Chapter 3. Features of Linguistic Brain Therapy, LBT

In this chapter, I will describe the features of Linguistic Brain Therapy (LBT). The treatment follows a pattern,although certain phases can be skipped or extended, the order can vary, and the same phase can be repeatedmultiple times. The objective is to disconnect from psychologically unpleasant experiences and connect topsychologically positive ones. This involves reducing psychological material that hinders functioning and increasing contact with well-being and coping skills. The connections and disconnections relate to the past, present, and future.

This pattern allows for a detailed prediction of the treatment process after a limited assessment. However, the treatment course will be modified if new issues arise during the treatment. It is important to specify the client’streatment goals, as this has a therapeutic effect by eliminating non-essential factors for improvement.

LBT is characterized by improvisation, spontaneity, and often humorous approaches. There is no contradictionbetween predictability, humor, and creative insights. If the psychological distress persists after the initial changeprocess is completed, a similar process is repeated using different perspectives and methods. Each set of problems is addressed one by one. Every consultation begins anew with Phase 1.

Assessment of the Client’s Problems

The client’s problems are examined to determine when they occur, what they entail, and their consequences. Thefocus is on what the client wants to improve and what causes psychological pain. The therapist records the client’sstatements without interpreting them beyond assessing whether they indicate desires for change or signs of psychological changes. The therapist pays attention to the sensory perceptions and statements that trigger,maintain, or alleviate psychological discomfort, as these serve as the basis for interventions. The therapist respects and does not alter the client’s statements about their situation. How the client expresses their feelings iscrucial for the therapist. This way, the client maintains ownership of their understanding and emotions, while thetherapist gains valuable information to inform the treatment. Additionally, the therapist maintains close contactwith how the client experiences psychological distress.

Two experts and two amateurs

In Linguistic Brain Therapy (LBT), two individuals assume four distinct roles: two experts and two amateurs. Thetherapist is an expert in psychological change but an amateur in understanding the client’s experience ofpsychological distress. Conversely, the client is an amateur in psychological change but an expert in their perceptionof psychological pain and their needs for improvement. The client sets the framework from which the therapist operates, and their statements and insights are validated. Even with severe psychological problems, the client is seen as rational, insightful, and competent.

LBT is influenced by neuro-linguistic programming and strategic therapy, emphasizing the therapist’s mastery of their craft and the importance of therapeutic craftsmanship. It combines the perspectives of solution-oriented therapy, which values the therapist’s expertise in psychological distress, and postmodern therapy, whichemphasizes listening and dialogue. The therapist in LBT must possess expertise and knowledge while maintainingdeep respect and a listening attitude towards clients.

Two forms of trust are essential in LBT. The therapist must trust that clients understand their struggles and are willing to collaborate, while clients must trust that the therapist knows how to reduce their psychological distress, acts in their best interest, and treats them respectfully. However, achieving this trust can be challenging, as clients often perceive the therapist as an expert.

The client’s role in LBT is crucial in facilitating their engagement in the processes of change. They define their psychological distress, set the treatment goals, initiate changes, and evaluate progress. The therapist avoids imposing goals and focuses on what the client wants to address, building on their goals from session to session. This client-centered approach empowers clients and ensures a personalized and meaningful therapeutic journey.

The therapist creates a safe and supportive environment by adopting a curious and open-minded stance, genuinely listening to the client’s perspectives and needs. It is challenging for the therapist to maintain a balance, as clients may perceive them as experts due to their professional background. The therapist must exercise restraint to avoid influencing the client’s viewpoint.

Therapy in LBT is guided by the client’s evolving needs, focusing on their current challenges and desired outcomes. Each session starts by exploring the client’s priorities and goals, and the therapist only returns toprevious topics if the client suggests it. This flexible approach allows for an organic and responsive treatment process.

LBT emphasizes a collaborative and respectful partnership between the therapist and the client. The therapistfacilitates the client’s self-discovery and journey toward positive change and well-being, rather than dictatingsolutions. This approach recognizes the client’s expertise in their own experience and honors their autonomy.

The client’s role and position in LBT have a profound therapeutic effect, affirming them as competent and resourceful individuals deserving of respect. Conversely, assuming an opposite role can increase psychologicaldistress and lead to poorer outcomes. This approach is justified as only the client knows what they need and should have influence and control over their treatment.

In the therapist’s experience, most clients seek therapy to improve their situation or alleviate discomfort. Only asmall number expressed a need for deeper insight into the underlying causes of their psychological distress. One client discontinued treatment when informed that a shorter period of therapy was sufficient, likely influenced bytheir friend, a psychodynamic therapist. However, this client still resolved the issues initially brought up.

Therapists must set aside their knowledge and listen to the client’s narratives, granting insight into their situation. The client and therapist are equal partners in a collaborative relationship, with both contributing to the therapeutic process.

The tasks of the therapist and the client

The tasks of the therapist and the client in LBT are distinct. The therapist, being an amateur in the client’sexperience, aims to affirm the client’s statements and build trust to encourage honest sharing. It is crucial for the therapist to be friendly, listen attentively, and avoid altering the client’s words. While listening, the therapist may ask questions to uncover sensory perceptions and mental elements underlying the client’s anxiety and psychological pain. The therapist maintains an expectant stance and actively seeks ways to modify the psychological material triggering distress. Additionally, the therapist provides the client with opportunities toengage with the distressing material as a starting point for the work of change.

The client’s task is to describe their experience of psychological distress. However, there is an exception whenexcessive anxiety is present, and the focus shifts to treating the anxiety without prior knowledge of the client (part 3,treatment without information). Through this process, the client directs the treatment’s focus, while the therapistpays attention to the client’s words and statements to gain insight and guide their interventions. This approachemphasizes the client’s reality and understanding, rather than the therapist’s assumptions or theories, fostering a sense of acknowledgement and importance for the client.

In this context, the client is regarded as an expert in their psychological distress and needs, while the therapist is anexpert in treatment and psychological change. The therapist’s expertise lies in their ability to facilitate contact with and modification of the psychological material causing distress.

Approach to the client’s statements

Client presentations can vary significantly. Some clients may appear well groomed, speak fluently, and discuss their problems and serious events with ease, seemingly downplaying their severity. Conversely, some clients may use dramatic statements, giving the impression of heightened distress. In LBT, regardless of how clients communicate their problems, their statements about psychological distress are taken seriously, and the therapistlistens for potential intervention points.

The relationship to the client’s emotions

Clients may be told that their reactions are excessive or oversensitive, creating a sense of incorrect or unnecessaryresponses, leading to new problems. However, emotional reactions are not inherently wrong; they reflect the mentalstate in specific moments and arise from contact with triggering psychological material. It is important to accept, respect, and explore the emotional experience while examining the psychological material underlying it. If the client desires to react differently, the therapist can reduce contact with distressing material and increase exposure to the psychological material that elicits desired emotions and reactions.

The goal of LBT is to reduce the client’s contact with internal sensory experiences, words, and statements that contribute to psychological pain.

The significance of the therapeutic relationship

The significance of the therapeutic relationship has been increasingly recognized in psychology, with research highlighting its importance for treatment outcomes (Duncan, 2009; Ulvestad, 2007). LBT also emphasizes theestablishment of a positive relationship between therapist and client. The therapist’s ability to empathize with and understand the client, as well as their perception of a good rapport, can impact the effectiveness of treatment. However, it’s worth noting that the therapist’s perception of the relationship may not always align with the client’s perception.

Furthermore, the client’s perception of the relationship holds more weight in determining treatment outcomes thanthe therapist’s perspective. Therefore, it is essential for the therapist to be attentive to whether the client feelsunderstood and comfortable, as this is crucial for facilitating psychological change. Building a strong therapeutic relationship primarily relies on the therapist’s actions and how they relate to the client. It is important to understand that complete understanding of the client is impossible, but it is not necessary to establish a good relationship and provide effective treatment.

The key is that clients feel understood, regardless of the therapist’s level of understanding. As the level of assistance decreases, the relationship between the client and therapist becomes more crucial for sustaining the treatment. However, there is a risk of mistaking a strong relationship for effective therapy. Treatment may continue because therapy sessions are pleasant and the therapist is enjoyable to be around, even if the client does notexperience improvement. I have encountered clients who saw a “competent” therapist for months without progress, and their condition worsened when the therapist went on vacation, fell ill, or retired. This raises the question: What happens when the client perceives the therapist as competent despite the lack of improvement?

As the client achieves significant psychological changes through treatment, the importance of the therapeuticrelationship diminishes, even though it may continue to improve. Some clients prefer a professional, friendly, respectful, and engaged yet business-like approach. They have their social needs fulfilled and receive validationfrom other sources. Their primary requirement in therapy is assistance in improving their psychological well-beingrather than seeking sympathy and understanding.

Empathy and relationship in linguistic brain therapy (LBT)

Empathy and the therapeutic relationship play significant roles in Linguistic Brain Therapy (LBT). Empathy involves the therapist’s ability to understand and validate the client’s experiences. However, it is important torecognize that an excessively empathetic and understanding stance can be counterproductive if the therapist becomes overly immersed in the client’s emotions, leading to their own psychological discomfort or fatigue. This type of empathy becomes unhelpful when the therapist lacks a clear direction based on the client’s narrative andcontinues to focus solely on the client’s emotions even after gathering enough information to initiate anintervention. Therefore, it is essential for the therapist to assess whether they are inadvertently perpetuating the client’s mental distress by fixating on their psychological pain. It should be noted that empathy and ongoing conversations centered on the problem do not guarantee psychological change. Consequently, the therapist needs to differentiate between conversations that provide insights into psychological discomfort, conversations that lead to understanding and a sense of well-being during the consultation without yielding improvement, andconversations that ultimately bring about psychological change. LBT places emphasis on conversations that drive transformative change.

While the importance of developing a strong therapist-client relationship in LBT is justified from both a humanistic and professional standpoint, there is a shift in focus towards the therapist’s relationship with the client’sdiscourse, rather than solely on the client-therapist relationship. This approach is based on the understanding that the therapist’s affirmation of the client’s discourse significantly influences the client’s perception of their relationshipwith the therapist. Affirming the client’s discourse is crucial for them to perceive a positive relationship with thetherapist and believe in the effectiveness of the treatment. However, it is essential to recognize that the fundamental prerequisite for the client to establish a good relationship with the therapist and with the treatment is the occurrence of psychological change.

Relationship and method

There has been a tendency to perceive the ability to establish a good therapeutic relationship as an innate talent orattribute that some therapists possess more than others. However, Linguistic Brain Therapy (LBT) argues that the development of a good relationship is a consequence of the therapist’s method, what they do and say in the treatment situation. Therefore, creating a good relationship is not solely dependent on some indefinable chemistry. Successful therapists may share a common methodological approach that is not explicitly described as a method in the therapeutic literature. While a good relationship is indeed significant for the outcome of treatment, the ability toestablish a good relationship without a conscious understanding of the therapeutic process is not inherent in all therapists, although it can be developed.

Language’s crucial role in Linguistic Brain Therapy (LBT) is recognized. LBT acknowledges that the languageclients use reflects their internal processes and cognitive structures. By closely attending to the client’s language,the therapist gains valuable insights into their thoughts, emotions, and beliefs.

LBT places emphasis on the importance of language within therapy sessions. The therapist actively listens to theclient’s words, tone, and linguistic patterns as they offer clues about underlying cognitive patterns and emotional states. Understanding how language constructs meaning, the therapist can guide the client towards more helpful and constructive narratives.

Language also serves as a powerful tool for intervention in LBT. Through linguistic techniques and exercises, the therapist can facilitate shifts in the client’s cognitive processes and promote psychological change. By encouraging the client to explore alternative ways of expressing themselves and reframing their narratives, the therapist helps them gain new perspectives and develop more adaptive cognitive patterns.

LBT recognizes the significant influence of language on the therapeutic relationship. The therapist’s choice of words, tone, and linguistic style can profoundly impact the client’s experience and engagement in the therapeuticprocess. By utilizing language that conveys empathy, respect, and understanding, the therapist establishes asupportive and collaborative relationship with the

client, thereby enhancing the effectiveness of the therapy.

In summary, language plays a central role in Linguistic Brain Therapy. By attentively listening to the client’slanguage and employing linguistic interventions, the therapist promotes psychological change, fosters a solid therapeutic relationship, and assists clients in constructing more adaptive narratives. LBT harnesses the power of language to enhance the therapeutic process and achieve positive outcomes.

Relationship, trust, and utterances

The therapist earns the trust they deserve. If the therapist does not receive the necessary trust, they must adapttheir therapeutic style to the client’s language and emotions. The client’s willingness to trust the therapist iscontingent upon feeling respected and well-cared for. Contacting the psychological material that triggers the client’s emotions—and therefore achieving results—requires the therapist’s recognition of the client’s way of experiencing reality, regardless of whether it is conveyed through delusions or ordinary statements.

No intervention without a yes signal

No treatment or sequence of change begins until the client conveys or signals that they are ready for thetreatment. If the therapist attempts to alter the psychological distress before the client has given a yes signal to thetreatment, the client may feel disregarded. Consequently, clients must provide more precise information about their situation, desires, and reactions to the therapist’s interventions. Implementing an intervention without the client’s receptiveness to change constitutes a minor therapeutic transgression. A client once shared, not without aparticular pride, that she had managed to deceive the therapist. It was a surprising statement. Why did she have to deceive the therapist? Moreover, how could the therapist be deceived without noticing it?

Specific interventions can be perceived as provocative. If this occurs, the therapist explores what the client desires. Once the client has indicated readiness for the therapist’s interventions, they never reject an intervention,but anxiety may diminish the client’s ability to execute it. In such cases, an alternative intervention is employed that provokes less anxiety in the client (Chapter 5: The Treatment Process)

The simplicity of treatment and pace of change

Psychological changes in therapy can sometimes occur as rapidly as in daily life. Moreover, various psychological disorders can be treated the same way, although the extent of the treatments may differ. Psychological disorders are often straightforward to treat, even though the work may be complex and time-consuming. The simplicity of treatment results from the ability to assess and subsequently modify thepsychological material, the mental elements that cause psychological distress. The simplicity of treatment also stems from the fact that the same methods can address severe and milder psychological disorders.

Obstacles to change

Obstacles do not imply that changing psychological distress is more complex, but rather that the treatment process will take longer. Cognitive capacity can be reduced due to side effects of medications and substances, making it challenging for the client to engage in the mental processes necessary for achieving psychological change, thus prolonging the duration of treatment. Medication side effects can also cause uncomfortable bodily reactions that are difficult to address through verbal means, especially when attempting to taper off medications. While medication can provide relief, it may also perpetuate psychological distress.

Is talking about it necessary?

Psychology is characterized by the belief that discussing psychological distress is crucial. The focus often lies onThe Talking Cure, which is valuable advice for those in need. However, it is important to distinguish between conversations that contribute to increased psychological distress, conversations that alleviate psychological painwithout resulting in change, and conversations that lead to change. The therapist should limit discussions that cause discomfort and conversations that do not facilitate change.

LBT (Linguistic Brain Therapy) leads to new insights because of the changes experienced by clients. The goal oftreatment is not solely to develop insights but to alleviate psychological distress. The clients’ new insights arise from no longer experiencing psychological distress and from the factors that previously hindered them from living as they desired, no longer having the same level of influence.

Engaging in conversations with clients to foster insight and hoping that this will eventually lead to change can be a lengthy process. Furthermore, change cannot be guaranteed. If the client’s goal is not to change but rather to have meaningful existential conversations with a wise therapist in LBT, they may be better suited for a therapist who focuses on insight development, such as psychodynamic therapy. For some clients, these conversations help thembecome aware of their problems and gain greater insight, but they do not eliminate psychological distress. For others, it brings psychological relief and improvement. This approach can be effective if clients can tolerate the psychological pain that may arise from the conversation and if they are personally paying for the treatment. However, this form of treatment becomes less acceptable if it is state-funded and there is an alternative treatmentavailable that could help clients alleviate their psychological distress more quickly and affordable. Some clientshave reported paying between 1700 to 2700 for a session with a psychologist or psychiatrist without experiencingany improvement. As a result, some clients discontinue treatment before fully recovering, while others have been rejected by the District Psychiatric Outpatient Clinic because they are deemed “too healthy. ”

Conversations with family and friends

The therapist should be aware of whether the client’s family members or certain friends enjoy hearing others talkabout themselves and being seen as important individuals whom the client can confide in. Engaging in such conversations may result in the psychologically distressed individual experiencing even more distress. Therefore, in LBT, a distinction is made between conversation partners who uplift the client and whom the client should seekout, and those with whom contact should be limited because the conversations lead to more pain. Many peoplelive with their problems for a long time without discussing them, which can exacerbate the issues.

Some are tired of talking.

Some clients express feeling “tired of talking about it” because talking leads to more psychological pain. Manyindividuals who have undergone treatment share that meeting a listening and friendly but passive therapist wassignificant at the beginning of treatment, but it became less helpful later on. The therapist should be aware of whether and when this situation arises for the client. It is also important to note that therapy focused less on change can still hold meaning for specific clients. Therefore, different therapists are needed to cater to clients withdifferent needs. Some clients should refrain from further talking about their problems and instead engage in othermeaningful activities. There are cases where clients have been in treatment for several years, seeing multiple psychologists and therapists, and have shared their stories with receptive and friendly individuals withoutexperiencing improvement. Instead of alleviating psychological pain, they have become experts in understanding psychological distress. Consequently, moments of vitality, mastery, warmth, closeness from others, and a meaningful life have been overshadowed by psychological distress, and they have developed a new identity as someone plagued by psychological distress.

It is about how one talks.

Some individuals come with the expectation that they should talk about their psychological distress and share theirproblems with someone, whether it’s parents, friends, or a therapist. However, talking does not help everyone. Therefore, discussing psychological distress is not just about how one talks, but also why, how often, and for howlong one talks. While some clients think and talk their way out of their problems, others talk and think their wayinto them. They acquire more problems that persist for extended periods due to their way of talking and thinking. This especially applies to those who have experienced psychological distress for a long time and have sought helpfrom multiple psychologists over an extended period. Continually discussing their situation can lead to morepsychological distress. I have had several clients who discontinued therapy with a therapist or psychologist becausethey had repeatedly recounted their stories without finding it helpful. For example, one client immediately conveyed to me upon contacting me that she did not want to talk about her early childhood and experiences with her parents. Another client who had been in therapy for many years only wanted to address one issue: the fear of being alone. However, it is also worth noting that those who have benefited greatly from talking about their childhood, adolescence, and experiences with their family members and have found significant help have not sought treatment from me.

LBT focuses on psychological change.

When clients come with the expectation of providing more detailed accounts of their lives, the therapist can respond in the following way:

“When discussing what has happened and what is challenging, pay attention to what happens. Do you experiencediscomfort afterward? Does it feel okay? Notice what feels okay for you and what does not. Let us continue withwhat feels okay. Also, explore whether you genuinely want to improve something quickly. ” If the therapist observes that the client becomes more psychologically distressed when sharing, which happens quite often, the client is subtly guided toward a more constructive perspective. In LBT, therapists listen to establish a starting point forchanging psychological distress. However, some therapists may dwell longer on psychological discomfort than others. When the therapist focuses on the client’s problems, they operate within a different framework than the brain psychology perspective. Nonetheless, some therapists may still adopt an eclectic approach, applyingknowledge and methods from multiple therapeutic traditions.

Avoiding Moralizing

Moralizing can have negative effects on the client’s psychological well-being, self-esteem, and feelings of guilt. Itcreates a sense of distance between the therapist and the client, leading to a decrease in trust and cooperation. When moral judgments come into play, the client’s focus shifts from their psychological distress to their relationship with the therapist. This shift diminishes the potential for positive outcomes. Some individuals mayinternalize these moral judgments and feel suppressed once again.

LBT draws inspiration from the attitudes attributed to Milton Erickson, which help prevent moralizing and promote a more accepting approach towards clients. These attitudes include recognizing that everything is perfectly aligned with what is happening for the client, understanding that every client is doing their best in their current situation, and acknowledging that everything the client does or has done serves a significant purpose forthem at that moment. Embracing these attitudes reduces the inclination to moralize, fosters client acceptance, andkeeps the focus on addressing psychological distress.

The Pace of Change and Results

Psychology and psychiatry often suggest that treatment takes a long time, but it’s essential to recognize thenuances of this notion. The following examples illustrate instances where significant progress or complete recoverywas achieved within relatively short treatment periods:

A woman who had seen various therapists for over 20 years experienced anxiety about being alone at night and inher cabin. After a 90-minute consultation, she achieved complete recovery. She could now sleep alone withoutneeding to call a friend and could finally be alone at her cabin, something she had longed for. Her brother was moved to tears upon hearing about her achievement.

A client with a 30-year history of post-traumatic distress, severely affecting their functioning as a middle manager, was cured in two consultations lasting three and four hours, respectively. Similarly, disabling post-traumatic distress resulting from life-threatening violence and a prolonged hospital stay was resolved in three consultations, even though previous treatment had been ineffective.

A young woman who had undergone two years of unsuccessful treatment was referred to me by a specialist in clinical psychology. After five consultations, she achieved complete recovery from post-traumatic distress stemming from childhood incest and later breakdown in adulthood. Another case involving post-traumatic distress following rape required five consultations, resulting in significant improvement after the client had previously seenseven therapists over four years.

A musician who had experienced panic attacks, workplace conflicts, and family issues and was approved for continuous disability benefits achieved a cure in eight consultations over five days. Similarly, a client with hypochondria and depression was cured in eight consultations. The treatment of a client following a suicide attempt took three consultations, with the first lasting 3. 5 hours. Additionally, eight consultations were sufficientto address intense grief and psychotic reactions following a sudden divorce after 20 years of marriage. While clients with multiple psychological issues can experience improvement within a single consultation, full recovery typically requires 3-8 consultations. Minor and specific psychological distress, such as performance anxiety,conflict experiences, and the consequences of bullying, can be addressed in 1-3 consultations.

It’s important to note that none of my clients required hospitalization during the treatment period, although somehad been admitted in the past. Several clients received concurrent outpatient treatment.

The results from these examples indicate that even heavily burdened clients can experience improved emotional states within a single consultation, although treatment may become more extensive for some cases. Positiveemotional changes have been reported by nearly all clients within the initial 1015 minutes of consultation. The dropout rate is minimal, and almost 100% of those who completed the treatment either experienced an improved situation or achieved full recovery. While providing exact figures on the number of consultations necessary for more severe cases is challenging, these examples demonstrate promising trends.

These experiences are not unique, as many therapists and psychologists have encountered sudden and surprisingly positive outcomes. Professor Tom Andersen, an internationally renowned therapist, expressed interest in researching these sudden improvements during a research seminar in Tromsø.

The high percentage of short-term treatments in Linguistic Brain Therapy (LBT) is intriguing, as it highlights thepotential to transition from an unpleasant psychological state to psychological well-being within minutes.

Assessing Psychological Changes

One method for assessing changes experienced by clients involves comparing their level of distress before andafter a series of interventions or a consultation or treatment session. This assessment includes tracking an increase in the client’s affirming statements of change and changes in how they discuss their psychological distress. It alsoinvolves observing shifts in the client’s focus. When clients shift their focus from a broader issue to a more specificproblem, it often indicates a psychological change. Identifying these changes is possible because anypsychological change leads to alterations in the psychological material, the psychobiological elements that trigger psychological distress. Methods for examining achieved changes can also be used to assess the remainingpsychological distress. Follow-up phone conversations conducted several months after treatment can serve as anassessment tool, although this approach is less commonly used.

About Celebrating

Insoo Kim Berg, one of the founders of solution-focused therapy along with Steve deShazer, was known for herenthusiastic reactions when clients im-

proved or achieved something. Her expressions of “wow, fantastic, incredible” had a therapeutic effect. Clientswere celebrated with warmth and enthusiasm, which made them feel valued, brilliant, and capable. As a result, they left the consultation feeling proud, energized, optimistic, and with reduced pain.

From a neuropsychological perspective, these celebratory moments are not fleeting and disappear once thecelebration subsides. Insoo Kim Berg’s enthusiasm and joy create mental material that triggers more psychologicalwell-being, energy, and pride in clients. This enthusiasm strengthens clients’ coping abilities and turns the treatment into a fond memory, confirming their capacity to achieve and succeed.

Celebrating the client is also essential in solution-focused brief therapy (SFBT). It helps clients connect with and experience themselves as unique individuals, something they may not have been aware of or acknowledged before. Celebrating the client is a valuable therapeutic tool that goes beyond having cake. It involves the therapist praisingthe client for their accomplishments and acknowledging their positive qualities and results.

Relapse

Temporary relapses occurring a few days after a consultation are a characteristic of the standard change process and indicate that some psychological discomfort still needs to be addressed. One reason for relapse is clients’tendency to generate psychological discomfort through internal dialogue between consultations, suggesting that there is still work to be done.

Honor and Responsibility for the Outcome

If the treatment results in a positive outcome, the client is credited for it. However, if the treatment fails, it is thetherapist’s responsibility to take ownership of the situation. The rationale behind this is that clients seek outtherapists to help them solve their problems. They come to a therapist who offers a service and believes they can assist the client. If the treatment falls short, therapists must accept responsibility for it. Simply put, we have not been effective enough in achieving the treatment goal.

Higher Ambitions Along the Way

Clients often begin treatment with modest goals and aspirations. However, increasing ambitions throughout the process indicates that the client has experienced psychological change. For example, a young person who had suffered life-threatening injuries due to violence initially believed they couldn’t continue their education because of psychological issues. Their academic performance declined, they isolated themselves, and anxiety paralyzed them, leading to the loss of friends and the inability to engage in hobbies. By the second session, their goal had shifted to becoming a police officer to reduce crime and youth violence. By the midway point of the third and final session, their ambitions had further increased, and they now aspired to become a lawyer. The rise in ambitions paralleled the reduction in anxiety. There is often a strong connection between psychological distressand lowered ambitions, as well as between positive psychological changes and heightened career aspirations.

Can Change Be Guaranteed?

Can clients be assured of achieving psychological changes through solution-focused brief therapy? The answer is yes. However, can full recovery be guaranteed for everyone? No. All clients experience changes within a few minutes of a consultation, which provides evidence that the treatment is effective. We can observe the changes inthe psychological material that triggered the distress. It is possible to detect and test these results during theconsultation before clients leave, and changes from one session to another can also be evaluated.

While positive changes during a consultation do not guarantee complete recovery over time, some clients maychoose to terminate treatment prematurely because they experience joy from the positive psychological changes, even if their issues are not completely resolved. Others may continue engaging in a lifestyle that perpetuates psychological distress.

A good outcome can be guaranteed if clients follow through with treatment until they have fully resolved theirissues. This entails no longer creating or sustaining psychological distress through their thoughts and behaviors after the treatment. However, I must make a caveat: Full recovery cannot be guaranteed when working with heavily burdened individuals or those heavily medicated, although all individuals can experience improvement. This is because psycho-

logical and physical problems may arise when attempting to reduce medication usage.

Multiple Therapeutic Approaches, but Only One Form of Psychological Change

All psychological changes in therapy stem from activating or deactivating mental material that contains positive oruncomfortable emotions. This holds true regardless of whether the therapist practices behavior therapy,psychoanalysis, psychotherapy, existential therapy, cognitive therapy, strategic therapy, gestalt therapy, solution-focused therapy, narrative therapy, or postmodern therapy. Therefore, an extensive range of methods is unnecessary if the sole goal is to address psychological distress. Instead, a primary method with variations is sufficient (chapters 15-24).

Reversal of Treatment

In solution-focused brief therapy, it is possible to reverse undesirable outcomes if they occur. This ability is crucial in protecting the client from psychological discomfort. However, it requires an understanding of the mentalprocesses that occur when treatment fails.

Responsibility for Ineffective Treatment

Psychiatry rarely acknowledges its weaknesses or shortcomings to clients. Some psychologists or psychiatristsattribute the client’s personality or psychological distress as the cause of treatment failure. Less commonly, it iscommunicated that the therapist lacks the necessary expertise or that the treatment environment may impede change. Therapists must take responsibility for the lack of results; otherwise, they impose another defeat on the client. It is an honest acknowledgment that one may not know or possess enough knowledge and that results are not always achieved. In LBT, as mentioned earlier, clients receive credit for their achievements, while therapists assume responsibility if the treatment is ineffective.

Medicine and LBT

Clients may share stories suggesting that some therapists have a greater tolerance for the psychological pain caused by medication than the psychological discomfort resulting from mental distress, even if both can beequally distressing. Some encourage clients to continue taking medication despite side effects and the client’sdesire to reduce their medication use. The reason behind this is likely a significant trust in medication due to underlying research and knowledge that tapering off can be challenging.

LBT does not advocate the attitude that clients should not take medication if it is effective, has no harmful sideeffects, does not impair cognitive capacity, and does not cause psychological and physiological burdens that aredifficult to eliminate through tapering. In LBT, clients’ preferences are supported, whether they choose to continue with medication or not. Those who wish to continue with medication receive support because it can reduce anxietyor psychological pain, make implementing the therapist’s interventions easier, and contribute to faster change. However, clients should be informed that at some point, they should reduce or taper off their medication to assessthe remaining mental distress and evaluate whether the medication itself leads to psychological distress. Clients who want to taper off medication receive support with the rationale that it will allow them to connect with their mental distress, enabling them to differentiate between genuine mental problems and reactions resulting from medication. If the medication is ineffective or the client experiences unpleasant side effects, it should be replaced with other medications or tapered off. If the prescribed medications do not work, it is not necessarily a sign that clients should have more or different medications. Instead, they require better follow-up from their therapists.

At times, medications may appear to function as indulgences. The therapist or doctor may not know how to effectively treat the clients but still wants to contribute, so they provide the client with a pill or two and hope for the best. Therapists and clients should consider tapering off if the new medications also fail.

Regarding tapering, I emphasize that it must comply with the regulations in the standard catalog and be done incollaboration with a doctor or psychiatrist. Another justification for supporting clients’ preferences, whether for oragainst medication, is to develop their trust in their judgment, self-assurance, and ability to recognize the consequences of their choices.

However, it must also be stated that relying on chemicals signifies that therapists do not precisely know how toeffectively treat mental distress through verbal therapy. It is concerning that individuals with schizophrenia have an average lifespan around 20 years shorter than the general population. Some clients take anywhere from 4 to 10different medications daily. The introduction of such a large quantity of chemical substances into the body throughmedication may not necessarily prolong life.

Misunderstood Loyalty

Some therapists dislike it when clients seek therapy from other therapists simultaneously or want to switchtherapists. However, clients do not need to be loyal to their therapists. We earn money from and exist for them, whileclients exist for themselves. They should be loyal to their mental well-being and prioritize their ability to care forand protect it as best as possible. If we fail, despite our best efforts, clients should discontinue therapy. Continuingwith ineffective treatment, even with well-intentioned therapists, can cause psychological distress to clients. If clientschoose to terminate treatment, they should do so with a sense of self-worth and resilience. Moreover, they should be supported in finding a new therapist.

At times, clients may find better help elsewhere. It is important for them to seek a new therapist where they can start anew rather than continuing with a therapist who does not know how to approach their issues. Clients havealready faced enough setbacks; they should not feel like they have also failed at therapy.

Conclusion

This chapter describes various aspects of LBT. LBT follows a predictable pattern, though improvisation is possible. It is characterized by optimism, with both the therapist and client holding positions as amateurs and experts. Thishighlights the equality and mutual dependency between therapist and client that characterizes LBT. The chapter alsoemphasizes the therapist’s relationship with the client’s statements and the significance of the therapeutic relationship. Understanding the importance of the therapeutic relationship in LBT aligns with, yet differs from, other therapeutictraditions. The chapter also justifies why no interventions are implemented without explicit consent from theclients.

The chapter describes the simplicity of treatment and the pace of change, whether it is necessary to discuss theproblems, and the type of insights developed through treatment, even though less emphasis is placed on the circumstances surrounding the mental distress. It addresses the absence of moralizing, the pace of change,achievable results, and how to assess the psychological changes experienced during treatment. The chapter also discusses the significance of celebrating achieved results, assigning credit and responsibility for the outcomes, the possibility of relapse, and developing the client’s ambitions during treatment. It explores whether psychologicalchange can be guaranteed and delves into the claim that there is only one form of psychological change, the possibility of reversing achieved results, who is responsible if treatment does not work, and the relationship to medication use. The chapter also highlights fundamental attitudes in LBT and the inevitable consequences of these values. Thus, the chapter can serve as a starting point for adjusting one’s practice if something is not working.

As these factors are expressed through how the therapist uses language, the chapter can be seen as a preparation forthe next chapter on the significance of language for psychological change.