Solution Focused Brief Therapy (SFBT)

Solution-Focused Brief Therapy (SFBT) is a form of treatment that is future-focused, goal-directed, and focuses on solutions, rather than on the problems that brought clients to seek therapy.

SFBT is used to treat people of all ages and a variety of issues, including child behavioural problems, family dysfunction, domestic or child abuse, addiction, and relationship problems.

Though not a cure for psychiatric disorders, SFBT may help improve quality of life for those who suffer from these conditions.

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WHAT IS SFBT?

Solution-Focused Brief Therapy (SFBT) is a strength-based form of psychotherapy. It was originally developed in the 1970’s and 1980’s by Insoo Kim Berg and Steve deShazer. The foundation of SFBT is about what is going right with clients, as opposed to the focus of many other forms of therapy which is on the problems that people are experiencing.

solution focused brief therapyWhen someone decides to see a psychologist, it is usually because things are not going as well in his or her life as he or she would like. There is usually some kind of problem. People have a tendency to focus on the negative, but SFBT utilises conversation and language to help shift the focus on what is working and create more solutions as a result.

Unlike many traditional forms of psychotherapy, SFBT is not based on any theory. It is not about solving problems, diagnosing mental illness, or healing sicknesses. There is not a focus on the past, such as one’s childhood, unless the therapist and client are discussing strengths and situations in which the client was resilient. SFBT is also not based on insight, unlike some approaches such as psychoanalytic theories.

SFBT is a form of “brief therapy” because it is not meant to continue for years. You can expect a simple approach based on clear, solution-oriented questions. There is an emphasis on simplicity, and the most simple way to the solution is the most preferable.

HOW DOES SFBT WORK?

SFBT is grounded in the belief that although individuals may already have the skills to create change in their lives, they often need help identifying and developing those skills. Similarly, SFBT recognises that people already know, on some level, what change is needed in their lives. SFBT practitioners work to help the people in their care clarify their goals.

Practitioners of SFBT encourage individuals to imagine the future they desire and then work to collaboratively develop a series of steps that will help them achieve those goals. In particular, therapists can help those in treatment identify a time in life when a current issue was either less detrimental or more manageable and evaluate what factors were different or what solutions may have been present in the past. 

A basic understanding of the SFBT treatment approach is embodied in the acronym: M.E.C.S.T.A.T.

M – Miracle Questions
E – Exception Questions
C – Coping Questions
S – Scaling Questions
T – Time-Out
A – Accolades
T – Task

Miracle Questions:

The Miracle Question involves the therapist asking the client to think about the future and what it would be like if their concern no longer existed. This helps the client shape their preferred future and establish goals for work.

A SFBT therapist may ask:

“What if you went home today, a miracle happened, and your problem disappeared?”

The therapist would allow the client time to process what their lives would be like without their current concern/problem and then ask:

“What would your life be like?”

Once the client and therapist process The Miracle Question, the therapist can follow up by scaling where the client feels like they are in relation to their preferred future. The therapist might ask:

“On a scale from 0-10, 0- being the worst things have been, 10- being a time when you no longer have this problem/concern, where do you feel like you are today?”

 

Exception Seeking Questions:

In SFBT  the therapist operates under the assumption that there has been a time in the client’s life when the problem/challenge either did not exist or was present in a less severe form.

The goal is for the therapist to work with the client to identify these occurrences and emulate them in the client’s current and future lives. The idea is that the client develops an understanding that they have either coped or lived without the problem in the past, and they have the ability to do it again.

The therapist may ask:

“Tell me about a time when you were not bothered by your weight/body image? What was different back then? What has worked for you in the past? How can you incorporate the practices that have worked in the past into your current life?”

 

Coping Questions:

Coping Questions are used to support the client’s self-efficacy. Regardless of how debilitating a problem/concern may seem, the client is living and is making efforts to work towards change. Coping Questions can be seen as a method to improve the client’s belief that they are in control of their problem/concern.

The therapist may ask:

“I see that things have been difficult for you recently. How are you continuing to get through each day? What has made you strong enough to come in to the office today to see me?”

With the Coping Questions, the therapist does not work to minimize the client’s problem/concern but rather validates their experience. The therapist utilizes the second portion as a way for the client to identify what resources they are utilizing to cope with their experience.

This tool moves away from the problem focused discussion and begins hi-lighting what is currently working for the client and possible solutions to build upon.

Scaling Questions:

Scaling Questions involve the client tracking their progress towards their goals (preferred future).
When using a scaling question, the therapist may ask:

“On a scale of 0-10, 0- being the worst things have ever been, 10- being the problem no longer exist, where are you today with your preferred future of no longer being bothered by your weight/body image?”

The client would then absorb the question and provide a concrete numerical designation for their current experience.

The therapist may ask follow up questions like:

“What would it take for you to move up one number?”

The client may respond:

“Losing 2 pounds.”

 

Time Out:

A Solution Focused Therapist will traditionally utilise a brief break or “time out” to reflect on the developments of the current session. This occurs during the second portion of the session and is preceded by the therapist asking the client if there is anything that the therapist has not asked that the client feels like would be important for the therapist to know.

Accolades:

During the brief break, the client is complimented for their efforts during the treatment session. It is important that the therapist display genuineness during this time period. Clients are sensitive to this aspect of the therapist/client relationship.

The therapist may say:

“When we discussed your coping resources, you quickly identified that you deal with your body image concerns by focusing on other areas of your life like your social relationships and your interests in movie development. This tells me that you really value your friendships and craft.”

 

Task:

During the Task portion of the SFBT treatment session, the therapist invites the client to discuss what behaviours may help them move towards their preferred future. The client brainstorms several tasks and discuss their willingness to participate or perform each task.

The therapist assigns a task for work based upon the client’s reported willingness to participate and their stage of change. It is important that the therapist realize that the client may or not be ready for each task they generated during the brainstorming portion of the session.

BENEFITS OF SFBT

SFBT has been used successfully in individual therapy and with both families and couples. Developed with the primary intention of helping those in therapy to find solutions to challenges, the approach has expanded to address issues in other areas of life, such as schools and workplaces. Individuals from different cultures, backgrounds, and age groups have all been shown to benefit from this type of therapy. 

SFBT can be used to treat a wide range of issues. It is most often used to address challenges for which the person in therapy already has some idea of possible solutions. In SFBT, the person seeking treatment is considered the “expert” on their concerns, and the therapist encourages the individual to envision their solution, or what change would look like, and then outline the steps necessary to solve problems and achieve goals. Because this modality focuses on solutions to issues, rather than the reasons behind them, it may be more effective at treating some concerns than others. 

Research has shown SFBT may be a helpful intervention for youth who are experiencing behavioural concerns or academic/school-related concerns. It has also proven effective as an approach to family therapy and couples counselling. This method is often used in conjunction with other approaches.  

SFBT may not be recommended for those who are experiencing severe mental health concerns.

REFERENCES

  1. Berg, I. K. (n.d.). About solution-focused brief therapy. Retrieved from http://www.sfbta.org/about_sfbt.html
  2. Dolan, Y. (n.d.). What is solution-focused therapy? Retrieved from http://www.solutionfocused.net/what-is-solution-focused-therapy
  3. International Alliance of Solution-Focused Teaching Institutes. (n.d.). Certification of trainees. Retrieved from http://iasti.org/?page_id=19
  4. Iveson, C. (2002). Solution-focused brief therapy. Advances in Psychiatric Treatment, 8(2), 149-156. DOI: 10.1192/apt.8.2.149. Retrieved from http://apt.rcpsych.org/content/8/2/149
  5. Trepper, T. S., McCollum, E.E., De Jong, P., Korman, H., Gingerich, W., Franklin, C. (n.d.). Solution focused therapy treatment manual for working with individuals. Retrieved from http://www.sfbta.org/research.pdf
  6. Yalom, V. & Rubin, B. (2003). Insoo kim berg on brief solution-focused therapy. Retrieved from https://www.psychotherapy.net/interview/insoo-kim-berg
  7. Berg, I.K. & Dolan, Y. (2001). Tales of solution: A collection of hope inspiring stories. New York:  W.W. Norton.
  8. Berg, I. K., & de Shazer, S. (1993).  Making numbers talk: Language in therapy. In S. Friedman (Ed.), The new language of change: Constructive collaboration in psychotherapy. New York: Guilford.
  9. De Jong, P., & Berg, I.K.(2007).  Interviewing for solutions (3rd Edition).  Brooks/Cole: Pacific Grove.
  10. De Shazer, S. (1984).  The death of resistance.  Family Process, 23, 79-93.
  11. De Shazer, S. & Dolan, Y. with Korman, H , Trepper, T. S., McCollom, E., Berg, I. K. (2007). More Than Miracles: The State of the Art of Solution-Focused Brief Therapy. Binghamtom, N.Y: Haworth Press.
  12. Gingerich, W., & Eisengrat,   S.  (2000).  Solution-Focused brief therapy: A review of the outcome research.  Family Process, 39, 477-498.
  13. Lindforss, L. & Magnusson, D. (1997). Solution-Focused therapy in prison.  Contemporary Family Therapy: An International Journal, 19, 89-1-3.
  14. McGee, D., Del Vinto, A., & Bavelas, J. (2005).  An interactional model of questions as therapeutic interventions.  Journal of Marital and Family Therapy, 31, 371-384.