Mental health counselors and substance abuse treatment: advantages, difficulties, and practical issues to solution-focused interventions.

Mental health counselors increasingly work with a wide variety of client issues, including substance abuse. This article addresses the use of solution-focused counseling as a viable treatment option for clients who experience problems with substance abuse and addiction. A brief overview of traditional substance abuse treatment is offered. The basic assumptions of solution-focused counseling are then discussed, and differences from traditional approaches are delineated. Benefits of using solution-focused counseling with substance abase issues, such as the collaborative and client-centered nature of the approach, are presented; and sample interventions are described. Difficulties to using solution-focused counseling techniques with substance abuse issues are also discussed.

**********

Mental health counselors (MHCs) are increasingly working in a variety of treatment settings (American Mental Health Counselors Association, 2004). These settings include medical settings, private practices, community mental health centers, non-profit organizations, primary and secondary schools, institutions of higher education, and substance abuse treatment clinics. As a result of this diversity in practice, MHCs are encountering a greater variety of clients and clinical issues. One client population encountered by MHCs in all treatment settings is persons with substance abuse issues.

Whether accurate or not, many clients with substance abuse (SA) problems are labeled as unmotivated and treatment resistant (Berg & Miller, 1992; Connors, Donovan, & DiClemente, 2001; Miller & Rollnick, 2002). When encountering substance-abusing clients who are accurately labeled as treatment resistant, MHCs need new, diverse, and evidence-based techniques to address issues of addiction, motivation, and resistance. Because many MHCs have been trained in programs emphasizing the scientist-practitioner model (Pistole, 2002), these practitioners have the knowledge and ability to choose and apply these new, research-tested techniques. Solution-focused counseling (SFC) has emerged in recent years as one such viable treatment model for use with SA issues. The purpose of this article is to introduce MHCs to solution-focused counseling for use with unmotivated and resistant clients who have substance abuse issues. I provide a brief overview of traditional approaches to substance abuse treatment, discuss solution-focused counseling theory and techniques, and outline the advantages and difficulties to using SFC interventions with the target population of treatment resistant substance abusing clients. The article concludes with a brief discussion of future areas for research development.

TRADITIONAL MODELS OF SUBSTANCE ABUSE TREATMENT

Most traditional models of SA treatment are founded on the disease model of addiction (Stevens & Smith, 2001). The disease model views addiction as an incurable, lifelong, and potentially fatal physiological disease over which afflicted persons are powerless. The disease model, which is the basis for many 12-step self-help groups including Alcoholics and Narcotics Anonymous (Doweiko, 2002), further delineates that persons are in denial of their addiction problem until they admit their powerlessness over alcohol and other drugs (AOD). Once this admission occurs, individuals are no longer considered actively addicted to AOD. Disease-based approaches, therefore, view heavy confrontation of denial as the central tool of treatment, with the overall goal of counseling being total abstinence from AOD. Because addiction is viewed as a disease, persons are never cured of their addiction problem; once attaining abstinence, they are labeled as being in recovery from the disease and must actively work to control it one day at a time.

Newer models of substance abuse treatment informed by social learning and cognitive behavioral theory (CBT) have emerged in recent years (Craig, 2004; Fisher & Harrison, 2000; Stevens & Smith, 2001). In these models, which are progressively being incorporated into traditional treatment approaches, problematic use of AOD is thought to result from "overlearned habits that can be analyzed and modified in the same manner as other habits" (Fisher & Harrison, p. 241) rather than from a physiological disease. Mental health counselors operating from a CBT orientation work collaboratively with clients to identify unrecognized (a) determinants or "triggers" of their AOD use (e.g., social settings, affective states such as anxiety or stress, times of day or week), (b) errors in thinking related to problematic AOD use (Wanberg & Milkman, 1998), (c) irrational beliefs about the role of AOD use in other life problems, and (d) previously unacknowledged consequences of excessive AOD use (e.g., driving offenses, conflict with friends and family, financial problems, physical health issues). The MHC and client then collaborate to identify, understand, and change problematic determinants, thinking errors, and irrational beliefs. To complete these tasks MHCs employ confrontation as a central tool of treatment to assist their clients to identify and change unrecognized triggers, thinking errors, and irrational beliefs. Total abstinence from AOD is not necessarily the goal of CBT treatment and some clients are thought to be able to return to moderate AOD use after appropriate intervention.

Disease-based and CBT models of SA treatment are problem-based approaches to treatment. Mental health counselors using the disease-based approach seek to address clients' deficits and foster coping skills to manage the incurable disease of addiction. Likewise, MHCs using CBT assist clients to develop skills to cope with triggers and identify and change problematic patterns of thinking related to AOD use. As a result, MHCs operating from either the disease-based or CBT theoretical orientation take the stance that treatment should focus on seeking out and fixing clients' problems and deficits relative to their AOD use.

SOLUTION-FOCUSED COUNSELING

Solution-focused counseling (SFC) can provide MHCs with an alternative approach to disease-based and CBT models of SA treatment. Solution-focused theory emerged from the works of Milton Erickson, the brief family therapy movement, the Mental Research Institute's Brief Therapy Center, and de Shazer and Berg's efforts at the Brief Family Therapy Center (Becvar & Becvar, 2000; de Shazer, 1985; Mason, Chandler, & Grasso, 1995). A similar approach entitled solution-oriented therapy, developed by O'Hanlon and Weiner-Davis (2003), shares these origins. Solution focused counseling is rooted in post-modern, constructivist thought (de Shazer; O'Hanlon and Weiner-Davis). Post-modern constructivist approaches are built on the premise that there is no single absolute and objective truth. Instead, what is viewed as reality is a subjective construction based on a person's interactions with the world, meanings made of life experiences, and personalized interpretations of ambiguous stimuli and events (Nichols & Schwartz, 2004; White & Epston, 1990).

Berg and Miller (1992) assert that as a result of this constructivist orientation, "the solution-focused approach makes no assumptions about the 'true' nature of the problem that clients experience" (p. 7). Instead, the approach focuses on the personalized constructions that the client creates about his or her unique experiences and how the client, or someone else in the client's life, defines the problem based on those experiences. When applied to SA counseling, this idea challenges the notion that there is one true pattern of addiction: "the solution-focused counselor treats many [addictions]--a different type for each client that is treated" (Berg & Miller, p. 7). Therefore, solution-focused counselors attempt to understand each client's personalized construction of the problem and assist him or her to construct different meanings about it.

The main difference between SFC and other therapeutic approaches is a focus on solutions rather than problems (de Shazer, 1985). Because they do not adhere to the belief that all problems have one objective definition or cause, solution-focused MHCs assert that an understanding of the problem is not necessary in order to change it and that the problem and its solution may not even be related. Taking special care not to reify client problems, MHCs using SFC concentrate on positive aspects of clients' lives and seek to expand on them (O'Hanlon & Weiner-Davis, 2003). In addition, this positive, strength-based approach assumes that change is constant. As a result, solution-focused MHCs assist clients in directing naturally occurring change, generating new perspectives on problems, identifying strengths, and finding parsimonious solutions that work (Berg & Miller, 1992; Miller, 1999).

Solution-focused counseling methods have been described as useful in enhancing motivation with unmotivated and treatment-resistant clients (Berg, 1996; Berg & Miller, 1992; Talef, 1997). In recent years, several scholars have discussed and validated the effectiveness of SFC and established it as a viable treatment option with this population of clients (Aambo, 1997; Banks, 1999; Berg, 1996; Lee, Sebold, & Uken, 2003; Pichot, 2001; Schorr, 1995; Schorr, 1997; Zimmerman, Jacobsen, Macintyre, & Watson, 1996). For example, several authors have described the successful application of solution-focused counseling with court-mandated domestic violence offenders, a population that is generally described as being resistant to treatment (Lee et al.; Linton, Bischof, & McDonell, in press). Solution-focused interventions have also been described for use with unmotivated and resistant substance abusing clients (Berg; Pichot; Pichot & Donlan, 2003).

To assist clients in developing solutions, solution-focused MHCs use numerous techniques. Mental health practitioners using a solution-focused approach describe the careful use of questions as a central intervention technique; in essence, each question is an intervention in and of itself (de Shazer, 1985; O'Hanlon & Weiner-Davis, 2003). Accordingly, solution-focused MHCs use very precise language when formulating questions. Solution-focused MHCs utilize three types of questions to elicit change in treatment: (a) scaling questions, (b) miracle questions, and (c) exception and coping questions (Berg & Miller, 1992).

In scaling questions, clients use a scale of 1 to 10, or some scale of their choosing, to rank the magnitude of the problem, their confidence in their ability to make changes, and their goal for where they would like to be after counseling is completed (Berg & Miller, 1992; Miller, Huble, & Duncan, 1996; O'Hanlon & Weiner-Davis, 2003; Roes, 2002). For example, a solution-focused MHC may ask, "On a scale from 1 to 10, how confident are you that you can be successful in your treatment goals?" This question may then be followed with, "What would have to happen for you to be one point higher on the scale?" Within these discussions, MHCs attempt to determine how much change is necessary in order for clients to feel successful.

With the second type of question, the miracle question, solution-focused MHCs inquire as to what will be happening in clients' lives when the problem is no longer occurring (Berg & Miller, 1992). For example, a MHC might ask, "Let's say that while you are sleeping tonight a miracle occurs and your problem has disappeared. How would you notice that the problem was gone? What would you be doing differently? What would other people notice as different about you?" After a detailed description of change is developed, one that includes behavioral components (e.g., "How will you be acting differently?"), solution-focused MHCs and clients work together to "make the miracle happen" (i.e., the client is instructed to behave in the ways that they would if the miracle did occur). In essence, through therapeutic intervention MHCs ask clients to describe goals in active, positive, and behavioral terms and then indirectly prescribe those goals as an intervention (de Shazer, 1985).

Third, solution-focused MHCs use exception and coping questions. In doing so, they inquire at length about exceptions to the presenting problem and clients' coping skills (Roes, 2002). Often, clients are focused entirely on their problems and are not cognizant of times when the problem is under control (Berg, 1996; Berg & Miller, 1992; O'Hanlon & Weiner-Davis, 2003). Solution-focused MHCs may therefore use an exception question to inquire about times when the problem is not occurring. The client and MHC then work together to identify what the client did in those instances to experience problem free times (e.g., "What are you doing during the times when the problem is not occurring?"). With coping questions, solution-focused MHCs attempt to orient clients to examples of times when they are coping effectively with the problem. Here, a sample question is, "Things sound like they are really challenging for you. Given that the situation is so bad, how come it is not worse?" Out of these discussions, client strengths are identified, and positive solutions are developed.

While using these and other questions, solution-focused MHCs do not seek to eliminate the problem entirely via their interventions; rather, they assume that small changes will create a ripple effect leading to larger changes (Berg & Miller, 1992; de Shazer, 1985; O'Hanlon & Weiner-Davis, 2003). Likewise, the absence of the problem is seen as only part of the solution, and solution-focused MHCs are more concerned with what clients are going to do instead of engaging in the problem behavior (de Shazer). Moreover, the SFC perspective emphasizes a collaborative, client-centered, and respectful approach to treatment that assumes clients have the internal strength, desire, and skill to make change happen.

USING SOLUTION-FOCUSED COUNSELING WITH SUBSTANCE ABUSE ISSUES

There are several advantages to utilizing a SFC approach with SA issues. Because the approach is client-centered, solution-focused MHCs assume that clients know what is best for themselves and do not have a predetermined set of counseling goals (Berg & Miller, 1992). Accordingly, goals are developed in conjunction with clients and are specific to their desires. Abstaining from drugs and alcohol, examining and changing situational triggers, altering dysfunctional thoughts and beliefs, and attending self-help groups are not thought to be the only treatment methods for addressing SA issues.

Pursuant to goal setting, one advantage of using SFC with SA issues is that SFC can operate as a stand alone approach or in conjunction with traditional models of SA treatment. Solution-focused MHCs do not view SFC and traditional models of SA treatment as incompatible. Collaborating with clients to create counseling goals, be they directed towards abstinence, self-help group attendance, changes in thinking errors, or some other goal of the client's choosing, selves to enhance motivation to change (Mott & Gysin, 2003). A basic assumption of SFC, however, is that clients will only be motivated to change if the solutions identified in counseling are compatible with their own goals for treatment (Pichot & Dolan, 2003). A solution-focused MHC would therefore be apprehensive about prescribing abstinence from AOD as the ultimate goal of treatment, at least at the outset of therapy, if the client did not consider abstinence as a desirable solution.

To elicit client goals, solution-focused MHCs may begin by using language that presupposes that clients desire some sort of change in their lives, as is consistent with a strongly held belief in the SFC approach (Berg & Miller, 1992; de Shazer, 1985; O'Hanlon & Weiner-Davis, 2003). For example, a MHC may begin an initial session with a SA client by saying, "What goal brings you to counseling today?" Asking this type of questions, rather than "Tell me about the substance abuse problems that bring you to counseling today," is more likely to result in clients' orientating towards achievement instead of maintaining a problem-saturated view of themselves and the situation. The miracle question can also be helpful in the goal setting process. By using the miracle question, the solution-focused MHC orients the client to the future where their SA issues, as defined by the client or someone else in the client's life, are under control. This process assists the client in creating a personalized definition of success, rather than his or her own or someone else's definition of pathology, and directs the counseling process toward that success. Encouraging the client to think about a possible future without the problem can lead to the establishment of realistic and attainable treatment goals (Berg & Miller).

A second advantage to using SFC with SA issues is that the approach is flexible and seeks parsimonious solutions that work. Because solution-focused MHCs concentrate on solutions rather than problems, these clinicians are able to explore any number of intervention strategies to address SA complaints (Berg & Miller, 1992). If and when a solution fails to resolve the client's identified SA issue, solution-focused MHCs assert that this failure happened because the client and counselor developed an ineffective solution. This approach differs from traditional models of SA treatment, which often seem to prescribe predetermined interventions (e.g., confrontation of denial, identification of thinking errors, attendance at self-help meetings) and then place the blame on client resistance and denial if the interventions fail (Connors et al., 2000; Miller & Rollnick). By placing blame on the intervention instead of the client, solution-focused MHCs maintain a focus on strengths and abilities rather than deficits. A fundamental assertion of SFC is that if an intervention does not work, it should not be used again; something else should be tried instead (Berg, 1996; Berg & Miller; de Shazer, 1985).

A third major advantage of using SFC with SA clients pertains to the model's emphasis on internal strengths and resources (Berg & Miller, 1992; Taleff, 1997). This focus differs from traditional models of SA treatment, which have as a basic assumption that SA is the result of (a) an incurable disease over which clients' are powerless, (b) strongly entrenched errors in thinking, or (c) problems related to situational and environmental factors (Connors et al., 2000; Miller & Rollnick, 2002). Mental health counselors using SFC recognize that every person, no matter what his or her current situation, has strengths and abilities. Solution-focused counseling teaches clients that they have the power to overcome their past difficulties and works to assist SA clients in recognizing and using those competencies.

Exception and coping questions may be useful techniques to elicit client strengths. For example, when using a coping question a solution-focused MHC may remark to an unmotivated client with SA issues, "Your situation sounds really troubling, and it must be difficult for you to have come here today in spite of the fact that you didn't want to. Given that you wish you were not here and the stress of your situation, how did you get yourself to make it to this appointment? How come you are not drinking more?" Similarly, when using an exception question a solution-focused MHC may inquire about times when the client is not using or using less AOD. By assisting clients to see that they are functioning in some positive ways, these types of questions draw out client responses that are oriented to strengths rather than deficits. Asking clients to think about their strengths, rather than using language that suggests that the client is resistant to change or in denial of the problem (e.g., "Why is it that everyone else realizes that you have a drinking problem and you can't see it?" "Don't you think it is a problem that you got another drunk driving charge?" "Isn't losing your wife over drug use enough to make you want to quit?") is more likely to help clients realize that they do have some control over their situation and may result in a stronger therapeutic alliance and a change-minded orientation.

When using coping and exception questions to elicit client strengths, the solution-focused MHC and client should recognize and appreciate even the smallest of successes (Berg, 1996; Berg & Miller, 1992). In this respect, it becomes the MHC's job to help clients look beyond the problem-saturated view they have of themselves and see instances of small change or problem management. Likewise, the solution-focused MHC should encourage clients to aim towards small increments of change when generating solutions to the problem. Scaling questions may be useful to accomplish each of these tasks. First, in identifying previous successes, a sample scaling question may ask the client to consider differences in the problem's magnitude over a period of time ("On a scale from 1 to 10, how intense would you say your desire to use AOD was on Saturday night?"; "How about today?"). Following this with a coping question such as, "What did you do to make any improvements happen?" can help the client to see small changes and take responsibility for them.

When using scaling questions to set the stage for future change, the solution-focused MHC may ask the client to rate the current magnitude of the problem and then inquire as to what would have to happen for the problem to improve by one point on the scale. This question may be followed with another scaling question asking the client to rate her confidence in her ability to make such a small change happen ("How confident are you that you could do something to improve by just one point?") Out of this discussion, small and realistic goals begin to emerge. Because solution-focused MHCs assert that small changes lead to larger ones, it is assumed that these small increments of change will be the "difference that makes the difference" (Berg & Reuss, 1998, p. 13).

A final important benefit of applying SFC to SA counseling pertains to its stance on client motivation for counseling. As stated previously, many SA clients are labeled as unmotivated and resistant to treatment (Mahon, 1992; Miller & Rollnick, 2002; Pichot & Donlan, 2003). When such clients present to treatment, traditional SA treatment approaches may begin by applying the resistant label and confronting it as the primary obstacle to change. As Berg (1996) points out, confronting perceived denial and resistance at the beginning of treatment only serves to raise client defensiveness and puts the mental health professional in a position where he or she is arguing for change while the client is arguing against change (Miller & Rollnick). Rather than using the terms denial and resistance, SFC describes clients as falling into one of three categories (Berg): (a) visitors (i.e., clients that are involuntary to treatment and see no need for personal change), (b) complainants (i.e., clients who attend treatment with goals to change others rather than themselves), and (c) customers (i.e., clients who are motivated with personal goals). Berg and Miller (1992) state that clients with substance abuse issues are often labeled as unmotivated or resistant due to assumptions made by clinicians that all clients in treatment should present as customers. When this assumption is made, the MHC fails to appreciate and accept the complainant and visitor roles and may become frustrated with clients who do not desire change at the outset of counseling. Solution-focused MHCs, on the other hand, accept the client in whatever role they are in at the outset of treatment. At the same time, solution-focused MHCs assume that all clients are hidden customers, thereby allowing the clinician to take a positive stance in the clinical work.

To bring out the hidden customer, solution-focused MHCs join clients where they are "at" and collaborate with them on treatment goals. For example, a visitor or complainant with an SA issue may present to counseling with the goal of appeasing his or her probation officer. Rather than confront what may be perceived in other treatment approaches as an obvious display of denial, the solution-focused MHC further delineates this goal and works with the client to determine how to make it happen. Exception questions may be useful here. For example, in the situation described above, a solution-focused MHC may ask, "What are you doing during the times when you feel like your probation officer is not hassling you?"; "How did you make that happen?" Using such presuppitory language persuades clients to recognize times when they are handling the problem with the probation officer well. In solution-focused SA counseling, what may result from these types of questions is a discussion of the behavioral and situational factors leading to the probation officer's satisfaction with the client's behaviors during these exception times. Decreased alcohol or drug use and increased prosocial social behavior then may be determined to be necessary components to reaching the client's stated goal of improving his or her relationship with the probation officer.

In general, SFC does not reify SA problems as insurmountable and lifelong. While SFC acknowledges that overcoming SA problems is difficult (Taleff, 2001), the approach recognizes that symptoms can remit quite quickly. As Pichot (2001) noted, solution-focused counselors assume that even complicated problems can be resolved with simple solutions. Although traditional models may characterize rapid success as short flights into health, solution-focused MHCs frame them as effective solutions and assist clients in developing plans to maintain progress (Pichot & Donlan, 2003; Roes, 2001). Similarly, substance use relapse is not viewed as a signal of a failure to engage in treatment but rather implementation of inappropriate treatment goals, a situation for which both the counselor and the client take responsibility. The SFC approach is similar to traditional models of SA treatment in that clients are encouraged to address their problems one day at a time (Taleff). However, the way in which the problem can be addressed on a day-to-day basis is not predetermined.

DIFFICULTIES IN SOLUTION FOCUSED APPLICATION TO SUBSTANCE ABUSE

The majority of difficulties in applying SFC to SA issues pertain to mental health practitioners' lack of skill and theoretical understanding of the approach, confusion regarding the application of the model, and referral source expectations. Additionally, SFC may not be a good match for some clients because of their personal concerns, issues, and expectations for counseling. Each of these difficulties is discussed below.

Solution-focused counseling, as a general approach, has been the focus of much criticism in the literature (e.g., Efron & Veenendaal, 1993). Critics often assert that the approach appears too simple and is, therefore, ineffectual. As well, SFC has often been viewed as a mixed bag of techniques rather than a true theoretical orientation. When MHCs are confronted with court mandated and unmotivated SA clients, they may be tempted to apply SFC as a quick and popular fix without a firm understanding of the theoretical underpinnings that guide intervention. As Berg (1994) points out, however, "no amount of technique will disguise the therapist's lack of listening skills, [or] lack of faith in the client's ability to know what is good for him" (p. 14). Berg and Miller (1992), and de Shazer (1985) admit that their simple and straightforward descriptions of SFC may make the approach seem overly simplistic leading critics to see it as a "less of the same" approach to counseling. In the end, this simplistic view of SFC may present as an obstacle to the success of SFC approaches with SA clients as MHCs may unsuccessfully (and unethically) apply the theory without a firm understanding of and belief in its basic assumptions (Miller, 1999).

Other difficulties related to the application of SFC with SA issues may also exist. For example, writings on SFC to date have not directly addressed physiological aspects of SA and addiction in terms of how they affect counseling efficacy. Solution-focused counselors, in their solution mindedness, may not recognize when SA clients' have suffered real physiological and neurological damage, a situation which could have a profound impact on drug and alcohol cravings and on clients' ability to engage in treatment (Inaba & Cohen, 2000). Solutions that do not include other modalities of the SA continuum of care, such as medical management, may therefore, be ignored. Because some clients with SA issues have experienced many losses in their lives, physically, socially, cognitively, and mentally, cooperating with other health care professionals in the treatment process becomes crucial to success. Fortunately, because SFC is collaborative and flexible in nature, recognizing the physiological effects of prolonged SA use and conferring with other professionals is easily incorporated into any treatment goals.

A third difficulty that may arise when applying SFC to SA issues pertains to referral source and community expectations. Based on the history of SA treatment practices, when referrals are made to SA treatment, there may be implicit or explicit expectations that clients will be treated in certain ways. In the my experience, these expectations may include using heavy confrontation, holding clients accountable for their actions, enforcing abstinence as the only goal of treatment, and catching clients in manipulative behavior. When a solution-focused MHC does not provide these services, referral sources may become dissatisfied with the treatment being provided and even inadvertently sabotage treatment efforts. This dissatisfaction may be especially true with referrals from the criminal justice system where, in the author's experience, considerable blurring has developed between corrections staff and substance abuse professionals' roles in recent years. As a result, solution-focused MHCs must be cognizant of referral source expectations and educate these professional on the services that can and cannot expected (Tohn & Oshlag, 1996).

Finally, SFC may not be appropriate with certain clients who have SA issues, particularly those who prefer more traditional approaches. Although SFC can be used adjunctively to traditional models, clients who are heavily invested in the traditional 12-step based treatment models may not find solution-focused techniques helpful. In all cases, the solution-focused MHC remains free to use whatever works. However, in cases where clients state a strong preference for traditional SA treatment approaches, what may work is a referral to a local 12-step self help group or a traditional model SA treatment center. In these instances, the solution-focused MHC assumes that clients knows what is best for themselves and makes appropriate arrangements for preferred modalities of treatment.

CONCLUSION

In conclusion, this article has presented the application of SFC to clients with SA issues. Generally speaking, because of the SFC model's client-centered and flexible nature, the benefits of skilled application to SA issues appear to outweigh the potential difficulties. If applied correctly, SFC holds much potential and promise for MHCs in the SA counseling field. Although SFC can be a highly effective counseling approach, MHCs working with SA clients are cautioned against employing SFC techniques without a firm understanding of its theoretical underpinnings. Such a practice is unethical at best and, at worst, may have iatrogenic effects on clients in treatment. It is also important to note that SFC does not compete with other, more traditional models of SA treatment and can be used either conjunctively with these approaches or as a stand-alone intervention.

Although anecdotal descriptions suggest that SFC can be effective with SA clients (Berg, 1996; Berg & Miller, 1992; Pichot, 2001; Taleff, 1997), further research is needed in order to confirm treatment efficacy and improve applications to clients with SA issues. This research should be focused on client-treatment matching with SFC as well as SFC treatment outcomes with SA issues. Research should also focus on the multicultural aspects of applying SFC to SA issues. Clearly, clinical trials are needed to validate positive treatment effects and improve the approach to working with SA problems. Until such research is undertaken, however, it is recommended that MHCs working with SA issues begin to consider this collaborative approach to practice and join their clients in a search for solutions that lead to longstanding change.

REFERENCES

Aambo A. (1997). Tasteful solutions: Solution-focused work with groups of immigrants. Contemporary Family Therapy, 19, 63-79.

American Mental Health Counselors Association (2004). About AMHCA. Retrieved October 26, 2004, from http://www.amhca.org/about

Banks, V. (1999). A solution focused approach to adolescent group work. The Australian and New Zealand Journal of Family Therapy, 20, 78-82.

Becvar, D. S., & Becvar, R. J. (2000). Family therapy: A systemic integration (4th ed.). Worldwide: Allyn & Bacon.

Berg, I. K. (1994). A wolf in disguise is not a grandmother. Journal of Systemic Therapies, 13(1), 13-14.

Berg, I. K. (1996). Solution-focused brief therapy with substance abusers. In A. Washton (Ed.), Psychotherapy and substance abuse: A practitioner's handbook (pp. 223-242). New York: Guilford.

Berg, I. K., & Miller, S. D. (1992). Working with the problem drinker: A solution oriented approach. New York: Norton.

Berg, I. K., & Reuss, N. H. (1998). Solutions step by step: A substance abuse treatment manual. New York: Norton.

Connors, G. J., Donovan, D. M., & DiClemente, C. C. (2000). Substance abuse and the stages of change: Selecting and planning interventions. New York: Guilford.

Craig, R. J. (2004). Counseling the alcohol and drug dependent client: A practical approach. Worldwide: Allyn & Bacon.

de Shazer, S. (1985). Keys to solution in brief therapy. New York: Norton.

Doweiko, H. E. (2002). Concepts of chemical dependency. Worldwide: Brooks-Cole.

Efron, D., & Veenendaal, K. (1993). Suppose the miracle doesn't happen: The non-miracle option. Journal of Systemic Therapies, 12(1), 11-18.

Fisher, G. L., & Harrison, T. C. (2000). Substance abuse: Information for school counselors, social workers, therapists, and counselors. Worldwide: Allyn & Bacon.

Inaba, D. S., & Cohen, W. E. (2000). Uppers, downers, and all-arounders: Physical and mental effects of psychoactive drugs (4th ed.). Ashland, OR: CNS.

Lee, M., Sebold, J., & Uken, A. (2003). Solution-focused treatment of domestic violence offenders: Accountability for change. New York: Oxford.

Linton, J. M, Bischof, G. H., & McDonnell, K. A. (in press). Solution-oriented treatment groups for assaultive behavior. Journal for Specialists in Group Work.

Mahon, N. (1992). Treatment in prisons and jails. In J. Lowinson, P. Ruiz, R. Millman, & J. Langrod (Eds.), Substance abuse: A comprehensive textbook (3rd ed; pp. 455-457). Worldwide: Williams & Wilkins.

Mason, W. H., Chandler, M. C., & Grasso, B. C. (1995). Solution based techniques applied to addiction: A clinic's experience in shifting paradigms. Alcoholism Treatment Quarterly, 13(4), 39-49.

Miller, G. (1999). Learning the language of addiction counseling. Worldwide: Allyn & Bacon.

Miller, S. D., Huble, M. A., & Duncan, B. L. (1996). Handbook of solution-focused brief therapy. San Francisco: Jossey Bass.

Miller, W. R., & Rollnick, S. (2002). Motivational interviewing: Preparing people for change. New York: Guilford.

Mott, S., & Gysin, T. (2003). Post-modern ideas in substance abuse treatment. Journal of Social Work Practice in the Addictions, 3(3), 3-19.

Nichols, M. P., & Schwartz, R. C. (2004). Family therapy: Concepts and methods (6th ed.). Worldwide: Allyn & Bacon.

O'Hanlon, W. H., & Weiner-Davis, M. (2003). In search of solutions: A new direction in psychotherapy. New York: Norton.

Pichot, T. (2001). Co-creating solutions for substance abuse. Journal of Systemic Therapies, 20(2), 1-23.

Pichot, T, & Donlan, Y. M. (2003). Solution-focused brief therapy: Its effective use in agency settings. Worldwide: Haworth.

Pistole, M. C. (2002). Mental Health Counseling: Toward Resolving Identity Confusions. Journal of Mental Health Counseling, 24, 1-19.

Roes, N. A. (2001). Solutions for the "treatment resistant" addicted client: Therapeutic techniques for engaging challenging clients. New York: Hawthorn.

Schorr, M. (1995). Finding solutions in a relaxation group. Journal of Systemic Therapies, 14, 55-63.

Schorr, M. (1997). Finding solutions in a roomful of angry people. Journal of Systemic Therapies, 16, 201-210.

Stevens, P., & Smith, R. L. (2001). Substance abuse counseling: Theory and practice. Upper Saddle River, NJ: Prentice Hall.

Taleff, M. J. (1997). Solution oriented and traditional approaches to alcohol and other drug treatment: Similarities and differences. Alcoholism Treatment Quarterly, 15(1), 65-73.

Tohn, S. L., & Oshlag, J. A. (1996). Solution-focused therapy with mandated clients: Cooperating with the uncooperative. In S. Miller, M. Huble, & B. Duncan (Eds.) Handbook of solution-focused brief therapy (pp. 152-183). San Fransico: Jossey-Bass

Wanberg, K. W., & Milkman, H. B. (1998). Criminal conduct and substance abuse treatment: Strategies for self-improvement and change: The provider's guide. New York: Sage.

White, M., & Epston, D. (1990). Narrative means to therapeutic ends. New York: Norton.

Zimmerman, T. S., Jacobsen, R. B., Macintyre, M., & Watson, C. (1996). Solution-focused parenting groups: An empirical study. Journal of Systemic Therapies, 15(4), 12-25.

Jeremy M. Linton, Ph.D., is an assistant professor of counseling and human services in the School of Education at Indiana University South Bend. Email: [e-mail].