Richard Kahn, Ph.D., MS, RD

The Miracle Question (MQ) is an important tool in SFBT. Some practitioners, like me, have trouble asking the MQ. Help came from Cami Boyer, a psychotherapist. She offered a MQ workshop at the 2017 Solution-Focused Brief Therapy Conference in Santa Fe. Boyer likened using the MQ to bread baking. Bread baking is recipe-free when you understand the principles that underlie recipes.  The essential recipe for the MQ, she proposed based on work with Teri Pichot, is a question that helps clients imagine their preferred future. About a dozen perplexed SBFT colleagues responded with MQ problems that turned into solutions with Boyer’s help.

One challenge the MQ presents is the amount of skill and time needed to prepare the client and the therapist.^1,2   In a separate workshop, family therapist Brandon Eddy, PhD, confirmed the time challenges. He needs two sessions to ask the MQ with families with children on the autism spectrum. He uses the time for assessment and for the parents to establish goals.

In the nutrition program for low-income families, where I work, appointments last about 20 minutes with paperwork. We see most families every two or three months. Another colleague noted, with general agreement, that with some people of faith, the word miracle pulls in other feelings and ideas that create other pitfalls when asking the MQ.

Solutions soon appeared. One participant recalled that the MQ arose when Insoo Kim Berg responded to her patient’s saying, “Maybe only a miracle would help.”¹ Berg and colleagues followed up with what became the MQ. From this perspective, the MQ itself was co-constructed, not invented. Another session participant said that asking for Best Hopes helps elicit a preferred future. From this perspective, the MQ is means rather than an iron clad end.

A stricter view of the MQ structure comes from the influential practitioners at The Center for Solution-Focused Practice in the UK. Their firmer view of MQ shows up in their adaptation called the Tomorrow Question (TQ).³ Here’s the TQ: “Suppose you achieved your hopes overnight, what would you be doing different tomorrow?”  The Centre team maintains that  (1) the time element, specifically night and tomorrow, the same ingredients in the MQ, and, (2) the pairing of the problem to the solution, together, like flint against steel, ignite the preferred future and are key to the MQ formula.

The broader view is taken by Pamela King, LFMT. She adapted the MQ for questions that spark a preferred future in children in Tools for Effective Therapy with Families and Children.⁴ One is the magic question: “Let’s pretend you have magical powers to make the future exactly how you want it to be. What will be happening in your just right future?” She also adapted a crystal ball question from Erikson and de Shazer. There is one ball for past successes, one for current encouraging signs and one for the preferred future. She has a three part wish game: “You have three wishes. What can you do to start the magic in yourself?” King also lists the Magic Wand Technique invented by Selekman for the child to cognitively immature to manage the MQ.⁵ Selekman zaps children with his magic wand to generate a preferred future. In my experience, the wand requires less build up and is less fraught than using the word ‘miracle.’ I declare my pen is a magic wand and tell the client I will wave it over their head 3 times to help elicit the child’s preferred future or solution.  When I see the clients smile or some other body language tip-off, I know I can proceed. Other times, I sharpen a new pencil, perform the magic and give child or adult the ‘wand’ as a take home gift for future magic making. Perhaps, very little build up is needed with children who still live with magic.

Fort adults, the MQ requires some build up even when the time is short. Yvonne Dolan gave me some suggestions to help manage the known challenges of the MQ.⁶ Even with limits, she suggests that goal setting and scaling questions can prepare the patient for the MQ. The patient’s expressed goal is the steel against the problem-talk flint. Scaling creates the opportunity for some kind of refinement of the goal. At this point, Dolan suggests that we can ask something along the lines of, “Let’s suppose that sometime during the night tonight something wonderful happens, a sort of miracle, and when you awaken you are a 10.  How would you discover this?” 

Here’s a case vignette of using a magic wand during a first session in private practice.

The health goal was to have their 6 year old daughter restart weight gain and vertical growth after one year of no growth. Ceasing to grow taller for a 6 year old is most likely a grave sign of protein-energy malnutrition usually due to family stress or extreme poverty. A gastrointestinal evaluation was planned by the pediatrician to rule out any digestive disorder.

Prior to the first session, I asked for a 3-day diet history, the foods eaten in a three day period, and a list of Mary’s strengths related to eating. That prep might have led to the pre-session change. Mary, not her real name, had begun to eat more. Her diet history revealed insufficient protein and calories. After we reviewed diet changes that met the family’s lifestyle, I asked how mealtimes went. The parents reported common parenting errors in feeding children: electronics at the table, bribing, force feeding and mealtime chaos. Prior to my SFBT training, I would dig into the past. I took advice offered by McFarland and stuck with present strengths.⁷ If mealtimes changed, other things would change in the family system.

I gave the parents the basics on Mary’s nutritional needs based on Mary’s preferences and standard guidance on how to establish calm family meals. Some of these established tips matched Mary’s already present eating strengths written down on the pre-session list. She ate better, for example, when both parents ate with her on weekends or at extended family events. More expert-family pairs were discovered so I could confirm some practices rather than introduce new ideas.  On the other hand, weekday meals were unproductive. Mary ate little at rushed breakfasts on schooldays. Mom’s profession often forced her to work past dinner time. There was little family life at the table during the work week. While we adults spoke about scheduling possibilities, Mary either sat on the couch or danced around the office.

When Mary next sat down between her parents, a good omen, I hoped she would have a good breakfast solution. In this case, there was little build up other than some short conversation about mealtime and breakfast. Declaring my pen a magic wand, I asked her to close her eyes and told her that I would wave the wand over her head three times. She would then tell me what would be a good breakfast for her. Out came the perfect dietary prescription of high protein and calorie breakfast. She then asked to woken up by her mother calmly. I could never invent that tip quickly! The discovery process would take forever. Mom and Mary embraced.  Mom agreed to wake up that much earlier to support Mary’s wish.  We agreed to meet 6 weeks later in order to see what was working.

Three weeks into the gap, I received an email. A pediatric weigh-in visit revealed a 1.5lb increase which eliminated the need for a GI evaluation. Dad, the primary caregiver, added that Mary is now a member in good standing in the clean plate club with no fussing. Mary’s weight continued to increase by the second appointment. Score one for the Magic Wand. We had a second meeting that included a further weight increase. Case closed!

1. de Shazer S, Dolan Y, Korman H, Trepper T, McCollum E, Berg IK. More Than Miracles: State of the Art of Solution-Focused Brief Therapy. Oxon, UK: Routledge; 2012.
2. Stith S, Miller M, Boyle J, Swinton J, Ratcliffe G, McCollum E. Making a Difference in Making Miracles: Common Roadblocks to Miracle Question Effectiveness. Journal of marital and family therapy. 2012;38(2):380-393.
3. Brief Therapy Practice. How Brief is Brief? https://www.brief.org.uk/resources/faq/how-brief-is-brief. Accessed December, 2017.
4. King PK. Tools for Effective Therapy with Families and Children. New York and London: Routledge; 2017.
5. Selekman M. Solution-Focused Brief Therapy With Children. New York: Guilford Press; 1997.
6. Dolan Y. MIracle Question. 2018.
7. McFarland B. Brief Therapy and Eating Disorders. Jossey-Bass; 1995.

Richard Kahn, Ph.D., MS, RD

Richard Kahn, PhD, RD, is a nutrition therapist specializing in the needs of both typically developing and atypically developing infants and young children. Nutrition therapy is a counseling approach that places nutrition for children in the context of family life. He is the father of two, as well as a cook at an organic restaurant, specialty-food-store owner and manager at Fairway Market, a leading food retailer in New York City.  He serves on the board of the New York Zero to Three, a nonprofit advocacy group that works to promote the optimal development of young children, their families, and their communities in the New York region. We were fortunate to have him be a part of our online certificate course. Thank you Richie for your wonderful contribution! He can be reached at:

RichardKahnNutrition.com | Facebook page is RichardKahnNutrition

Wynn Calder – 6/19/18

In the spring of 2017, as a mid-career graduate student in counseling psychology at Framingham State University, I took Dr. Anne Lutz’s course, Solution-Focused Fundamentals and Practice. In thinking about what I might do for my final project, a light bulb went off: Solution Focused questions could improve my sustainability assessment interview process. They could build on the content-oriented questions of my Sustainability Assessment Questionnaire (SAQ) and help foster a more strength-based narrative.

As an educational consultant and former teacher, I have spent a lot of time thinking about how schools work and how they change. Institutions are collections of people and they present many of the same challenges as individuals when it comes to figuring out what they want to become, what’s making them stay the same, and how I to help them change. I attempt to help K12 schools (mainly private and independent) become more sustainable in their teaching and operations. My primary service has two parts: a sustainability assessment followed by a collaborative process to develop a long-term sustainability plan. This article suggests that Solution Focused questions can enhance an institutional assessment process, just as they have been shown to be effective in the therapeutic realm.

A comprehensive definition of sustainability in education, given in the questionnaire introduction, reads: “The concept of sustainability – which, at a minimum, addresses how humans can live on the planet over time in a manner that protects cultural and biological diversity, recognizes and appreciates ecological limits, offers just and accountable governments and economies for all, and draws on the human capacity for adaptive learning and innovation – offers a tremendous challenge for education. It requires educational institutions to rethink their missions and to re-structure their courses, research priorities, community outreach, and campus operations. By preparing students – and the whole campus community – to be more adept decision makers in the increasingly complex, dynamic, and uncertain future that we all face, integrating sustainability into all of the major activities of educational institutions also presents a tremendous opportunity.”

When I conduct a sustainability assessment, I typically visit a school campus for one to two days and interview both individuals (like teachers and staff members) and groups (like committees and student groups) using the SAQ as my guide. The questionnaire is divided into five sections: Curriculum; Campus Operations; Community Service; Student Engagement; and Administration, Mission & Policy.

It includes questions such as:

• Indicate the extent to which sustainability is a focus woven into traditional disciplinary education in science, math, English, history, the arts, etc.?
• What do you see when you walk around campus that tells you this is an institution committed to sustainability?
• To what extent are student groups on campus directly involved in sustainability initiatives?
• Please describe the key factors that support the advancement of environmental and sustainability issues on your campus?
• What factors do you think account for resistance to or lack of responsiveness to these concerns?
• What “next steps” do you feel ought to be taken?

Based on what I’d learned in Professor Lutz’s course, I generated a set of SFT questions to supplement the SAQ and organized them into four groups:
1- questions for a faculty or staff member with a positive orientation toward sustainability;
2- questions for a faculty or staff member with a negative orientation toward sustainability;
3- questions for a student environmental or sustainability group; and
4- questions for an environmental or sustainability committee.

Here are some examples:

Faculty/staff member with positive orientation:
• What are your best hopes for this conversation?
• How can I be most helpful for you today so that this conversation is worthwhile?
• What are your best hopes for this school in sustainability over the next several years?
• How do you see yourself playing a part in that vision?
• On a scale of 1-10, how empowered do you feel you are to contribute to that vision?
• What makes it not lower?
• What would it take to raise it by one or two points?
• On a scale of 1-10, where 10 is that you’re fully satisfied with your contribution to sustainability at ________, and 1 is the opposite, how would you rate yourself?
• What makes it not lower?
• What would it take to raise it by one or two points?
• What have you tried to do that has been most helpful for the school?
• What else have you tried?

Analyzing a recent success (Example: An advisor to the student environmental group is helping them articulate their goals and successfully work toward them):
• Looking at your recent success, how was it different from other efforts you’ve made to enhance sustainability at ________?
• How else?
• How did you do it? How else did you do it? (Let’s list these things so you can make use of them going forward.)
• On a scale of 1-10, where 10 is you are confident you could do this again and 1 is the opposite, where would you say you are now?

Analyzing a recent setback (Example: A teacher is attempting to get her history department colleagues to start mapping sustainability content that is relevant to history, and to consider ways of incorporating key issues into the existing curriculum):

• How did you cope with what this setback? What did you learn from it?
• Where do you get your resolve to move forward?
• What do you think you would do differently next time?
• What else would you do instead? (Let’s list these things so you and I can make use of them going forward.)
• On a scale of 1-10, where 10 is you are very confident in your ability, as a history teacher, to reach your goals and 1 is the opposite, where would you rate things now?

Faculty/staff member with negative orientation:
• What aspects of sustainability are most appealing to you?
• If you were tasked with trying to improve the school in those ways, how would you go about doing that?
• Etc.

Student Environmental or Sustainability Group:
• What are your best hopes for this group?
• What does it look like to be successful and effective?
• What have you tried to do that has been most helpful for other students? For the school?
• What else have you tried?
• Who are the most important people in the school for enabling you to achieve success in environmental or sustainability action? Who else?
• What do you most appreciate about them? How are they helpful to you?
• On a scale of 1-10, where 10 is that you’re making the most use of these important people, and 1 is the opposite, where would you rank the group?
• How can you engage these individuals in your future efforts?

Environmental or sustainability committee:
• On a scale of 1-10, where 10 is that you’re fully satisfied with the progress of this committee, and 1 is the opposite, how would you rate yourselves?
• Etc.

In addition to supporting individual and group strengths in the context of school sustainability, the SFT questions help uncover the personal, motivational and relational dimensions of taking action and trying to affect change. In retrospect, the Sustainability Assessment Questionnaire has been overly focused on “what” someone accomplished rather than “how” they did it, or “how” they handled a setback. In other words, understanding the power of motivation, patience, resourcefulness, and creativity, in this context, can be illuminating for thinking about what might be tried next, or how to proceed differently to get different results.

In reviewing the SAQ for this exercise, I discovered that it already includes some SFT-oriented questions. But the supplemental questions above illustrate a level of strengths-based inquiry that I had not considered. Since last spring, my interview process has been enhanced in a couple of ways. In addition to providing new insights into how to improve sustainability at schools, I’ve noticed that the SFT questions help people become more animated and interested in discussing these issues. Perhaps that is because they’re asked to delve deeper and to shine a light on their strengths and successes.

Wynn Calder

We were thrilled to have Wynn join us for our online certificate course in 2017 and are excited to share his article for our Summer 2018 Inspirations Newsletter. William (Wynn) Calder directs Sustainable Schools, LLC, which helps schools and colleges improve their teaching and practice of sustainability. He is also currently pursuing an MA in counseling psychology. See www.sustainschools.org. Wynn can be reached at wynn@sustainschools.org.

A Simple Graph Which Answers The Question:

“Why has my life ALWAYS been terrible?”

Seth Bernstein, Ph.D.

Corvallis, Oregon

A common perception of clients who are experiencing major depression is that their lives have always been terrible. They are not speaking metaphorically. They are being literal. They only have memories of the times in their lives when they were feeling the way they are feeling now – depressed. How can a person answer the Miracle Question, how can they think about their Preferred Future when they have no access to an affective state that is positive? They can’t.

For over thirty years I have used the graph illustrated above to help my depressed clients understand the relationship between affect and memory. The explanation takes about five minutes and in my experience, the insight it provides emotionally opens clients to thinking about a future that contains accomplishments, meaning, and positive feelings.

I first became aware of the concept of “state-specific memory” in the 1970’s when I had an interest in para-psychology. At the time, Charles Tart was one of the foremost researchers in the field. The term he used, “state-specific memory,” has evolved since that time and is now called “state-dependent memory” or “state-specific learning.” Wikipedia defines it as “the phenomenon through which memory retrieval is most efficient when an individual is in the same state of consciousness as they were when the memory was formed.” I would suggest that those who are interested in exploring the research on state-dependent memory, which dates from 1937, start with the Wikipedia summary.

In talking with clients about this subject, it isn’t necessary to cite the research. They will trust you when you say, “there is a lot of research to support what I am about to show you.” Some clients, however, will be interested in the research. So, be prepared to provide them with directions on how to find it.

I have found that giving a handout with the graph above to a sitting client is not as effective as having the client stand up and walk over to my white board where I draw the graph as I explain it. The process is more dynamic. The physicality of changing from a sitting position to a standing position and literally moving across the room creates an unconscious metaphor for changing perspective and changing bodily sensations, both of which, currently, are rigid and stuck.

Here is my explanation:

It is not surprising that you feel hopeless. You think back on your life and all you see is blackness. When you look forward, all you can imagine is continued blackness. Why wouldn’t you – or anyone for that matter – if all they could remember when they looked back were the times they were depressed. It is logical to assume that your life, looking forward, will just be more of the same.

 There is a considerable body of research which explains why people who are significantly depressed can only remember the times in their lives when they were depressed. This body of research is called ‘state-dependent’ memory.’ Let me show you how it works. <I create the diagram, above, as I talk.>

You see this wavy line? It’s a person’s mood going up and down. We all have good days and bad days. We have times when we are feeling positive about things and times that when we feel doubtful or pessimistic. When our highs and lows fall between these two lines, our memory functions effectively. When we are feeling up, we can still remember the times in our lives when we were feeling down. When our mood is in the low part of the wavy line, we can still remember the times we were feeling positive about ourselves and our lives. Also, we are able to anticipate that there will be future times in our lives when things will be looking and we will be feeling brighter.

However, when our mood drops below this black line or goes above this pink line (that’s called mania), our memory does not function effectively. When we are down, ALL we can remember is the times we were feeling down. That’s literally all our brain allows us to remember. See the tops of these inverted mountains? That’s where we live and have ALWAYS lived.  We can ONLY remember the lows.

So, it is no wonder that people whose mood drops below this line cannot see a future for themselves that has any potential for being better. It all looks bleak, both looking back and looking ahead.

Does that make sense to you?

Generally, my clients answer this question in the affirmative and what follows is a slow opening up to memories and affects that had been previously locked out by state-dependent memory. I believe the mechanism which does this unlocking is hope. Where there had only been pain and fear, my explanation helps my clients reorganize their conceptualization of their experience. In so doing, a door is opened. This is very much in line with Freud’s explanation of how interpretation works.

In describing the transition from locked memory to unlocked, my colleague Yvonne Dolan observes that “I routinely watch for signs of physical relaxation in order to decide what to offer the client next. Specifically these signs usually include  a slight slowing of breathing and  settling further into the chair, body movements or fidgeting slowing down, accompanied by  some head nods, followed by  what Milton Erickson and Ernie Rossi used  to call an ” expectant look,” in which  the client at least briefly makes some eye contact with the therapist or otherwise appears to be comfortably waiting for the therapist to say something. Rossi viewed these signs as a signal of the client’s readiness to be invited into a therapeutic trance. With the SF approach, I have learned to view these “yes set” responses as a sign that the client is now feeling safe and calm enough to consider a SF question.”

Colleagues, I would suggest you try using this graph and this explanation. See for yourselves whether they unlock your clients’ potential to imagine a future for themselves that includes positive experiences, accomplishments, and pleasure. As we know from our training and experience in Solution-Focused Therapy, until clients can imagine a real future for themselves, the rest of what therapy has to offer will not be of much use.

Erin Sepe

Several years ago I was substituting, for a day, in a kindergarten classroom when the school practiced a “code red” drill. I found myself, with 20 five-years-olds, huddled under the desk, lights off, shades drawn, and classroom door locked. Part of the drill includes the principal walking down the halls and checking that the classroom doors are locked. When she got to our classroom, we could hear the doorknob move. I noticed a five-year-old girl, crouched near me, crying. She said something like, “Is that the bad guy?” she may have even used the word “shooter.” I tried to reassure her, comfort her, by saying, “No, that is the principal checking that we are practicing the right safety.” Immediately, another little girl said, “For when it really happens.”

My children are now fourteen and twelve. They are in middle school, and they have never known a world without school shootings and terrorist attacks. After the recent horror in Florida where a former student returned to his high school and killed seventeen, wounded, some critically, another twenty and shook to the core hundreds of thousands of on-lookers, I wonder how we use Solution Focused Therapy to aid in what we have not been able to control.

A colleague and friend said her nineteen-year-old son commented, “I’m numb. It just happens, and there’s nothing you can do about it”. He’s not alone. What do we do as clinicians when we cannot assure a positive outcome or a remedy? My kids made it through elementary school and when these gut-wrenching atrocities occur, I think, “We’re almost there” my daughter has four years of high school left and my son six. The reality is though that this happens on college campuses, concerts, and shopping malls. How do we counsel the uncontrollable? After all, if it is in the back of our minds as parents, it’s at least on our children’s minds when “code red lockdown” is unexpectedly announced over the intercom. We all see the images, and when we begin to push it out of the forefronts of our minds, we are ambushed again.

Talking about the frequency, intensity and unpredictability of the problem can reinforce feeling prey and fearful. I appreciate that Solution-Focused Therapy can offer something else. As counselors, we can turn the focus from the problem by focusing on questions. Asking, “What helps to deal with, manage or cope” with regard to our clients’ feelings surrounding these shootings. Scaling “How well are you coping on a scale of 0-10” can be helpful, recognizing that “10” may not be something attainable by one individual. Maybe it’s a matter of a “good enough” coping number. Maybe a “7” is the best an individual can manage. Asking clients, “Who helps them get a good enough number,” “What do you do that helps to move you up the scale when you are lower?” Scaling “Where were you on the scale just before the tragedy occurred?”, “What was it like when you were higher on the scale?” and “What small thing would help to return to that number?” Also helpful is asking “How come” the number on their current scale is not lower.

Additionally, asking clients how a “VIP,” a mother, father, teacher, sibling or other VIP would rate the client’s ability to cope is a way to bring the perspective of others and introduce information that the client had not given consideration. Often clients or their VIP’s gain knowledge that is helpful in moving toward solutions. Exploring VIP’s and what a client values about their VIP’s helps the client recall the support and care she has received from them. Finally, asking clients, “What do you think it would mean for your VIP to see you moving up the scale toward your goal?” allows a client to consider the impact their success has on the people they find important.

If ever and until we have a solution to school shootings and terrorist attacks, focusing on how we cope with the possibility that it could happen again might be better than focusing on the unpredictable and vast nature of the problem.

Anne Bodmer Lutz, B.S.N. M.D.

What does “person-centered care” mean? The use of this terminology is frequent, but the concept is vague. “Person-centered care” (PCC) has been recognized as one of the critical elements needed for the redesign of our nation’s health care system (IOM, 2001). The Institute of Medicine (2001) defined PCC as “care that is respectful and responsive to individual patient preferences, needs, values, and ensuring the patient values guide all clinical decisions”. Stephanie Morgan, and Linda Yoder have defined PCC “as a holistic (bio-psychosocial-spiritual) approach to delivering care that is respectful and individualized, allowing negotiation of care, and offering choice through a therapeutic relationship where persons are empowered to be involved in health decision at whatever level is desired by that individual who is receiving the care.” (Morgan and Yoder, 2011).

The Solution-Focused approach is one of the most pragmatic ways to implement PCC when having conversations with clients. How does the solution-focused approach fit into PCC? How do you know when you are utilizing a “Solution-Focused PCC” approach? Who is the person in PCC? How might clinicians implement “Solution-Focused PCC”? Here are a few examples illustratng how assessing important relationships in a client’s life broadens “who” the person is and fosters additional possibilities to develop solutions based on each client’s unique social context.
All people live in relationships. Relationships are not only crucial for survival but essential resources that help people solve their problems. Problems are solved in one of two ways, either the problem is solved, or the individual and those most important to them no longer view the behaviors or difficulties as problematic. I think about the many youths who I don’t see who may be considered as having a substance use disorder. What is the reason I don’t see them? Certainly, access is one challenge, but also whether or not this youth and the social context they live in view this as a problem. Perhaps the youth is using substances with their parents, and it is viewed as normal. Perhaps, the parents do not view it as a problem unless their grades have declined. The context may change when the youth is discovered to be selling drugs at school; thus now the school views it as problematic. Or they are caught drinking while driving and legal entities “mandate” them to treatment.

Mapping out a client’s context is critical in understanding and assisting them in building solutions from the multiple perspectives of those most important in their life. I propose the idea of developing a “VIP map,” much like you weave a beautiful quilt that has differing colors, textures, fabrics, and designs. I define VIPs as the relationships that are most important in a client’s life. VIPS are used when negotiating goals as well as when evaluating treatment progress. For example, asking what are would your client say are their VIP’s “best hopes” for them, and incorporating VIPs when asking scaling questions such as: How confident they are that you will remain sober from 1-10? How satisfied from 1-10 would they say things are between you? How confident are they from 1-10 that you can remain safe?

Inquiring about a client’s VIPs early on and throughout the conversation broadens “who” the client is and integrates the social context within the dialog, fostering additional possibilities and hope for solutions. I invite you to consider six categories of VIPs: Classic, Vulnerable, Hidden, Spirit, Pets, and Future VIPs. Categorizing VIPs in this way has been a helpful way for me to organize and map a client’s social context.

“Classic VIPs” are those relationships that we typically think of when considering important people in our life. They may be spouses, children, friends, co-workers, grandparents, aunts, uncles, teachers, community supports, clergy, people who have died – whoever the client identifies. It is important not to assume who these relationships are, but instead, ask clients.

“Classic VIP Questions”
1. Who are the most important people in your life?
2. Who else? Who else?
3. What do you most appreciate about them?
4. What else? What else?

When practicing these questions with trainees, they are often surprised by the intimacy and vulnerability that may arise. Frequently, they feel a heightened sense of gratitude and appreciation for those important in their life. These questions can help activate relational resources when clients are experiencing thoughts of suicide. It is often important people and relationships in an individual’s life that stop them from acting on these thoughts contributing to a “resilience assessment” when evaluating safety concerns.

“Hidden VIPs” are those relationships that clients may want out of their life, yet are still important for them in that they may be critical in determining decisions in a client’s life. They may be DCF workers, Probation officers, therapists, psychiatrists, judges, or family members. Hidden VIPs are important to consider for “mandated” or “externally motivated” clients. As a child psychiatrist, there are very few youths who want to come and see me. Most of my clients are “externally motivated” with the goal of not having to see me again. Asking them who would decide when they no longer need to see me often uncovers important relationships in their life. I remember an adolescent girl who I was treating in a residential facility for substance use. When I asked her about her “Classic VIPs,” she could not identify anyone. She had been living on the streets selling and using drugs to survive as both her parents had died. This VIP map was very challenging to develop. When thinking more about her situation, I reflected that someone cared enough about her to get her into treatment, even if she did not think of this as “caring.” It was a teacher at her school. This discovery led to more questions about what she thought the teacher appreciated about her and what her teacher knew about her that she would be successful in her life.

“Hidden VIPs” Questions
1. Who was “worried” or “concerned” about you that they thought coming here would be helpful for you?
2. Whose idea was it for you to come here?
3. What are they saying you need to do so you don’t need to come here anymore or can go back to home, to the school they want, etc.?

Pet VIPs (Very important pets). In my work with children and families, I have increasingly been inspired by how important pets are in people’s lives. They are often a source of comfort, companionship, and reason for living. I discovered this by accident. In my private office, I would sometimes bring my dogs to work when I needed to get paper-work done. Because of this, I had a dog bed hidden in the corner with a small dog toy. I was amazed to discover how often both youth and parents asked whether I would bring a dog to the session. I acknowledged that my dogs are not therapy dogs, but I do enjoy bringing them when not seeing clients. This began a conversation about animals in their life. Do they have pets? Are they important in their life? What do they most appreciate about them? What difference have they made in their life? These relationships are often very beneficial. They may also be painful such as when clients divulge a beloved animal they lost.

It also led me to consider asking them if it would be helpful for them to bring their animal to the session, much like I would invite them to bring other important human family members. I have found clients very honest about whether it would be helpful. Some have said, no – it would just cause them worry about their animal destroying my office or distracting them from what they needed. Others have said it would be very helpful. This has led to the delightful discovery of including some of my client’s pets in sessions. I have met multiple dogs, cats, birds, and even a hedgehog. One particular client brings his dog to every visit. He acknowledges that it is his loving dog that is his reason for living and gives him the motivation to come to his appointments. His dog even knows when the 50 minutes are ending and will jump off the couch and politely wait for his weekly treat!

“Pet VIP Questions”
1. Do you have pets?
2. Are they helpful for you?
3. How are they helpful for you? How else?
4. What do you most appreciate about them?
5. What else? What else?
6. What do your pets most appreciate about you? What else?

“Vulnerable VIPS” are those relationships in a person’s life who are in need of support, special care, protection, and help. One of my prior workshop participants, Erin Sepe, came up with this name and I give her all the credit! Often these people are reasons and motivation for clients to move forward in their life. Another workshop participant who works with boys in detention created a group in which she had the boys identify vulnerable VIPs in their life. She then had them write a letter to them expressing their best hopes for them and what they most appreciate about them. This also helped them develop empathy and normalized their experiences with the others.

“Vulnerable VIP Questions”
1. Whose wellbeing do you feel responsible for?
2. Who relies on you for help and support?
3. Who depends on you?
4. What would they say you have done to help and support them?
5. What would they say they appreciate about you? What else?

“Spiritual VIPs” can be considered a client’s spiritual beliefs and may also include relationships people have lost. Loss is a natural part of life, and I have found this concept a helpful way to strengthen and expand resources when mapping a client’s VIPs. Spiritual VIPs are unique for every client, and can assist them in talking about beliefs around the meaning of their life, connection with others, and provide them with a sense of peace and purpose. Spiritual VIPs often help clients cope in very challenging circumstances. When I ask clients how they have coped and endured incredible loss, they often talk about their faith in God and how this has provided them the strength and endurance to carry on. This can foster hope by exploring in more detail how God has been helpful for them, how else, what they appreciate about God and what God appreciates about them. It can also provide opportunities to compliment them on their faith and how they have nurtured and developed this strength in their own life.

Spiritual VIPs may also include relationships clients have lost. Exploring losses through Spiritual VIPs can further deepen how their loved ones remain in their heart. I had a client who lost her mother, father, and her primary guardian was unable to care for her because of active substance abuse. When I asked her whether there had been important people in her life who she lost, she spoke about her grandmother. I began asking her what she appreciated about her grandmother and what her grandmother would appreciate about her. I asked her what her grandmother would say she is most proud of about her. This opened up a conversation about this loss in a tolerable way and helped her talk about all the ways her grandmother remains in her heart. Rather than feel only the loss and separation, it helped her realize how her grandmother carries on within her heart. I think of the quote by William Shakespeare: “Give sorrow words; the grief that does not speak knits up the o-er wrought heart and bids it break.”

“Spiritual VIP” Questions
1. Many people have lost important relationships in their life. Is this something you have coped with?
2. What did you most appreciate about them? What else?
3. Are there small ways in which you have kept them in your heart?
4. How have you kept them in your heart? How else?
5. Has it been helpful for you?
6. How has it been helpful for you?
7. What would they say they most appreciate about you? What else?
8. What would they say they are most proud of supposing they were with us in the room as we are talking? What else?
9. What would their best hopes be for you? What else?

“Future VIPs” are relationships clients hope to develop in the future. This again came from a prior workshop participant! It can be helpful to explore best hopes for relationships in the future and what clients would be “doing” when they are in satisfying relationships. How would they know these relationships were satisfying for them? Has there ever been even a little bit of these future VIP qualities in their current relationships? On a scale from 1-10, how confident are they that will be able to find their future VIP? How satisfied are they from 1-10 with their current VIPS? What is a good enough number? What keeps the number from being lower? How would they discover when it goes up by one point?

“Future VIP” Questions
1. What are your best hopes for a satisfying relationship?
2. What do you know that you need/want in a relationship?
3. What else?
4. What are “green flags” that would tell you this relationship is what you hope for? What else?
5. Are there aspects of your “future VIP” happening even a little bit now in your relationships?
I hope this article helps you to see the beauty, complexity, and challenge of broadening “who” the client is in PCC. I invite you to try some of these questions and co-create a beautiful tapestry that is helpful for your clients and enriching for the privileged work we all do.

References:
Crossing the Quality Chasm. (2001). doi:10.17226/10027
Morgan, S., & Yoder, L. H. (2011). A Concept Analysis of Person-Centered Care. Journal of Holistic Nursing, 30(1), 6-15. doi:10.1177/0898010111412189

“BUT NOW IT’S COOL TO SEE THAT

MY PARENTS ARE PROUD OF ME!:”

A SPARKLING MOMENT INTERVIEW

 James G. McCullagh

            In the spring of 2017 one of the assignments at the end of the semester in Dr. Anne Lutz’s Solution-Focused Fundamentals course

Anne Bodmer Lutz, B.S.N., M.D.

Human beings are unique in two ways – we are tool-bearing and talkative. This ability to talk provides us with opportunities to communicate with others. Some conversations enhance possibility, while others diminish it. When possibility is enhanced, we have self-agency – a sense that we can take the necessary actions to address what concerns or troubles us – to accomplish our hopes, ambitions, and dreams. How can we help people transform their stories and create a conversational space that enhances hope and possibilities? Solution-Focused brief therapy (SFBT) can be thought of like a new language requiring fluency and skills different from the native problem-solving language we are all fluent in.

SFBT is a future-focused, goal-directed approach to brief therapy. The developers meticulously observed hundreds of therapy sessions, carefully noting which questions proved to be most consistently linked to clients’ subsequent reports of progress. These questions were then incorporated into the solution-focused approach. (More Than Miracles, de Shazer et al.).

Let’s get started on the Top Ten Solution-Focused Translations!

#10: The Indirect Compliment: How did you do it?

Let’s look at this lovely question. How conveys “in what manner? By what means?” Notice the question is not “Did you do it?” but instead “HOW” did you do it. Did (observe it is past tense), conveys they have done it already. Noticing with clients what they have already done enhances a sense of self-efficacy because they have already accomplished it. The second verb “to do” (to accomplish, perform and execute) conveys past success. How are problems (or as I like to translate “challenges”) solved? It requires action or the verb “to do.” Most of us are less fluent in the use of the indirect compliment, which is in the form of a question, and have greater ease when providing “direct compliments” such as “Wow” or “Congratulations.” Listening for opportunities to compliment clients based on their complaints (and who doesn’t love to complain) with indirect compliments is a powerful question to enhance self-efficacy and hope. What the heck – try asking the indirect compliment with your patients, colleagues, children, loved ones. I assure you no harm will be done!

#9: What are your best hopes?

This is the solution-focused translation of the chief complaint (What brought you here). The question is not “do you have hopes?, But rather “What” are your best hopes. It is hopeful, future-directed and creates a narrative which communicates to clients their competence and hopes to live a more satisfying life on their behalf.

#8: What else? How else? Who else?(Three for the price of one)

Effective solution-building requires getting as many details as possible about prior successes. These questions leave no potential strength uncovered and are the metaphorical “language shovels” that dig for the details of success. What else are you good at? How else did you do it? How else was it helpful? Who else is most important to you?

#7: Who are the most important people in your life and what do you most appreciate about them?

All people live in relationships. Relationships are not only crucial for survival but also essential resources that help people solve their problems. Problems are solved in one of two ways. Either the problem is solved, or the client and those most important to them no longer view the behaviors as problematic. For “challenges” to be considered solved, the client’s system must be in agreement that there are no significant problems. What better way to learn who is important to your client than to ask.

#6: What do you know?

What do you know conveys that clients have knowledge, understanding and a recognition of what is important in their life. Asking clients what they know about marijuana, medications, their diagnosis attests to their competence. One of my favorites is to ask parents “What do you know about your child that tells you they will succeed in life?” It has continually amazed me that parents are always able to answer this question no matter how dire the situation appears.

#5: Have you ever had to cope with trauma, domestic violence, hurricanes, homelessness, mudslides, poverty, loss, death, etc. ?

Incorporating the one-word “cope” within the question demonstrates that your client has coped. If they say yes, my next question is “How have you coped?” When clients are sitting in front of you talking, they have indeed coped. Remember that cope is one letter away from hope.

#4: You must have a good reason?

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 ways they are useful and beneficial for them. The question does not condone the behavior but instead helps to understand the client’s motivation to do what they are doing. This can help lead the conversation towards alternatives.

#3: Was it different for you?

Noticing positive differences, also known as exceptions, are times when an expected problem could have occurred but didn’t. Positive differences often go unnoticed by clients. Meticulously paying attention to these differences often discovers past successes.

#2: On a scale from 1-10, where ten is you are satisfied, and things are good enough, and one is the opposite, where would you say you are?

Scaling questions can minimize language confusion that often occurs within conversations. They are quick, easily adaptable and client-centered. Solution-Focused scaling questions are constructed in such a way that the 10 highlights a positive direction of where the clients want to move forward (i.e.) confidence in ability, satisfaction with relationships, ability to keep safe, or helpfulness of medications. Asking what keeps the number from being lower (and what else) often uncovers further undiscovered strengths and past successes. It is one of many potential amplifying questions used to “work the scale” and often leads to more possibilities to compliment and bring to light more past successes.

#1: What are you good at and enjoy?

This question affords your client an opportunity to talk about parts of their life going well and communicates they are more than their presenting problem. These strengths are essential resources that would otherwise often be undiscovered within the conversation and are critical resources that can often assist them in solving their problem. Investigating details by asking how they learned the skills; what else they are good at and how else they learned these skills recognizes a client’s expertise and mastery expanding the narrative of their accomplishments and abilities.

De Shazer, Steve, et al. More than Miracles: the State of the Art of Solution-Focused Brief Therapy. London, Routledge, 2012.

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

Lutz, Anne Bodmer. Learning Solution-Focused Therapy: an Illustrated Guide. Arlington, VA, American Psychiatric Publishing, a Division of American Psychiatric Association, 2014.

Anne Bodmer Lutz, B.S.N., M.D.

Anxiety is a common occurrence for children and adolescents with lifetime prevalence rates ranging from 2.6% to 20%. Children and adolescents coping with anxiety may experience lower achievement, difficulties with social and emotional functioning, depression, and substance use disorders. There are many examples of how anxiety presents with youth: school refusal, anxiety when transitioning from middle school to HS, from HS to college, and from college to becoming a working adult, fears of separation and illness of loved ones, somatic symptoms such as headaches, stomachaches, discomfort in social situations, intense fear that occurs unexpectedly, panic attacks, obsessions and compulsions.

Solution-Focused Brief Therapy is an effective treatment approach for youth managing anxiety. The goal of this article is to demonstrate how to apply solution-focused techniques with youth coping with anxiety and how these strategies can provide an additive dimension to the problem-focused treatments typically utilized.

Traditional problem-focused Cognitive Behavioral Treatment (CBT) of anxiety addresses deficits in coping with both children and parents such as avoidance, distraction, rumination, self-blame and catastrophizing. There is a focus on education about anxiety, threat overestimation and the use of fear hierarchies, cognitive restructuring, problem-solving, and contingency management. Parental anxiety, “over-controlling” parenting behaviors and parental accommodation are additional areas of focus. The classic CBT triangle focuses on the interaction of thoughts, feelings, and behaviors.

Some Specific Solution-Focused Approaches in the treatment of Anxious Youth

Commencing with Competencies: Commencing with strengths is especially important for youth coping with anxiety. Activating resources from the onset of the conversation by exploring what they enjoy and are good at creates a narrative in which the client views themselves as more than their presenting problem. For example, one client who presented with severe anxiety and was refusing to go to school talked about her love for her animals and biking. She was unique in her ability to bond with her snake, and in her skill riding dirt bikes with her older brother. Taking time to explore these “problem-free” areas was essential and not a waste of time, exemplifying positive behaviors (actions) in which she was able to courageously approach situations that are typically challenging for many others.

Complimenting: Children and adolescents experiencing anxiety frequently present with significant distress. Children in distress often generate anxiety and concern on the part of their parents. Parents try their best to support their child, but this often presents as reassurance, accommodations and frequent texting and phone calls. It is important to compliment parents on their efforts to remain calm, demonstrate empathy, maintain consistent limits and get their child to school despite the child’s level of discomfort. Asking about the specific details of how they managed to get their child on the bus, to school, refrain from texting them, while at the same time successfully managing their anxiety helps strengthen parental confidence and competence in supporting their child. These kinds of compliments can impart much-needed energy and stamina to both youth and families, enabling them to persevere when they are feeling exhausted and overwhelmed.

For You Statements: Integrating the words “for you” into responses to clients is a language technique that serves to quickly and easily communicate empathy. “For you” statements can be used in several different ways, helping to build emotional agreement within the conversation, while providing validation and acknowledgment of the client’s situation and feelings. Clients and families who are coping with anxiety and panic are experiencing significant distress, and this is critical to acknowledge. Some examples of “For You” statements include how scary and frightening it must be “for you” to see your child struggling with anxiety. For the adolescent, this may take the form of acknowledging how difficult it must be “for you” to be having these experiences, how frustrating it must be “for you” to be forced to go to school, and how uncomfortable it is to be experiencing such distress. “For you” statements can also be used to acknowledge positive client experiences, such as how exciting it must “for them” to be making progress towards their goals, to make it to school and experience academic and social successes. Positive “for you” statements reinforce with clients that what they are doing that is working for them.

Positive Differences/Exceptions: Listening for and discovering positive differences when youth are having some measure of success is crucial. These may include times when they can approach and “do” things that are challenging. Acknowledging and appreciating how children managed to get to school even 1 out of 5 days, or even part of a day, made a decision even if seemingly small, slept in their own bed for part of the night, talked to people even if for only brief moments, tried something new, no matter how small, tolerated uncomfortable feelings even if for a short-lived amount of time. While these moments could easily go unnoticed, they are the very times that are crucial to amplify. It is especially important to explore whether these actions constitute differences for the parents and children. If so, how were they different? Were they helpful for them? How were they helpful? How did they do it? How else? (Notice how the use of the past tense (how “did” they do it) highlights accomplishments clients has already had success with and further builds their sense of self-efficacy.)

Best Hopes: Inviting clients to talk about their “best hopes” for treatment and asking how you can be most helpful for them so that meeting with them is worthwhile maintains the focus on what the client wants, their desired outcome. For example, “to not feel so stressed,” ” feel comfortable going to school,” ” be able to sleep in their own bed,” ” be better able to make decisions,” ” not have panic attacks,” ” make more friends,” ” not pull at their hair.” The list is endless and unique just as clients are each unique.

After eliciting a client’s best hopes, the question then becomes how to help clients achieve their goals. What do they need to make their best hopes come to fruition? Moving from best hopes to solutions takes actions (doing). “Doing” means explicitly helping clients discover outward actions such as trying to speak up a few more times in class, attempting to talk to someone new, or staying in their own bed a little longer. These “outwardly doing” actions are best discovered from the client and what they have already tried and know about themselves. The word “do” can also include what clients are thinking, what they are saying inwardly to themselves, and how they are managing uncomfortable feelings. It can also include a conversation about what their VIPs have noticed they have done and what they know about them that has already helped them achieve their goal.

In solution-focused therapy, most of the “actions” come from the client as well as their social context, those most important in their lives. Discovering client based “actions” and solutions does not mean a clinician refrains from offering possible action steps that they think may be helpful for the client. Rather these suggestions come much later in the conversation, and only after there has been detailed questions about what the client has already done and knows they need to do to meet their goals.

Ericksonian idea epitomized by his adage “The patient knows the solution to his problem, he only does not know that he knows”.

Solution-Focused Triangle Approach to the Treatment of Anxiety

The following is an explanation of how I have adapted a Solution-Focused Triangle approach for the treatment of anxiety. I begin by exploring the client’s best hopes for today’s session. If clients use the word “anxious,” I make sure to explore what they mean by this word. It can mean many different things to people and taking the time to understand what it means for them is important when building a shared dialect. Exploring what they have tried to manage their anxiety suggests they have been trying their best to deal with their difficulties.

Providing education about how anxiety is a common occurrence for all humans (and mammals) and normalizing the fight or flight response helps youth feel they are “not alone” in their distress, and how anxiety “worry” can be a protective mechanism.

Use of Small Index Cards:
I begin by drawing a triangle on one side of a small index card and a scale from 1-10 on the opposite side, where ten is they are managing their anxiety in a satisfactory “good enough” way, and 1 is the opposite. The front side of the index card addresses the three core focal points when successfully managing anxiety:

1: What they are “doing” to approach challenging situations
2. What they are doing to manage and tolerate uncomfortable feelings while still approaching challenging situations
3. What helpful self-talk and helpful questions do they ask themselves to assist in approaching their unique, challenging situations?

The back of the card has the scale from 1-10. I also use scaling to create courage hierarchies (instead of fear hierarchies). I find that children are more inclined to be able to answer “Are you up for the challenge of making a courage hierarchy? We then list from 1-10 courage challenges with one being the easiest and ten the most challenging. I ask them where they are at now. If it is higher than a 1, we explore how they managed to overcome the challenge, how ready they are to try the next challenge (from 1-10) and how confident they are that they can try their best to overcome this challenge.

Following our discussion of discovered hopes and skills, I give the card to the client and also make a copy for my chart. Often clients will put the card in a special place and bring it back to the next session on their initiative.

I provide clients the analogy of how airline pilots face an emergency. Pilots don’t “wing it,” but instead refer to their emergency checklists. When people feel they are in danger, their amygdala gets shaken up. And when your amygdala is shaken up it is challenging to think clearly. Having this index card available assists clients in remembering what to do and check on when they are having “psychic emergencies.”

The importance of sleep: I also make sure to ask about sleep.

• How satisfied are you with your sleep from 1-10, where ten is the best?
• What is good enough?
• When was it last good enough?
• What have they tried to do to help them sleep?

Sometimes simple things can be very effective in helping improve sleep such as getting on a regular sleep schedule, turning off electronics an hour before bedtime, limiting caffeine, to name a few. The important point is to assess sleep satisfaction. Without good sleep, it is difficult to calm the amygdala and manage anxiety.

The Solution-Focused Triangle Approach for Treatment of Anxiety

OVERALL GOAL NEGOTIATION (BEST HOPES)

• What are your best hopes for today?
• What are your best hopes that would tell you that you are managing your anxiety in a way that is “good enough” and “satisfactory” for you?
• What will you be doing when you are managing “good enough”?
• What else will you be doing?
• What will your VIPS notice you are doing? What else will they notice you are doing?
• What have you tried to do to manage your anxiety?
• What has been most helpful?

DOING (APPROACHING)
Supposing we made a list of challenges to approach that would tell you that you are managing your anxiety what would you be doing?

What else would you be doing? What else?

(i.e.) Going to school, getting my homework done, talking to teachers, staying in class, calling people on the phone, trying a new activity, studying for tests, starting on homework sooner, writing in my agenda, talking to one friend at school, managing unexpected situations.

What would others notice you are doing that tells them you are managing your anxiety?

What else? What else?

Scaling Approaching Challenging Situations:

• Supposing ten is you are satisfied with how well you have approached situations that are challenging for you and one is the opposite, where would you say you are now?
• What is a good enough number?
• What is the highest number it has been?
• What keeps it from being lower?
• What else?
• What number would your VIPS give you regarding your ability to approach situations that are challenging for you?
• What would be the next step that would tell you that number went up by one point?

HELPFUL SELF-TALK AND HELPFUL QUESTIONS THAT ASSIST IN YOU APPROACHING/”DOING” CHALLENGES

What are your best hopes that would tell you that you are managing your anxiety? What do you want?
What else?

• (i.e.) I want to be able to graduate to the next grade
• I want to spend time with friends
• I want to be successful
• I want to go to school and enjoy it
• What questions could you ask yourself that you think would be helpful for you in approaching your challenges?
• Is it going to help me to stay at home?
• What have I done when I’ve made it to school before?
• In what ways have I successfully managed my OCD symptoms?
• What has helped me calm down?
• What would I say to my friends in this situation?

MANAGING/TOLERATING UNCOMFORTABLE FEELINGS

What have I done to manage uncomfortable feelings?
What else? What else?

(i.e.) Take a walk, acknowledge feelings are uncomfortable, but not dangerous, practice deep breathing and smiling, practice breathing and counting, remind myself that uncomfortable feelings usually last 10 minutes and then pass and what have I done to tolerate them before?

SCALING THE TRIANGLE

For each of the points on the triangle I scale where they are:

DOING/APPROACHING:

• How satisfied are you with your ability to approach challenging situations where ten is the best and one is the opposite?
• What is a good enough number?
• What keeps it from being lower? What else?
• What number would your VIPS say you are at? What number would they say would be “good enough”?
• What would you be doing when it goes up by one point? What else?
• How confident are you that you can try your best to raise it by one point?

HELPFUL SELF-TALK AND QUESTION:

• How satisfied are you with your ability to ask yourself helpful questions and tell yourself helpful statements that will encourage you to approach the challenging situations we discussed?
• What is a good enough number?
• What’s the highest it has been?
• What number would your VIPS give you?
• What would you be doing when that number goes up by one point?
• How confident are you that you can try to raise that number by one point from 1-10?

MANAGING UNCOMFORTABLE FEELINGS:

• How satisfied are you with your ability to manage your uncomfortable feelings so that you can approach the challenges you hope to achieve?
• What is a good enough number?
• What is the highest it has been?
• What keeps it from being lower? What else?
• How well would your VIPS say you are managing your uncomfortable feelings so that you can approach the challenges you hope to achieve from 1-10?

By Richard Kahn, Ph.D., MS, RD
Specializing in Infants, Children, and Families
RichardKahnNutrition.com | Facebook page is RichardKahnNutrition

Solution-Focused brief therapists use lists. We make lists every time we keep track of positive exceptions or explore the details of exceptions, e.g., “is there anything or anyone else?” Lists are especially useful when applying SFBT in the nutrition context. Shopping lists or menus transform into insight with an SFBT approach to nutrition.

Lists have incantatory power. Lists poems take advantage of this rhetorical power. Poetry teacher, Betsy Franco, says list poems are easy to write, repetitive, conventional all in the context of personal interests and passions. SFBT lists tap into the personal and passionate by detailing routines as they lead clinicians to ask more questions and open up windows into strengths. Co-creating the list can effect catharsis which is the purpose of poetry.

The Bible contains an early example of a list poem in the story of creation which counts the days of the week. This story progresses from chaos to the sublime order of rest and sufficiency. At the end of the first seven days, God has created a “yes set” by declaring the work “good.” Looking closer, God compliments Himself often by repeating the word “good” and does not use the word “perfect.”

Lists in Nutrition

Food lists are utilized by nutritionists under the terms diet histories, food frequencies and “food recalls”. These lists become long once we include ingredients, ethnic, health or religious concerns. Detail is paramount with some health concerns.

Nutritionists trained in SFBT view their patients’ food lists through a second lens, searching for the strengths, VIPs, positive exceptions and surprise comments. What SFBT recalls lose in detail, they gain in creating insight. Rather than focusing on every detail of food consumption, SF nutritionists co-create food recall lists with their patients within individual emotional and social frames.

Because food is intimately linked to daily experience and deep emotions co-created SFBT food recall lists intentionally jog pleasant and stressful food memories. The resulting co-created food “poems” often lead to inspiration, helping the patient to identify and experience ‘good’ things regardless of whether the list is perfect. In the Pragmatics of Hope, Yvonne Dolan suggests that such lists let clients see their own wishes and abilities.

SFBT “diet recalls” balance the need for technical information and behavior change. After patients present their seeming incoherent lists, dietitians can group the foods to demonstrate that a given diet, even a diet circumscribed by health condition, economics, and custom, may correspond at least to some degree, to nutritional norms.

As a dietitian, parents often tell me that their child eats few foods or vegetables. Usually, however, a list eventually gets long enough to satisfy the parents. However long they take to make, lists typically shake up the patient’s’ original views. Making a list can shift a parent’s limbically charged view of their child’s food habits into a calmer and more logical “frontal lobe” perspective. The pursuit of minutiae, according to Dolan, helps people remind themselves about existing successes. In my experience, her view is useful even when developmental delays cloud abilities or challenge normative views of children’s diets. Achieving a “good enough” diet can be a cathartic experience for parents simultaneously relieving worries and satisfying the need to be good, not perfect, nurturers.

For example, here is what happened in a workshop for parents of special needs children, aged 3-5 years, with most of the children on the autism spectrum. Children on the autism spectrum frequently have extremely limited diets. Limited diets lead to additional parental stress. The parents may see no “good” in their creation’s diet. The child may not even eat a tempting treat making mealtime socializing one more challenge.

The workshop proceeded with questions and answers about feeding and nutrition framed within the standard developmental guidance that usually helps parents at the table. One couple from this group volunteered to tell me what foods their child ate. At first, the list was maybe ten foods. As more parents began to participate, the volunteer parents kept chiming in with more foods their child routinely ate. By the end, the child had a less limited diet than first expressed and demonstrably ate at least a few foods from all food groups. The class triggered a sparkling moment. Another parent stood up with tears in her eyes, affirming how she had not realized until now that she was, in fact, doing a good job of nurturing her delayed child. Her listing had created the insight.

It may take skill, time and digressions for memory jolts and as if by chance to create a list of foods for a person with a limited diet. Stressed parents, especially, become chronically preoccupied with the chaos of frustrations instead of the facts of rest. Sticking with the ‘what else,’ ‘with whos,’ and positive exceptions can prove worthwhile, providing the time to create meaningful contexts to reveal what is clinically important for the patient.