Fam Proc 30:241-250, 1991

The BRIEFER Project: Using Expert Systems as Theory Construction

Tools
WALLACEJ.GINGERICH, Ph.D.
a
STEVEde SHAZER, M.S.S.W.
b
a
Professor, Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland OH 44106. Send correspondence
to Dr. Gingerich.
b
Brief Family Therapy Center, 6815 West Capitol Drive, Milwaukee WI 53216.
This article describes the development of BRIEFER I and BRIEFER II, expert systems that advise the therapist on
selecting, designing, and developing an intervention at the end of the first therapy session. The process of developing
expert systems has aided us in describing what brief therapists do, in modeling the intervention design process, and in
training brief therapists.
Fam Proc 30:241-250, 1991
Over the past 4 years, we have been involved in the development of expert systems. Expert systems are computer
programs that seek to embody the expertise of human experts for the purpose of consulting on real-world problems in a
specific domain (2, 10, 17). As such, they are usually rule-based and follow predictable inferencing strategies. The purpose
of our expert systems project was to make the knowledge of the team at the Brief Family Therapy Center (BFTC) more
explicit and communicable. Specifically, our interest was two-fold: (a) to model clinical decision making, particularly the
intervention design process, and (b) to assist us in theory construction. A tertiary purpose, inherent in the concept of expert
systems, was to assess whether it was feasible to use an expert system to provide increased access to scarce expertise. We
wish to make it clear at the outset that we do not intend to replace therapists with computers. The skill and knowledge
required for successful therapy seems to require a human being. However, we believe computers may be able to assist
therapists in important ways as they develop and carry out therapeutic interventions.
Clinical Decision Making
Throughout the course of a therapy session, the therapist makes many decisions about what to do and what not to do. In
large part, the criteria for these decisions are embedded or even just implicit in the particular model the therapist is using.
Further, for experienced therapists these decisions seem to come automatically. Expert therapists frequently find it difficult
to explain or justify their decisions, which often seem to be intuitive or obvious to them (1, 9).
It is clear from watching expert therapists at work, however, that they seem to follow rules, or at least that their decisions
can be modeled using rules. It is also clear that therapists think that there are good or useful decisions and that there are bad
or not so useful decisions. In order to better understand what goes on in therapy and to learn how to do therapy well, it
would be helpful if these decision criteria were more explicit. Eliciting and describing these rules for therapeutic decision
making should also facilitate the transferability of expert knowledge.
Theory Construction
In order to construct a useful theory of doing (brief) therapy, we need to identify what is observable and repeatable about
therapy sessions. We need to describe the consistencies from session to session and case to case based on what therapists
and clients actually do during therapy sessions. Therefore, theory development needs to be based on the disciplined
observation of therapy being done within a specific context. From this process, a description of what is done in therapy
sessions can be built and then rules can be created that will enable other people to do therapy "in the same way."
Developing such a theory has been a primary purpose of the "research team" at BFTC since our beginning in 1978 (3, 5,
6, 7, 8, 11, 16). Expert systems technology appeared to be a convenient and natural methodology for describing and
researching our theory of brief therapy (10). Brief therapy lends itself readily to theory construction because the "data" are
limited to 4 or 5 hours of observation (from behind the mirror and/or on videotape) per case.
SOLUTION-FOCUSED BRIEF THERAPY
Historically, brief therapy has been labeled "problem-solving therapy" (3, 14, 18) because of its focus on solving the
problems clients bring to therapists. Within these models there is an explicit relationship between the problem to be solved,
methods to use, specific prescriptions or interventions (called tasks), and specific, concrete goals.
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In 1982 at BFTC an anomaly began to develop. We had the first in a series of cases in which the task given to the client
was apparently not related to the problem presented, and yet the task proved useful in helping the client solve the problem
(4, 5, 8). Since then, this same task
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has proven useful to literally hundreds of clients. As a result, we lost the connection
between the problem-to-be-solved and the process of developing a solution (5, 6, 7).
While exploring the idea that "you don't need to know what the problem is in order to solve it," we also discovered that,
if asked in the right way, clients can frequently describe times when the presenting complaint is unexpectedly absent. We
labeled these anomalies "exceptions" (to the "it-always-happens" rule of the complaint). Broadly speaking, descriptions of
exceptions fall into two groups: (a) those that are described as unplanned or happening spontaneously and (b) those that are
deliberate or are intentionally carried out by the client.
To illustrate the difference between "problem solving" and "solution development," a case example will be useful:
Jack's parents complained that he was always late for school. They framed this as part of a long-standing difficulty
they have had getting Jack out of bed in the morning. It is likely that this problem could have been solved by
interrupting the failed attempt at a solution. However, we discovered that there had been some recent,
unexplainable exceptions. Curiously, mother, father, and Jack were unable to account for these infrequent events.
We gave mother, father, and Jack the task of secretly predicting each day whether or not the next morning would
prove to be an exception, that is, that Jack would get to school on time. Although mother and father continued their
waking-Jack-up routine, Jack was on time 4 of the next 5 days, a new record. The prediction task was assigned the
next session, since it had worked, and Jack's on-time rate continued to increase.
Thus far, the simplest way we have found to construct solutions involves helping the client to increase the frequency of
the exceptions. This also seems "automatically" to decrease the frequency of the problem, or even eliminate it, without any
deliberate problem-solving activities. This simple approach seems to be most effective when the exceptions (what the client
is already doing) are directly related to the client's goal.
The natural environment for solution-focused brief therapy includes an interviewing room and an observation room
connected by a see-through mirror, videotaping equipment, and a telephone hookup. The primary therapist conducts the
interview with the client (an individual or couple or family) while a team observes from the other room. The team's function
is twofold: (a) primarily to work on research and theory construction projects and (b) secondarily to consult on the therapy.
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First Sessions
In the first session the problem is described, exceptions are elicited, and the goal set. These decisions outline the
direction for the course of therapy. When all goes well, the client will report improvement and/or movement toward the
goal in the second session. The therapeutic task then becomes helping the client find ways to continue the improvement.
Thus, the theory of doing brief therapy (and the BRIEFER project) has focused on the first session. Although subsequent
sessions are not without theoretical interest, we believe that the first session is most important for therapeutic success.
THE BRIEFER PROJECT
The BRIEFER project has comprised a series of projects in which we took different approaches to developing expert
systems, leading to different ways to model the first session.
BRIEFER 0
This project, a precursor to the expert systems projects, used a simple branching structure to check for the fit between
our theory and therapist's description of a session. For instance, if the client reported that some worthwhile things had
happened between the first and second sessions, then logically the next step was to find out if the client saw this as a
difference that made a difference, that is, were things better, the same, or worse. When things were better, logically, the
next step was to worry about a relapse.
Often enough, the descriptions of the sequences of events in real sessions fit within the logic of the program, giving us
some confidence that our theory was internally consistent. Of course, not all descriptions fit, and using the program helped
us to see what went wrong and/or to flag potential anomalies, which might require revision of our theory.
BRIEFER 0 was concerned only with the patterns of the interview in a formal, abstract, and logical way. Various cases
could be seen to fit regardless of the content of the session and regardless of the specific problem or complaint. In this way
the process could be simply described. The fact that the program was sometimes right-on-track was particularly
encouraging since we had long held the view that describing the underlying patterns of therapy is essential to understanding
what works.
Checking the program against real cases revealed that sometimes "illogical" sequences occurred. For instance, it turned
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out that sometimes changes outside the area of the presenting complaint made things "good enough" for the client to be
satisfied and to terminate therapy even though the complaint itself had not changed. Also, it sometimes happened that the
complaint was eliminated and, logically, therapy should terminate since the goal was met, but the client did not see things
as better. What was going on here? Is the perception that "things are better" more relevant to clients than solving or
resolving or eliminating the complaint that brought them to therapy in the first place (5)?
This lack of fit between the theory (as expressed in BRIEFER 0) and the way things actually occurred meant that the
theory needed to be revised in accord with the way solutions actually developed. We decided to try to model this revision
using an expert system.
BRIEFER I
Our first true expert system, a demonstration prototype, was designed to assist the brief therapist in devising
interventions for first sessions (12, 13). We intended that BRIEFER I function like the team behind the mirror. Therefore,
at the conclusion of the first session, it asked a series of yes/no questions about the nature of the exceptions and other
relevant information elicited in the interview. BRIEFER I then used these "facts" of the case along with its decision-making
rules to arrive at all the pertinent ingredients that should go into the intervention.
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Sometimes a recommendation was based on a single fact. For example, a "yes" response to the question "Is there too
much information?" resulted in the suggestion to invite fewer people to the next session.
4
At other times a recommendation
was based on several facts:
Has someone already started doing somethingis there a DELIBERATE exception?
No
Are there SPONTANEOUS exceptions to the problem pattern or to the perception of the problem pattern?
Yes
Can the exceptions be defined in behavioral terms?
Yes
Has the exception occurred recently?
Yes
These facts about a case led to the suggestion to include randomness in the assigned task, or use a prediction task, a task
including a coin toss, or a task built around odd-even day variations.
We compared BRIEFER I with actual therapists working with real cases to see if its advice was comparable. Most of the
timebetween 60%-70% of the time (12)at least some of BRIEFER I's suggestions were consistent with what the actual
therapists had done. In some casesabout 20% (12)there was a one-to-one correspondence between what the therapist
did and what BRIEFER I suggested. In other cases the suggestions were logically similar, and occasionally BRIEFER I's
suggestions were totally different from what the therapist had done. In a sense, BRIEFER I was like human therapists: its
advice was not always perfect or complete.
BRIEFER I's advice was sometimes less consistent with observers of a case than with the actual therapist. In retrospect,
this is not surprising since the program was based on the rules therapists were seen to follow rather than the rules
consultants or observing team members followed. Other times when BRIEFER I was off-track, the interview was not
conducted by a solution-focused brief therapist. This resulted in the user being unable to answer some, or even many of the
questions, which suggests to us that the interview needs to be run from a solution-focused perspective for the theory to
apply and the program to be useful.
The most significant times BRIEFER I was off-base centered on cases in which the "client unit" included more than one
person and each person related to the therapist in a different way. In these cases, the program did not take the
client-therapist relationship pattern into account in the same way the therapist did.
Although we had intended for BRIEFER I to model the intervention selection/design process, it turned out to be a model
of how to conduct the session in order to generate the information needed to design an intervention. In fact, the underlying
structure of the rule-base that emerged during development turned out to be a good map for conducting the first session.
Nothing that emerged in the BRIEFER I flowchart (shown in Figure 1) was new to us, yet we had not been able to describe
our procedure for conducting the initial interview so clearly or succinctly. This simple schematic helped us keep more
on-track in first sessions, particularly so for less experienced therapists.
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Figure 1.
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Flowchart of BRIEFER I.
BRIEFER I successfully represented one aspect of our theory of the initial interview. Although BRIEFER I's suggestions
fit very well with what the therapist conducting the session did, its way of arriving at those suggestions did not reflect the
way in which the team or a "behind-the-mirror consultant" seemed to do it. That is, the program replicated the therapist's
in-session behavior quite well, but it did not model the intervention design process that occurs behind the mirror. Thus,
there was the need for an expansion of our theory and a revision of the expert system.
BRIEFER II
We decided to redesign BRIEFER so that it would give only one piece of advice rather than many. Further, we wanted
BRIEFER II to model the way in which a behind-the-mirror consultant arrived at a recommendation, namely, to begin with
a list of likely possible tasks and eliminate them one by one until the most suitable task remained. This meant a different
way of thinking about the problem and resulted in a different kind of program (15). In other words, we wanted BRIEFER II
to begin with the first possible task and then test to see if the conditions for recommending it have been met. If so, the
recommendation is made, and no additional recommendations are considered. If the conditions for the first recommendation
are not true, then BRIEFER II considers the next possible task and tests to see if its conditions are met. If true, it makes the
recommendation; if not, it considers the next task, and so forth (see Figure 2). Unlike BRIEFER I, BRIEFER II gives only
one recommendation or piece of advice.
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Figure 2.
Flowchart of BRIEFER II.
BRIEFER II begins by asking if the situation is "vague." If so, it recommends the "formula first session" task and ends
the consultation. If the situation is not vague, BRIEFER II inquires if the client and therapist were able to construct a goal.
If not, BRIEFER II asks if there is a joint work project. If so, the "formula first session" task is given, if not, BRIEFER II
recommends not giving a task at all. If the situation is not vague, and there is a viable goal, BRIEFER II asks if an
"exception" was found. If not, BRIEFER II recommends a "pretend the miracle has happened" task and ends the
consultation. If an exception was constructed, however, the consultation continues.
If there is a goal and an exception, BRIEFER II asks whether the goal and the exception are related, that is, if increasing
the frequency of the exception will lead to the goal. If not, the therapist is advised to give a "do something different task." If
the goal and exception are related, BRIEFER II asks if the exception is deliberate. If not, BRIEFER II recommends giving a
prediction task and concludes the consultation. If the exception is deliberate, BRIEFER II suggests giving a "do more of it"
task.
As a general consideration for all tasks, BRIEFER II asks whether the therapist is convinced that the situation has been
constructed in such a way that the client is likely to do a behavioral task (that is, the client is a "customer"). If not, the task is
modified to require observation rather than "doing."
The content of a specific session is used by the therapist to select a specific task from a class of tasks. At BFTC, although
the set of "all known tasks" contains over 1,000 tasks, a limited number are used with high frequency at the end of first
sessions (5, 6).
BRIEFER II represents our current theory of intervention design (or solution development) from the perspective of the
behind-the-mirror consultant (see Figure 2). Although it explicitly covers only first sessions, the map or diagram can be
used for subsequent sessions by substituting "change" or "improvement" for "exception."
DISCUSSION
The majority of the time (in approximately 80% of the "successful" tests, that is, when the programs suggest doing what
the therapist actually did), BRIEFER II's suggestion is the same as one or more of the suggestions BRIEFER I gave on the
same case. For example, in a case where the client said that sometimes, for no apparent reason, he had "up days," but the
majority of the time he was "very depressed," BRIEFER I's suggestions were:
1. There is a usable exception.
2. Use randomizer as part of the task, that is, predicting or coin toss or secret surprise.
3. Give a task to "pay attention to what is going on when the exception happens."
4. Give a task to "notice what is different about those occasions when the exception happens."
5. Client is likely to do the homework.
BRIEFER II's suggestion was: In this situation, it seems best to give a message that includes a prediction task.
The actual task (which follows BFTC's standard form for prediction tasks) was:
"Each night before you go to bed, predict whether the next day will be an 'up day' and then, in the middle of the next
day, figure out whether your prediction was right or wrong and then account for how come it was right or wrong."
In this case, both versions of BRIEFER were on track; their advice fit with what the therapist did.
This is theoretically interesting because the intervention design process is expressed in distinctly different ways in the
two programs. BRIEFER I uses a clinical decision-making model that accumulates pieces of advice as therapists
(frequently) do during the session, while BRIEFER II starts with all the options and uses rules to eliminate them until only
the most pertinent remains.
Our experience with using both versions on the same case is rather similar to using a team. The two reasoning processes
can be compared and trainees, for instance, can readily see the various connections between the questions and answers and
intervention choice and design. Interestingly, the strength of each version is also it major weakness.
For BRIEFER I, the process leads to a list of suggestions or options. This is theoretically interesting because it
demonstrates the rule-based nature
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of the interview itself and the intervention design process. In front of the mirror, the
majority of therapists seem to use a similar strategy. As the session evolves, various things happen between the therapist
and the client that point to the various clues involved in constructing a useful therapeutic reality. Like the therapist,
BRIEFER I's user has to decide which piece or pieces of the accumulated advice fits for any particular situation.
Sometimes this can result in confusion when the various pieces contradict each other, but at other times it can result in
creatively putting the pieces together in a unique and useful way.
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For BRIEFER II the process leads to one (or rarely two) pieces of advice. This is theoretically interesting because it
demonstrates the logic and internal consistency of the theory's rules. As the observed session evolves, various things
happen between the therapist and the client that help to narrow the range of options. In effect, throughout the session this
process aims at deciding what not to do. The result is a more elegant and more interesting expert system. While this
approach eliminates confusion and contradiction, thus promoting clarity, it also eliminates options and creativity, which
may be the reason the majority of therapists use the other way of thinking when conducting a session.
A bonus from the binocularity: Demonstrations of the two expert systems have proven unexpectedly useful for trainees.
Not only do the programs help trainees learn some of the principles of intervention choice and intervention design, which
was a major purpose of the project, they also help trainees learn about the structure and purpose of the therapeutic
interview. Both answering the questions and being unable to answer them has proven useful because running the programs
gives the user different ways to order their observations. From the sequences of questions and answers, the user is able to
see the "if this, then that" line of thought that lies behind what the therapist does during the interview and what the team or
consultant does behind the mirror. From the comparison between BRIEFER I and BRIEFER II, we are able to see that
different ways of using the same theory often lead to the same results.
CONCLUSION
The BRIEFER project has already helped advance our theory construction program, even though the systems continue to
undergo development.
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BRIEFER I and II have proven useful tools in disciplining our observations and, recursively, they
have given us a new way to discipline our observation. Furthermore, the project has helped us to specify what it is that
therapists and clients do during therapy sessions, thus aiding in assuring treatment integrity in our studies.
Of course, it is highly likely that the shape of the interview will continue to evolve over time and then we will have to
determine whether or not these differences make a difference in terms of the theory and/or the clinical decision-making
process. If so, there will need to be yet another program developed in the BRIEFER project.
REFERENCES
1. Benner,P., From novice to expert. American Journal of Nursing, 82, 402-407, 1982.
2. Buchanan,B.G. and Shortliffe,E.H. (Eds.), Rule-based expert systems. Reading MA: Addison-Wesley, 1984.
3. de Shazer,S., Patterns of brief family therapy: An ecosystemic approach. New York: Guilford Press, 1982.
4. de Shazer,S., The death of resistance. Family Process, 23, 11-17, 1984.
5. de Shazer,S., Keys to solution in brief therapy. New York: W.W. Norton, 1985.
6. de Shazer,S., Clues: Investigating solutions in brief therapy. New York: W.W. Norton, 1988.
7. de Shazer,S., Berg,I.K., Lipchik,E., Nunnally,E., Molnar,A., Gingerich,W. and Weiner-Davis,M., Brief
therapy: Focused solution development. Family Process, 25, 207-221, 1986.
8. de Shazer,S. and Molnar,A., Four useful interventions in brief family therapy. Journal of Marital and Family
Therapy, 10, 297-304, 1984.
9. Dreyfus,H.L. and Dreyfus,S.E., Mind over machine. New York: Free Press, 1986.
10. Gingerich,W.J., Expert systems and their potential uses in social work. Families in Society, 71, 220-228, 1990.
11. Gingerich,W.J., de Shazer,S. and Weiner-Davis,M., Constructing change: A research view of interviewing. In
E. Lipchik (ed.), Interviewing. Rockville MD: Aspen Publications, 1986.
12. Goodman,H., BRIEFER: An expert system for brief family therapy. Unpublished Master's Thesis, University of
Wisconsin-Milwaukee, 1986.
13. Goodman,H., Gingerich,W.J. and de Shazer,S., BRIEFER: An expert system for clinical practice. Computer in
Human Services, 5(1/2), 53-68, 1989.
14. Haley,J., Problem-solving therapy: New strategies for effective family therapy. San Francisco: Jossey-Bass,
1976.
15. Kim,J., de Shazer,S., Gingerich,W.J. and Kim,P., BRIEFER: An expert system for brief therapy. Presented at
the IEEE Systems Man and Cybernetic Annual Conference, Alexandria VA, 1987.
16. Molnar,A. and de Shazer,S., Solution-focused therapy: Toward the identification of therapeutic tasks. Journal of
Marital and Family Therapy, 13, 349-358, 1987.
17. Waterman,D.A., A guide to expert systems. Reading MA: Addison-Wesley, 1986.
18. Weakland,J.H., Fisch,R., Watzlawick,P. and Bodin,A.M., Brief therapy: Focused problem resolution. Family
Process, 13, 141-168, 1974.
19. Winston,P.H., Artificial intelligence. Reading MA: Addison-Wesley, 1977.
20. Winston,P.H. and Horn,B.K.P., LISP (2nd ed.). Reading MA: Addison-Wesley, 1984.
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Manuscript received April 13, 1989; Revisions submitted October 29, 1990; Accepted November 21, 1990.
1
The formula for the first-session task is as follows: "Between now and next session, we want you to observe what happens in
your life that you want to continue to have happen."
2
At times, when the therapist is a trainee, the team takes on additional supervision tasks. Of course, doing brief therapy does not
depend on having a team. The team's main functions are model-building, research, and theory construction; using the team for
consultation is a luxury.
3
This is a program design strategy called "forward chaining," which works "from the current state toward the goal state" (19, p.
152). The program "starts with a collection of assertions and tries all available rules over and over, adding new assertions as it goes,
until no rule applies" (20, p. 271).
4
Having "too many people" is not the cause of "too much information"; but we have observed that having fewer people will
usually allow the therapist to reorganize and simplify observations, and to feel less overwhelmed by the available information.
5
BRIEFER II employs a "backward chaining" inferencing strategy, which works from the goal state toward the initial state (19).
6
It is important to remember that such rules are part of the observer's toolkit, and it is only "AS IF" the therapist follows these
rules. That is, rules are used to discipline observation and to make the program do its work, but they do not necessarily determine
what happens in the interview.
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We do not yet use the expert systems "on-line" to give advice on live cases. A formal evaluation of the systems would be
required and, further, issues of liability must be resolved since the legal standing of expert systems (and their developers) is still not
clear.
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