What is Solution Focused Brief Therapy?
Solution Focused Brief Therapy (SFBT) is a short-term future-focused therapeutic approach which helps clients change by constructing solutions rather than dwelling on problems. Elements of the desired solution often are already present in the client's life (that is, someone who wants to be happier most likely already has times when they are a little happier), and become the basis for ongoing change. The ability to articulate what the changes will be like is often more important than understanding what led to the problem.
The approach was developed by Steve de Shazer, Insoo Kim Berg, Eve Lipchik and their colleagues at the Brief Family Therapy Center in Milwaukee, USA in the 1980s and has spread internationally.
SFBT is based on the idea that, if our aim is to help clients CHANGE, we ought to use things related to how change happens rather than concentrating on how problems develop. Understanding the details and 'cause' of the problem is often not necessary to building a solution. The important issues are how does the client want things to be different and what will it take to make it happen (or, more importantly, when is any of it ALREADY happening?). Envisioning a clear and detailed picture of how things will be when things are better creates hope and expectation and makes solution possible. SFBT focuses on the future (and how it will be better when things change) and majors on the establishing and elaboration of a clear "picture" or description of that preferred future. The preferred future directs the therapy process and helps it remain focused and brief (if we don't know where we're going, we won't know when we've got there!). SFBT also focuses on client strengths and resources, as a way of helping clients recognise how to use their resources to bring about changes (and, importantly, how they are ALREADY on their way to their preferred future).
How "brief" is brief?
Solution Focused Brief therapists don't set out to artificially limit the number of sessions. A good brief therapist will not focus on limiting sessions or time, but rather helping clients set ideas about desired outcomes and develop strategies to reach those outcomes.
Nonetheless, focusing on preferred outcomes and how pragmatically to achieve them and not getting caught up with digging around in the past tends to make counselling briefer. The therapist intervenes only to the extent necessary, with treatment usually lasting for less than six sessions. Solution Focused therapists ascribe to the ethical value of providing clients with the most effective treatment in the most time-efficient manner possible so that clients can get on with living their lives. (It is worth remembering that much research, across the range of therapy approaches, shows that a majority of clients attend six or fewer sessions).
Does this mean Solution Focused Therapy is only for "minor" problems?
Brief therapy has been effectively used with a wide variety of presenting problems and client populations, including depression, eating disorders, drug and alcohol problems, difficulties related to sexual abuse, relationship difficulties, parent-adolescent difficulties, mental health problems, and so on. Since it focuses on the process of change rather than the murky details of the problem, more major problems do not necessarily require different treatment. The task of a Solution Focused therapist is to help clients translate seemingly major problems into clearly defined and achievable preferred outcomes.
Isn't Solution Focused therapy simplistic?
To the casual student, the tenets of SFBT appear simple. However, a careful examination of the constructs from which these readily understandable and seemingly obvious "Solution Focused" techniques are derived reveals a highly organised and rigorous system of thinking. The approach has developed some key techniques and kinds of questions that are used routinely; however, it is neither simplistic nor mechanistic. Importantly, these techniques have developed from ongoing examination of "what do clients and therapists do that works?". As with any good therapy, it has to fit with the unique needs of the particular client.
Does Solution Focused Brief Therapy actually work?
Research shows that many different approaches to therapy "work" and arguments about which model is better than the others are often spurious. Nonetheless, there is evidence that Solution Focused Brief Therapy is effective.
It is interesting to note that SFBT has always been "evidence-based". de Shazer, Berg and their colleagues did not develop the approach by starting from theory — rather than beginning with theory, they observed actual therapy sessions specifically looking for those things that seemed to help clients move in the direction of their goals and then developed their therapy approach by doing more of these things and observing what happened.
A number of follow-up studies conducted at the Brief Family Therapy Centre in Milwaukee (the "home" of SFBT) reported success rates — clients reporting at one-year follow-up that the problem that took them to counselling was resolved or significantly better — of 70% and above. Interestingly, in a number of such studies, there is no difference in success rates when different problem types or diagnoses were examined separately.
Recent more rigorous studies support the effectiveness of the approach. One review paper reviewed 15 controlled studies of Solution Focused Brief Therapy which employed "objective" measures of outcome and concluded that 13 of these showed the approach achieved successful client outcomes2.
One study of 48 male patients in a rehabilitation program following work injury found significant differences in psychosocial adjustment and domestic harmony for those who had 6 sessions of Solution Focused therapy compared to those who only had the physical rehabilitation program. A week after the end of the program, 68% of the SFBT patients had successfully resumed work compared to only 4% of the others. Another study showed that prisoners who received an average of 5 sessions of SFBT had significantly lower rates of recidivism at 12 and 16 month follow-up than prisoners in a control group.
A more recent review of a greater number of studies found "The studies reviewed provide strong evidence that SFBT is an effective treatment for a wide variety of behavioral and psychological outcomes and, in addition, it may be briefer and therefore less costly than alternative approaches."5
In 2012, Oxford University Press published a comprehensive review of the research evidence supporting Solution Focused Brief Therapy6.
Solution Focused Brief Therapy has been classified as an "evidence-based" approach by a major US government agency, by professional psychology associations in Australia, the UK and the USA, and by state health departments in Australia and the US.
1. Lipchik, E., Derks, J, LaCourt, M., & Nunnally, E. (2012). The evolution of Solution-Focused Brief Therapy. In Cynthia Franklin, Terry S. Trepper, Wallace J. Gingerich, & Eric E. McCollum (Eds), Solution-Focused Brief Therapy: A handbook of evidence-based practice. New York: Oxford University Press, pp. 3-19.
2. Gingerich, W. J. & S. Eisengart (2000). Solution-focused brief therapy: A review of the outcome research. Family Process, 39(4), 477-498.
3. Cockburn, J. T., Thomas, F. N., & Cockburn, O. J. (1997). Solution-focused therapy and psychosocial adjustment to orthopedic rehabilitation in a work hardening program. Journal of Occupational Rehabilitation,72, 97-106.
4. Lindforss, L., & Magnusson, D. (1997). Solution-focused therapy in prison. Contemporary Family Therapy, 19(1), 89-103
5. Gingerich, W. J. & Peterson, L. T. (2013). Effectiveness of Solution-Focused Brief Therapy: A systematic qualitative review of controlled outcome studies. Research on Social Work Practice, 23(3), 266–283.
6. Franklin, Cynthia, Trepper, Terry S., Gingerich, Wallace J. & McCollum, Eric E. (Eds), (2012). Solution-Focused Brief Therapy: A handbook of evidence-based practice. New York: Oxford University Press.
Can you do Solution-Focused Therapy with involuntary clients?
Yes and no. Solution-Focused therapists work with clients who are "forced" into treatment by maintaining a delicate balance between acknowledging that the client doesn't want to be there and trying to find a goal the client would be motivated to work towards. We would talk to them pragmatically about what they need to do to achieve the goal of staying out of jail, of getting people off their back, or whatever is something meaningful and motivating for them — including what the challenges will be and what they will have to do to demonstrate that the change is lasting. If we can build a direction that is meaningful, we've got something to work towards.