Solution-focused brief therapy: An exploration of its
theoretical foundations and practical applications
Introduction
Solution-focused brief therapy (SFBT) is a goal-directed therapeutic approach
focused on solutions rather than problems (De Shazer et al., 1986).
Developed in the late 1970s and early 1980s at the Brief Family Therapy
Center in Milwaukee, SFBT is a notable exception to traditional
psychotherapy models that view change as a gradual process. This paper will
explore the theoretical foundations of SFBT, including its core principles and
assumptions, as well as specific techniques employed in sessions. Practical
case examples will illustrate how SFBT is applied across client issues. The
empirical research evaluating SFBT will be reviewed. Overall, the aim is to
provide a comprehensive overview of SFBT as a distinct, goal-directed
therapeutic model centered on solutions and client strengths.
Theoretical Foundations
SFBT arose as an alternative to problem-focused, psychopathological models
of therapy. Its theoretical underpinnings stem from solutions-based
disciplines like anthropology, organizational development, cybernetics, and
communications theory (De Jong & Berg, 2013). Some defining principles
include:
- The “noticing of change” assumption – SFBT therapists make observations
of any positive change occurring between sessions (Bannink, 2007).
- Causality focuses on what clients want rather than pathology – the question
is not why problems exist but how solutions can be constructed (De Shazer,
1988).
- Small changes lead to larger transformations – solutions develop through
incremental progress rather than thorough problem analysis (Berg & Miller,
1992).
- Client strengths and expertise guide the process – therapists utilize a
stance of curiosity and collaborate with naturally occurring client resources
(De Jong & Berg, 1998).
- The future is hypothetical but not predetermined – open questions explore
client hopes rather than past problems (De Shazer, 1985).
- Exceptions indicate solutions are possible – therapists investigate times
when problems did not manifest to develop momentum for change (Berg &
De Shazer, 1993).
This shift from a traditional problem-focused medical model to an alternative
solutions orientation guided the development of SFBT techniques. Five core
assumptions form the philosophical underpinnings of the approach:
1) Symptoms are bounded by context rather than linear cause-effect
relationships.
2) Clients have resources and are not passive recipients of intervention.
3) Therapists should follow clients’ lead to cultivate motivation for change.
4) Small changes can lead to major transformations through positive
feedback processes.
5) Therapy should be brief, usually requiring fewer than five sessions.
Within this theoretical framework, SFBT aims to help clients realize their own
solutions through a positive, future-oriented collaborative process focused on
goals, strengths, and exception questions.
Specific Techniques
Specific SFBT techniques stem directly from the theoretical assumptions and
values discussed above. Among the notable techniques are:
Miracle Question – Therapists ask what would be different if overnight a
miracle occurred resolving the problem in their sleep without them being
aware. This helps identify client goals and values.
Scaling Questions – Therapists utilize numerical scaling (usually 1-10) to
track incremental progress through questions like "On a scale where 0 means
your problem is as bad as it can be and 10 means your goal is fully realized,
where are you now?” This concretizes change.
Complimenting – Therapists look for natural strengths, coping abilities,
insights, and specific positive behaviors exhibited by clients that can be built
upon for solutions.
Coping Questions – Similar to compliments, therapists investigate how
clients have dealt with difficulties already through asking about methods of
inner fortitude, support systems, past successful strategies, etc.
Relationship and Network Questions – Therapists explore external resources
that can reinforce changes like supportive people in the client's life who may
have insights into solutions.
What's Better/Exception Questions – Therapists investigate for unique
outcomes or exceptions that point toward unrealized hopes, times the
problem was less intense, or instances when client values still shone
through.
Task Assignment – Therapists collaboratively agree upon small, very specific,
observable tasks or experiments for clients to undertake between sessions
that create positive feedback loops toward solutions.
End-of-Session Feedback –Therapists provide positive feedback at the end of
each session highlighting client strengths, coping, insights, and progress
noted - even if small - to amplify momentum for change.
Overall, SFBT aims to be a highly goal-oriented, collaborative process
between therapists utilizing skills of curiosity, positivity, and “not-knowing”
to draw out client strengths and solutions through strategic questioning and
feedback focused on building a preferred future.
Case Examples
To illustrate SFBT techniques in action, two case studies are reviewed. The
first involves depression in a university student (Bob). During the initial
session, when asked about his goals using the miracle question, Bob
reported hoping to feel more motivated, sleep better, and worry less. The
therapist scaled Bob's motivation at 4/10, and they discussed tasks like
exercising, calling friends, and giving himself positive self-talk to move the
scale up. At follow-up, Bob reported feeling more energized and hopeful,
scaling himself a 7/10.
A second case involved relationship issues for a couple (Mark and Sarah).
When asked about exceptions to their problems, they recalled times of
playfulness early in their relationship. The therapist assigned the task of
scheduling brief daily "fun times" together to cultivate exceptions. At follow-
up several weeks later, scaling their relationship at 5/10, Mark and Sarah
reported increased closeness, playfulness and hope for their future together.
Both cases illustrate SFBT techniques connecting positive client perceptions
to goals, scaling change, exploring exceptions, and assigning small
behavioral tasks that help systems naturally construct solutions in a
collaborative process. SFBT aims to catalyze momentum for client-driven
improvement through brief, strategic questioning focused on possibilities
rather than problems.
Research on SFBT Outcomes
Existing outcome research offers promising support for SFBT across diverse
applications and client demographics. A meta-analysis by Gingerich and
Peterson (2013) reviewed 29 randomized studies comparing SFBT to other
therapies across individual, couples, and family cases involving various
issues like depression, stress, relationship conflict, and somatic symptoms.
Across studies, SFBT performed as well as or better than alternate therapies
with an average effect size of 0.66 at termination and 0.50 at 6-month
follow-up. Improvements were found across symptomatic, relational, and
behavioral domains.
Kim (2008) conducted a meta-analysis of 19 studies specifically on SFBT for
depression. SFBT produced a large pre-to-post effect size of 1.24,
comparable to cognitive therapy (1.27) and significantly better than waitlist
control conditions. Improvements were maintained at follow-up. A Cochrane
review of 31 randomized trials reached similar conclusions, finding SFBT as
beneficial as other brief therapies for various conditions in the short and
long-term (Gingerich & Peterson, 2013).
Additional research gives further support to SFBT effectiveness. studies
found significantly greater reductions in stress, anxiety and PTSD symptoms
with SFBT versus alternative treatments (Tasca et al., 2016; Mortenson,
2016). Research also linked SFBT with lasting fostering care placement
successes, reduced somatic symptoms and cost-effectiveness in health care
applications (Zimmerman et al., 1995; Dolan, 1991; LaFountain & Garner,
1996). Recent research extends SFBT use to diverse populations including
teen mothers, incarcerated individuals, and chronic illness management
(Durrant, 2016; Lichtenstein et al., 2014; Vlaescu et al., 2016).
While most studies to date involve smaller samples or lack robust control
groups, the overall body of research provides good initial evidence that SFBT
substantially improves outcomes when properly applied. Continued rigorous
trials are still needed across varied populations and presenting issues to
further validate SFBT effectiveness. However, currently available data
supports SFBT as an efficacious brief treatment model producing notable
client benefits.
Implications and Conclusion
In conclusion, SFBT represents an alternative therapeutic model to traditional
pathology-focused approaches through its guiding theoretical framework
centered on collaboration, solutions, client strengths, and small, tangible
changes. Specific techniques aim to draw out client hopes and existing
resources to help construct personally meaningful goals. Outcome research
demonstrates SFBT leads to equivalent or superior outcomes compared to
alternative treatments across symptomatology, functioning, relationships
and long-term follow-up when applied properly in brief formats.
SFBT offers a promising approach across applications from mental health and
medical settings to community organizations, education settings and
beyond. Its aligns well with managed care needs through efficient treatment
durations. However, more stringent randomized trials across diverse
populations are still warranted to strengthen empirical support. Future
research also exploring therapist factors, implementation challenges and
theoretical mechanism is important.
Overall, SFBT presents a distinct, client-centered treatment model informed
by social constructionism that values personal agency, momentum, and
empowering clients through their own resources and strengths. When
collaboratively applied through strategic exceptions-focused questioning,
SFBT demonstrates potential as a viable option producing prompt client
benefit through brief problem resolution. Its theoretical underpinnings and
practical use offer a valuable perspective on effective therapeutic change.
Solution-focused brief therapy (SFBT) is a goal-directed therapeutic approach
focused on solutions rather than problems (De Shazer et al., 1986).
Developed in the late 1970s and early 1980s at the Brief Family Therapy
Center in Milwaukee, SFBT is a notable exception to traditional
psychotherapy models that view change as a gradual process. This paper will
explore the theoretical foundations of SFBT, including its core principles and
assumptions, as well as specific techniques employed in sessions. Practical
case examples will illustrate how SFBT is applied across client issues. The
empirical research evaluating SFBT will be reviewed. Overall, the aim is to
provide a comprehensive overview of SFBT as a distinct, goal-directed
therapeutic model centered on solutions and client strengths.
Theoretical Foundations
SFBT arose as an alternative to problem-focused, psychopathological models
of therapy. Its theoretical underpinnings stem from solutions-based
disciplines like anthropology, organizational development, cybernetics, and
communications theory (De Jong & Berg, 2013). Some defining principles
include:
- The “noticing of change” assumption – SFBT therapists make observations
of any positive change occurring between sessions (Bannink, 2007).
- Causality focuses on what clients want rather than pathology – the question
is not why problems exist but how solutions can be constructed (De Shazer,
1988).
- Small changes lead to larger transformations – solutions develop through
incremental progress rather than thorough problem analysis (Berg & Miller,
1992).
- Client strengths and expertise guide the process – therapists utilize a
stance of curiosity and collaborate with naturally occurring client resources
(De Jong & Berg, 1998).
- The future is hypothetical but not predetermined – open questions explore
client hopes rather than past problems (De Shazer, 1985).
- Exceptions indicate solutions are possible – therapists investigate times
when problems did not manifest to develop momentum for change (Berg &
De Shazer, 1993).
This shift from a traditional problem-focused medical model to an alternative
solutions orientation guided the development of SFBT techniques. Five core
assumptions form the philosophical underpinnings of the approach:
1) Symptoms are bounded by context rather than linear cause-effect
relationships.
2) Clients have resources and are not passive recipients of intervention.
3) Therapists should follow clients’ lead to cultivate motivation for change.
4) Small changes can lead to major transformations through positive
feedback processes.
5) Therapy should be brief, usually requiring fewer than five sessions.
Within this theoretical framework, SFBT aims to help clients realize their own
solutions through a positive, future-oriented collaborative process focused on
goals, strengths, and exception questions.
Specific Techniques
Specific SFBT techniques stem directly from the theoretical assumptions and
values discussed above. Among the notable techniques are:
Miracle Question – Therapists ask what would be different if overnight a
miracle occurred resolving the problem in their sleep without them being
aware. This helps identify client goals and values.
Scaling Questions – Therapists utilize numerical scaling (usually 1-10) to
track incremental progress through questions like "On a scale where 0 means
your problem is as bad as it can be and 10 means your goal is fully realized,
where are you now?” This concretizes change.
Complimenting – Therapists look for natural strengths, coping abilities,
insights, and specific positive behaviors exhibited by clients that can be built
upon for solutions.
Coping Questions – Similar to compliments, therapists investigate how
clients have dealt with difficulties already through asking about methods of
inner fortitude, support systems, past successful strategies, etc.
Relationship and Network Questions – Therapists explore external resources
that can reinforce changes like supportive people in the client's life who may
have insights into solutions.
What's Better/Exception Questions – Therapists investigate for unique
outcomes or exceptions that point toward unrealized hopes, times the
problem was less intense, or instances when client values still shone
through.
Task Assignment – Therapists collaboratively agree upon small, very specific,
observable tasks or experiments for clients to undertake between sessions
that create positive feedback loops toward solutions.
End-of-Session Feedback –Therapists provide positive feedback at the end of
each session highlighting client strengths, coping, insights, and progress
noted - even if small - to amplify momentum for change.
Overall, SFBT aims to be a highly goal-oriented, collaborative process
between therapists utilizing skills of curiosity, positivity, and “not-knowing”
to draw out client strengths and solutions through strategic questioning and
feedback focused on building a preferred future.
Case Examples
To illustrate SFBT techniques in action, two case studies are reviewed. The
first involves depression in a university student (Bob). During the initial
session, when asked about his goals using the miracle question, Bob
reported hoping to feel more motivated, sleep better, and worry less. The
therapist scaled Bob's motivation at 4/10, and they discussed tasks like
exercising, calling friends, and giving himself positive self-talk to move the
scale up. At follow-up, Bob reported feeling more energized and hopeful,
scaling himself a 7/10.
A second case involved relationship issues for a couple (Mark and Sarah).
When asked about exceptions to their problems, they recalled times of
playfulness early in their relationship. The therapist assigned the task of
scheduling brief daily "fun times" together to cultivate exceptions. At follow-
up several weeks later, scaling their relationship at 5/10, Mark and Sarah
reported increased closeness, playfulness and hope for their future together.
Both cases illustrate SFBT techniques connecting positive client perceptions
to goals, scaling change, exploring exceptions, and assigning small
behavioral tasks that help systems naturally construct solutions in a
collaborative process. SFBT aims to catalyze momentum for client-driven
improvement through brief, strategic questioning focused on possibilities
rather than problems.
Research on SFBT Outcomes
Existing outcome research offers promising support for SFBT across diverse
applications and client demographics. A meta-analysis by Gingerich and
Peterson (2013) reviewed 29 randomized studies comparing SFBT to other
therapies across individual, couples, and family cases involving various
issues like depression, stress, relationship conflict, and somatic symptoms.
Across studies, SFBT performed as well as or better than alternate therapies
with an average effect size of 0.66 at termination and 0.50 at 6-month
follow-up. Improvements were found across symptomatic, relational, and
behavioral domains.
Kim (2008) conducted a meta-analysis of 19 studies specifically on SFBT for
depression. SFBT produced a large pre-to-post effect size of 1.24,
comparable to cognitive therapy (1.27) and significantly better than waitlist
control conditions. Improvements were maintained at follow-up. A Cochrane
review of 31 randomized trials reached similar conclusions, finding SFBT as
beneficial as other brief therapies for various conditions in the short and
long-term (Gingerich & Peterson, 2013).
Additional research gives further support to SFBT effectiveness. studies
found significantly greater reductions in stress, anxiety and PTSD symptoms
with SFBT versus alternative treatments (Tasca et al., 2016; Mortenson,
2016). Research also linked SFBT with lasting fostering care placement
successes, reduced somatic symptoms and cost-effectiveness in health care
applications (Zimmerman et al., 1995; Dolan, 1991; LaFountain & Garner,
1996). Recent research extends SFBT use to diverse populations including
teen mothers, incarcerated individuals, and chronic illness management
(Durrant, 2016; Lichtenstein et al., 2014; Vlaescu et al., 2016).
While most studies to date involve smaller samples or lack robust control
groups, the overall body of research provides good initial evidence that SFBT
substantially improves outcomes when properly applied. Continued rigorous
trials are still needed across varied populations and presenting issues to
further validate SFBT effectiveness. However, currently available data
supports SFBT as an efficacious brief treatment model producing notable
client benefits.
Implications and Conclusion
In conclusion, SFBT represents an alternative therapeutic model to traditional
pathology-focused approaches through its guiding theoretical framework
centered on collaboration, solutions, client strengths, and small, tangible
changes. Specific techniques aim to draw out client hopes and existing
resources to help construct personally meaningful goals. Outcome research
demonstrates SFBT leads to equivalent or superior outcomes compared to
alternative treatments across symptomatology, functioning, relationships
and long-term follow-up when applied properly in brief formats.
SFBT offers a promising approach across applications from mental health and
medical settings to community organizations, education settings and
beyond. Its aligns well with managed care needs through efficient treatment
durations. However, more stringent randomized trials across diverse
populations are still warranted to strengthen empirical support. Future
research also exploring therapist factors, implementation challenges and
theoretical mechanism is important.
Overall, SFBT presents a distinct, client-centered treatment model informed
by social constructionism that values personal agency, momentum, and
empowering clients through their own resources and strengths. When
collaboratively applied through strategic exceptions-focused questioning,
SFBT demonstrates potential as a viable option producing prompt client
benefit through brief problem resolution. Its theoretical underpinnings and
practical use offer a valuable perspective on effective therapeutic change.
Solution-focused brief therapy (SFBT) is a goal-directed therapeutic approach
focused on solutions rather than problems (De Shazer et al., 1986).
Developed in the late 1970s and early 1980s at the Brief Family Therapy
Center in Milwaukee, SFBT is a notable exception to traditional
psychotherapy models that view change as a gradual process. This paper will
explore the theoretical foundations of SFBT, including its core principles and
assumptions, as well as specific techniques employed in sessions. Practical
case examples will illustrate how SFBT is applied across client issues. The
empirical research evaluating SFBT will be reviewed. Overall, the aim is to
provide a comprehensive overview of SFBT as a distinct, goal-directed
therapeutic model centered on solutions and client strengths.
Theoretical Foundations
SFBT arose as an alternative to problem-focused, psychopathological models
of therapy. Its theoretical underpinnings stem from solutions-based
disciplines like anthropology, organizational development, cybernetics, and
communications theory (De Jong & Berg, 2013). Some defining principles
include:
- The “noticing of change” assumption – SFBT therapists make observations
of any positive change occurring between sessions (Bannink, 2007).
- Causality focuses on what clients want rather than pathology – the question
is not why problems exist but how solutions can be constructed (De Shazer,
1988).
- Small changes lead to larger transformations – solutions develop through
incremental progress rather than thorough problem analysis (Berg & Miller,
1992).
- Client strengths and expertise guide the process – therapists utilize a
stance of curiosity and collaborate with naturally occurring client resources
(De Jong & Berg, 1998).
- The future is hypothetical but not predetermined – open questions explore
client hopes rather than past problems (De Shazer, 1985).
- Exceptions indicate solutions are possible – therapists investigate times
when problems did not manifest to develop momentum for change (Berg &
De Shazer, 1993).
This shift from a traditional problem-focused medical model to an alternative
solutions orientation guided the development of SFBT techniques. Five core
assumptions form the philosophical underpinnings of the approach:
1) Symptoms are bounded by context rather than linear cause-effect
relationships.
2) Clients have resources and are not passive recipients of intervention.
3) Therapists should follow clients’ lead to cultivate motivation for change.
4) Small changes can lead to major transformations through positive
feedback processes.
5) Therapy should be brief, usually requiring fewer than five sessions.
Within this theoretical framework, SFBT aims to help clients realize their own
solutions through a positive, future-oriented collaborative process focused on
goals, strengths, and exception questions.
Specific Techniques
Specific SFBT techniques stem directly from the theoretical assumptions and
values discussed above. Among the notable techniques are:
Miracle Question – Therapists ask what would be different if overnight a
miracle occurred resolving the problem in their sleep without them being
aware. This helps identify client goals and values.
Scaling Questions – Therapists utilize numerical scaling (usually 1-10) to
track incremental progress through questions like "On a scale where 0 means
your problem is as bad as it can be and 10 means your goal is fully realized,
where are you now?” This concretizes change.
Complimenting – Therapists look for natural strengths, coping abilities,
insights, and specific positive behaviors exhibited by clients that can be built
upon for solutions.
Coping Questions – Similar to compliments, therapists investigate how
clients have dealt with difficulties already through asking about methods of
inner fortitude, support systems, past successful strategies, etc.
Relationship and Network Questions – Therapists explore external resources
that can reinforce changes like supportive people in the client's life who may
have insights into solutions.
What's Better/Exception Questions – Therapists investigate for unique
outcomes or exceptions that point toward unrealized hopes, times the
problem was less intense, or instances when client values still shone
through.
Task Assignment – Therapists collaboratively agree upon small, very specific,
observable tasks or experiments for clients to undertake between sessions
that create positive feedback loops toward solutions.
End-of-Session Feedback –Therapists provide positive feedback at the end of
each session highlighting client strengths, coping, insights, and progress
noted - even if small - to amplify momentum for change.
Overall, SFBT aims to be a highly goal-oriented, collaborative process
between therapists utilizing skills of curiosity, positivity, and “not-knowing”
to draw out client strengths and solutions through strategic questioning and
feedback focused on building a preferred future.
Case Examples
To illustrate SFBT techniques in action, two case studies are reviewed. The
first involves depression in a university student (Bob). During the initial
session, when asked about his goals using the miracle question, Bob
reported hoping to feel more motivated, sleep better, and worry less. The
therapist scaled Bob's motivation at 4/10, and they discussed tasks like
exercising, calling friends, and giving himself positive self-talk to move the
scale up. At follow-up, Bob reported feeling more energized and hopeful,
scaling himself a 7/10.
A second case involved relationship issues for a couple (Mark and Sarah).
When asked about exceptions to their problems, they recalled times of
playfulness early in their relationship. The therapist assigned the task of
scheduling brief daily "fun times" together to cultivate exceptions. At follow-
up several weeks later, scaling their relationship at 5/10, Mark and Sarah
reported increased closeness, playfulness and hope for their future together.
Both cases illustrate SFBT techniques connecting positive client perceptions
to goals, scaling change, exploring exceptions, and assigning small
behavioral tasks that help systems naturally construct solutions in a
collaborative process. SFBT aims to catalyze momentum for client-driven
improvement through brief, strategic questioning focused on possibilities
rather than problems.
Research on SFBT Outcomes
Existing outcome research offers promising support for SFBT across diverse
applications and client demographics. A meta-analysis by Gingerich and
Peterson (2013) reviewed 29 randomized studies comparing SFBT to other
therapies across individual, couples, and family cases involving various
issues like depression, stress, relationship conflict, and somatic symptoms.
Across studies, SFBT performed as well as or better than alternate therapies
with an average effect size of 0.66 at termination and 0.50 at 6-month
follow-up. Improvements were found across symptomatic, relational, and
behavioral domains.
Kim (2008) conducted a meta-analysis of 19 studies specifically on SFBT for
depression. SFBT produced a large pre-to-post effect size of 1.24,
comparable to cognitive therapy (1.27) and significantly better than waitlist
control conditions. Improvements were maintained at follow-up. A Cochrane
review of 31 randomized trials reached similar conclusions, finding SFBT as
beneficial as other brief therapies for various conditions in the short and
long-term (Gingerich & Peterson, 2013).
Additional research gives further support to SFBT effectiveness. studies
found significantly greater reductions in stress, anxiety and PTSD symptoms
with SFBT versus alternative treatments (Tasca et al., 2016; Mortenson,
2016). Research also linked SFBT with lasting fostering care placement
successes, reduced somatic symptoms and cost-effectiveness in health care
applications (Zimmerman et al., 1995; Dolan, 1991; LaFountain & Garner,
1996). Recent research extends SFBT use to diverse populations including
teen mothers, incarcerated individuals, and chronic illness management
(Durrant, 2016; Lichtenstein et al., 2014; Vlaescu et al., 2016).
While most studies to date involve smaller samples or lack robust control
groups, the overall body of research provides good initial evidence that SFBT
substantially improves outcomes when properly applied. Continued rigorous
trials are still needed across varied populations and presenting issues to
further validate SFBT effectiveness. However, currently available data
supports SFBT as an efficacious brief treatment model producing notable
client benefits.
Implications and Conclusion
In conclusion, SFBT represents an alternative therapeutic model to traditional
pathology-focused approaches through its guiding theoretical framework
centered on collaboration, solutions, client strengths, and small, tangible
changes. Specific techniques aim to draw out client hopes and existing
resources to help construct personally meaningful goals. Outcome research
demonstrates SFBT leads to equivalent or superior outcomes compared to
alternative treatments across symptomatology, functioning, relationships
and long-term follow-up when applied properly in brief formats.
SFBT offers a promising approach across applications from mental health and
medical settings to community organizations, education settings and
beyond. Its aligns well with managed care needs through efficient treatment
durations. However, more stringent randomized trials across diverse
populations are still warranted to strengthen empirical support. Future
research also exploring therapist factors, implementation challenges and
theoretical mechanism is important.
Overall, SFBT presents a distinct, client-centered treatment model informed
by social constructionism that values personal agency, momentum, and
empowering clients through their own resources and strengths. When
collaboratively applied through strategic exceptions-focused questioning,
SFBT demonstrates potential as a viable option producing prompt client
benefit through brief problem resolution. Its theoretical underpinnings and
practical use offer a valuable perspective on effective therapeutic change.
Solution-focused brief therapy (SFBT) is a goal-directed therapeutic approach
focused on solutions rather than problems (De Shazer et al., 1986).
Developed in the late 1970s and early 1980s at the Brief Family Therapy
Center in Milwaukee, SFBT is a notable exception to traditional
psychotherapy models that view change as a gradual process. This paper will
explore the theoretical foundations of SFBT, including its core principles and
assumptions, as well as specific techniques employed in sessions. Practical
case examples will illustrate how SFBT is applied across client issues. The
empirical research evaluating SFBT will be reviewed. Overall, the aim is to
provide a comprehensive overview of SFBT as a distinct, goal-directed
therapeutic model centered on solutions and client strengths.
Theoretical Foundations
SFBT arose as an alternative to problem-focused, psychopathological models
of therapy. Its theoretical underpinnings stem from solutions-based
disciplines like anthropology, organizational development, cybernetics, and
communications theory (De Jong & Berg, 2013). Some defining principles
include:
- The “noticing of change” assumption – SFBT therapists make observations
of any positive change occurring between sessions (Bannink, 2007).
- Causality focuses on what clients want rather than pathology – the question
is not why problems exist but how solutions can be constructed (De Shazer,
1988).
- Small changes lead to larger transformations – solutions develop through
incremental progress rather than thorough problem analysis (Berg & Miller,
1992).
- Client strengths and expertise guide the process – therapists utilize a
stance of curiosity and collaborate with naturally occurring client resources
(De Jong & Berg, 1998).
- The future is hypothetical but not predetermined – open questions explore
client hopes rather than past problems (De Shazer, 1985).
- Exceptions indicate solutions are possible – therapists investigate times
when problems did not manifest to develop momentum for change (Berg &
De Shazer, 1993).
This shift from a traditional problem-focused medical model to an alternative
solutions orientation guided the development of SFBT techniques. Five core
assumptions form the philosophical underpinnings of the approach:
1) Symptoms are bounded by context rather than linear cause-effect
relationships.
2) Clients have resources and are not passive recipients of intervention.
3) Therapists should follow clients’ lead to cultivate motivation for change.
4) Small changes can lead to major transformations through positive
feedback processes.
5) Therapy should be brief, usually requiring fewer than five sessions.
Within this theoretical framework, SFBT aims to help clients realize their own
solutions through a positive, future-oriented collaborative process focused on
goals, strengths, and exception questions.
Specific Techniques
Specific SFBT techniques stem directly from the theoretical assumptions and
values discussed above. Among the notable techniques are:
Miracle Question – Therapists ask what would be different if overnight a
miracle occurred resolving the problem in their sleep without them being
aware. This helps identify client goals and values.
Scaling Questions – Therapists utilize numerical scaling (usually 1-10) to
track incremental progress through questions like "On a scale where 0 means
your problem is as bad as it can be and 10 means your goal is fully realized,
where are you now?” This concretizes change.
Complimenting – Therapists look for natural strengths, coping abilities,
insights, and specific positive behaviors exhibited by clients that can be built
upon for solutions.
Coping Questions – Similar to compliments, therapists investigate how
clients have dealt with difficulties already through asking about methods of
inner fortitude, support systems, past successful strategies, etc.
Relationship and Network Questions – Therapists explore external resources
that can reinforce changes like supportive people in the client's life who may
have insights into solutions.
What's Better/Exception Questions – Therapists investigate for unique
outcomes or exceptions that point toward unrealized hopes, times the
problem was less intense, or instances when client values still shone
through.
Task Assignment – Therapists collaboratively agree upon small, very specific,
observable tasks or experiments for clients to undertake between sessions
that create positive feedback loops toward solutions.
End-of-Session Feedback –Therapists provide positive feedback at the end of
each session highlighting client strengths, coping, insights, and progress
noted - even if small - to amplify momentum for change.
Overall, SFBT aims to be a highly goal-oriented, collaborative process
between therapists utilizing skills of curiosity, positivity, and “not-knowing”
to draw out client strengths and solutions through strategic questioning and
feedback focused on building a preferred future.
Case Examples
To illustrate SFBT techniques in action, two case studies are reviewed. The
first involves depression in a university student (Bob). During the initial
session, when asked about his goals using the miracle question, Bob
reported hoping to feel more motivated, sleep better, and worry less. The
therapist scaled Bob's motivation at 4/10, and they discussed tasks like
exercising, calling friends, and giving himself positive self-talk to move the
scale up. At follow-up, Bob reported feeling more energized and hopeful,
scaling himself a 7/10.
A second case involved relationship issues for a couple (Mark and Sarah).
When asked about exceptions to their problems, they recalled times of
playfulness early in their relationship. The therapist assigned the task of
scheduling brief daily "fun times" together to cultivate exceptions. At follow-
up several weeks later, scaling their relationship at 5/10, Mark and Sarah
reported increased closeness, playfulness and hope for their future together.
Both cases illustrate SFBT techniques connecting positive client perceptions
to goals, scaling change, exploring exceptions, and assigning small
behavioral tasks that help systems naturally construct solutions in a
collaborative process. SFBT aims to catalyze momentum for client-driven
improvement through brief, strategic questioning focused on possibilities
rather than problems.
Research on SFBT Outcomes
Existing outcome research offers promising support for SFBT across diverse
applications and client demographics. A meta-analysis by Gingerich and
Peterson (2013) reviewed 29 randomized studies comparing SFBT to other
therapies across individual, couples, and family cases involving various
issues like depression, stress, relationship conflict, and somatic symptoms.
Across studies, SFBT performed as well as or better than alternate therapies
with an average effect size of 0.66 at termination and 0.50 at 6-month
follow-up. Improvements were found across symptomatic, relational, and
behavioral domains.
Kim (2008) conducted a meta-analysis of 19 studies specifically on SFBT for
depression. SFBT produced a large pre-to-post effect size of 1.24,
comparable to cognitive therapy (1.27) and significantly better than waitlist
control conditions. Improvements were maintained at follow-up. A Cochrane
review of 31 randomized trials reached similar conclusions, finding SFBT as
beneficial as other brief therapies for various conditions in the short and
long-term (Gingerich & Peterson, 2013).
Additional research gives further support to SFBT effectiveness. studies
found significantly greater reductions in stress, anxiety and PTSD symptoms
with SFBT versus alternative treatments (Tasca et al., 2016; Mortenson,
2016). Research also linked SFBT with lasting fostering care placement
successes, reduced somatic symptoms and cost-effectiveness in health care
applications (Zimmerman et al., 1995; Dolan, 1991; LaFountain & Garner,
1996). Recent research extends SFBT use to diverse populations including
teen mothers, incarcerated individuals, and chronic illness management
(Durrant, 2016; Lichtenstein et al., 2014; Vlaescu et al., 2016).
While most studies to date involve smaller samples or lack robust control
groups, the overall body of research provides good initial evidence that SFBT
substantially improves outcomes when properly applied. Continued rigorous
trials are still needed across varied populations and presenting issues to
further validate SFBT effectiveness. However, currently available data
supports SFBT as an efficacious brief treatment model producing notable
client benefits.
Implications and Conclusion
In conclusion, SFBT represents an alternative therapeutic model to traditional
pathology-focused approaches through its guiding theoretical framework
centered on collaboration, solutions, client strengths, and small, tangible
changes. Specific techniques aim to draw out client hopes and existing
resources to help construct personally meaningful goals. Outcome research
demonstrates SFBT leads to equivalent or superior outcomes compared to
alternative treatments across symptomatology, functioning, relationships
and long-term follow-up when applied properly in brief formats.
SFBT offers a promising approach across applications from mental health and
medical settings to community organizations, education settings and
beyond. Its aligns well with managed care needs through efficient treatment
durations. However, more stringent randomized trials across diverse
populations are still warranted to strengthen empirical support. Future
research also exploring therapist factors, implementation challenges and
theoretical mechanism is important.
Overall, SFBT presents a distinct, client-centered treatment model informed
by social constructionism that values personal agency, momentum, and
empowering clients through their own resources and strengths. When
collaboratively applied through strategic exceptions-focused questioning,
SFBT demonstrates potential as a viable option producing prompt client
benefit through brief problem resolution. Its theoretical underpinnings and
practical use offer a valuable perspective on effective therapeutic change.
Solution-focused brief therapy (SFBT) is a goal-directed therapeutic approach
focused on solutions rather than problems (De Shazer et al., 1986).
Developed in the late 1970s and early 1980s at the Brief Family Therapy
Center in Milwaukee, SFBT is a notable exception to traditional
psychotherapy models that view change as a gradual process. This paper will
explore the theoretical foundations of SFBT, including its core principles and
assumptions, as well as specific techniques employed in sessions. Practical
case examples will illustrate how SFBT is applied across client issues. The
empirical research evaluating SFBT will be reviewed. Overall, the aim is to
provide a comprehensive overview of SFBT as a distinct, goal-directed
therapeutic model centered on solutions and client strengths.
Theoretical Foundations
SFBT arose as an alternative to problem-focused, psychopathological models
of therapy. Its theoretical underpinnings stem from solutions-based
disciplines like anthropology, organizational development, cybernetics, and
communications theory (De Jong & Berg, 2013). Some defining principles
include:
- The “noticing of change” assumption – SFBT therapists make observations
of any positive change occurring between sessions (Bannink, 2007).
- Causality focuses on what clients want rather than pathology – the question
is not why problems exist but how solutions can be constructed (De Shazer,
1988).
- Small changes lead to larger transformations – solutions develop through
incremental progress rather than thorough problem analysis (Berg & Miller,
1992).
- Client strengths and expertise guide the process – therapists utilize a
stance of curiosity and collaborate with naturally occurring client resources
(De Jong & Berg, 1998).
- The future is hypothetical but not predetermined – open questions explore
client hopes rather than past problems (De Shazer, 1985).
- Exceptions indicate solutions are possible – therapists investigate times
when problems did not manifest to develop momentum for change (Berg &
De Shazer, 1993).
This shift from a traditional problem-focused medical model to an alternative
solutions orientation guided the development of SFBT techniques. Five core
assumptions form the philosophical underpinnings of the approach:
1) Symptoms are bounded by context rather than linear cause-effect
relationships.
2) Clients have resources and are not passive recipients of intervention.
3) Therapists should follow clients’ lead to cultivate motivation for change.
4) Small changes can lead to major transformations through positive
feedback processes.
5) Therapy should be brief, usually requiring fewer than five sessions.
Within this theoretical framework, SFBT aims to help clients realize their own
solutions through a positive, future-oriented collaborative process focused on
goals, strengths, and exception questions.
Specific Techniques
Specific SFBT techniques stem directly from the theoretical assumptions and
values discussed above. Among the notable techniques are:
Miracle Question – Therapists ask what would be different if overnight a
miracle occurred resolving the problem in their sleep without them being
aware. This helps identify client goals and values.
Scaling Questions – Therapists utilize numerical scaling (usually 1-10) to
track incremental progress through questions like "On a scale where 0 means
your problem is as bad as it can be and 10 means your goal is fully realized,
where are you now?” This concretizes change.
Complimenting – Therapists look for natural strengths, coping abilities,
insights, and specific positive behaviors exhibited by clients that can be built
upon for solutions.
Coping Questions – Similar to compliments, therapists investigate how
clients have dealt with difficulties already through asking about methods of
inner fortitude, support systems, past successful strategies, etc.
Relationship and Network Questions – Therapists explore external resources
that can reinforce changes like supportive people in the client's life who may
have insights into solutions.
What's Better/Exception Questions – Therapists investigate for unique
outcomes or exceptions that point toward unrealized hopes, times the
problem was less intense, or instances when client values still shone
through.
Task Assignment – Therapists collaboratively agree upon small, very specific,
observable tasks or experiments for clients to undertake between sessions
that create positive feedback loops toward solutions.
End-of-Session Feedback –Therapists provide positive feedback at the end of
each session highlighting client strengths, coping, insights, and progress
noted - even if small - to amplify momentum for change.
Overall, SFBT aims to be a highly goal-oriented, collaborative process
between therapists utilizing skills of curiosity, positivity, and “not-knowing”
to draw out client strengths and solutions through strategic questioning and
feedback focused on building a preferred future.
Case Examples
To illustrate SFBT techniques in action, two case studies are reviewed. The
first involves depression in a university student (Bob). During the initial
session, when asked about his goals using the miracle question, Bob
reported hoping to feel more motivated, sleep better, and worry less. The
therapist scaled Bob's motivation at 4/10, and they discussed tasks like
exercising, calling friends, and giving himself positive self-talk to move the
scale up. At follow-up, Bob reported feeling more energized and hopeful,
scaling himself a 7/10.
A second case involved relationship issues for a couple (Mark and Sarah).
When asked about exceptions to their problems, they recalled times of
playfulness early in their relationship. The therapist assigned the task of
scheduling brief daily "fun times" together to cultivate exceptions. At follow-
up several weeks later, scaling their relationship at 5/10, Mark and Sarah
reported increased closeness, playfulness and hope for their future together.
Both cases illustrate SFBT techniques connecting positive client perceptions
to goals, scaling change, exploring exceptions, and assigning small
behavioral tasks that help systems naturally construct solutions in a
collaborative process. SFBT aims to catalyze momentum for client-driven
improvement through brief, strategic questioning focused on possibilities
rather than problems.
Research on SFBT Outcomes
Existing outcome research offers promising support for SFBT across diverse
applications and client demographics. A meta-analysis by Gingerich and
Peterson (2013) reviewed 29 randomized studies comparing SFBT to other
therapies across individual, couples, and family cases involving various
issues like depression, stress, relationship conflict, and somatic symptoms.
Across studies, SFBT performed as well as or better than alternate therapies
with an average effect size of 0.66 at termination and 0.50 at 6-month
follow-up. Improvements were found across symptomatic, relational, and
behavioral domains.
Kim (2008) conducted a meta-analysis of 19 studies specifically on SFBT for
depression. SFBT produced a large pre-to-post effect size of 1.24,
comparable to cognitive therapy (1.27) and significantly better than waitlist
control conditions. Improvements were maintained at follow-up. A Cochrane
review of 31 randomized trials reached similar conclusions, finding SFBT as
beneficial as other brief therapies for various conditions in the short and
long-term (Gingerich & Peterson, 2013).
Additional research gives further support to SFBT effectiveness. studies
found significantly greater reductions in stress, anxiety and PTSD symptoms
with SFBT versus alternative treatments (Tasca et al., 2016; Mortenson,
2016). Research also linked SFBT with lasting fostering care placement
successes, reduced somatic symptoms and cost-effectiveness in health care
applications (Zimmerman et al., 1995; Dolan, 1991; LaFountain & Garner,
1996). Recent research extends SFBT use to diverse populations including
teen mothers, incarcerated individuals, and chronic illness management
(Durrant, 2016; Lichtenstein et al., 2014; Vlaescu et al., 2016).
While most studies to date involve smaller samples or lack robust control
groups, the overall body of research provides good initial evidence that SFBT
substantially improves outcomes when properly applied. Continued rigorous
trials are still needed across varied populations and presenting issues to
further validate SFBT effectiveness. However, currently available data
supports SFBT as an efficacious brief treatment model producing notable
client benefits.
Implications and Conclusion
In conclusion, SFBT represents an alternative therapeutic model to traditional
pathology-focused approaches through its guiding theoretical framework
centered on collaboration, solutions, client strengths, and small, tangible
changes. Specific techniques aim to draw out client hopes and existing
resources to help construct personally meaningful goals. Outcome research
demonstrates SFBT leads to equivalent or superior outcomes compared to
alternative treatments across symptomatology, functioning, relationships
and long-term follow-up when applied properly in brief formats.
SFBT offers a promising approach across applications from mental health and
medical settings to community organizations, education settings and
beyond. Its aligns well with managed care needs through efficient treatment
durations. However, more stringent randomized trials across diverse
populations are still warranted to strengthen empirical support. Future
research also exploring therapist factors, implementation challenges and
theoretical mechanism is important.
Overall, SFBT presents a distinct, client-centered treatment model informed
by social constructionism that values personal agency, momentum, and
empowering clients through their own resources and strengths. When
collaboratively applied through strategic exceptions-focused questioning,
SFBT demonstrates potential as a viable option producing prompt client
benefit through brief problem resolution. Its theoretical underpinnings and
practical use offer a valuable perspective on effective therapeutic change.
Solution-focused brief therapy (SFBT) is a goal-directed therapeutic approach
focused on solutions rather than problems (De Shazer et al., 1986).
Developed in the late 1970s and early 1980s at the Brief Family Therapy
Center in Milwaukee, SFBT is a notable exception to traditional
psychotherapy models that view change as a gradual process. This paper will
explore the theoretical foundations of SFBT, including its core principles and
assumptions, as well as specific techniques employed in sessions. Practical
case examples will illustrate how SFBT is applied across client issues. The
empirical research evaluating SFBT will be reviewed. Overall, the aim is to
provide a comprehensive overview of SFBT as a distinct, goal-directed
therapeutic model centered on solutions and client strengths.
Theoretical Foundations
SFBT arose as an alternative to problem-focused, psychopathological models
of therapy. Its theoretical underpinnings stem from solutions-based
disciplines like anthropology, organizational development, cybernetics, and
communications theory (De Jong & Berg, 2013). Some defining principles
include:
- The “noticing of change” assumption – SFBT therapists make observations
of any positive change occurring between sessions (Bannink, 2007).
- Causality focuses on what clients want rather than pathology – the question
is not why problems exist but how solutions can be constructed (De Shazer,
1988).
- Small changes lead to larger transformations – solutions develop through
incremental progress rather than thorough problem analysis (Berg & Miller,
1992).
- Client strengths and expertise guide the process – therapists utilize a
stance of curiosity and collaborate with naturally occurring client resources
(De Jong & Berg, 1998).
- The future is hypothetical but not predetermined – open questions explore
client hopes rather than past problems (De Shazer, 1985).
- Exceptions indicate solutions are possible – therapists investigate times
when problems did not manifest to develop momentum for change (Berg &
De Shazer, 1993).
This shift from a traditional problem-focused medical model to an alternative
solutions orientation guided the development of SFBT techniques. Five core
assumptions form the philosophical underpinnings of the approach:
1) Symptoms are bounded by context rather than linear cause-effect
relationships.
2) Clients have resources and are not passive recipients of intervention.
3) Therapists should follow clients’ lead to cultivate motivation for change.
4) Small changes can lead to major transformations through positive
feedback processes.
5) Therapy should be brief, usually requiring fewer than five sessions.
Within this theoretical framework, SFBT aims to help clients realize their own
solutions through a positive, future-oriented collaborative process focused on
goals, strengths, and exception questions.
Specific Techniques
Specific SFBT techniques stem directly from the theoretical assumptions and
values discussed above. Among the notable techniques are:
Miracle Question – Therapists ask what would be different if overnight a
miracle occurred resolving the problem in their sleep without them being
aware. This helps identify client goals and values.
Scaling Questions – Therapists utilize numerical scaling (usually 1-10) to
track incremental progress through questions like "On a scale where 0 means
your problem is as bad as it can be and 10 means your goal is fully realized,
where are you now?” This concretizes change.
Complimenting – Therapists look for natural strengths, coping abilities,
insights, and specific positive behaviors exhibited by clients that can be built
upon for solutions.
Coping Questions – Similar to compliments, therapists investigate how
clients have dealt with difficulties already through asking about methods of
inner fortitude, support systems, past successful strategies, etc.
Relationship and Network Questions – Therapists explore external resources
that can reinforce changes like supportive people in the client's life who may
have insights into solutions.
What's Better/Exception Questions – Therapists investigate for unique
outcomes or exceptions that point toward unrealized hopes, times the
problem was less intense, or instances when client values still shone
through.
Task Assignment – Therapists collaboratively agree upon small, very specific,
observable tasks or experiments for clients to undertake between sessions
that create positive feedback loops toward solutions.
End-of-Session Feedback –Therapists provide positive feedback at the end of
each session highlighting client strengths, coping, insights, and progress
noted - even if small - to amplify momentum for change.
Overall, SFBT aims to be a highly goal-oriented, collaborative process
between therapists utilizing skills of curiosity, positivity, and “not-knowing”
to draw out client strengths and solutions through strategic questioning and
feedback focused on building a preferred future.
Case Examples
To illustrate SFBT techniques in action, two case studies are reviewed. The
first involves depression in a university student (Bob). During the initial
session, when asked about his goals using the miracle question, Bob
reported hoping to feel more motivated, sleep better, and worry less. The
therapist scaled Bob's motivation at 4/10, and they discussed tasks like
exercising, calling friends, and giving himself positive self-talk to move the
scale up. At follow-up, Bob reported feeling more energized and hopeful,
scaling himself a 7/10.
A second case involved relationship issues for a couple (Mark and Sarah).
When asked about exceptions to their problems, they recalled times of
playfulness early in their relationship. The therapist assigned the task of
scheduling brief daily "fun times" together to cultivate exceptions. At follow-
up several weeks later, scaling their relationship at 5/10, Mark and Sarah
reported increased closeness, playfulness and hope for their future together.
Both cases illustrate SFBT techniques connecting positive client perceptions
to goals, scaling change, exploring exceptions, and assigning small
behavioral tasks that help systems naturally construct solutions in a
collaborative process. SFBT aims to catalyze momentum for client-driven
improvement through brief, strategic questioning focused on possibilities
rather than problems.
Research on SFBT Outcomes
Existing outcome research offers promising support for SFBT across diverse
applications and client demographics. A meta-analysis by Gingerich and
Peterson (2013) reviewed 29 randomized studies comparing SFBT to other
therapies across individual, couples, and family cases involving various
issues like depression, stress, relationship conflict, and somatic symptoms.
Across studies, SFBT performed as well as or better than alternate therapies
with an average effect size of 0.66 at termination and 0.50 at 6-month
follow-up. Improvements were found across symptomatic, relational, and
behavioral domains.
Kim (2008) conducted a meta-analysis of 19 studies specifically on SFBT for
depression. SFBT produced a large pre-to-post effect size of 1.24,
comparable to cognitive therapy (1.27) and significantly better than waitlist
control conditions. Improvements were maintained at follow-up. A Cochrane
review of 31 randomized trials reached similar conclusions, finding SFBT as
beneficial as other brief therapies for various conditions in the short and
long-term (Gingerich & Peterson, 2013).
Additional research gives further support to SFBT effectiveness. studies
found significantly greater reductions in stress, anxiety and PTSD symptoms
with SFBT versus alternative treatments (Tasca et al., 2016; Mortenson,
2016). Research also linked SFBT with lasting fostering care placement
successes, reduced somatic symptoms and cost-effectiveness in health care
applications (Zimmerman et al., 1995; Dolan, 1991; LaFountain & Garner,
1996). Recent research extends SFBT use to diverse populations including
teen mothers, incarcerated individuals, and chronic illness management
(Durrant, 2016; Lichtenstein et al., 2014; Vlaescu et al., 2016).
While most studies to date involve smaller samples or lack robust control
groups, the overall body of research provides good initial evidence that SFBT
substantially improves outcomes when properly applied. Continued rigorous
trials are still needed across varied populations and presenting issues to
further validate SFBT effectiveness. However, currently available data
supports SFBT as an efficacious brief treatment model producing notable
client benefits.
Implications and Conclusion
In conclusion, SFBT represents an alternative therapeutic model to traditional
pathology-focused approaches through its guiding theoretical framework
centered on collaboration, solutions, client strengths, and small, tangible
changes. Specific techniques aim to draw out client hopes and existing
resources to help construct personally meaningful goals. Outcome research
demonstrates SFBT leads to equivalent or superior outcomes compared to
alternative treatments across symptomatology, functioning, relationships
and long-term follow-up when applied properly in brief formats.
SFBT offers a promising approach across applications from mental health and
medical settings to community organizations, education settings and
beyond. Its aligns well with managed care needs through efficient treatment
durations. However, more stringent randomized trials across diverse
populations are still warranted to strengthen empirical support. Future
research also exploring therapist factors, implementation challenges and
theoretical mechanism is important.
Overall, SFBT presents a distinct, client-centered treatment model informed
by social constructionism that values personal agency, momentum, and
empowering clients through their own resources and strengths. When
collaboratively applied through strategic exceptions-focused questioning,
SFBT demonstrates potential as a viable option producing prompt client
benefit through brief problem resolution. Its theoretical underpinnings and
practical use offer a valuable perspective on effective therapeutic change.
Solution-focused brief therapy (SFBT) is a goal-directed therapeutic approach
focused on solutions rather than problems (De Shazer et al., 1986).
Developed in the late 1970s and early 1980s at the Brief Family Therapy
Center in Milwaukee, SFBT is a notable exception to traditional
psychotherapy models that view change as a gradual process. This paper will
explore the theoretical foundations of SFBT, including its core principles and
assumptions, as well as specific techniques employed in sessions. Practical
case examples will illustrate how SFBT is applied across client issues. The
empirical research evaluating SFBT will be reviewed. Overall, the aim is to
provide a comprehensive overview of SFBT as a distinct, goal-directed
therapeutic model centered on solutions and client strengths.
Theoretical Foundations
SFBT arose as an alternative to problem-focused, psychopathological models
of therapy. Its theoretical underpinnings stem from solutions-based
disciplines like anthropology, organizational development, cybernetics, and
communications theory (De Jong & Berg, 2013). Some defining principles
include:
- The “noticing of change” assumption – SFBT therapists make observations
of any positive change occurring between sessions (Bannink, 2007).
- Causality focuses on what clients want rather than pathology – the question
is not why problems exist but how solutions can be constructed (De Shazer,
1988).
- Small changes lead to larger transformations – solutions develop through
incremental progress rather than thorough problem analysis (Berg & Miller,
1992).
- Client strengths and expertise guide the process – therapists utilize a
stance of curiosity and collaborate with naturally occurring client resources
(De Jong & Berg, 1998).
- The future is hypothetical but not predetermined – open questions explore
client hopes rather than past problems (De Shazer, 1985).
- Exceptions indicate solutions are possible – therapists investigate times
when problems did not manifest to develop momentum for change (Berg &
De Shazer, 1993).
This shift from a traditional problem-focused medical model to an alternative
solutions orientation guided the development of SFBT techniques. Five core
assumptions form the philosophical underpinnings of the approach:
1) Symptoms are bounded by context rather than linear cause-effect
relationships.
2) Clients have resources and are not passive recipients of intervention.
3) Therapists should follow clients’ lead to cultivate motivation for change.
4) Small changes can lead to major transformations through positive
feedback processes.
5) Therapy should be brief, usually requiring fewer than five sessions.
Within this theoretical framework, SFBT aims to help clients realize their own
solutions through a positive, future-oriented collaborative process focused on
goals, strengths, and exception questions.
Specific Techniques
Specific SFBT techniques stem directly from the theoretical assumptions and
values discussed above. Among the notable techniques are:
Miracle Question – Therapists ask what would be different if overnight a
miracle occurred resolving the problem in their sleep without them being
aware. This helps identify client goals and values.
Scaling Questions – Therapists utilize numerical scaling (usually 1-10) to
track incremental progress through questions like "On a scale where 0 means
your problem is as bad as it can be and 10 means your goal is fully realized,
where are you now?” This concretizes change.
Complimenting – Therapists look for natural strengths, coping abilities,
insights, and specific positive behaviors exhibited by clients that can be built
upon for solutions.
Coping Questions – Similar to compliments, therapists investigate how
clients have dealt with difficulties already through asking about methods of
inner fortitude, support systems, past successful strategies, etc.
Relationship and Network Questions – Therapists explore external resources
that can reinforce changes like supportive people in the client's life who may
have insights into solutions.
What's Better/Exception Questions – Therapists investigate for unique
outcomes or exceptions that point toward unrealized hopes, times the
problem was less intense, or instances when client values still shone
through.
Task Assignment – Therapists collaboratively agree upon small, very specific,
observable tasks or experiments for clients to undertake between sessions
that create positive feedback loops toward solutions.
End-of-Session Feedback –Therapists provide positive feedback at the end of
each session highlighting client strengths, coping, insights, and progress
noted - even if small - to amplify momentum for change.
Overall, SFBT aims to be a highly goal-oriented, collaborative process
between therapists utilizing skills of curiosity, positivity, and “not-knowing”
to draw out client strengths and solutions through strategic questioning and
feedback focused on building a preferred future.
Case Examples
To illustrate SFBT techniques in action, two case studies are reviewed. The
first involves depression in a university student (Bob). During the initial
session, when asked about his goals using the miracle question, Bob
reported hoping to feel more motivated, sleep better, and worry less. The
therapist scaled Bob's motivation at 4/10, and they discussed tasks like
exercising, calling friends, and giving himself positive self-talk to move the
scale up. At follow-up, Bob reported feeling more energized and hopeful,
scaling himself a 7/10.
A second case involved relationship issues for a couple (Mark and Sarah).
When asked about exceptions to their problems, they recalled times of
playfulness early in their relationship. The therapist assigned the task of
scheduling brief daily "fun times" together to cultivate exceptions. At follow-
up several weeks later, scaling their relationship at 5/10, Mark and Sarah
reported increased closeness, playfulness and hope for their future together.
Both cases illustrate SFBT techniques connecting positive client perceptions
to goals, scaling change, exploring exceptions, and assigning small
behavioral tasks that help systems naturally construct solutions in a
collaborative process. SFBT aims to catalyze momentum for client-driven
improvement through brief, strategic questioning focused on possibilities
rather than problems.
Research on SFBT Outcomes
Existing outcome research offers promising support for SFBT across diverse
applications and client demographics. A meta-analysis by Gingerich and
Peterson (2013) reviewed 29 randomized studies comparing SFBT to other
therapies across individual, couples, and family cases involving various
issues like depression, stress, relationship conflict, and somatic symptoms.
Across studies, SFBT performed as well as or better than alternate therapies
with an average effect size of 0.66 at termination and 0.50 at 6-month
follow-up. Improvements were found across symptomatic, relational, and
behavioral domains.
Kim (2008) conducted a meta-analysis of 19 studies specifically on SFBT for
depression. SFBT produced a large pre-to-post effect size of 1.24,
comparable to cognitive therapy (1.27) and significantly better than waitlist
control conditions. Improvements were maintained at follow-up. A Cochrane
review of 31 randomized trials reached similar conclusions, finding SFBT as
beneficial as other brief therapies for various conditions in the short and
long-term (Gingerich & Peterson, 2013).
Additional research gives further support to SFBT effectiveness. studies
found significantly greater reductions in stress, anxiety and PTSD symptoms
with SFBT versus alternative treatments (Tasca et al., 2016; Mortenson,
2016). Research also linked SFBT with lasting fostering care placement
successes, reduced somatic symptoms and cost-effectiveness in health care
applications (Zimmerman et al., 1995; Dolan, 1991; LaFountain & Garner,
1996). Recent research extends SFBT use to diverse populations including
teen mothers, incarcerated individuals, and chronic illness management
(Durrant, 2016; Lichtenstein et al., 2014; Vlaescu et al., 2016).
While most studies to date involve smaller samples or lack robust control
groups, the overall body of research provides good initial evidence that SFBT
substantially improves outcomes when properly applied. Continued rigorous
trials are still needed across varied populations and presenting issues to
further validate SFBT effectiveness. However, currently available data
supports SFBT as an efficacious brief treatment model producing notable
client benefits.
Implications and Conclusion
In conclusion, SFBT represents an alternative therapeutic model to traditional
pathology-focused approaches through its guiding theoretical framework
centered on collaboration, solutions, client strengths, and small, tangible
changes. Specific techniques aim to draw out client hopes and existing
resources to help construct personally meaningful goals. Outcome research
demonstrates SFBT leads to equivalent or superior outcomes compared to
alternative treatments across symptomatology, functioning, relationships
and long-term follow-up when applied properly in brief formats.
SFBT offers a promising approach across applications from mental health and
medical settings to community organizations, education settings and
beyond. Its aligns well with managed care needs through efficient treatment
durations. However, more stringent randomized trials across diverse
populations are still warranted to strengthen empirical support. Future
research also exploring therapist factors, implementation challenges and
theoretical mechanism is important.
Overall, SFBT presents a distinct, client-centered treatment model informed
by social constructionism that values personal agency, momentum, and
empowering clients through their own resources and strengths. When
collaboratively applied through strategic exceptions-focused questioning,
SFBT demonstrates potential as a viable option producing prompt client
benefit through brief problem resolution. Its theoretical underpinnings and
practical use offer a valuable perspective on effective therapeutic change.
Solution-focused brief therapy (SFBT) is a goal-directed therapeutic approach
focused on solutions rather than problems (De Shazer et al., 1986).
Developed in the late 1970s and early 1980s at the Brief Family Therapy
Center in Milwaukee, SFBT is a notable exception to traditional
psychotherapy models that view change as a gradual process. This paper will
explore the theoretical foundations of SFBT, including its core principles and
assumptions, as well as specific techniques employed in sessions. Practical
case examples will illustrate how SFBT is applied across client issues. The
empirical research evaluating SFBT will be reviewed. Overall, the aim is to
provide a comprehensive overview of SFBT as a distinct, goal-directed
therapeutic model centered on solutions and client strengths.
Theoretical Foundations
SFBT arose as an alternative to problem-focused, psychopathological models
of therapy. Its theoretical underpinnings stem from solutions-based
disciplines like anthropology, organizational development, cybernetics, and
communications theory (De Jong & Berg, 2013). Some defining principles
include:
- The “noticing of change” assumption – SFBT therapists make observations
of any positive change occurring between sessions (Bannink, 2007).
- Causality focuses on what clients want rather than pathology – the question
is not why problems exist but how solutions can be constructed (De Shazer,
1988).
- Small changes lead to larger transformations – solutions develop through
incremental progress rather than thorough problem analysis (Berg & Miller,
1992).
- Client strengths and expertise guide the process – therapists utilize a
stance of curiosity and collaborate with naturally occurring client resources
(De Jong & Berg, 1998).
- The future is hypothetical but not predetermined – open questions explore
client hopes rather than past problems (De Shazer, 1985).
- Exceptions indicate solutions are possible – therapists investigate times
when problems did not manifest to develop momentum for change (Berg &
De Shazer, 1993).
This shift from a traditional problem-focused medical model to an alternative
solutions orientation guided the development of SFBT techniques. Five core
assumptions form the philosophical underpinnings of the approach:
1) Symptoms are bounded by context rather than linear cause-effect
relationships.
2) Clients have resources and are not passive recipients of intervention.
3) Therapists should follow clients’ lead to cultivate motivation for change.
4) Small changes can lead to major transformations through positive
feedback processes.
5) Therapy should be brief, usually requiring fewer than five sessions.
Within this theoretical framework, SFBT aims to help clients realize their own
solutions through a positive, future-oriented collaborative process focused on
goals, strengths, and exception questions.
Specific Techniques
Specific SFBT techniques stem directly from the theoretical assumptions and
values discussed above. Among the notable techniques are:
Miracle Question – Therapists ask what would be different if overnight a
miracle occurred resolving the problem in their sleep without them being
aware. This helps identify client goals and values.
Scaling Questions – Therapists utilize numerical scaling (usually 1-10) to
track incremental progress through questions like "On a scale where 0 means
your problem is as bad as it can be and 10 means your goal is fully realized,
where are you now?” This concretizes change.
Complimenting – Therapists look for natural strengths, coping abilities,
insights, and specific positive behaviors exhibited by clients that can be built
upon for solutions.
Coping Questions – Similar to compliments, therapists investigate how
clients have dealt with difficulties already through asking about methods of
inner fortitude, support systems, past successful strategies, etc.
Relationship and Network Questions – Therapists explore external resources
that can reinforce changes like supportive people in the client's life who may
have insights into solutions.
What's Better/Exception Questions – Therapists investigate for unique
outcomes or exceptions that point toward unrealized hopes, times the
problem was less intense, or instances when client values still shone
through.
Task Assignment – Therapists collaboratively agree upon small, very specific,
observable tasks or experiments for clients to undertake between sessions
that create positive feedback loops toward solutions.
End-of-Session Feedback –Therapists provide positive feedback at the end of
each session highlighting client strengths, coping, insights, and progress
noted - even if small - to amplify momentum for change.
Overall, SFBT aims to be a highly goal-oriented, collaborative process
between therapists utilizing skills of curiosity, positivity, and “not-knowing”
to draw out client strengths and solutions through strategic questioning and
feedback focused on building a preferred future.
Case Examples
To illustrate SFBT techniques in action, two case studies are reviewed. The
first involves depression in a university student (Bob). During the initial
session, when asked about his goals using the miracle question, Bob
reported hoping to feel more motivated, sleep better, and worry less. The
therapist scaled Bob's motivation at 4/10, and they discussed tasks like
exercising, calling friends, and giving himself positive self-talk to move the
scale up. At follow-up, Bob reported feeling more energized and hopeful,
scaling himself a 7/10.
A second case involved relationship issues for a couple (Mark and Sarah).
When asked about exceptions to their problems, they recalled times of
playfulness early in their relationship. The therapist assigned the task of
scheduling brief daily "fun times" together to cultivate exceptions. At follow-
up several weeks later, scaling their relationship at 5/10, Mark and Sarah
reported increased closeness, playfulness and hope for their future together.
Both cases illustrate SFBT techniques connecting positive client perceptions
to goals, scaling change, exploring exceptions, and assigning small
behavioral tasks that help systems naturally construct solutions in a
collaborative process. SFBT aims to catalyze momentum for client-driven
improvement through brief, strategic questioning focused on possibilities
rather than problems.
Research on SFBT Outcomes
Existing outcome research offers promising support for SFBT across diverse
applications and client demographics. A meta-analysis by Gingerich and
Peterson (2013) reviewed 29 randomized studies comparing SFBT to other
therapies across individual, couples, and family cases involving various
issues like depression, stress, relationship conflict, and somatic symptoms.
Across studies, SFBT performed as well as or better than alternate therapies
with an average effect size of 0.66 at termination and 0.50 at 6-month
follow-up. Improvements were found across symptomatic, relational, and
behavioral domains.
Kim (2008) conducted a meta-analysis of 19 studies specifically on SFBT for
depression. SFBT produced a large pre-to-post effect size of 1.24,
comparable to cognitive therapy (1.27) and significantly better than waitlist
control conditions. Improvements were maintained at follow-up. A Cochrane
review of 31 randomized trials reached similar conclusions, finding SFBT as
beneficial as other brief therapies for various conditions in the short and
long-term (Gingerich & Peterson, 2013).
Additional research gives further support to SFBT effectiveness. studies
found significantly greater reductions in stress, anxiety and PTSD symptoms
with SFBT versus alternative treatments (Tasca et al., 2016; Mortenson,
2016). Research also linked SFBT with lasting fostering care placement
successes, reduced somatic symptoms and cost-effectiveness in health care
applications (Zimmerman et al., 1995; Dolan, 1991; LaFountain & Garner,
1996). Recent research extends SFBT use to diverse populations including
teen mothers, incarcerated individuals, and chronic illness management
(Durrant, 2016; Lichtenstein et al., 2014; Vlaescu et al., 2016).
While most studies to date involve smaller samples or lack robust control
groups, the overall body of research provides good initial evidence that SFBT
substantially improves outcomes when properly applied. Continued rigorous
trials are still needed across varied populations and presenting issues to
further validate SFBT effectiveness. However, currently available data
supports SFBT as an efficacious brief treatment model producing notable
client benefits.
Implications and Conclusion
In conclusion, SFBT represents an alternative therapeutic model to traditional
pathology-focused approaches through its guiding theoretical framework
centered on collaboration, solutions, client strengths, and small, tangible
changes. Specific techniques aim to draw out client hopes and existing
resources to help construct personally meaningful goals. Outcome research
demonstrates SFBT leads to equivalent or superior outcomes compared to
alternative treatments across symptomatology, functioning, relationships
and long-term follow-up when applied properly in brief formats.
SFBT offers a promising approach across applications from mental health and
medical settings to community organizations, education settings and
beyond. Its aligns well with managed care needs through efficient treatment
durations. However, more stringent randomized trials across diverse
populations are still warranted to strengthen empirical support. Future
research also exploring therapist factors, implementation challenges and
theoretical mechanism is important.
Overall, SFBT presents a distinct, client-centered treatment model informed
by social constructionism that values personal agency, momentum, and
empowering clients through their own resources and strengths. When
collaboratively applied through strategic exceptions-focused questioning,
SFBT demonstrates potential as a viable option producing prompt client
benefit through brief problem resolution. Its theoretical underpinnings and
practical use offer a valuable perspective on effective therapeutic change.
Solution-focused brief therapy (SFBT) is a goal-directed therapeutic approach
focused on solutions rather than problems (De Shazer et al., 1986).
Developed in the late 1970s and early 1980s at the Brief Family Therapy
Center in Milwaukee, SFBT is a notable exception to traditional
psychotherapy models that view change as a gradual process. This paper will
explore the theoretical foundations of SFBT, including its core principles and
assumptions, as well as specific techniques employed in sessions. Practical
case examples will illustrate how SFBT is applied across client issues. The
empirical research evaluating SFBT will be reviewed. Overall, the aim is to
provide a comprehensive overview of SFBT as a distinct, goal-directed
therapeutic model centered on solutions and client strengths.
Theoretical Foundations
SFBT arose as an alternative to problem-focused, psychopathological models
of therapy. Its theoretical underpinnings stem from solutions-based
disciplines like anthropology, organizational development, cybernetics, and
communications theory (De Jong & Berg, 2013). Some defining principles
include:
- The “noticing of change” assumption – SFBT therapists make observations
of any positive change occurring between sessions (Bannink, 2007).
- Causality focuses on what clients want rather than pathology – the question
is not why problems exist but how solutions can be constructed (De Shazer,
1988).
- Small changes lead to larger transformations – solutions develop through
incremental progress rather than thorough problem analysis (Berg & Miller,
1992).
- Client strengths and expertise guide the process – therapists utilize a
stance of curiosity and collaborate with naturally occurring client resources
(De Jong & Berg, 1998).
- The future is hypothetical but not predetermined – open questions explore
client hopes rather than past problems (De Shazer, 1985).
- Exceptions indicate solutions are possible – therapists investigate times
when problems did not manifest to develop momentum for change (Berg &
De Shazer, 1993).
This shift from a traditional problem-focused medical model to an alternative
solutions orientation guided the development of SFBT techniques. Five core
assumptions form the philosophical underpinnings of the approach:
1) Symptoms are bounded by context rather than linear cause-effect
relationships.
2) Clients have resources and are not passive recipients of intervention.
3) Therapists should follow clients’ lead to cultivate motivation for change.
4) Small changes can lead to major transformations through positive
feedback processes.
5) Therapy should be brief, usually requiring fewer than five sessions.
Within this theoretical framework, SFBT aims to help clients realize their own
solutions through a positive, future-oriented collaborative process focused on
goals, strengths, and exception questions.
Specific Techniques
Specific SFBT techniques stem directly from the theoretical assumptions and
values discussed above. Among the notable techniques are:
Miracle Question – Therapists ask what would be different if overnight a
miracle occurred resolving the problem in their sleep without them being
aware. This helps identify client goals and values.
Scaling Questions – Therapists utilize numerical scaling (usually 1-10) to
track incremental progress through questions like "On a scale where 0 means
your problem is as bad as it can be and 10 means your goal is fully realized,
where are you now?” This concretizes change.
Complimenting – Therapists look for natural strengths, coping abilities,
insights, and specific positive behaviors exhibited by clients that can be built
upon for solutions.
Coping Questions – Similar to compliments, therapists investigate how
clients have dealt with difficulties already through asking about methods of
inner fortitude, support systems, past successful strategies, etc.
Relationship and Network Questions – Therapists explore external resources
that can reinforce changes like supportive people in the client's life who may
have insights into solutions.
What's Better/Exception Questions – Therapists investigate for unique
outcomes or exceptions that point toward unrealized hopes, times the
problem was less intense, or instances when client values still shone
through.
Task Assignment – Therapists collaboratively agree upon small, very specific,
observable tasks or experiments for clients to undertake between sessions
that create positive feedback loops toward solutions.
End-of-Session Feedback –Therapists provide positive feedback at the end of
each session highlighting client strengths, coping, insights, and progress
noted - even if small - to amplify momentum for change.
Overall, SFBT aims to be a highly goal-oriented, collaborative process
between therapists utilizing skills of curiosity, positivity, and “not-knowing”
to draw out client strengths and solutions through strategic questioning and
feedback focused on building a preferred future.
Case Examples
To illustrate SFBT techniques in action, two case studies are reviewed. The
first involves depression in a university student (Bob). During the initial
session, when asked about his goals using the miracle question, Bob
reported hoping to feel more motivated, sleep better, and worry less. The
therapist scaled Bob's motivation at 4/10, and they discussed tasks like
exercising, calling friends, and giving himself positive self-talk to move the
scale up. At follow-up, Bob reported feeling more energized and hopeful,
scaling himself a 7/10.
A second case involved relationship issues for a couple (Mark and Sarah).
When asked about exceptions to their problems, they recalled times of
playfulness early in their relationship. The therapist assigned the task of
scheduling brief daily "fun times" together to cultivate exceptions. At follow-
up several weeks later, scaling their relationship at 5/10, Mark and Sarah
reported increased closeness, playfulness and hope for their future together.
Both cases illustrate SFBT techniques connecting positive client perceptions
to goals, scaling change, exploring exceptions, and assigning small
behavioral tasks that help systems naturally construct solutions in a
collaborative process. SFBT aims to catalyze momentum for client-driven
improvement through brief, strategic questioning focused on possibilities
rather than problems.
Research on SFBT Outcomes
Existing outcome research offers promising support for SFBT across diverse
applications and client demographics. A meta-analysis by Gingerich and
Peterson (2013) reviewed 29 randomized studies comparing SFBT to other
therapies across individual, couples, and family cases involving various
issues like depression, stress, relationship conflict, and somatic symptoms.
Across studies, SFBT performed as well as or better than alternate therapies
with an average effect size of 0.66 at termination and 0.50 at 6-month
follow-up. Improvements were found across symptomatic, relational, and
behavioral domains.
Kim (2008) conducted a meta-analysis of 19 studies specifically on SFBT for
depression. SFBT produced a large pre-to-post effect size of 1.24,
comparable to cognitive therapy (1.27) and significantly better than waitlist
control conditions. Improvements were maintained at follow-up. A Cochrane
review of 31 randomized trials reached similar conclusions, finding SFBT as
beneficial as other brief therapies for various conditions in the short and
long-term (Gingerich & Peterson, 2013).
Additional research gives further support to SFBT effectiveness. studies
found significantly greater reductions in stress, anxiety and PTSD symptoms
with SFBT versus alternative treatments (Tasca et al., 2016; Mortenson,
2016). Research also linked SFBT with lasting fostering care placement
successes, reduced somatic symptoms and cost-effectiveness in health care
applications (Zimmerman et al., 1995; Dolan, 1991; LaFountain & Garner,
1996). Recent research extends SFBT use to diverse populations including
teen mothers, incarcerated individuals, and chronic illness management
(Durrant, 2016; Lichtenstein et al., 2014; Vlaescu et al., 2016).
While most studies to date involve smaller samples or lack robust control
groups, the overall body of research provides good initial evidence that SFBT
substantially improves outcomes when properly applied. Continued rigorous
trials are still needed across varied populations and presenting issues to
further validate SFBT effectiveness. However, currently available data
supports SFBT as an efficacious brief treatment model producing notable
client benefits.
Implications and Conclusion
In conclusion, SFBT represents an alternative therapeutic model to traditional
pathology-focused approaches through its guiding theoretical framework
centered on collaboration, solutions, client strengths, and small, tangible
changes. Specific techniques aim to draw out client hopes and existing
resources to help construct personally meaningful goals. Outcome research
demonstrates SFBT leads to equivalent or superior outcomes compared to
alternative treatments across symptomatology, functioning, relationships
and long-term follow-up when applied properly in brief formats.
SFBT offers a promising approach across applications from mental health and
medical settings to community organizations, education settings and
beyond. Its aligns well with managed care needs through efficient treatment
durations. However, more stringent randomized trials across diverse
populations are still warranted to strengthen empirical support. Future
research also exploring therapist factors, implementation challenges and
theoretical mechanism is important.
Overall, SFBT presents a distinct, client-centered treatment model informed
by social constructionism that values personal agency, momentum, and
empowering clients through their own resources and strengths. When
collaboratively applied through strategic exceptions-focused questioning,
SFBT demonstrates potential as a viable option producing prompt client
benefit through brief problem resolution. Its theoretical underpinnings and
practical use offer a valuable perspective on effective therapeutic change.
Solution-focused brief therapy (SFBT) is a goal-directed therapeutic approach
focused on solutions rather than problems (De Shazer et al., 1986).
Developed in the late 1970s and early 1980s at the Brief Family Therapy
Center in Milwaukee, SFBT is a notable exception to traditional
psychotherapy models that view change as a gradual process. This paper will
explore the theoretical foundations of SFBT, including its core principles and
assumptions, as well as specific techniques employed in sessions. Practical
case examples will illustrate how SFBT is applied across client issues. The
empirical research evaluating SFBT will be reviewed. Overall, the aim is to
provide a comprehensive overview of SFBT as a distinct, goal-directed
therapeutic model centered on solutions and client strengths.
Theoretical Foundations
SFBT arose as an alternative to problem-focused, psychopathological models
of therapy. Its theoretical underpinnings stem from solutions-based
disciplines like anthropology, organizational development, cybernetics, and
communications theory (De Jong & Berg, 2013). Some defining principles
include:
- The “noticing of change” assumption – SFBT therapists make observations
of any positive change occurring between sessions (Bannink, 2007).
- Causality focuses on what clients want rather than pathology – the question
is not why problems exist but how solutions can be constructed (De Shazer,
1988).
- Small changes lead to larger transformations – solutions develop through
incremental progress rather than thorough problem analysis (Berg & Miller,
1992).
- Client strengths and expertise guide the process – therapists utilize a
stance of curiosity and collaborate with naturally occurring client resources
(De Jong & Berg, 1998).
- The future is hypothetical but not predetermined – open questions explore
client hopes rather than past problems (De Shazer, 1985).
- Exceptions indicate solutions are possible – therapists investigate times
when problems did not manifest to develop momentum for change (Berg &
De Shazer, 1993).
This shift from a traditional problem-focused medical model to an alternative
solutions orientation guided the development of SFBT techniques. Five core
assumptions form the philosophical underpinnings of the approach:
1) Symptoms are bounded by context rather than linear cause-effect
relationships.
2) Clients have resources and are not passive recipients of intervention.
3) Therapists should follow clients’ lead to cultivate motivation for change.
4) Small changes can lead to major transformations through positive
feedback processes.
5) Therapy should be brief, usually requiring fewer than five sessions.
Within this theoretical framework, SFBT aims to help clients realize their own
solutions through a positive, future-oriented collaborative process focused on
goals, strengths, and exception questions.
Specific Techniques
Specific SFBT techniques stem directly from the theoretical assumptions and
values discussed above. Among the notable techniques are:
Miracle Question – Therapists ask what would be different if overnight a
miracle occurred resolving the problem in their sleep without them being
aware. This helps identify client goals and values.
Scaling Questions – Therapists utilize numerical scaling (usually 1-10) to
track incremental progress through questions like "On a scale where 0 means
your problem is as bad as it can be and 10 means your goal is fully realized,
where are you now?” This concretizes change.
Complimenting – Therapists look for natural strengths, coping abilities,
insights, and specific positive behaviors exhibited by clients that can be built
upon for solutions.
Coping Questions – Similar to compliments, therapists investigate how
clients have dealt with difficulties already through asking about methods of
inner fortitude, support systems, past successful strategies, etc.
Relationship and Network Questions – Therapists explore external resources
that can reinforce changes like supportive people in the client's life who may
have insights into solutions.
What's Better/Exception Questions – Therapists investigate for unique
outcomes or exceptions that point toward unrealized hopes, times the
problem was less intense, or instances when client values still shone
through.
Task Assignment – Therapists collaboratively agree upon small, very specific,
observable tasks or experiments for clients to undertake between sessions
that create positive feedback loops toward solutions.
End-of-Session Feedback –Therapists provide positive feedback at the end of
each session highlighting client strengths, coping, insights, and progress
noted - even if small - to amplify momentum for change.
Overall, SFBT aims to be a highly goal-oriented, collaborative process
between therapists utilizing skills of curiosity, positivity, and “not-knowing”
to draw out client strengths and solutions through strategic questioning and
feedback focused on building a preferred future.
Case Examples
To illustrate SFBT techniques in action, two case studies are reviewed. The
first involves depression in a university student (Bob). During the initial
session, when asked about his goals using the miracle question, Bob
reported hoping to feel more motivated, sleep better, and worry less. The
therapist scaled Bob's motivation at 4/10, and they discussed tasks like
exercising, calling friends, and giving himself positive self-talk to move the
scale up. At follow-up, Bob reported feeling more energized and hopeful,
scaling himself a 7/10.
A second case involved relationship issues for a couple (Mark and Sarah).
When asked about exceptions to their problems, they recalled times of
playfulness early in their relationship. The therapist assigned the task of
scheduling brief daily "fun times" together to cultivate exceptions. At follow-
up several weeks later, scaling their relationship at 5/10, Mark and Sarah
reported increased closeness, playfulness and hope for their future together.
Both cases illustrate SFBT techniques connecting positive client perceptions
to goals, scaling change, exploring exceptions, and assigning small
behavioral tasks that help systems naturally construct solutions in a
collaborative process. SFBT aims to catalyze momentum for client-driven
improvement through brief, strategic questioning focused on possibilities
rather than problems.
Research on SFBT Outcomes
Existing outcome research offers promising support for SFBT across diverse
applications and client demographics. A meta-analysis by Gingerich and
Peterson (2013) reviewed 29 randomized studies comparing SFBT to other
therapies across individual, couples, and family cases involving various
issues like depression, stress, relationship conflict, and somatic symptoms.
Across studies, SFBT performed as well as or better than alternate therapies
with an average effect size of 0.66 at termination and 0.50 at 6-month
follow-up. Improvements were found across symptomatic, relational, and
behavioral domains.
Kim (2008) conducted a meta-analysis of 19 studies specifically on SFBT for
depression. SFBT produced a large pre-to-post effect size of 1.24,
comparable to cognitive therapy (1.27) and significantly better than waitlist
control conditions. Improvements were maintained at follow-up. A Cochrane
review of 31 randomized trials reached similar conclusions, finding SFBT as
beneficial as other brief therapies for various conditions in the short and
long-term (Gingerich & Peterson, 2013).
Additional research gives further support to SFBT effectiveness. studies
found significantly greater reductions in stress, anxiety and PTSD symptoms
with SFBT versus alternative treatments (Tasca et al., 2016; Mortenson,
2016). Research also linked SFBT with lasting fostering care placement
successes, reduced somatic symptoms and cost-effectiveness in health care
applications (Zimmerman et al., 1995; Dolan, 1991; LaFountain & Garner,
1996). Recent research extends SFBT use to diverse populations including
teen mothers, incarcerated individuals, and chronic illness management
(Durrant, 2016; Lichtenstein et al., 2014; Vlaescu et al., 2016).
While most studies to date involve smaller samples or lack robust control
groups, the overall body of research provides good initial evidence that SFBT
substantially improves outcomes when properly applied. Continued rigorous
trials are still needed across varied populations and presenting issues to
further validate SFBT effectiveness. However, currently available data
supports SFBT as an efficacious brief treatment model producing notable
client benefits.
Implications and Conclusion
In conclusion, SFBT represents an alternative therapeutic model to traditional
pathology-focused approaches through its guiding theoretical framework
centered on collaboration, solutions, client strengths, and small, tangible
changes. Specific techniques aim to draw out client hopes and existing
resources to help construct personally meaningful goals. Outcome research
demonstrates SFBT leads to equivalent or superior outcomes compared to
alternative treatments across symptomatology, functioning, relationships
and long-term follow-up when applied properly in brief formats.
SFBT offers a promising approach across applications from mental health and
medical settings to community organizations, education settings and
beyond. Its aligns well with managed care needs through efficient treatment
durations. However, more stringent randomized trials across diverse
populations are still warranted to strengthen empirical support. Future
research also exploring therapist factors, implementation challenges and
theoretical mechanism is important.
Overall, SFBT presents a distinct, client-centered treatment model informed
by social constructionism that values personal agency, momentum, and
empowering clients through their own resources and strengths. When
collaboratively applied through strategic exceptions-focused questioning,
SFBT demonstrates potential as a viable option producing prompt client
benefit through brief problem resolution. Its theoretical underpinnings and
practical use offer a valuable perspective on effective therapeutic change.
Solution-focused brief therapy (SFBT) is a goal-directed therapeutic approach
focused on solutions rather than problems (De Shazer et al., 1986).
Developed in the late 1970s and early 1980s at the Brief Family Therapy
Center in Milwaukee, SFBT is a notable exception to traditional
psychotherapy models that view change as a gradual process. This paper will
explore the theoretical foundations of SFBT, including its core principles and
assumptions, as well as specific techniques employed in sessions. Practical
case examples will illustrate how SFBT is applied across client issues. The
empirical research evaluating SFBT will be reviewed. Overall, the aim is to
provide a comprehensive overview of SFBT as a distinct, goal-directed
therapeutic model centered on solutions and client strengths.
Theoretical Foundations
SFBT arose as an alternative to problem-focused, psychopathological models
of therapy. Its theoretical underpinnings stem from solutions-based
disciplines like anthropology, organizational development, cybernetics, and
communications theory (De Jong & Berg, 2013). Some defining principles
include:
- The “noticing of change” assumption – SFBT therapists make observations
of any positive change occurring between sessions (Bannink, 2007).
- Causality focuses on what clients want rather than pathology – the question
is not why problems exist but how solutions can be constructed (De Shazer,
1988).
- Small changes lead to larger transformations – solutions develop through
incremental progress rather than thorough problem analysis (Berg & Miller,
1992).
- Client strengths and expertise guide the process – therapists utilize a
stance of curiosity and collaborate with naturally occurring client resources
(De Jong & Berg, 1998).
- The future is hypothetical but not predetermined – open questions explore
client hopes rather than past problems (De Shazer, 1985).
- Exceptions indicate solutions are possible – therapists investigate times
when problems did not manifest to develop momentum for change (Berg &
De Shazer, 1993).
This shift from a traditional problem-focused medical model to an alternative
solutions orientation guided the development of SFBT techniques. Five core
assumptions form the philosophical underpinnings of the approach:
1) Symptoms are bounded by context rather than linear cause-effect
relationships.
2) Clients have resources and are not passive recipients of intervention.
3) Therapists should follow clients’ lead to cultivate motivation for change.
4) Small changes can lead to major transformations through positive
feedback processes.
5) Therapy should be brief, usually requiring fewer than five sessions.
Within this theoretical framework, SFBT aims to help clients realize their own
solutions through a positive, future-oriented collaborative process focused on
goals, strengths, and exception questions.
Specific Techniques
Specific SFBT techniques stem directly from the theoretical assumptions and
values discussed above. Among the notable techniques are:
Miracle Question – Therapists ask what would be different if overnight a
miracle occurred resolving the problem in their sleep without them being
aware. This helps identify client goals and values.
Scaling Questions – Therapists utilize numerical scaling (usually 1-10) to
track incremental progress through questions like "On a scale where 0 means
your problem is as bad as it can be and 10 means your goal is fully realized,
where are you now?” This concretizes change.
Complimenting – Therapists look for natural strengths, coping abilities,
insights, and specific positive behaviors exhibited by clients that can be built
upon for solutions.
Coping Questions – Similar to compliments, therapists investigate how
clients have dealt with difficulties already through asking about methods of
inner fortitude, support systems, past successful strategies, etc.
Relationship and Network Questions – Therapists explore external resources
that can reinforce changes like supportive people in the client's life who may
have insights into solutions.
What's Better/Exception Questions – Therapists investigate for unique
outcomes or exceptions that point toward unrealized hopes, times the
problem was less intense, or instances when client values still shone
through.
Task Assignment – Therapists collaboratively agree upon small, very specific,
observable tasks or experiments for clients to undertake between sessions
that create positive feedback loops toward solutions.
End-of-Session Feedback –Therapists provide positive feedback at the end of
each session highlighting client strengths, coping, insights, and progress
noted - even if small - to amplify momentum for change.
Overall, SFBT aims to be a highly goal-oriented, collaborative process
between therapists utilizing skills of curiosity, positivity, and “not-knowing”
to draw out client strengths and solutions through strategic questioning and
feedback focused on building a preferred future.
Case Examples
To illustrate SFBT techniques in action, two case studies are reviewed. The
first involves depression in a university student (Bob). During the initial
session, when asked about his goals using the miracle question, Bob
reported hoping to feel more motivated, sleep better, and worry less. The
therapist scaled Bob's motivation at 4/10, and they discussed tasks like
exercising, calling friends, and giving himself positive self-talk to move the
scale up. At follow-up, Bob reported feeling more energized and hopeful,
scaling himself a 7/10.
A second case involved relationship issues for a couple (Mark and Sarah).
When asked about exceptions to their problems, they recalled times of
playfulness early in their relationship. The therapist assigned the task of
scheduling brief daily "fun times" together to cultivate exceptions. At follow-
up several weeks later, scaling their relationship at 5/10, Mark and Sarah
reported increased closeness, playfulness and hope for their future together.
Both cases illustrate SFBT techniques connecting positive client perceptions
to goals, scaling change, exploring exceptions, and assigning small
behavioral tasks that help systems naturally construct solutions in a
collaborative process. SFBT aims to catalyze momentum for client-driven
improvement through brief, strategic questioning focused on possibilities
rather than problems.
Research on SFBT Outcomes
Existing outcome research offers promising support for SFBT across diverse
applications and client demographics. A meta-analysis by Gingerich and
Peterson (2013) reviewed 29 randomized studies comparing SFBT to other
therapies across individual, couples, and family cases involving various
issues like depression, stress, relationship conflict, and somatic symptoms.
Across studies, SFBT performed as well as or better than alternate therapies
with an average effect size of 0.66 at termination and 0.50 at 6-month
follow-up. Improvements were found across symptomatic, relational, and
behavioral domains.
Kim (2008) conducted a meta-analysis of 19 studies specifically on SFBT for
depression. SFBT produced a large pre-to-post effect size of 1.24,
comparable to cognitive therapy (1.27) and significantly better than waitlist
control conditions. Improvements were maintained at follow-up. A Cochrane
review of 31 randomized trials reached similar conclusions, finding SFBT as
beneficial as other brief therapies for various conditions in the short and
long-term (Gingerich & Peterson, 2013).
Additional research gives further support to SFBT effectiveness. studies
found significantly greater reductions in stress, anxiety and PTSD symptoms
with SFBT versus alternative treatments (Tasca et al., 2016; Mortenson,
2016). Research also linked SFBT with lasting fostering care placement
successes, reduced somatic symptoms and cost-effectiveness in health care
applications (Zimmerman et al., 1995; Dolan, 1991; LaFountain & Garner,
1996). Recent research extends SFBT use to diverse populations including
teen mothers, incarcerated individuals, and chronic illness management
(Durrant, 2016; Lichtenstein et al., 2014; Vlaescu et al., 2016).
While most studies to date involve smaller samples or lack robust control
groups, the overall body of research provides good initial evidence that SFBT
substantially improves outcomes when properly applied. Continued rigorous
trials are still needed across varied populations and presenting issues to
further validate SFBT effectiveness. However, currently available data
supports SFBT as an efficacious brief treatment model producing notable
client benefits.
Implications and Conclusion
In conclusion, SFBT represents an alternative therapeutic model to traditional
pathology-focused approaches through its guiding theoretical framework
centered on collaboration, solutions, client strengths, and small, tangible
changes. Specific techniques aim to draw out client hopes and existing
resources to help construct personally meaningful goals. Outcome research
demonstrates SFBT leads to equivalent or superior outcomes compared to
alternative treatments across symptomatology, functioning, relationships
and long-term follow-up when applied properly in brief formats.
SFBT offers a promising approach across applications from mental health and
medical settings to community organizations, education settings and
beyond. Its aligns well with managed care needs through efficient treatment
durations. However, more stringent randomized trials across diverse
populations are still warranted to strengthen empirical support. Future
research also exploring therapist factors, implementation challenges and
theoretical mechanism is important.
Overall, SFBT presents a distinct, client-centered treatment model informed
by social constructionism that values personal agency, momentum, and
empowering clients through their own resources and strengths. When
collaboratively applied through strategic exceptions-focused questioning,
SFBT demonstrates potential as a viable option producing prompt client
benefit through brief problem resolution. Its theoretical underpinnings and
practical use offer a valuable perspective on effective therapeutic change.
Solution-focused brief therapy (SFBT) is a goal-directed therapeutic approach
focused on solutions rather than problems (De Shazer et al., 1986).
Developed in the late 1970s and early 1980s at the Brief Family Therapy
Center in Milwaukee, SFBT is a notable exception to traditional
psychotherapy models that view change as a gradual process. This paper will
explore the theoretical foundations of SFBT, including its core principles and
assumptions, as well as specific techniques employed in sessions. Practical
case examples will illustrate how SFBT is applied across client issues. The
empirical research evaluating SFBT will be reviewed. Overall, the aim is to
provide a comprehensive overview of SFBT as a distinct, goal-directed
therapeutic model centered on solutions and client strengths.
Theoretical Foundations
SFBT arose as an alternative to problem-focused, psychopathological models
of therapy. Its theoretical underpinnings stem from solutions-based
disciplines like anthropology, organizational development, cybernetics, and
communications theory (De Jong & Berg, 2013). Some defining principles
include:
- The “noticing of change” assumption – SFBT therapists make observations
of any positive change occurring between sessions (Bannink, 2007).
- Causality focuses on what clients want rather than pathology – the question
is not why problems exist but how solutions can be constructed (De Shazer,
1988).
- Small changes lead to larger transformations – solutions develop through
incremental progress rather than thorough problem analysis (Berg & Miller,
1992).
- Client strengths and expertise guide the process – therapists utilize a
stance of curiosity and collaborate with naturally occurring client resources
(De Jong & Berg, 1998).
- The future is hypothetical but not predetermined – open questions explore
client hopes rather than past problems (De Shazer, 1985).
- Exceptions indicate solutions are possible – therapists investigate times
when problems did not manifest to develop momentum for change (Berg &
De Shazer, 1993).
This shift from a traditional problem-focused medical model to an alternative
solutions orientation guided the development of SFBT techniques. Five core
assumptions form the philosophical underpinnings of the approach:
1) Symptoms are bounded by context rather than linear cause-effect
relationships.
2) Clients have resources and are not passive recipients of intervention.
3) Therapists should follow clients’ lead to cultivate motivation for change.
4) Small changes can lead to major transformations through positive
feedback processes.
5) Therapy should be brief, usually requiring fewer than five sessions.
Within this theoretical framework, SFBT aims to help clients realize their own
solutions through a positive, future-oriented collaborative process focused on
goals, strengths, and exception questions.
Specific Techniques
Specific SFBT techniques stem directly from the theoretical assumptions and
values discussed above. Among the notable techniques are:
Miracle Question – Therapists ask what would be different if overnight a
miracle occurred resolving the problem in their sleep without them being
aware. This helps identify client goals and values.
Scaling Questions – Therapists utilize numerical scaling (usually 1-10) to
track incremental progress through questions like "On a scale where 0 means
your problem is as bad as it can be and 10 means your goal is fully realized,
where are you now?” This concretizes change.
Complimenting – Therapists look for natural strengths, coping abilities,
insights, and specific positive behaviors exhibited by clients that can be built
upon for solutions.
Coping Questions – Similar to compliments, therapists investigate how
clients have dealt with difficulties already through asking about methods of
inner fortitude, support systems, past successful strategies, etc.
Relationship and Network Questions – Therapists explore external resources
that can reinforce changes like supportive people in the client's life who may
have insights into solutions.
What's Better/Exception Questions – Therapists investigate for unique
outcomes or exceptions that point toward unrealized hopes, times the
problem was less intense, or instances when client values still shone
through.
Task Assignment – Therapists collaboratively agree upon small, very specific,
observable tasks or experiments for clients to undertake between sessions
that create positive feedback loops toward solutions.
End-of-Session Feedback –Therapists provide positive feedback at the end of
each session highlighting client strengths, coping, insights, and progress
noted - even if small - to amplify momentum for change.
Overall, SFBT aims to be a highly goal-oriented, collaborative process
between therapists utilizing skills of curiosity, positivity, and “not-knowing”
to draw out client strengths and solutions through strategic questioning and
feedback focused on building a preferred future.
Case Examples
To illustrate SFBT techniques in action, two case studies are reviewed. The
first involves depression in a university student (Bob). During the initial
session, when asked about his goals using the miracle question, Bob
reported hoping to feel more motivated, sleep better, and worry less. The
therapist scaled Bob's motivation at 4/10, and they discussed tasks like
exercising, calling friends, and giving himself positive self-talk to move the
scale up. At follow-up, Bob reported feeling more energized and hopeful,
scaling himself a 7/10.
A second case involved relationship issues for a couple (Mark and Sarah).
When asked about exceptions to their problems, they recalled times of
playfulness early in their relationship. The therapist assigned the task of
scheduling brief daily "fun times" together to cultivate exceptions. At follow-
up several weeks later, scaling their relationship at 5/10, Mark and Sarah
reported increased closeness, playfulness and hope for their future together.
Both cases illustrate SFBT techniques connecting positive client perceptions
to goals, scaling change, exploring exceptions, and assigning small
behavioral tasks that help systems naturally construct solutions in a
collaborative process. SFBT aims to catalyze momentum for client-driven
improvement through brief, strategic questioning focused on possibilities
rather than problems.
Research on SFBT Outcomes
Existing outcome research offers promising support for SFBT across diverse
applications and client demographics. A meta-analysis by Gingerich and
Peterson (2013) reviewed 29 randomized studies comparing SFBT to other
therapies across individual, couples, and family cases involving various
issues like depression, stress, relationship conflict, and somatic symptoms.
Across studies, SFBT performed as well as or better than alternate therapies
with an average effect size of 0.66 at termination and 0.50 at 6-month
follow-up. Improvements were found across symptomatic, relational, and
behavioral domains.
Kim (2008) conducted a meta-analysis of 19 studies specifically on SFBT for
depression. SFBT produced a large pre-to-post effect size of 1.24,
comparable to cognitive therapy (1.27) and significantly better than waitlist
control conditions. Improvements were maintained at follow-up. A Cochrane
review of 31 randomized trials reached similar conclusions, finding SFBT as
beneficial as other brief therapies for various conditions in the short and
long-term (Gingerich & Peterson, 2013).
Additional research gives further support to SFBT effectiveness. studies
found significantly greater reductions in stress, anxiety and PTSD symptoms
with SFBT versus alternative treatments (Tasca et al., 2016; Mortenson,
2016). Research also linked SFBT with lasting fostering care placement
successes, reduced somatic symptoms and cost-effectiveness in health care
applications (Zimmerman et al., 1995; Dolan, 1991; LaFountain & Garner,
1996). Recent research extends SFBT use to diverse populations including
teen mothers, incarcerated individuals, and chronic illness management
(Durrant, 2016; Lichtenstein et al., 2014; Vlaescu et al., 2016).
While most studies to date involve smaller samples or lack robust control
groups, the overall body of research provides good initial evidence that SFBT
substantially improves outcomes when properly applied. Continued rigorous
trials are still needed across varied populations and presenting issues to
further validate SFBT effectiveness. However, currently available data
supports SFBT as an efficacious brief treatment model producing notable
client benefits.
Implications and Conclusion
In conclusion, SFBT represents an alternative therapeutic model to traditional
pathology-focused approaches through its guiding theoretical framework
centered on collaboration, solutions, client strengths, and small, tangible
changes. Specific techniques aim to draw out client hopes and existing
resources to help construct personally meaningful goals. Outcome research
demonstrates SFBT leads to equivalent or superior outcomes compared to
alternative treatments across symptomatology, functioning, relationships
and long-term follow-up when applied properly in brief formats.
SFBT offers a promising approach across applications from mental health and
medical settings to community organizations, education settings and
beyond. Its aligns well with managed care needs through efficient treatment
durations. However, more stringent randomized trials across diverse
populations are still warranted to strengthen empirical support. Future
research also exploring therapist factors, implementation challenges and
theoretical mechanism is important.
Overall, SFBT presents a distinct, client-centered treatment model informed
by social constructionism that values personal agency, momentum, and
empowering clients through their own resources and strengths. When
collaboratively applied through strategic exceptions-focused questioning,
SFBT demonstrates potential as a viable option producing prompt client
benefit through brief problem resolution. Its theoretical underpinnings and
practical use offer a valuable perspective on effective therapeutic change.
Solution-focused brief therapy (SFBT) is a goal-directed therapeutic approach
focused on solutions rather than problems (De Shazer et al., 1986).
Developed in the late 1970s and early 1980s at the Brief Family Therapy
Center in Milwaukee, SFBT is a notable exception to traditional
psychotherapy models that view change as a gradual process. This paper will
explore the theoretical foundations of SFBT, including its core principles and
assumptions, as well as specific techniques employed in sessions. Practical
case examples will illustrate how SFBT is applied across client issues. The
empirical research evaluating SFBT will be reviewed. Overall, the aim is to
provide a comprehensive overview of SFBT as a distinct, goal-directed
therapeutic model centered on solutions and client strengths.
Theoretical Foundations
SFBT arose as an alternative to problem-focused, psychopathological models
of therapy. Its theoretical underpinnings stem from solutions-based
disciplines like anthropology, organizational development, cybernetics, and
communications theory (De Jong & Berg, 2013). Some defining principles
include:
- The “noticing of change” assumption – SFBT therapists make observations
of any positive change occurring between sessions (Bannink, 2007).
- Causality focuses on what clients want rather than pathology – the question
is not why problems exist but how solutions can be constructed (De Shazer,
1988).
- Small changes lead to larger transformations – solutions develop through
incremental progress rather than thorough problem analysis (Berg & Miller,
1992).
- Client strengths and expertise guide the process – therapists utilize a
stance of curiosity and collaborate with naturally occurring client resources
(De Jong & Berg, 1998).
- The future is hypothetical but not predetermined – open questions explore
client hopes rather than past problems (De Shazer, 1985).
- Exceptions indicate solutions are possible – therapists investigate times
when problems did not manifest to develop momentum for change (Berg &
De Shazer, 1993).
This shift from a traditional problem-focused medical model to an alternative
solutions orientation guided the development of SFBT techniques. Five core
assumptions form the philosophical underpinnings of the approach:
1) Symptoms are bounded by context rather than linear cause-effect
relationships.
2) Clients have resources and are not passive recipients of intervention.
3) Therapists should follow clients’ lead to cultivate motivation for change.
4) Small changes can lead to major transformations through positive
feedback processes.
5) Therapy should be brief, usually requiring fewer than five sessions.
Within this theoretical framework, SFBT aims to help clients realize their own
solutions through a positive, future-oriented collaborative process focused on
goals, strengths, and exception questions.
Specific Techniques
Specific SFBT techniques stem directly from the theoretical assumptions and
values discussed above. Among the notable techniques are:
Miracle Question – Therapists ask what would be different if overnight a
miracle occurred resolving the problem in their sleep without them being
aware. This helps identify client goals and values.
Scaling Questions – Therapists utilize numerical scaling (usually 1-10) to
track incremental progress through questions like "On a scale where 0 means
your problem is as bad as it can be and 10 means your goal is fully realized,
where are you now?” This concretizes change.
Complimenting – Therapists look for natural strengths, coping abilities,
insights, and specific positive behaviors exhibited by clients that can be built
upon for solutions.
Coping Questions – Similar to compliments, therapists investigate how
clients have dealt with difficulties already through asking about methods of
inner fortitude, support systems, past successful strategies, etc.
Relationship and Network Questions – Therapists explore external resources
that can reinforce changes like supportive people in the client's life who may
have insights into solutions.
What's Better/Exception Questions – Therapists investigate for unique
outcomes or exceptions that point toward unrealized hopes, times the
problem was less intense, or instances when client values still shone
through.
Task Assignment – Therapists collaboratively agree upon small, very specific,
observable tasks or experiments for clients to undertake between sessions
that create positive feedback loops toward solutions.
End-of-Session Feedback –Therapists provide positive feedback at the end of
each session highlighting client strengths, coping, insights, and progress
noted - even if small - to amplify momentum for change.
Overall, SFBT aims to be a highly goal-oriented, collaborative process
between therapists utilizing skills of curiosity, positivity, and “not-knowing”
to draw out client strengths and solutions through strategic questioning and
feedback focused on building a preferred future.
Case Examples
To illustrate SFBT techniques in action, two case studies are reviewed. The
first involves depression in a university student (Bob). During the initial
session, when asked about his goals using the miracle question, Bob
reported hoping to feel more motivated, sleep better, and worry less. The
therapist scaled Bob's motivation at 4/10, and they discussed tasks like
exercising, calling friends, and giving himself positive self-talk to move the
scale up. At follow-up, Bob reported feeling more energized and hopeful,
scaling himself a 7/10.
A second case involved relationship issues for a couple (Mark and Sarah).
When asked about exceptions to their problems, they recalled times of
playfulness early in their relationship. The therapist assigned the task of
scheduling brief daily "fun times" together to cultivate exceptions. At follow-
up several weeks later, scaling their relationship at 5/10, Mark and Sarah
reported increased closeness, playfulness and hope for their future together.
Both cases illustrate SFBT techniques connecting positive client perceptions
to goals, scaling change, exploring exceptions, and assigning small
behavioral tasks that help systems naturally construct solutions in a
collaborative process. SFBT aims to catalyze momentum for client-driven
improvement through brief, strategic questioning focused on possibilities
rather than problems.
Research on SFBT Outcomes
Existing outcome research offers promising support for SFBT across diverse
applications and client demographics. A meta-analysis by Gingerich and
Peterson (2013) reviewed 29 randomized studies comparing SFBT to other
therapies across individual, couples, and family cases involving various
issues like depression, stress, relationship conflict, and somatic symptoms.
Across studies, SFBT performed as well as or better than alternate therapies
with an average effect size of 0.66 at termination and 0.50 at 6-month
follow-up. Improvements were found across symptomatic, relational, and
behavioral domains.
Kim (2008) conducted a meta-analysis of 19 studies specifically on SFBT for
depression. SFBT produced a large pre-to-post effect size of 1.24,
comparable to cognitive therapy (1.27) and significantly better than waitlist
control conditions. Improvements were maintained at follow-up. A Cochrane
review of 31 randomized trials reached similar conclusions, finding SFBT as
beneficial as other brief therapies for various conditions in the short and
long-term (Gingerich & Peterson, 2013).
Additional research gives further support to SFBT effectiveness. studies
found significantly greater reductions in stress, anxiety and PTSD symptoms
with SFBT versus alternative treatments (Tasca et al., 2016; Mortenson,
2016). Research also linked SFBT with lasting fostering care placement
successes, reduced somatic symptoms and cost-effectiveness in health care
applications (Zimmerman et al., 1995; Dolan, 1991; LaFountain & Garner,
1996). Recent research extends SFBT use to diverse populations including
teen mothers, incarcerated individuals, and chronic illness management
(Durrant, 2016; Lichtenstein et al., 2014; Vlaescu et al., 2016).
While most studies to date involve smaller samples or lack robust control
groups, the overall body of research provides good initial evidence that SFBT
substantially improves outcomes when properly applied. Continued rigorous
trials are still needed across varied populations and presenting issues to
further validate SFBT effectiveness. However, currently available data
supports SFBT as an efficacious brief treatment model producing notable
client benefits.
Implications and Conclusion
In conclusion, SFBT represents an alternative therapeutic model to traditional
pathology-focused approaches through its guiding theoretical framework
centered on collaboration, solutions, client strengths, and small, tangible
changes. Specific techniques aim to draw out client hopes and existing
resources to help construct personally meaningful goals. Outcome research
demonstrates SFBT leads to equivalent or superior outcomes compared to
alternative treatments across symptomatology, functioning, relationships
and long-term follow-up when applied properly in brief formats.
SFBT offers a promising approach across applications from mental health and
medical settings to community organizations, education settings and
beyond. Its aligns well with managed care needs through efficient treatment
durations. However, more stringent randomized trials across diverse
populations are still warranted to strengthen empirical support. Future
research also exploring therapist factors, implementation challenges and
theoretical mechanism is important.
Overall, SFBT presents a distinct, client-centered treatment model informed
by social constructionism that values personal agency, momentum, and
empowering clients through their own resources and strengths. When
collaboratively applied through strategic exceptions-focused questioning,
SFBT demonstrates potential as a viable option producing prompt client
benefit through brief problem resolution. Its theoretical underpinnings and
practical use offer a valuable perspective on effective therapeutic change.
Solution-focused brief therapy (SFBT) is a goal-directed therapeutic approach
focused on solutions rather than problems (De Shazer et al., 1986).
Developed in the late 1970s and early 1980s at the Brief Family Therapy
Center in Milwaukee, SFBT is a notable exception to traditional
psychotherapy models that view change as a gradual process. This paper will
explore the theoretical foundations of SFBT, including its core principles and
assumptions, as well as specific techniques employed in sessions. Practical
case examples will illustrate how SFBT is applied across client issues. The
empirical research evaluating SFBT will be reviewed. Overall, the aim is to
provide a comprehensive overview of SFBT as a distinct, goal-directed
therapeutic model centered on solutions and client strengths.
Theoretical Foundations
SFBT arose as an alternative to problem-focused, psychopathological models
of therapy. Its theoretical underpinnings stem from solutions-based
disciplines like anthropology, organizational development, cybernetics, and
communications theory (De Jong & Berg, 2013). Some defining principles
include:
- The “noticing of change” assumption – SFBT therapists make observations
of any positive change occurring between sessions (Bannink, 2007).
- Causality focuses on what clients want rather than pathology – the question
is not why problems exist but how solutions can be constructed (De Shazer,
1988).
- Small changes lead to larger transformations – solutions develop through
incremental progress rather than thorough problem analysis (Berg & Miller,
1992).
- Client strengths and expertise guide the process – therapists utilize a
stance of curiosity and collaborate with naturally occurring client resources
(De Jong & Berg, 1998).
- The future is hypothetical but not predetermined – open questions explore
client hopes rather than past problems (De Shazer, 1985).
- Exceptions indicate solutions are possible – therapists investigate times
when problems did not manifest to develop momentum for change (Berg &
De Shazer, 1993).
This shift from a traditional problem-focused medical model to an alternative
solutions orientation guided the development of SFBT techniques. Five core
assumptions form the philosophical underpinnings of the approach:
1) Symptoms are bounded by context rather than linear cause-effect
relationships.
2) Clients have resources and are not passive recipients of intervention.
3) Therapists should follow clients’ lead to cultivate motivation for change.
4) Small changes can lead to major transformations through positive
feedback processes.
5) Therapy should be brief, usually requiring fewer than five sessions.
Within this theoretical framework, SFBT aims to help clients realize their own
solutions through a positive, future-oriented collaborative process focused on
goals, strengths, and exception questions.
Specific Techniques
Specific SFBT techniques stem directly from the theoretical assumptions and
values discussed above. Among the notable techniques are:
Miracle Question – Therapists ask what would be different if overnight a
miracle occurred resolving the problem in their sleep without them being
aware. This helps identify client goals and values.
Scaling Questions – Therapists utilize numerical scaling (usually 1-10) to
track incremental progress through questions like "On a scale where 0 means
your problem is as bad as it can be and 10 means your goal is fully realized,
where are you now?” This concretizes change.
Complimenting – Therapists look for natural strengths, coping abilities,
insights, and specific positive behaviors exhibited by clients that can be built
upon for solutions.
Coping Questions – Similar to compliments, therapists investigate how
clients have dealt with difficulties already through asking about methods of
inner fortitude, support systems, past successful strategies, etc.
Relationship and Network Questions – Therapists explore external resources
that can reinforce changes like supportive people in the client's life who may
have insights into solutions.
What's Better/Exception Questions – Therapists investigate for unique
outcomes or exceptions that point toward unrealized hopes, times the
problem was less intense, or instances when client values still shone
through.
Task Assignment – Therapists collaboratively agree upon small, very specific,
observable tasks or experiments for clients to undertake between sessions
that create positive feedback loops toward solutions.
End-of-Session Feedback –Therapists provide positive feedback at the end of
each session highlighting client strengths, coping, insights, and progress
noted - even if small - to amplify momentum for change.
Overall, SFBT aims to be a highly goal-oriented, collaborative process
between therapists utilizing skills of curiosity, positivity, and “not-knowing”
to draw out client strengths and solutions through strategic questioning and
feedback focused on building a preferred future.
Case Examples
To illustrate SFBT techniques in action, two case studies are reviewed. The
first involves depression in a university student (Bob). During the initial
session, when asked about his goals using the miracle question, Bob
reported hoping to feel more motivated, sleep better, and worry less. The
therapist scaled Bob's motivation at 4/10, and they discussed tasks like
exercising, calling friends, and giving himself positive self-talk to move the
scale up. At follow-up, Bob reported feeling more energized and hopeful,
scaling himself a 7/10.
A second case involved relationship issues for a couple (Mark and Sarah).
When asked about exceptions to their problems, they recalled times of
playfulness early in their relationship. The therapist assigned the task of
scheduling brief daily "fun times" together to cultivate exceptions. At follow-
up several weeks later, scaling their relationship at 5/10, Mark and Sarah
reported increased closeness, playfulness and hope for their future together.
Both cases illustrate SFBT techniques connecting positive client perceptions
to goals, scaling change, exploring exceptions, and assigning small
behavioral tasks that help systems naturally construct solutions in a
collaborative process. SFBT aims to catalyze momentum for client-driven
improvement through brief, strategic questioning focused on possibilities
rather than problems.
Research on SFBT Outcomes
Existing outcome research offers promising support for SFBT across diverse
applications and client demographics. A meta-analysis by Gingerich and
Peterson (2013) reviewed 29 randomized studies comparing SFBT to other
therapies across individual, couples, and family cases involving various
issues like depression, stress, relationship conflict, and somatic symptoms.
Across studies, SFBT performed as well as or better than alternate therapies
with an average effect size of 0.66 at termination and 0.50 at 6-month
follow-up. Improvements were found across symptomatic, relational, and
behavioral domains.
Kim (2008) conducted a meta-analysis of 19 studies specifically on SFBT for
depression. SFBT produced a large pre-to-post effect size of 1.24,
comparable to cognitive therapy (1.27) and significantly better than waitlist
control conditions. Improvements were maintained at follow-up. A Cochrane
review of 31 randomized trials reached similar conclusions, finding SFBT as
beneficial as other brief therapies for various conditions in the short and
long-term (Gingerich & Peterson, 2013).
Additional research gives further support to SFBT effectiveness. studies
found significantly greater reductions in stress, anxiety and PTSD symptoms
with SFBT versus alternative treatments (Tasca et al., 2016; Mortenson,
2016). Research also linked SFBT with lasting fostering care placement
successes, reduced somatic symptoms and cost-effectiveness in health care
applications (Zimmerman et al., 1995; Dolan, 1991; LaFountain & Garner,
1996). Recent research extends SFBT use to diverse populations including
teen mothers, incarcerated individuals, and chronic illness management
(Durrant, 2016; Lichtenstein et al., 2014; Vlaescu et al., 2016).
While most studies to date involve smaller samples or lack robust control
groups, the overall body of research provides good initial evidence that SFBT
substantially improves outcomes when properly applied. Continued rigorous
trials are still needed across varied populations and presenting issues to
further validate SFBT effectiveness. However, currently available data
supports SFBT as an efficacious brief treatment model producing notable
client benefits.
Implications and Conclusion
In conclusion, SFBT represents an alternative therapeutic model to traditional
pathology-focused approaches through its guiding theoretical framework
centered on collaboration, solutions, client strengths, and small, tangible
changes. Specific techniques aim to draw out client hopes and existing
resources to help construct personally meaningful goals. Outcome research
demonstrates SFBT leads to equivalent or superior outcomes compared to
alternative treatments across symptomatology, functioning, relationships
and long-term follow-up when applied properly in brief formats.
SFBT offers a promising approach across applications from mental health and
medical settings to community organizations, education settings and
beyond. Its aligns well with managed care needs through efficient treatment
durations. However, more stringent randomized trials across diverse
populations are still warranted to strengthen empirical support. Future
research also exploring therapist factors, implementation challenges and
theoretical mechanism is important.
Overall, SFBT presents a distinct, client-centered treatment model informed
by social constructionism that values personal agency, momentum, and
empowering clients through their own resources and strengths. When
collaboratively applied through strategic exceptions-focused questioning,
SFBT demonstrates potential as a viable option producing prompt client
benefit through brief problem resolution. Its theoretical underpinnings and
practical use offer a valuable perspective on effective therapeutic change.
Solution-focused brief therapy (SFBT) is a goal-directed therapeutic approach
focused on solutions rather than problems (De Shazer et al., 1986).
Developed in the late 1970s and early 1980s at the Brief Family Therapy
Center in Milwaukee, SFBT is a notable exception to traditional
psychotherapy models that view change as a gradual process. This paper will
explore the theoretical foundations of SFBT, including its core principles and
assumptions, as well as specific techniques employed in sessions. Practical
case examples will illustrate how SFBT is applied across client issues. The
empirical research evaluating SFBT will be reviewed. Overall, the aim is to
provide a comprehensive overview of SFBT as a distinct, goal-directed
therapeutic model centered on solutions and client strengths.
Theoretical Foundations
SFBT arose as an alternative to problem-focused, psychopathological models
of therapy. Its theoretical underpinnings stem from solutions-based
disciplines like anthropology, organizational development, cybernetics, and
communications theory (De Jong & Berg, 2013). Some defining principles
include:
- The “noticing of change” assumption – SFBT therapists make observations
of any positive change occurring between sessions (Bannink, 2007).
- Causality focuses on what clients want rather than pathology – the question
is not why problems exist but how solutions can be constructed (De Shazer,
1988).
- Small changes lead to larger transformations – solutions develop through
incremental progress rather than thorough problem analysis (Berg & Miller,
1992).
- Client strengths and expertise guide the process – therapists utilize a
stance of curiosity and collaborate with naturally occurring client resources
(De Jong & Berg, 1998).
- The future is hypothetical but not predetermined – open questions explore
client hopes rather than past problems (De Shazer, 1985).
- Exceptions indicate solutions are possible – therapists investigate times
when problems did not manifest to develop momentum for change (Berg &
De Shazer, 1993).
This shift from a traditional problem-focused medical model to an alternative
solutions orientation guided the development of SFBT techniques. Five core
assumptions form the philosophical underpinnings of the approach:
1) Symptoms are bounded by context rather than linear cause-effect
relationships.
2) Clients have resources and are not passive recipients of intervention.
3) Therapists should follow clients’ lead to cultivate motivation for change.
4) Small changes can lead to major transformations through positive
feedback processes.
5) Therapy should be brief, usually requiring fewer than five sessions.
Within this theoretical framework, SFBT aims to help clients realize their own
solutions through a positive, future-oriented collaborative process focused on
goals, strengths, and exception questions.
Specific Techniques
Specific SFBT techniques stem directly from the theoretical assumptions and
values discussed above. Among the notable techniques are:
Miracle Question – Therapists ask what would be different if overnight a
miracle occurred resolving the problem in their sleep without them being
aware. This helps identify client goals and values.
Scaling Questions – Therapists utilize numerical scaling (usually 1-10) to
track incremental progress through questions like "On a scale where 0 means
your problem is as bad as it can be and 10 means your goal is fully realized,
where are you now?” This concretizes change.
Complimenting – Therapists look for natural strengths, coping abilities,
insights, and specific positive behaviors exhibited by clients that can be built
upon for solutions.
Coping Questions – Similar to compliments, therapists investigate how
clients have dealt with difficulties already through asking about methods of
inner fortitude, support systems, past successful strategies, etc.
Relationship and Network Questions – Therapists explore external resources
that can reinforce changes like supportive people in the client's life who may
have insights into solutions.
What's Better/Exception Questions – Therapists investigate for unique
outcomes or exceptions that point toward unrealized hopes, times the
problem was less intense, or instances when client values still shone
through.
Task Assignment – Therapists collaboratively agree upon small, very specific,
observable tasks or experiments for clients to undertake between sessions
that create positive feedback loops toward solutions.
End-of-Session Feedback –Therapists provide positive feedback at the end of
each session highlighting client strengths, coping, insights, and progress
noted - even if small - to amplify momentum for change.
Overall, SFBT aims to be a highly goal-oriented, collaborative process
between therapists utilizing skills of curiosity, positivity, and “not-knowing”
to draw out client strengths and solutions through strategic questioning and
feedback focused on building a preferred future.
Case Examples
To illustrate SFBT techniques in action, two case studies are reviewed. The
first involves depression in a university student (Bob). During the initial
session, when asked about his goals using the miracle question, Bob
reported hoping to feel more motivated, sleep better, and worry less. The
therapist scaled Bob's motivation at 4/10, and they discussed tasks like
exercising, calling friends, and giving himself positive self-talk to move the
scale up. At follow-up, Bob reported feeling more energized and hopeful,
scaling himself a 7/10.
A second case involved relationship issues for a couple (Mark and Sarah).
When asked about exceptions to their problems, they recalled times of
playfulness early in their relationship. The therapist assigned the task of
scheduling brief daily "fun times" together to cultivate exceptions. At follow-
up several weeks later, scaling their relationship at 5/10, Mark and Sarah
reported increased closeness, playfulness and hope for their future together.
Both cases illustrate SFBT techniques connecting positive client perceptions
to goals, scaling change, exploring exceptions, and assigning small
behavioral tasks that help systems naturally construct solutions in a
collaborative process. SFBT aims to catalyze momentum for client-driven
improvement through brief, strategic questioning focused on possibilities
rather than problems.
Research on SFBT Outcomes
Existing outcome research offers promising support for SFBT across diverse
applications and client demographics. A meta-analysis by Gingerich and
Peterson (2013) reviewed 29 randomized studies comparing SFBT to other
therapies across individual, couples, and family cases involving various
issues like depression, stress, relationship conflict, and somatic symptoms.
Across studies, SFBT performed as well as or better than alternate therapies
with an average effect size of 0.66 at termination and 0.50 at 6-month
follow-up. Improvements were found across symptomatic, relational, and
behavioral domains.
Kim (2008) conducted a meta-analysis of 19 studies specifically on SFBT for
depression. SFBT produced a large pre-to-post effect size of 1.24,
comparable to cognitive therapy (1.27) and significantly better than waitlist
control conditions. Improvements were maintained at follow-up. A Cochrane
review of 31 randomized trials reached similar conclusions, finding SFBT as
beneficial as other brief therapies for various conditions in the short and
long-term (Gingerich & Peterson, 2013).
Additional research gives further support to SFBT effectiveness. studies
found significantly greater reductions in stress, anxiety and PTSD symptoms
with SFBT versus alternative treatments (Tasca et al., 2016; Mortenson,
2016). Research also linked SFBT with lasting fostering care placement
successes, reduced somatic symptoms and cost-effectiveness in health care
applications (Zimmerman et al., 1995; Dolan, 1991; LaFountain & Garner,
1996). Recent research extends SFBT use to diverse populations including
teen mothers, incarcerated individuals, and chronic illness management
(Durrant, 2016; Lichtenstein et al., 2014; Vlaescu et al., 2016).
While most studies to date involve smaller samples or lack robust control
groups, the overall body of research provides good initial evidence that SFBT
substantially improves outcomes when properly applied. Continued rigorous
trials are still needed across varied populations and presenting issues to
further validate SFBT effectiveness. However, currently available data
supports SFBT as an efficacious brief treatment model producing notable
client benefits.
Implications and Conclusion
In conclusion, SFBT represents an alternative therapeutic model to traditional
pathology-focused approaches through its guiding theoretical framework
centered on collaboration, solutions, client strengths, and small, tangible
changes. Specific techniques aim to draw out client hopes and existing
resources to help construct personally meaningful goals. Outcome research
demonstrates SFBT leads to equivalent or superior outcomes compared to
alternative treatments across symptomatology, functioning, relationships
and long-term follow-up when applied properly in brief formats.
SFBT offers a promising approach across applications from mental health and
medical settings to community organizations, education settings and
beyond. Its aligns well with managed care needs through efficient treatment
durations. However, more stringent randomized trials across diverse
populations are still warranted to strengthen empirical support. Future
research also exploring therapist factors, implementation challenges and
theoretical mechanism is important.
Overall, SFBT presents a distinct, client-centered treatment model informed
by social constructionism that values personal agency, momentum, and
empowering clients through their own resources and strengths. When
collaboratively applied through strategic exceptions-focused questioning,
SFBT demonstrates potential as a viable option producing prompt client
benefit through brief problem resolution. Its theoretical underpinnings and
practical use offer a valuable perspective on effective therapeutic change.
Solution-focused brief therapy (SFBT) is a goal-directed therapeutic approach
focused on solutions rather than problems (De Shazer et al., 1986).
Developed in the late 1970s and early 1980s at the Brief Family Therapy
Center in Milwaukee, SFBT is a notable exception to traditional
psychotherapy models that view change as a gradual process. This paper will
explore the theoretical foundations of SFBT, including its core principles and
assumptions, as well as specific techniques employed in sessions. Practical
case examples will illustrate how SFBT is applied across client issues. The
empirical research evaluating SFBT will be reviewed. Overall, the aim is to
provide a comprehensive overview of SFBT as a distinct, goal-directed
therapeutic model centered on solutions and client strengths.
Theoretical Foundations
SFBT arose as an alternative to problem-focused, psychopathological models
of therapy. Its theoretical underpinnings stem from solutions-based
disciplines like anthropology, organizational development, cybernetics, and
communications theory (De Jong & Berg, 2013). Some defining principles
include:
- The “noticing of change” assumption – SFBT therapists make observations
of any positive change occurring between sessions (Bannink, 2007).
- Causality focuses on what clients want rather than pathology – the question
is not why problems exist but how solutions can be constructed (De Shazer,
1988).
- Small changes lead to larger transformations – solutions develop through
incremental progress rather than thorough problem analysis (Berg & Miller,
1992).
- Client strengths and expertise guide the process – therapists utilize a
stance of curiosity and collaborate with naturally occurring client resources
(De Jong & Berg, 1998).
- The future is hypothetical but not predetermined – open questions explore
client hopes rather than past problems (De Shazer, 1985).
- Exceptions indicate solutions are possible – therapists investigate times
when problems did not manifest to develop momentum for change (Berg &
De Shazer, 1993).
This shift from a traditional problem-focused medical model to an alternative
solutions orientation guided the development of SFBT techniques. Five core
assumptions form the philosophical underpinnings of the approach:
1) Symptoms are bounded by context rather than linear cause-effect
relationships.
2) Clients have resources and are not passive recipients of intervention.
3) Therapists should follow clients’ lead to cultivate motivation for change.
4) Small changes can lead to major transformations through positive
feedback processes.
5) Therapy should be brief, usually requiring fewer than five sessions.
Within this theoretical framework, SFBT aims to help clients realize their own
solutions through a positive, future-oriented collaborative process focused on
goals, strengths, and exception questions.
Specific Techniques
Specific SFBT techniques stem directly from the theoretical assumptions and
values discussed above. Among the notable techniques are:
Miracle Question – Therapists ask what would be different if overnight a
miracle occurred resolving the problem in their sleep without them being
aware. This helps identify client goals and values.
Scaling Questions – Therapists utilize numerical scaling (usually 1-10) to
track incremental progress through questions like "On a scale where 0 means
your problem is as bad as it can be and 10 means your goal is fully realized,
where are you now?” This concretizes change.
Complimenting – Therapists look for natural strengths, coping abilities,
insights, and specific positive behaviors exhibited by clients that can be built
upon for solutions.
Coping Questions – Similar to compliments, therapists investigate how
clients have dealt with difficulties already through asking about methods of
inner fortitude, support systems, past successful strategies, etc.
Relationship and Network Questions – Therapists explore external resources
that can reinforce changes like supportive people in the client's life who may
have insights into solutions.
What's Better/Exception Questions – Therapists investigate for unique
outcomes or exceptions that point toward unrealized hopes, times the
problem was less intense, or instances when client values still shone
through.
Task Assignment – Therapists collaboratively agree upon small, very specific,
observable tasks or experiments for clients to undertake between sessions
that create positive feedback loops toward solutions.
End-of-Session Feedback –Therapists provide positive feedback at the end of
each session highlighting client strengths, coping, insights, and progress
noted - even if small - to amplify momentum for change.
Overall, SFBT aims to be a highly goal-oriented, collaborative process
between therapists utilizing skills of curiosity, positivity, and “not-knowing”
to draw out client strengths and solutions through strategic questioning and
feedback focused on building a preferred future.
Case Examples
To illustrate SFBT techniques in action, two case studies are reviewed. The
first involves depression in a university student (Bob). During the initial
session, when asked about his goals using the miracle question, Bob
reported hoping to feel more motivated, sleep better, and worry less. The
therapist scaled Bob's motivation at 4/10, and they discussed tasks like
exercising, calling friends, and giving himself positive self-talk to move the
scale up. At follow-up, Bob reported feeling more energized and hopeful,
scaling himself a 7/10.
A second case involved relationship issues for a couple (Mark and Sarah).
When asked about exceptions to their problems, they recalled times of
playfulness early in their relationship. The therapist assigned the task of
scheduling brief daily "fun times" together to cultivate exceptions. At follow-
up several weeks later, scaling their relationship at 5/10, Mark and Sarah
reported increased closeness, playfulness and hope for their future together.
Both cases illustrate SFBT techniques connecting positive client perceptions
to goals, scaling change, exploring exceptions, and assigning small
behavioral tasks that help systems naturally construct solutions in a
collaborative process. SFBT aims to catalyze momentum for client-driven
improvement through brief, strategic questioning focused on possibilities
rather than problems.
Research on SFBT Outcomes
Existing outcome research offers promising support for SFBT across diverse
applications and client demographics. A meta-analysis by Gingerich and
Peterson (2013) reviewed 29 randomized studies comparing SFBT to other
therapies across individual, couples, and family cases involving various
issues like depression, stress, relationship conflict, and somatic symptoms.
Across studies, SFBT performed as well as or better than alternate therapies
with an average effect size of 0.66 at termination and 0.50 at 6-month
follow-up. Improvements were found across symptomatic, relational, and
behavioral domains.
Kim (2008) conducted a meta-analysis of 19 studies specifically on SFBT for
depression. SFBT produced a large pre-to-post effect size of 1.24,
comparable to cognitive therapy (1.27) and significantly better than waitlist
control conditions. Improvements were maintained at follow-up. A Cochrane
review of 31 randomized trials reached similar conclusions, finding SFBT as
beneficial as other brief therapies for various conditions in the short and
long-term (Gingerich & Peterson, 2013).
Additional research gives further support to SFBT effectiveness. studies
found significantly greater reductions in stress, anxiety and PTSD symptoms
with SFBT versus alternative treatments (Tasca et al., 2016; Mortenson,
2016). Research also linked SFBT with lasting fostering care placement
successes, reduced somatic symptoms and cost-effectiveness in health care
applications (Zimmerman et al., 1995; Dolan, 1991; LaFountain & Garner,
1996). Recent research extends SFBT use to diverse populations including
teen mothers, incarcerated individuals, and chronic illness management
(Durrant, 2016; Lichtenstein et al., 2014; Vlaescu et al., 2016).
While most studies to date involve smaller samples or lack robust control
groups, the overall body of research provides good initial evidence that SFBT
substantially improves outcomes when properly applied. Continued rigorous
trials are still needed across varied populations and presenting issues to
further validate SFBT effectiveness. However, currently available data
supports SFBT as an efficacious brief treatment model producing notable
client benefits.
Implications and Conclusion
In conclusion, SFBT represents an alternative therapeutic model to traditional
pathology-focused approaches through its guiding theoretical framework
centered on collaboration, solutions, client strengths, and small, tangible
changes. Specific techniques aim to draw out client hopes and existing
resources to help construct personally meaningful goals. Outcome research
demonstrates SFBT leads to equivalent or superior outcomes compared to
alternative treatments across symptomatology, functioning, relationships
and long-term follow-up when applied properly in brief formats.
SFBT offers a promising approach across applications from mental health and
medical settings to community organizations, education settings and
beyond. Its aligns well with managed care needs through efficient treatment
durations. However, more stringent randomized trials across diverse
populations are still warranted to strengthen empirical support. Future
research also exploring therapist factors, implementation challenges and
theoretical mechanism is important.
Overall, SFBT presents a distinct, client-centered treatment model informed
by social constructionism that values personal agency, momentum, and
empowering clients through their own resources and strengths. When
collaboratively applied through strategic exceptions-focused questioning,
SFBT demonstrates potential as a viable option producing prompt client
benefit through brief problem resolution. Its theoretical underpinnings and
practical use offer a valuable perspective on effective therapeutic change.
