Alasdair Macdonald - The European Brief Therapy Association Outcome Study

EUROPEAN BRIEF THERAPY ASSOCIATION OUTCOME STUDY: RESEARCH DEFINITION

DESCRIPTION OF THE TREATMENT

Therapies included in the EBTA Outcome Study should be conducted following the solution-therapy model as developed by Steve de Shazer and Insoo Kim Berg (De Shazer, 1988, 1991, 1994; de Shazer and Berg, 1992).

During the sessions, therapists should focus on clients´ goals, exceptions, pretreatment changes and, in general, clients´ resources. They should do that by asking the Miracle Question, discussing exceptions and pretreatment changes, by using coping questions and scales. Therapists should do this using their clients´ language, and at the same time promote descriptions in specific, small, positive (presence of solutions rather that absence of problems; start of something new rather than stopping something) and interactional terms. Therapists should adopt a respectful, non-blaming and cooperative stance, working towards their clients´ goals from within their clients´ frame of reference.

After some 45 minutes of conversation with their clients, the therapist may take a break. After this break (or, if no break was taken, simply at the end of the sessions) the therapist should compliment the client(s) and is likely to give some suggestions, following the rules described in de Shazer, 1988. Closing the session, the therapist will consult with the client(s) on whether and when to schedule another session.

Therapies to be included in the sample of the EBTA Outcome Study should include all of or most of the features described above, but have to meet at least all of the following minimal requirements:

First session

The therapist...
1. ...asks and follows up on the Miracle Question
2. ...asks and follows up on the Progress Scale Question
3. ...compliments the client(s) at the end of the session.

Second and following sessions

The therapist...
4. ...asks "What is better?" at the beginning of the session and follows up on it.
5. ...asks and follows up on the Progress Scale Question.
6. ...compliments the client(s) at the end of the session.

Therapists will have to adjust to the exact wording and (where applicable) timing of these elements, as described in the following sections of this treatment protocol. Therapies where one or more of these elements are missing in one or more of the session can not be included in the sample.

MINIMAL REQUIREMENTS

1. "The therapists asks and follows-up on the Miracle Question"

1.1. The Miracle Question has to be asked in the following way:

"I'd like to ask you a strange question…Suppose…that you go home tonight…and go to bed…and fall asleep as usual…and while you are sleeping, a miracle happens...and the miracle is that the problems that brought you in here are gone…and you don´t know because you are sleeping… What will you notice different tomorrow…that will tell you that there has been a miracle?"

1.2. Follow up questions serve the purpose of getting a description in specific, small, positive and interactional terms. They should focus on who will be doing what , where, when and with whom , and may be asked both from the clients´ or from somebody else´s perspective, for instance:

-How will that be different?
-What will you be doing instead when you are not...?
-When you stop..... what will you do then?
-When you are feeling...... what will you be doing?
-How will she notice that you are feeling ...?
-Who else will notice your being more...?
-What will they do when you.....?
-What will you do when she...?
-What would be the first sign that he...?
The therapist may also ask "what else...?" (will the client notice, will the father be doing, etc.), how the client (or his wife, her friends...) will do that, or what needs to happen so that the client (his wife, her friends...) can see that happening. For instance:
-How will you do that?
-In what way will that be helpful?
-What needs to happen so that she...?

2. "The therapist asks and follows up on the Progress Scale"

2.1.The Progress Scale has to be asked in the following way:

"On a scale, where 10 stands for the day after the miracle and 0 stands for when the problems that brought you in were at their worst, where would you put yourself right now?

2.2. Follow up questions serve the purpose of getting a description in specific, small, positive and interactional terms. They should focus on who is or will be doing what , where, when and with whom , and may be asked both from the clients´ or from somebody else´s perspective.

Follow up questions of the Progress Scales may be used to:
2.2.1. Amplify exceptions and/or improvements. For instance, the therapist may ask:

-Now that you are at a..., how have things changed?
-What are you doing different now that you are at a ...?
-How did she notice that you were at a....?
-Who else may have noticed your being at a...?
-What do they do when you.....?
-What do you do when she...?
-What was the first sign for them that you got up to a...?
The therapist may also ask "what else...?" ( comes into that....., is different now that you are at a... ), how the client (or his wife, her friends...) did go up to that point in the scale, or what happened so that the client (his wife, her friends...) could go up to that point in the scale. For instance
-How did it happen that you went from ... to....?
-How did you go from ... to....?
-How did you know that was the right thing to do in order to go up to a ....?
-How did he decide to do that?
-How did that help?
-In what way was that helpful to you?
-How do you know you can do more of it?
-What needs to happen so that you can do more of it?
The therapist may also ask how come things are not further down on the scale, how the client has been able to keep at that point,what is the highest he has ever been on the scale, etc.
2.2.2. Discuss next steps towards goals, for instance:
-How will you notice that you are at a... (one point more on the scale)?
-What will she be doing different when you are at a...?
-What will be going on between her and you once you are at a...?
-At a ... how often will you be doing....?
-What needs to happen so that you can go up to a....?
2.2.3. Negotiate intermediate goals, for instance:
-How much on the scale would be "good enough" for you?
-At what point on the scale do you think you could stop coming in here?
-If that happened, how much higher on the scale would you be?
2.2.3. Other questions

3. "The therapist compliments the client(s) at the end of the session"

3.1. During the session the therapist may compliment the client(s) by making remarks using the client's language and quoting their statements (eg goals, exceptions, resources) on what they have done, are doing, or plan to do that is helpful, positive or valuable.

3.2. Compliments should be given at the end of the session, within the last five minutes of the session.

They may be followed by homework assignments or suggestions.

Examples of compliments:
-The team and I are impressed with how well you described your picture of this day after the miracle and...
-We think that it takes a lot of courage to come here and....
-We are struck by how committed you are about your daughter.
-I am impressed with how many things you are doing now that seem to work for you.
-The team and I are impressed with how far you have come in...

4. "Return visits. The therapist asks `what is better?´ at the beginning of the session and follows up on it"

4.1. The therapist asks "what is better (since the last time you were here)?".

4.2. This question should be the opening of the session, and therefore should be asked within the first two minutes of the session.

4.3. Follow up questions serve the purpose of getting a description in specific, small, positive and interactional terms. They should focus on who has been doing what , where, when and with whom , and might be asked both from the clients´ or from somebody else´s perspective, for instance:

-How has that changed?
-What have you been doing instead, when you´ve not...?
-When you stopped..... what did you do then?
-When you are feeling...... what do you do?
-How did she notice that you were feeling ...?
-Who else noticed your being more...?
-What did they do when you.....?
-What did you do when she...?
-What was the first sign that he...?
The therapist may also ask "what else...?" ( is better, did the client notice, was the father doing, etc.), how the client (or his wife, her friends...) did that, or what happened so that the client (his wife, her friends...) could see that happening:
-How did you do that?
-How did you know that was the right thing to do?
-How did he decide to do that?
-How did that help?
-In what way was that helpful to you?
-How do you know you can do more of it?
-What needs to happen so that you can do more of it?

4.4. Ask and follow up on Progress Scale questions (as paragraph 2).

4.5 The therapist compliments the client(s) in relation to this session (as paragraph 3).

Mark Beyebach - Salamanca - for Bruges Research Group. 26 May 2000

EBTA PROTOCOL SUMMARY - 21 October 2007
1 Supervisors register for OQ-45 (www.oqfamily.com) and select therapists. Confirm that core therapy conditions will be adhered to. (Appropriate AV session recording to be available to confirm this.)
2 Obtain ethical approval and consent under local procedures.
3 Obtain copies of OQ-45; GAF / GARF in most appropriate language. Translate follow-up questionnaire into local language.
4 Each group's cases to be taken in sequence following agreed starting date.
5 At referral: send OQ-45 with first-contact paperwork used by team or clinic.
6 Session 1: Initial Data Collection sheet: basic demographic data (name; age; sex; educational level; whether individual / couple / family in treatment). Problem in a few words and DSM-IV diagnosis. Client scaling score. OQ-45. GAF / GARF by therapist.
7 Session 2 and each subsequent: client scaling scores. OQ-45; GAF / GARF by therapist.
8 Last session: client scaling scores. OQ-45; GAF / GARF by therapist. Record: number of sessions attended; whether they ceased attendance by mutual agreement or whether they failed to attend appointments; when follow-up details due. If you did not know it was the last session until they failed to return, send OQ-45 by post.
9 Confidentiality: name removed before papers passed to research group; replaced by therapist name and a number eg Macdonald1; Beyebach2. Thus cases can be traced but not as individuals.
10 Supervisor checks papers for completeness and passes them to research group for processing.
11 One year after last session: therapist sends goal achievement questionnaire and OQ-45. If follow-up interview GAF / GARF can be repeated.
12 Repeat sending of paperwork if no reply after four weeks. Note: many do not reply to postal enquiries (30% in UK), but even more will refuse follow-up interviews.
13 Supervisor checks papers for completeness and passes them to research group for processing.
Alasdair Macdonald (macdonald@solutionsdoc.co.uk) / Mark Beyebach (mbeyebach@upsa.es) / Wally Gingerich (wjg4@po.cwru.edu)

PRIVATE AND CONFIDENTIAL

Date

Name
Address
Address

Dear

About a year ago you came to brief therapy. We would like to know how you have been getting on. This may help us to help other people in the future. Your replies will be kept confidential.

1 Was your goal for therapy achieved? Yes / In part / No

2 Where are you now on a scale of 0-10 for your goal? ....

3 Where would the most important person to you say you are on the scale now? ….
4 Where would your therapist say you are on the scale now? .…
5 Did you achieve any other goals at the same time? Yes / No

6 Have any problems appeared since you were seen? Yes / No

7 Did you solve them on your own? Yes / No

8 Did you seek further professional help? Yes / No

9 Are there any comments that you would like to add about your experience of brief therapy?

...........................................................................................................................………

Thank you for your assistance in returning the questionnaires. A stamped addressed envelope is enclosed.

Yours sincerely

Brief Therapist