焦点解决疗法三技巧强化目标达成

英文原文

What is Solution-Focused Therapy: 3 Essential Techniques Imagine this scenario: You work at a company that produces widgets. You’re at an important business meeting, and you’re there to discuss some problems your company is having with its production. At the meeting, you explain what’s causing the problems: The widget-producing machine your company uses is getting old and slowing down. The machine is made up of hundreds of small parts that work in concert, and it would be much more expensive to replace each of these old, worn-down parts than to buy a new widget-producing machine. You are hoping to convey to the other meeting attendees the impact of the problem, and the importance of buying a new widget-producing machine. You give a comprehensive overview of the problem and how it is impacting production. One meeting attendee asks, “So which part of the machine, exactly, is getting worn down?” Another says, “Please explain in detail how our widget-producing machine works.” Yet another asks, “How does the new machine improve upon each of the components of the machine?” A fourth attendee asks, “Why is it getting worn down? We should discuss how the machine was made in order to fully understand why it is wearing down now.” You are probably starting to feel frustrated that your colleagues’ questions don’t address the real issue. You might be thinking, “What does it matter how the machine got worn down when buying a new one would fix the problem?” In this scenario, it is much more important to buy a new widget-producing machine than it is to understand why machinery wears down over time. When we’re seeking solutions, it’s not always helpful to get bogged down in the details. We want results, not a narrative about how or why things became the way they are. This is the idea behind solution-focused therapy. For many people, it is often more important to find solutions than it is to analyze the problem in great detail. This article will cover what solution-focused therapy is, how it’s applied, and what its limitations are. What Is Solution-Focused Therapy? Solution-focused therapy, also called solution-focused brief therapy (SFBT), is a type of therapy that places far more importance on discussing solutions than problems. Of course, you must discuss the problem to find a solution, but beyond understanding what the problem is and deciding how to address it, solution-focused therapy will not dwell on every detail of the problem you are experiencing. Solution-focused brief therapy doesn’t require a deep dive into your childhood and the ways in which your past has influenced your present. Instead, it will root your sessions firmly in the present while working toward a future in which your current problems have less of an impact on your life. This solution-centric form of therapy grew out of the field of family therapy in the 1980s. Creators Steve de Shazer and Insoo Kim Berg noticed that most therapy sessions were spent discussing symptoms, issues, and problems. De Shazer and Berg saw an opportunity for quicker relief from negative symptoms in a new form of therapy that emphasized quick, specific problem-solving rather than an ongoing discussion of the problem itself. The word “brief” in solution-focused brief therapy is key. The goal of SFBT is to find and implement a solution to the problem or problems as soon as possible to minimize time spent in therapy and, more importantly, time spent struggling or suffering. SFBT is committed to finding realistic, workable solutions for clients as quickly as possible, and the efficacy of this treatment has influenced its spread around the world and use in multiple contexts. SFBT has been successfully applied in individual, couples, and family therapy. The problems it can address are wide-ranging, from the normal stressors of life to high-impact life events. The only realm in which SFBT is generally not recommended is that of the more extreme mental health issues, such as schizophrenia or major depressive disorder. Popular Techniques and Interventions While some of these techniques are used specifically in SFBT, others have applicability to a wide range of therapies, or even to individuals working on solving their problems without the guidance of a therapist. Working with a therapist is generally recommended when you are facing overwhelming or particularly difficult problems, but not all problems require a licensed professional to solve. For each technique listed below, it will be noted if it can be used as a standalone technique. Questions Asking good questions is vital in any form of therapy, but SFBT formalized this practice into a technique that specifies a certain set of questions intended to provoke thinking and discussion about goal-setting and problem-solving. One such question is the “coping question.” This question is intended to help clients recognize their own resiliency and identify some of the ways in which they already cope with their problems effectively. There are many ways to phrase this sort of question, but generally, a coping question is worded something like, “How do you manage, in the face of such difficulty, to fulfill your daily obligations?” Another type of question common in SFBT is the “miracle question.” The miracle question encourages clients to imagine a future in which their problems are no longer affecting their lives. Imagining this desired future will help clients see a path forward, both allowing them to believe in the possibility of this future and helping them to identify concrete steps they can take to make it happen. This question is generally asked in the following manner: “Imagine that a miracle has occurred. This problem you are struggling with is suddenly absent from your life. What does your life look like without this problem?” If the miracle question is unlikely to work, or if the client is having trouble imagining this miracle future, the SFBT therapist can use “best hopes” questions instead. The client’s answers to these questions will help establish what the client is hoping to achieve and help him or her set realistic and achievable goals. The “best hopes” questions can include the following: * What are your best hopes for today’s session? * What needs to happen in this session to enable you to leave thinking it was worthwhile? * How will you know things are “good enough” for our sessions to end? * What needs to happen in these sessions so that your relatives/friends/coworkers can say, “I’m really glad you went to see [the therapist]”? To identify the exceptions to the problems plaguing clients, therapists will ask “exception questions.” These are questions that ask about clients’ experiences both with and without their problems. This helps to distinguish between circumstances in which the problems are most active and the circumstances in which the problems either hold no power or have diminished power over clients’ moods or thoughts. Exception questions can include: * Tell me about the times when you felt the happiest; * What was it about that day that made it a better day? * Can you think of times when the problem was not present in your life? Another question frequently used by SFBT practitioners is the “scaling question.” It asks clients to rate their experiences (such as how their problems are currently affecting them, how confident they are in their treatment, and how they think the treatment is progressing) on a scale from 0 (lowest) to 10 (highest). This helps the therapist to gauge progress and learn more about clients’ motivation and confidence in finding a solution. For example, an SFBT therapist may ask, “On a scale from 0 to 10, how would you rate your progress in finding and implementing a solution to your problem?” Do One Thing Different This exercise can be completed individually, but the handout may need to be modified for adult or adolescent users. This exercise is intended to help the client or individual to learn how to break his or her problem patterns and build strategies to simply make things go better. The handout breaks the exercise into the following steps: Step One * Think about the things you do in a problem situation. Change any part you can. Choose to change one thing, such as the timing, your body patterns (what you do with your body), what you say, the location, or the order in which you do things; * Think of a time that things did not go well for you. When does that happen? What part of that problem situation will you do differently now? Step Two * Think of something done by somebody else does that makes the problem better. Try doing what they do the next time the problem comes up. Or, think of something that you have done in the past that made things go better. Try doing that the next time the problem comes up; * Think of something that somebody else does that works to make things go better. What is the person’s name and what do they do that you will try? * Think of something that you have done in the past that helped make things go better. What did you do that you will do next time? Step Three * Feelings tell you that you need to do something. Your brain tells you what to do. Understand what your feelings are but do not let them determine your actions. Let your brain determine the actions; * Feelings are great advisors but poor masters (advisors give information and help you know what you could do; masters don’t give you choices); * Think of a feeling that used to get you into trouble. What feeling do you want to stop getting you into trouble? * Think of what information that feeling is telling you. What does the feeling suggest you should do that would help things go better? Step Four * Change what you focus on. What you pay attention to will become bigger in your life and you will notice it more and more. To solve a problem, try changing your focus or your perspective. * Think of something that you are focusing on too much. What gets you into trouble when you focus on it? * Think of something that you will focus on instead. What will you focus on that will not get you into trouble? Step Five * Imagine a time in the future when you aren’t having the problem you are having right now. Work backward to figure out what you could do now to make that future come true; * Think of what will be different for you in the future when things are going better; * Think of one thing that you would be doing differently before things could go better in the future. What one thing will you do differently? Step Six * Sometimes people with problems talk about how other people cause those problems and why it’s impossible to do better. Change your story. Talk about times when the problem was not happening and what you were doing at that time. Control what you can control. You can’t control other people, but you can change your actions, and that might change what other people do; * Think of a time when you were not having the problem that is bothering you. Talk about that time. Step Seven * If you believe in a god or a higher power, focus on God to get things to go better. When you are focused on God or you are asking God to help you, things might go better for you. * Do you believe in a god or a higher power? Talk about how you will seek help from your god to make things go better. Step Eight * Use action talk to get things to go better. Action talk sticks to the facts, addresses only the things you can see, and doesn’t address what you believe another person was thinking or feeling—we have no way of knowing that for sure. When you make a complaint, talk about the action that you do not like. When you make a request, talk about what action you want the person to do. When you praise someone, talk about what action you liked; * Make a complaint about someone cheating at a game using action talk; * Make a request for someone to play fairly using action talk; * Thank someone for doing what you asked using action talk. Following these eight steps and answering the questions thoughtfully will help people recognize their strengths and resources, identify ways in which they can overcome problems, plan and set goals to address problems, and practice useful skills. While this handout can be extremely effective for SFBT, it can also be used in other therapies or circumstances. Presupposing Change This is a handy technique for SFBT therapists and it doesn’t really apply to individuals who are not working with a therapist. The “presupposing change” technique has great potential in SFBT, in part because when people are experiencing problems, they have a tendency to focus on the problems and ignore the positive changes in their life. It can be difficult to recognize the good things happening in your life when you are struggling with a painful or particularly troublesome problem. This technique is intended to help clients be attentive to the positive things in their lives, no matter how small or seemingly insignificant. Any positive change or tiny step of progress should be noted, so clients can both celebrate their wins and draw from past wins to facilitate future wins. Presupposing change is a strikingly simple technique to use: Ask questions that assume positive changes. This can include questions like, “What’s different or better since I saw you last time?” If clients are struggling to come up with evidence of positive change or are convinced that there has been no positive change, the therapist can ask questions that encourage clients to think about their abilities to effectively cope with problems, like, How come things aren’t worse for you? What stopped total disaster from occurring? How did you avoid falling apart? A Take-Home Message Solution-focused therapy puts problem-solving at the forefront of the conversation and can be particularly useful for clients who aren’t suffering from major mental health issues and need help solving a particular problem (or problems). Rather than spending years in therapy, SFBT allows such clients to find solutions and get results quickly.

中文翻译

什么是焦点解决疗法：三种核心技巧 想象这样一个场景：你在一家生产小部件的公司工作。你正在参加一个重要商务会议，讨论公司生产遇到的问题。在会议上，你解释了问题的原因：公司使用的小部件生产机器老旧且速度变慢。这台机器由数百个协同工作的小部件组成，更换每个老旧磨损部件的成本远高于购买一台新机器。 你希望向其他与会者传达问题的影响以及购买新机器的重要性。你全面概述了问题及其对生产的影响。 一位与会者问道：“那么，机器的哪个部分确实磨损了？”另一位说：“请详细解释我们的小部件生产机器如何工作。”又一位问道：“新机器如何改进机器的每个组件？”第四位与会者问道：“为什么它会磨损？我们应该讨论机器的制造方式，以充分理解为什么现在会磨损。” 你可能开始感到沮丧，因为同事的问题没有触及真正的问题。你可能会想：“当购买新机器就能解决问题时，机器如何磨损又有什么关系？”在这个场景中，购买一台新的小部件生产机器比理解机器随时间磨损的原因重要得多。 当我们寻求解决方案时，陷入细节并不总是有帮助。我们想要结果，而不是关于事情如何或为何变成这样的叙述。 这就是焦点解决疗法背后的理念。对许多人来说，找到解决方案往往比详细分析问题更重要。本文将介绍什么是焦点解决疗法、如何应用及其局限性。 什么是焦点解决疗法？ 焦点解决疗法，也称为焦点解决短期疗法（SFBT），是一种更重视讨论解决方案而非问题的疗法。当然，你必须讨论问题以找到解决方案，但除了理解问题是什么并决定如何解决之外，焦点解决疗法不会纠结于你经历的每个问题细节。 焦点解决短期疗法不需要深入探讨你的童年以及过去如何影响现在。相反，它将你的会话牢固地扎根于当下，同时致力于一个未来，让你当前的问题对生活的影响减小。 这种以解决方案为中心的治疗形式起源于20世纪80年代的家庭治疗领域。创始人Steve de Shazer和Insoo Kim Berg注意到，大多数治疗会话都花在讨论症状、问题和困难上。 De Shazer和Berg看到了在新疗法中更快缓解负面症状的机会，这种疗法强调快速、具体的问题解决，而不是持续讨论问题本身。 焦点解决短期疗法中的“短期”一词是关键。SFBT的目标是尽快找到并实施问题解决方案，以最小化治疗时间，更重要的是，最小化挣扎或痛苦的时间。 SFBT致力于尽快为客户找到现实可行的解决方案，这种治疗的有效性影响了其在全球的传播和在多种情境中的使用。 SFBT已成功应用于个人、夫妻和家庭治疗。它能解决的问题范围广泛，从正常的生活压力到高影响的生活事件。 SFBT通常不推荐的唯一领域是更极端的精神健康问题，如精神分裂症或重度抑郁症。 流行技巧和干预措施 虽然其中一些技巧专门用于SFBT，但其他技巧适用于广泛疗法，甚至适用于在没有治疗师指导的情况下解决问题的个人。 当你面临压倒性或特别困难的问题时，通常建议与治疗师合作，但并非所有问题都需要持牌专业人士解决。 对于下面列出的每种技巧，将注明是否可用作独立技巧。 提问 在任何形式的治疗中，提出好问题都至关重要，但SFBT将这种做法形式化为一种技巧，指定了一组旨在激发关于目标设定和问题解决的思考和讨论的问题。 其中一个问题是“应对问题”。这个问题旨在帮助客户认识到自己的韧性，并确定他们已经有效应对问题的一些方式。 这种问题有多种表达方式，但通常，应对问题的措辞类似于：“面对如此困难，你如何设法履行日常义务？” SFBT中常见的另一种问题是“奇迹问题”。奇迹问题鼓励客户想象一个未来，其中问题不再影响他们的生活。想象这个期望的未来将帮助客户看到前进的道路，既让他们相信这种未来的可能性，又帮助他们确定可以采取的具体步骤来实现它。 这个问题通常以下列方式提出：“想象一个奇迹发生了。你正在挣扎的问题突然从你的生活中消失了。没有这个问题，你的生活是什么样子？” 如果奇迹问题不太可能奏效，或者客户难以想象这个奇迹未来，SFBT治疗师可以使用“最佳希望”问题代替。客户对这些问题的回答将有助于确定客户希望实现什么，并帮助他或她设定现实且可实现的目标。 “最佳希望”问题可以包括： * 你对今天的会话有什么最佳希望？ * 需要发生什么才能让你离开时觉得这次会话有价值？ * 你怎么知道事情“足够好”可以结束我们的会话？ * 需要在这些会话中发生什么，才能让你的亲戚/朋友/同事说：“我真的很高兴你去看[治疗师]”？ 为了识别困扰客户的问题的例外情况，治疗师会问“例外问题”。这些问题询问客户在有和没有问题时的经历。这有助于区分问题最活跃的情况和问题要么没有力量要么对客户情绪或思想影响减弱的情况。 例外问题可以包括： * 告诉我你感到最快乐的时刻； * 那天是什么让它成为更好的一天？ * 你能想到问题不在你生活中的时候吗？ SFBT从业者经常使用的另一个问题是“量表问题”。 它要求客户在0（最低）到10（最高）的量表上评估他们的经历（例如问题目前如何影响他们、他们对治疗的信心如何以及他们认为治疗进展如何）。这有助于治疗师评估进展并更多地了解客户寻找解决方案的动力和信心。 例如，SFBT治疗师可能会问：“在0到10的量表上，你如何评价你在寻找和实施问题解决方案方面的进展？” 做一件不同的事 这个练习可以单独完成，但手册可能需要为成人或青少年用户修改。 这个练习旨在帮助客户或个人学习如何打破他或她的问题模式，并建立策略让事情变得更好。 手册将练习分解为以下步骤： 第一步 * 思考你在问题情境中所做的事情。改变你能改变的任何部分。选择改变一件事，如时间、身体模式（你用身体做什么）、你说的话、地点或你做事的顺序； * 想到一个事情进展不顺利的时候。那是什么时候发生？你现在会以不同方式处理该问题情境的哪部分？ 第二步 * 思考别人做的让问题变好的事情。下次问题出现时尝试做他们做的事。或者，思考你过去做的让事情变好的事情。下次问题出现时尝试做那件事； * 思考别人做的让事情变好的事情。那个人的名字是什么，他或她做什么你会尝试？ * 思考你过去做的帮助让事情变好的事情。你做了什么下次会做？ 第三步 * 感觉告诉你需要做某事。你的大脑告诉你做什么。理解你的感觉是什么，但不要让它们决定你的行动。让你的大脑决定行动； * 感觉是很好的顾问但糟糕的主人（顾问提供信息并帮助你知道你可以做什么；主人不给你选择）； * 想到一个过去让你陷入麻烦的感觉。你想停止哪个感觉让你陷入麻烦？ * 思考那个感觉告诉你什么信息。那个感觉建议你应该做什么来帮助事情变得更好？ 第四步 * 改变你关注的东西。你注意的东西会在你的生活中变得更大，你会越来越多地注意到它。要解决问题，尝试改变你的关注点或视角。 * 想到你过度关注的东西。当你关注它时，什么让你陷入麻烦？ * 想到你会转而关注的东西。你会关注什么不会让你陷入麻烦？ 第五步 * 想象一个未来你没有当前问题的时刻。倒推找出你现在可以做什么来实现那个未来； * 思考当事情变得更好时，未来对你有什么不同； * 思考在事情未来变得更好之前，你会做一件不同的事。你会做哪一件不同的事？ 第六步 * 有时有问题的人谈论别人如何导致那些问题以及为什么不可能做得更好。改变你的故事。谈论问题没有发生的时候以及你当时在做什么。控制你能控制的。你无法控制别人，但你可以改变你的行动，这可能会改变别人的行为； * 想到一个你没有困扰你问题的时候。谈论那个时刻。 第七步 * 如果你相信上帝或更高力量，关注上帝让事情变得更好。当你关注上帝或请求上帝帮助你时，事情可能会对你变得更好。 * 你相信上帝或更高力量吗？谈论你将如何寻求上帝的帮助让事情变得更好。 第八步 * 使用行动谈话让事情变得更好。行动谈话坚持事实，只处理你能看到的东西，不处理你认为另一个人在想或感觉什么——我们无法确定知道。当你抱怨时，谈论你不喜欢的行动。当你提出请求时，谈论你希望那个人做什么行动。当你表扬某人时，谈论你喜欢的行动； * 用行动谈话抱怨某人在游戏中作弊； * 用行动谈话请求某人公平玩耍； * 用行动谈话感谢某人做了你要求的事。 遵循这八个步骤并深思熟虑地回答这些问题将帮助人们认识到自己的优势和资源，确定克服问题的方式，计划和设定目标解决问题，并练习有用的技能。 虽然这个手册对SFBT非常有效，但它也可以用于其他疗法或情况。 预设改变 这是SFBT治疗师的一个方便技巧，不适用于不与治疗师合作的个人。 “预设改变”技巧在SFBT中具有巨大潜力，部分原因是当人们经历问题时，他们倾向于关注问题而忽视生活中的积极变化。 当你与痛苦或特别麻烦的问题斗争时，很难认识到生活中发生的好事。 这种技巧旨在帮助客户关注生活中的积极事物，无论多么微小或看似微不足道。任何积极变化或微小进步步骤都应被注意，以便客户既能庆祝胜利，又能从过去的胜利中汲取经验促进未来胜利。 预设改变是一种极其简单的使用技巧：提出假设积极变化的问题。这可以包括诸如“自从我上次见你以来，有什么不同或更好？”的问题。 如果客户难以提出积极变化的证据或确信没有积极变化，治疗师可以提出问题鼓励客户思考他们有效应对问题的能力，例如，为什么事情没有对你更糟？什么阻止了完全灾难发生？你是如何避免崩溃的？ 带回家的信息 焦点解决疗法将问题解决置于对话的前沿，对于没有遭受重大精神健康问题且需要帮助解决特定问题（或多个问题）的客户特别有用。与其花多年时间治疗，SFBT允许此类客户快速找到解决方案并获得结果。

文章概要

本文以“SFBT techniques for goal reinforcement in therapy”为关键词，系统介绍了焦点解决短期疗法（SFBT）的核心概念、发展背景及三种关键技巧。文章通过生动的商业场景比喻，阐释了SFBT“聚焦解决方案而非问题”的基本理念，强调其短期、目标导向的特点。核心内容详细解析了三种强化目标的技巧：1）提问技巧（包括应对问题、奇迹问题、最佳希望问题、例外问题和量表问题），通过结构化提问帮助客户识别资源、设定目标并跟踪进展；2）“做一件不同的事”练习，通过八步法引导客户打破问题模式、建立有效策略；3）“预设改变”技巧，帮助客户关注积极变化并庆祝小胜利。文章还简要提及了SFBT的适用场景、局限性及其与积极心理学的关联，整体突出了SFBT在快速、有效强化治疗目标方面的实用价值。

高德明老师的评价