Research

Solution-Focused Brief Therapy:
A Review of the Outcome Research

Sheri Eisengart, a Doctoral Candidate at the Mandel School, CWRU, and I have just completed a review of all of the published outcome research on SFBT up through 1998. We're pleased to make a summary of it available here for your review. If you would like the complete paper, please email me (mailbox on my home page).

To be included in our review, the intervention had to to be identified as solution-focused or solution-oriented brief therapy, and the report had to reference the writings of de Shazer and the Milwaukee group. In the summary table of outcome studies we indicate how many of core conditions of SFBT were included in the intervention. We take these core conditions from de Shazer and Berg and the proposed research protocol of the European Brief Therapy Association.

In addition to investigating SFBT interventions, the study had to meet three other criteria to be included in our review:

it employed some form of experimental control,

it assessed client behavior or functioning (not satisfaction), and

it looked at end-of-treatment or follow-up outcomes.

Our review located fifteen controlled outcome studies. Table 2, below, summarizes the results of the studies along key dimensions. The complete reference for each study is given following the table. [If you are aware of any other studies meeting our selection criteria which aren't included here, please let us know.]

So, what did we find? Is SFBT effective? Here are the "box score" results. Fifteen controlled studies have been reported in the literature up through 1998. Thirteen of the fifteen reported that SFBT resulted in improved client outcomes – two studies did not report pre-post results for SFBT clients. A more stringent test of effectiveness is to ask whether SFBT is as good as or better than standard treatments. Eleven studies allowed such a comparison, and in 7 of the 11 studies SFBT equaled or surpassed the outcomes of the standard treatment. SFBT sometimes produced better outcomes, and sometimes it produced comparable outcomes in less time. Only one study (Littrell et al, 1995) failed to report any positive outcomes for SFBT. We conclude that the box score analysis provides strong initial support for the effectiveness of SFBT.

Summary Table

	Sundstrom, 1993	Littrell, et al, 1995	LaFountain, et al, 1996	Polk, 1996	Zimmerman, et al, 1996	Cockburn, et al, 1997	Eakes, et al, 1997
Subjects/ Problem
setting	university	high school	elem. – high school	Employee Assist. Prog.	university clinic	occup. rehab.	out-pt. mental health.
subjects	40	61	311	1	42	48 s’s plus spouses	10 s’s plus family mems.
problem	depression	academic, pers. & social concerns	unspecified	problem drinking	parent-child conflict	orthopedic injury	schizophrenia
target behavior	normal functioning	normal functioning	unspecified	abstinence	parenting skills	work hardening	family functioning
demographics	all female ave age: 19	52% male; ave age: 16	53% male; elem. – high school age	all male; age: 36	36% male; ave age: 41	58% male; ave. age: 37	all male; ave. age: 36
clinical pop.?	no	yes	yes	yes	no	yes	yes
Intervention
# SFBT core conditions	5	2	5	6	4	?	6
modality	individual	individual	group	individual	group	couple	family
# sessions	1, 1�-hr. ses.	1	8	6	6, �-hr. ses.	6, 1 hr. ses.	5
tmt manual or protocol?	yes	no	yes	yes	yes	no	no
therapist exper.	varied exper.; newly trained in SFBT	counselors; newly trained in SFBT	counselors; newly trained in SFBT	not reported	trainees; newly trained in SFBT	not reported	nurses; newly trained in SFBT
Design
type	pre/post-test comparison group	post-test only comparison group	pre/post-test comparison group	single-subject AB with reconstructed baseline	pre/post-test control group	Solomon 4 group	pre/post-test comparison group
randomized?	yes	yes	yes	n.a.	yes	yes	no
comparison group	prob-focused; interpersonal therapy	problem-focused brief therapy	standard counseling groups	n.a.	no treatment	standard rehab treatment	standard aftercare
Outcomes/ Results
measures used – end of treatment outcome	Beck Depr. Inv.; Depr. Adject. Checklist Rosenberg Self-Esteem Scale	self-ratings of problem severity, goal attainment, and intensity of feelings	Index of Personality Chara. - sig. between group differences on 3 of 8 scales; Counselor reports of goal attainment – 81% achieved goals	days abstinent – modest increase; days work attended – modest increase	Parenting Skills Inventory – sig. between group differences on 4 of 8 scales; Family Strengths Assess. – no sig. between group diffs.	F-COPES –sig. between group differences on all 5 scales; PAIS-R – sig between group differences on 4 of 5 scales	Family Environment Scale – sig. between group differences on 4 of 11 scales
follow-up	7-10 days – both groups sig. improved on BDI and DAC; no sig. between group diffs on any measures	2 weeks and 6 weeks – no sig. between group differences on any of the measures	none	none	none	60 days 68% tmt s’s vs. 4% control s’s returned to work in less than days	none
Other
location	U.S.	U.S.	U.S.	U.S.	U.S.	U.S.	U.S.

Summary Table (cont’d)

Franklin, et al, 1997	Lindforss, 1997	Seagram, 1997	Sundman, 1997	Triantafillou, 1997	Zimmerman, et al, 1997	Geil, 1998	Lambert, et al, 1998
Subjects/ Problem
out-pt. family counseling	prison	secure custody	public social services	residential treatment	university clinic	elem. school	private practice
3 s’s plus family mems.	59	40	382 s’s and family mems.	12	36 couples	8	27 plus compar. s’s
parent-child conflict	drugs; discipline problems	adolescent offenders	living allowances; child welfare	depression; hyperactivity; oppositional	interested in improving marital relat.	externalizing behavior	depression, sub abuse, anxiety, etc.
family functioning	pro-social behavior	prosocial attitude & beh.	self-sufficiency	pro-social behavior	improved marital relat.	academic and task mgmt.	normal functioning
2 males, 1 female; all adolescents	all men	all male; age 16-19	not reported	male & female age: 10-14	marr. couples; age: most in 30’s	75% male; grades 1-5	14 male, 13 female; age 22-45
yes	yes	yes	yes	yes	no	yes	yes
Intervention
5	4	7	3	7	3	5	5
individual	network	individual	individ./family	supervision	couples group	consultation	individual
4-5	1-12; ave. 5	10, 1-hr. ses.	not reported	4, 3-hr. ses.	6, 1�-hr. ses.	8 cons. ses.	2-7; ave. 3.1
no	no	yes	no	yes	?	yes	yes
agency staff	not reported	advanced student	newly trained in SFBT	newly trained in SFBT	trainees, recent grads.	sch. psychols; newly trained in SFBT	therapist experienced in SFBT
Design
single-subject AB with reconstructed baselines	post-test only control group	pre/post-test control group	post-test only comparison group	post-test only comparison group	pre/post-test comparison group	single-subject AB with prospective baselines	pre/post-test comparison group
n.a.	yes	matched	no	matched	non-distress.	n.a.	no
n.a.	no treatment	standard institutional services	standard social services	standard child care	no treatment	behavioral & standard consultation	eclectic; time unlimited
Outcomes/ Results
self-anchored rating scales – sig. change in all 3 s’s FACES-III – all 3 s’s showed clinically sig. change	recidivism (new offense with return to probation or prison)	multiple (Jesness; Coopersmith; Carlson; SF Quest.) – tmt s’s had sig. lower chem. abuse tend., higher empathy, greater prob. solving, higher optimism	therapist & client completed questionnaire	serious incident reports (restraints, police, hosp.); medication use	Dyadic Adjustment Scale -- sig. change in tmt group on all 5 scales; posttest scores approached pretest scores of nondistress. comparison group	CISSAR (time-sampled beh. observation. using trained obsvrs.) – 2 of 3 SFBT s’s improved; behav. s’s improved more on ave.	Outcome Questionnaire – tmt s’s improved 21.3 points; 36% tmt s’s vs. 2% comp. s’s recovered after 2 sess.
3 months – changes maintained	12 months – 53% tmt s’s vs. 76% control s’s recidivated; 16 months – 60% tmt vs. 86% control recidivated	6 months – 20% tmt vs. 42% control recividism rate	1 year – no differences in goal attainment	16 weeks – 65% tmt vs. 15% control reduction in incident rpts; tmt group decreased/ control incr. med use	none	none	none
Other
U.S.	Sweden	Canada	Finland	Canada	U.S.	U.S.	U.S.

References

Cockburn, J. T., Thomas, F. N., & Cockburn, O. J. (1997). Solution-focused therapy and psychosocial adjustment to orthopedic rehabilitation in a work hardening program. Journal of Occupational Rehabilitation, 7(2), 97-106.

Eakes, G., Walsh, S., Markowksi, M., Cain, H., & Swanson, M. (1997). Family centred brief solution-focused therapy with chronic schizophrenia: A pilot study. Journal of Family Therapy, 19(2), 145-158.

Franklin, C., Corcoran, J., Nowicki, J., & Streeter, C. (1997). Using client self-anchored scales to measure outcomes in solution-focused therapy. Journal of Systemic Therapies, 16(3), 246-265.

Geil, M. (1998). Solution focused consultation: an alternative consultation model to manage student behavior and improve classroom environment. Unpublished doctoral dissertation, University of Northern Colorado, Greeley, CO.

LaFountain, R. M., & Garner, N. E. (1996). Solution-focused counseling groups: The results are in. Journal for Specialists in Group Work, 21(2), 128-143.

Lambert, M. J., Okiishi, J. C., Finch, A. E., & Johnson, L. D. (1998). Outcome assessment: From conceptualization to implementation. Professional Psychology: Research and Practice, 29(1), 63-70.

Lindforss, L., & Magnusson, D. (1997). Solution-focused therapy in prison. Contemporary Family Therapy, 19(1), 89-103.

Littrell, J. M., Malia, J. A., & Vanderwood, M. (1995). Single-session brief counseling in a high school. Journal of Counseling and Development, 73(4), 451-458.

Morrison, J. A., Olivos, K., Dominguez, G., Gomez, D., & Lena, D. (1993). The application of family systems approaches to school behavior problems on a school-level discipline board: an outcome study. Elementary School Guidance & Counseling, 27(4), 258-272.

Seagram, B. C. (1997). The efficacy of solution-focused therapy with young offenders. Unpublished doctoral dissertation, York University, New York, Ontario.

Sundman, P. (1997). Solution-focused ideas in social work. Journal of Family Therapy, 19(2), 159-172.

Sundstrom, S. M. (1993). Single-sesssion psychotherapy for depression: Is it better to focus on problems or solutions? Unpublished doctoral dissertation, Iowa State University, Ames, IA.

Triantafillou, N. (1997). A solution-focused approach to mental health supervision. Journal of Systemic Therapies, 16(4), 305-328.

Zimmerman, T. S., Jacobsen, R. B., MacIntyre, M., & Watson, C. (1996). Solution-focused parenting groups: An empirical study. Journal of Systemic Therapies, 15(4), 12-25.

Zimmerman, T. S., Prest, L. A., & Wetzel, B. E. (1997). Solution-focused couples therapy groups: an empirical study. Journal of Family Therapy, 19(2), 125-144.

Last updated: 12/13/99