Elliott Connie - Solution Focused Brief Therapy Treatment Manual (2023)

Solution Focused Brief Therapy Diamond Approach Treatment Manual – Version 1: November 2023 2
Table of Contents
Introduction
Evidence-Base of Solution Focused Brief Therapy
ADOPT The Stance of the The Solution Focused Diamond

A: Autonomy is Sacred
D: Difference-led
O: Outcome-led
P: Presuppose the best
T: Trust capability
The Language of Solution Focused Brief Therapy
Overview of the Diamond Approach

● Desired Outcome
● Description
○ History of the Outcome
○ Resources for the Outcome
○ Future of the Outcome
● Closing
References
Introduction
What is Solution Focused Brief Therapy?
Solution Focused Brief Therapy (SFBT) is an evidence-based therapeutic approach (Kim,
Jordan, Franklin, & Froerer, 2019) that takes the radical perspective that clients are competent,
capable, and have the resources necessary to make desired changes in their lives. SFBT is a
language-based therapeutic approach that is founded on building hope through co-construction
(Connie, 2018; de Shazer et al, 2007). SFBT is an approach founded on the belief that clients do
not need to re-experience problematic events, do not need to be re-traumatized, or dread coming
to therapy in order to achieve healing and lasting change. Solution Focused Brief Therapy
maximizes what is good in people’s lives and utilizes this goodness to help clients achieve
greatness!
SFBT was created in the early 1980’s by Steve de Shazer, Insoo Kim Berg, and their
colleagues at the Brief Family Therapy Center in Milwaukee, Wisconsin (Lipchik, Derks,
LaCourt, & Nunnally, 2012). These founders specifically went about developing an approach to
psychotherapy that challenged the methods of traditional psychotherapy. They built an approach
that did not require individuals to focus on problems, did not encourage the retelling the traumas
of their past, and did not spend quality time digging for the route cause of the current symptoms,
which often only frustrated clients. Instead, these founders created an approach that oriented
clients to focusing on and detailing how life would be different when they were managing life
better, living consistently with their dreams and desires, and acting in accordance with the best
version of themselves.
SFBT is a unique therapy type, in which it is not intended to be an ongoing, lifelong
therapy approach, and is transformation-oriented and action-based. Elliott Connie and Dr. Adam
Froerer built on this future-oriented foundation and developed The Diamond Approach of SFBT.
The Diamond Approach focuses specifically on helping the client articulate their desired
outcome, describing the details of their lives that indicate the desired outcome is present, and
honoring the agency of clients at all times. By shifting the control into the hands of the client in a
conscious-specific format, SFBT practitioners have seen greater progress in shorter amounts of
time, and progress even in cases which have been exceptionally complex. Agency and consent,
as in all things, are key to helping clients transform their lives consistent with their desired
outcomes. This is the shift in focus, and the miracle, of the Diamond Approach.
Evidence-Base of Solution Focused Brief Therapy
Since its founding, Solution Focused Brief Therapy has been tested and studied in
multiple ways and with multiple different populations with positive outcomes (Kim, Jordan,
Franklin, & Froerer, 2019). There is a growing body of evidence that supports the evidence-base
of SFBT. Several meta-analyses of SFBT research have shown that SFBT produces positive
outcomes with various populations (ranging from small to very large effect sizes). Table 1 below
shows the known meta-analyses and the statistical effect sizes. Each study supports the
effectiveness of SFBT.
Table 1. Solution Focused Meta-Analyses

Author(s) Publish Title of Study Population Effect Size
Year
Stams, 2006 Efficacy of Solution Focused Brief Personal behavior 0.37**

Dekovic, Therapy: A Meta-Analysis change in adults
Buist, & de
Vries
Kim 2008 Examining the Effectiveness of Various personal 0.26*

Solution-Focused Brief Therapy: A behavior changes
Meta-Analysis
Park 2014 Meta-Analysis of the Effect of the Elementary Self-esteem =

Solution-Focused Group Counseling students in Korea 1.61***; School
Program for Elementary School Students adjustment =
1.35***;
Interpersonal
relationships =
1.07***;
Self-efficacy =
1.03***
Gong, Hsu 2015 A Meta-Analysis on the Effectiveness of Various Overall =

Solution-Focused Brief Therapy: populations in 0.99***; Schools
Evidences From Mainland China and China and Taiwan = 1.01***;
Taiwan Medical settings =
0.94***;
Mainland =
1.03***; Taiwan
= 0.92***; Follow
up = 1.07***
Kim, 2015 Solution-Focused Brief Therapy in Internalized Overall = 1.26***

Franklin, China: A Meta-Analysis problems in
Zhang, Liu, Chinese
Qu, & Chen population
Carr, 2016 Parents Plus Systemic, Solution-Focused Parent with 0.58**

Hartnett, Parent Training Programs: Description, children who
Brosnan, & Review of the Evidence-Base and misbehave
Sharry Meta-Analysis
Gong, Hsu 2016 The effectiveness of Solution-Focused Group therapy Immediate =

Group Therapy in Ethnic Chinese School with Chinese 1.03***; Follow
Settings: A Meta-Analysis Children up = 1.09***
Schmit, 2016 Meta-Analysis of Solution Focused Brief Various clinical 0.24*

Schmit, & Therapy for Treating Symptoms of samples with
Lenz Internalizing Disorders youth,
adolescents, and
adults
Kim, Lee, & 2017 The Effect of Solution-Focused Group Emotional, social 1.223***
Park Counseling: Effect Size Analysis by and behavioral
Multilevel Meta-Analysis problem in Korea
Zhang, 2017 The Effectiveness of Strength-Based, Medical settings Psychosocial

Franklin, Solution-Focused Brief Therapy in outcomes = .34*;
Currin-McCu Medical Settings: A Systemic Review Health-related
lloch, Park, & and Meta-Analysis of Randomized outcomes = .28*
Kim Controlled Trials
Hsu, Eads, 2021 Solution-focused brief therapy for Children and 0.43** (no effect
Lee, & Wen behavior problems in children and adolescents (and size difference for
adolescents: A Meta-analysis of treatment their families) family
effectiveness and family involvement involvement)
Externalizing
behaviors =
0.43**;
Internalizing
behaviors = 0.18*
Franklin, 2022 Solution-Focused Brief Therapy for Children and 0.176*

Guz, Shang, Students in Schools: A Comparative adolescents
Kim, Sheng, Meta-Analysis of the U.S. and Chinese
Hai, Cho, & Literature
Shen
Franklin, 2023 Solution-Focused Brief Therapy in Adults in 0.654***

Ding, Kim, Community-Based Services: A Community-based
Zhang, Hai, Meta-Analysis of Randomized Controlled agencies
Jones, Studies
Nachbaur, &
O’Connor
Karababa 2023 A meta-Analysis of Solution-Focused Children and 1.80***

Brief Therapy for School-Related adolescents
Problems in Adolescents
* = small effect size
** = medium effect size
*** = large effect size
Beyond just knowing that SFBT has been shown to be effective, it is also valuable to
know that it has worked with many individuals from various cultures and countries around the
globe. Table 2 provides a representation of various cultures served by SFBT. This table is a small
representation of the locations and populations SFBT has been used with effectively. Other
studies in various countries may be available and will be added as we become aware of them.
Table 2: Cultures Served Effectively by Solution Focused Brief Therapy

Country/Culture Supporting Paper(s)
Chili Schade, Torrez, & Beyebach (2011)
China Gong & Hsu (2015); Gong & Hsu (2016)
German Jonas, Leuschner, & Tossmann (2016)
Finland Maljanen, Knekt, Lindfors, Virtala, Tillman, Harkanen, & Helsinki

Psychotherapy Study Group (2015)
Korea Kim, Lee, & Park (2017); Park (2014)
Latino/a Suitt, Franklin, & Kim (2016)
Netherlands Stams, Dekovic, Buist, & de Vries (2006)
Persian Abbasi, Mohammadi, M. Zahrakar, Davarniya, & Babaeigarmkhani

(2017); Hosseinpour, Jadidi, Mirzaian, & Hoseiny (2015)
Spain Neipp, Beyebach, Nunez, & Martinez-Gonzalez (2016)
Taiwan Gong & Hsu (2015)
Thailand Ngammoh, Inang, & Koolnaphadol (2017); Pennapha (2015)
Turkey Nedim & Kaya (2017)
United States Kim (2008); Richmond, Jordan, Bischof, & Sauer (2014).
This body of supporting research is building a solid case that the innovative approach to
mental health care espoused by SFBT, works effectively and is now being recognized by
governments and government agencies for its effectiveness. The Office of Juvenile and
Delinquency Prevention (OJJDP) and the Substance Abuse and Mental Health Services
(SAMHSA) National Registry of Evidence-Based Programs and Policies (NREPP), two federal
agencies have evaluated the relevant SFBT evidence and have granted the solution focused
approach a “promising practice” status. “Beyond the federal registries, two states in the United
States have also included SFBT on their websites as evidence-based interventions. Oregon’s
Addiction and Mental Health Services Department lists various treatment approaches as
evidence-based for addiction and/or mental health disorders, co-occurring disorders, or
prevention approaches. Currently, SFBT is listed as evidence-based for mental health disorders
(Oregon Health Authority: Addictions and Mental Health Services, 2017). Similarly, the state of
Washington has listed solution-based casework as an evidence-based practice through the

Washington State Department of Social and Health Services: Children’s Administration (2017)”
(Kim, Jordan, Franklin, & Froerer, 2019). It is anticipated that more and more states and federal
agencies will also follow suit and recognize SFBT for the effective treatment it is.
SFBT has been shown to be effective in working with the following presenting problems
and/or populations (among others): children with behavior problems (Carr, Hartness, Brosnan, &
Sharry, 2016), individuals with medical concerns (Gong & Hsu, 2015), emotional issues
(depression, anxiety, etc.), social issues (Kim, Lee, & Park, 2017), self-esteem concerns (Park,
2014), substance abuse (Smock, Trepper, Wetchler, McCollum, Ray, & Pierce, 2008), and
marital satisfaction (Abbasi, Mohammadi, Zahrakar, Davarniya, & Babaeigarmkhani, 2017).
Evolution of the Approach
In addition to the evidence listed above, it should be noted that SFBT has evolved and
changed over time (McKergow, 2016). Although the titles of these evolutionary steps have been
debated and are somewhat controversial, it is clearly evident that changes have taken place. This
evolution can be seen in the treatment/practice manuals that have preceded this one. McKergow
(2016), called the original version of the approach, developed by Insoo Kim Berg and Steve de
Shazer and colleagues, as the 1.0 version of SFBT. McKergow described later evolutionary steps,
like BRIEF in London, developed by Chris Iveson, Evan George, and Harvey Ratner as the 2.0
version of SFBT. We see these evolutionary steps as valuable and important to the continuing
development and clarity of the approach.
The Solution Focused Brief Therapy Association (SFBTA) provided a treatment manual
for working with individuals in 2013 that consistently laid out the 1.0 version of the approach
(Bavelas, De Jong, Franklin, Froerer, Gingerich, Kim, et al, 2013). BRIEF provided a more
recent practice manual that clearly and thoroughly outlines the SFBT 2.0 version, entitled
BRIEFER (George, Iveson, & Ratner, 2017). This current treatment manual is a representation of
a next evolutionary step and is based on the Connie-Froerer Diamond Approach to SFBT. Some
might argue this is the 3.0 version of SFBT.

ADOPT The Stance of the The Solution Focused Diamond
Doing SFBT will require that you forget everything you learned previously about doing
psychotherapy. You will need to realize that your role is not to assess the client for problems or
character flaws, you do not need to analyze the root cause of the problem or hypothesize about
what behaviors are sustaining the problem, nor will you need to develop a conceptualization
about what will fix the problem or minimize symptomatology. Instead you will be asked to
ADOPT an entirely different perspective of the client AND your role within the therapeutic
context. ADOPTing the SFBT stance requires that before you even engage in any therapeutic
work you recognize your privilege and power.
Recognizing Your Power and Privilege
Without understanding your own power and privilege within the therapeutic context you
are at risk of overlooking important contextual variables that are paramount within the clients
life, and therefore insufficiently co-construct with the client descriptions that are meaningful and
useful. You may inadvertently do more harm than good, you may misinterpret, misunderstand, or
misuse the client’s language, thus fracturing the therapeutic relationship in significant and
irreparable ways. One focus of a SFBT therapist should be on giving up power to the client.
Ways to give up power
● Acknowledge that you have it simply because of the chair you occupy in the room
● Share it with clients-honor their autonomy and agency
● Only talk about what the client invites you to talk about
● Abolish self-imposed limitations-stop looking at people as though they are only one thing
● Avoid using stereotypical language (i.e. As an African American…, or from a woman’s
perspective…)
In addition to enabling our client to claim power and privilege in the therapeutic room, it
is essential that we use language in a way that fosters an egalitarian relationship between
co-experts/co-constructors, i.e., the therapist and the client. The therapist is the expert of the
therapeutic process and the client is the expert of the content of their lives. In order for SFBT
sessions to be useful, both experts must simply co-construct a description of the client’s desired
outcome.
In the pursuit of building the desired outcome description it will be helpful if therapists
let go of social constructions. The following is a list of ideas that will help in this pursuit.
● Don’t believe the client when they say, “I don’t know”
● Don’t believe that clients with “significant” presenting complaints/problems may not be
suitable for SFBT
● Don’t believe that the client’s “best hopes” isn’t the best place to start
● Don’t believe that the client isn’t ready to think about things that are hopeful
● Don’t believe that you have some good advice or insight that the client needs in order to
feel better
● Don’t believe that psychoeducation is the best way forward
Finally, sharing power with your client will enable you to foster a solid relationship with
them; this is the foundation of ALL effective therapy. Effective SFBT therapists will 1) Listen
with caring ears, 2) Convey warmth and acceptance of EVERY client answer, 3) Use the client’s
exact language whenever possible, 4) Only talk about the client’s desired outcome, 5) Honor the
problem (don’t ignore or minimize it), but focus on the parallel experience of strength and
resilience that is evident along side the problem, and 6) Communicate through loving language
that they believe completely in the client and their abilities.
ADOPT the Stance
Sharing power is only a portion of what can strengthen a therapeutic relationship. In
addition there are five things you can do to foster a collaborative interaction with your client.
These can be summarized with the acronym ADOPT.
1. A is for autonomy: Autonomy is sacred. Begin each session with asking the
client to utilize their autonomy by asking what they would like to achieve as a
result of the conversations. Carry through the session by honoring their autonomy
by using their language and only including information they introduce you to.
And finally, end the session by avoiding doing anything to shift the focus away
from the description you constructed together during the session.
2. D is for difference: SFBT is a difference led approach. Focus on the three levels
of difference throughout the session.
1- What differences (signs) are present when the desired outcome is a part
of the client's life?
2- What impact/difference would these differences make?
3- What does it mean about the client that they are able to bring
about/achieve these differences?

3. O is for Outcome: SFBT is an outcome lead approach. Begin each session
focusing on the client’s best hopes (more to come about this later). Take every
opportunity to ask questions that are embedded in hope, i.e. connected to the
presence of the desired outcome/best hopes. Don’t focus on goals, or creating
steps to achieve the desired outcome, rather get detailed descriptions of what
impact the desired outcome has on the client’s life.
4. P is for presuppose: presuppose the best in your client. Start with small
presuppositions and move to bigger presuppositions as the session progresses.
a. Small presupposition could include things like, “What are your best
hopes?” “What would be the first thing you would notice?” “Who else
might notice?”
b. Medium presuppositions could include things like, “What difference
would experiencing that make?” “How did you do that?” “How would you
let that person know that you were pleased that they had noticed?”
c. Large presupposition could include things like, “What does it mean about
you that you’re the kind of person who could do that [insert best hopes]?”
“But if [insert problem] stopped impacting you so much, what would that
tell you about your capability?”
5. T is for trust: Trust your client’s capability. Believe your clients abilities, even
when all evidence points to the contrary. Disbelieve all aspects of hopelessness.
“Argue” with the client when they insert doubt into the conversation by asking
about the presence of the desired outcome, despite how unbelievable it might
seem. Presuppose strength by saying things like, “suppose you do know” and
“what thoughts come to your mind now once you take a minute to think about it”.
Don’t rescue clients by providing answers when they are struggling to articulate a
response. And, don’t set a bar by offering suggestions; clients will surprise you
with how much they achieve when you leave them to their own devices.
The Language of Solution Focused Brief Therapy
From its inception, SFBT has had a focus on language. “Therapy happens within
language and language is what therapists and clients use to do therapy” (de Shazer, 1994, pp. 3).
Language has the “ability to solidify certain views of reality” (O’Hanlon, 2003, p. 60), and SFBT
orients the client to certain realities due to the questions we ask (de Shazer, Dolan, Korman,
Trepper, McCollum, & Berg, 2007). As clients answer SFBT questions their realities shift.
Because language has the ability to solidify and shift reality, SFBT therapists should be
attentive and purposeful with the language they use at each stage of the therapeutic process and
within each individual session. SFBT emphasizes the client’s words and hopes (MacDonald,
2011). According to Froerer and Jordan (2013), SFBT therapists only preserve about 5-7% of the
client’s words. This means that in an approach that is reliant on client language, therapists need
to be very selective and purposeful about the small percentage of words they can select from the
many words the client uses.
SFBT therapists use various language tools to co-construct conversations with their
clients. The goal of SFBT clinicians is to become fluent in SFBT language in order to most
effectively co-construct conversations that are useful with their clients. Fluency is achieved when
clinicians understand and appropriately utilize the language tools available, become proficient at
structuring SFBT conversations consistent with the Diamond Approach, and consistently select
client words within individual conversations that are in line with the clients’ desired outcome
without violating the autonomy and agency of the client.

General Focus of SFBT Diamond Approach Language
The Diamond Approach will be outlined in detail below, but it is important here to
highlight the general trajectory of Diamond Approach language. First, the language at the
beginning of each session should focus solely on the client’s desired outcome from this
session/work. Typically we begin sessions with the presuppositional question, “What are your
best hopes from this session?”. However, it is rare that a client will develop a fully formed “best
hopes” from this single question. Therefore, persistence will be needed to help the client
articulate their desired outcome. The responsibility for making the questions answerable is the
therapist’s, not the client’s. Every answer the client gives is the right answer. If the client is
struggling to answer, that’s okay; that is the work of therapy. If the client is struggling, the
therapist digs in a bit more and works to formulate questions that help the client get to an answer
that can be used to build the desired outcome description.

Overview of the Diamond Approach
How Did We Get to The Diamond
The Diamond was formulated after years of thinking about how to teach SFBT while
carefully honoring the different ways clinicians do it. That process included a specific
consideration for what works within Solution Focused Therapy. It was determined that broadly
what is crucial to an effective Solution Focused conversation is the following:
● The outcome is always the entry point to the conversation
● There needs to be a detailed description about the presence of the client’s desired
outcome in their lives
● The ending must honor the client’s autonomy and agency
In constructing the Diamond the intention was not to create something new. The intention
was to provide a conceptual roadmap for how to structure a Solution Focused session. It is very
much based on what SFBT professionals have done and conceptualized before, but it provides
structure for clinicians upon which to base their work. That structure allows them to say at any
point in the session what they are doing and why they are doing it. As much as the Diamond can
inform the practice of the approach, it also serves as a unifying conceptualization of the many
styles of the SFBT approach. It validates the many different effective pathways a clinician could
take while tying the pathways together in an inclusive depiction of how to execute a SFBT
conversation.
Desired Outcome: The Transformation
All Solution Focused conversations should begin with the therapist and client
co-constructing, as clearly as possible, the change/transformation the client wants as a result of
the conversation.
Transformation vs. Outcome
The desired outcome is the transformation the client is seeking. It can be described as a
“transformation” because an “outcome” might be too connected to a goal rather than an
experience. “Outcome” identifies what the client wants, which is seminal to the Solution
Focused conversation, but “transformation” makes room for the idea that this is a process. The
transformation the Solution Focused conversation will center around is the difference the client is
looking to experience from having come to therapy. In establishing the Desired Outcome, the
clinician is inviting the client to tell them the transformation they are seeking. It is far more
effective to view SFBT, not as a goal-oriented approach or a future-focused approach, but
specifically as a change-focused approach. The conversation is focused on difference and
change. In order to have the conversation, the clinician must identify what modification will take
place as a result of this exchange.
There is a strong inclination to ask the client why they have come to therapy. What makes
SFBT different from other approaches can be found at the very onset of therapy. A Solution
Focused clinician does not ask why the client has come. They ask what transformation they are
in pursuit of, which can look like “What are your Best Hopes from our talking?” or “What
difference do you hope being here will make in your life?” Those kinds of questions immediately
orient the conversation toward change, difference, and transformation. Instead of a conversation
about what brought the client to therapy, this is a conversation more about what they were
motivated to experience a change in. The Desired Outcome or the transformation the
conversation is focused on is often centered on an internal state, as described by Chris Iverson.
The transformation is something the client wants to change within themselves such as more
hope, more peace, more confidence, etc. Establishing a Desired Outcome for the conversation is
navigating through the language to get to a place where the client is describing a transformation
they want to occur within themselves.
To simplify that, a strong hint for where one might find the state that makes up the
Desired Outcome is what the client has control over. If a client says “I want to be able to smile as
I do when it’s sunny outside”, the client has no control over how sunny it is going to be, but they
do have control over their smile. Their smile corresponds with the state or transformation they
are seeking. If the client is giving an external answer or referencing something that is outside of
their control, the clinician must still be very accepting and thus must take on the responsibility of
shifting from external to internal, to something the client can control. This highlights two
important aspects to this approach: first, it reiterates that the conversation is oriented around
difference, and it also reinforces the idea that this entire interaction is a co-construction. The
clinician cannot dismiss the client’s contribution to the co-construction and must convey that
they accept every response the client gives, usually by building it into their next question.
Additionally, what may also help in establishing a good Desired Outcome is staying
aware of the difference between what is unlikely and what is impossible. The Desired Outcome
for the session does not have to be likely, but it does have to be possible. A client who is
currently in jail, but who wants to be a movie star is hoping for something that does not have a
good chance of happening, but what they are hoping for is not impossible. A Solution Focused
clinician can hold onto and accept anything the client says that is possible even if it may seem
very unlikely.
A big obstacle to identifying a usable Desired Outcome is misunderstanding the
clinician’s role in this therapy. A Solution Focused clinician is not there to solve problems. If one
were to enter a session with a focus on solving problems, that may lead to a natural
inquisitiveness about the problem. If the clinician accepts that their job is to facilitate change,
they will become inquisitive about the process of change. This is similar to parenting. If a
parent’s job is to prepare their child for life, they can’t always tie their child’s shoe; What they
must do is raise the child into someone who can tie their own shoes and do other things for
themselves. This is very much related to the stance that is necessary for Solution Focused work.
In order to have these conversations and stay secure in this role, one has to hold certain beliefs
about people and what they are capable of. Overcoming the misunderstanding of the clinician’s
role in a session is made easy by seeing people in the appropriate way. This actually helps to
overcome many of the obstacles that might surface in a Solution Focused session. When a client
responds with “I don’t know”, having a belief in them can push through that in order to keep
asking questions. The belief in people turns into perseverance.
The Desired Outcome is well-established for the session once the clinician feels confident
they can put the client’s answer into a description question, the most prominent description
question being the Miracle Question. The clinician is ready to move on from Desired Outcome
into the Description section once they are able to place the transformation the client is seeking,
one they have control over, into a description question. It is important to remember that one
cannot place things that are outside of the client’s control in functional positions in description
questions. The day after the miracle cannot be dependent on the client's spouse’s change to
sobriety for example or anything that they have no control over themselves.
Tips for a Good-Enough Best Hopes
● You have a name for the best hopes (e.g., hope, confidence, peace, or happiness)
● You are excited about asking more detailed questions about the named best hopes
● The desired outcome is about a transformation of the client
● Something inside of the client changes (i.e., they have more hope)
● Something outside the client changes because the client changes (e.g., their family is
getting along better)
● The desired outcome is based on the client’s currency (a.k.a., what is most meaningful
to them)
● You feel confident that you can ask questions about this transformation for the bulk of
the session
(Taken from Connie & Froerer, 2023)
History of the Outcome
Each of the types of description are about the presence of the desired outcome. The
History of the Outcome is specifically about the presence of the desired outcome somewhere in
the past. Begin this particular type of description by asking clients when they noticed their
desired outcome showing up in their lives previously. Immediately in these questions, there is a
presupposition that they have noticed the presence of their desired outcome before. Some clients
may respond to this with the refute that they have never before had the outcome they are now
seeking. Our response to that as Solution Focused practitioners is to continuously ask them to
look closer. Whatever outcome the client is hoping for, it is impossible for them to have never
had experienced it at all in their past. Peace, joy, enlightenment, or excitement, anything the
client is now saying they would like to see in their life, they must have had some taste of that
outcome at some point before. They’ve had it even if only for a fleeting moment or only in a
small amount. It is our clinical responsibility to understand that they have experienced this
outcome before and that we must ask about the presence of it, even if it might be hard for them
to find. Even when a client tells us they have never been happy, it is our job to keep asking
questions to allow them to look closer at their past.
From Exceptions to Instances to History of the Outcome
Historically, the concept of “exceptions'' highlighted a portion of this idea but was
specifically built on the understanding that there absolutely must have been a moment where the
problem was not there or where the problem was less of a problem. This is how Steve and Insoo
talked about it, but this was just an initial evolutionary step. Exceptions still included problem
language, so BRIEF went on to make use of “instances”, where the desired outcome is present
rather than just the problem being absent. Now, with History of the Outcome we can go even
further assuming not only that there was a moment where the desired outcome was present but
that it was noticed and the client had a relationship with it. An important aspect of the evolution
to this point is that this is no longer just a set of questions that serve a technical purpose. This is
building an entire description based on the presence of the outcome in the client’s past. Since this
is an entire description, it then includes many other details. “When was the outcome present?
What did you do to bring it about? Who else noticed? What did they notice? What difference did
it make to the way you interacted with each other when it was present?” The addition of
acknowledging that the client has had a past active relationship with their desired outcome
allows them to describe it extensively while instances and exceptions are more static. We don’t
treat the desired outcome in the future as a static moment, so the History of the Outcome allows
us to do the same with the past. What’s so useful about this acknowledgement is that if a client
can accept that they have had happiness or any desired outcome in the past, it makes it much
more achievable and realistic to have more moments like that in the future.
The key to having this particular kind of conversation with the client, as well as getting
them to a point of accepting the presence of the outcome in their past, is persistence. We are not
entitled to answers from the client, but we must persist in asking them questions that help them
find moments like these in their past. What helps us to be so persistent in finding these moments
is an enamourment with the client’s achievement. We, as the clinicians, should so deeply value
the client’s attaining their desired outcome that we feel compelled to keep asking about the
presence of it. When we persistently ask about the History of the Outcome, we ask the client a
variety of noticing questions about. “How did you notice happiness was present in your life?
Who else noticed? What role did happiness play on others around you?” We can ask any noticing
question possible but in the past tense. Noticing questions are particularly useful in this kind of
description because they continuously remind the client that they have had the outcome before,
and with each answer to these questions, the client must acknowledge that assertion. One way of
looking at this description is to view it as taking the desired outcome, which is quite internal, and
making it external through noticing questions, asking about how it became noticeable to the
client and the people around them. This is very similar to the description we build in the
preferred future. The Diamond demonstrates that the Solution Focused approach is not
exclusively a future-oriented approach. More accurately, it is a detail-oriented approach, and
each type of description uses the same noticing questions only differing in the tense that they use,
either past, present, or future.
Another powerful kind of question we can use to ask about the past is a “legacy
question”. Legacy questions give credit to the source of things the client is proud of. When
someone says they are good with money, the most obvious legacy question we could ask is
“Where did you learn that?” The common response clients give to these questions is to attribute
it to someone important in their life like their grandmother or their father. Not only do legacy
questions identify the origin of good things or things that bring the client pride, they also invite
the client to take ownership of those things. “If your grandmother taught you this, how did you
make it your own? How did you decide this was something you wanted to carry?” Knowing
where you came from fills a significant amount of meaning into your understanding of who you
are now, and legacy questions help accomplish this knowing. Additionally, legacy questions
make all the change and difference at the center of our conversations relevant to the entire
history of this person.
Possible History of the Outcome Questions
● How did you help the outcome to show up?

● What did you notice when the outcome showed up?
● What difference did it make to you when the outcome showed up?
● What differences did it make to your partner/friend/co-worker when the outcome
showed up?
● When you were [insert the desired outcome] last time, how did you notice it?
● What were the clues?
● When was it present?
(Taken from Connie & Froerer, 2023)
Possible Legacy Questions
● Where did you learn to be [insert the desired outcome]?

● Where did you learn that you were the kind of person who was capable of being [insert
desired outcome]?
● Who helped you realize that you had what it took to be [insert desired outcome]?
● What was that like?
● How did that process happen?
● How did you know you were receiving it?
● What did it mean to you that [insert important person] handed this legacy to you?
● How did you let them know you were pleased that you had inherited this legacy?
Resource Talk:
Resource Talk answers the question of how someone made their accomplishments
happen. It is assigning responsibility to the client for something positive in their lives. Assigning
that responsibility to them should lead to an investigation of what the client did to make the
positive thing happen. Some of it will be circumstantial, but some of it is attributional. There
might be factors of their circumstances that helped make an accomplishment happen, but the
accomplishment also came to be because of the skills, traits, and abilities the person possessed. A
Solution Focused clinician has to treat any accomplishment, regardless of the perceived size of
the accomplishment, as worthy of investigating. If there exists an accomplishment, that means
there must be some circumstances that allowed it, and furthermore, there must be some attributes
that allowed those circumstances to happen. It is necessary to refrain from judging the
accomplishments and to consider the context surrounding these events in order to see a client’s
accomplishments as worthy of investigation.

Here, one can begin to see the influence the clinician might have in this therapeutic
process considering that the client may not inherently value the accomplishment being described.
It is through the questions of the clinician that said accomplishment may seem more worthwhile.
This is the co-construction that is built into the Solution Focused conversation. Clients will talk
about their everyday lives and experiences, but it is the job of the clinician to hear something
valuable. The Solution Focused stance, how the clinician views the client, leads the clinician to
hear something, find it impressive, and ask presuppositional questions about how the client made
the accomplishments come about. These conversations are revolving around the client’s own
familiar information; they’re about their accomplishments, their resources, and their contexts.
What often leads to something useful in a Solution Focused conversation is the clinician’s
perception of that information and the questions they ask about it. This demonstrates the role of
co-construction in this therapeutic process.
Doing effective Resource Talk is inquiring about something positive in all the ways you
would similarly do in placing blame for something negative. If a child brings home an F on a
test, it raises many questions about what they did wrong to receive an F. Resource Talk is
noticing the A the child brought home, and asking about what they did right to receive an A. It
requires a very exploratory inclination of the clinician regarding the resources and
accomplishments of the client that leads them to look for all the ways those positive things came
to be, have shown up, and continue to show up. The point of Resource Talk is to make people
more fluent in what is positive about them. To do this well, the clinician must listen with the
understanding that anything can be a resource, even gifts that the client possesses that might have
been used or are currently used in harmful ways, such as inmates using unique ingenuity to
obtain contraband, ingenuity that could also be quite useful in overcoming their vices.
It is important to note that Resource Talk is different from building rapport or working on
the therapeutic alliance. These can occur simultaneously, but Resource Talk itself is a distinct
task. Mistaking this exchange for simply building rapport can distort its purpose into the idea that
it’s only being done for the specific aim of the relationship between clinician and client while the
true purpose should be building the client’s fluency in positive things and hearing themselves
give fluent responses to the questions.
Possible Resource Questions
● What makes the difference?

● What have you done to ensure that [insert desired outcome] is a likely possibility?
● What is it about you that makes this desired outcome a possibility?
● What have you seen from yourself that lets you know that you are on the pathway to
achieving this kind of desired outcome?
● When you’re living your life, what makes you capable of doing all the things you seem
to get done, despite [insert the current challenge they are experiencing]?
● How did you get this quality that is helpful to you? How did you foster it? Who helped
you to develop it?
● What did you do in order to grow this ability or characteristic?
Future of the Outcome
Steve de Shazer and Insoo Kim Berg introduced the miracle question, one of the first
questions that officially shifted the focus of the conversation into the future. However, when they
first introduced this question they phrased it as though the presenting problem was no longer an
issue, (i.e., “Suppose you go to sleep tonight and a miracle happens. The miracle is that the
problems that brought you here today are completely gone, what would be the first thing you
would notice that would let you know your problems were no longer bothering you?”). This
question was revolutionary to the psychotherapy field, however the phrasing of this question still
required clients to filter their answer through a consideration of the problem. In the Future of the
Outcome version of this question no problem-filter is necessary. The Future of the Outcome is
completely contingent upon the desired outcome being present. A possible question might be,
“Suppose you went home tonight and a miracle happened, the miracle is that now your desired
outcome is present. What would be the first thing you noticed that would let you know, now
you’re living in a world where your desired outcome is present?” This version of the question
still orients the client to difference and to the future, without requiring the client to filter the
answer through a consideration of the problem.
Similar to the History of the Outcome and the Resources for the Outcome descriptions, in
the Future of the Outcome the Desired Outcome is the central feature of the description. The
Future of the Outcome conversation can be placed or oriented anywhere in the future, from a half
an hour from now all the way to right before the end of someone’s life.
Also, because this type of description is about the presence of the desired outcome,
clinicians must remember that this description has nothing to do with the removal of someone’s
problem. In fact, the problem is likely irrelevant. We don’t need to understand the relationship
between the client’s problem and the presence of their desires; in fact there may actually be no
relationship between these two things at all! Removing the problem is not the agent of change.
When setting up a useful Future of the Outcome conversation in might actually be very helpful to
hold all the problems and situations in the client’s life stable and consider them still relevant, but
not that the client is different (given the presence of their internal desired outcome) they will
interact with EVERYTHING differently, even their problems, because they are discovering that
they are a different version of themselves, a version that is capable of interacting with problems
differently.
Also, it is important to presuppose that this internal, desired outcome change, will impact
everything. It won’t CHANGE everything, but it will IMPACT everything. Therefore we are free
to ask questions like, “What would be the first thing you would notice?” or “What would be
different about the way you eat your breakfast on a morning when your desired outcome was
present?” or even, “What would be different about the way you walked on a day when you were
feeling [insert desired outcome]?” The internal change will impact the interaction this person has
with everything and everyone around them, because they are a different version of themselves.
One of the major focuses of the Future of the Outcome conversation is to maintain the
hope that was introduced by the Desired Outcome questions. At times people will answer the
difference questions presented in the Future of the Outcome conversation, but will quickly
follow these answers up with something like, “But that couldn’t happen because [presenting
problem] is still happening or relevant in my life”. When client’s do this, we need to take their
concern or skepticism seriously. However, it is our job to make sure that hope and change persist.
We can use presuppositions in these moments by saying something like, “Well suppose, given
that your desired outcome is present, suppose for a minute that it was possible, or that it did
actually happen, what would you notice then or what difference would that make?” Presupposing
change persisting serves to retain the hope that is being built by the co-constructed conversation.
Again, it is important to remember that we aren’t trying to problem solve with this type
of conversation. We are NOT saying, what do you need to do to take steps toward achieving this
desired outcome. We are NOT saying, if you followed a successful path, in the future, and
achieved that goal, what step would come first and what step would come after that. The Future
of the Outcome isn’t about making a plan for success, but rather it is a description about
difference. Remember, this is a difference-oriented approach. Remember this is a language-based
approach, not a behavior-based approach.
Important tips for setting up the desired outcome effectively
● Make sure that you use the client’s exact desired outcome language
● Use details that you know about your client and their life to make the situation seem real
and plausible to them
● Make sure that the desired outcome appears suddenly/immediately in their life. They go
from not having their desired outcome to having it all at once
● Make sure that the desired outcome appears outside of the awareness of the client. This is
why a miracle is often helpful.
● Make sure that the client is obligated to discover the signs of the presence of the desired
outcome. Since the desired outcome appeared suddenly (by a miracle) the client needs
learn that it appeared by noticing one small difference or sign after another
● Make sure that the client is the only thing that changes when the desired outcome
appears. The world doesn’t change and the client’s problems/challenges may not have
changed. The desired outcome appearing is an indication that a new version of the client
is present to interact with these unchanged elements in a new/different way.

Possible Future of the Outcome Questions
● What is the first thing you would notice that would let you know that [insert desired
outcome] were present?
● What would be the next thing you would notice?
● Who in your life would also realize that something was different about you when
[desired outcome] was present? What would they notice that would let them know
something is different about you? How would they let you know they noticed? What
difference would it make to you if they noticed this about you?
●
Closing a session
Closing a session is all about trust! We are trusting that the language we developed with
the client throughout the session did indeed create a new reality. This new reality is present
because the conversation literally changed the client to a new version of themselves because they
considered and articulated things that were new and different. The work of the session has been
completed! Because change has occurred no other work needs to be encouraged at this time. We
need to honor and maintain the autonomy and agency of the client to use the session in whatever
way is right for them.
If we honor the client’s autonomy and agency we no longer need to do any of the
following:
● Give compliments
● Summarize the main points or the takeaways from the session
● Assign homework or tasks to be completed between sessions
If we do any of these things, we are violating the clients autonomy and we are reclaiming the
power within a session. We are communicating that our opinion of what happened during the
session is more important than their impression. We are communicating that we don’t trust that
they will make the most of what happened in the session on their own, but that we know how
they should continue to change going forward. We are communicating that we have been
assessing them (even if our assessment is positive) and that we, as the experts in the room, know
what is valuable about them. None of these things are helpful or convey trust in our clients.
Instead of doing these things we have two simple tasks during the closing of the session.
First, express gratitude. Any participation in the session is a gift from the client to us. They
agreed to collaborate with us. They agreed to be vulnerable with us. They were introspective and
worked throughout the session. Without them this work would be pointless. We express gratitude
for their contributions. Second, we offer a return appointment if they feel like that would be
helpful. This is not presuming that they will return, but rather, it is giving them the option to
return if they want. A simple statement like, “If you would like to return for another
appointment, you are more than welcome” will suffice. It might also come in the form of a
simple question, “Would you like to meet again? If so, you are more than welcome.”
References
Abbasi, A., Mohammadi, M., Zahrakar, K., Davarniya, R., & Babaeigarmkhani, M. (2017).
Effectiveness of solution-focused brief therapy (SFBT) on reducing depression and
increasing marital satisfaction in married women. Iran Journal of Nursing, 30(105), 34-
46.
Bavelas, J. De Jong, P., Franklin, C., Froerer, A., Ginerich, W., Kim, J., Korman, H., Langer, S.,
Lee, M. Y., McCollum, E. E., Jordan, S. S., & Trepper, T. S. (2013). Solution focused
therapy manual for working with individuals. Solution Focused Brief Therapy
Association. Retrieved from
https://irp-cdn.multiscreensite.com/f39d2222/files/uploaded/Treatment%20Manual%20Fi
nal%2C%20Update%203-17-18.pdf on September 25, 2020.
Carr, A., Hartnett, D. Brosnan, E., & Sharry, J. (2016). Parent plus systemic, solution-focused
parent training programs: Description, review of the evidence-base and meta-analysis.
Family Process, 56(3), 652-668. doi: 10.1111/famp.12225.
Connie, E. E. & Froerer, A. S. (2023). The Solution focused brief therapy diamond: A new
approach to SFBT that will empower both practitioner and client to achieve the best
outcomes. New York: Hay House.
De Shazer, S., Dolan, Y., Korman, H., Trepper, T., McCollum, E., & Berg, I. K., (2007). More
than miracles: The state of the art of solution-focused brief therapy. Binghamton, NY:
Haworth.
Froerer, A. S. & Jordan, S. S., (2013). Identifying solution building formulations through
microanalysis. Journal of Systemic Therapies, 32(3), 60-73.
George, E., Iveson, C., & Ratner, H. (2017). BRIEFER: A solution focused practice manual.
BRIEF.
Gong, H., Hsu, W. S. (2015) A meta-analysis on the effectiveness of solution-focused brief
therapy: Evidence from mainland China and Taiwan. Studies of Psychology and
Behaviors, 13(6): 709-803.
Gong, H. & Hsu, W. S. (2016) The effectiveness of solution-focused group therapy in ethnic
Chinese school settings: A meta-analysis. International Journal of Group Psychotherapy,
383-309. DOI: 10.1080/00207284.2016.1240588.
Hosseinpour, N., Jadidi, M., Mirzaian, B., & Hoseiny, H. (2015). The efficiency of
solution-focused brief therapy on adjustment problems of female students in Amol, Iran.
International Journal of School Health, 3(1), 1-5.
Jonas, B., Leuschner, F., & Tossmann, P. (2016). Efficacy of an internet-based intervention for
burnout: A randomized controlled trial in the German working population. Anxiety,
Stress, & Coping, 30(2):133-144.
Kim, D. I., Lee, H. E., & Park, E. (2017). The effect of solution-focused group counseling: Effect
size analysis by multilevel meta-analysis. Research in Counseling 18(1):157-179.
Kim, J.S. (2008). Examining the effectiveness of solution-focused brief therapy: A
meta-analysis. Research on Social Work Practice 18:107-116.

Kim, J. S., Franklin, C., Zhang, Y., Liu, X., Qu, Y., & Chen, H. (2015). Solution-focused brief
therapy in China: A meta-analysis. Journal of Ethnic & Cultural Diversity in Social
Work, 24(3):187- 201.
Kim, J., Jordan, S. S., Franklin, C., and Froerer, A., (2019). Is solution-focused brief therapy
evidence-based? An update 10 years later. Families in Society: The Journal of
Contemporary Social Services, 100(2), 127-138. DOI:10.1177/1044389419841688.
Maljanen, T., Knekt, P., Lindfors, O., Virtala, E., Tillman, P., Härkänen, T., & Helsinki
Psychotherapy Study Group. (2015). The cost-effectiveness of short-term and long-term
psychotherapy in the treatment of depressive and anxiety disorders during a 5-year
follow-up. Journal of Affective Disorders,190, 254-263. doi:10.1016/j.jad.2015.09.065.
McKergow, M. (2016). SFBT 2.0: The next generation of solution focused brief therapy has
already arrived. Journal of Solution Focused Practices, 2(2), 1-17.
Nedim, B. P., & Kaya, C. (2017). Sinif öğrencilerinin okul tükenmişliği ile baş etmede çözüm
odakli grupla psikolojik danişmanin etkisi (The effect of solution focused group
counseling program on dealing with school exhaustion of sixth grade students).
Uluslararası Sosyal Araştırmalar Dergisi (The Journal of International Social Research),
51(10), 769-777.
Neipp, M., Beyebach, M., Nuñez, R. N., & Martínez-González, M. (2016). The effect of
solution-focused versus problem-focused questions: A replication. Journal of Marital and
Family Therapy, 42(3), 525-535. doi: 10.1111/jmft.12140.

Ngammoh, P., Inang, P., & Koolnaphadol, P. (2017). Theory of the short-term exit approach to
self-sufficiency of undergraduate students in the faculty of education, Journal of
Education Naresuan University,19(1), 90-102.
O’Hanlon, B. (2003). A guide to inclusive therapy: 26 techniques for respectful, resistance
dissolving therapy. New York, N.Y.: W. W. Norton.
Park, J. I. (2014). Meta-analysis of the effect of the solution-focused group counseling program
for elementary school students. Journal of the Korea Contents Association 14(11):
476-485.
Pennapha, N. (2015) The consultant theory emphasizes short-term solution to reflect their inner
thoughts of employees. Burapha University Journal Online, 25(3).
Richmond, C. J., Jordan, S. S., Bischof, G. H., & Sauer, E. M. (2014). Effects of
solution-focused versus problem-focused intake questions on pre-treatment change.
Journal of Systemic Therapies, 33(1), 33-47.
Schade, N., Torres, P. & Beyebach, M. (2011). Cost-efficiency of a brief family intervention for
somatoform patients in primary care. Families, Systems, & Health, 29(3), 197-205.
Smock, S. A., Trepper, T. S., Wetchler, J. L., McCollum, E. E., Ray, R., & Pierce, K. (2008).
Solution-focused group therapy for level 1 substance abusers. Journal of Marital and
Family Therapy 34(1):107–120.
Stams, G. J. J., Dekovic, M., Buist, K., & de Vries, L. (2006). Effectiviteit van
oplossingsgerichte korte therapie: een meta-analyse (Efficacy of solution focused brief
therapy: a meta-analysis). Gedragstherapie 39(2):81-95.

Suitt, K. G., Franklin, C., & Kim, J. (2016). Solution-focused brief therapy with Latinos: A
systematic review. Journal of Ethnic & Cultural Diversity in Social Work 25(1), 50-67.
Zhang, A., Franklin, C., Currin-McCulloch, J., Park, S., & Kim, J. (2017). The effectiveness of
strength-based, solution-focused brief therapy in medical settings: A systematic review
and meta-analysis of randomized controlled trials. Journal of Behavioral Medicine,
41(2), 139-151. DOI: 10.1007/s10865-017-9888-1.

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Solution Focused Brief Therapy Diamond Approach Treatment Manual – Version 1: November 2023 2

Evidence-Base of Solution Focused Brief Therapy

ADOPT The Stance of the The Solution Focused Diamond

The Language of Solution Focused Brief Therapy

Overview of the Diamond Approach

What is Solution Focused Brief Therapy?

Solution Focused Brief Therapy (SFBT) is an evidence-based therapeutic approach (Kim,

language-based therapeutic approach that is founded on building hope through co-construction

SFBT is a unique therapy type, in which it is not intended to be an ongoing, lifelong

Evidence-Base of Solution Focused Brief Therapy

Table 1. Solution Focused Meta-Analyses

Stams, 2006 Efficacy of Solution Focused Brief Personal behavior 0.37**

Kim 2008 Examining the Effectiveness of Various personal 0.26*

Park 2014 Meta-Analysis of the Effect of the Elementary Self-esteem =

Gong, Hsu 2015 A Meta-Analysis on the Effectiveness of Various Overall =

Kim, 2015 Solution-Focused Brief Therapy in Internalized Overall = 1.26***

Carr, 2016 Parents Plus Systemic, Solution-Focused Parent with 0.58**

Gong, Hsu 2016 The effectiveness of Solution-Focused Group therapy Immediate =

Schmit, 2016 Meta-Analysis of Solution Focused Brief Various clinical 0.24*

Zhang, 2017 The Effectiveness of Strength-Based, Medical settings Psychosocial

Franklin, 2022 Solution-Focused Brief Therapy for Children and 0.176*

Franklin, 2023 Solution-Focused Brief Therapy in Adults in 0.654***

Karababa 2023 A meta-Analysis of Solution-Focused Children and 1.80***

Table 2: Cultures Served Effectively by Solution Focused Brief Therapy

Chili Schade, Torrez, & Beyebach (2011)

China Gong & Hsu (2015); Gong & Hsu (2016)

German Jonas, Leuschner, & Tossmann (2016)

Finland Maljanen, Knekt, Lindfors, Virtala, Tillman, Harkanen, & Helsinki

Korea Kim, Lee, & Park (2017); Park (2014)

Latino/a Suitt, Franklin, & Kim (2016)

Netherlands Stams, Dekovic, Buist, & de Vries (2006)

Persian Abbasi, Mohammadi, M. Zahrakar, Davarniya, & Babaeigarmkhani

Spain Neipp, Beyebach, Nunez, & Martinez-Gonzalez (2016)

Taiwan Gong & Hsu (2015)

Thailand Ngammoh, Inang, & Koolnaphadol (2017); Pennapha (2015)

Turkey Nedim & Kaya (2017)

evidence-based for addiction and/or mental health disorders, co-occurring disorders, or

Washington has listed solution-based casework as an evidence-based practice through the

marital satisfaction (Abbasi, Mohammadi, Zahrakar, Davarniya, & Babaeigarmkhani, 2017).

Evolution of the Approach

development and clarity of the approach.

might argue this is the 3.0 version of SFBT.

ADOPT The Stance of the The Solution Focused Diamond

work you recognize your privilege and power.

Recognizing Your Power and Privilege

Ways to give up power

● Share it with clients-honor their autonomy and agency

● Avoid using stereotypical language (i.e. As an African American…, or from a woman’s

● Don’t believe the client when they say, “I don’t know”

suitable for SFBT

● Don’t believe that psychoeducation is the best way forward

that they believe completely in the client and their abilities.

ADOPT the Stance

Sharing power is only a portion of what can strengthen a therapeutic relationship. In

These can be summarized with the acronym ADOPT.

from the description you constructed together during the session.

of difference throughout the session.

of the client's life?

2- What impact/difference would these differences make?

about/achieve these differences?

3. O is for Outcome: SFBT is an outcome lead approach. Begin each session

presence of the desired outcome/best hopes. Don’t focus on goals, or creating

impact the desired outcome has on the client’s life.

presuppositions and move to bigger presuppositions as the session progresses.