Old Assumptions vs. New Assumptions

Psychotherapist discusses O'Hanlan and Davis' work challenging assumption of traditional psychotherapy and the roles of psychotherapist and client.

My present work with victims of trauma is based largely on holistic, humanistic and feminist principles, as well as influenced by the work of William Hudson O'Hanlon, Michele Weiner-Davis, and Yvonne Dolan.

In their book, In Search of Solutions, A New Direction in Psychotherapy (1989), O'Hanlon and Davis challenge a number of assumptions of traditional psychotherapy including:

A) Symptoms are related to some deep underlying cause.

B) The client must possess some awareness or insight into the cause of the problem in order for change to occur.

C) Symptoms serve some purpose or function in the client's life.

D) Clients are ambivalent at best or do not really want to change.

E) Because real change takes time, brief interventions do not provide lasting change.

F) The focus should be identifying and correcting deficits and pathology.

New Assumptions:

O'Hanlon and Davis reject the assumptions of such a pathology-based model and offer new assumptions based on health rather than sickness. These are:

A) Clients possess resources and strengths with which to resolve their problems.

Very often it becomes the role of the therapist to identify these strengths and resources and to remind the client of them.

B) Change is constant and therefore inevitable.

The therapist creates an expectation that change will occur and that, in fact, it is inevitable. He or she can accomplish this to a large extent by giving the impression that it would be surprising if the presenting complaint persisted.

C) The therapist's primary job becomes one of identifying and amplifying change.

The therapist uses the information presented by the client and focuses on what seems to be working, labels it as worthwhile, and sets out to amplify it.

D) Generally, it is not necessary to know a great deal about the complaint in order to resolve it.

For solution-oriented therapists, the significance lies not in the specifics of what is not working, but in what is. O'Hanlon and Davis point out that when the focus is on the problem, then problems are what are perceived; when the focus is on solutions, then it is solutions that capture the therapist's and client's attention.

E) Knowing the cause or function of a problem is not necessary in order to resolve it.

When a client begins to ponder the "why's" of a problem, the solution-oriented therapist might ask, "would you be willing to live with the fact that your problem is gone and no longer causes you pain, even though you never knew why you had it in the first place?" Typically, clients respond affirmatively.

F) A small change can be all that is necessary.

As illustrated earlier in this paper via the use of Bradshaw's mobile, a small change impacts the larger system and can trigger other, and at times, more significant changes.

G) Clients, rather than the therapist, define the goal.

If the client is not interested or inclined to accomplish the established goal, then very little is likely to be accomplished in spite of whatever value the therapist might place on the objective.

H) It is possible for problems to be resolved or change to occur rapidly.

Sometimes, points out the authors', all that is required to initiate significant change is a shift in the client's perception of the situation. Once this occurs, change can often be rapid and lasting.

I) Rather than focusing on what is impossible and intractable, focus on what is possible and changeable.

O'Hanlon and Davis advise that when identifying a problem with the client, negotiate a solvable problem. This is done in part by making the problem appear more manageable as well as by creating an atmosphere that facilitates the client's recognition of their strengths and abilities. The therapist may begin to explore what has worked in the past for the client, what is working now, and what needs to continue to happen. Utilizing one's language can be a powerful tool for the therapist. By shifting the talk, says O'Hanlon and Davis, we begin to shift the client's thinking. When the session is used to create a distinction between that which happened before and all that will happen in the future, this shift in thinking can begin to occur. For instance, when the client states, "I fall apart when I'm criticized" and the therapist replies, "so you were falling apart when you were criticized," and later in the session observes, "so when you used to fall apart when..." he or she begins to establish the problem as related more to the past then in the present.

Utilizing the word "yet" also characterizes the work of the solution-oriented therapist. The therapist's observation that, "While you're not always able to stay on top of your feelings yet, you certainly seem to be heading in the right direction", implies that the client will be "on top" of his or her feelings eventually. When a client complains that they have never, will never, etc., the therapist can respond by saying, "you haven't yet".

Solution-oriented therapists also demonstrate their confidence in the client's abilities to reach their goals by asking questions using "definitive" terms vs. "possibility" terms. For example, the therapist asks, "What will you be doing differently, when you are no longer cutting yourself when you are anxious" instead of "What might you be doing differently" (which implies that doing it differently is only a possibility.)

Looking for the exceptions to the problem is another activity that distinguishes solution-oriented therapists, maintain O'Hanlon and Davis. Such therapists have learned that solutions can be found by examining the differences between times when the problem has occurred and times when it has not. Hence, if an individual is troubled by anxiety attacks and wants to rid himself of these, it is important to assist the client in identifying what is different about the times when he is feeling relaxed and calm. Once the client is able to recognize what activities contribute to the desired state of calmness and relaxation, he can experience more of these times by increasing those activities which lead to the desired state. When a client describes a time when he is not experiencing the problem, and the therapist responds by inquiring as to "how did you get that to happen?", the client is able to clarify what it is that he does that works and what he needs to continue doing, while at the same time the therapist is giving him credit for the achievement.

Exploring when and if the client had the same difficulty in the past, and how he resolved it then, as well as what would he need to do to achieve the same results again, can sometimes produce solutions in cases where all the client needs to do is employ the same methods with the new situation.

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