Insoo en Steve

An Interview with Steve de Shazer and Insoo Kim Berg

by Dan Short

BACKGROUND:

Steve de Shazer and Insoo Kim Berg are widely recognized as pioneers in the field of brief therapy and key figures in the promotion of a competency-based, constructivist orientation to therapy. In 1978, they co-founded the Brief Therapy Center in Milwaukee which continues to serve as a research and training facility.

In 1985, de Shazer published the conceptual model for solution-focused therapy. His prolific writings include six books and more than 50 professional papers and collaborative works. He has served on the editorial board for journals such as American Journal of Family Therapy, Journal of Marital and Family Therapy, Family Process and Zeitschrift fur Systemiche Therapie. A highly sought after trainer, de Shazer has been invited to speak in conferences across North America, Europe, Australia, and Asia. Following the scientist-practitioner model, de Shazer has served as Senior Research Associate at BFTC since 1989. He also is a fellow of the American Association for Marital and Family Therapy and member of the European Brief Therapy Association.

A native of Korea, Insoo Kim Berg has close to 30 years of clinical practice and more than 25 years of consulting and teaching experience. Berg has written more than 25 papers and collaborative works. Her major publications include Working with the Problem Drinker (with Miller), Family Based Services, Interviewing for Solutions (with DeJong) and Solutions Step by Step (with Reuss). She has conducted workshops on the topic of solution-focused therapy in diverse settings such as Berlin, El Paso, Washington D.C., Hong Kong, Copenhagen, and Tasmania. She was a visiting professor for Flinders University, Medical Center and has worked with other schools as lecturer and consultant. Berg is a participant in numerous professional organizations and has served on the editorial board of the Journal of Marriage and Family Therapy, Family Psychology and Counseling Services and Families in Society .

Dan Short (DS): Hypothetically, if a miracle occurred and hundreds of readers who do not know very much about solution therapy suddenly had an article that points out some really important details about you and your work, what kinds of things would be in that article?

Insoo Kim Berg (IKB): That's not fair! He is using the miracle question on us. [laughter]

Steve de Shazer (SdS): One thing would be for people to know that we are not a response to managed care. We've been doing brief therapy for 30 years. We developed this a long time before managed care was even somebody's bad idea. That is a piece of the miracle.

DS: Solution focused therapy is considered a brief therapy but the way you work is very different from how others have been taught to do brief therapy. In your approach there is no defining the problem, no contracts or treatment goals.

SdS: After seeing my tapes a lot of people say, "What you are doing doesn't even look like therapy!" And I think it is because often therapists have been trained to make eye contact, make "I" statements, sit in the right position, as if that is what makes therapy effective. Neither of us pays any attention to that.

IKB: The field has emphasized "empathic understanding" so everybody strives for this. But that is impossible. I don't ever expect anybody to understand me completely. Sometimes I don't understand myself or I may change my mind. So I think the best we can do is be open to what is said. That is why I emphasize using the client's exact words, instead of paraphrasing. Because when we rephrase what they have said we fit it to our idea of what they mean.

DS: But almost every text on counseling teaches paraphrasing.

IKB: That is absolutely wrong. Because the implication is, "The way you talk is not good enough. So I have to teach you how to talk."

SdS: It means the client has done it the wrong way.

DS: Now that you mention it, I have seen clients respond to paraphrasing by correcting themselves in order to use my words. That is terrible!

IKB: I think it is terrible.

DS: Do you use diagnostic labels?

SdS: Years and years ago, we had three or four different anorexics and their families. And at that time anorexics were a big deal, Minuchin's book, Psychosomatic Families (Minuchin, Rosman & Baker, 1978), had just come out. So we compared our tapes of the anorexics with each other. The therapies were totally different but all four were successful. And none of them bore any similarity to what Minuchin had said. I have no faith in labels, they don't mean anything. To quote Jay Haley, "It is one of those ideas that handicaps therapists."

DS: All of this is counter to traditional ways of approaching a problem. For instance with drinking, you were talking about not looking at what causes the relapse but how they got out of the relapse.

SdS: Absolutely. Therapists have been trained to look for the signs of relapse. But we train people to look for signs that the relapse is not going to happen. We are looking at what people do not look at.

IKB: Clients only look at it from one way, the way that gets them stuck. So we give them another way of looking at it. They are in the same situation, but turning it just a small degree helps them look at things from a different angle. And I think that is where the solution comes from. Not because every thing we say is right or smarter.

DS: I used to think that your model was overly simplistic, a cook book approach to therapy. But after watching you work I have decided that it is much more difficult and complex than it looks.

SdS: "Simple but not easy," is what we say.

IKB: Often people think that simple is easy, but to me simple takes a great deal of discipline.

SdS: It is just the miracle question and scaling. But how you use them, when you use them, what you do with them once you get them, that requires skill.

IKB: Like hypnosis. Anybody can put someone in a trance. But you have to know what to do after you put somebody in a trance. Anybody can ask the miracle question. But you have to know what to do with it afterwards.

DS: In what way is a good solution focused therapist self-disciplined?

IKB: The important ingredient of self-discipline is not imposing your own agenda on the client.

DS: For instance, "You must never drink again if you are an alcoholic."

IKB: That's right. That is AA's idea. It is not the client's idea.

SdS: And it's not held up in the research, either.

IKB: It takes a lot of discipline not to impose your ideas. It's very seductive to get into being the "expert," having someone want you to tell them what to do.

SdS: After watching a video of my work with a couple, the audience questioned me about why I did not talk with him about his drinking. But neither he nor his wife complain about drinking. All she does is tell him that when he is sober he is a good father.

DS: Yes. The audience was very uncomfortable with you allowing the client to decide what the problem is.

SdS: But if the client does not think it is a problem, then it is not a problem. It is their reality so you have got to stick to what they bring.

IKB: That takes a great deal of faith in the client--faith that they will do what is right for them. And that is very hard. We have been trained to always look at the dark side. The undesirable, unattractive side of human nature.

DS: Your work has so much flexibility. Does your flexibility come from your faith in the client?

IKB: Not only faith in the client but also the idea that solutions come from many different facets of life, not just from the therapist. Everywhere we look there are solutions. Being willing to look at life's solutions is very important. If someone becomes sick, has a baby, gets a different job, each of these changes one's perspective and even one's philosophy of life. Ordinary life provides a lot of very important milestones. So it is important to be aware of that, to make use of what is there.

SdS: Almost none of the natural changes you are talking about involve stopping something. Stopping something in order to change is not normal and it's the most difficult way to change something. Fifty percent of the people who stop drinking do it with no treatment. But how? Well, basically, they do something else instead. They don't stop drinking, they start doing something else. So the change seems spontaneous.

DS: Insoo, you said in your workshop that "Just because I am solution focused does not mean that I am problem phobic." I think that some people could become rigid, only allowing solution talk.

IKB: I agree with you. That seems to be the common misunderstanding. And we have even been accused of "solution forced therapy." But anyone who has watched our sessions knows that is not how we work.

DS: How would you describe what you do?

IKB: One thing that I do is go back and forth. It is a sort of an ebb and flow process. I don't go in just one direction. The client can go back to talking about how terrible life is, or life was. Then I ask, "So how do you want things to be different?" This addresses both sides of it. There is a very natural flow, a lot of rhythm to it.

SdS: Always bring it back to, "How will life be different after the miracle?" "Before the miracle she nagged me all the time." "Well, after the miracle what is she going to do instead of nag?"

DS: Is there room for intuition in this approach?

IKB: Why sure. What is intuition? Intuition comes from a lot of experience and training. Experience tells you, "Going that way is likely to lead to this."

SdS: Like playing center field. It takes a lot of intuition. I remember watching Henry Aaron, for instance, or Willie Mays. They were sort of hanging around out there in center field, not paying attention to much of anything. They stick their glove up and all of a sudden they've got a ball. Therapy is the same. First you use the miracle question and scales. Then you can use your intuition once you know what to do.

Nobody does it exactly the same way. I would be very concerned about that. One of my big fears is of developing an orthodoxy--the idea that "this is the way you have got to do it." We see some of that. I refer to them as "the fundamentalists." They take an example, of one day, and they watch it and then keep replicating that one day.

IKB: Well, I have been accused of not following the model.

SdS: I've had that happen too.

DS: Even while using the standard questions there is more flexibility than is at first apparent.

IKB: Oh, sure.

SdS: Clients invent their own milieu. If they don't like numbers they invent a different way. Like the violinist whose scale went from triple f to triple p. She used this to get rid of the pain in her elbow.

DS: What about the Miracle Question? Is there other ways you do that?

IKB: Yes, especially when working with children. You adapt the question to fit the child's language. You can get them to draw pictures like this [Insoo draws a series of cartoon frames] and in this one "you are lying in bed and all of this gold dust comes down from the sky."

DS: Like a fairy tale?

IKB: Yes. And you have the child draw a termination picture. You can ask, "What will it look like when you don't have to come back any more?" Kids like that. One time I had a child draw a frowning face. That was what the problem looked like. And then at the other end she drew her mother's smiling face.

SdS: There are some people I know in Germany who do a psychodrama "the morning after the miracle." They have the clients act it out. That works quit nicely.

DS: Utilization seems to be an important part of your work

SdS: My view is that the Ericksonian idea of utilization does not go far enough. We use it in a lot broader way. We try to utilize everything.

IKB: Everything!

SdS: When Erickson used the term utilization in his papers he was talking about utilizing trance phenomenon. That is the most narrow, and the original use of the word. Erickson was detailed and very precise in his written work about hypnosis. He did not go into the same level of explanation when he talked about his therapeutic interventions.

People don't seem to realize that in his work, Erickson used everything. If you read his case reports, you will see that utilization was an all-encompassing concept in his therapeutic work. This has given us a deeper appreciation of a part of Erickson's work that few people understand.

When we first began working with the conceptualization of solution focused therapy, we developed the idea of using what the client brings to the session. That is what we do most of the time--we use whatever the client has brought to us.

DS: What I hear you saying is that you utilize beliefs, values, their ability to evaluate themselves...

IKB: Absolutely!

SdS: Utilize the fact that their answer to the scaling question is not -2, it is only -1. You can utilize almost anything. If you are listening to it.

I remember a woman who came to us, years and years ago. She had a double diagnosis, schizophrenic and alcoholic. Her husband had been a junky for many years and he was in and out of prison. And she is talking about all this crap in her life but her kids are on the honor role. So I ask her how come her kids are on the honor role, "How come things aren't worse?" So we get to talking and come to find out her husband the junky takes the kids to school every morning, picks them up in the evening, supervises the homework, and attends all the meetings with the teachers. He is high as a kite, but he is there. These are the kind of exceptions to listen for.

DS: And when you said, "Why aren't things worse?" It almost sounds like a paradoxical intervention. Or is it something different?

SdS: No. Why aren't things worse? It should be worse with what she told us. You've got a schizophrenic, alcoholic married to a junky. Now how come these kids turned out to be honor students? That shouldn't be happening. Why is that happening? How come it is not worse?

DS: Watching you work, it seems like you are somehow giving people a sense of ability.

SdS: Yes. And that is were the scaling question comes in and adds to the therapy. "Oh! You are at five. You are half way there!"

IKB: "You are all the way up to five!" or "You are all the way up to three!"

SdS: "No longer at zero. That's wonderful!"

IKB: Instead of saying "Only three," I will say, "Oh my God, you are all the way up to three!" Its a very different way to look at it.

DS: It is almost like you seduce the person into believing in themselves.

IKB: Absolutely.

SdS: Of course.

DS: What is it like living with a solution oriented therapist?

IKB: We don't think about it that way. We never talk about business when we are together.

SdS: Even years ago, when we were in the office all day, day after day, the minute we walked out the door there was never therapy talk. There might be some business talk, financial talk. And the only time we used to do that was when we played hooky from the office. We would drive to Chicago and that would be our administrative meeting. Therapy is a job we do in the office and we leave it in the office.

IKB: Now we are separated a great deal of time. We sort of travel in separate circles. We have a very unusual marriage, in that sense. It is not like other people who go off to work in the morning and then see each other in the evening.

SdS: But when we are together, we are together 24 hours a day. So the total number of daytime hours is more than most couples, even though we have these long intervals of three to four weeks [of being apart].

IKB: I guess its what they would call a "long distance marriage." Probably we are able to do that successfully because we have been together for a long time. We have that foundation. If you were just beginning, I don't think this could work.

DS: I was wondering if specializing in the same area would create competition in a marriage?

SdS: Well it's clear, we both know that she is a better therapist than I am.

IKB: [laughter] We knew that! We understood that.

SdS: [laughter] So we have never had that problem.

IKB: I think we are in some ways very critical of each other's work. And at the same time we are very supportive of each other's work. I am very honest with my feedback about anything that he has written. I might say, "Oh no, not that way!" But then I will also have a suggestion for what to do about it, how to correct it.

SdS: You always have done that.

IKB: That is important. It is a rule we made fairly early, while doing training. When we first developed this model we spent a lot of time supervising from behind a mirror...

SdS: Oh God, 30 to 40 hours a week sometimes.

IKB: And we would never call in unless someone had an idea about what to do.

DS: In some of your cases you ask the client to pretend to be ok on certain days of the week but not to tell the other spouse when he or she is pretending. What are you doing?

SdS: Well, two things. One is protecting the client from telling, if we can. Because if he were to advertise what he was doing, then it might be discounted. Even if he doesn't pretend, he might still do something that his partner likes. She is watching for him to pretend that the miracle has happened. She will be watching for good things instead of watching for bad things.

DS: You create a positive expectation.

SdS: Usually we get them both to do that.

IKB: I think the clients come in with that. They expect something.

SdS: Utilize that. I think they come with as much motivation as they need. What we have to do is try not to interfere with that. If a therapist ends up at the end of the session thinking that the client is not motivated, then I know that the session has been mishandled. That means the therapist has taken away the client's motivation.

DS: You have said that treating a client with respect means paying attention to details.

IKB: Of course. Because you are paying attention, respecting the unique way that they do things. For instance, how you get up in the morning. Some people like to shower first, before they drink coffee. I like to drink coffee first, before I get into the shower. That is the unique way that we are different and I am respecting that. Individualizing treatment comes from paying attention to details . Also it is important because talking about the details is where you find a small strength or small success. So details are very important. The details of the miracle picture, of the solution, of how they would like things to be.

SdS: And if they want to talk about the problem, then discover details about that. Whatever it is, you want details because that is what eventually provides you with the material you and the client need to build the solution.

IKB: It is a big deal now to study generalities about ethnic families, about Asian families, Hispanic families, African American families, etc. But I think that is ignoring the details. It results in not knowing how to individualize treatment. Even among the Asian families there are so many varieties. Even among the same social class there are so many differences. With ethnic families I think there is even a greater need to pay attention to the individual family details.

SdS: Clients want you to pay attention to the details of what they are saying or doing, to take them for their word. Give them the right to schedule when they think they should come back, rather than saying, "I'll see you next Tuesday at three." Instead ask, "When are you going to come back?"

DS: So you do not assume that you know what the client is all about.

SdS: This is something we learned from John Weakland as well as from our own experience. A parent says they use "grounding." What the hell does this mean? It is necessary to ask, "What are you doing? What does that involve?" Thirty years ago when parents said they grounded the kid, I assumed that I knew what that meant. But when you ask it always has a different meaning. Sometimes mother and father, of the same family, have a different idea about what grounding means.

DS: Steve, you said, "I never initiate a topic." Yet you are very influential. It almost seems counterintuitive.

SdS: I'm not going to tell someone to stop drinking or that alcohol is the problem. My rule of thumb is that if the client doesn't talk about it, then it is none of my business.

DS: Did you always do it this way or did you learn to do it this way?

SdS: I think I have always done it that way. Even before we got together, I didn't have any notion about, "This is the right way to do things." I have never been very normative.

IKB: You are very accepting. That is how he can live with me. Because he does not try to change me.

DS: How has meeting each other affected the development of the model?

IKB: We are very different people. Our styles for thinking and doing are very different. Our cultural and family backgrounds are very different. So we made a conscious effort to use those differences rather than trying to eliminate the differences.

SdS: In Korea the family has certain rules and they seem to work. A family in the United States does the exact opposite and that seems to work! So you can't have any judgment that "this" is the right way to do things.

IKB: Coming from a different culture really helps you not take everything for granted. Years ago, when I was student, I would have parents say, "We ground the kids." I did not know what this meant. What do you do when you ground a kid? So I asked and they said, "Well, we make him stay with the family." "You mean that is a punishment...to stay with your family?" I was really shocked by that.

SdS: For the same reason that an American family will ground a kid, a Korean family will expel him. "Get out of the house! We don't want anything to do with you."

IKB: So families can have very different approaches And I think that we learned this very early, that there is no good or bad about it. It is just different. And I think that has also spilled into the model, about accommodating differences and working with differences rather than trying to eliminate the differences.

DS: Are there any final points you would like to make about your work?

IKB: I would like to say that Erickson's work seems to share a great deal with Eastern philosophy, that is, the wisdom and intuition about human like are very similar. Knowing when to push, when to let go, what to listen to, and what to ignore--all these skills are based on the profound respect for human dignity and working to restore the sense of who they are and what they want to be.

END

© 1998 Milton H. Erickson Foundation. All rights reserved.