Practitioner Review: The Effectiveness of Solution Focused Brief Therapy with Children and Families

Background and Scope of Solution Focused Brief Therapy (SFBT)

Solution Focused Brief Therapy (SFBT) is a therapeutic approach that emphasizes the resources and strengths that individuals possess, and how these can be utilized to facilitate positive change.

• Origin: SFBT evolved from clinical practice at the Brief Family Therapy Centre, Wisconsin, in the early 1980s, influenced by the work of Milton Erickson.

• Core Principles: SFBT focuses on a strengths-based partnership with clients, encouraging them to take an active role in identifying exceptions to their problems and doing more of what works. It emphasizes ‘life without the problem’ rather than detailed problem analysis.

• Key Elements: Common elements include focusing on client goals, eliciting exceptions to the problem, and identifying client strengths and resources.

• Tools & Techniques: Therapists use tools like the miracle question, coping questions, and scaling to elicit client skills and potential for change.

• Session Structure: Sessions typically last about an hour, ending with compliments, identifying the need for further sessions, and setting homework tasks.

• Duration: SFBT interventions are usually short-term, often consisting of a small number of sessions or even a single session.

• Applications: SFBT has been applied across a range of contexts and client groups, including family problems, mental health issues, and problem behaviors. More recently, it has been used for complex family problems like child protection issues.

Methodology

The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

• Focus: Evaluations published in English between 1990 and 2010, reporting the effectiveness of SFBT with children and young people aged 0–18 years and their families.

• Search Terms: Focused on three areas: SFBT, the population under study (children, young people, and families), and terms relating to interventions.

• Databases: 44 databases were searched, including PsychInfo, ISI Web of Knowledge, and Medline, along with web searches using Google and Google Scholar.

• Inclusion Criteria: Peer-reviewed studies and book chapters reporting primary studies were included; reviews and meta-analyses were used for reference harvesting.

• Quality Assessment: Studies were coded using a purpose-made framework, evaluating approach, focus, methods, quality, and findings.

Criteria for Quantitative Studies

• Use of a randomized group design.

• Focus on a specific, well-defined disorder or problem.

• Comparison with treatment-as-usual, placebo, or standard control.

• Use of manuals and procedures for monitoring and fidelity checks.

• Sample large enough to detect effect (from Cohen, 1992).

• Use of outcome measure(s) that have demonstrable reliability and validity.

Criteria for Qualitative Studies

• Appropriateness of the research design.

• Clear sampling rationale.

• Well-executed data collection.

• Analysis close to the data.

• Emergent theory related to the problem.

• Evidence of explicit reflexivity.

• Comprehensiveness of documentation.

• Negative case analysis.

• Clarity and coherence of the reporting.

• Evidence of researcher-participant negotiation.

• Transferable conclusions.

• Evidence of attention to ethical issues.

Quality Rating

• Quantitative Studies: Low quality (0–2 points), medium quality (3–4 points), high quality (5–7 points).

• Qualitative Studies: Low quality (0–4 points), medium quality (5–8 points), high quality (9–12 points).

• Mixed Methods: ‘Dual coded’ and evaluated as both qualitative and quantitative, with the higher quality rating awarded in case of disparity.

Methodological Appropriateness

Evaluations took account of:

• Having a clearly defined participant sample and some measure of outcome.

• The soundness of the SFBT model used.

• The use of objective outcome measures relating to children/families.

Best Evidence Studies

• Studies reported as being at least medium quality.

• Studies having at least medium level appropriateness to the main purpose of the review.

• Out of 83 studies, 38 were identified as best evidence.

Findings

Findings are organized according to problem area, consistent with previous reviews. Case studies illustrate contextual factors relevant to SFBT efficacy in emerging practice areas.

SFBT and Internalizing Child Behavior Problems

Studies focus on internalizing behaviors (e.g., anxiety, low self-esteem, and depression).

High-Quality Studies

• Green, Grant, and Rynsaardt (2007): Used SFBT as part of a broader life coaching intervention, demonstrating a reduction of internalizing difficulties for teenage girls showing nonclinical levels of depression, anxiety, and stress at baseline.

• Kvarme et al. (2010): Demonstrated moderate increases in self-efficacy for girls post-intervention and improvements for both boys and girls at follow-up.

• Daki and Savage (2010): Showed greater reduction of anxiety and improvement in reading skills following a reading intervention incorporating SFBT, compared with a reading intervention alone. Effect size for intervention was $0.7$ (moderate).

Medium Quality Studies

• Springer, Lynch, and Rubin (2000): Combined SFBT with interactional and mutual aid approaches for Hispanic children of incarcerated parents, finding a moderate effect size of $0.57$ for the intervention.

• Grandison (2007): Combined SFBT and Eye Movement Desensitization and Reprocessing (EMDR), with pupils reporting increased confidence and parents and teachers confirming improvements.

• Smyrnios and Kirkby (1993): A family group intervention where Brief Therapy intervention results were matched by a minimal contact control intervention.

Case Studies

• Frels, Leggett, and Larocca (2009): Reported improved coping skills in a girl undergoing long-term surgery, using creative SFBT sessions.

• Korman (1997): Provided a positive case study of a SFBT intervention with a girl displaying psychosomatic symptoms.

• Georgiades (2008): Reported the effectiveness of a 4-year combined SFBT and empowerment intervention with a boy who witnessed and experienced domestic violence, resulting in remission of symptoms and improved relationships.

SFBT and Externalizing Child Behavior Problems

Studies focus on externalizing behaviors (e.g., aggression, oppositional behavior, and social adjustment).

Medium Quality Studies

• Cepukiene and Pakrosnis (2010): Evaluated an individual SFBT intervention with young people in children’s homes, showing significant progress in relation to behavior difficulties (average ES $= 0.61$) compared with controls.

• Shin (2009): Undertook a RCT with young people on probation, finding that the intervention group had decreased aggression and improved social adjustment compared with the control group.

• Conoley et al. (2003): Reported single case experimental studies of family SFBT for children displaying aggressive and oppositional behavior, with families reporting resolution of issues post-intervention.

• Corcoran and Stephenson (2000): Evaluated the effectiveness of family group SFBT, noting increases in conduct problems at post-test and a high attrition rate.

• Vostanis, Anderson, and Window (2006): Evaluated SFBT as a service delivery model for families with oppositional behavior or mild emotional difficulties, finding that intervention programs offered an earlier response.

• Zimmerman et al. (1996): Focused on SFBT with self-referring parents of adolescents with problem behavior, with mixed but generally positive results for the intervention group alongside significant attrition in the control group.

• Moore (2002): Reported a quasi-experimental evaluation of individual SFBT and teacher support for children with poor classroom behavior, demonstrating positive improvements.

• Emanuel (2008) and Franklin, Biever, Moore, Clemons and Scamardo (2001): Provided promising results for small scale SFBT interventions with children displaying moderate levels of externalizing behavior difficulties at pre-test.

• Violeta and Dafinoui (2009): Combined SFBT and motivational interventions to decrease truancy, finding significant decreases in truancy rates for the experimental group.

• Window, Richards and Vostanis (2004): Using SFBT and behavioral techniques, reported most improvement in school and child problem behavior domains.

Caveats:

• Vostanis et al. (2006): Regular Child and Adolescent Mental Health referral services also reduced child behavior difficulties.

• Corcoran and Stephenson (2000): Some increase in self-reported conduct problems post intervention.

• Yarbrough and Thompson (2002): The comparison intervention achieved slightly better results.

SFBT with Both Internalizing and Externalizing Child Behavior Problems

Studies address groups of young people who demonstrated both externalizing and internalizing behavior problems.

High Quality Study

Franklin et al. (2008): School-based SFBT intervention for children with social and emotional difficulties showed decreases in teacher reports of externalizing and internalizing behavior problems.

Medium Quality Studies

• Wilmshurst (2002): Evaluated an intervention for ‘at risk’ youths with severe emotional and behavioral difficulties, finding improvements but unclear impacts on anxiety, depression and ADHD.

• Seagram (1997): Reports a RCT for the use of SFBT with young people in secure custody; results were mixed, with staff reporting improvements in some areas, but no reoffending differences.

Other Applications of SFBT

Describes applications in areas where there has been less research.

High Quality Study

Lloyd and Dallos (2008): Process evaluation of the first SFBT session for mothers of children with intellectual disabilities, questioning the use of the miracle question.

Medium Quality Studies

• Adams, Piercy & Jurich (1991): Found an initial SF task yielded a more positive response compared to a problem based task.

• Antle, Barbee, Christensen and Sullivan (2009): Adherence study using SFBT as part of a broader child protection approach (Solution Based Casework), showing promising evidence for effectiveness in reducing maltreatment recurrence.

• Corcoran and Franklin (1998): Provided a positive case description illustrating the application of SFBT in relation to physical abuse.

• Thompson and Littrell (1998): Successfully adapted SFBT to help 16–18 year olds with learning disabilities solve problems.

• Murphy and Davis (2005): Used a combined SFBT and behavioral modelling approach to increase the signing rate for a boy with learning difficulties and hearing impairment.

• Cook (1998): Evaluated an SFBT group approach to improve self-concept, but there were no significant differences between intervention and control groups at outcome.

• Triantafillou (2002): Evaluated an SFBT intervention for young people and their foster parents, but there were no significant differences between intervention and control groups post intervention.

• Ziffer, Crawford and Penney-Wietor (2007): Provided reports of positive long-term outcomes for a group intervention for parents and children undergoing divorce.

Conclusions

• The evidence base is relatively weak, with only five high-quality research studies identified.

• SFBT is used within a broad range of therapeutic practices, sometimes in combination with other approaches, limiting conclusions about effectiveness as an intervention in its own right.

• Studies provide some preliminary support for the use of SFBT with children presenting with internalizing and externalizing behavior problems in both school settings and with their families, particularly as an early intervention for mild-to-moderate issues.

• Further research is needed to address gaps, such as its use by teachers to improve child behavior difficulties or with parents and family groups to reduce the recurrence of child maltreatment.

Based on the information provided in this article, several aspects of the counselling work context or setting could affect the way you use Solution Focused Brief Therapy (SFBT):

1. Integration with Other Approaches: SFBT is often used in combination with other therapeutic practices. This suggests that the setting may require you to integrate SFBT with other models, which could influence how purely you can apply its principles.

2. Specific Client Groups: The effectiveness of SFBT has been noted particularly with children presenting mild-to-moderate internalizing and externalizing behavior problems. The presenting issues of your client base may influence the applicability and effectiveness of SFBT.

3. Limited Evidence Base: The article notes that the evidence base for SFBT is relatively weak, and further research is needed in certain areas. This may mean you need to be prepared to justify your approach or adapt it based on emerging evidence and contextual demands.

4. Setting-Specific Constraints: Depending on whether you are in a school setting, family service, or mental health service, there may be constraints related to session length, follow-up capabilities, or required reporting that will need to be negotiated to effectively implement SFBT.

5. Resources: The availability of funding, training, and supervision