Autor: Esther Krohner

Problem Solving Brief Therapy: the trunk of the tree

Problem Solving Brief Therapy (PSBT) is the trunk of the tree in the family of different modalities of postmodern therapies. Solution Focused, Narrative, Motivational Interviewing , to name just a few. 

There are many advantages  to working from the original model, that extend to knowing when to implement what tools, working firmly from a non pathologizing framework and deep listening. These skills  of PSBT encourage   positive change, which is by definition what clients are asking for.  The clinician can move between the person coming for help and the complexities of the system in which this person operates. By changing the “tree” we impact the “forest”.

In contrast with other approaches to therapy, a fundamental distinction is that PSBT is non-pathologizing. We can acknowledge what isn’t working and see how the brain and body exhibit these things. However, we focus on the concerning indications of the psychopathology that are bringing someone- a client- to therapy. Something hurts and that becomes the focus of our work with this person. In the PSBT model, psychopathology is a construct developed for reimbursement purposes, to operate within systems of care and to have a common language for providers. It can also sometimes be useful  for a person to have a name with which to establish care. We need to be able to see it and speak that language, however it is not the focus of our interactions with our client (s). In fact, we think it can hinder that process when it is emphasized, by creating a power dynamic that is implicit in the diagnostic process. How? Because the client doesn’t feel they have the power to be in charge of the changes that will happen in therapy?

Within the pathology framework, clinicians and clients, despite having defined diagnosis, can get lost as to “what to do about it”. This is the place  where Narrative therapy, Strategic therapy, Solution Focused therapy, relationally oriented systems therapy , Internal family systems and Motivational interviewing share the Problem Solving trunk that originated at the Mental Research Institute in Palo Alto, California in the early 1960s. There is a solid grounding process that looks at the presenting problem more holistically and tries to approach it from the clients’ perspective without layering medical terminology to promote the necessary change 

Another vital shared component is the emphasis on communication. These postmodern models look at communication in a very conscious way.There is an emphasis on how communication is shown and how to communicate in a way that might result in a preferred outcome. This process of developing a picture, theme, story or a movie of what is happening for the client is where we start to see the branching out of the MRI- PSBT model of care.  

Another branch on the tree is the focus is the continual anchoring in the “here and now”. However, PSBT emphasizes this as a tool and intervention that is spread like  seeds throughout  our sessions. It is a tool both for figuring out where to go with the work and also so the client learns how to start this navigation between pain and the concretization of the problems they are working with. It is also a tool to encourage hope in the client: there is nothing that is frightening enough that cannot be brought to the table to talk about. The implication is that it can change. In that sense it is already a positive intervention. 

What is unique about PSBT is that, by listening intently to what hurts for the client, it provides the framework and tools for  directing where to focus and  how. The emphasis on interactions that are relevant to the problem at hand will assist any of the other branches to produce fruitful results. Our model is built  on a premise of continuous feedback loop with the client about whether or not   the process is working towards the preferred change. This too, is a key for collaborative, non-pathologizing and client centered care. This model can be seen as an umbrella model: when deeply understood and applied, there is space for integrating  tools  from almost every other systems model of therapy . It all depends on  how the client is guiding us  and the forest they wish to cultivate.

Esther Krohner

Master en Psic.
I have 14 years of experience working in mental health settings. I am and LMFT and RYT. I have been training and practicing  family therapy with Karin Schlanger for 5 years at the Mental Research Institute. I help couples, families, kids and teens  to make the changes they want to. When faced wit...

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