Solution-Focused Therapy, or as it is often termed Solution-Focused Brief Therapy (SFBT), was founded by married psychotherapists Steve de Shazer and Insoo Kim Berg and their colleagues in the late 1970s at a Milwaukee, Wisconsin, outpatient mental health center. The team of therapists spent many hours viewing therapy sessions and recording the types of questions being asked, what behaviors led to effective therapeutic outcomes, and how therapists’ techniques and interactions with clients were associated with the treatment outcome.
The focus of SFBT is centered on the development of realistic, concrete, and specific goals. Therapists in SFBT make the assumption that their clients have some knowledge of how to better themselves even know they may need considerable assistance in reaching their goals.
Assumptions of SFBT
SFBT makes several assumptions that provide the background for its implementation:
- Focusing on positive things and future solutions is advantageous in therapy.
- Placing the focus on the person’s strengths and solutions will reduce the length of therapy to its functional minimum.
- People in therapy have the capacity to act in an effective manner; however, this capacity may be temporarily blocked by negative thoughts.
- Every problem has exceptions.
- Clients in therapy tend to present one side of the problem/issue. SFBT encourages them to view their problems from a different angle.
- Small changes lead to bigger changes.
- Clients want to change, have the capacity to change, and do their best to make changes.
- Each person is unique, and each solution is unique.
Major Concepts of SFBT
Solution-Focused Brief Therapy views all forms of psychotherapy as specialized discussions or conversations. In SFBT, the therapeutic conversation is targeted at understanding the client’s goals and the client’s vision for reaching them. SFBT uses many different approaches to help the client clarify goals and preferred methods of achieving those goals. A few of these approaches include:
- Discussing what has worked in the past: Therapists understand that most people have learned to solve problems in the past and have some conceptualization, even if it is vague, as to how to solve their current problem. Therapists often inquire as to whether there have been times in the client’s past where the issue was not a problem, or if the client did something or knew of others who did something that was helpful in solving similar problems.
- Trying to find exceptions: Even with severe problems, such as substance abuse or addiction, most every client in therapy has experienced a time in the past where the problem could happen but for some reason it did not happen. SFBT defines these instances as exceptions. An exception is something that occurs instead of the problematic behavior and may often occur without conscious intent. By understanding both past solutions (as described above) and exceptions when the problem did not occur but could have occurred, clients are proactively working out potential future solutions to their problems.
- Identifying compliments: Few people are total failures or living totally unsuccessful lives. Therapists also validate what clients are already doing that works for them and at the same time acknowledge how difficult it is for them to have to deal with their issues. Using compliments in therapeutic sessions can help accentuate behaviors that clients are already performing that are useful and also communicate to the client that the therapist is listening, understands, and is concerned.
- Encouraging clients to engage in behaviors that are already working or to experiment: Therapists encourage clients to do more of what has previously worked for them in addition to trying to limit changes that clients believe to be successful (therapists refer to these as experiments). Therapists may encourage clients to try new potential solutions by asking them to experiment in this way.
- Asking the miracle question (MQ): SFBT is most likely best known for this aspect of its special approaches. The MQ goes something like this: The therapist asks, “Suppose that tonight while you were sleeping a miracle occurred and your problem was completely solved. When you woke up tomorrow, what would be some of the things that would tell you that your life had suddenly gotten better – as if a miracle had occurred?” The therapist continues to focus on the question even if the client says that such a miracle would be impossible. Eventually, the client begins to describe certain aspects that would have to be present in order for such a miracle to have occurred, and the therapist acknowledges these and then asks something to the effect of, “And how would that make a difference?” The therapist uses the client’s answer as a springboard to help the client find already existing facets of life that can act in a similar manner. This helps clients separate themselves from their issues and move into a situation, even if it is imaginary, where their problems are solved. The strategy highlights potential existing solutions that are available to clients to help them understand and deal with their current issues.
- Using other questions, such as present and future-focused questions, scaling responses, developing coping questions, etc.: Therapists ask questions that are focused on the future or the present. This reflects the notion that the client’s particular problems are best solved by focusing on what is already working or what can work. Therapists may also ask clients to rate potential solutions or current problems on a scale of 1-10 where 10 is the most effective potential solution and 1 is the worst-case scenario of the problem. This helps put both problems and potential solutions in perspective.
Of course, there are a number of other different approaches that can be used in SFBT. The goal is to get the client focused on a solution and to help the client generate potential solutions that have worked or possibly could work. Then the therapist and the client work together to implement these solutions as they relate to the client’s presenting issues.
SFBT is an intervention that attempts to find immediate solutions to the client’s issues and to implement them efficiently and relatively quickly compared to other types of therapies. Therapists will typically have a flexible timeline that is often relatively brief. During this time, therapists help clients to solve their problems and get them to be as independent as possible. Of course, the timeline can be changed if needed but therapists in SFBT attempt to address their clients’ issues as quickly and efficiently as possible. However, many of the treatments in SFBT rarely extend beyond 8-10 sessions.
Some Problems with SFBT
Several problematic features of the SFBT approach include the following:
- Assuming that clients already know the solutions to their problems is often problematic for conditions like substance abuse and other severe psychological disorders. Clients may have a general idea of the solution to their problems, such as stopping substance abuse or something to that effect; however, they may need a structured approach to help them reach that goal. Clients with severe issues often oversimplify their problems and potential solutions.
- Most therapists learn that always taking what the client says at face value can be a mistake. A good therapist learns to listen to clients and ask them what they mean or how they feel as opposed to simply taking clients’ self-report as being totally accurate.
- Most therapeutic paradigms approach change as a collaborative relationship between the client and therapist where the therapist is a guide or teacher. The therapist is considered to be knowledgeable regarding psychological diagnoses, therapeutic methods that work with particular diagnoses, etc. While gleaning information from clients regarding what they think will work can be important, it may not always fit in with empirically validated treatment protocols. For instance, many clients with substance abuse issues are able to relate times when they only used a small amount of their drug of choice and did not abuse it, or did not give into cravings to use drugs until they believed it was more appropriate to do so. The majority of substance abuse treatment providers would not consider these examples as potential courses of action for clients with addictions.
- Clients are often wrong about their interpretations of events. Many standard forms of treatment, such as Cognitive Behavioral Therapy, identify the client’s irrational belief system as the potential source of the problems. SFBT may actually be more prone to taking the opposite approach – that the irrational belief system of the client can be a source of the solution.
- As for chronic issues, like substance abuse, personality disorders, major depression, and anxiety, SFBT may actually be too brief since most therapists attempt to keep the length of the treatment under 10 total sessions. SFBT may have more relevance in counseling situations where the client’s problems are not chronic or severe, or do not reflect psychological disorders.
Nonetheless, SFBT does offer a number of interesting techniques that can help therapists understand clients’ points of view better. A recent review in the journal Families in Society found that the research evidence regarding the effectiveness of SFBT is encouraging but still lacking and more research needs to be done; however, there were no controlled research studies using SFBT for substance abuse.
SFBT techniques can be used in other types of Cognitive Behavioral Therapies, such as Dialectic Behavioral Therapy, Rational Emotive Behavioral Therapy, etc. However, as a standalone treatment for chronic issues such as substance abuse, SBFT does not have sufficient research support to warrant its exclusive use.