What Does the Research Say About Solution-Focused Brief Therapy?

Solution-Focused Brief Therapy (SFBT) is an evidence-based approach to psychotherapy. Empirically-derived rather than theoretically-based both in construct and practice, the SFBT approach is a goal-directed collaborative approach to psychotherapeutic change primarily conducted through direct clinical observation of clients’ responses to a series of carefully constructed questions.

SFBT is one of the few approaches in psychotherapy that began as “evidence-based,” vs. most other models which are typically “theory-driven”. SFBT developers Steve de Shazer and Insoo Kim Berg and their team spent countless hours carefully observing real-life therapy sessions,  meticulously noting any words or behavior on the part of the therapist that resulted in progress towards the client’s stated goal. Language or behavior that reliably led to positive movement in the direction of the client’s goal were preserved and incorporated into the Solution-Focused approach and those that did not were discarded.(Lipchik, Derks, LaCourt, and Nunnally, 2012).

There has been a great deal of empirical outcome research on SFBT, including over 150 randomized clinical trials (RCTs) most of it occurring over the past fifteen years (for a complete review of the scope of research in SFBT, see Kim, Smock, Trepper, McCollum, and Franklin, 2010; and Kim, Jordan, Franklin, and Froerer, 2019). The conclusion of eight meta-analyses, a number of systematic reviews, and the over-all conclusion of the most recent scholarly works on SFBT, is that SFBT is an effective approach to the treatment of psychological problems, with effect sizes similar to other evidenced-based approaches, such as Cognitive Behavior Therapy and Interpersonal Therapy, but that these effects are found in fewer average sessions, and using an approach style that is more benign (Gingerich, Kim, and MacDonald, 2012; Kim et al, 2019; Trepper & Franklin, 2012). That is, the more collegial and collaborative approach of SFBT does not involve confrontation or interpretation. Given its equivalent effectiveness, shorter duration, and more benign approach, SFBT is considered to be an excellent first-choice evidenced-based psychotherapy approach for most psychological, behavioral, and relational problems.

SFBT is effective with diverse clinical populations and different classes of presenting problems. For example, SFBT was found to be effective in the treatment of child and adolescents (Carr, Hartnett, Brosnan, and Sharry, 2018; Gong and Xu, 2015; Gong and Hsu, 2017; Kim, 2008); as well as adults (Kim, 2008; Kim et al, 2015; Schmit, Schmit, and Lenz, 2016). With regard presenting problems, SFBT has been shown to be effective in the treatment of child and adolescent behavioral problems (Carr et al, 2017; Gong and Xu, 2015; Gong and Hsu, 2017); externalizing behavioral problems, including conduct disorder, and conflict management (Kim, 2008; Stams, Dekovic, Buist, and de Vries, 2006); internalizing behavioral problems, such as depression, anxiety, and self-esteem (Gong and Xu, 2015; Kim, 2008; Schmit and Schmit, 2016); and for behavioral support for  health related problems (Zhang, Franklin, Currin-McCulloch, Park, and Kim, 2018).  Also, SFBT has shown to be an effective intervention for substance abuse (Kim, Brook, and Akin 2018; Smock et al, 2008); domestic-violence (McCollum, Stith, and Thomsen, 2011); burn victims (Wang, Xiaomin, Yufeng, and Jinxing, 2016); and depression (Habibi, Ghaderi, Abedini, and Jamshidnejad, 2016). And a recent study (Kim et al, 2018) investigated the effectiveness of SFBT with parents of children with trauma-related problems and substance abuse for children in the child welfare system. It was found that SFBT was as effective as other evidence-based treatment approaches.

There have been numerous studies examining the specific processes and mechanisms of change underlying the SFBT approach. In general, SFBT has been shown to have different mechanisms of change than other approaches, most notably Cognitive Behavioral Therapy with which it is sometimes compared. Specifically, SFBT has more positive content within the session with a concomitant tendency for clients to respond in kind (Jordan, Froerer, and Bavelas 2013); SFBT therapists are more likely to use the specific language of the client to co-construct the goals and solutions (Korman, Bavelas, and De Jong, 2013); the SFBT interventions which focus on the strengths and resources of the clients tend to contribute to its successful outcomes  (Beyebach, 2014; Franklin, Zhang, Froerer, and Johnson, 2017).

The research into the language processes underlying SFBT has led to some intriguing clinical applications. For example, Richmond, Jordan, Bishof, and Sauer (2014) demonstrated that clients taking solution-focused intake questionnaires described significantly more solutions, described fewer problems, and improved significantly before their first therapy session than those taking traditional problem-oriented intake procedures. A psychometrically sound assessment device, the Solution-Building Inventory (SBI) (Jordan, 2014) was developed which, instead of measuring the problems and deficiencies, assesses clients’ ability to identify solutions, exceptions to problems, and hope. Sanchez-Prada and Beyebach (2014) showed how therapists can use different language choices and dialogue deconstruction to help clients who report no improvement or worsening between sessions stop the negative spiral and begin showing improvement again.

• There have been approximately 150 randomized clinical trials with SFBT (RCTs, the “gold standard” of clinical research);
• There are been eight meta-analyses on the effectiveness of SFBT;
• Effect-sizes found in these meta-analyses are in the low to high range, suggesting that SFBT is an effective approach for the populations studied;
• The research was done with a variety of clinical populations and presenting problems, and was done in “real world” settings, so the results are more generalizable.
• SFBT’s effectiveness is equivalent to or greater than other evidence-based practices, such as Cognitive-Behavior Therapy and Interpersonal Psychotherapy.
• While effect sizes are similar to other evidence-based approaches, these effects are attained in fewer sessions, averaging about five sessions and rarely extending over eight or ten.
• Process research shows that the language mechanisms underlying SFBT is different from other approaches with which it is sometimes compared.