What Is Solution Focused Brief Therapy (SFBT)?

What is Solution-Focused Therapy?

Solution-Focused Brief Therapy (SFBT), also referred to as Solution-Focused Therapy (SFT), is a form of psychotherapy or counseling.

This form of therapy focuses on solutions to problems or issues and discovering the resources and strengths a person has rather than focusing on the problem like more traditional talking therapies do.

Thus, instead of analyzing how the issue arose or interpretations of it and why it is there and what it really means for the person, SFBT instead concentrates on the issue in the here and now and how to move forward with a solution for it (De Shazer, 1988; De Shazer & Dolan, 2012).

Solution-Focused Therapy was created in the late 1970s and early 1980s in the Brief Family Therapy Center in Milwaukee by De Shazer and Berg (De Shazer et al. 1986).

The reason for its creation was that De Shazer and Berg noticed that clients would often speak about their problems and issues, seeming unable to notice their own inner resources for overcoming these problems and focusing on the future.

They also noticed that the client’s problems or issues showed inconsistency in the way that sometimes they were present and other times they were not, as the person did have moments in life where they could function without the problems being there.

Thus it was important to think about and explore these exceptions when the problem is not affecting the person (Iveson, 2002).

What is Solution-Focused Therapy used for?

Solution-Focused Therapy is currently used for most emotional and mental health problems that other forms of counseling are used to treat, such as:

• Depression
• Anxiety
• Self-esteem
• Personal stress and work-related stress
• Substance abuse/ addiction
• Relationship problems

SFBT is best used when a client is trying to reach a particular goal or overcome a particular problem.

While it is not suitable to use as a treatment for major psychiatric conditions such as psychosis or schizophrenia, it could be used in combination with a more suitable psychiatric treatment/ therapy to help alleviate stress and bring awareness to the person’s strengths and internal resources.

Research has shown that after a one-year follow-up, SFBT was effective in reducing depression, anxiety, and mood-related disorders in adults (Maljanen, et al., 2012).

A study on substance abuse in adults showed SFBT to be just as effective as other forms of talking therapy (problem-focused therapies) in treating addiction and decreasing addiction severity and trauma symptoms (Kim, Brook, & Akin, 2018).

A literature review showed SFBT to be most effective on child behavioral problems when it was used as an early intervention before behavioral issues became very severe (Bond et al. 2013).

Solution-Focused Therapy Techniques

In a solution-focused therapy session, the practitioner and client will work collaboratively to set goals and find solutions together, to overcome the problem or issue.

The practitioner will ask questions to gain an understanding of the client’s strengths and inner resources that they might not have noticed before.

The practitioner will also use complimentary language to bring awareness to and to support the strengths that the client does have, to shift the client’s focus to a more solution-oriented, positive outlook, rather than ruminating on the problem, unaware of the strengths and abilities that they do have.

Sessions usually will last between 50 – 90 minutes, but can be as brief as 15 – 20 minutes, usually once per week, for around 6 – 12 weeks, but are also given as one-off, stand-alone sessions.

There are lots of techniques used in SFBT to shift the client’s awareness onto focusing on the future and on a solution.

These techniques include the miracle question, coping questions, exceptions to the problem, compliments, and using scales, which are explained in more detail below:

1. The Miracle Question

This is where the practitioner will ask the client to imagine that they have gone to sleep and when they wake up in the morning, their problems have vanished.

After this visualization, they will ask the client how they know that the problems or issues have gone and what is in particular that is different.

For example:

‘Imagine that when you next go to sleep, a miracle occurs during the night, so that when you wake up feeling refreshed, your problem has vanished. I want to ask you how do you know that your problem has gone? What is different about this morning? What is it that has disappeared or changed in your life?’

This question can help to identify and gain a greater understanding of what the problem is and how it is affecting the person and can provide motivation to want to move forward and overcome it after imagining what it could be like to wake up without it (De Shazer et al., 1986).

2. Coping Questions

Coping questions are questions that the practitioner will use to gain an understanding of how the person has managed to cope.

When someone has been suffering from depression or anxiety for a long time, it often begs the question of how they have continued in their life despite the potentially degrading or depleting effects of such mental and emotional health problems.

Examples of coping questions include:

‘After everything you have been through, I am wondering what has helped you to cope and keep you afloat during all this?”;

‘I feel to ask you, what it is exactly that has helped you through this so far?’.

These questions cause the client to identify the resources they have available to them, including noticing the internal strength that has helped them make it thus far, which they might not have been consciously aware of before (De Shazer et al., 1986).

3. Exceptions to the Problems

Solution-focused therapy believes that there are exceptions or moments in a person’s life when the problem or issue is not present, or the problem is there; however, it does not cause any negative effects (De Shazer et al., 1986).

Thus, raising the question of what is different during these times. The practitioner can investigate the exceptions to the problem by asking the client to think about and recall moments in their life when the problem was not an issue; they can then inquire as to what was different about these moments.

This could lead to clues for helping to create a solution for the problem. It also will help the client to know that there are times when they are not affected by the problem, which could help lessen the power it has over their emotional and mental state.

As we can often be ‘clouded’ or consumed by our problems, it can be empowering to notice or be reminded of times when we were not.

4. Compliments

This involves the practitioner actively listening to the client to identify and acknowledge their strengths and what they have done well, then reflecting them back to the client whilst also acknowledging how difficult it has been for them.

This offers encouragement and values the strengths that the client does have. The practitioner will use direct compliments (in reaction to what the client has said), for example, ‘that’s amazing to hear!’, ‘wow, that’s great.’

Indirect compliments are also used to encourage the client to notice and compliment themselves, such as coping questions or using an appreciatively toned voice to dive deeper into something highlighting the positive strengths of the client.

For example, ‘How did you manage that?!’ with a tone of amazement and happy facial expressions.

5. Scales

The practitioner will ask the client to rate the severity of their problem or issue on a scale from 1-10. This helps both the practitioner and client to visualize whereabouts they are with the problem or issue.

Examples of scaling questions include:

• ‘On a scale of 1 to 10, where would you rate your current ability to achieve this goal?’;
• ‘From 1-10, how would you rate your progress towards finding a job?’;
• ‘Can you rate your current level of happiness from 1-10?’;
• ‘From 1-10, how much do you attribute your level of alcohol consumption to be one of the main obstacles or sources of conflict in your marriage?’.

They can be used throughout sessions to compare where the client is now, in comparison to the first or second session, and also to rate how far from or near their ideal way of being or to complete their goal.

This can help both practitioner and client notice if something is still left to be done to reach a 9 or 10, and can then start exploring what that is.

Scaling helps to give clarity on the client’s feelings, it also helps to give sessions direction and highlights if something is holding back the client’s ability to solve the problem still or not.

Critical Evaluation

Advantages

• SFBT is a short-term therapy; on average, sessions will last for 6-10 weeks but can even be one stand-alone session, which helps it be more cost-effective compared to longer-term therapy that lasts for months or years (Maljanen et al. 2012).
• It can help clients to identify their problems and then find a goal to overcome them; the practitioner also offers the client support through compliments which gives them the motivation to notice their strengths, increase their self-esteem, and keep striving to achieve their goals.
• It is future-oriented, so it helps to motivate the client to move forward in life and not to feel stuck in their past; also, SFBT is positive in nature, so it gives the client the optimism needed to move forward into the future.
• It is non-judgmental and compassionate in its approach; the client chooses their own goals, not the therapist, and they are praised/ complimented for their strengths no matter how small; even if they fail at achieving their set goal, they are praised for showing their strengths in other ways in life, helping them not to lose sight of their inner resources and still feel encouraged.

Disadvantages

• Because it is short term, it is not a good fit for everyone, for example, clients with more severe problems that need more time and clients who are withdrawn or struggle to speak and open up fully to the therapist, who would naturally need more time to gain trust and feel comfortable, before being able to work towards a solution with the help of the practitioner.
• Has less importance placed on past traumas, giving less room during sessions to explore these significant events (sometimes of great complexity), and help the client to understand why something in their past happened and why it is still affecting them today.
• As it is solution-focused, it could minimize the client’s pain, making them feel like their past traumas have not been heard or felt by the counselor, which can and does affect the therapeutic alliance, as you are more likely to openly and honestly speak about something traumatic, if you feel the other person deems it important as well, and if they give you space for it. It is also a reason some people choose to see a counselor because they have not had the opportunity to speak about their problems or traumas with other people in their life.
• As the therapy is client-led, this could lead to a few problems. For example, if the client wishes to talk about and explore a past trauma or gain an understanding of a past issue, despite cues from the practitioner to focus on the near future in a solution-focused way, then it will be difficult for the practitioner to actually use this method at all with the client, as SFBT requires the client to actively be ready and want to find a solution and focus towards their near future.
• Also, the client-led approach means that the client can decide when their goals have been sufficiently reached. Therefore, they can end the therapy sessions early if they feel it’s enough, even if the practitioner is concerned about this.

References

Bond, C., Woods, K., Humphrey, N., Symes, W., & Green, L. (2013). Practitioner review: The effectiveness of solution focused brief therapy with children and families: A systematic and critical evaluation of the literature from 1990–2010 . Journal of Child Psychology and Psychiatry, 54 (7), 707-723.

De Shazer, S. (1988). Clues: Investigating solutions in brief therapy . New York: Norton & Co.

De Shazer, S., Berg, I. K., Lipchik, E., Nunnally, E., Molnar, A., Gingerich, W., & Weiner-Davis, M. (1986). Brief therapy: focused solution development. Family Process, 25(2): 207–221.

De Shazer, S., & Dolan, Y. (2012). More than miracles: The state of the art of solution-focused brief therapy. New York: Haworth Press

Franklin, C., Biever, J., Moore, K., Clemons, D., & Scamardo, M. (2001). The Effectiveness of Solution-Focused Therapy with Children in a School Setting. Research on Social Work Practice, 11 (4): 411-434.

Iveson, C. (2002). Solution-focused brief therapy. Advances in Psychiatric Treatment, 8(2), 149–157.

Kim, J, S., Brook, J., Akin, B, A. (2018). Solution-Focused Brief Therapy with Substance-Using Individuals: A Randomized Controlled Trial Study . Research on Social Work Practice, 28 (4), 452-462.

Maljanen, T., Paltta, P., Härkänen, T., Virtala, E., Lindfors, O., Laaksonen, M. A., Knekt, P., & Helsinki Psychotherapy Study Group. (2012). The cost-effectiveness of short-term psychodynamic psychotherapy and solution-focused therapy in the treatment of depressive and anxiety disorder during a one-year follow-up. Journal of Mental Health Policy and Economics. 15 (1), 13–23.

Sanai, B., Davarniya, R., Bakhtiari Said, B., & Shakarami, M. (2015). The effectiveness of solution-focused brief therapy (SFBT) on reducing couple burnout and improvement of the quality of life of married women. Armaghane danesh, 20 (5), 416-432.