S. (1991). Motivational interviewing. New York: Guilford.
Minuchin S. (1974). Families and family therapy. Cambridge, MA:Harvard University Press.
Minuchin S. and Fischman Ch. (1981). Family therapy techniques. Cambridge MA: Harvard
Universtiy Press.
Nardone, G. and Watzlawick, P. (1990). L´Arte del cambiamento. Florence (Italy): Ponte alle
Grazie.
Navarro Góngora, J. (1992). Técnicas y programas en terapia familiar. Barcelona: Paidós.
28
Norcross J.C. and Newman C.F. (1992). Psychotherapy integration: setting the context. In J.C.
Norcross and C.F. Newman (eds.) Handbook of psychotherapy integration. (pp. 3-45) New
York: Basic Books.
O´Hanlon, W.H., & Weiner-Davis, M. (1989). In search of solutions: A new direction in

psychotherapy. New York: Norton.
Orlinsky, D.E., Grawe K., and Parks, B.K. (1994). Process and outcome in psychotherapy -noch
einmal. In (A.E.Bergin and S.L. Garfield, eds) Handbook of Psychotherapy and Behavior
Change (4th edition). New York: Wiley, 270-376.
Penn P. (1982). Circular questioning. Family Process, 21, 267-280.
Perrone R. y Nannini (1997). Violencia y abusos sexuales en la familia. Barcelona: Paidós.
Reuterlov, H, Lofgren, T., Nordstrom, K. and Ternstrom, A. (2000). What is better? A preliminary
investigation of between-session change. Journal of Systemic Therapies, 19, 111-115.
Rolland, J.S. (1987). Chronic illness and the family life cycle: A conceptual framework. Family
Process, 26, 203-221
Saggese, M.L. & Foley, F.W. (2000) From problems or solutions to problems and solutions:
integrating the MRI and solution-focused models of Brief Therapy. Journal of Systemic
Therapies, 19, 59-73.
Selekman, M. (1993). Pathways to change: Brief therapy solutions with difficult adolescents.
New York: Guilford Press.
Selekman M. (1997). Solution-focused therapy with children: Harnessing family strengths for
systemic change. New York: Norton.
Selvini-Palazzoli M., Boscolo L., Cecchin G. y Prata G. (1978). Paradox and Counterparadox.
New York: Aronson.
Shilts, L. and Reiter, M.D.(2000). Integrating externalization and scaling questions: Using "visual"
scaling to amplify children´s voices. Journal of Syst emic Therapies, 19, 82-89
Shoham V. & Rohrbaugh M. (1996). Promises and perils of empirically supported psychotherapy
integration. Journal of Psychotherapy Integration, 6, 191-206.
Shoham V. & Rohrbaugh M. (1997). Interrupting ironic processes. Psychological Science, 8, 1-3.
Tohn, S. and Oshlag, J. (1995). Crossing the bridge: Integrating solution-focused therapy into
clinical practice. New York: Norton.
Tomm K.(1987) Interventive Interviewing. Part II: Reflexive questioning as a means to enable self-
healing. Family Process, 26, 2, 167-183.
29
Touyz, S.W. and Beumont, P. (1999). Anorexia nervosa: New approaches to management.
Modern Medicine of Australia , 95-110.
Vaughn, C. and Leff,J. (1976). The influence of family and social factors on the course of
psychiatric illness. A comparison of schizophrenic and depressed neurotic patients. British
Journal of Psychiatry, 29, 125-137.
Watzlawick P. y Weakland J. H. y Fisch R. (1982). Change: Principles of problem formation and

Pproblem resolution. New York: Norton.
Weakland J. H. (1983). "Family Therapy" with individuals. Journal of Strategic and Systemic
Therapies, 2, 25-33.
Weiner-Davis, M. (1992). Divorce busting: A revolutionary and rapid program for staying
together. New York: Simon & Schuster.
White, M. (1995). Re-authoring lives: Interviews and essays. Adelaide: Dulwich Centre
Publications.
White, M., & Epston, E. (1989). Narrative means to therapeutic ends . Adelaide: Dulwich
Centre Publications.
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-INTEGRATIVE BRIEF SOLUTION -FOCUSED THERAPY-

INTEGRATIVE BRIEF SOLUTION-FOCUSED

Mark Beyebach PhD

THE EVOLUTION OF AN INTEGRATIVE SOLUTION-FOCUSED

TECHNICAL INTEGRATION IN A SOLUTION-FOCUSED

In our practice, my colleagues and I do not pretend to integrate models or approaches of

GETTING MORE COMPLEX WHEN SOLUTION-FOCUSED

* Small problem-pattern modifications (O´Hanlon & Weiner-Davis, 1989; De Shazer, 1982).

* Externalization of the problem (White, 1995; White and Epston, 1989).

*Interventions designed to interrupt the problem -maintaining attempted solutions, usually

* Use of a reflecting team format (Andersen, 1987) so as to allow different constructions to

* Psychoeducational interventions (Anderson et al., 1986; Berkowitz et al., 1984; González

INTEGRATION AS A WAY OF IMPROVING FIT WITH OUR

8 And aggravated by the university context we work in.

"Shortcuts" in certain clinical situations

Only one party is coming

Working with visitors

"Shortcuts" for types of problems

Alcohol and drug abuse

Physical illnes in the family

Phobias, fears and other monsters

LIMITATIONS OF OUR APPROACH

The risks of integration in solution-focused practice

2. To use non-solution-focused techniques in the same respectful way as any solution-focused

Shortcomings of our integration proposal

Beyebach M. and Rodríguez Morejón A. (1997). Lösungsorientierte Therapie in Spanien: die

de Shazer, S. (1982). Patterns of brief family therapy. New York: Norton.

de Shazer, S. (1985). Keys to solution in brief therapy. New York: Norton.

de Shazer, S.. (1991). Putting difference to work. New York: Norton.

Dolan, I. (1991). Resolving sexual abuse. New York: Norton.

Gergen, K (1985). The social constructionist movement in modern psychology. American

Goldfried, M.R.(1991). Research issues in psychotherapy integration. Journal of Psychotherapy

Hjerth, M. (1997). Workshop presented in Salamanca, Spain.

Navarro Góngora, J. (1992). Técnicas y programas en terapia familiar. Barcelona: Paidós.

O´Hanlon, W.H., & Weiner-Davis, M. (1989). In search of solutions: A new direction in

Penn P. (1982). Circular questioning. Family Process, 21, 267-280.

Perrone R. y Nannini (1997). Violencia y abusos sexuales en la familia. Barcelona: Paidós.

Watzlawick P. y Weakland J. H. y Fisch R. (1982). Change: Principles of problem formation and

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