Can You Combine Multiple Therapeutic Approaches?

There are a couple of questions that are really popular, that come up really often, when I do trainings about Solution Focused Brief Therapy. And I’m gonna address one of them here today. I was just doing a training, an online training for the military, actually, in the Army, and there was like 30 people there. And of course this particular question came up, and that question is, “Can you combine Solution Focused Brief Therapy with other approaches?”

Now, I’ve tried to address this before. I make a video about this once every year or two. And I think now is the time to make it because I want to make sure that people understand that that question comes from a place of doubt. Most of us were not trained to do Solution Focused Brief Therapy while we’re in graduate school. We’re taught to do kind of very problem focused approaches, things like CBT.

And CBT is a very problem oriented framework, which I think kind of comes more naturally to us because it fits with what we’ve always been taught.

So then when someone teaches you about Solution Focused Brief Therapy, which I think comes even more naturally to us, but it’s not something that is in line with what we’ve always been taught. It’s logical, it makes more sense, and it’s very clearly a direct line from the situation the client is in to the outcome they want to achieve. And people gravitate towards it, but their brains create this doubt.

And they’re like, “But, can it be used on its own?” Because the problem is almost like a warm, comforting blanket. If I’m doing therapy in this way, what if I get stuck? Well, if I can ask a question on the problem, that seems to free things up.

But there are two problems on why you can’t use Solution Focused Brief Therapy with other approaches.

The first one is, you need to increase your confidence. So you can just stick deliberately to and diligently, I guess, to this way of working. When you believe in what you’re doing, then you don’t, out of fear or anxiety or doubt, want to switch what you’re doing.

And then the second thing is, most of us only understand therapy to the point of techniques. So of course I can take a technique of Solution Focused Brief Therapy and combine it with a technique of Cognitive Behavioral Therapy or a technique of Narrative Therapy or whatever the other thing is.

But what makes Solution Focused Brief Therapy so different is not the techniques. It’s the stance that the therapist takes in the work towards the client that they’re working with. And you either are using that stance or you are not. And Solution Focused Brief Therapy is the only stance that focuses on having the client do a description of their hoped-for-future, based solely on their outcome and not their problem.

Now I’m not trying to say that Solution Focused Brief Therapy is better than the other approach. I’m just saying it’s different. And once you start combining Solution Focused Brief Therapy with something else, then you have to decide, I’m going to take the stance of Solution Focused Brief Therapy, or I’m going to take the stance of that other thing.

And if I’m combining it with techniques of things associated with problem oriented ways of working, then obviously I’m no longer doing Solution Focused Brief Therapy. I’m just using Solution Focused techniques to achieve a problem-solving outcome, to solve a problem rather than build an outcome. And that’s the difference.
So if you find yourself thinking, “Can I combine Solution Focused Brief Therapy with other approaches?”, I would advise you, strongly encourage you, to just increase your confidence and your belief in your skills when using this approach and that will eradicate that thought or that feeling.

And also remember, if you believe that your client can change through conversation, and you believe by identifying the outcome the client wants to achieve, then describing the presence of that outcome, then Solution Focused Brief Therapy is the approach that sits with that stance.

If you believe the client needs to be re-storied, then that’s Narrative Therapy. If you believe I have to find the client’s faulty cognitions and address their thought patterns, that’s Cognitive Behavioral Therapy.

And every approach has a stance that is the foundation of that approach. And those stances aren’t really combinable, they’re unique to each approach. So if your stance is in line with Solution Focused Brief Therapy, then you have to build your skill in doing that approach. And that’s why you can’t really combine Solution Focused Brief Therapy with anything else, because it’s the only one that has the stance.

And the last thing I’ll say about this topic is, I don’t understand why so many people in our field would refer to themselves as eclectic, or theoretically integrative. I don’t know why so many do that. When we’re in graduate school, we studied the gurus of this field and of these approaches. None of them advocated for switching approaches based on the client problem.

That’s actually not the best way to achieve outcomes. And as a field we know it. There’s no research supporting that thought. There’s no research supporting that way of doing this work. So why do we do it? We do it because it makes us feel safe, it makes us more comfortable, and it reduces our anxiety. But it’s not in line with how to get best outcomes.

The way to get best outcomes is to show fidelity to one approach. Research has proven that time and time again. And that’s why I’m such an advocate for do whatever you want. Do CBT, do Narrative, do Solution Focused. Do whatever you want, but get really, really good at it. Master it. And stop trying to combine things just because it makes you more comfortable.