Abstract
In psychosomatic medicine, the routine procedure begins with the identification of the patient's problems and disease and goes on to the problem talk. In the solution-focused approach, however, the effort is concentrated on the solution talk, without introducing the problems. These two approaches are thus not always coordinative. Furthermore doubts remain regarding whether or not the solution-focused approach is sufficiently effective in busy clinical practice. In our present study, we applied the solution-focused approach to two patients as part of their psychosomatic treatment and examined its clinical possibility as well as its status in psychosomatic medicine. Case 1 : A 40-year-old housewife, diagnosed as having hyperventilation syndrome. As her expectancy anxiety and depression exacerbated, she became unable to do any housework. On the basis of her plea that she was a victim of the disease, we regarded our relationship to be a "complainant" type. Accordingly, we carefully listened to her problems, established the diagnosis, praised her fortitude against adversities, and talked about the images of concrete solutions. We also asked her to determine, by the next visit, any more existing problems and/or the conditions for any "exceptionally" better state. From the second visit onward, we referred to the problems in the past tense and encouraged her to continue favorable practices in her life. After five such short sessions, her problems were solved and the treatment terminated. Case 2 : An 18-year-old girl, a high school senior, diagnosed as suffering from personality disorder and eating disorder. She refused to eat and repeatedly resorted to violence and even cut her wrists. Receptive psychotherapy was ineffective and no stable relationship between therapists and patient developed. We then regarded our relationship to be a "complainant" type and treated her consistently as such. Without mentioning her ploblematic behavior, we elicited attainable goals and the images of solutions from her with questions supposing a miracle to happen, and praised her for what achievement she had made. As the result of four such short interviews, her violent behavioral manifestations eventually subsided. We demonstrated that, even in busy clinical practice, it was possible and effective to evaluate the type of patient's relationship to the therapeutic staff, utilize the problems as resources for solution, conduct dialog designed to inspire the patient's possibility, and standardize necessary questions. The solution-focused approach thus appeared to be a valuable technique, if incorporated into psychosomatic medicine, to expediate and consolidate solutions.
