July 13, 2011

Conversation between Alasdair Mcdonald and Coert Visser

Alasdair Mcdonald is a consultant psychiatrist who is the research coordinator and former president and secretary of the European Brief Therapy Association. He is the author of Solution-Focused Therapy. Theory, Research & Practice (2007) and he works as a trainer and supervisor and as a management consultant. Coert Visser is a psychologist, author and expert on the solution-focused approach to coaching and change. His website www.solutionfocusedchange.blogspot.com has become, over the years, a trusted source of reference regarding cutting-edge psychological research which is relevant to solution-focused practitioners, coaches and consultants.

Coert: When did you first hear about the solution-focused approach and how did you get involved with it? Could you share some memories?

Alasdair: I chose the field of mental health intending to work as a psychiatrist and psychodynamic psychotherapist. However, there was waning interest in such therapy within the medical establishment and the workloads provided little opportunity for such training. My great good fortune during my child psychiatry training was to meet a young consultant from the Middle East who had a special interest in family therapy. He recommended MRI / strategic therapy which I found useful. We then set up a family therapy clinic in a mental health day hospital for adults.

I moved to another hospital and set up a training team using strategic therapy. In 1988 reading about BRIEFER II (de Shazer 1988) provoked our interest. We agreed that for a six month trial period we would employ solution-focused practice instead of our MRI model. At once we found that sessions became less demanding for the therapist and that the families became more receptive. Our team discussions in the break became shorter because we had already noted strengths and ideas within the family during the conversations. It became more common for our families to attend only once or twice. This was important because they had sometimes driven 100 miles each way to attend the appointment, and had to receive their therapy within the demands of isolated farms with many animals to care for. The practical rural population of the county found solution-focused thinking and using their own resources more congenial than the psychodynamic and Rogerian methods which had previously been the main local options.

Our follow-up programme showed no adverse effect on our success rate when we changed to the new solution-focused model. At the end of the six month trial period, every member of the team believed that solution-focused therapy was a significant improvement on our previous strategic approach.

When did you first hear about the solution-focused approach? Did you get involved with it through management or by some other route? Can you share some memories?

Coert: I first heard about the solution-focused approach around 2000. I remember when I heard about it I was actually quite sceptical. It sounded so simple, too simple actually. And I thought it wasn’t very original, too. I remember thinking that it sounded just like the application of some basic psychological principles. I remember thinking there must be some clever guys behind it trying to make some easy money. Another reason I was sceptical was that this was a therapy approach and I did not do therapy at all. Although I had studied both work and organizational psychology and clinical psychology I had never done therapy and I had only been working as a coach, consultant and manager. So I thought this therapy approach would probably not be useful at all for me.

A few weeks later, I came across the book ‘Interviewing for Solutions’ by Peter de Jong and Insoo Kim Berg. I read about students asking some questions to the client. They were all traditional questions which seemed okay to me. I remember thinking, I’d like to know what’s wrong with these questions because I don’t see what’s wrong with them. Then the book went on to provide some brief explanation of the medical model and problem focused questions. After that a second interview with this client was described with solution-focused questions. When I read this I began to understand some of the essence of the approach and my perspective changed drastically. I immediately saw numerous things I could try in my work as a coach. I started trying these things and was amazed at how much better my conversations with clients went and how much more fun they became for me. I remember realizing that this approach would keep me busy for many years which turned out to be true.

You're a psychiatrist. Can you tell a bit about how the solution-focused approach is received/viewed by psychiatrists?

Alasdair: In spite of my efforts, my colleagues in adult psychiatry think of it as a personal talent and not as a technique that they could learn. Mental health practice in this country follows much of US practice, with a heavy emphasis on medication and ‘expert’ techniques such as traditional cognitive-behaviour therapy. Mental health nurses are more open to studying interview skills and many of them like using solution-focused methods. We find that about one-third of nurses take to it enthusiastically, about one-third use it sometimes and the remainder say that they already have effective skills in other models and will not use solution-focused methods often. Drug and alcohol services in the United Kingdom use solution-focused therapy because it is brief and easily understood by their populations (who may be intoxicated or have poor educational abilities). Also, little background history is needed, which suits work with these clients. Many learning disability teams use solution-focused because it is practical and does not require detailed conversations. It combines well with structured behavioural methods aimed at individual issues. There are formal programmes for providing care in learning disability which are largely based on solution-focused principles.

I guess that you moved from using solution-focused ideas in your coaching work on to using it in management consultancy more generally. Can you say something about how solution-focused is received/viewed by businessmen who have not encountered it before? Is it difficult for businessmen to separate technique from person; 'what is done' from 'who does it'?

Coert: That’s right. At first I only used it in the coaching setting but I started trying it out in projects and consultancy, soon after that. My general experience is that managers respond well to it. I think I have benefited to some degree from having been a manager myself. As a manager I used to be rather sceptical about any new approaches promising all sorts of wonderful things. So when I started to use the solution-focused approach in my work with management teams, for instance, I tried to use it in a quite simple and sober way, phrasing questions in such a way that people usually don't notice I am using 'techniques'. I think this helps them to feel you are really taking their situation very seriously instead of applying some mere ‘questioning technique’. Recently, I considered it a wonderful compliment when I had facilitated a group meeting and someone, afterwards, said: "I really found this very useful. Usually the people who present workshops for us are very theoretical. But you aren't theoretical at all! You are very practical and simple." I really liked that especially because I actually have great theoretical interest.

Regarding the ‘who does it?’ aspect, I think it may work best when your clients don’t have any specific expectation about you as person. When they do know you, or may have read your books, they may sometimes focus a bit more on you as a person that on the process of finding solutions. Another situation in which I think the solution-focused approach usually works particularly well is when you, as a coach or consultant have no knowledge of the situation or profession of the client. This makes it easier to stick with the client perspective. For example, some of the work I did with financial, medical or technical specialists were fine examples of solution-focused helping. For instance, I helped an accountant to determine at what price he would sell his company to the buyer. I had very limited knowledge about these things while he was an expert himself. By asking lots of questions I helped him determine the right price. Another example is how I coached someone working in a hospital who had made a few serious mistakes which might have endangered patients’ health. This person found the coaching useful and so did his manager and personnel manager. A year after the coaching had started he said this about the coaching: "At first, I was sceptical. I really thought the real intention of this coaching was to get rid of me in a decent way. And, at first, I thought, well, I might as well play along. What else could I do? But after one conversation with the coach, I knew this could not be true, so I really started trying. These conversations were really helpful. They helped me to organize my thoughts. I learned how to step outside of myself and to observe myself. This helped me to gradually change my behaviour. What was really helpful was to talk to someone who knows nothing about our work. I could easily notice the coach knew nothing about our work. That was really helpful. I had to explain everything."

My next question to you is about evidence based work. Both in therapy and in a work setting, the demand for evidence based work has increased, I think. What I admire a lot in your work is that you have constantly been contributing to the establishment of the evidence base of the solution-focused approach. What would you say the evidence base for solution-focused work in therapy and outside therapy now is?

Alasdair: The current published evidence base for solution-focused applications finds 103 relevant studies including two meta-analyses and 18 randomised controlled trials showing benefit from solution-focused approaches with nine showing benefit over existing methods. Of 39 comparison studies, 30 favour the solution-focused model. Effectiveness data are also available from some 4000 cases with a success rate exceeding 60%; requiring an average of 3 – 5 sessions of therapy time.

Like many others, solution-focused therapy is approved by the US Federal Government (www.samhsa.gov; www.ncbi.nlm.nih.gov/books). It is approved by the State of Washington and the State of Oregon (www.oregon.gov/DHS). The State of Texas is examining evidence for approval. Finland has a government-approved accreditation programme. Canada has a registration body for practitioners and therapists. Those who construct national guidelines usually begin with a Google search for relevant studies. Because solution-focused workers and researchers tend not to use formal diagnostic categories it is often overlooked when guidelines are being constructed. So the evidence base for therapy is good but does not always achieve recognition.

Coaching is an increasing area for solution-focused work. The solution-focused approach is unusual in that there are numerous scientific studies of its use in coaching and within organisations. Many consultants are using solution-focused models as a basis for change management in organisations. It is also a good model for conflict management and is used internationally as well as within businesses.

I know that you have an interest in language analysis. Is this relevant to your comments about using ‘simple and sober questions’ rather than visible ‘techniques’? How does this interest affect other work that you do?

Coert: Language analysis opens up new ways to learn about the effectiveness of the solution-focused approach. Standard approaches of determining psychotherapy or coaching effectiveness involve randomized controlled experiments in which the treatment of interest is compared with a reference approach and a control group. While this approach to determine the effectiveness of therapy and coaching approaches is indispensable it is not the only useful approach and it is not without weaknesses. For one thing, this type of research requires the existence of generally accepted definitions of the treatments that are researched. For example, a generally accepted definition of solution-focused therapy requires the use of the miracle question, scaling questions, exception-seeking questions, and the what’s better question. This type of research comparing therapy or coaching approaches may say something about the relative effectiveness of these approaches but does not say much about the relative contribution of the constituent elements of these approaches because these are not examined separately in these types of experiments but in combination with each other.

This is why research aimed at a micro level can add much and is in my view also indispensable. There are many ways of designing research aimed at this micro level. For instance, Christine Tomori and Janet Beavin Bavelas have micro-analysed conversations of four distinguished therapists, client-centered therapists Carl Rogers, and Nathanial Raskin and solution-focused therapists Steve de Shazer and Insoo Kim Berg. This type of research is interesting because it does not focus on the theories or assumptions behind models but it shows you what practitioners actually do in conversations with their clients. One of the things Tomori and Bavelas compared is the occurrence of negative and positive expressions by the four therapists. They found the solution-focused therapists use much more positive and much less negative expressions.

Another line of research which I think will emerge will use software to analyse language used in conversations. As it will become easier to convert spoken language into written language and to analyse this language with software many possibilities for research present themselves. Therapy or coaching sessions may be taped and transcribed and analysed. These data may be used as dependent variables while client satisfaction and other variables may be used as independent variables. As this type of research will develop a much more nuanced and specific kind of knowledge will emerge about what works and what not.

I’d be interested to know which authors have been important influences to you.

Alasdair: Steve de Shazer and Insoo Kim Berg, naturally. However, I have also learned a great deal from Yvonne Dolan and from Andrew Turnell, often about how to apply solution-focused ideas in unusual situations. In conflict management the ideas of Fredrike Bannink have been helpful. With domestic violence I have learned from Lee, Sebold and Uken in California and from Judith Milner in the United Kingdom. I still think back to the work of the MRI writers such as Watzlawick, Fisch, Weakland and Segal, as well as Jay Haley and Brian Cade.

I know that you read very widely and share ideas with many other people. Which themes in current linguistic or other research do you plan to follow in the coming months?

Coert: I am planning to read a lot of stuff that is not related to the solution-focused approach directly. Several examples of books I am planning to read are The Cambridge Handbook of Expertise and Expert Performance (by Anders Ericsson and others), Thinking, Fast and Slow (by Daniel Kahneman), The Better Angels of Our Nature: Why Violence Has Declined (by Steven Pinker), The Secret Life of Pronouns: What Our Words Say About Us (by James Pennebaker), Redirect: The Surprising New Science of Psychological Change (by Timothy Wilson), and The Progress Principle: Using Small Wins to Ignite Joy, Engagement, and Creativity at Work (by Amabile and Kramer). A solution-focused book I hope to read is Solution-Focused Brief Therapy. A Handbook of Evidence-Based Practice.

Can you tell me a bit about recent discoveries, changes of insight you may have had and current interests you have?

Alasdair: I will follow your example and read Steven Pinker: that sounds most intriguing! At present I am pursuing two lines of thought. Many clients, both adults and children, are reluctant to attend therapy, yet they often benefit. Mandated clients do less well. What can we do that will increase our effectiveness? I am exploring the use of Simple Therapy, devised by Plamen Panayotov of Bulgaria. This model is of great interest because it avoids all prior assumptions while keeping responsibility with the client. It is quite similar to my own microtool for the management of urgent situations in the workplace (Macdonald 2007/2011).
Simple Therapy
What do you think is the most useful question we must answer first?
Then the therapist simply repeats the client’s question.
If the client’s first question is ‘Why?’, the therapist relies on The Razor’s Final Cut: Everything happens once and then becomes a habit.
If needed you can ask:
When did this habit happen first (last)?
How often does this habit happen lately?
Then: What are we going to do about it? asked by clients of themselves.
The therapist writes down from 1-5 written tasks, self-chosen by the clients, and hands this to the client.
If you let one of us here ask you 6 months from now please write down your phone number.
At that time we ask:
How are things going on for you?
Was our meeting(s) useful for you?
As well as your list of reading, what other plans have you for the coming months?

Coert: I will be doing many training programs the in the coming months. I’ll be training solution-focused coaches and I’ll be training managers. Also, I’ll be doing a workshop based on Carol Dweck’s work into mindsets. I’ll also be doing some writing and some survey research into coaching effectiveness.

Alasdair: Thank you for the chance to have this enjoyable conversation. I look forward to hearing more of your work in the future.

Also read: interview with Wally Gingerich

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