E•B•T•A

European Brief Therapy Association

Conference at Brugge
28-30th of september 2007

WHAT MAKES FOR GOOD OUTCOMES IN

SOLUTION-FOCUSED BRIEF THERAPY?
A FOLLOW-UP STUDY
Cortés B., Peralta A., Machado M.C.
 QUESTIONS

1. What is outcome of Solution-Focused Therapy

conducted in Salamanca?

2. What clinical and process variables are associated

with outcome at termination and follow-up?

3. Does success last? Outcome at termination and

follow-up

Slide 2
 METHODS
I. SAMPLE:
- Universe was composed by cases attended
between October 2002 and November 2006
- Criteria of inclusion:
1. Telephone number available to make the
follow-up call.

2. At least 6 months since termination

(6 months to 39 months; mean 15.6 months).
Slide 3
 METHODS
Telephone calls (follow-up): 90 cases
- Sixteen cases were not located (wrong
number, telephone no available, does not
live in Spain any more).
- Only 1 case refused to participate
- Finally, 74 cases were included
• 47 (63,5%) cases – Family Therapy
Center of the Universidad Pontificia de
Salamanca (Spain)
• 27 (36,5%) cases – Private office
Slide 4
 METHODS
SAMPLE DESCRIPTION:
0% 5% 10% 15% 20% 25% 30% 35%

Anxiety 29%
Mood Problems 28%
Children behavior 13%
Parents-children comunication problems 13%
Couples 7%
Addictions 3%
Others family problems 3%
SAMPLE ACCORDING TO
Adolescent behavior 1% TYPE OF PROBLEMS
Eating disorders 1%
Various 3%

Source: First-Session Rating Questionnaire

Slide 5
 METHODS
SAMPLE DESCRIPTION:
40%
35% SAMPLE ACCORDING TO AGES
35%
30%
25%
19% 18%
20%
15% 14%
11%
10%
4%
5%
0%
10 or less 11 to 20 21 to 30 31 to 40 41 to 50 51 or more

Source: First-Session Rating

Q i i Slide 6
 METHODS
II. INSTRUMENTS:
1. First-Session Rating Questionnaire (video) :
- Clients’ description of their problem
- Any diagnosis given to them by a mental health
professional
- Clients’ report of any medications they are taking
- Clients’ goals as given in response to the “Miracle
Question”
- Clients’ report of pre-treatment change
- Clients’-therapist relationship type
- Clients’ answer to scaling questions
Slide 7
 METHODS
II. INSTRUMENTS:
2. Last-Session Rating Questionnaire (video):

- Whether clients talk about their initial complaint (s)

in the past tense
- Clients’ report of goal attainment
- Judges’ perception of degree of problem resolution
- Clients’ perception of any new problems
- Clients’ nature of termination

Slide 8
 METHODS
II. INSTRUMENTS:
3. Follow-up Questionnaire:
- 12-Item questionnaire
- Administered to clients over the phone

Slide 9
 METHODS

III. MAIN VARIABLES:

1. Success at termination: the case met at
least two of the three criteria indicative
of success
- Clients talk about their complaint (s) in past tense
- Clients report that they have reached totally or
partially theirs goals
- Judges consider that the complaint is already
resolved

Slide 10
 METHODS

III. MAIN VARIABLES:

2. Success at follow-up:
- A score of at least a 5 on the scaling question
- A scaling score higher than in the first session
- The clients report that they had not consulted another
mental health professional for the same problem

Slide 11
 RESULTS
AVERAGE OF SESSION

5 Mean 4,5 Mean 4,4

(Median 4)
Sessions

4 (Median 4)

0
All the cases Excluding dropouts

Source: First-Session Rating Questionnaire

Slide 12
 RESULTS
HISTOGRAM NUMBER OF SESSIONS

• 1 or 2 sessions: 23% (16/69)

• Less or equal to 5: 80% (55/69)
• More than 5: 20% (14/69)

Slide 13
 RESULTS

COMPLAINT AND GOALS All the cases

Dropouts excluded
Clients talk about their complaint in past 41% (15/37)
tense 48% (10/21)
88% (57/65)
Goals reached (totally or partially)
88% (37/42)
17% (11/66)
Complaint is totally resolved
26% (11/43)
76% (50/66)
Complaint is partially resolved
65% (28/43)

0% 20% 40% 60% 80% 100%

Source: Last-Session Rating Questionnaire percentage

Slide 14
 RESULTS (Judges)
SUCCESS AT TERMINATION

Not Successful
14% (9/66)

Successful
86% (57/66)
Source: Last-Session Rating Questionnaire

Slide 15
 RESULTS (Clients)
SATISFACTION, THERAPY UTILITY AND
RESOLUTION OF THE PROBLEM

100%
80% 97%
91% 89%
Percentaje

(72/74)
60% (67/74) (65/73)
40%
20%
0%
Very much satisfied or The therapy was useful The problem was
satisfied with the or very useful solved (totally or
treatment partially) during therapy
Source: Follow-Up Questionnaire

Slide 16
 RESULTS (Follow-up)
IMPROVEMENTS IN OTHER AREAS

NO
IMPROVEMENTS
44%
(32/73)
OTHERS IMPROVEMENTS
56%
(41/73)

Source: Follow-Up Questionnaire

Slide 17
 RESULTS

NEW PROBLEMS AFTER THERAPY

NEW
PROBLEMS,
36%
(26/73)

How the clients solved their new problems?

64% - "I remember the exercises learned in therapy"

(47/73) - "I do not attach great importance to the problem"
- "I am used to the problem"

Source: Follow-Up Questionnaire

Slide 18
 RESULTS
CONSULTATION WITH ANOTHER MENTAL HEALTH
PROFFESIONAL AFTER THERAPY
Having
consulted with
another mental
health
professional;
21%

Having not
consulted; 79%

Source: Follow-Up Questionnaire

Slide 19
 RESULTS
WHO HAVE THEY CONSULTED AFTER THERAPY?

10 9 (59%)
9 (n=15)
8
7
6
Cases

5 4 (27%)
4
3
2 1 (7%) 1 (7%)
1
0
Psychologist Psychiatrist Psychiatrist and Medical doctor
Psychologist
Source: Follow-Up Questionnaire

Slide 20
 RESULTS
MEDICATION STATUS VS HAVE CONSULTED
WITH ANOTHER MENTAL HEALTH PROFESSIONAL
0% 10% 20% 30% 40%

29%
Taking medication
(5/17)

20%
No medication
(10/51)
Fisher; p=0,50
% - Consulted with another mental healt professional
Source: Follow-Up Questionnaire

Slide 21
 RESULTS
COMPLAINTS AND PROFESSIONAL CONSULTATION
AFTER THERAPY

Interpersonal 24% (8/33)

Intrapersonal 19% (7/36)

Chi-square, p=0,629

0% 5% 10% 15% 20% 25% 30%

% - Consulted with another mental healt professional
Source: Follow-Up Questionnaire

Slide 22
 RESULTS
PSYCHIATRIC DIAGNOSIS VS. HAVE CONSULTED
WITH ANOTHER MENTAL HEALTH PROFESSIONAL
0% 10% 20% 30% 40% 50%

Psychiatric
diagnosis
45%
(9/20)

No psychiatric 13%
diagnosis (6/48)
; Fisher; p=0,04*

% - Consulted with another mental healt professional

Source: Follow-Up Questionnaire

Slide 23
 RESULTS
SUCCESS AT FOLLOW-UP
33%
(21/63)

Success at
When dropouts were excluded, follow up,
percentage increased to 76% (32/42) 67% (42/63)

Source: Follow-Up Questionnaire

Slide 24
 RESULTS
AVERAGE SCORE ON THE SCALING QUESTION

8
7
6 Mean 6,6 Mean 6,8
Average score

CI 95%: 3,1–10 CI 95%: 2,6–10

5 (Median 7)
(Median 7)
4
Mean 4,0
3
CI 95%: 0,7–7,3 Student t-Test
2 (Median 4) - First vs. last session: p = 0,00
- First vs. last session: p = 0,00
1
- Last session vs. follow-up: p = 0,98
0
First session Last session Follow-Up

Scores on the scaling question had a normal distribution.

Source: First-Session Rating, Last-Session Rating and Follow-Up
Q ti i
Slide 25
 RESULTS
HISTOGRAM INTERMEDIATE OUTCOME

Mean 2,4
Median 2,5

SD 2,3
Skewness 0,1
K-S p=0,76

Source: First-Session Rating and Last-Session Rating Questionnaire

Slide 26
 RESULTS
INTERMEDIATE OUTCOME INTO THREE CATEGORIES

Significant
progress No progress
28% (12/42) 17% (7/42)

CATEGORIES:
● No progress: -3,5 to 0
● Moderate progress: 0,5 to 3,5 Moderate
● Significant progress: 4 or more progress
Moderate + Significant progress = 83% (35/42) 55% (23/42)

Source: First-Session Rating and Last-Session Rating Questionnaire

Categories from: De Jong P, Hopwood LE (1996). Outcome research on treatment conducted at he brief
family therapy center, 1992-1993. In: Miller SD, Hubble MA, Duncan BL. Handbook of solution-focused brief
therapy. Josey Brass
Slide 27
 RESULTS
SUCCESS AT TERMINATION AND SCORE ON
FIRST SESION SCALE

10

7
6
5
Cut-off points
4
3
Statistical difference was found
2 between successful and
1 not successful cases at termination
(Chi-square, p=0,01)

Slide 28
 RESULTS
INTERMEDIATE OUTCOME MEANS VS.
SUCCESS AT TERMINATION

3
Mean (Intermediate Outcome)

Mean 2,7
2,5

1,5

1 Student´s t-Test; p=0,03*

0,5
Mean 0,1
0
Successful at termination No successful

Source: First-Session Rating and Last-Session Rating Questionnaire

Slide 29
 RESULTS
AVERAGE OF SESSIONS VS. SUCCESS AT TERMINATION
7
6
(Student´s t-Test, p=0,49)
5 Mean 4,9
Sessions

4 SD=3,0 Mean 4,1

Median=4 SD=3,9
3 Mode=3 Median=3
2 Mode=2

1
0
Success at termination No successful
Source: First-Session Rating and Last-Session Rating Questionnaire

Slide 30
 RESULTS

TYPE OF COMPLAINTS

Interpersonal
49% (34/70) Intrapersonal
51% (36/70)
1. Parent-child comunication problems
2. Couples 1. Mood problems
3. Adolescent behavior 2. Anxiety
4. Others family problems
3. Addictions
4. Eating disorders

Source: First-Session Rating Questionnaire

Slide 31
 RESULTS
COMPLAINTS AND SUCCESS AT TERMINATION
97%
(33/34)
Succesful at termination

100% 77%
(23/30)
80%
60%
40%
20%
(Fisher, p=0,02)*
0%
Intrapersonal Interpersonal
complaints complaints
Source: First-Session Rating Questionnaire

Slide 32
 RESULTS
TYPE OF PROBLEM (SCPP) AND
SUCCESS AT TERMINATION

% Succesfull at termination
100
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% %

Mood problems 100%

(18/18)
90%
Anxiety
(18/20)
88%
Parent-child comunication problems
(7/8)
71%
Child behavior
(5/7)

Note: It was attended only one case of addictions.

The three couples were a success at termination
Source: First-Session Rating Questionnaire

Slide 33
 RESULTS
SUCCESSFUL AT TERMINATION ACCORDING
TO COMPLAINT AND THERAPY FORMAT
Individual
Conjoint
100% (15/15)
100% 95% (18/19)
Fisher; p=0,60 Conjoint
80% Individual 79% (19/24)
67% (4/6)
Percentage

60%

40%

20%

0%
Intrapersonal Interpersonal
Complaints
Source: First-Session Rating Questionnaire

Slide 34
 RESULTS
DROPOUTS
(Unilateral Termination by the clients)

Dropouts
33% (23/70)

Continuers
67% (47/70)

Source: Last-Session Rating Questionnaire

Slide 35
 RESULTS
DROPOUTS AND THERAPIST EXPERIENCE

50%
(Chi-square; p=0,34) 40% (Fisher; p=0,650) 40%
(10/25) (4/10)
40%
29%
% Dropouts

(13/45)
30% 23%
(3/13)
20%

10%
All dropouts Early dropouts*
0%
Experts Trainees Experts Trainees

* Early dropouts: after 1 or 2 sessions

Source: First-Session Rating and Last-Session Rating Questionnaire

Slide 36
 RESULTS
DROPOUTS AND SUCCESS AT TERMINATION

100% 86% 86%

(18/21) (37/43)
% Successful at termination

80%

60%

40%

20%
(Fisher; p=1,00)
0%
Dropouts Continuers
Source: Last-Session Rating Questionnaire

Slide 37
 RESULTS
DROPOUTS AND PROBLEM RESOLUTION DURING THE THERAPY
(Partially and Totally)
92%
100% 86% (43/47)
90% (19/22)
80%
70%
60%
% Solved

50%
40%
30%
20%
10%
(Fisher; p=0,672)
0%
Dropouts Continuers
Source: Last-Session Rating and Follow-up Questionnaire
Slide 38
 RESULTS
THERAPIST EXPERIENCE AND
SUCCESSFUL AT TERMINATION

88%
100% 83%
% Successful at termination

(38/43)
(19/23)
80%

60%

40%

20%
(Fisher; p=0,708)
0%
Experts Trainees

Source: First-Session Rating and Last-Session Rating Questionnaire

Slide 39
 RESULTS
THERAPIST EXPERIENCE AND SUCCESS AT FOLLOW-UP

(Chi-square; p=0,28)
100%
% Success at Follow-up

72%
80% (28/39)
58%
60% (14/24)

40%

20%

0%
Experts Trainees
Source: First-Session Rating and Last-Session Rating Questionnaire

Slide 40
 RESULTS
SUCCESS AT TERMINATION AND
SUCCESS AT FOLLOW-UP
Success at
follow-up Total
Yes No
34 16 50
Yes
Success at 68% 32% 100%
termination 3 4 7
No
43% 57% 100%
37 20 57
Total
65% 35% 100%
Chi-square, p = 0,226
Slide 41
 RESULTS
Elements of the therapy that clients liked
or felt were useful in therapy
• Therapeutic relationship:
- To speak with someone that listens to you and
supports you and transmits kindness, resources,
confidence, tranquillity, patience, proximity,
optimism , etc
- Disposition, genuine interest and questions
about their feelings
- To go step by step

Slide 42
 RESULTS
Elements of the therapy that clients liked
or felt were useful in therapy
• Technical:
- 5-4-3-2-1
- To write feelings & thinking, to express them
with drawings
- Curative letters
- Secrets: guess when other/s do…
- Externalization
- Toss a coin
- Alternative thoughts to the negative ones
- To face fear instead to avoid it

Slide 43
 RESULTS
Elements of the therapy that clients liked
or felt were useful in therapy
• To visualize feared things
• “Little happiness”
• To count things
• To put the placard in room with objectives
• Relaxation techniques
• To write the good and the bad things, and to
keep the good memories in a box
• To count backwards
• Thinking chair

Slide 44
 RESULTS
Useful or liked things for the clients
• Cognitive:
- Point of view of the therapist
- To cause to see the things otherwise
- To be accommodated to the position: to go to
step by step
- To remove labels, to normalize

Slide 45
 RESULTS
Useful or liked things for the clients
• Psicoeducation:
• To locate the problem to try to do something
different
• To verbalize feelings to another

Slide 46
 CONCLUSIONS

1. ? ? ? ? ?
2. ? ? ? ? ? ? ?
3. ? ? ? ? ? ? ? ? ? ? ?

Slide 47
 CONCLUSIONS
1. Globally, it’s well known that the Solution Focus
Brief Therapy reaches the “minimum efficacy
permitted”.

2. The cases of dropout do not necessarily ended in a

therapeutic failure.

3. There were no differences between the success and

the therapist’s experiences and others variables of
the therapy’s process.

Slide 48