Solution-focused therapy is proposed as an effective strength-based model for children with social phobia. Social phobia is described along with the etiology and prevailing treatment approaches. A case illustration demonstrates the application of solution-focused therapy with a child who experienced social phobia. Implications for counseling and recommendations for research are discussed.
Social phobia is an extremely debilitating syndrome that is estimated to affect 3% to 4% of children each year in the United States (Beidel, Turner, & Morris, 1999). The Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR; American Psychiatric Association [APA], 2000) describes social phobia as a marked and persistent fear of social or performance situations in which scrutiny by others, embarrassment, or humiliation may occur. Clients with social phobia experience severe social discomfort and often avoid eye contact when speaking to others (den Boer, 1997). In addition, clients with social phobia experience performance discomfort that usually leads to presituational catastrophizing, increased physiological arousal (e.g., dry mouth and increased heart rate), and subsequent avoidance of social situations that may expose the individual to scrutiny (King, Murphy, & Heyne, 1997). Various etiological theories and corresponding treatment approaches explaining the cause of social phobia have been set forth, including cognitive behavioral (Alfano, Beidel, & Turner, 2006; Hudson & Rapee, 2000; King et al., 1997; Nevid, Rathus, & Greene, 2000; Velting & Albano, 2001), and neurobiological (Bell, Malizia, & Nutt, 1999; Tillfors, 2004).
In this article, I propose that solution-focused therapy provides an effective framework for treating children with social phobia. Solution-focused therapy was developed by de Shazer (1988, 1994) and his colleagues (Molnar & de Shazer, 1987) at the Brief Family Therapy Center in Milwaukee, Wisconsin. Solution-focused therapy is grounded on the assumption that for every problem there is a solution. To formulate solutions, the counselor helps the client build on exceptions. Exceptions are times in the client's life when the problem could have occurred but did not or was less severe (DeJong & Berg, 1998). Solution-focused therapy is especially fitting for children with social phobia for several reasons. First, it addresses the resiliency of children; that is, it is an approach in which children build upon a strength-based foundation to work toward solutions. Chevalier (1995) asserted that it is easier to build on strengths and past successes than to correct past failures or mistakes. Second, through solution-focused therapy, a counselor understands, accepts, and uses the client's unique worldview during the process of identifying and amplifying exceptions. The counselor accepts the client's view of the world and how she or he chooses to live in it. Third, solution-focused therapy uses the imagination of children to visualize the future through the miracle question (Lethem, 2002). The miracle question allows for a clear picture of what the solution looks like even when the problem may not be clearly defined (de Shazer, 1988).
Solution-focused therapy shares important features with Carl Rogers's person-centered therapy. For example, Cepeda and Davenport (2006) noted that both therapies emphasize facilitating a client's ability to cope and to solve problems, and both therapies are known for their long-term positive effects. In addition, both approaches view the client as having existing resources for solving her or his problems. Furthermore, both approaches entail accepting the client's internal frame of reference and working collaboratively with the client to bring about desired change.
To date, no solution-focused therapy applications specific to children with social phobia have been reported in the literature. …