Basic ideas

Therapist (MS): "What are you good at"?
Cecile: (long pause) "Nothing" - (she pauses) - "I couldn't even handle elementary school".

We carry with us ideas about what we are like and what other people are like and we carry ideas about how our life is developing (or not developing) and we try to behave in accordance with these ideas. At the same time these ideas about ourselves are influenced by our experience. Hence we exist in a circular context where our ideas about ourselves and about others are both influenced by and influences our reality.

Cecile describes the world as she perceives it and perceives it the way she describes it. When she senses, tastes, smells, looks and listens to her surroundings and herself in relation to others she does not normally perceive lines, colors, smells or input from any specific part of her sensory system. She experiences wholeness and patterns. These experiences are interpretations based on her experience and knowledge which are background to her theory about the world and herself.

The theory that Cecile has about herself and about her life, both as an individual and in relation to other people, can be likened to a story or a narrative that she tells herself. "I am a skilful person", or "I always get into trouble" or "why do bad things always happen to ME" or "everyone is mean and evil" are all descriptions that help her to create meaning and order, and to understand what is going on in her life. It is of course obvious that the ideas Cecile has about herself and others, at the same time will very much affect how she behaves.

The story and time

In the story that we continually create in the present lies history, present and future. Cecile's story is; I am not good at anything. I have never been good at anything and I will never be good at anything. Problematic stories often have these features: "I've always been - depressed - different - to kind - to good-hearted - to dumb - etc., and I will always be that way, and as I am what I am, which is what I've always been, I can not change."

The story and other people

Cecile's story about herself contains thoughts about herself as stupid, worthless, and a failure. She is someone who has only herself to blame when misery hits her. In interactions with others she continuously sees and hears others confirm her self-image (a story in itself). When people are friendly to her she has difficulty understanding it. Maybe she doesn't even "see" it or she gets suspicious and awkward. It's difficult for her to establish close relationships with other people. When she fails in her relationships with others this becomes a confirmation of her story about herself and adds new parts to the old story.

Coincidences or differences

Similar events will be understood and interpreted differently by different people. If an apple hits Cecile on her head while she is walking in the fruit garden it is unlikely that she will use this event to develop Newton's ideas. It is more likely that she will think; "This happening to me is typical. It’s my usual bad luck". One of us (authors) would have picked up the apple angrily and thrown it far away, the other would have eaten it.

One day Cecile walks in the garden. Uncommonly and without being really aware of it, her thoughts are contented. An apple falls on her head and by an amazing coincidence it bounces on her head, falls into her hand and she catches it. It doesn't hurt and with a small laughter bubbling inside she takes a big bite out of the apple and for a few seconds enjoys the fresh taste. The moment is short and soon she lets the apple fall to the ground while looking shyly around herself. Half an hour later she remembers only the shame; "what if anyone saw me when that apple hit me on the head".

Cecile's story about herself is dominated by her idea about herself as victimized, depressed and incompetent. When events occur that do not conform with this narrative she will see them as coincidences or flukes that have nothing to do with her. These events and behaviors do not carry any meaning, so they will pass by without being noticed as different. This has nothing to do with quantity. Cecile can very well do good things for herself 6 days a week and only do problematic behaviors 1 hour a week and her story about herself could still be the same. Differences remain unnoticed coincidences if they are to small or to slow .

It is only when Cecile starts creating a new story about herself that these events can be of some importance for how she perceives herself and thus how she describes what she is doing and thus influence what she is doing. "I can catch opportunities in the air. I can enjoy the unexpected" etc.

In Patterns of brief family therapy, Steve de Shazer describes what he calls the binocular theory of change. When we look at something with our eyes, each eye sees one image. The left and the right eye do not see exactly the same image as the angle eye - object is not identical. The difference between the images convey another type of information than the images in themselves, which is depth. If the images were identical it wouldn't be of any importance that we had two eyes, and if the difference between the two images were too great we wouldn't be able to create meaning out of the merging of the images. It is only when the images are sufficiently alike and sufficiently different that the requirements are met for the difference to yield more information; depth.

In the encounter between client and therapist a narrative is created that takes its origin in the clients experience of his problematic existence. The client doesn't come with a finished story. He has an experience of the problem but the description - the narrative around his problems and solutions is shaped in interaction with you. This description created in the conversation can be extremely similar to the client's experience and can thus deeply confirm to the client that he has an insoluble problem and this will eventually make him feel deeply understood. No new information is brought forward and without new information the client will not be able to find any tools to start doing something about his problem.

Requisites for change are at hand when the narrative is sufficiently similar to the client's experience to be accepted, but at the same time sufficiently different to bring forth a new and different perspective. If the difference is too small the requisites for change are not met and if the difference is too big there may not even be a new meeting. The client says: "That therapist didn't understand anything, there was no use in continuing", or he thinks "that was the most stupid I ever heard" and stops coming.

Useful feed-back for the client is when the story is sufficiently similar to be accepted as a valid description of the clients experience, and sufficiently different to open up new perspectives, possibilities and hope.

Even positive, hopeful, and future oriented narratives can be to different.

A colleague has heard of solution focused therapy and has read an article and has understood that it is possible to focus on the future in situations and in ways that she couldn't imagine before.

She tries with a young girl who sits at home and doesn't go to school and together they dream up a world far into the future, a world full of hope, resources and possibilities. The atmosphere is very pleasant when the girl suddenly says; "You are trying to make me think of this so that I shall feel even worse so that I'll understand how impossible it is, aren't you?" It is impossible to reestablish contact with her again during the rest of the session.

A narrative that is both similar enough and different enough is Magdalena page *.

"The difference that makes a difference" is one of the favorite sayings of Gregory Bateson, who meant that without knowledge of death, there can be no knowledge of life. To know what heat is, we must know what cold is, etc. All concepts contain differences as a prerequisite for their existence as concepts, either as opposites or as levels on a scale. If there were no differences we would only see light or dark, feel smooth surfaces that never started or ended, hear nothing or a no-sense murmur, and we would not be able to describe any of it.

At least for therapy, for something to be defined as a problem there must exist at least a possible solution. Without a possible solution the problem is not a problem but a fact of life. It may be painful, but will never the less be a fact of life.

A problem is thus a difference that makes a difference, but a difference in relation to what? For the client evidently in regard to his or hers idea about what "not-problem" looks like or how it is experienced - no matter how vague or incomplete.

When Cecile took a bite out of the fresh apple she did something unusual and had an unusual experience. As this event doesn’t mean anything to her she doesn’t think much about it. Yet it was an exception to her problem-saturated story (victim, depressed, incompetent).

When asked questions about what she did to "enjoy" the apple, or what she did to "catch the opportunity when it came" she will bring forth answers like "I don't know" or "I didn't think about it" or "I just did it". These expressions are descriptions of behaviors, and even though they are vague and perhaps hazardous they are descriptions of her behaviors. Hence they have the potential to become descriptions that can become stories that bring meaning to the behaviors they are trying to describe. Thus a possibility arises for alternative stories about Cecile's life.

Stories that are built on exceptions have the advantage of being built upon what the client actually did. They can therefore be similar enough to be accepted as part of the client's history and world, but at the same time different enough to make a difference that will open up the possibility for new stories about oneself. These new stories can suggest different ways to see oneself, and thus a possibility opens for clients to do different things than those existing in their dominant story.

Addicts do not abuse 24 hours a day 365 days a year. It's impossible both for economic and time reasons and besides the addict would die pretty soon. The addict, his family and the professionals involved do not see the drug free periods as important. Instead they are seen as part of the pattern of addiction. "Things always go up and down. I/he had no money, there was no heroin in town, I/he was to sick to go out and chase drugs or steal" etc. What could have been a positive drug or alcohol free period is not noticed, and will thus not make a difference that makes a difference.

The therapist, on the contrary, can pay attention to events and irregular patterns that do not match the dominating (and often destructive) story. The therapist simply assumes that the client does something that is good for him even if he doesn't know it. The therapist therefore asks why the addict didn't do what he usually does; for instance, take something else than heroin, steal to get money, or if he was so sick, had someone else get drugs for him. Why didn't he do that? How come? What did he do instead? What did he do to resist the urge?

The therapist's questions focus on the choices the addicts had and the choices he actually made. Efforts and willpower is put forward and (eventually) becomes a difference that will make a difference for the client and his network. This type of questioning challenges the client, brings forth new perspectives and thus opens up for change as meaning is created around what functions well, making it something different then just coincidence or chance.

We think it is important to differentiate between exceptions and resources. Resources are briefly (more further on) everything that keeps the client alive despite his condition, while exceptions are when things happen that are in line with what the client wants (goals). It is thus important that when you inquire about exceptions, think both about what the client is complaining about and what it is he wants help with.

Norbert comes with his social worker who has tried for 2 months to send him to an institution for a 30-day AA program for his alcoholism. Nils lost his job because of his drinking and is now, according to his social worker, about to loose his family for the same reason.

In the interview Norbert describes problem with his wife, but he also describes instances of intimacy and closeness, when he, for instance, hugs his wife and gets a positive response, and when the two of them have fun together with their children. This is something everyone in the family appreciates. Norbert doesn't talk about his drinking. When the social worker puts it on the table, he confirms that his wife's worrying is a problem, as she constantly worries about when he is going to have his next period of drinking and her worrying risks spoiling the marriage, which he is certain both of them want to continue.

Norbert's complaint revolves around his relationship with his wife, not his relationship to alcohol. His goals for therapy are connected to the relationship with his wife. Out of curiosity the therapist (JLK) wonders whether Norbert believes that a change in the relationship with his wife will result in a change concerning his relationship with alcohol and Norbert nods.

The exceptions in the relationship with his wife (the good moments) are further highlighted and Norbert is given a few ideas that he could try as an experiment that could make these moments happen more often. (None of these ideas has anything to do with alcohol, as Norbert doesn't seem to believe that this is the crucial problem (or solution) in the relationship).

When Norbert returns after a week he has discovered what he needs to do to improve his relationship with his wife (breakfast in bed, help the children with their homework, have dinner ready when she comes home from work etc). She is as worried as before about his next relapse, but there isn't very much he can do about it and despite her worrying they have had many good moments during the week.

After another 3 sessions with the same theme over a 3 month period, treatment is terminated. Nils has not had any relapses neither with his drinking nor with the problem with his wife. He says she is satisfied too, and his drinking behavior is no longer a subject of conversation between them.

If the client is complaining about his relationship with his wife, this is the complaint for which we are looking for exceptions. It is impossible to create meaning around behaviors, that are exceptions to our (or the social workers) ideas about the clients problem.

Deliberate exceptions

Deliberate exceptions are exceptions the client can do whenever he wants to. Donald sniffs gas in a compulsory manner and wants to stop. He never sniffs when he is with his girlfriend "she would beat the shit out of me". When Donald doesn't want to sniff he stays with his girlfriend, which he does 2 or 3 evenings a week. He can also abstain from sniffing when he is with his mother, and he is 100% sure that he can abstain tomorrow if he decides to (by being with his mother or with his girlfriend).

Spontaneous exceptions

These are exceptions that occur out of the blue. What makes them happen, when they happen, and why they happen where they happen is a mystery. They just happen. Sometimes an aspect of what is going on is obvious but the description does not have the same character as with deliberate exceptions.

Cecile is good at cooking and likes reading. She is interested in art and she is extremely well versed when it comes to Impressionism. In school she received very high grades in drawing, and she shyly discloses that she paints a little (badly she thinks, and she doesn't understand why her teacher appreciated her so much). Cecile's mother tells the therapist that she has always been very impressed with Cecile's talent in this area. Cecile gets very upset with her mother who hasn't told her this before, but her mother harshly makes it clear that she has shown her appreciation many times.

Even people with "difficult" problems often have many areas in their lives that function well (food, sex, cultural interests, job, etc). These areas are important, because they can be likened to islands of competence and resources onto which exceptions and solutions can be connected to become continents.

Competence and resources is everything in the clients life that is fun, inspiring, delightful, good and useful. In fact anything clients and families do or has the possibility to do that makes them feel good (or at least not worse) and be proud of themselves and each other.

What the therapist think is efficient therapy will guide and control both the content and the structure of his conversations with clients and families. His view is represented in his first utterances and his first reactions to what the client presents.

As we think that most of the therapeutic work has to do with the therapist and the client/family co-creating a changeable reality, we think it's good that therapists are not blank mirrors. Therefore we make efforts to make our basic ideas as apparent as possible to ourselves and our clients.

Our first basic idea is that clients and families do their utmost to co-operate with us with the purpose to get help in changing what they do in their lives. Our job is therefore to do our utmost to find ways of co-operation considering each family's unique way, conditions and life situation.

Maria says "I'm fed up with crying with therapists, it doesn't change anything. Don't make me cry!!!" and then she starts crying before the therapist (HK) has had a chance to answer. He immediately leans forward and says loudly and remorsefully with an accompanying smile; "it wasn't me, it wasn't me" and Maria's crying turns into laughter.

Co-operation is developed in a relationship.

Our second basic idea is that we as therapists have difficulties co-operating with people who come to get help and that we therefore must work very hard to understand what they are telling us about their goals and solutions. We try to adjust ourselves and our model to our clients.

Jonny looks spitefully at the therapist (HK).

"A scale for how I feel. Things like that cannot be reduced to scales!"

"Ok", the therapist answers, and stops using scales with Jonny.

What we do can be seen as trying very hard to understand where the clients wants to go (their goal) and then trying to help them find the shortest way to get there. If this is to work, the road must be accessible within their repertoire, but it will often not be the road they imagined at outset (had that one worked, they wouldn't have needed therapy).

Donald's mother calls and wonders if the therapist (HK) can't hypnotize Donald at the next session so that he can tell "the real reason he is sniffing gas". The therapist then wonders if she believes this would lead to him stopping and she confirms this. The therapist than recounts that nobody uses hypnosis like that anymore, but that next week a colleague from the United States is coming to do some training and consultation (Steve de Shazer) and he is one of the foremost hypnotherapists in the world and he has completely stopped using hypnosis because he thinks "it works better without". The therapist also adds that Steve de Shazer is very good at discussing with young people what they have to do to "stop problematic behaviors". She is asked to discuss with the boy and the father and call back and confirm if she wants one of the consultation-opportunities.

During the telephone-call the therapist accepts her goal but indicates an alternative route.

Our third basic idea is that no matter how bad it seems clients and families do a lot of things that are good for them and it is our job to find out what those things are.

Our forth basic idea is that change is . When working like this nothing is ever the same. It is always possible to find differences in the present, the past or in ideas about how the future can be different. With time we have become almost incurably optimistic.

Our fifth basic idea is that change happens through developing resources rather than treating defects. This is expressed through a relative non-interest in problems and an insatiable interest in what people are good at.

Our sixth basic idea is that laughter liberates and that efficient therapy often is fun. Laughter has a tendency to lure out resources instead of deficiencies. What you can not laugh about you can't take seriously.

Our seventh basic idea is that the step from the told (expected) problem free story to actually living it is smaller than usually believed and it pays off for clients to experiment.

Our eight basic idea is that it is important for clients to own their change.

Our ninth basic idea is that credit for change should be shared among those who deserve it.

Our tenth basic idea is that the briefer the therapy the better.

Jon is 17 years old, and his mother phones because Jon has been sluggish, passive and indifferent for a long time and has failed completely in school. He now works in a youth-place since a couple of months and has practically – but not entirely – stopped going there. The police have picked him up with hashish in his pocket and mother has succeeded in making him confess several years of hashish-abuse. She wants help immediately and gets an appointment a week later.

They come together for the first session.

"What are you good at"? the therapist (HK) asks and he immediately answers: "Nothing".

"Come on", the therapist says, "what are you good at"?

With a nonchalant smile he answers; "Sleeping... particularly in the mornings". The therapist seriously notes what he said and adds:

"What else"?

Jon thinks for a few moments, looks questioningly at his mother and says:

"I don't know".

"Hmm", says the therapist, turns toward mother and asks:

"What is he good at"?

"A lot. He is intelligent and sensitive, he can when he wants, he is good at cooking, he is considerate to his friends, he has always been very independent. He has matured early."

The therapist takes notes again, turns to Jon and wonders if he agrees with his mother, and he does. The therapist than asks him what his mother is good at.

"Nagging", he answers, but his voice already sounds a little bit less defensive, and one senses the beginning of a smile there somewhere in the middle of all the sullenness. He continues without any need for encouragement.

"She is good at cooking, and she is damned good at keeping order",

"Aha, so your mother is orderly" the therapist comments and notes.

The next question starts with a small lecture. "When things like this happen in families and one finally decides to get some help, this seeking help is a big step. We often see that it is only one of many other things that already started changing. So what I want to ask you is; what has improved since you called and made the appointment to come here?"

Mother answers thoughtfully: "That's quite right. He has been calmer, and we talk a lot more". In the discussion that follows they tell the therapist that Jon was very angry during the days that followed his exposure. Angry because mother contacted the parents of his friends, angry because mother contacted the hospital, angry because mother wanted him to go with her to child psychiatry. He then seemed to accept it and became calmer at home. He also went to work every day. He got up in the mornings, with great difficulty, but he has been in time for work every day except one and it has become easier from day to day. Mother also believes that he hasn't smoked any hashish.

The therapist and the family talk for a while about the efforts he made and how he has been able to use mother's determination in a constructive way, and the help she has provided. To questions concerning why he bothers to go to his workplace (just boring and killing him and he just sits of his time), he answers that he has to, as he needs the points to get into high-school next fall. The therapist is pretty surprised by his realism and willpower, and mother has to inform him about her son: "He knows how if he wants to. He matured early."

The therapist thinks it is time to talk about goals and asks the "miracle-question" (page *). Both listens carefully when he asks the question: "Suppose tonight when you are sleeping a miracle happened, and the miracle is that the problems that brought you here was solved. As you were asleep when the miracle happened you wouldn't know it had happened. What would be different tomorrow that would make you think there had been a miracle".

Jon answers: "I wouldn't know there had been a miracle if I was asleep when it happened". He notices that the therapist looks surprised and adds. "I haven't smoked anything now for a fortnight and that's no problem. I'm not saying I'll never smoke again, but I'm not hooked and I'll probably smoke a pipe now and then".

"Aha", says the therapist, "but what about mom. What would she notice that would make her think there had been a miracle?"

Jon answers: "I would be more successful with girls."

The therapist wonders what he means by this, and they talk together about the mysteries with girls. Has he talked with his mother about this, "she is after all a girl"?

"No way"! says he, and all three laugh together at this preposterous idea.

"What do you mean when you say 'more successful with girls'? Do you know when a girl is interested in you?"

"It doesn't happen often", says he, and mother and the therapist unite in playful conspiracy around the idea that he is probably blind when it comes to yearning teenage girls. Maybe it is so, the therapist adds, that the hashish hasn't made this problem any easier to solve as hashish is a drug that tends to turn people inward, paying more attention to themselves than to others.

What would she notice after the miracle the therapist wonders and mother answers: "I would see a boy that was glad in the morning. He'd probably still have difficulties getting out of bed, but he would be glad when he got down to the kitchen. In the afternoon he would tell me something about his day, without me having to pull every word out of him, and he would say something positive about his job. An evening now and then he'd be home, doing something with me. I never see him", she finishes a little whining.

The therapist repeats everything she said except for the last (never sees him), as he notes it. He also checks with her if she means that Jon would answer with less effort on her behalf, or if she means that he would talk to her spontaneously, and she confirms the last. Cautiously the therapist turns to Jon, wondering how this fits for him. Maybe it does but he'll never enjoy that job, but sure it's possible that it can be fun to do something with mom sometime.

"Great", says the therapist.

The therapist wonders to himself, if any of this happens from time to time? Are there exceptions? He asks:

"Does any of this happen now and then, or are there things going on that are in the direction of this happening"?

Mother recounts that for the last few days she has the impression that Jon is more considerate toward his little brother and sister and there has been much less arguing and fighting. Jon proudly and a little bit shyly adds that yesterday he actually had a long conversation with his 12-year old brother.

The therapist ends the interview with scaling-questions.

"On a scale from 1 to 10, where 10 stands for this problem being enormously serious and 1 not serious at all, how do see that"?

Jon thinks for a while, looks furtively at his mother and answers "6".

"On the same scale, what are your chances of getting out of it"?

He answers "8".

"On the same scale where 10 means you are prepared to do anything to solve this problem and 1 means the only thing you are prepared to do is to sit on your bottom and wait for a miracle"?

"6"

The therapist notes, looks in his papers and says he would like a couple of minutes for himself in the corridor. He wants to think about what they talked about, what he thinks of their situation, and if he has any ideas that he thinks could be useful. Before he rises he asks: "Is there anything important at this point that you want me to know before I go out to discuss with myself, or is there a question you think I forgot to ask"? They both think for a while, shake their heads and he goes out.

When he comes back after about ten minutes to summarize the session, they are both very attentive.

"First I want to say that I think it's a good thing you came. This is a serious problem and you are both well aware of the fact that it will take a lot of hard work to solve this problem".

The therapist then turns to mother and continues:

"I am very impressed with your boy. His open mindedness, his sense for nuances, his honesty and sensitivity and this nice contact he is offering. I agree with you that he matured early, and while walking in the corridor thinking, I got this idea that maybe he has needed this period of hashish-abuse to slow down his development to manhood".

She nods and the therapist turns to Jon:

"I think you are lucky to have a mother who dares show her involvement in many different ways".

He nods and the therapist says he has a task for each of them that he thinks can be of some help. To mother he says;

"Pay attention to when you see that he gets up in a good mood in the morning, when he is kind with his siblings, when he makes a positive comment about his job or does anything else in line with the miracle. Note the time and give him a present 24 hours later without telling him why".

"As for you Jon, till we meet next, I want you to pay attention to whatever happens in your life that you would like to continue to have happen in the future when the problem is solved".

They agree on 2 weeks till next session. The therapist actually would have preferred one week, but mother and Jon agree that 2 weeks is best and the therapist accepts without discussion. Just before they leave the therapist says: "Think about bringing anyone that you think could be helpful in solving this problem".

Useful ideas are ideas that have helped us in our work. They consist of a few simple thoughts that help us co-operate with the people we meet. We do not mean that these ideas are the only ideas conceivable in therapy or that they are the truth or the way things should be done. Problem-solution and treatment varies as everyone is unique. The way to find and describe exceptions and solutions need to be fitted individually with clients, families and therapists. Problems are solved in many different ways and we are convinced that most of the "therapeutic" work is not done at the therapists office but in the clients ordinary environment.

The ideas are grouped in three categories. First we talk about ideas that facilitate for us (and hopefully for you) to establish a working-relation based on co-operation. We call that "developing fit". Thereafter we talk about ideas that have more to do with technique, we call that part "method-ideas", and finally we talk about our goals for treatment. We call that "ambitions".

Developing fit

Creating confidence and developing fit is much more than technique. Some even call it art. The following ideas can facilitate the task.

One of the more important things to think about as a therapist is that it is not your job to change your clients. Most people come to therapy to solve difficulties, not to change their personality. You should be curious, ask questions about the client's situation and accept their way of seeing things. Accepting does not mean agreeing with everything. It means that you do your best to listen to your client, you ask about the things you don't understand, you don't criticize, and you pay attention to what the client handles well. It is the client who decides what he wants to change, not you.

Accept the problem and the goal the client or the family set for the contact with you. When you get ideas about what people should change, it is not certain you are wrong, but you can never have your clients'/families' perspective on their lives It is impossible not to lack in respect for peoples own capacity to deal with their lives, when you try to decide what's best for them. Besides, it's rare that you can change something your client does not want to change themselves. One experience we, as many others have had over time is that you can trust that people know what they have to do first. So listen to their complaints and their idea about what their solutions looks like. Try to avoid letting your normative and "healthy" ideas take over.

Jon's mother want help so she can help her son quit using drugs. What he wants help with is not entirely clear, but since he looks proud and glad when he participates in the descriptions of what has changed since his exposure, we assume that he want more things like that to happen in his life. Furthermore he doesn't seem to react negatively to mothers "miracle" and - as a preliminary hypothesis - we assume that his goal and mothers are not mutually exclusive.

A famous brief therapist (Bill O'Hanlon) recommends that you should have an analysts couch in every brief therapy office, to be used by the therapist every time he gets the urge to define a problem, a solution or a goal for a client. It is important to stay on the couch until the urge has passed.

People always have good reasons for their behavior, even when it seems incomprehensible and crazy to others (and sometimes even to themselves). If an addict does not want to go into in-patient treatment it does not mean that the addict is "unmotivated". It means that the addict has good reasons not to want to: Maybe he or she is afraid to leave town, fearing what might happen to his parents. Maybe he has some previous unfortunate experience with treatment. Maybe he is afraid to expose himself in a group therapy setting, where he doesn't really trust anybody. Maybe it simply means that the addict wants to do something entirely different from what we or others want him to do.

When meeting Jon we assume from the positive things he did since the exposure that he wants to have a good life for himself and for his family, and that he is prepared to do something to make this possible. We don't ask why he did all those things, as we don't ask why he is using drugs. Jon may not know how to change his life, or if it is at all possible and because of this he may not seem 100% determined to make the effort. This doesn't mean that he doesn't want to have a good life.

We have never yet met a parent who has given up entirely and who no longer cares for his or her child. Every parent we’ve met hopes for a good future for their child and, like Jon's mother, have been prepared to do anything that has a reasonable chance of being helpful.

It is useful to assume that other professionals, like ourselves are genuinely interested in helping the client and prepared to do what they can. Press and TV sometimes paint pictures of social workers being loathsome figures whose only goal is to take children into custody and make misery for ordinary people. We have worked in child psychiatry and drug treatment for a number of years and we have not yet met any professional that fits this picture. The professionals we have met have always tried to do the best they can, sometimes in impossible working conditions and often with very little support and backup.

Jon is unique. His mother is unique. The resources, wishes and dreams of every individual are unique. We always assume that every client feels special in one way or another. Almost every addict thinks that other addicts are more wasted, more aggressive, less honest, less smart or.. (a number of other adjectives). It is a useful (and unusual) experience for our clients to be seen and confirmed as unique in one or several respects.

Every family has in its own way created patterns, rules and habits. Every family is a miniculture and the therapist should act as a respectful social anthropologist in his meeting with them, which means that he should be curious, observe the unique and pass it back to the family members.

When we talk to Jon and his mother about goals, exceptions and solutions (and not about the problem) it does not mean that we see their problem as insignificant. We talk with them about the differences between their problems and their goals. These differences we take very seriously and hopefully we meet them in such a way that they understand that we think that none of this is trivial.

Addiction is a serious problem that can – and often will – lead to early death. Even when it doesn't result in death the consequences are very serious; disease, criminality, prostitution, battering etc.

If you obstinately avoid talking about the seriousness, the situation can become very strange. Talking about danger and risks with addicts is not dangerous, they are very much aware of them. Pia for instance says: "I gamble with death every day".

The danger of talking too much about problems is that you risk getting caught by the seriousness. The sessions then become morose and hopeless, and if you can't move on both therapist and client are drained of energy, creativity and ideas for solutions.

What you can't laugh about you can't take seriously. Humor is important in therapy even - and maybe particularly - when the problems are serious and difficult.

Method

Our first question to Jon is: "What are you good at"? Our second question is: "What has already started changing for the better"?

Our working hypothesis is that clients and families have already started solving the problems before they meet us the first time. If asked, more than 60% of our clients, announce that there has been positive changes in their life before the first interview with the therapist.

Assume that exceptions to the problem always exist. All addicts stop their abuse for longer or shorter periods of time. All disobedient children sometimes obey. It is impossible for people to know that something is a problem if they don't have any idea of what the no-problem to this problem is or will be.

Assume that the addict has drug free periods and can resist the urge, at least occasionally. Ask when and how he did it instead of asking if it happens.

Assume that the family is doing and has done a lot of different things to succor their son, daughter, husband or wife and invite them to describe when and how they did things they think were helpful.

Also assume that the professionals have done and continue to do good things and that they notice when the client shows strength, willpower and courage. Ask them to comment on such things.

People experience the problem in relation to time. The "depressed" client feels that his problem will never pass. The client with agoraphobia is not only afraid of that gnawing feeling of uncertainty and anxiety that is tormenting his stomach. He is also paralyzed by the certainty that he will die when he walks out onto the square.

On a simplified level all problems can be described as belonging to one of two categories.

There are problems of type "I would like to be able to do that or that, but I dare not or I can not", and there are problems of type "I would like to be able to not do that and that". (Addiction is most often described as belonging to this second type of problem).

The goal in one case is then to do that or that which the client is not doing, and in the other case to do something different than the problem (not doing the problematic behavior). By helping people project themselves into the future and imagine (fantasize about) a future without the problem we obtain a description of the clients goal. At the same time we get a description of the difference between the problem and the goal which can help us express the understanding clients sometimes needs to dare take on the hard work for a future without drugs or alcohol.

In the practical reality of every day clinical work you get the impression that when people can connect the idea of the absence of the problem with specific behaviors that are possible for them, this is enough for them to start them doing these specific behaviors.

What interests us are therefore goals described in concrete terms. So small they may have happened (be attained) at least in some instances before the session next week and concrete enough for us and the client to know if and when they happened. That they occurred doesn't automatically mean that the goals are attained. For this the client also needs to be confident that he can continue to do them. On the other hand goals can never be attained without them happening.

Useful goals are small, important to the client, described in concrete behavioral terms and possible to achieve in the clients life-situation. The goals should also require hard work to be reached.

Huge goals lay the foundation for failure and frustration. Therefore small goals are preferable - several small attainable goals in succession instead of one unattainable one.

Useful goals are goals described in concrete behavioral terms and described as the beginning of something instead of the end of something. It is also important that the goals are described as the presence of something rather than the absence of something. These three things that make the description concrete make it easy to evaluate whether or not the goal is attained.

Goals that can't be reached because they are not realistic in the clients life-situation are meaningless, if not destructive within this model. If you form goals that are unattainable you risk increasing the clients sense of desperation.

If hard work is not required to reach the goals, you infer that the client should have solved this problem a long time ago, and he must therefore be stupid since he hasn't solved the problem already.

From this follows that not abusing is not a good goal. It is impossible to know for sure when it is reached. It contains no concrete and specific behavioral descriptions. It is not described as the beginning of something. It is of course desirable and for certain it's hard work.

A better formed goal can be: When the problem is solved I get up at eight o'clock in the morning, eat breakfast and go out looking for a job. This can then be broken down into smaller goals (waking from the alarm, etc) or be built upon with more goals (being on time for work).

Useful goals directly related to addictive behaviors often have the form; "saying no thanks to a drink", "arranging for someone else to answer the phone", passing a shop with alcohol with money in the pocket without going in".

Addicts sometimes want to get rid of social workers who interfere in their lives while social workers and families want the addict to stop abusing. It is then important to help everyone formulate these goals in smaller steps and more concrete terms asking questions like: "What do you have to do for them to calm down and leave you alone?"

"What will be different when K stopped abusing"? and

"What will be the first sign that will tell you that K started stopping"?

Your responsibility for the lives of your clients varies between two extremes. One suggested by the word responding (re-sponding: re-thinking), which essentially means that your only responsibility is to respond from one human being to another and have as nice and useful a conversation as possible. You don't have any responsibility, and can not be held accountable for anything the client does or does not do outside of the therapy room.

The other pole is that you are in a statutory function. You are investigating child custody cases or you are doing pre-sentence investigations for the penitentiary system and the assessments you do are important for the freedom of your clients or if he or she will be allowed to take care of his or her children etc.

Often you are situated somewhere in between these poles and it is not unusual that you have to move between them.

When you do assessments or take a stand as a person in authority on questions concerning protective aspects for children you have to decide "how things really are". Your context is then one in which there exists a truth in the form of "daddy hits his children" or "father and mother abuse so much that they can't take care of their children" or "her abuse means that her children are at risk". These are static descriptions that are essential to settle questions concerning "social control" and it is not possible to get an answer to these questions and at the same time carry out treatment.

It is important that you clarify your context and your responsibility to the client. Many misunderstandings and muddles will be avoided when you are clear about your assignment. Are you there as a person in authority who has been ordered to do an assessment in a child protection case or are you working in an outpatient unit for addicts where they can seek help anonymously? The preconditions for your session will be dramatically different, and hence the content of your conversation.

Brynolf and Amelia are brought in because the child protection agency has asked for a child psychiatric assessment. For more than 6 months the social worker has tried to help the couple in many different ways in order not to be obliged to take their two children into custody, but during all this time the couple has continued to leave urine samples "soiled" with amphetamines, benzodiazepines and cannabis. The social worker has informed the child psychiatrist (HK) that the couple just can't understand that there are drugs in their urines.

HK's first question is: "Do you know why you're here?"

Amelia looks true-heartedly at him and answers: "Yes, it is to get some help with our children".

HK than explains in great detail and as clearly as he can that this is not the case. They are in his office because he has to make an assessment as to their capacity for parenting, and he is to write down this assessment and then the court will decide if they are able to take care of their children, or if the children should live somewhere else.

HK then asks what they think their chances are of keeping their children and they answer 100%, to which HK retorts that they must be out of their minds, and don't they know how the courts look at drug abusing parents. After some further negotiation they settle for 50%. HK then asks what they think would increase their chances of keeping the children and after some reflection and discussion they think that clean urines and that Brynolf goes to work could increase their chances. After some further discussion they also reach the conclusion that it would help if the Valium disappeared too, despite the fact that it is prescribed by a doctor. It is mostly Amelia who is pushing for this, and she calmly points out to her somewhat reluctant husband, that under those positive drug-analysis for Valium, anything can hide. During some time she herself took 600 pills/month so she speaks with a certain authority to which Brynolf eventually bends.

As the couple is leaving, HK summarizes with a point built on the session; "It's interesting that you and the social workers have the same goal." They look at him with some surprise wondering what he means. "Neither you nor them seems to want your kids to grow up with addicted parents". They confirm under calm reflection, go home and start bringing in clean urine samples.

The assessment is then carried out during 4 sessions and is sent to the child protective agency. HK says in his assessment that continued abstinence from drugs is a precondition for the parents to be able to take good care of their children and that abstinence can not be guaranteed. The couple then continues in out-patient treatment elsewhere.

With Jon and his mother the context is defined at outset. The therapist is a doctor in a child psychiatric clinic and the mother and the boy comes to get help with a specific problem. Still you can not neglect the law. When the psychological or physical health of children or adolescents is at risk this must be reported to the authorities concerned. (social, police etc.)

When your context is purely one of therapy there are no absolute truths. Nothing is stable and you are interested in all the different possibilities that exist in the future when the problem is solved. You are not even trying to find out how things "really" are as this among other things doesn't give much information about how things can become in the future.

There is no problem in doing this when other professionals carry the official responsibility, for instance when the referral source is a social worker who takes charge of controlling drug abstinence. It is nevertheless obvious that you must quit your therapeutic relationship when the 15-year old cannabis-smoking adolescent tells you that her dad makes love to her three times a week or when therapy isn't helping Jon.

Jon's mother cancels the second session because Jon has an infection and on the phone she says happily "talk about a miracle".

When they come a week later the miracle has continued. It is as though all the problems have vanished and Jon is satisfied with everything except that he still has not had "more success with girls".

A month later the situation dramatically deteriorates and mother comes alone to discuss the situation. She suspects he started smoking hashish again, and maybe he also started to try "heavier" drugs. She is in despair and very worried that maybe she has entirely lost control over her son. The therapist can not rule out that she may be right and when he has seen her for another 2 sessions and there is no sign of improvement, they agree that the therapist shall inform child protection that Jon is in danger.

A social worker meets with Jon and discusses the different alternatives that exist. What we know about that meeting is that the social worker is very clear with what she is forced to do if Jon doesn't straighten up and stop doing drugs. They agree that Jon shall give it another shot with HK and after a few sessions the situation stabilizes.

Don't forget that your world-view is in your questions. Use that knowledge actively. Pay attention to how you formulate your questions and to whom you put them. With simple means you can then quickly and with little ambiguity define context and responsibility.

"I have been asked by your social worker to meet with you to make an assessment for the court".

To the client who comes on his own initiative: "How can I be of help to you?"

To the referrer who comes with the client to the first session: "If this becomes a profitable meeting - what will we have talked about?"

In the investigation situation: "I have been asked by the court to see you to make an assessment of your situation."

There are many advantages to brief therapy. The message from the therapist is that the client has resources of his own and can handle his situation by himself in the future. The implicit message of long-term treatment is that the client can't do without help, and that the problems are almost irresolvable. We also say that if therapy is not a part of the solution (which shows rapidly), it has become part of the problem.

When the goals for therapy are well formed (page *) it's easy to know when they are attained. It will then be obvious to terminate when they are reached or when the client is certain that they can be reached without further therapeutic help. Unclear goals lead to unclear results (for the clients) and long-term or interrupted treatments.

When having therapeutic contact with "multiple goal families" it is better to have several short successful therapies extending over a long period of time, than have one continuing treatment ongoing year after year.

With addicts having problems on several levels - drugs, family, habits of different kind - there is the risk that the addict will replace one dependency for another (treatment, therapist). The responsibility for the clients situation will still remain outside of his own control.

We see therapy as time-limited help to self help. We see brief therapy as an attitude with the therapist so concerned with respect for - and faith in - the clients own resources and creativity, that every session can be the last.

The ambition

When a client's life changes for the better and this is connected to the client having done things he didn't think he could do, this is something encouraging, uplifting and beyond all, it is something the client can do again. When the therapist, mother and Jon notices that Jon already started changing his life for the better, these changes will be signs showing that Jon has resources, willpower and competence to handle his own difficulties.

It is always the client’s own resources and actions that causes positive change. This will mean that he is not at the mercy of others or to chance or destiny, and he will be more responsible for his own life. If new problems arise the client has a model for how to act.

This means that the therapist shall take responsibility for what goes on in the sessions. If a session is destructive it is the therapists responsibility that this happened and also his responsibility to correct the situation or at least apologize (and thereby take on the responsibility). Apologizing is a respectful way to take on responsibility and something clients appreciates.

To us this implies that when things are moving in the right direction it is the client who shall have the praise, the endorsement and the responsibility. If things go badly it is always the therapist’s fault.

Addicts do not solve their problems on their own. Jon has a mother who "dares show her involvement in many different ways". We humans are not islands in an ocean of loneliness. When things are going better it is because people in the addicts environment in some way participate in things getting better. Very often it is family members. It is important that these people are given merit for the changes and that the addict can feel proud of his competent family members, and through this can feel proud of his own competence.

"How were they helpful?"

"What was most important, their support or their confrontation?"

From the above it is clear that we see the therapists role as one of a guide or pilot. Someone who knows about finding/constructing solutions and someone who for a short while helps the client and the family notice what is working and finding ways to do more of it. The therapist is not a locomotive pulling or pushing the wagons (client and family) from start to goal. The therapist is a pilot who at certain difficult passes helps the boat find its way and then trusts it to go the rest of the way on its own.

We see addicts and their families as people in difficult if not impossible situations. The help they need is to get some acknowledgment of them being normal reasonable people who wants to do something about their situation. Recognition that they already found solutions to difficult problems and some support and advice that help them do more of what works - even if this at outset seems to be very little.

Teamwork has been the foundation for the evolution we experienced during the years of work with addicts.

With team we mean that a group consisting of one or several people follow the therapists work with the client/family either in the room, or via a one-way screen or via a closed television circuit. The team actively participates by passing on their points of view through telephone calls, by the therapist taking a break to discuss with the team or by someone from the team walking into the session. We are rigorous in making this clear: "We are a team working for you".

It is often impossible to work with a team – most of the work within health- and social service system is done by one therapist or, in the best of circumstances, two. It is neither reasonable, nor necessary, to have a team in all cases. In most workplaces it is possible though to work with colleagues at least one or two half-days a week.

After a difficult period you will find that the team approach means an enormous security in your work and that the team's encouragement and points of view are very useful.

The team has many roles. Some of the more important are:

•  Help the therapist observe and notice the clients' resources, competence and strengths. It is easier for team members who follow the session from behind the one-way screen to see nuances and subtleties. It is easier for the team to listen than it is for the therapist. The team members don't have to think about the next question or think about how to react to what the client just said. Team members also have the possibility to write down peculiar or characteristic expressions that the client uses often. Observations by team-members are useful both for concluding and summarizing the ongoing session and for subsequent sessions. Four, six or seven eyes and ears see and hear more than two.

• Help the therapist keep the direction of the session, getting an answer to the questions he asks and not being distracted by everything of less importance coming up in the session. Conversing with people in difficult situations and making the conversation a constructive event in the clients' life is an art that demands concentration, respect and humbleness. Loosing the thread and direction is no catastrophe and happens to every therapist. The team can be an invaluable resource in finding the way back.

• Help the therapist keep different descriptions of reality alive, so he doesn't get caught in one truth – one description. As the different team members are different persons, carry with them different experiences and have different distance and involvement in the session, the same event will be seen differently. The descriptions will be different, ideas can flow and the ambiance can become extremely creative.
   Teamwork is not easy. It takes hard work and endurance to respect each other's different ways of working and to find ways to give comments that are useful.
   For many therapists it is a relief to know that the colleagues will intervene if things get completely out of hand. This gives more freedom to follow hunches and impulses.

• Help therapists in training to find their way of working. Teamwork is a very efficient learning situation. As a team member you are actively participating in the treatment but you are not obliged in the beginning to take on huge responsibilities. Later when you are in the room with the client it gives a sense of security to have the support of the team. Teamwork in this way trains observational skills, conceptualizing skills and the skills needed to carry on sessions when you work alone.

When it comes to how teamwork shall be put into practice there are two points we like to stress - the importance of assigning responsibility and the importance of a positive attitude.

One of the first days we (the authors) worked together after we started co-operating back in 1983, we had two sessions. In the first, we waited for the other to take the initiative and in the other, we kept interrupting each other. "We can't go on like this" we said to each other, and then decided that we from then on would work with one therapist in the room with the family and that therapist should be responsible for treatment. The other one should follow the session through a one-way screen or on TV. It is advantageous to have clear and simple sharing of responsibility when you deal with issues on life and death.

Teamwork stands and falls with the team members' attitude towards each other. The work is awarding and constructive if everyone makes an effort to encourage and support each other and actively see and hear what other people in the team are doing well. In the solution focused model one central objective is to notice and acknowledge resources, competence and exceptions in the clients life. The same goes for team-work – noticing what functions well for the therapist in the session and what he does well.

Inspired by Ben Furman sometimes we (particularly MS) work with the therapist and the team sitting in the therapy room with the client/family. Some families prefer this, but the most important point as we see it, is that the team become living persons to the client/family. This they become by being active and sharing their observations in different ways with the therapist and the client – phoning in to the therapist, a team member goes into the session and makes a point or the therapist and the team have a discussion about the session where the client observes and listens.

MS has met Rolf and his family for a few sessions in the heroin program (see page *). On one occasion we had made a triple booking and neither one-way screen nor team was available. It was decided that MS should be the one to have a session without a team. Afterwards MS jokingly told the team that "it was good to decide for oneself and not be interrupted by the team."

At the next session the team participated as ordinary. A while into the session the telephone rings. Mother in the family exclaims: "Ah, you have a team today - good. It sorts of becomes more real then".

Nobody in the therapy-room can avoid hearing the pleased laughter of the team (bad sound-proofing).

One final comment on teamwork. In a follow-up study from the child psychiatric clinic of Karlshamn (in the south of Sweden), where among other things the families were interviewed about what they thought about having a team behind the one-way screen, several families complained that the team was to anonymous and that they would have liked to have the team members presented to them. In Karlshamn following this study every team member always greets the families. We are not that radical. We ask if the family members would like to say "hallo" to the team and about half of the families choose to do that.