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School Nurses use of Solution Focused Brief

Therapy to Support Children Affected by
Bullying

Article in The Journal of School Nursing · January 2008

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Education
Use of solution focused brief
therapy in bullying
Bullying in schools is still a major concern globally and raises great health problems for
children affected. There is evidence that using peer support groups based on solution
focused brief therapy can help pupils with a range of difficulties caused by the bullying.
T
he problem of bullying in schools is not new;
‘bullying’ crosses all boundaries of culture,
language, and ways of life globally. This article
reports on how school nurses can be trained to use
Solution Focused Brief Therapy (SFBT) to support a
child who has been bullied at school.
Background
Bullying is a considerable problem in schools, because
of its complex nature and serious consequences to the
health of pupils who have become victims (Natvig et
al, 2001).
Victims of bullying often suffer from anxiety, depression
and low self-esteem (Dao et al, 2006). Nansel et al (2001)
found that children who suffered bullying had poorer
social and emotional adjustment. They also found it
difficult to make friends, had poorer relationships with
classmates and often experienced greater feelings of
loneliness.
Bullying, when it occurs in schools, undermines a
fundamental right of children; namely to be educated in
a safe and secure environment to enable them to reach
their full potential (UNICEF, Article 4 and 29). It is
clear that children are not given this protection if they
are subjected to bullying or live in fear of being bullied
while in school.
There is an expectation that adults in authority
within school settings are accountable for children’s
wellbeing while they are in this environment and
must therefore safeguard them from harm. Although
teachers have both an educational and pastoral role to
play, it is often school nurses who have the training and
Lisbeth Kvarme is assistant professor in the Department of
Nursing, University/college Diakonova, Norway; Winifred Eboh
is a lecturer, School of Nursing and Midwifery, The Robert
Gordon University, Scotland; Edwin van der Teijlingen is in the
Department of Public Health, University of Aberdeen, Scotland;
and John Love is senior lecturer, School of Applied Social
Studies, The Robert Gordon University, Scotland
Email: lisbeth.kvarme@diakonova.no
Key words
n Bullying n School nurse’s role n Solution focused brief therapy
n Support group
346
remit to support pupils subjected to bullying. There are
barriers to school nurses realizing this role however,
such as their heavy workload and in some cases, lack
of training.
To fully appreciate what children who find themselves
in such dire situations face, there is a need to consider
what ‘bullying’ is within this context, the effect on both
the victim and the perpetrators who are said to be
victims themselves (Alexander et al, 2004). SFBT offers
the opportunity to use existing resources to meet this
very important need for children.
Studies in England, Japan, Italy and USA have
reported varying incidence of bullying among children
aged 8–18 years; at its worst, it can occur weekly, and
in some cases it arises occasionally—sometimes weekly,
sometimes once a month (Berger, 2007).
In Scotland, Todd et al (2004) reported findings from
an extensive Scottish study which suggested that 8.4%
of school children stated that they regularly endured
bullying with significantly higher levels of bullying
occurring among 11 year olds. These studies show that
bullying is a global problem that does not discriminate
against political, social or cultural norms. However,
the devastation it causes is evident in the psychosocial
impact it has on these children as discussed previously.
What forms does bullying
take in schools?
Olweus (1996) defines bullying as follows:
‘A student is being bullied when another student
or several other students say mean and hurtful
things or make fun of him or her or call him or
her mean and hurtful names; completely ignore
or exclude him or her from their group of friends
or leave him or her out of things on purpose, hit,
kick, push, shove around or lock him or her inside
a room; tell lies or spread false rumours about him
or her or send mean notes and try to make other
students dislike him or her and other hurtful
things like that. These things happen repeatedly.
But it is not bullying when two students of about
equal strength or power argue or fight.’
As shown in the above definition, bullying can
British Journal of School Nursing November 2008 Vol 03 No 07

take many forms; it can be physical or verbal abuse
(mocking, name calling, spreading of rumours) (Berger,
2007) or psychological cruelty through ostracizing and/
or rejection, and can be perpetrated by one person or
a group.
The common causes of bullying within the school
setting involves children selecting victims who are
smaller, younger and/or not as strong as them (physically
or emotionally). Alexander et al (2004) identified that
many cases of bullying are carried out by children who
have been bullied themselves at some point in their
lives. This suggests that any intervention should target
both victim and their perpetrators to ensure that the
problem is not shifted to another time or setting.
In this era of advanced technology, cyber-bullying is
becoming common place because many school children
have mobile telephones and internet access. This now
provides an added problem of the bully not necessarily
being known to the victim.
What measures have been
put in place to combat bullying?
The main programme addressing bullying in Norwegian
schools is known as the proactive intervention, based on
the Programme against bullying and anti-social behaviour
(Olweus, 1992) and the anti-bullying programme called
Zero, developed by the Centre for Behavioural Research
at the University of Stavanger, Norway (Roland and
Vaaland, 2003). These programmes consist of rules that
pupils need to comply with including a no-bullying
policy, but the programme is reliant upon school nurses
cooperating with teachers to make it work. The main
focus of this programme is in primary school settings,
working to prevent and stop bullying.
Solution focused brief therapy
The SFBT approach was developed by Kim Berg and
Steve de Shazer (Berg and Jong, 2002). It is based around
talks, where the focus is on solutions and the users’
resources, with an emphasis on the user developing
strategies to solve their problems. Acknowledging the
experience and recourses of the individuals are among
the basic approaches in SFBT (Berg and Jong, 2002).
People are able to change and this shift from being a
victim to taking a stand creates optimism, self-belief and
hope that their situation is changeable.
Children who are bullied often become extremely
introvert, finding it difficult to make friends for fear of
rejection. The SFBT approach uses the role of friendship
in promoting social and emotional competence in pupils.
It is paramount that school nurses are appropriately
trained to give the right support to affected children.
One example where SFBT was successfully used is
presented in the following case study, based on Sue
Young’ approach (1998; Young and Holdorf, 2003)
called The support group approach to bullying in schools.
November 2008 Vol 03 No 07 British Journal of School Nursing
Education
(The names used in this case study are fictitious for
confidentiality reasons.)
Case Study
Clara, a 12-year-old girl, presented to the school nurse
(Ann) in tears. She said that the boys in her class always
followed her during break times and were being nasty
towards her and calling her nick-names. The worst thing
for Clara was not having any friends at school. Clara
told the school nurse that she could not cope with this
situation anymore. The school nurse asked Clara if she
had any suggestions on how she could stop this name
calling and isolation, but Clara had none.
The following conversation then took place between
Ann and Clara:
Ann: ‘Can you remember any day that you enjoyed
being at school? What happen that day? Who were
you with?’
Clara: ‘Well, I remember one day two weeks ago
I enjoyed being at school because that day one of
the bullying leaders was absent and Iris, a new
girl, started in our class. She did not know any
pupils, so she asked me if she could join me. That
was a really nice day!’
Ann: ‘Are there any other girls you like being with
in school?’
Clara: ‘Susan use to be nice to me when Alice was
not around and Cheryl in the other class can also
be nice sometimes.’
Ann: ‘Would it be okay for you if I asked these
girls along to a meeting with you in a group? We
can then discuss what to do to help you have a
better time at school?’
Clara: ‘I really would like that!’
Following this conversation Ann asked the teacher,
to arrange a group discussion with the girls that Clara
had said were kind to her (their parents were asked for
permission for the girls to join the group discussion).
Once permission was given, all the girls agreed to be
part of the group discussion.
At the first meeting they started with light-hearted
conversation about themselves to help them get to know
each other. Ann gave an introduction and an overview of
what the purpose of the group was and what they could
do to help Clara to make life more enjoyable at school.
As the girls talked, Ann wrote down each suggestion
from the group members and they promised to support
Clara and follow the suggestions they had made. The
following week they met again to evaluate how these
suggestions had affected Clara’s situation in school.
347
Education
These group talks continued for some weeks until Clara
said that her days at school were much better and she
had made nice friends to socialize with at school.
One of the aims of the group meetings was to develop
empathy for the victim of bullying from her peers,
but not to discuss the bullying itself. By asking all the
group members if they remember any day at school
when they felt unhappy or had a problem, this became
generalized and not focused on the one child. The group
members then made suggestions about how to help the
child experiencing the bullying. It is important that
these suggestions are written down, taken seriously and
that credit given to all ideas. Some of the suggestions
included playing together in their free time, eating
lunch and doing group work together. It was also equally
important that the suggestions came from the group
members.
These talks worked well with groups of between
five and seven children. This is in line with the advice
suggested for the size of focus groups in social science
research (six to eight) (Tang and Davies, 1995). The
pupils were encouraged to focus their discussion on
what was better since the last meeting (if they were
getting along better) and how to improve the situation.
While this is going on, the facilitator should praise
the group and the bullied child for any progress they
make.
In SFBT the solutions were independent of the
problem and the focus was on possible solutions. Actual
questions that were asked of pupils involved in group
discussions are:
n How would you wish your days at school to be?
n Are there any pupils who can be supportive and
helpful to you?
The focus in SFBT is on recourses and what the
pupils can do. There is evidence that using a SFBT peer
support group could help the pupils through a variety of
difficulties arising from bullying (Young, 1998; Young
and Holdorf, 2003; Fekkes, 2005). The aim of this
approach is to strengthen victims of bullying, but not
punish the bully. However, it is important not to forget
the bully; the teacher or the school nurse should have
individual and separate talks with the bully as well as the
victims, at which point it is important to make it clear
that bullying is not acceptable in any shape or form.
Key Points
n Bullying in schools raises great health problems for children affected
n Solution focused brief therapy support groups can create optimism
and hope that their situation is changeable
n Support groups uses the role of friendship in promoting social and
emotional competence in pupils
n Cooperation with the school staff and parents are needed to stop and
prevent bullying
348
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Conclusions
Bullying is a problem which can cause extreme stress
for its victims as they often lack support from peers and
friends. School nurses have heavy workloads across very
different aspects of their job, but the prospect of offering
children a means to support fellow pupils who are being
bullied must be seen as a worthwhile investment of time
and resources.
The previous case study demonstrates that SFBT can
work with the help of group support offered through
open discussions between affected children and their
peers. More research is needed to explore the best
ways of using SFBT to reduce bullying in, for example,
different situations and age groups. It is imperative that
school nurses are approachable, available, contactable
and skilled in using this approach to help children. The
support of teachers and parents would ensure that such
children do not feel abandoned. Finally, cooperation
with the school staff and parents are needed to prevent
and stop bullying.
BJSN
Conflict of interest: Please note that to the best of our
knowledge there are no conflicts of interest that will
arise from publication of this paper.
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