Solution-Focused Approach to Care Empowers Patients

As physicians shift care from a disease-centered to a patient-centered clinical method, there is a need for a compatible counseling paradigm. Solution-focused therapy is an evidenced-based approach highly congruent with patient-centered care, providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that the patient’s values guide all clinical decisions, according to Anne Bodmer Lutz, M.D., training director for the Institute of Solution-Focused Therapy. It is a competency-based model that minimizes emphasis on past problems and failings and instead focuses on patients’ best hopes for their desired future, strengths, and resources. The solution-focused approach often results in briefer lengths of treatment and can be utilized even in brief interactions. As such, this approach is an essential skill for physicians, whose services are in short supply and high demand.

A solution-focused conversation begins by joining with competencies inviting patients to discuss parts of their life that are going well, the strengths and talents that contributed to this, the people who are most important in their life, and what they most appreciate about them. Compliments are used frequently and function to support what is working well in the patient’s life, thereby setting up the expectation for future success.

Paying attention to times when patients are doing things differently, in a positive way when the problem did not occur or was less severe, are called positive differences or exceptions. Diagnosing these “positive differences” requires a very different intentionality when listening to patients and often enhances patient engagement. Solution-focused scaling questions ask patients to rate their goals, satisfaction, coping strategies, motivation for change, and confidence on a numerical scale from 1 to 10. They help to formulate goals and measure myriad issues from a multitude of patient-centered perspectives. The patient, not the physician, defines what a 3 or 7 or 10 means. The solution-focused approach to goal negotiation begins by asking patients their best hopes for the appointment so they can say it was helpful and not a waste of time for them to come in that day.

The lack of practitioners' widespread knowledge and access to the solution-focused approach compelled Lutz, a child psychiatrist who provides clinical care and training utilizing this method, to write a comprehensive and practical book on this therapeutic technique. The book aims to bridge the gap between the traditional medical model of problem-focused assessment and treatment with a practical “how to” patient-centered, strength-based treatment approach. The book provides learning exercises, case illustrations, and video examples that will help the reader implement practical strategies immediately with patients, students, supervisees, and trainees. Solution-focused therapy is both hopeful and optimistic, putting ownership of patients' health back into their hands, reminding them of the control, authority, and responsibility they have over their lives. This feels good to patients and physicians alike.

Lutz is the author of Learning Solution-Focused Therapy: An illustrated Guide from American Psychiatric Publishing. APA members may purchase Learning Solution-Focused Therapy: An illustrated Guide at a discount here. Case illustrations are included on video.