Young people can’t change their past, but they can change their future.
Why Tellmi took a solution-focused approach to therapeutic intervention.
Cognitive behavioural therapy (CBT) is the most commonly offered psychological intervention in the UK. There is plenty of evidence to show that CBT works, but we didn’t feel that it was the right model for Tellmi because the therapy sessions tend to focus on the things that are wrong in a person’s life¹. We figured that young people have very little agency over their lives. They don't have the power to change the family that they were born into, the money they have, or the school that they go to, so a therapeutic intervention that focused on ‘the problem’ probably wasn’t going to be particularly helpful.
We spent a long time searching for a more suitable approach. When we discovered Solution Focused Therapy (SFT) it was a lightbulb moment. Instead of focusing on the problem, SFT encourages young people to focus on possible solutions. It helps young people to identify the characteristics, skills, and strengths that they already possess that will help them to achieve specific ambitions, rather than focusing on deficits that might be holding them back. By helping them to think about possible futures, SFT helps to motivate young people to move forward in life and not to feel stuck in their past.
We were super excited about the approach. It fitted with the Tellmi ethos but because it is less well-known than CBT, we needed evidence that was just as effective. Randomised Control Trials are the “gold standard” of clinical research. We discovered that approximately 150 RCTs had tested the efficacy of SFT. Overall, those trials have shown that SFT’s effectiveness is equivalent to, or greater than CBT, but the effects are achieved in fewer average sessions². Most of the research was conducted in the US, but in 2017, Cathy Creswell conducted a randomised controlled trial at four NHS primary child and mental health services in Oxfordshire. Children aged 5-12 years who had been referred for anxiety were randomly allocated to receive either CBT or SFT. The study results showed that at the end of the treatment, 69% of the children in the SFT group had improved compared to 59% of children in the CBT group³.
SFT was originally developed by husband and wife psychotherapists Steve de Shazer and Insoo Kim Berg in 1978. Evan George, Chris Iveson, and Harvey Ratner were working in an NHS clinic when they heard about Shazer and Berg’s work at the Brief Family Therapy Centre in Milwaukee, Wisconsin. George, Iveson, and Ratner teamed up and founded BRIEF to deliver SFT and train SFT practitioners. BRIEF is now Europe's largest provider of SFT training with over 4000 professionals from the NHS, local authorities, education, and private sector undertaking courses each year. With BRIEF’s help, Tellmi began designing and developing our text-based SFT service. Chris Iveson introduced us to our first SFT counsellors who helped us to test the system and iron out any bugs and we worked with clinical psychologist and intervention scientist Jessica Schleider at Northwestern University in Chicago to develop integrated outcome measures.
In July, we finally launched the service in Berkshire West and Tellmi SFT is now available to all young people in areas where the service is commissioned. It’s an ideal solution for those seeking support at an early stage, including those who are on CAMHS waiting lists, those who have been turned away from CAMHS, or those who have been discharged after treatment. Young people can self-refer, or be referred by schools, family members, GPs, or local VCSFEs. Sessions are available between 12 pm and 10 pm daily (except bank holidays), so they can be accessed outside of school or work hours. Most importantly, there is no assessment, no waiting list, and no threshold for treatment. Young people can have as many, or as few, sessions as they require, and they are encouraged to continue to use Tellmi’s peer support feed and Directory in between sessions for continued support. The results are very promising. So far, we can see that 64% of young people who have Tellmi SFT see an improvement in their wellbeing within a single 50-minute session. The feedback from young people shows that taking a solution-focused approach helps young people to see how much they are already doing right and that helps them to feel more hopeful about the future.
“We didn’t focus on what I was doing wrong. Instead I was guided towards the answers which I already had. It made me realise things from a different point of view and I actually feel a lot more hopeful now.”
Tellmi’s vision is a world where no one waits for mental help. Our mission is to design, develop, and deliver safe, scalable, pre-moderated digital peer support and solution-focused therapeutic interventions that measurably improve mental health and happiness in young people. Commissioned by the NHS, or independently by schools and organisations, Tellmi is free to access for children and young people, with no referrals, and no waiting times. Contact us for more information.
References
Smock Jordan, 2013; Microanalysis of positive and negative content in Solution-Focused Brief Therapy and Cognitive Behavioral Therapy expert sessions. Journal of Systemic Therapies, Vol. 32, No. 3, 2013, pp.46–59
Gingerich, W. J., Kim, J. S., Stams, G. J. J. M., & Macdonald, A. J., 2012; Solution-focused brief therapy outcome research. In C. Franklin, T. S. Trepper, W. J. Gingerich, & E. E. McCollum (Eds.), Solution-focused brief therapy: A handbook of evidence-based practice. Oxford University Press. 2012, pp. 95–111
Creswell et al., 2017; Clinical outcomes and cost-effectiveness of brief guided parent-delivered cognitive behavioural therapy and solution-focused brief therapy for treatment of childhood anxiety disorders: a randomised controlled trial. The Lancet Psychiatry, Vol. 4, Issue 7, July 2017, pp.529-539