Frequently Asked Questions
About Possibility Therapy
What is Possibility Therapy?
Possibility Therapy is a method and philosophy of psychotherapy, usually brief, which stresses respect and collaboration as well as effectiveness and results. Combining the best of Carl Rogers' use of acknowledgment and validation, as well as the directive approaches of Milton Erickson and strategic therapies, Solution-Oriented Therapy considers clients experts on their concerns, problems, goals and responses to therapy. Therapists using this method work to evoke (not merely to convince clients of) solutions, spiritual and personal resources, strengths, competence, and exceptions to the usual rule of the problem. Akin to solution-focused (or solution-focussed) therapy, co-developed by the late Steve de Shazer of the Brief Therapy Center in Milwaukee, Wisconsin, USA, Possibility Therapy is different in its emphasis on the importance of validation of felt experience and points of view and a flexible rather than formulaic method.
What does a Possibility Therapist do?
The three principles guide the work of a Possibility Therapist: 1. Acknowledge and validate clients' reality and experience; 2. Guide clients to shift how they view things (perceptions of the problem) and/or do things (patterns that support or create the problem); 3. Tap their resources, expertise, and experiences for solutions and consult them on their preferences on the process and direction of therapy.
How do you decide the focus of treatment?
Most therapeutic approaches and theories have what is called a "normative model"- prescribed ideas about what is normal and healthy and what is abnormal and deviant. Treatment then is based on what the theory says is wrong with you (even if you have a different idea about it) and of course, the therapist's subjective interpretation of that normative model. So you may go to a family therapist for help in dealing with your child's temper tantrums and he or she may tell you that you the problem is really that you need to work on your marriage. Possibility Therapy generally eschews prescribed ideas about normalcy as they are most often subjective (your idea about what works for you is different than my idea about what works for me), dated (one decade homosexuality is an illness, the next homophobia is the problem instead), and ethnocentric (culturally biased). In Possibility Therapy (and solution-focused, solution-oriented, solution-based and other related approaches) when a client says they want to work on preventing their child's temper tantrums, we work on that. If upon observation we have an idea that marital conflict may be a contributing factor, we may offer that to a client as a possibility. We view ourselves as cab drivers. Yes, we have a vast knowledge of the city, traffic patterns and various routes to reach any given destination, but the client provides us with the destination and we negotiate the route.
Are you the only Possibility Therapist?
Many therapists who call themselves brief, solution-oriented, solution-focused, narrative or collaborative use many similar ideas and methods. Others have adopted the term Possibility Therapy for their work. The labels are not as essential as the approach and philosophy.
Does Possibility Therapy work?
As far as research is concerned, this is a tough question, because measuring psychotherapy is a bit like nailing Jell-O to a tree. Because psychotherapy variables are so subjective, no one agrees on what constitutes a problem or a successful outcome. We do know that Possibility Therapy is usually brief, lasting 4 sessions on average. But meta-analyses (studies that compile statistics from many smaller individual studies to get a bigger and better picture) indicate that all therapies are relatively brief (about 4-7 sessions on average).
Consumers report very high satisfaction with Possibility Therapy, as they feel they are partners in directing the treatment. We work on their concerns in a way that is comfortable and productive to them and end when they are satisfied. Follow-up surveys have indicated continued satisfaction after the treatment has ended.
Are you always collaborative in Possibility Therapy?
No! If someone is destructive to themselves or someone else, we intervene. This includes if unhelpful and hurtful interchanges erupt in our office (we don't stop to ask how the parties feel, we break it up and cool things down).
What is your stance regarding self-help groups and medications as adjuncts to your therapy?
If clients find self-help groups helpful, I'm all for them. I think there are potential dangers in them, of course, and I warn clients to be on the lookout for those dangers. A danger with self-help groups is that you can fall under the influence of group beliefs, which may be helpful and may be limiting or create new problems you didn't even know you had. Most of the groups provide good validation ("You mean there are other people out there like me? I'm not weird or different? You've had these kinds of feelings and experiences too?") but sometimes also give the impression that you can never be okay if you don't continue to attend the group or live by their principles.
Medications are also a double-edged sword. I have clients who have been greatly helped by medication, when what I was doing was only moderately helpful for them. I have also seen people get worse or be hurt by medication. I have also seen some people who were told they would have to live their lives on medications find other solutions and some who despite their best efforts and desire could not.
Can you do Possibility Therapy with mandated clients?
Yes and no. Possibility Therapists work with clients who are pressured into treatment by maintaining a delicate balance between acknowledging that the client doesn't want to be there and trying to find a goal the client would be motivated to work on. It's important to first listen to the clients experience of being mandated into treatment and any complaints they may have about by whom and how they were mandated. While we hold clients accountable for their actions, often they have suffered some injustices along the way and it is important to include this. We then try to see if there is a goal that they do want to pursue. For example, a teenager who has been hospitalized or court ordered to treatment maybe interested in getting out of the hospital or out of legal services. We would talk to them pragmatically about what they need to do to get out of the hospital or out of juvenile service, including what the challenges will be and what they will have to do to demonstrate that the change is lasting ("The hospital staff sees lots of kids who want to get out. What can you do to show them you are ready to handle the stresses that put you here?"). We then make a plan of action and act as coach. We use this approach successfully with a wide variety of mandated clients. Here’s “a motto for you: Don't be the most motivated person in the room." If in the end a client doesn't want to be there, we respectfully explain the consequences of that decision and what we will say when Social Services or the court calls. If we can't find something they are motivated to work on (which rarely happens), ultimately we don't do therapy with them.
Is Possibility Therapy for everyone or just certain problems and people?
Possibility Therapy is done with a wide range of people and problems. Because it focuses on clients' problems, it can be used whether your problem is hearing voices, asking your boss for a raise, sexual problems with your spouse or a past trauma. As we have a wide variety of ways to help people find solutions, we can work with a wide variety of problems. Some problems are solved in one session and others take years. Some people experience big changes; others small successes. The only people we don't do Solution-Oriented Therapy with are people who can't find a reason to be in therapy.
What is the difference between solution-focused and solution-oriented therapy?
In the early 1980s, I began a correspondence with Steve de Shazer, who had moved from California, where he had written a number of papers on Erickson's work, to Milwaukee, Wisconsin, where he and some colleagues had begun what came to be called the Brief Family Therapy Center (BFTC). de Shazer and I shared a common view that mainstream therapies that saw clients as pathological and resistant were wrong and could be damaging. People were naturally cooperative if approached in the right way and treated as resourceful and competent. de Shazer's work began to take shape and has turned into "solution-focused therapy." My work took shape and I called it "solution-oriented therapy." There is some disagreement on who came up with the approach (it was actually first proposed by a therapist named Don Norum from Milwaukee in a talk/paper called, "The Family Has The Solution," in 1978, long before deShazer and I articulated our models). The most generous view is that there were a lot of mutual influences. While I see much of value in the BFTC emphasis on client strengths and solutions, there are some areas of clear difference.
It became clear to me that because the Milwaukee approach put such a value on focusing on solutions, it had left out several elements that I found crucial in my therapeutic work. First, there was no significant discussion of the importance of validation of emotions (this has begun to shift very recently). Because the emphasis is so much on "solution talk," sometimes clients have the sense that the therapist is minimizing or not attending to the problem and feel "forced" or "rushed" to come to a solution. In contrast, hearing, acknowledging and validating the client's experience is a major first step in Solution-Oriented Therapy, laying the foundation for subsequent work. I learned this long ago from Carl Rogers' work, and never forgot its importance.
Another difficulty I see with the Milwaukee approach is its tendency to be formulaic. One invariably asks certain questions (like "The Miracle Question") and follows certain sequences. There are flow charts providing procedures for various client responses. While this may be a fine way to learn a new approach, the ultimate effect is sometimes one of rigidity and imposition. While the proponents of the Milwaukee approach may protest that this is evidence of the approach being done incorrectly, my experience is that a formulaic approach has this built-in risk.
Another concern I have about the Milwaukee approach is that it ignores political, historical and gender influences on the problem (as well as the inner worlds of physiology and biochemistry) as being irrelevant to the process of therapy (since the focus is to develop solutions and solution-focused conversations). Because of its minimalist approach, in its strictest version, one gets the sense that if a couple came in for therapy and the man was drunk or the woman had a black eye, the purest solution-focused therapist would be constrained from mentioning or inquiring about the potential evidence of alcohol problems or domestic abuse unless the couple mentioned it themselves or violence was what they were referred for. In contrast, in Solution-Oriented Therapy, while we take care not to bring in extraneous material and inquiries, at times these areas are crucial for both the therapist's understanding of the issues and of the felt experience of the client and for the development of solutions. Solution-Oriented Therapy maintains that it is inappropriate for the therapist to impose ideas about the problem or to push topics for discussions unless there is a suspicion of dangerousness (such as suicidality, homicidality, sexual abuse of children, or seriously self-harming behaviors) of if blatantly socially oppressive issues (such as racism, sexism, ideals of gender or weight, sexual orientation biases) are present. In these situations, it is then incumbent on the therapist, regardless of whether the clients think it is relevant or whether or not they brought up the topic, to pursue these lines of inquiry and to do his or her best to ensure physical safety or to explore the social context of the problem.
In the end, I decided to call my approach Possibility Therapy, to avoid confusion and to help differentiate the approaches.
-BIll O'Hanlon, July 2010