About Anne Lutz

This author has not yet filled in any details.
So far Anne Lutz has created 47 blog entries.

Can One Call Make A Difference? Training Mental health professionals within the Alzheimer’s Association

2021-08-01T12:15:22+00:00July 30th, 2021|

solution focused Therapy Alzheimer

Institute Director Emeritus Yvonne Dolan interviews David Parris, Alzheimer’s Association Care Consultants Director, about their clinician’s experience using Solution-Focused Brief Therapy to help caregivers and patients deal with the crises associated with Alzheimer’s.

One of the most rewarding aspects of being a Solution-Focused Brief Therapy trainer is the opportunity to interact with inspiring colleagues and organizations. Getting to know the Alzheimer’s Care Consultants who staff the Alzheimer Association’s 24/7 Helpline: 800-272-3900 provided a unique opportunity for our Institute staff to learn about the invaluable services provided by the organization. Working with the Alzheimer’s Association Care Consultant Clinicians who staff the Contact Center was a singularly uplifting experience.

A few months ago, the Contact Center’s wonderful Clinical Director, David Parris LCSW, graciously allowed me to record an interview with him. David and his colleagues exemplify what I consider to be the best combination of counseling skills: expertise and compassion. As you will see in the following interview, the Alzheimer’s Association is truly an organization with heart.

In the conversation that preceded our interview, David made such poignant observations that I decided ( with his permission) to start with this.  You can watch my interview with David here:

For the latest updates on Alzheimer’s disease research, support, resources, and information on how to get a proper diagnosis and the warning signs for Alzheimer’s and other related dementias, go to alz.org.

Click here for more information on having your organization receive staff training in Solution-Focused Brief Therapy Practices.

For those wishing more training in using the Solution-Focused Brief Therapy approach with clients experiencing trauma and grief, You may wish to check out the following Institute online, self-paced courses:

Solution-Focused Brief Therapy for the Treatment of Trauma (4 CE Credit/Clock Hours available)

Clients Experiencing Grief: A Solution-Focused Approach (5 CE Credit/Clock Hours available)

Single Session Solution-Focused Therapy: Harnessing the Moment in Crisis Mental Health

2021-08-03T17:05:58+00:00July 30th, 2021|

 Anne Bodmer Lutz, M.D.

Mental health workforce shortages combined with increased demand for services have required mental health professionals and organizations to devise innovative service delivery strategies. In emergencies and crises, the inability to offer multiple session treatment and follow-up for mental health often makes Single Session Therapy the only option. Solution-Focused Brief Therapy, an evidenced-based pragmatic approach, is an ideal method to use in Single Session Therapy.

About Single Session Therapy

single session therapySolution-Focused Single Session therapy provides an evidenced-based, trauma-informed practice that can be implemented in crisis situations. The absence of intake, triage, waiting list or assessment is key to the accessibility of single session services. Single Session Therapy has potential applications as used in emergency triage, EMS, crisis call centers, emergency settings, and where access to care can be poor (Paul & van Ommeren 2013). The World Health Organization has proposed Single Session Therapy as a potential model when responding to the Psychosocial and Mental Health needs of people who have experienced trauma. Mental health professionals have adapted the Single Session Therapy framework in emergency settings, including Hurricane Katrina, the armed conflict in Columbia, and the 2010 Haiti earthquake (WHO et al., 2012). In emergencies, Single Session Therapy can be offered as part of a specialized mental health crisis service (Miller 2010).

Single Session Therapy is not new. In 1977, a walk-in counseling center in Minneapolis, Minnesota, provided Single Session Therapy (Love, 1983). Talmon in 1990 found that at 3-12 month follow-ups, 58.6% of their sample reported that a single session had been sufficient and led to improvement in the presenting problem (Talmon and Hoyt 2014). Bernard Bloom wrote in 1981 that “Single Session Therapy would potentially be the only way for publicly funded mental health agencies to meet rising service demands and long waitlists of the future.” (Bloom, 1981).

About Solution-Focused Single Session Therapy

Solution-Focused Single Session Therapy requires the clinician to view every interaction as an intervention.  Solution-Focused Single Session Therapy is intended to be pragmatic and based on the clients’ presenting concerns focusing on what the client has already done to cope and what the client wants, rather than exploring history or theories about root causes. The goal is for the client to leave with a plan and know they have the skills and resources available to move forward in a good enough way.  

Can Solution-Focused Single Session Therapy reduce barriers to mental health access?

Solution-Focused Single Session Therapy promises to mitigate many of the access-to-service barriers in mental health organizations and modify the relationship between therapists and their communities. Solution-Focused Single Session Therapy can also foster a relationship with the organization providing service beyond the professionals who provide that service. Broad access to this service would enhance the mental health delivery system, provide a solution to workforce mental health shortages, and improve the quality of care in any community (Slive and Bobel 2011).

How does Solution-Focused Therapy Address the Therapeutic Common Factors?

Solution-Focused Brief Therapy is an approach that operationalizes common factors in a practical and evidence-based way that is consistent with Single Session Therapy. Research on common factors relates a positive therapeutic outcome to focus on client’s strengths and resources, a solid therapeutic alliance, focusing on client’s motivation, needs, what they want, and continually gathering feedback from the client while activating their resources (Lambert 1999, Lambert 2005, Lambert & Ogles 2014). Psychotherapy research findings suggest that most change occurs during the first couple of therapy sessions (Hansen & Lambert, 2002 & Seligman, 1995). The single-session model proposes that many people receive sufficient support from a single session with the offer of future single sessions if needed. A review of the clinical and research literature shows that between one-third and one-half of randomly selected clients seen in single-session psychotherapy report being sufficiently helped by the experience so that the therapeutic episode can be terminated (Bloom, 2001).

How does Solution-Focused Single Session Therapy Differ from Psychological First Aid?

Solution-Focused Single Session requires more in-depth training and relies upon previous clinical experience and skill sets. The purpose of Psychological First Aid is to assess the immediate concerns and needs of an individual in the aftermath of a disaster and not to provide on-site therapy.

How can Solution-Focused Brief Therapy be applied to Single Session Therapy?

The following is a practice exercise to help guide clinicians through a solution-focused single-session interview. This exercise is a learning opportunity to practice some solution-focused techniques and questions within single-session therapy.


Setting a collaborative, positive tone at the beginning of a Solution-Focused Single Session Therapy conveys confidence in the client’s abilities.

  • Thank you for reaching out.
  • I hope this conversation will be helpful for you.
  • I will ask you several questions and will do my best within the next hour, so this session will be worth your time.
  • Would this be ok with you?

Building a Yes-Set:

The yes-set is a solution-focused skill that involves creating a conversation in which both the clinician and client say yes and agree on as many aspects of the conversation as possible. “For you” statements enhance the “yes-set” while providing validation and acknowledgment of the client’s predicament. Clients and families coping with crises often experience a lack of control, exhaustion, fear, frustration, and anxiety, requiring a great deal of “for you” responses. “For you” statements are often combined with coping questions enabling clients to recognize how they have been managing.

  • This must be so difficult for you; how have you been managing?
  • This must be exhausting for you; how have you managed to get through even a part of your day?
  • This must be so frustrating for you; how have you managed to make this even a little bit more bearable for you?


Activating resources at the onset of the conversation helps build client engagement. Resource activation co-discovers with clients aspects of their life that are satisfying. What has been working well?  How have they managed in a tolerable way?   Different from listing strengths, activation of resources questions in detail how clients have managed, how have they endured, where do they get their strength from, and what keeps them going? Questioning clients in-depth on their strengths co-discovers hidden resources often ignored by clients unless specifically noticed and asked.  

Client’s coping with acute crises experience many challenges affecting the quality of their daily life. Asking clients what they know and have tried regarding their situation affirms their knowledge in managing their circumstances. Compliments can impart much-needed energy and stamina to both clients and their loved ones. It is important to ask questions that detail these successes. 

  • Tell me some things you enjoy and are good at?
  • What else do you enjoy?
  • How did you learn these skills?
  • How have you been coping given the challenges you have been facing?
  • Where do you get your strength from?
  • What else has helped? 
  • How else did you cope? 

Punctuating positive differences (Past successes)

Listening for and discovering positive differences when clients have had or are having some measure of success is crucial. Positive differences, also known as exceptions, are when the presenting problem could have occurred but did not or was less severe. These past successes may include when clients have had periods of relief from their distress- even if very brief. Perhaps they were able to manage for a moment in a tolerable way. Maybe they had the strength to work and manage their responsibilities despite their intense emotions. Perhaps they persevered in their efforts to care for their needs and those they are responsible for.


Inviting clients to identify their VIPs and what they most appreciate about them is especially critical when engaging clients who are coping with crises. Mapping out a client’s social context is essential in understanding and assisting them in building solutions from multiple perspectives expanding their relational resources.

  • Who are the most important people in your life?
  • What do you most appreciate about them?
  • Are there people/pets you are responsible for helping care for?
  • What do you most appreciate about them?
  • What do you suppose they would say they most appreciate about you?
  • What do you suppose they would say they know about you that you can get through this challenging time?


“What are your best hopes for this one-hour appointment so you can say it was helpful and worth your time?” This question is future-directed, assists in goal negotiation, and conveys a belief in your client that they have best hopes.  Solution-Focused Brief Therapy focuses on the client’s expertise in knowing their situation and condition best. Asking clients (and their loved ones) what they know about their condition and what they have tried helps attest to their competence. For many clients in crisis, their situation can seem out of control. Solution-focused brief therapy invites clients to focus on how they have adapted and managed to deal with their challenges in a “tolerable/bearable” way. This increases their self-efficacy in managing their situation.

Asking a client’s best hopes is only the beginning of goal negotiation. Moving from their best hopes to specific actions requires discovering with clients what they would be doing instead when they have achieved their best hopes?  

  • What are your best hopes (in the client’s words) that would tell you this one-hour session will be helpful for you and worth your time?
  • What do you know about your best hopes?
  • What do you know has helped you manage even a little bit?
  • What do you know about yourself that you can achieve your best hopes?
  • What do your VIPs know about you that you can achieve your best hopes?
  • When was the last time things were a little better or more bearable for you?
  • What have you tried to do to help?
  • Supposing you achieve your best hope, what would you be doing differently?
  • What would your VIPS notice you doing differently?


Scaling questions invite clients to rate their goals on a numerical scale from 1-10. Scaling questions are used to rate solutions, different from many other scales which rate problems. They are developed from the client’s best hopes and can be amplified by asking patients to predict how their VIPs would rate them. Scaling questions convey empathy, are client-centered and can assist clients and clinicians in understanding perspectives from multiple viewpoints quickly.  They are extremely useful in even brief Single Session Therapy encounters.

It is essential to amplify scaling questions. Working the scale provides additional opportunities to activate resources. What keeps the number from being lower? What’s the highest number it has been?  What would be a good enough number? Clients often do not need the best but are very satisfied with good enough.

  • Suppose 10 is you are confident in your plans to achieve your best hopes, and 1 is the opposite; where would you say you are now?
  • Suppose 10  is confident you can keep yourself safe, and 1 is the opposite; where are you now?
  • What would be a good enough number?
  • What keeps the number from being lower?
  • Suppose we asked your VIPS how confident they are in you that you can achieve your best hopes from 1-10 (10 being the best); where would they say you are?
  • What do you suppose you would be doing when the number goes up by one point?
  • How confident are you from 1-10 that you can take that next small step to increase your number by 1 point?
  • What do you know about yourself that you can do this?



In Solution-Focused Single Session Therapy, end-of-session feedback includes compliments, positive differences, VIPs, and successes co-discovered in the conversation. Scaling questions challenge clients to consider the next small steps to take toward achieving their goals. Feedback confirms that there is no other information clients think would be helpful for the clinician to know to be most beneficial for them.

  • Provide a list of compliments
  • Reiterate next steps that were co-discovered
  • On a scale from 1-10, how helpful was this session?
  • What was most helpful for you?
  • Is there anything else before we end that would be important for me to know?

Click here for more information on having your organization receive training in Solution-Focused Brief Therapy Practices.

For those wishing more training in using the Solution-Focused Brief Therapy approach, you may wish to check out the following Institute online, self-paced courses:

Solution-Focused Brief Therapy: An Introduction to the Pragmatics of Hope (3 CE Credit/Clock Hours available)

Foundations of Solution-Focused Practice Online Intensive (3 CE Credit/Clock Hours available)


Asay, T. P., & Lambert, M. J. (1999). The empirical case for the common factors in therapy: Quantitative findings. The Heart and Soul of Change: What Works in Therapy., 23–55. https://doi.org/10.1037/11132-001 

Bloom, B. L. (2001). Focused Single‐Session Psychotherapy: A Review of the Clinical and Research Literature. Brief Treatment and Crisis Intervention, 1(1), 75–86. https://doi.org/10.1093/brief-treatment/1.1.75 

Budman, S. H. (1981). Forms of brief therapy. Guilford Press. 

Campbell, A. (2012). Single-Session Approaches to Therapy: Time to Review. Australian and New Zealand Journal of Family Therapy, 33(01), 15–26. https://doi.org/10.1017/aft.2012.3 

Courtnage, A. (2020). Hoping for Change: The Role of Hope in Single-Session Therapy. Journal of Systemic Therapies, 39(1), 49–63. https://doi.org/10.1521/jsyt.2020.39.1.49 

Gullickson, T. (1992). Review of Single-Session Therapy: Maximizing the                                                Effect of the First (and Often Only) Therapeutic Encounter. Contemporary Psychology: A Journal of Reviews, 37(5), 501–501. https://doi.org/10.1037/032170 

Guthrie, B. (2016). Single Session Therapy as a framework for post disaster practice in low and middle income countries. Intervention, 14(1), 18–32. https://doi.org/10.1097/wtf.0000000000000107 

Hansen, N. B., Lambert, M. J., & Forman, E. M. (2002). The psychotherapy dose-response effect and its implications for treatment delivery services. Clinical Psychology: Science and Practice, 9(3), 329–343. https://doi.org/10.1093/clipsy.9.3.329 

Hoyt, M. F. (2021). The Hope and Joy of Single Session Thinking and Practice. Single Session Thinking and Practice in Global, Cultural, and Familial Contexts, 29–41. https://doi.org/10.4324/9781003053958-2-4 

Hymmen, P., Stalker, C. A., & Cait, C.-A. (2013). The case for single-session therapy: Does the empirical evidence support the increased prevalence of this service delivery model? Journal of Mental Health, 22(1), 60–71. https://doi.org/10.3109/09638237.2012.670880 

Lambert, M. J. (2005). Early response in psychotherapy: Further evidence for the importance of common factors rather than “placebo effects.” Journal of Clinical Psychology, 61(7), 855–869. https://doi.org/10.1002/jclp.20130 

Lambert, M. J., & Ogles, B. M. (2014). Common factors: Post hoc explanation or empirically based therapy approach? Psychotherapy, 51(4), 500–504. https://doi.org/10.1037/a0036580 

Lambert, M. J., & Ogles, B. M. (2014). Using clinical significance in psychotherapy outcome research. Quantitative and Qualitative Methods in Psychotherapy Research, 189–203. https://doi.org/10.4324/9780203386071-12 

Love, R. L. (1983). A Walk-In Clinic in a University Mental Health Service: Some Preliminary Findings. Journal of American College Health, 31(5), 224–225. https://doi.org/10.1080/07448481.1983.9939562 

Lutz, A. B. (2014). Learning solution-focused therapy: an illustrated guide. American Psychiatric Publ. 

Paul, K. E., & van Ommeren, M. (2013). A primer on single session therapy and its potential application in humanitarian situations. Intervention, 11, 8–23. https://doi.org/10.1097/wtf.0b013e32835f7d1a 

Perkins, R. (2006). The effectiveness of one session of therapy using a single-session therapy approach for children and adolescents with mental health problems. Psychology and Psychotherapy: Theory, Research and Practice, 79(2), 215–227. https://doi.org/10.1348/147608305×60523 

Responding to the Psychosocial and Mental Health Needs of Sexual Violence Survivors in Conflict-Affected Settings. Resource Centre. (2019, April 23). https://resourcecentre.savethechildren.net/library/responding-psychosocial-and-mental-health-needs-sexual-violence-survivors-conflict-affected. 

Seligman, M. E. (1995). The effectiveness of psychotherapy: The Consumer Reports study. American Psychologist, 50(12), 965–974. https://doi.org/10.1037/0003-066x.50.12.965 

Shazer, D. S. (2021). More than miracles: the state of the art of solution-focused brief therapy. Routledge. 

Slive, A., & Bobele, M. (2011). When one hour is all you have: effective therapy for walk-in clients. Zeig, Tucker and Theisen. 

Slive, A., & Bobele, M. (2012). Walk-In Counselling Services: Making the Most of One Hour. Australian and New Zealand Journal of Family Therapy, 33(01), 27–38. https://doi.org/10.1017/aft.2012.4 

Talmon, M. (1990). Single-session therapy: maximizing the effect of the first (and often only) therapeutic encounter. Jossey-Bass. 

Talmon, M., & Hoyt, M. F. (2014). Capturing the moment: single-session therapy and walk-in services. Crown House Publishing Limited. 

Todahl, J. (2012). When one hour is all you have: effective therapy for walk-in clients. Journal of Marital and Family Therapy, 38(3), 569–569. https://doi.org/10.1111/j.1752-0606.2012.00313.x 

WHO, UN Action, UNFPA, UNICEF (2012).Responding to the Psychosocial and Mental

Health Needs of SexualViolence Survivors in Conflict-Affected Settings, Final Report. Technical meeting on Responding to the Psychosocial and Mental Health Needs of Sexual Violence Survivors in Conflict-Affected Settings, Ferney-Voltaire, November  28-30, 2011.

Young, J. (2013). Implementing Single-Session Therapy. PsycEXTRA Dataset. https://doi.org/10.1037/e605172013-001 

Solution-Focused Article List Evidence 2019 updated

2020-07-21T19:36:08+00:00February 5th, 2020|

Brockman, Mariah, et al. “Managing Child Behavior Problems in Children With Autism Spectrum Disorders: Utilizing Structural and Solution Focused Therapy With Primary Caregivers.” The American Journal of Family Therapy, vol. 44, no. 1, 2015, pp. 1–10., doi:10.1080/01926187.2015.1099414.

Carr, Alan, et al. “Parents Plus Systemic, Solution-Focused Parent Training Programs: Description, Review of the Evidence Base, and Meta-Analysis.Family Process, vol. 56, no. 3, 2016, pp. 652–668., doi:10.1111/famp.12225.

Corcoran, Jacqueline. “A Comparison Group Study of Solution-Focused Therapy versus ‘Treatment-as-Usual’ for Behavior Problems in Children.Journal of Social Service Research, vol. 33, no. 1, 2006, pp. 69–81., doi:10.1300/j079v33n01_07.

Creswell, Cathy, et al. “Clinical Outcomes and Cost-Effectiveness of Brief Guided Parent-Delivered Cognitive Behavioural Therapy and Solution-Focused Brief Therapy for Treatment of Childhood Anxiety Disorders: a Randomised Controlled Trial.The Lancet Psychiatry, vol. 4, no. 7, 2017, pp. 529–539., doi:10.1016/s2215-0366(17)30149-9.

Franklin, Cynthia, et al. “Solution Focused Brief Therapy: A Systematic Review and Meta-Summary of Process Research.Journal of Marital and Family Therapy, vol. 43, no. 1, 2016, pp. 16–30., doi:10.1111/jmft.12193.

Franklin, Cynthia, et al. Solution-Focused Brief Therapy: a Handbook of Evidence-Based Practice. Oxford University Press, 2012.

Froeschle, Janet, et al. “The Efficacy of a Systematic Substance Abuse Program for Adolescent Females.Professional School Counseling, vol. 10, no. 5, 2007, pp. 498–505., doi:10.5330/prsc.10.5.a458605px1u57217.

Gassmann, Daniel, and Klaus Grawe. “General Change Mechanisms: the Relation between Problem Activation and Resource Activation in Successful and Unsuccessful Therapeutic Interactions.Clinical Psychology & Psychotherapy, vol. 13, no. 1, 2006, pp. 1–11., doi:10.1002/cpp.442.

Gingerich, W. J., and L. T. Peterson. “Effectiveness of Solution-Focused Brief Therapy: A Systematic Qualitative Review of Controlled Outcome Studies.Research on Social Work Practice, 2013, doi:10.1177/1049731512470859.

Gong, Huoliang, and Weisu Hsu. “The Effectiveness of Solution-Focused Group Therapy in Ethnic Chinese School Settings: A Meta-Analysis.International Journal of Group Psychotherapy, vol. 67, no. 3, 2016, pp. 383–409., doi:10.1080/00207284.2016.1240588.

Hosany, Z., et al. “Fostering a Culture of Engagement: a Pilot Study of the Outcomes of Training Mental Health Nurses Working in Two UK Acute Admission Units in Brief Solution-Focused Therapy Techniques.Journal of Psychiatric and Mental Health Nursing, vol. 14, no. 7, 2007, pp. 688–695., doi:10.1111/j.1365-2850.2007.01161.x.

Kim, Johnny S. “Examining the Effectiveness of Solution-Focused Brief Therapy: A Meta-Analysis.Research on Social Work Practice, vol. 18, no. 2, 2007, pp. 107–116., doi:10.1177/1049731507307807.

Kim, Johnny S., et al. “Solution-Focused Brief Therapy in China: A Meta-Analysis.Journal of Ethnic & Cultural Diversity in Social Work, vol. 24, no. 3, 2015, pp. 187–201., doi:10.1080/15313204.2014.991983.

Kim, Johnny S., et al. “Solution-Focused Brief Therapy to Improve Child Well-Being and Family Functioning Outcomes with Substance Using Parents in the Child Welfare System.Developmental Child Welfare, vol. 1, no. 2, 2019, pp. 124–142., doi:10.1177/2516103219829479.

Kim, Johnny S., et al. “Solution-Focused Brief Therapy With Substance-Using Individuals.Research on Social Work Practice, 2016, p. 104973151665051., doi:10.1177/1049731516650517.

Kim, Johnny, et al. “Is Solution-Focused Brief Therapy Evidence-Based? An Update 10 Years Later.Families in Society: The Journal of Contemporary Social Services, vol. 100, no. 2, 2019, pp. 127–138., doi:10.1177/1044389419841688.

Kramer, Jeannet, et al. “Effectiveness of a Web-Based Solution-Focused Brief Chat Treatment for Depressed Adolescents and Young Adults: Randomized Controlled Trial.Journal of Medical Internet Research, vol. 16, no. 5, 2014, doi:10.2196/jmir.3261.

Mache, Stefanie, et al. “Evaluation of Self-Care Skills Training and Solution-Focused Counselling for Health Professionals in Psychiatric Medicine: a Pilot Study.International Journal of Psychiatry in Clinical Practice, vol. 20, no. 4, 2016, pp. 239–244., doi:10.1080/13651501.2016.1207085.

Panayotov, Plamen A., et al. “Solution-Focused Brief Therapy and Medication Adherence with Schizophrenic Patients.Solution-Focused Brief Therapy, 2011, pp. 196–202., doi:10.1093/acprof:oso/9780195385724.003.0078.

Roeden, J. M., et al. “Processes and Effects of Solution-Focused Brief Therapy in People with Intellectual Disabilities: a Controlled Study.Journal of Intellectual Disability Research, vol. 58, no. 4, 2013, pp. 307–320., doi:10.1111/jir.12038.

Schmit, Erika L., et al. “Meta-Analysis of Solution-Focused Brief Therapy for Treating Symptoms of Internalizing Disorders.Counseling Outcome Research and Evaluation, vol. 7, no. 1, 2016, pp. 21–39., doi:10.1177/2150137815623836.

Smock, Sara A. “A Review of Solution-Focused, Standardized Outcome Measures and Other Strengths-Oriented Outcome Measures.Solution-Focused Brief Therapy, 2011, pp. 55–72., doi:10.1093/acprof:oso/9780195385724.003.0026.

Smock, Sara A., et al. “Solution-Focused Group Therapy for Level 1 Substance Abusers.Journal of Marital and Family Therapy, vol. 34, no. 1, 2008, pp. 107–120., doi:10.1111/j.1752-0606.2008.00056.x.

Stermensky, Gage, and Kristinas Brown. “The Perfect Marriage: Solution-Focused Therapy and Motivational Interviewing in Medical Family Therapy.” Journal of Family Medicine and Primary Care, vol. 3, no. 4, 2014, p. 384., doi:10.4103/2249-4863.148117.

Trepper, Terry S., et al. “Solution-Focused Brief Therapy Treatment Manual.Solution-Focused Brief Therapy, 2011, pp. 20–36., doi:10.1093/acprof:oso/9780195385724.003.0015.

Zhang, Anao, et al. “The Effectiveness of Strength-Based, Solution-Focused Brief Therapy in Medical Settings: a Systematic Review and Meta-Analysis of Randomized Controlled Trials.Journal of Behavioral Medicine, vol. 41, no. 2, 2017, pp. 139–151., doi:10.1007/s10865-017-9888-1.

Solution-Based Therapy Finding More Prominent Role

2020-01-31T19:42:04+00:00January 31st, 2020|

As physicians shift care from a disease-centered to a patient-centered clinical method, there is a need for a compatible counseling paradigm. Solution-focused therapy is a competency-based model that minimizes emphasis on past problems and failings and instead focuses on patient strengths and resources (Trepper et al., 2006).

Read the full article on Psychiatric New Update

In Memory of Luc Isebaert

2021-05-21T21:08:01+00:00October 9th, 2019|

Luc IsebaertIt is with deep sadness that we write of the passing of our longtime SF colleague and dear friend, Luc Isebaert. He died peacefully at home on September 30, surrounded by his beloved wife, Sophie, loved ones, and his loyal dog, Epicurious. He was 78 years old.
Luc was both an esteemed colleague and close friend of the late Steve de Shazer and Insoo Kim Berg, and had a significant influence on the later developments of the SFBT approach. Berg and de Shazer considered Luc to be a genius; they had good reason:

In addition to being a medical doctor, Luc was a Specialist in Neurology, Psychiatry, Psychosomatics, and Psychotherapy, and developer of the Bruges Model. Widely recognized as an international authority on alcohol dependency, he headed the Department of Psychiatry and Psychosomatics at St. John’s Hospital (Bruges, Belgium) for many years and made a significant contribution to the research on efficacy of SFBT for addiction treatment.

Luc was also the founding Director of the Kozybski Institute which officially started in 1984, original Founding Member, Secretary, and later, President of the European Brief Therapy Association, founding Secretary of the IASTI (International Alliance of Solution- Focused Teaching Institutes), Founding Member and former Secretary of the A.E.R.T.S. (Association Européenne pour la Recherche en Thérapie Systemique), Founding Member of the VVDO (Belgian Association of Solution- Focused Therapists, Member of the Royal Society of Psychiatry of Belgium, Member of the European Family Therapy Association, Member of IFTA ( International Family Therapy Association), Member of the BVRGS (Belgian Society for for Relational, Systemic and Family Interventions), Founding Member and Secretary of the AFACC (Association Francophone pour les Approches Centrées sur les Compétences), Founding Member of the Belgian Association of Systemic Family Therapy Trainers.

In addition to publishing over a dozen books in 4 different languages, Luc spoke at countless international conferences all over the world, regularly taught seminars, and trained literally thousands of students. He demonstrated deep respect and compassion for his patients.

He was also a gifted gourmet cook, a memorable, oftentimes hilarious storyteller, a wise and compassionate friend, and a delightful, endlessly entertaining travel companion. The latter was due in part to Luc’s almost encyclopedic knowledge of classical literature, western philosophy, and music, but even more so because of his gracious personality, generous sense of humor, and kind heart. He will be deeply missed by all of us who knew him.

How Solution-Focused-Therapy can enhance care of the medically complex patient

2021-05-11T20:54:45+00:00June 4th, 2019|

An Inspiring Conversation with Dr. Margret Cheng

I have had the immense pleasure of meeting Dr. Cheng, who has combined training in both Pediatrics and Internal Medicine. She dedicates her work to the care of medically and socially complex patients in underserved areas. She recently has been trying Solution Focused Skills in the care of her patients and has found it both inspiring for herself and beneficial for her patients. We recently spent a few hours sipping tea and conversing about the ways in which she has found Solution-Focused tools helpful in her practice. Below are a few of the pearls she has noticed in her work.

We began our conversation about a very complex patient she has been particularly inspired by. Briefly this patient is a 15y/o girl who is being treated for Diabetes and has coped with trauma and homelessness, Child protection involvement and family addiction. We will call her Sue.

Sue initially presented to the emergency room for chest pain and came to Dr. Cheng for a “sick visit” as an urgent appointment. She was not a patient she was regularly following. During this visit, Dr. Cheng discovered that she had poorly controlled diabetes (Her blood glucose in the upper 300s), and also found out she had visited the emergency room 6 times in the past 4 months and during all those ER notes, there was no mention that she had Diabetes Mellitus. During her ER visit, the focus was on her complaint of chest pain. She was given an EKG, told that her chest pain was due to anxiety and referred back to her Primary care provider.

Dr. Cheng met with both Sue and her mother for what was her initial visit with her and asked her gently how she could be helpful for them and whether it would be ok to talk with her about her Diabetes. Sue looked toward her mother for a response, and her mother said she wanted to keep her daughter out of the emergency room. Dr. Cheng had only 15 minutes during this visit, but by simply asking what they wanted help with and took time to validate and acknowledge the challenges of caring for her daughter’s complex needs, they both agreed to come back the following week.

They did return for the next appointment and also followed up with the request to get labs. During this visit, Dr. Cheng discovered Sue’s Hemoglobin A1C (A marker of how well Diabetes is managed) was the highest she had ever seen – almost 16. Dr. Cheng began the appointment by thanking them for coming to the appointment and inquiring how they were able to make it there and follow-up with the labs. She again asked their “best hopes” for this appointment so it would be helpful for them, and her mother said that she was now homeless. Dr. Cheng responded with a “for you” statement about how difficult this must be for them, followed by this question “Where do you get your strength from to continue?” This question invited Sue’s mother to open up about how she was one of 13 children and was “given nothing”. She was raised to just “carry one and not trust anyone, but to do what you needed to survive”. When asked how she had been coping, her mother said they have a place to stay with their family for now, and Dr. Cheng provided her with resources to help with housing. Sue and her mother were now making all follow-up appointments and during the next appointment when asked how she could be helpful for Sue, both her mother and Sue stated to “get her blood sugars under better control”. She asked her how she has tried to manage her sugars, and Sue and her mother said they were told by her brother’s endocrinologist to “do what he does”. Dr. Cheng asked what Sue and her mother know about how to manage blood sugars, and it became apparent they needed education on how often to monitor blood sugars. The next appointment Sue stated she was self-initiating checking her blood sugars once per day. She noticed it was high. Dr. Cheng explored this positive difference. Was it different for her to monitor her own sugars? Sue said yes. When asked how it was different, she stated she would often not check her sugars for days at a time. When asked if it was helpful for her, she stated that she is beginning to notice that when her sugars are high, she observes she is also more tired. When asked her how she managed to remember to check it, she stated she was getting a reminder from her mother and wanted to get better and get her driver’s license. Her mother was complimented on her support and asked how she managed to remember to remind her daughter.

This vignette brought up a several pearls for Dr. Cheng. The first being “You can do medicine best only after you have engaged positively with your client and their VIPs.” Dr. Cheng also noticed the paradox of starting “slowly” and how this paradoxically speeds things up. Dr. Cheng was inspired with the movement and progress of her patient. The nurses also were excited and pleased. Practicing the Solution-Focused Approach can be used to satisfy both patients and clinicians. Dr. Cheng began conversations by activating resources, identifying both Sue and her mother’s strengths toward achieving their best hopes for their future, and aiming to do more of what is already working. Dr. Cheng was inspired by the difference it made to focus on what is currently working, how clients are coping with extremely challenging life situations and redirecting the conversation towards positive elements of their situation. She was reminded that a patient’s “best hopes” may or may not align with those of the physician, but this is the place to start. At the end of the conversation, Dr. Cheng began reflecting on her excitement to try some additional questions we talked about when she returned to work: “ What’s happening that you want to continue to happen?” and “On a scale from 1-10, where 10 is you are satisfied with how you are coping with your challenges and 1 is the opposite, where are you now?” “ What keeps the number from being lower” What else? What would be a good enough number?” “How satisfied are you with how you are managing the diabetes from 1-10, where 10 is you are satisfied” “What number would your mother give you?”

We agreed to meet next month for tea and continue the inspiring conversation about how solution-focused skills are very effective tools when working with medically complex patients. Stay tuned!

A Language of Hope: Solution-Focused Translations

2021-05-11T20:55:29+00:00May 16th, 2019|

By Anne Bodmer Lutz, M.D.

In my over 20 years as a practicing child and family psychiatrist, I have come to realize that in addition to a very different paradigm than problem-focused therapies, solution-focused therapy pays meticulous attention to language and words that instill hope and respect. I invite you to consider a few examples of how the choice of words used can make a difference in navigating a solution-focused conversation.

I have asked many people who have fluency in multiple languages what they have found most helpful in learning a new language, and four consistent answers have emerged. One, there is a need and motivation to want to learn the new language. Two, there is a need to have knowledge and fluency of basic verbs as well as some general vocabulary. Three, there is a need to understand fundamental grammar. And four, it is essential to practice and speak with other people who are fluent in the language you are trying to learn, and to speak with others at a level commensurate with your skill level in order to build confidence. With these concepts in mind, I invite you to consider my first translation, the word “problem.”

A problem can be defined as a matter or situation regarded as unwelcome or harmful and needing to be dealt with. Problems generally cause difficulties, complications, obstacles, and trouble for people. I realize how often and continually I, and those around me use this word. Contrast the problem-focused word “problem” to the solution-focused translation “challenge.” The word challenge summons one to a contest of skill and strength. It is a task that tests someone’s abilities assuming it will be met with success. Requesting clients to accept and confront their problem is very different than asking them whether they are up for the challenge of learning new skills. Asking children to do homework to address their problem of anxiety is much less palatable than posing to them whether they are up for the challenge of learning new skills. Challenges invite and dare people to succeed. Problems need to be faced and fixed and convey something burdensome and onerous. Personally, I have taken on the challenge to rid myself of the word problem from my lexicon, and hope you may take this challenge on as well and see what difference it makes for you.

I’m looking forward to sharing a few more of the following translations in our upcoming newsletters.

Cope is one letter away from Hope: Solution-Focused Safety Assessment (SFSA)

2021-05-11T20:56:12+00:00May 3rd, 2019|

By Anne Bodmer Lutz, M.D.

“And for all those tea drinkers out there: Let’s learn a lesson from tea. It shows it’s real worth when it gets into hot water” ~ Annonymous

“There are questions which illuminate, and there are those that destroy. We should ask the first kind” ~ Quote from Nobel physicist Isaac Isador Rabi.


Suicide presents a major challenge to public health in the United States and worldwide. Current global estimates indicate that approximately one million people die by Suicide each year, accounting for more than half of all violent deaths in the world. (Ting, Sarah, A., et al.). In the mental health field, managing “risk” is the dominant paradigm in responding to suicidal thoughts and behaviors. Risk assessment focuses on ensuring the client’s safety and minimizing the danger of harm without treatment. A solution-focused safety assessment (SFSA) is a paradigm shift providing an additive dimension to conventional risk assessment and cultivates hope. It highlights individual, and relationship resources (VIPs), coping strategies, reasons for living, and client needs. An SFSA emphasizes how clients have coped and managed to endure, even a little bit, the seemingly overwhelming distress that they have found unbearable at the moment.


In my practice, I often am challenged with clients coping with suicidal thoughts and behaviors. Incorporating an SFSA has been very helpful both for my clients, their VIPs, and managing my own anxiety in these very stressful situations. Preparing clients for questions that evaluate their safety, by explaining that these questions are routinely asked, helps to normalize their struggles, aiding them in feeling less alone. Framing questions about safety in the context of “pain” and “good reason” imparts empathy. Asking clients their “good reasons” for behaviors that appear harmful (i.e.) self-harm, drug use, staying in a domestically violent relationship, to name a few, reveals how clients engage in these behaviors because in some way they are useful and beneficial for them. The question does not condone the behavior but instead helps to understand the client’s motivation and can help lead the conversation towards alternatives. When clients have contemplated suicide and not followed through, it is essential to ask what kept them from acting on their thoughts — asking clients their reasons for living guides the conversation towards their hopes, goals and future dreams.

Below is a picture of my Solution-Focused Safety Scale (SFSS)

Solution-Focused Safety Scale (SFSS)

I keep a stack of solution-focused safety cards available in my office. I write the plan on the card with the client present and, if possible, also include their VIPs in the conversation. I have found the act of giving them the safety card which we have worked on together and which can be kept with them at all times, provides a tangible reminder of the work with have accomplished as a team. It can cue them to their strengths, resources, and coping strategies in times of distress.

SFSA and creating a “VIP Map.”

Inquiring about a client’s VIPs early on and throughout the conversation broadens “who” the client is and assists in integrating their unique social context within the dialog. VIPs highlight relationship resources, enhancing possibilities for solutions. Assessing who is a client’s VIPs is critical in understanding and assisting them in building solutions from the multiple perspectives of those most important in their life. VIPs are often the primary reason people stop themselves from acting on destructive thoughts. VIPs may include spouses, friends, children, teachers, coaches, grandchildren, pets, people whom they feel responsible for, and even people who may have died but whom they keep in their heart. Below are questions I ask to create a client’s “VIP map.”

  • Who are the most important people in your life?
  • Who else? Who else?
  • What do you most appreciate about them?
  • What else? What else?
  • Who was “worried” or “concerned” about you that they thought coming here would be helpful for you?
  • Do you have pets? How are they helpful for you? What do you most appreciate about them?
  • Whose wellbeing do you feel responsible for?
  • Who relies on you for help and support?


On the front of the card is a picture of a scale from 1-10 (10 being the best). Solution-focused scaling questions are constructed in such a way that the 10 highlights a positive direction of where the clients want to go. When performing an SFSA, scaling questions measure how confident the client is that they can keep themselves safe. It is important to “work the scale.” Asking a variety of questions that amplify the scale often uncovers more opportunities to compliment clients and cultivate hope. Below is a list of questions that can “work the scale”.

What do you “KNOW” questions

  • What do you know you need to do to keep yourself safe?
    • This is asked to both clients and their VIPs
  • What else do you know you need to keep yourself safe?

What have you “TRIED” questions

  • What have you tried that has helped you endure these very painful moments and make them “even a little bit tolerable?”
  • What else have you found has helped you cope to make it even a little bit bearable for you?
  • What would your VIPs say has helped you manage these moments in a bearable way? What else would they say?

Scaling CONFIDENCE in safety: “On a scale from 1-10, where ten is the best:”

  • How confident are you that you can keep yourself safe?
  • What keeps the number from being lower?
  • What else keeps it from being lower?
  • What would be a “good enough” number?
  • What would you be doing at this “good enough” number?
  • What else would you be doing?
  • What would your VIPs notice you are doing at this “good enough number?
  • What else would your VIPs notice you doing?
  • How would you discover when it goes up by one point?
  • What would you be doing? What else would you be doing?
  • How confident would you predict your VIPs would say you can keep yourself safe?
  • What was the highest number it has been?
  • When was this?
  • What were you doing at that number? What else were you doing?
  • What do you think helped the number be higher at those times? What else helped?
  • At what number would you require a higher level of care, such as going to the emergency room, calling 911, or calling a crisis team?
  • At what number would your VIPS say you require a higher level of care?
  • How confident are you from 1-10 that you can do the necessary things you need to keep yourself safe?

Scaling a “Good enough” number to keep safe
Scaling can also help clients and their VIPs confirm what they need at particular numbers. Of particular importance is to confirm a “good enough number” in which they know they can keep themselves safe. This is important to ask both to clients and confirm with their VIPs. If clients think they can keep themselves safe and their VIPs do not agree, it is critical to detail the reasons for the discrepancy. What is the reason the client is confident 10/10 they will keep themselves safe, but their VIP thinks it is only a 2? Ensuring a client can maintain their safety requires confirmation that their VIPs are in agreement.

Asking clients what number they would be at if things are “not good enough” and they do not feel confident in their ability to keep themselves safe affords an opportunity to detail what they would be doing at that number and connecting that number to what they need. When things are “not good enough”, they may report behaviors such as contemplating Suicide, staying in their room for much of the day, not talking, sleeping all day or not have the energy to do what is required of them. Detailing the actions of clients at each of the numbers and correlating these actions to what they need acknowledges their pain while elucidating to both clients and their VIPs a concrete plan of action that corresponds to their needs. They may need to call someone, have someone stay with them, go for a walk, pet their dog, call a crisis hotline, or go to the emergency room. What is critical is to refrain from assuming what you think they need, and instead ask both clients and their VIPS what they know is required at each particular number. I have found this level of detail reassuring to clients and their VIPs, as well as equipping them with a highly individualized plan that can be mutually confirmed.

Safety Number Check-Ins with VIPs
Scaling questions also limit language confusion and assist in creating a safety plan that both the client and their VIPs can agree on. Asking clients if they think it would be helpful to have someone do a “safety number check- in” provides a way for clients and their VIPs to assess confidence in their safety quickly and easily. Inquiring with clients who they think would be most helpful to check in with, how often, and by what method (i.e.) text, phone, email, can incorporate their VIPs within a safety plan in tangible ways.

Indirect Compliments and Positive Differences
Clients and their loved ones are understandably very distressed when suicide is disclosed. Providing indirect compliments to clients in the form of a question (How did you do it?) invites clients to appreciate what they have already done and are doing to cope with their painful situation. The meticulous use of past tense verbs highlights that clients have already done something to cope with their painful situation and thus can do it again. How did they decide to have the courage to ask for help? How have they endured their pain, even if only a little bit? How have they managed even if for brief times to keep from acting on the suicidal thoughts? These moments may seem negligible and can be easily passed over in a clinical encounter, yet it is these seemingly “micro-positive” differences that are critical to amplify in times of despair. What clients are doing to cope in seemingly small ways are the very things they need to do more of to endure their situation. These positive differences may include when clients were able to get through part of a day, got dressed, talked or texted a friend, cared for their pet, ate some food, drank a cup of tea, helped a friend, accomplished even a small part of a goal, and stopped themselves from acting on their suicidal thoughts. Amplifying these differences by exploring whether these differences were helpful, how they are helpful and how they accomplished these differences uncovers additional resources.

Highlighting situations as temporary instead of permanent
“Rewording,” a client’s “permanent language” to “temporary” can help clients endure their situation even “a little bit.” Emphasizing the temporary nature of their situation can subtly impart hope. For example, when a client says “I don’t see any way out,” rephrasing it to “right now,” it doesn’t feel like there is a way out. Or when clients say nothing seems to matter, rewording their statement to “It seems right now” nothing seems to matter.

A Language of Empathy: “For You” Statements
Clients and families who are struggling with suicide often experience hopelessness, fear, anger, and anxiety, requiring a great deal of “for you” responses. Examples of “For You” statements with clients might be acknowledging how exhausting it must be “for you” to endure the suffering and painful situation you have been dealing with. For parents and loved ones, it might be validating how scary and frightening it must be “for you” to see your child struggling with suicide. Acknowledging how difficult it must be “for them” confirms their emotional perspective and can help them tolerate their situation even a little bit.

SFSA Risk Assessment
An SFSA integrates solution-focused language in a “traditional” risk assessment. The following are SFSA risk assessment questions.

  • How well from 1-10 (10 being the best) are you managing your mood, anxiety, cravings, substance use, and other health conditions? What are good enough numbers for these domains? What do they need to help them manage these areas?
  • Have you ever had to cope with domestic violence, abuse, natural disasters, war, homelessness, substance use, loss, divorce?
  • How have you coped? How else?
  • Have you ever had to cope with prior suicidal ideation or behaviors?
  • How did you cope?
  • What kept you from acting on those thoughts? What else?
  • What treatments/providers/medications have been most helpful for you?
  • What do know has been most helpful about your prior treatments/ providers and medications?
  • How satisfied are you from 1-10 with your most important relationships?
  • Has anyone in their family had to cope with depression, substance use, suicide, or other mental health conditions?
  • What do you know has been helpful for them?
  • Who in your family is doing well?
  • What do you know about what has helped your family members who are doing well?
  • How well from 1-10 are you managing your work and financial stress?
  • What is a good enough number? What keeps the number from being lower?
  • How satisfied are you from 1-10 with the treatment and resources available to you in your community?
  • Do you have guns/ unlocked medications in your home?
  • What do you know is needed to manage these means of harm?
How confident from 1-10 are you that you can do what is needed to minimize these lethal means?
  • What is a good enough number?How confident from 1-10 are your VIPs that the lethal means can be minimized in the home can be minimized?
  • How confident are you that you can call and ask for help if you are not feeling confident in your safety?
  • Whose phone numbers are most important for you to have? Who else?

Remaining solution-focused when a higher level of care is needed
When a client requires a higher level of care, it is still possible to stay solution-focused. The following questions can help to sustain a solution-focused conversation encouraging both patients and their VIPs to be involved in this difficult decision while conferring a sense of control and responsibility.

  • What are the patient’s best hopes for hospitalization?
  • What are their VIP’s best hopes for their hospitalization?
  • How are they hoping the hospitalization will be helpful?
  • What will tell them they are ready to leave the hospital and have learned the necessary skills to keep safe?
  • What will tell the client’s VIPs that they have learned the necessary skills to help their loved one stay safe?

Resources if you are need of help now
The National Suicide Prevention Lifeline number is: 1-800-273-8255

For the National Text Hotline, text the word TALK to 741741

Locally, the crisis line for Call2Talk is 508-532-2255. Or text C2T to 741741

The American Foundation for Suicide Prevention has additional resources at https://afsp.org/find-support/

Castro, Sahily De, and Jeffrey T. Guterman. “Solution-Focused Therapy for Families Coping with Suicide.” Journal of Marital and Family Therapy, vol. 34, no. 1, 2008, pp. 93–106., doi:10.1111/j.1752-0606.2008.00055.x.

Fiske, Heather. Hope in Action: Solution-Focused Conversations about Suicide. Routledge, 2008.

Henden, John. Preventing Suicide: the Solution Focused Approach. Wiley, 2017.

Kondrat, David C, and Barbra Teater. “Solution-Focused Therapy in an Emergency Room Setting: Increasing Hope in Persons Presenting with Suicidal Ideation.” Journal of Social Work, vol. 12, no. 1, 2010, pp. 3–15., doi:10.1177/1468017310379756.

Lutz, Anne Bodmer. Learning Solution-Focused Therapy: an Illustrated Guide. American Psychiatric Publ., 2014.

Ronquillo, Linda, et al. “Literature-Based Recommendations for Suicide Assessment in the Emergency Department: A Review.” The Journal of Emergency Medicine, vol. 43, no. 5, 2012, pp. 836–842., doi:10.1016/j.jemermed.2012.08.015.

“The Solution Focused Approach in Working with the Suicidal.” Preventing Suicide, 2017, pp. 123–151., doi:10.1002/9781119162926.ch8.

Ting, Sarah A., et al. “Trends in US Emergency Department Visits for Attempted Suicide and Self-Inflicted Injury, 1993–2008.” General Hospital Psychiatry, vol. 34, no. 5, 2012, pp. 557–565., doi:10.1016/j.genhosppsych.2012.03.020.

All You Need Is Love

2021-05-11T20:57:00+00:00July 5th, 2018|

As parents, we foist our dreams and aspirations on our children, push them to be more that we could ever be. But do we have the courage and honesty to look within ourselves and ask whether our parenting is driven by our own needs or those of our children? Just as importantly, are we able to accept them and respect them for who they are?

All You Need Is Love will convince you that parenting is not just about bringing up children; it is about empowering ourselves to be better human beings. It is not about teaching but about learning from our children. This is a book of strategies, tools, reflections and anecdotes for twenty-first century parenting. It will help you connect to the immense wealth of wisdom that is already present in you.

Child & adolescent psychologist and family therapist Dr Shelja Sen highlights this through her five anchors of parenting – Connect (create the foundation of parenting); Coach (build the necessary skills in children through an understanding of their unique wiring and temperament); Care (nurture ourselves for a more wholesome life); Community (build caring ecosystems for children to thrive in) and Commit (sustain the courage and compassion).

Imagine: No Child Left Invisible
Building emotionally safe spaces for inclusive spaces and creative learning

Why do we send our children to school? How can learning be meaningful? And most importantly, how can we build schools worthy of our children?

From the time children are little, we start making stories about them. Schools are like factories where these stories are manufactured all the time. Some children at the top of the hierarchy enjoy rich, diverse and colorful stories which are told and retold. However, there are many who spend most of their lives in school, clutching on to single, thin narratives of ‘failure’: ‘can do better’ and ‘not up to the mark’, ‘not reaching potential’ – every ‘not’ restricting and making their narratives thinner, limited, with lesser scope for possibilities. These are the children who are forgotten, who are invisible and who are seen as never being good enough.

At the core of this book is a deep faith that learning is about the magical relationship the teacher builds with each child; it is about building emotionally safe, inclusive spaces for creative learning. That is the heart, the lifeblood, the bare bones of learning.

Imagine is a call to action for teachers, parents, counselors, therapists, activists, thought leaders and other change agents in our society. A game changer that will force us to reflect, rethink, redesign schools that our children truly deserve.

 Watch her talk about her new book, Imagine: No Child Left Invisible as she answers pertinent questions.

Buy Imagine at Amazon

Go to Top