Complex is not (the same as) difficult (1)
Pieter Jansen and Fredrike Bannink
The solution-focused model
We often see unpredictability and complexity as difficult or tough. We prefer to control and understand things. This also applies to health care. Having control and understanding is, however, not always possible. How do we act in case of uncertainty?
In our opinion, there is (too) little attention for this topic. We advocate the use of the solution-focused model, an amazingly practical way of working. And we connect this method with science that deals explicitly with unpredictability. System theory and information theory are fascinating fields and have a lot to offer. In other domains (artificial intelligence and computer science), these branches of science are self-evident.
It is about time to add a bit more complexity to our profession.
You get into a taxi and the taxi driver asks: “Where do you want to go?”. He does not ask: “What do you want to leave behind?” Or “Where do you come from?”. This is the core of the solution-focused approach.
In the 1980s, a group of psychotherapists in the US, including De Shazer and Berg, were dissatisfied with the results of their approach. They filmed their sessions and saw that talking about problems increased the focus on these problems. With this, the patients got further away from the solution. They noticed that ‘problem talk’ creates problems; whereas ‘solution talk’ creates solutions.
They opted for a radically different approach. They chose the preferred outcome as a starting point and laid the foundation for Solution-Focused Brief Therapy (SFBT). It is a fundamentally different approach than the conventional reductionist medical model, in which practitioners first examine the problem, make a diagnosis and determine the treatment accordingly. In the solution-focused functional approach, examination and diagnosis are often not necessary. SFBT does not ask ‘why’, but asks ‘how’.
Once the preferred outcome is described in detail, practitioners and patients find out how far the patient has already progressed and what the next signs of progress might look like. The strengths, possibilities and resources of the patients are optimally used. This approach has been elaborated and is applied in a much wider context.
In addition to the use in psychotherapy, it is used in health care and in education, mediation, coaching, management, leadership and sports. A more detailed description can be found in our book . Positieve Gezondheidszorg. Oplossingsgericht werken in de huisartsenpraktijk [Positive Health Care. The solution-focused model in primary health care].
The solution-focused model is developed by practitioners based on experiences in their work: it is a pragmatic approach. There are many striking parallels with system theory and information theory. Here too, the starting point is how a road to the preferred outcome can be constructed without prior analysis of the past. Unpredictability is not a problem, but a factor that can be worked with. In a few short pieces with the same title but a different number, we will explore these analogies.