Research Article

Research on Social Work Practice

2024, Vol. 34(3) 265–276
Solution-Focused Brief Therapy in © The Author(s) 2023

Community-Based Services: A Meta-Analysis Article reuse guidelines:

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of Randomized Controlled Studies DOI: 10.1177/10497315231162611

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Cynthia Franklin1, Xiao Ding1 , Johnny Kim2, Anao Zhang3, Audrey Hang Hai4,
Kristian Jones5, Melissa Nachbaur6, and Ashley O’Connor7

Abstract
Purpose: Solution-focused brief therapy (SFBT) is practiced by social workers in clinical, community-based services, but no
reviews of the outcome research have been completed. Methods: A meta-analysis of randomized studies. Outcome domains
included depression, anxiety, behavioral health, health and wellbeing, family functioning, and psychosocial adjustment.
Results: Twenty-eight studies with 340 effect sizes were analyzed in meta-regression with robust variation estimation
(RVE). Overall, statistically significant and medium treatment effect sizes were found across outcome domains, g = 0.654,
95% CI: 0.386–0.922, p < 0.001. Interventions with 4 or more SFBT techniques across three categories (cooperative language,
co-construction, and developing a therapeutic relationship; strengths and resources; and future-focused questions) showed a
moderate treatment effect. Implications: SFBT is an effective intervention for depression, behavioral health, family function-
ing, and psychosocial outcomes when delivered in community-based services.

Keywords
solution-focused brief, RCTs, outcomes, community-based settings, techniques

Solution-focused brief therapy (SFBT) is a strengths-based,
collaborative, and future-oriented, clinical intervention that
evolved out of the systemic family approaches to therapy in
the early 1980s (de Shazer, 1985; de Shazer et al., 1986).
SFBT was developed in a community-based, family services
clinic, the brief family therapy center (BFTC) in Milwaukee
by two social workers, Steve de Shazer and Insoo Kim
Berg, and an interdisciplinary group of clinicians and
researchers (Lipchik et al., 2012). The BFTC served as a
routine practice setting and a training clinic and was on a
public bus line providing access for families who were
involved in social services systems. Consistent with its
origins, SFBT has continued to be practiced across different
types of community- based services. While community-based
services can be defined in different ways this article defines
community-based services as practice settings within a geo-
graphical or catchment area that offers a network of non-profit
and public, clinical and social services (McLeroy et al., 2003).
Clinical services in community-based settings refer to activi-
ties undertaken in the community, rather than in institutional
settings, to promote mental health (e.g., children and family
services agencies, community mental health clinics, probation
offices, and educational settings, American Psychological
Association [APA], 2015). Community-based services
provide clinical interventions to several different types of
underserved populations with varying problems and the
same was the case for the BFTC where SFBT was first
practiced. Children, adolescents, adult clients, and families
with different presenting problems such as, family and
couple conflicts, child behavioral problems, depression, and
substance use were among the cases from the BFTC (de
Shazer & Berg, 2002).
The practice and research literature on SFBT offers several
examples demonstrating how SFBT was practiced in
community-based services. Berg and De Jong (1996), for
example, showed how SFBT can be practiced with mandated
clients who were involuntary and sent to social workers in
family services. Berg (1994) provided instructions on how
to practice SFBT in family preservation services delivered
in homes with clients from the child protective services.
Pichot and Dolan (2014) presented case studies and life
lessons for how SFBT can be practiced in the clinical and
1
Steve Hicks School of Social Work, The University of Texas at Austin,
Austin, USA
2
Graduate School of Social Work, The University of Denver, Denver, USA
3
School of Social Work, The University of Michigan, Ann Arbor, USA
4
School of Social Work, Tulane University, New Orleans, USA
5
School of Social Work, University of Washington, Seattle, USA
6
Travis County Sheriff’s Office, Austin, USA
7
School of Social Work, University of Alaska Anchorage, Anchorage, USA
Corresponding Author:
Cynthia Franklin, Steve Hicks School of Social Work, Mail Code, D3500,
1925 San Jacinto, Austin, TX 78712, USA.
Email: cfranklin@austin.utexas.edu
266
administrative practices of a community agency serving
clients with substance use and behavioral health problems.
In a systematic review, Gingerich and Peterson (2013)
noted that SFBT is widely used by social workers and other
human services professionals because it focuses on strengths
instead of problems and is brief as it is usually delivered in six
or fewer sessions. In a review of 251 outcome studies, Neipp
and Mark Beyebach (2022) analyzed the practice of SFBT in
schools and community services and found that over 20% of
the studies they reviewed were in some type of community-
based setting. Kim et al. (2019b) further summarized the
results from eight meta-analyses on SFBT and discussed spe-
cific examples of how SFBT was practiced in community-
based services. Practice literature and the three independent
reviews mentioned here show the feasible use of SFBT as
an effective, brief intervention in community-based services.
Studies have also concluded that there is a need to study the
outcomes of SFBT when practiced within community-based
services (Neipp & Mark Beyebach, 2022).
SFBT Practice
SFBT is now practiced globally within psychotherapy, social
services, schools, child welfare, and communities-based orga-
nizations (Beyebach et al., 2021). According to Abdulla and
Woods (2021), the lack of study of SFBT practice techniques
in relation to outcomes is a major shortcoming in the empir-
ical studies of SFBT. We found no meta-analysis examining
the efficacy of SFBT questions and techniques in community-
based services. Studying the outcomes of different types of
SFBT techniques has clinical implications, because it may
be beneficial to know the numbers and types of SFBT tech-
niques needed to achieve effective outcomes. The study of
SFBT techniques also has important implications for how to
achieve SFBT intervention fidelity and for the effective train-
ing of social workers within community-based services
(Yates & Lee, 2021). Founders of SFBT, de Shazer and
Berg (2002), argued that it was important to identify specific
SFBT techniques so that practitioners and researchers could
better understand SFBT and complete rigorous, clinically rel-
evant, and comparative research studies. Four key techniques
were identified by the developers of SFBT: (1) asking the
miracle question; (2) asking scaling questions; (3) taking a
break; and (4) offering the clients compliments followed by
a homework task or experiments.
The SFBT treatment manual developed by the
Solution-Focused Brief Therapy Association expands upon
these techniques (Bavelas et al., 2013) discussing techniques
such as, (1) pre-treatment change, (2) difference questions
and amplifying differences, (3) relationship questions, (4)
coping questions, and (5) exception questions. The manual
also discusses the importance of the collaborative therapeutic
alliance, the co-construction process—listening, selecting,
and building questions and formulations (paraphrases and
Research on Social Work Practice 34(3)
reflections) from the client’s statements, and the focus on
building a desired future (Bavelas et al., 2013, p 10).
Past Studies on SFBT Techniques
Past studies compared solution-focused questions to problem-
focused questions and these studies found mixed results with
some studies favoring SFBT techniques (e.g., Beyebach,
2014; Richmond et al., 2014) and other studies showing
equivocal results between solution-focused questions and
problem-focused questions (e.g., Neipp et al., 2021).
Richmond et al. (2014) specifically found that SFBT
improved scores on the outcome questionnaire at intake com-
pared to problem-focused questions. Beyebach (2014) found
that SFBT techniques, pre-treatment change, scaling, and
negotiating goals had a positive impact on therapeutic out-
comes such as goals, expectations, and self-efficacy. Neipp
et al. (2021) study found positive results for SFBT questions
but also for problem-focused questions. Specific to the SFBT
techniques studied, the miracle and exception questions were
more effective than problem-focused questions in decreasing
negative affects, while scaling questions produced more
action steps.
To better understand the SFBT techniques and process,
Franklin et al. (2016) performed a meta-summary of 33
SFBT process studies to investigate what techniques are
used to achieve outcomes in SFBT. For the purpose of com-
parisons, these researchers grouped SFBT techniques and
processes into four categories to evaluate which techniques
had the most empirical support across studies: (1) linguistic
and collaborative language; (2) therapeutic relationship and
style; (3) strengths and resources, and (4) future-oriented
techniques. The most empirical support was found for the lan-
guage techniques (co-construction process) and the
strengths-oriented techniques. However, Franklin et al.
(2016) study did not examine SFBT techniques in relation
to specific outcomes (e.g., depression, family functioning),
which would strengthen existing reviews and current practice
literature.
Specific Problems, Populations and Outcomes
Problems and populations have been examined in past meta-
analyses and systematic reviews, but previous meta-analyses
did not examine the effects of various techniques of SFBT.
In a review of 43 outcome studies, for example, Gingerich
and Peterson (2013) reported the strongest evidence for
SFBT was with adult clients with depressive symptoms
where five separate studies used the Beck Depression
Inventory to reliably measure outcomes. These authors
also concluded that SFBT may be efficacious with adoles-
cents. Reviews within schools show SFBT is effective for
psychosocial and interpersonal outcomes where researchers
found small to medium effects across different outcomes
(Franklin et al., 2022). Health-related psychosocial
Franklin et al.
outcomes have also been studied in medical settings across
nine studies showing small effect sizes (Zhang et al., 2017).
Other reviews have examined outcomes such as trauma,
substance use, and family functioning (Eads & Lee 2019;
Franklin & Hai, 2021; Kim et al., 2019a), reporting positive
results when analyzing the results from quasi-experimental
and experimental studies.
Meta-analyses on SFBT have repeatedly examined inter-
nalizing and externalizing behaviors as an outcome but with
mixed results and without studying specific problems
within those dimensions (e.g., depression, anxiety, sub-
stance use). Corcoran (2012), for example, found that
SFBT was not effective for externalizing behaviors, but
Bond et al. (2013) and Hsu et al. (2021) found statistical
support for SFBT’s effectiveness for externalizing behav-
iors, showing small to medium effect sizes, but no
support for internalizing behaviors. Kim (2008) and
Schmit et al. (2016) respective reviews showed SFBT
achieved small effect sizes for internalizing symptoms and
behaviors and the Kim study did not yield positive statisti-
cal results with externalizing behaviors. Previous reviews
and meta-analyses included both experimental and
quasi-experimental studies and authors have mentioned
limitations for the interpretation of the positive results
because of the weaknesses in research designs, small
sample sizes, and the lack of precise enough measures to
determine specific outcomes, such as grouping different
measures together under broader categories (e.g., internaliz-
ing disorders). A meta-analysis of randomized controlled
studies that includes an examination of SFBT techniques
and specific outcomes, such as depression, anxiety,
trauma, substance use, family functioning, health, and psy-
chosocial outcomes, is especially clinically relevant and
will build on previous reviews.
Study Aims
This study aimed to conduct a meta-analysis of randomized
controlled trials (RCTs) on SFBT for adolescent and adult
clients that received services in outpatient, community-based
settings. Despite the prevalent use of SFBT in community-
based services, no meta-analysis has specifically examined
the effects of SFBT on outcomes in community-based ser-
vices or examined the effectiveness of specific SFBT tech-
niques on outcomes. We planned this study to analyze how
effective the number and types of SFBT techniques for the
outcomes studied. This meta-analysis will especially contrib-
ute to the practice literature by examining SFBT across RCT
studies on clinically relevant outcomes, such as depression,
anxiety, behavioral health, health and wellbeing, family func-
tioning, and psychosocial outcomes. The results of this study
will make a unique contribution by providing implications for
the efficacious practice of SFBT in outpatient, community-
based services.
267
Methods
Search Procedures
The Cochrane recommendations for searching RCTs were
followed for the search process (Higgins et al., 2019), for
example, articulating types of participants, intervention, com-
parison, outcomes (PICO framework), choosing effect mea-
sures and computing estimates of effect, and summarizing
risk of bias and publication bias. Six electronic databases
were searched: PsycINFO, SocINDEX, Medline, Education
Resource Information Center (ERIC), Psychology and
Behavioral Sciences Collection, and Dissertations and
Theses Global. The following keywords and terms were
used to search study title, abstract, and keywords:
(Solution-Focused OR “Solution Focused” OR SFBT OR
“Solution-Focused Brief Therapy” OR Solution-Oriented)
AND (random* OR experiment*). In addition, forward and
backward searches were conducted to identify potentially eli-
gible studies that were cited by articles and reviews. The data-
base search and the manual search of literature included
studies published (for published studies) or completed (for
unpublished studies) before October 2018, yielding a total
of 2625 records. Due COVID-19 pandemic related delays,
we conducted an updated search using the original search cri-
teria for the time period 2018–2021, which yielded another
134 records. This study was registered with PROSPERO
(study number: CRD42020163906).
Inclusion and Exclusion Criteria
This review included published and non-published studies
from all countries as long as the study report was available
in English. Studies in this review met the following preset
criteria:
1. SFBT Intervention. Studies were focused on SFBT,
which was identified by the individual studies’
authors by name and through further examination by
the research team based on the SFBT therapeutic tech-
niques identified in the studies. We included SFBT
therapeutic techniques, such as focusing on strengths,
scaling questions, exception questions, coping ques-
tions, the miracle question, and other techniques that
were identified in the SFBTA treatment manual and
that have been defined in previous studies (e.g.,
Gingerich & Peterson, 2013). Studies that combined
SFBT techniques with other therapeutic approaches
were included as long as the authors explicated the
study’s intention was to examine the outcomes of
SFBT and described the techniques of SFBT that met
the criteria for this review.
2. Sample. Study participants were adolescents, adults,
and/or families. This review specifically focused on
adolescents and adult populations because other
268 Research on Social Work Practice 34(3)

studies have suggested efficacy with these age groups Functioning Outcomes included trauma, substance
(Franklin et al., 2022; Gingerich & Peterson, 2013). use, and other general psychiatric symptoms, such as
Studies with children 5–10 years old were excluded somatization and psychosis. (e) Family Functioning
because the literature on SFBT indicated a need to cre- Outcomes included quality of couple and family rela-
atively adapt SFBT techniques to meet the develop- tionships, communication, conflict resolution, parent-
mental needs of children of this age group (e.g., Berg ing skills, coping, and problem-solving abilities
& Steiner, 2003). within a family. (f) Psychosocial Adjustment
3. Community-Based Services Settings. Studies were Outcomes included functioning in social roles across
included if SFBT was studied in any outpatient different settings, such as health care, living situations,
setting in the community, such as hospital clinic, social and interpersonal relationships, and employment
social services agency, university clinic, or mental settings.
health center. High schools and in-school mental
health services were excluded because a recent meta-
analysis has been conducted on those studies Data Extraction
(Franklin et al., 2022).
4. Research Designs. Only RCTs were included. Different The research team consists of an experienced group of faculty
types of comparators and controls were included, such members and doctoral students with expertise in meta-
as inactive controls (i.e., no treatment, waitlist control, analysis and SFBT. The team developed a coding form
treatment as usual) and active controls (i.e., using other based on Cochrane’s recommendations (Higgins & Green,
interventions). 2011) for data extraction and is available upon request. The
5. Outcome Measures. Studies were included if they data extraction form was used to collect information on
focused on any behavioral health, health, family func- research design, participant and setting descriptors, interven-
tioning, or psychosocial outcomes. The following def- tion descriptors, moderators (i.e., SFBT techniques) and
initions were used in this review to categorize the effect size data. SFBT techniques were further categorized
outcomes: (a) Health and Wellbeing Outcomes using a modified version of the categories used in the
included health status, adjustment to illness, and indica- Franklin et al. (2017) study (see Table 1 for categories of
tions of wellbeing, such as personal strengths, positive SFBT techniques).
emotion, and quality of life. (b) Anxiety Outcomes Five studies were originally coded with the form to pilot
included anxiety symptoms and anxiety disorders. (c) the coding categories before two coders proceeded with
Depression Outcomes included symptoms of depres- coding. Rayyan, a web and mobile app for systematic
sion and depressive disorders. (d) Behavioral Health reviews (Ouzzani et al., 2016), was used in this review to
help expedite the initial screening of titles, abstracts, and full-
text articles. Two reviewers independently conducted title and
Table 1. Categories of SFBT Techniques. abstract screening and full-text review. The inter-rater agree-
ment rate was calculated by the number of studies with a con-
Cooperative Language/ Client Strengths/ sensus in a reviewer pair divided by the total number of
Therapeutic Resources Future-Focus studies screened and came out to be 97.5%. The two review-
Relationship Questions Questions and Questions and ers resolved disagreements through discussion, and if an
and Techniques Techniques Techniques
agreement could not be reached, a third reviewer was con-
• Co-construction talk • Focusing on • Future-focus sulted. Two coders coded the data independently and sepa-
• Solution-building talk strengths, questions rately; hence no formal measures of inter-rater reliability
• Amplifying questions resources, and • Fast-forward were obtained. Two other coders checked all the data and spe-
• Difference questions solutions questions
cifically examined each measure and the SFBT techniques for
• Developing • Building • Miracle question
collaborative competencies of • Goal setting accuracy in coding.
relationship the client • End of session
• Increasing positive homework
emotions • Scaling questions Risk of Bias Assessment
• Pre-session change • Formula first
questions session question Two reviewers independently conducted risk of bias assess-
• Exception ment using the Cochrane Collaboration’s tool for assessing
questions risk of bias in randomized trials (Higgins et al., 2019).
• Coping questions Studies were rated with high, low, or unclear risk in seven
• Providing domains: sequence generation, allocation concealment, blind-
compliments ing of participants and personnel, blinding of outcome assess-
• Relationship
ment, incomplete outcome data, reporting bias, and other
questions
bias. Studies were rated as having low other bias (1) when
Franklin et al.
baseline balance was achieved or (2) when baseline balance
was not achieved but the imbalanced variables were adjusted
in primary analyses. Baseline balance is achieved when par-
ticipants in treatment and control groups do not differ
significantly.
Statistical Analysis
Data analyses were conducted in R statistical software
(version 3.5.3), including the metafor and robumeta packages
to implement robust variance estimation (RVE) in meta-
regression. Other than descriptive statistics of study character-
istics, we first calculated standardized mean differences and
small sample size corrected Hedges’ g as treatment effect
sizes. We encountered a couple of odds ratio effect sizes
and converted these into the same metric as Hedges’ g.
Specifically for meta-analysis, we first calculated an overall
treatment effect size across all outcome domains. Then, we
estimated treatment effect sizes for each outcome domain sep-
arately (domain-specific subgroup analysis) for the following:
health and wellbeing, anxiety, depression, behavioral health
functioning, family functioning, and psychosocial adjust-
ment. For moderator analysis, we evaluated “outcome
domain” as a potential moderator to evaluate the between-
domain treatment effect differences.
In addition, we considered the number of SFBT interven-
tion techniques and categories of SFBT techniques for sub-
group and moderator analysis in relation to SFBT’s
treatment effects. We also considered participants’ demo-
graphic and intervention characteristics as potential modera-
tors. However, due to missing data in included studies,
these analyses were not feasible.
We selected meta-regression with RVE (Tipton &
Pustejovsky, 2015) as the primary analytical framework for
a couple of important reasons. First, meta-regression with
RVE enables us to include multiple effect sizes from the
same study to promote statistical power while effectively
accounting for the within-study dependence among effect
size estimates. Second, meta-regression with RVE effectively
models the variances associated with meta-regression coeffi-
cients (i.e., intercepts and coefficients) across fixed- versus
random-effects models. As a result, meta-regression with
RVE does not require an investigation of heterogeneity
among studies (or effect sizes) to pre-determine a meta-
analysis model, that is, between a fixed- versus and random-
effects meta-analysis model.
Results
Thirty-three publications from 28 studies met study criteria
and were detailed in the preferred reporting items for system-
atic reviews and meta-analyses (PRISMA) diagram (see
Figure 1). For the meta-analysis, we combined those publica-
tions from the same study, resulting in a final meta-analytical
sample of 28 studies. Sensitivity analysis comparing our
269
decision to combine those studies and the alternative decision
to separate those publications from the same study revealed
very similar findings.
The average sample size across studies was 72. Across the
28 included studies, 26 reported on participants’ sex, and
females accounted for the majority of the included sample
(68.25%). Slightly more than half of the 28 studies reported
information on participants’ race/ethnicity (n = 15, 53.57%).
Of the studies that reported participants’ race/ethnicity, an
average of 38.69% of participants were White, 19.12%
were Asian, 11.12% were Black, 2.76% were Hispanic, and
28.31% were other races/ethnicities (e.g., American Indian/
Alaskan Native, Native Hawaiian/Pacific Islander, mixed
race, Iranian). In addition, six studies took place in commu-
nity services agencies (21.43%), five studies in hospital
clinics (17.86%), four studies in mental health centers
(14.29%), three studies in university mental health clinics
(10.71%), two in social security offices (7.14%), one study
in a counseling center (3.57%), one in prison (3.57%), one
in a residential program (3.57%), one in a call center
(3.57%), one in a probation setting (3.57%), one online
(3.57%), and two in unspecified outpatient settings (7.14%).
Risk of Bias and Publication Bias Assessment
Across 28 studies, 50% (n = 14) of the studies were rated as
having a low risk of bias in random sequence generation;
35.71% (n = 10) were rated to have an unclear risk of bias;
and 14.29% (n = 4) were rated as high risk of bias in
random sequence generation. In terms of allocation conceal-
ment, 57.14% (n = 16) were identified as having an unclear
bias, 28.57% (n = 8) had a low risk of bias, and 14.29% (n
= 4) had a high risk of bias. For blinding of participants and
personnel, most of the included studies (n = 17, 60.71%)
were reported as having a high risk of bias, 21.43% of
studies (n = 6), and 17.86% (n = 5) studies were unclear or
low risk of bias, respectively. Similarly, most studies (n =
20, 71.43%) reported a high risk of bias in the blinding of
outcome assessment; 7 studies (25%) reported a low risk of
bias, and one study (3.57%) reported an unclear risk of
bias. In terms of incomplete outcome data, 57.14% of
studies (n = 16) were reported as having a low risk of bias,
28.57% (n = 8) studies had a high risk of bias, and 14.29%
(n = 4) had an unclear risk of bias. Most studies were identi-
fied as having an unclear risk of bias in selective reporting (n
= 22, 78.57%); 5 studies (17.86%) reported a low risk of bias,
and 1 study (3.57%) reported a high risk of bias in selective
reporting. Lastly, for other biases, 24 studies (85.71%) were
identified as having a low risk of bias, 3 studies (10.71%)
had unclear risk of bias, and 1 study (3.57%) had high risk
of bias.
Publication bias was evaluated using visual inspection by
plotting effect sizes against standard errors, and a reasonably
symmetric funnel plot is evidence supporting the absence of
publication bias. As shown in Figure 2, the funnel plot is
270
Figure 1. PRISMA diagram.
Figure 2. Funnel plot for publication bias.
Research on Social Work Practice 34(3)
reasonably symmetric, suggesting no strong concern of pub-
lication bias. The conclusion of the visual inspection was
further supported by the Vevea and Woods sensitivity
weight function model by comparing an observed treatment
effect size and a theoretical effect size when the funnel plot
is perfectly symmetric. The differences between the two
effect sizes were not statistically significant, and the likeli-
hood ratio test is statistically non-significant, confirming the
visual conclusion that there’s no major concern of publication
bias.
Meta-Analysis and Subgroup Analysis. Across 28 studies and
340 effect sizes, meta-regression with RVE revealed an
overall statistically significant and medium treatment effect
size across outcome domains (i.e., depression, anxiety,
behavioral health, health, family functioning, and psychoso-
cial adjustment), g = 0.654, 95% CI: 0.386–0.922, p <
0.001. Across outcome domains, participants receiving
SFBT on average are expected to have 0.654 standard
Franklin et al. 271

Table 2. Results of Meta-Analysis Across Outcomes and Within Outcome Domains.

Estimatea N/Kb df 95% CI

Overall Treatment Effect 0.654*** 28/340 26.4 0.386–0.922
Health and Wellbeing 0.394 11/57 9.78 −0.042 to 0.831
Anxiety 0.522 8/20 6.2 −0.056 to 1.100
Depression 0.652* 11/30 9.81 0.146–1.160
Behavioral and Health Function 0.573** 16/140 14.4 0.216–0.930
Family Function 0.615* 9/34 7.78 0.097–1.130
Psychosocial Adjustment 0.410* 12/55 10.6 0.001–0.820
a
Estimate is the point estimate of an overall treatment effect size.
b
N = number of studies; K = number of effect size estimates.
*p < 0.05.
**p < 0.01.
***p < 0.001.

Table 3. Results of Subgroup Analysis.

Estimatea N/Kb df 95% CI

Number of categories of techniques
2 out of 3 categories 0.382 8/157 6.77 −0.121 to 0.885
3 out of 3 categories 0.771*** 20/183 18.7 0.433–1.110
Number of techniques
4 to 5 techniques 0.645* 7/62 5.92 0.145–1.140
6 to 9 techniques 0.702** 12/186 10.6 0.235–1.170
10 or more techniques 0.611 9/92 7.96 −0.004 to 1.230
a
Estimate is the point estimate of an overall treatment effect size.
b
N = number of studies; K = number of effect size estimates.
*p < 0.05.
**p < 0.01.
***p < 0.001.

deviations greater improvement than their counterparts in the
control condition, and the difference was statistically signifi-
cant (see Table 2).
Subgroup analysis for specific outcome domains revealed
that SFBT was statistically significant with medium treatment
effects for depression outcomes, g = 0.652, 95% CI: 0.146–
1.116, p = 0.017, behavioral health function, g = 0.573, 95%
CI: 0.216–0.930, p < 0.01, family function, g = 0.615, 95%
CI: 0.097–1.130, p = 0.026, and psychosocial adjustment, g
= 0.410, 95% CI: 0.001–0.820, p = 0.049. In contrast, the
overall treatment effect of SFBT was statistically non-
significant for health and wellbeing outcomes g = 0.394,
95% CI: −0.042 to 0.831, p = 0.072, and anxiety outcomes
g = 0.522, 95% CI: −0.056 to 1.100, p = 0.070.
Outcome Domain as a Moderator
Moderator analysis evaluating the between-domain treatment
effect size differences was evaluated using meta-regression
with effect size as a dependent variable and treatment
category as an independent variable. Outcome domain was
not a significant moderator, suggesting no significant differ-
ences in SFBT’s treatment effect across outcome domains
(results not shown in a table due to statistical
non-significance).
Number and Category of SFBT Techniques for
Subgroup and Moderator Analysis
As shown in Table 3, the subgroup analysis findings of the
SFBT techniques revealed that SFBT studies that used 2
out of 3 categories of SFBT techniques (see Table 1 for cat-
egory descriptions) reported an overall statistically non-
significant treatment effect g = 0.382, 95% CI: −0.121 to
0.885, p = 0.115, whereas SFBT studies that used all 3 cate-
gories of SFBT techniques reported an overall statistically
significant and large treatment effect, g = 0.771, 95% CI:
0.433–1.110, p < 0.001. The difference between the two
types of studies (i.e., those that used only 2 versus those
272
that used all 3 categories of SFBT techniques) was statisti-
cally non-significant.
In terms of the number of SFBT techniques in relation to
treatment effect, an overall statistically significant treatment
effect was identified among SFBT studies that used 4 to 5
techniques, g = 0.645, 95% CI: 0.145–1.140, p = 0.019, and
SFBT studies that used 6 to 9 techniques, g = 0.702, 95%
CI: 0.235–1.170, p < 0.01. However, SFBT studies that
used 10 or more techniques reported an overall statistically
non-significant treatment effect, g = 0.611, 95% CI: −0.004
to 1.230, p = 0.051.When we evaluated the number of tech-
niques used as a moderator, its moderation effect was not stat-
istically significant.
Discussion
This study examined the outcomes of SFBT with adolescent
and adult clients who received services in outpatient,
community-based services, analyzing the results from 28
RCT studies across six different outcome domains. The
overall results indicated that SFBT had a statistically signifi-
cant and medium treatment effect size across outcome
domains, g = 0.654, 95% CI: 0.386–0.922, p < 0.001 when
compared to different types of comparators such as inactive
controls (i.e., no treatment, waitlist control, treatment as
usual) or active controls (i.e., other interventions). When
compared to other interventions, SFBT was mostly compared
to CBT and treatment as usual that used eclectic, non-
specified interventions (60.71%) or nothing at all (39.29%).
Outcome Domains
An aim of this study was to evaluate specific outcomes so that
we can see on what types of problems SFBT has an effect.
The results showed that SFBT was effective in four of the
six outcome domains, including depression outcomes (g =
0.652, p = 0.017), behavioral health functioning (g = 0.573,
p < 0.01), family functioning (g = 0.615, p = 0.026), and psy-
chosocial adjustment (g = 0.410, p = 0.049). The overall treat-
ment effect of SFBT was statistically non-significant for
health and wellbeing outcomes (g = 0.394, p = 0.072) and
anxiety outcomes (g = 0.522, p = 0.070).
The statistically significant results for depression have
been reported in other studies (Gingerich & Peterson 2013).
Other meta-analysis studies have also shown small effects
for internalizing behaviors that included depressive symp-
toms, such as Kim (2008) and Schmit et al. (2016). This
study makes a contribution by specifically examining depres-
sion across the studies thus building on Gingerich and
Peterson’s review. Gingerich and Peterson (2013) reported
the effectiveness of SFBT with adult clients with depressive
symptoms in five separate studies and four of these studies
found SFBT to be comparable to well-established alternative
treatments for depression such as CBT. The effect size in this
study approached a medium treatment effect for the
Research on Social Work Practice 34(3)
depression outcome, adding more evidence for the effective-
ness of SFBT. On the other hand, anxiety, another internaliz-
ing behavior that is strongly associated with depression and
other mental health conditions, did not show a statistically
significant treatment effect. This is an interesting finding
because some past studies have shown that SFBT is effective
with internalizing disorders (Kim, 2008; Schmit et al., 2016)
which is presumed to include anxiety symptoms; however,
other studies on internalizing disorders in children and adoles-
cents did not show a statistically significant effects (Bond
et al., 2013; Hsu et al., 2021). We speculate that the discrep-
ancies across studies have to do with differences in study
designs and types of measures and this warrants further
investigation.
This study showed an effective treatment effect for the
behavioral health outcome domain that included different
measures to assess trauma, substance use, and general psychi-
atric symptoms. The findings of this study build upon other
reviews that examined SFBT’s behavioral health outcomes
(e.g., Eads & Lee; 2019; Franklin & Hai, 2021) and make a
contribution to rigor by only including RCT designs. The lim-
itations of the different measurements and small sample sizes
within the behavioral health studies reviewed did not allow us
to assess specific outcomes (e.g., substance use) as we were
able to do with the depression outcome, but the medium treat-
ment effect found in this study shows that SFBT is a promis-
ing intervention for behavioral health conditions. The
implication is that it may be a useful intervention for clinical
work within community mental health settings and deserves
further study with more specific measures of behavioral
health outcomes.
The positive treatment effect of SFBT for family function-
ing is an important finding because there have only been a few
research studies done on this outcome domain and the studies
that have been reviewed have not shown statistical effective-
ness for SFBT with couple and family problems (Kim, 2008;
Neipp & Mark Beyebach 2022). In contrast to past studies,
this study showed a positive treatment effect for the family
functioning outcome domain and a medium treatment
effect. While these are encouraging results for the potential
applications of SFBT for family services, it is important to
note that the majority of studies dealt with parenting and
the behaviors of adolescents (e.g., Keating et al., 2016;
Priebe et al., 2013). The findings from this study thus are con-
sistent with past reviews that indicated that SFBT is a prom-
ising intervention with adolescents and families (Bond et al.,
2013). At the same time, more research is warranted for other
couple and family related problems (Davarniya et al., 2018)
given the limited number of studies that have been done on
SFBT in couple and family therapy.
The health and wellbeing outcome domain showed a stat-
istically non-significant treatment effect, and this is in contrast
to another meta-analysis. Zhang et al. (2017) found a small
effect for SFBT in medical settings with health-related out-
comes. Some differences between these studies were that
Franklin et al.
the present study was in outpatient clinic settings only and
fewer studies were included in the outcome analysis. The
health-related constructs in the Zhang et al. (2017) study
that found a small effect size also resembled depression and
psychosocial outcomes measured in the current study. In
the Zhang et al. (2017) study, for example, psychosocial out-
comes included health-related depression along with psycho-
social adjustment to illness. The health outcome and
wellbeing domain in this study included positive emotion out-
comes and other indicators of positive wellbeing that have
been posited to be important to change in SFBT (Kim &
Franklin, 2015). These measures deserve further study
because of their significance to the change process and out-
comes in SFBT (Neipp et al., 2021). In this study, psychoso-
cial adjustment further showed a positive effect. This builds
on other research (e.g., Gingerich & Peterson, 2013) that
showed SFBT is an effective intervention in community-
based services that involve adjustment to social roles, such
as workers’ compensation, job placement, and rehabilitation
settings.
SFBT Techniques
This study analyzed the numbers and types of SFBT tech-
niques by grouping techniques into three categories which
constitute a modified version of the four categories that
were first used in a review of process studies by Franklin
et al. (2017). An overall statistically significant treatment
effect was identified among SFBT studies that used 4 to 5
techniques, g = 0.645, 95% CI: 0.145–1.140, p = 0.019, and
SFBT studies that used 6 to 9 techniques, g = 0.702, 95%
CI: 0.235–1.170, p < 0.01. This finding implies that the use
of too few SFBT techniques (3 or less) may not be an effica-
cious way to practice SFBT. On the other hand, the use of ten
or more techniques was statistically non-significant in this
study. This means that the use of too many SFBT techniques
in an intervention may be counterproductive to client change.
SFBT has been discussed as being more than its techniques
and is a style of therapeutic conversation that uses various
techniques to co-construct a preferred future and facilitate
client change (Franklin et al., 2017). The results of this
study could possibly mean that practitioners who use too
many SFBT techniques may be technique-driven without
fully understanding how to use the various techniques to
support the client’s change. A similar finding has been dis-
cussed in studies on Motivational Interviewing, for example
(Wilson et al., 2018, cited in Yates & Lee, 2021).
The current study indicates a dosage effect of 4–9 SFBT
techniques to obtain intervention effectiveness. This finding
is important for training, practice, and research because tech-
niques in studies can vary considerably, and this variation has
implications for fidelity and the conclusions that may be
drawn about efficacy in studies. For example, Abdulla and
Woods (2021) concluded that SFBT was not effective in an
outcome study based on an intervention using one SFBT
273
technique (i.e., success scaling technique). In the future,
researchers need to give more attention to the numbers and
types of techniques in the SFBT interventions within
outcome studies. Future studies should include multiple
SFBT techniques and apply techniques across different cate-
gories (i.e., cooperative language/therapeutic relationship
questions & techniques; client strengths/resources questions
& techniques; and future-focused questions & techniques)
to improve the fidelity and effectiveness of SFBT. As indi-
cated, in this meta-analysis, the studies that used all three cat-
egories of SFBT techniques reported an overall statistically
significant and large treatment effect (g = 0.771, 95% CI:
0.433–1.110, p < 0.001), compared to studies that only used
two categories of techniques and did not achieve an effect.
This study builds upon Franklin et al. (2017) review of
SFBT process studies that showed the significance of the
strengths and resources’ techniques and the use of
co-construction of meaning in conversations. Moreover, this
study also shows that using techniques focusing on the
future is essential to client change in SFBT. Future-oriented
conversations are strongly emphasized by the SFBTA treat-
ment manual and in past studies and have been identified as
a necessary component for a therapy to be considered
SFBT (e.g., Gingerich & Peterson, 2013; Kim, 2008).
Limitations of Study
There are several limitations to this review and meta-analysis.
First, although the authors made every effort to conduct a
thorough search, it is impossible to guarantee that every
potentially eligible study was identified during the search
process. Second, due to the time and human resources restric-
tions caused by the COVID-19 pandemic, not all data was
double-coded; hence no formal measures of the coding inter-
rater reliability were obtained. Third, while authors made best
effort to ensure objectivity and rigor, there is always a chance
that our findings are subject to human errors during screening
and data extraction. Fourth, there is considerable missing data
on descriptive information within studies (i.e., race/ethnicity)
which limited further moderator analysis that could be com-
pleted. While we made considerable efforts to retrieve
SFBT intervention technique information from study reports
and contacting the authors, the missing data on this variable
may have impacted the related subgroup analysis and find-
ings. Finally, overall, the studies had small sample sizes,
and there were limitations to fidelity and measurement. As
indicated by the results of the risk of bias measure (described
in the results section), several limitations to study designs
limit the interpretation of positive findings with confidence.
This means that the effective outcomes in this study need to
be evaluated along with the overall quality of the primary
studies. Despite these limitations, this meta-analysis is the
first to investigate RCT studies in community-based services
and builds on previous research that has shown the effective-
ness of SFBT with clinically relevant outcomes.
274
Conclusion
This study found support for the effectiveness of SFBT when
used in outpatient, community-based services with adolescent
and adult clients and families. Results showed medium treat-
ment effects for depression, behavioral health functioning,
family functioning, and psychosocial functioning from avail-
able RCT studies. This study further showed that SFBT is
most efficacious when four to nine SFBT techniques are
used across three categories of SFBT techniques (i.e., cooper-
ative language/therapeutic relationship questions & tech-
niques; client strengths/resources questions & techniques;
and future-focused questions & techniques). The use of
three or fewer SFBT techniques or only two categories of
techniques did not achieve a statistically significant treatment
effect in this study. It is important to build on these findings
with other studies with larger samples, better treatment fidel-
ity, and more rigor in RCT study designs.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to
the research, authorship, and/or publication of this article.
Funding
The authors received no financial support for the research, author-
ship, and/or publication of this article.
ORCID iD
Xiao Ding https://orcid.org/0000-0003-3879-4398
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