Overview of Section 3 Notes

SFT Postmodern Challenges/Problems

Factors that constrain the use of Solution-Focused Therapy (SFT) and adaptations for specific work contexts or populations:

Closing the Acculturation Gap: A Solution-Focused Approach With East Asian American Families

Introduction

The East Asian American (EAA) population in the U.S. is increasing due to migration for better job opportunities (Ng, 1999).
EAA immigrants face psychological adjustment issues related to acculturation, leading to value conflicts between U.S. and East Asian cultures (C. Chang & Meyers, 1997).
Marriage and family practitioners must address various cultural elements when working with EAA clients.
A common issue is parent-child conflicts due to miscommunication and misunderstanding resulting from cultural dissonance (Juang et al., 2012; M. Y. Lee & Mjelde Mossey, 2004; R. M. Lee et al., 2000).
Intergenerational acculturation dissonance is negatively correlated with parent-child relationship satisfaction (R. M. Lee et al., 2000; Portes & Rumbaut, 2001; Wong et al., 2011).
Cultural dissonance is defined as “a lack of shared cultural understanding between parents and child” (Juang et al., 2012, p. 20).
Acculturation-based conflict can lead to mental health issues in Asian adolescents, such as low self-esteem, anxiety, depressive symptoms, and somatization (Juang et al., 2012).
The literature suggests that family counselors should develop a knowledge base in different cultural groups to practice in a culturally competent manner.

East Asian Culture and Family Therapy

Mental health awareness is increasing globally; however, Asian Americans still underutilize mental health services (Atkinson & Gim, 1989; Atkinson & Matsushita, 1991; Sung, Mayo, Ko, & Lasley, 2013).
This underutilization may be linked to EAA’s perception of psychotherapy as a family’s failure to support each other (C. Chang & Myers, 1997; Sung et al., 2013).
Traditional therapy approaches, applied through a Euro-centric and individualistic lens, may be ineffective or harmful to clients with different worldviews (Bernal & Rodrı´guez, 2009).
Process-oriented counseling approaches, such as person-centered or Gestalt therapy, can frustrate Asian clients due to inconsistency with East Asian cultural teachings (Li & Kim, 2004).
American counseling strategies emphasizing emotional catharsis or divulging personal wishes contrast with Confucian teachings of self-restraint and modesty (Atkinson & Matsushita, 1991; Li & Kim, 2004).
A problem-solving approach is more suitable for working with EAA families (C. Chang & Myers, 1997).
EAA clients view family counselors as more credible when they take a directive stance and provide instructions, enhancing client motivation and collaboration (C. Chang & Myer, 1997; M. Y. Lee, 2000).

Potential Tensions / Challenges in Applying SFT

The “client-as-expert” stance in SFT may conflict with cultural expectations of the therapist as an authority figure (Ng, 1999; Bannink, 2007; Trepper, 2012).
SFT’s use of compliments may feel uncomfortable or inappropriate for clients from collectivist backgrounds who avoid standing out (Kim, 2008).
Process-oriented, emotion-focused models may clash with cultural norms; SFT’s brief and structured approach may be more acceptable but still needs adaptation (Li & Kim, 2004).

A Study of Solution-Focused Brief Family Therapy: Outcomes and Issues (MO-YEE LEE)

Issues and Challenges Identified

Technique vs. Relationship: Rigid, overly positive, or artificial therapists had lower goal attainment, indicating the risk of overusing techniques without attunement.
Complexity of Family Dynamics: Goals related to family relationship issues had the lowest goal attainment, suggesting SFT may need adapting for deeper relational conflicts.
Mismatch Between Problems and Goals: Families often presented with school or emotional regulation problems but set goals focused on parent self-development or family relationships, revealing the need to help clients clarify practical, observable goals.

Respondents’ Reported Goals and Families’ Presenting Problems

“Family relationship problems” and “behavioral problems at home” were consistently the most frequently mentioned problems and goals.
Inconsistency was evident for “children’s emotional regulation problems” and “school-related problems,” which were less often mentioned as goals.
“School-related problems” were the second most frequently mentioned presenting problems (42.4%), but “improved school functioning” was the third least mentioned goal (11.9%).
35.6% of families mentioned “emotional regulation problems,” but only 15.3% reported “improved emotional regulation” as a goal.
Parents tended to select goals focusing on themselves rather than on the children's problems.
“Self-development in parents” and “improvement in parents’ marital situation and/or children’s coping” were the third and fourth most frequently mentioned goals.
This pattern may reflect the assumption in SFT that solutions don't necessarily need to be related to the problems (de Shazer et al., 1986).

Influence of Presenting Problems and Goals on Goal Attainment

Problems and goals related to “children’s emotional regulation” and “school-related issues” had the highest percentage of goal attainment.
Problems and goals related to “family relationship problems” had the lowest percentage of goal attainment.
A possible explanation is that SFT tends to focus on specific issues with small behavioral changes, making it more suitable for child-focused problems like emotional regulation and school issues.
Family relationship issues are more complex and involve dynamics among different subsystems in the family.

Challenges and Considerations (Zimmerman, T.S., Jacobsen, R.B., MacIntyre,M., & Watson, C. (1996))

Unequal Sample Sizes: Findings should be interpreted as preliminary or exploratory due to methodological limits.
Role Support Subscale Anomaly: The control group improved more on “role support” (co-parenting support), possibly due to pre-intervention conversations sparked by signing up for help.
Need for More Cultural & Structural Diversity in Samples: Future research should include single-parent families, diverse economic backgrounds, and different cultural groups, as well as data from adolescents themselves.

Practitioner Review: The Effectiveness of Solution Focused Brief Therapy with Children and Families: A Systematic and Critical Evaluation of the Literature from 1990–2010 (Caroline Bond, Kevin Woods, Neil Humphrey, Wendy Symes, Lorraine Green)

The evidence base for SFBT effectiveness remains relatively weak, with only five high-quality research studies identified.
SFBT is often used in combination with other approaches, limiting evidence for its effectiveness as an intervention in its own right.

Mixed Results with Complex Cases

Mixed or inconclusive outcomes occur when used with children exhibiting both internalizing and externalizing issues or with more complex trauma histories.
Studies suggest alternative interventions may yield better outcomes in some cases (Smyrnios & Kirkby, 1993).

Solution Focused in the Family (Thorana S. Nelson)

Potential Problems with Practice Principles

SFBT may face challenges in contexts where clients resist the positive, forward-looking approach (e.g., severe relational trauma, significant mistrust).
Cultural dynamics, such as race and socioeconomic status, may limit effectiveness if not adequately addressed.
Therapists must remain sensitive to these factors and adapt techniques to ensure inclusivity.
Power imbalances or differing views of the problem among family members can hinder the collaborative exploration of solutions.
Therapists may need to adapt techniques to address cultural variations in family roles and communication styles, ensuring that all voices are heard.

Challenges in Couple and Family Therapy

Couple and family therapy can be difficult.
It can be challenging to track individuals and communication.
An important skill is seeing the family as a whole.
Track patterns of interaction, not individuals or behaviors.

Contextual Factors

Solution-focused therapists are sometimes accused of not being concerned about contextual factors (race, sexual orientation, economic resources, family constellation).
Useful to have a general idea of family resources, but people will tell you what you need to know about their circumstances (Berg).
Therapists generally don't gather extensive background information initially, focusing instead of solution building.

Issues of Language and Culture in Family Therapy (James Morris Yueh-Ting Lee (2004))

Language and culture play an increasingly significant role in MFT training.
Non-native English-speaking trainees face challenges related to linguistic structures, cultural contexts, and the clinical language of MFT.
Supervisors and supervisees from different cultures of origin need to co-construct space for respectful discussion of cultural differences (Killian, 2001).
Increased supervisor sensitivity and active interest in other cultures are essential, establishing a foundation of trust.
REC (race, ethnicity, and culture) talk should develop from the conversation rather than as a formally introduced topic (Lawless, Gale, and Bacigalupe, 2001).
Efforts by non-native English-speaking trainees to accommodate differences in accents are generally positively received by clients.
Trainees may offer a preamble, inviting clients to ask for clarification if needed, which promotes care and attention in the interaction.

Potential Problems with SFT in Selected Context

SFT may not address underlying issues specific to certain cultural contexts, especially if conflicts arise from cultural misunderstandings.
Adaptations may be necessary to incorporate discussions about family dynamics, cultural heritage, and identity issues prevalent among immigrant families.
It could be inappropriate in scenarios where clients expect to explore deeper emotional issues rather than surface-level solutions.

Talking about Race, Culture and Racism in Family Therapy (Sim Roy-Chowdhury (2022))

Challenges in Applying SFT

Risk of cultural reification if SFT avoids deep cultural or racial trauma in its focus on future solutions.
SFT can be challenged when families operate with strong cultural hierarchies (e.g., elder respect).
Reinforces the need for cultural reflexivity among therapists.
SFT might inadequately address deep-rooted family issues stemming from historical trauma, requiring integration with other therapeutic models (e.g., Narrative Therapy).
Families from diverse backgrounds might find the SFT emphasis on solutions rather than problems dismissive of their lived experiences, necessitating a modification of the approach to make space for cultural narratives.
Older generations may resist movement towards solutions that diverge from traditional, deeply ingrained beliefs about family roles and responsibilities.
Flexibility and adaptability in applying SFT principles are needed to respect these dynamics.

Therapy Across Cultures and Races

The aim is to understand therapy across cultures and races, exploring the meaning of culture, especially when an individual identifies with multiple cultures.
Focus on the complex interplay of influences on individual subjectivity, resisting reductive accounts.
Systemic theory, with its 'not knowing' position and constructions of culture, is well-suited for this approach.
Promoting psychotherapy sensitive to cultural difference is an act of subversion, especially given the rise of xenophobia and far-right nationalism.
Must move away from Euro-American hegemony.
Changes in practice must be accompanied by structural changes in service delivery, involving local communities.
Therapy should not be imposed in a colonial manner but adapted to different communities.
Mental health constructions should move away from essentialist premises, considering social, cultural, and political contexts.

Evidence Base for Solution-Focused Brief Therapy (Franklin, C., Bolton, K. W., & Guz, S. (2019))

SFBT is more effective for adolescents with externalizing disorders than adults.
Mixed results regarding externalizing disorders may be related to the age of the population.
More studies are needed to learn how well SFBT may actually work in couple and family therapy and its specific effects on family and relationship outcomes.
Limited research on the efficacy of SFBT with families beyond studies focused on children’s behavior.

Cultural Dissonance Among Generations: A Solution-Focused Approach with East Asian Elders and Their Families (Mo Yee Lee and LeeAnn Mjelde-Mossey, 2004)

Clinical Challenges in Addressing Cultural Dissonance

Incorporating Multiple Worldviews is a major challenge.
Need to respect and incorporate a family’s worldview in the treatment process.
Treatment should be congruent with behaviors and expectations normative for a given community and adapted to specific needs of the families.
Therapies must enable the different worldviews and values of individual family members to be recognized and negotiated while respecting the unique intergenerational hierarchy.

Empowerment-Based Practice

The dynamic of power is an integral part of cross-cultural practice.
Power struggles in families with cultural dissonance will have multiple sets of cultural values in a precarious or conflicted position.
Understand each family member’s unique experiences, ensuring each participates fully in the process of change, and helping family members perceive themselves as causal agents in achieving solutions.
Therapist must respect and validate the knowledge and expertise of each individual.

Utilizing Cultural Strengths and Resources

Most helping professions in the United States are based upon a deficit or pathology perspective.
Strengths perspective: (1) all people and environments have abilities and resources that are not being used; (2) all people are capable of continued growth and change.
Utilizing and building on cultural strengths and resources is a more efficient and effective way for East Asian families to develop solutions.

Addressing Cultural Stigma

Disclosing family problems to an outsider leads to fear of shaming the family name or losing face.
It is rare for the presenting problem to be the problem of greatest importance because they are too shameful to disclose the more serious family problems to outsiders.
Effective family therapy should facilitate a treatment process that allows the family to save face and develop beneficial solutions.
Focus on how family members can contribute to the desired family relationships.

Cultural Value of Pragmatism

East Asian populations tend to be pragmatic and instrumental due to Confucianism.
Treatment should involve practical and useful assistance and an exchange of information and solutions for problem-solving.
Therapy should be goal-oriented, focus on the present and future, and emphasize small and achievable changes with clear indicators of progress.

Respecting Culturally Embedded Modes of Communication

Individuals learn their styles of social interaction from their socio-cultural backgrounds.
Consider Enryo (restraint or holding back), observed communication style among Japanese.
Koreans are generally reserved in the presence of superiors.
Under the influence of traditional cultural values, many elders from Chinese, Korean, and Japanese backgrounds tend to be reserved and inhibited about emotions. Lack of direct eye contact may be a sign of respect.
Family therapists should observe and respect characteristics of both verbal and nonverbal communication in each family member.

Using a Solution-Focused Approach

A Constructivist View

Solution-focused therapists do not assume an a priori expertise sufficient to objectively categorize and solve families’ problems.
The therapist would first seek to understand each family member’s view of the problems and solutions and incorporate their multiple worldviews in the treatment process prior to assisting them to define goals for treatment.
Use the miracle question to assist the family to envision a future with family harmony and acceptance and to establish explicit and clear indicators of change.
Use cultural beliefs and practices in phrasing the outcome questions as a way to elicit individual family members’ views of solutions.
Identify the decision-makers in the family and gain their support.
Join with the existing hierarchy of the family, inviting the oldest male member to speak first.
Holding individual family members accountable for solutions directs therapeutic conversation away from blaming talk to solution dialogue.
Focusing on small change in terms of observable behaviors/interaction is more possible and manageable.

Family Has the Answer

A fundamental assumption is that all people have strengths, resources, and competencies.
The task is to assist families in remembering, noticing, amplifying, sustaining, and reinforcing the identified cultural strengths and resources regardless of how small and/or infrequent they may be.
Exception questions and coping questions can assist the family to identify unnoticed strengths or resources.

Collaborating With the Families

Honors families as knowers of their experience with sufficient resources to define treatment goals and achieve change.
Use evaluative questions to explore goals and empower the family to take ownership of life choices and decisions.
Establish therapist’s expertise and honoring family as “knower” of their situation.
Provide information on personal credentials, qualities, and educational backgrounds early on.
Share successful work experience with families encountering similar problems.

Accountability for Solutions

Employs a nonconfrontational approach that holds a person accountable for solutions rather than focusing on their problems.
Aims to create a therapeutic dialogical context in which the family engages in a solution-building process that is initiated from within and grounded in family members’ cultural strengths as well as their construction of the solution reality.

Conclusion

Cultural differences between generations can result in problems of cultural dissonance.
The literature emphasizes the important of developing culture-specific knowledge.
A solution-focused approach offers a culturally respectful and responsive therapy process with East Asian families.
No one therapeutic approach should be viewed as the sole or ultimate solution for resolving the problem of cultural dissonance in families.