Roger Horbay

Solution-focused brief therapy (SFBT) is a therapeutic approach that regards therapy as a process whereby the client and counsellor construct a reality of healthy gambling behaviour or abstinence from gambling.

SFBT is compatible with several counselling techniques, as its primary emphasis is to assist clients to better use their own existing strengths and competencies. As noted earlier, a primary characteristic of gamblers is low or ambivalent motivation. SFBT focuses on strengths, solutions and a more favourable future that inspires clients and promotes empowerment. Client goals are well formed (small, salient, specific and achievable) and questions and responses are carefully punctuated to build or highlight a positive reality that will facilitate these goals.

SFBT allows the counsellor to start searching for solutions immediately, even when the gambler or family is in crisis. It provides tools for assisting the client in exploring all options, for working through ambivalence and for developing workable alternatives for excessive gambling. The following was adapted from Working with the Problem Drinker: A Solution-Focused Approach.

SFBT Philosophy

The central philosophy of SFBT can be summed up in three rules of thumb: Rule 1: If it isn’t broken, don’t fix it. Rule 2: If it’s working, do more of it. Rule 3: If it’s not working, do something different. (Berg & Miller, 1992. p. 17) These pragmatic guidelines help counsellors evaluate their clinical work while working with people affected by problem gambling.

Below are useful questions for guiding the counsellor through treatment sessions:

• Am I focusing on the problems presented by the gambler, such as difficulties with poker playing, or am I getting off-course because I’m pushing my own agenda (e.g., total abstinence)? (Rule 1)
• How can I assist and motivate the client to continue doing what’s effective? (Rule 2)
• Even small changes can lead to larger changes. So, any reduction in frequency and time spent gambling or amounts of money spent, are improvements to be encouraged.
• What can I do differently if the client is not responding? (Rule 3)
• If the client isn’t responding and taking action on stated goals, maybe the goals of treatment need to be re-evaluated. Often gamblers have their own agendas that simply need to be coaxed into the open. Begin by working with what the client feels is important. That will go a long way to keeping the client in treatment.

SFBT Assumptions

Along with the central philosophy, SFBT makes several assumptions that counsellors can use to guide their interactions with the client:

• Change is inevitable and constantly occurring.
• Focusing on the positive, the solution and the future facilitate change.
• The client is the “expert.”
• It’s not necessary to assess or diagnose the problem before being able to help.
• You don’t need to know a great deal about a problem in order to solve it.
• Only a small change may be necessary.
• No problems happen all the time.
• Individuals have strengths and resources they need to change.
• There are many ways to look at a situation. None is more correct than the others.

Levels of Therapeutic Relationship

SFBT conceptualizes the process of change by categorizing types of client counsellor relationships. Identifying the type of client-counsellor relationship has two main benefits. First, it reminds the counsellor that treatment outcome depends on teamwork with the client. Second, it helps determine which therapeutic intervention is most likely to result in increased client participation in changing. SFBT proposes three different types of client: the visitor, the complainant and the customer.

Visitors: are gamblers who have no clear problem or goal and who may be seeking treatment as a result of urgings from others. These clients are often ambivalent about changing their gambling behaviours. It is best to simply explore why they are seeking help and to empathize with their difficulties. Offer a safe atmosphere and invite them to return if they want further help.

Complainants: are clients who are aware that there is a problem. They may be able to identify goals but lack the motivation to act, often because they believe that others are the problem and that people don’t understand why they gamble. They believe their gambling can lead to good, if only others would leave them alone. The best intervention with complainants is to listen and empathize with their plight. Let them know you understand them but encourage them to reflect on why others think they have a problem.Ask them to think about why they gamble. Invite them back for further discussions.

Customers: are ideal but rare clients. They understand their problems and have clear goals. They take responsibility and are motivated to change. The best intervention here is to encourage them and give them behavioural tasks such as focusing on relapse prevention strategies.

SFBT Techniques

The question for the counsellor is “what in these approaches can I integrate with how I work as a therapist now?” Solution-focused techniques are not intended to be a bag of tricks but rather well-articulated expressions of attitude, posture and philosophy. Integrated into a clinical approach with gamblers, these methods can contribute to highly successful outcomes.

people affected by problem gambling typically don’t want psychotherapy. Most tend to be high-functioning and lead busy, active lives. SFBT is effective because it gives clients a sense of making progress right from the first session by immediately entering into goal-setting (rather than an in-depth exploration of family history and personal problems) with the client. In doing so, SFBT focuses on client strengths and on future possibilities.

Useful questions at initial contact
During the initial contact with gamblers, these typical questions invite the client to describe his or her problems and goals:

• “What brings you here today?”
• “How can I help?”
• “What would need to happen here today in order for you to know it was a good idea to come?”

These questions are effective because they evoke a greater depth of response in the client. Rather than assuming the client came to quit gambling, they encourage him or her to articulate why he or she came to therapy. This is questioning that is client-centred and respectful. Furthermore, it helps the therapist understand how the client perceives the role of the therapist.

Pre-session change questions
Another kind of question is one that seeks to outline any pre-session change that may have occurred. For example:

• “What has been different or better since you made the decision to come here today?”

This question recognizes that the client is already making an effort toward positive change by asking for help. When a client books an appointment you may want to give him or her a task such as:

• “Be aware of the positive things you are doing before our first meeting and we can talk about them when you come in.”
• “Be aware of the positive things you do when a trigger evokes in you an urge to gamble and you decide not to.”

These questions set the stage for the client to focus on positives and the solution right from the start.

The miracle question

One of the most powerful techniques developed by Berg and de Shazer is The miracle question:

• “Suppose that tonight, while you are asleep, a miracle happens. As a result of this miracle, all of the problems that brought you here today are gone. But, because you were sleeping, you don’t know a miracle has happened and the problems are now solved. What is the first thing you will notice that will tell you something is different?”

The miracle question is an effective tool because it helps clients set goals even when they are in crisis and feel stuck. Framed as unrealistic, the miracle question helps the client feel less threatened about expressing what he or she wants. Examples of responses that people affected by problem gambling may give in response to the miracle question include:

• “I wouldn’t be gambling anymore.”
• “I would have time to spend with my family.”
• “My financial situation would be back to how it was before I began gambling.”

The client and counsellor use the client’s responses as forms of concrete end goals for therapy.

Quantifying questions

These questions are particularly effective for clients who see things in visual, concrete terms.When in crisis, however, clients are often unable to see the steps between their current situations and their goals. As the therapist asks, “On a scale of 1 to 10, where 10 is your goal and you have placed yourself at a 3, what do you think it would take to move you to a 4?” the goal(s) that were established earlier in treatment are broken down into smaller, more concrete steps. Clients then begin to see realistic, achievable goals that move them toward their greater goal(s).

Counsellors often use the scaling question to help a client realize he or she is already making progress (such as leaving a credit card at home). In this instance, a counsellor may say, “You intentionally left your credit card at home yesterday.Where on the scale do you think that puts you?” Following are examples of quantifying questions using scaling and percentages.

Use: to construct criteria for improvement and to measure change.

• “On a scale of 1 to 10 (10 means that you have total control over your impulses to gamble, and 1 means you have no control), where are you now?”
• “Realistically, where on the scale do you want to be?”
• “What would you need to do in order to move up one point on the scale?”

Use: to measure therapeutic processes such as motivation and confidence:

• “On a scale of 1 to 10 (10 means “I’ll do anything” and 1 means “I couldn’t care less”), how willing are you to solve your gambling problem?”
• “What small step can you take to increase your willingness?”
• “On a scale of 1 to 10, where 10 indicates confidence and 1 indicates hopelessness, how confident are you that you can overcome your gambling problem?”
• “What small step can you take to increase your confidence?”

Use: Percentage questions can also be used to find exceptions to problems:

• “What percentage of the time do you feel you have control over your gambling problem?”
• “What percentage would you be comfortable with?”

Relationship questions

Client responses can be enhanced through the use of relationship questions, which expand the details of the solutions and make them relevant to the client’s life:

• “If your partner were here, what would he or she say would be a miracle?”
• “What will your partner notice that will tell him or her that a miracle has happened?”
• “What would your partner be doing differently if you did not have a gambling problem?”
• “What will other people notice?”

The effectiveness of relationship questions lie in the following functions:

• Introduce different perspectives to the problem gambler’s situation.
• Help the client step into another’s shoes.
• Help the client recognize that his or her behaviour affects someone else.

Homework

The work that the client continues to do outside the counselling office is as important as work done with the therapist. Furthermore, it allows clients to take responsibility for changing their own behaviour. Homework tasks vary depending on the client’s motivational stage and what the client has outlined as a goal (through the miracle question). If a client is a customer, he or she may benefit more from “doing” tasks and if one of the client’s goals is to increase his or her physical health, he or she may go to the gym rather than the casino.

Tasks must have a clear rationale and be driven by what the client needs to work on. Complainants tend to benefit from being assigned thinking tasks. If the client has a tendency to notice negatives in his or her relationships, ask him or her to make a mental note of all the positives or to notice any little thing that indicates “your partner trusts you.” If a client is working on relapse prevention, one task may be: “Only carry with you a very small amount of cash and no credit cards and note what happens.”

Using presuppositional language

Careful attention to the use of language is an integral part of SFBT. The use of presuppositional language can convey possibilities or expectations of a positive outcome:

• “How did you do that?” rather than “How did that happen?”
• “What will be different when you are feeling in control of your gambling?” rather than “What would be different if you are feeling in control of your gambling?”

Compliments

Compliments, a primary source of feedback with sfbt, are a very effective way of orienting clients toward their resources and strengths. Gamblers may be very demoralized due to long-term multiple losses and believe that they are indeed “losers.” Sincerely complimenting clients on their new positive behaviours and affirming how difficult the client’s problems are can be very helpful for boosting moral and motivation. Indirect compliments are also very helpful:

“WOW! REALLY? How did you manage that?”

A Solution-Focused Case Study

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