Solution-Focused Brief Therapy

Unlike many traditional forms of therapy that analyze problems by taking a deep dive into past life experiences, solution-focused therapy doesn't dwell on the details of why or how things came to be. Solution-focused therapy addresses the here-and-now, concentrating on present-day solutions.

What is Solution-Focused Brief Therapy (SFBT)?

Solution-focused therapy, also called solution-focused brief therapy (SFBT), takes the approach that individuals know what they need to do to improve their lives and—with the right road map and a little assistance—can find the best solutions. Solution-focused brief therapy arose from the field of family therapy during the 1980s. The solution-focused approach gained popularity when psychotherapists Steve de Shazer and Insoo Kim Berg identified a new model of brief therapy. Rather than engage patients in ongoing discussions about the problems that brought them to therapy, de Shazer and Berg refocused patients on their hopes for the future and their capacity to contemplate possible solutions. The forward-focused approach encourages change rather than pulling apart and analyzing the problem itself. The goals of this method are two-fold: minimize time in therapy and lessen an individual's time spent suffering. The impetus is to help individuals focus on what they can do rather than limitations. This brief therapy method can be used either as a sole therapeutic approach or in conjunction with other forms of psychotherapy, counseling or treatment modalities.

Who can SFBT help?

According to Psychology Today, therapists use solution-focused brief therapy to help people of all ages address everything from normal, everyday stressors to high-impact life events, including child behavioral problems, family dysfunction, domestic or child abuse, drug addiction or alcohol use disorder, and marriage or relationship challenges. A solution-focused brief therapy approach is not recommended as treatment for some acute or severe mental health disorders.

How does SFBT work?

The therapeutic approach, based on de Shazer and Berg's studies, begins with identifying and clarifying goals, and then working in collaboration with the patient to find solutions that can improve their quality of life. The method is rooted in the beliefs that people develop default patterns based on experiences, and these patterns dictate how they cope. According to Positive Psychology, "The solution-focused model holds that focusing only on problems is not an effective way of solving them. Instead, SFBT targets patients' default solution patterns, evaluates them for efficacy, and modifies or replaces them with problem-solving approaches that work." Solution-focused therapy follows the thinking that nearly everyone can be motivated to find solutions. By helping patients focus on what is working, de Shazer and Berg theorized that small, positive changes could produce a ripple effect.

The solution-focused model is based on several assumptions:

• The only constant in life is change
• The patient must want to change
• Small changes can lead to big outcomes
• The patient—not the therapist—is the expert
• Therapy is short term
• Every problem has exceptions
• Change can occur more easily when the patient’s focus is on the present and future
• Negative thoughts can be blocked, freeing patients in therapy to act in an effective, positive manner

What happens during SFBT sessions?

Typically, the therapist begins by finding out what the patient wants to get out of the session, and how life would change if their problems were resolved. This helps the therapist and patient work together to create reasonable, actionable goals to bring about the desired changes.

The "miracle question" is an important strategy in this type of therapy. Intended to open the lines of creative thinking, the psychotherapist might ask: "If a miracle occurred while you were sleeping, what changes would you notice in your life when you woke up?" If it's too challenging for a patient to picture an imaginary future, you might ask a "best hope question" such as "What are your best hopes for today's session?" or "How will you know things are good enough for our sessions to end?"

Another question, the "coping question," is intended to help individuals recognize their resiliency. One example would be: "In the face of such difficulty, how do you manage to fulfill your obligations?" In family therapy, the therapist might ask: "What do you like about your significant other and your marriage?"

"Exception questions" are also useful, asking about the patient's experiences with and without the problem(s) present. This question helps individuals see when the problem failed to have power over their thoughts or moods. An example of an exception question is: "At what times have you felt happiest?" Identifying exceptions is a critical part of this type of psychotherapy because the process helps patients focus on what works and make progress toward future solutions.

Before the end of each therapy session, patients are asked to evaluate their progress toward goals and plans, likely through rating them on a scale of zero to 10. This helps people identify small, reasonable steps they can take to diminish or eliminate their problems, and recognizes the progress they are making.

Interventions commonly used in solution-focused therapy:

• Ask miracle questions and best hope questions to elicit goal-setting thoughts
• Ask exception questions to determine when the problem(s) had no power over the patient
• Have the patients assess problems with a zero to 10 rating scale
• Ask patients to do one thing differently in a specific problem situation
• Reinforce patient's positive qualities, helping the individual recognize personal strengths and virtues as well as the good things in life, the small victories—rather than focusing on the negative
• Focus on problem-solving, not the problem itself
• Develop a plan to maintain the gains

What are the limitations of solution-focused therapy?

Goal-oriented SFBT is effective in helping patients address common, everyday stressors, such as problems at school or work, but the approach might not be appropriate for people who want to figure out the underlying reasons of how or why they got to where they are today. In addition, the short-term therapy format might not be adequate for the therapist and patient to develop a strong working relationship and connect on an emotional level. Another potential limitation is that some patients might get frustrated with the concept that problems can be fixed.

How many sessions are needed for effective outcomes?

One major advantage of short-term, solution-focused coaching is the brevity of the sessions. The format allows patients to quickly harness the resources they already have, rather than create new ones. When this approach is used as an intervention, outcomes could be achieved in a single session or require several sessions. Patients and therapists decide together, based on progress and individual circumstances, when it's appropriate to end therapy.

What is the effectiveness of solution-focused therapy in addiction treatment?

While more research is needed to gauge the effectiveness of SFBT in the treatment setting, some clinicians see the method as a beneficial supplement to other evidence-based therapies. With assistance from the therapist, patients in solution-focused brief therapy can gain important insight and skills needed to make changes in their lives.