Behavioral Health Minute

January 2010 - Solution focused conversations

The short summary

Exploring (or envisioning) with patients times when problems are less or coping is better can generate potential ideas or “solutions” to help patients move in those directions.

The modestly longer reflection

If you were to look at the graph of any human experience over time… how much time you spend reading journals, how faithfully you dental floss, your rating of muscle pain, how you feel emotionally… the graph will NEVER be a flat line.  All human experiences (emotional, cognitive and behavioral) have some degree of ups and downs.

Collaborating with patients to carefully observe the ups and downs of clinically important experiences can help them to develop solutions to the problems for which they come to you.  Solutions can often emerge, particularly, from looking at exceptions to problems; times when problems are not happening or when people are dealing with problems better.

When has there been a time when you have cut down on smoking before?  How did you do that?

You say you’ve been having a lot of arguments with your husband.  Tell me a little about a time when the two of you were getting along better.

Last Tuesday was a day when you rated your coping with pain a “6,” a notch or two higher than most of the other days.  What did you do in approaching your pain that helped you to cope with it a little better then?

Even if patients don’t readily identify times when their problems are less or their coping is better, they may be able to envision a future that has some of these qualities.

When you are less depressed, what will that look like and what will you be doing?

In dealing with anxiety, if you were 50% more confident than you feel now, what would you be doing differently?

Answers to such questions can help to identify behaviors and perspectives that can frame potential solutions, or directions, that people can pursue.  The patient from this morning who complains about distressing thoughts and feelings of hopelessness; if he were dealing with this better, he would be leaving the house more, interacting with his family more, being more respectful with co-workers, and picking up the guitar again.  Good potential solutions to thoughts of hopelessness.

The “intervention” arising out of solution-focused conversations can take three paths:

1. “I have some sense of what I do when I’m dealing with things better.”  The intervention is “Go forth and do this more.”

2. “There are times when things seem better, but I’m not sure what I do to bring them about.”  The intervention is “Notice these times as they occur and see what you can learn about what you do that makes the difference.”

3. “I’m not that aware of times when I’m dealing with things better.”  The intervention is “Picture a time when the problem is less (or you are handling it better), identify what you will be doing differently as a result, and do some small part of it now.”

Follow-up

Ask some patients about exceptions to problem states and help them to do some processing about what they do (and what they can do) to bring these exceptions about.

Fred Craigie, PhD