I don't believe in miracles: Using the ecological validity model to adapt the miracle question to match the client’s cultural preferences and characteristics.

Abstract

The Miracle Question (MQ) is a characteristic feature of solution-focused brief therapy (SFBT). However, there are times when the terminology of the Miracle Question may not fit the worldview of the client. The main objective of this article is to systematically review the various ways the MQ was adapted and the process of adaptation followed by therapists. The systematic review yielded 24 articles that showed the various ways of adapting the MQ substituting “miracle” with following words/phrases: a fresh start, dreams, at your best, harmony with people and life, click your fingers, something big is possible, and on track. The review highlighted a gap that many therapists did not follow a framework when adapting the MQ. Moreover, the review suggests the use of an expanded cultural adaptation framework based on the Ecological Validity Model, Hofstede’s cultural dimensions of national culture and a client’s time orientation provides clinical guidelines to help therapists’ adapt MQ and more broadly any intervention to match the client’s cultural preferences, values and beliefs. The framework includes the following cultural dimensions for consideration when adapting an intervention: (a) cultural sayings/symbols; (b) cultural customs/traditions/values; (c) cultural definitions of success in developing goals; (d) where a client lies on the collectivist-individualist continuum; (e) the importance of the role of hierarchy/authority and spirituality; and (f) a client’s time orientation. Finally, an example of an adaptation of the MQ, the Bounce Back Question was provided for therapists to demonstrate the process of how the adaptation could occur using these clinical guidelines.

Religion and Spirituality in Solution-Focused Brief Therapy

“…A miracle question that is not adapted to the client's preferences and characteristics could break the therapeutic alliance. In support of this interpretation, Kayrouz and Hansen (2020) found that some clients had difficulty with the term "miracle but could answer by saying they do not believe in miracles, so they struggled to answer it. The miracle question and religious/spiritual orientations may also conflict (Özkapu, 2022).…”

“…This flexible perspective also provides an important resource regarding the religious/spiritual field. Various studies have evaluated basic SFBT techniques from a spirituality perspective as well as spiritual SFBT models that include religious/spiritual-oriented techniques (Crockett and Prosek, 2013;Rassoul, 2016;Kayrouz and Hansen, 2020;Santich, 2020). The following section evaluates some of these common techniques in SFBT in terms of approach and spirituality.…”

“…Therefore, the language and expression of the miracle question may need to be adapted to the client's culture without losing its purpose, although this is typically not viewed as an issue (Trepper et al, 2010). Various studies have investigated examples of miracle questions adapted to different cultures and religious/spiritual content (Lambert, 2008;Kayrouz & Hansen, 2020;Özkapu, 2022). Studies examining the efficacy of the miracle question in relation to culture and thus religious/spiritual orientation show that it has various effects and is effective after treatment for children, adolescents, and adults from various ethnic groups who are experiencing anxiety, depression, and stress (Kayrouz & Hansen, 2020).…”

Preparing student therapists to work with Black mental health: Attending to the social and institutional organization of “culture” in Canadian counsellor education.

“…Viewing contributing factors to their problems as able to “disappear” to reveal a preferred future could even be experienced as therapeutically violent, particularly regarding experiences of racism and discrimination. As a result, the miracle question, which is an intervention used to explore clients’ hidden resources or solutions for their present problems, appeared to offend some of my clients and caused a disruption in therapy (Kayrouz & Hansen, 2020). This possibility was not presented in any of the educational and resource material about SFBT I had accessed.…”