RE: The construction of _hard case_

Chris Evans (
Wed, 20 Aug 1997 10:02:44 +0100

On 20 Aug 97 at 9:21, Jonathan Norton wrote:

> Dear Esteban
> It seems to me that establishing what sort of case is considered a
> "hard" one among different therapists and therapist groups will be
> important for you. I am reminded of the de Shazer solution-focused
> group in Milwaukee, who use the "miracle question" to allow clients
> to identify their own goals for more successful functioning. They
> estimate that about 80% of any clinical population can answer this
> question and thus imagine the possibility of (or anticipate and
> construe) improvements in the future. So this question may also be
> used for making an assessment about the level of "difficulty" of the
> case. In other words those unable to respond to the invitation to
> consider what things would be like in the absence of their "problem"
> are likely to offer particular challenges in the therapeutic work.
Good to see solution focussed therapy turning up on the PCP list,
let's hope PCP turns up in Milwaukee!

I wondered if there were people on the list who didn't know the
miracle question (I didn't until recently!). The family/individual
therapist asks something along the lines of "If a miracle happened in
the night, what would be the first thing you would notice that would
tell you that things had got better"

Some families now respond "On no, not _that_ old question, .... our
last therapist kept banging on about that too" and they are generally
regarded as "hard cases".

But seriously, I think there's a lot in the Milwaukee group's work
that reminds me of constructive alternativism and some of it is a bit
like the "fixed role technique" of Kelly.

Best wishes all,


Chris Evans, Senior Lecturer in Psychotherapy,
Locum Consultant to the
Prudence Skynner Family Therapy Clinic,
St. George's Hospital Medical School, London University