INTRODUCTION TO SFBT

Solution-Focused Brief Therapy (SFBT) is a short-term goal-

focused evidence-based therapeutic approach which helps clients change by
constructing solutions rather than dwelling on problems. In the most basic sense,
SFBT is a hope friendly, positive emotion eliciting, future-oriented vehicle for
formulating, motivating, achieving, and sustaining desired behavioural change.

Solution-Focused practitioners develop solutions by first generating

a detailed description of how the client’s life will be different when the problem is
gone or their situation improved to a degree satisfactory to the client. Therapist and
client then carefully search through the client’s life experience and behavioural
repertoire to discover the necessary resources needed to co-construct a practical and
sustainable solution that the client can readily implement. Typically, this process
involves identifying and exploring previous “exceptions,” e.g. times when the
client has successfully coped with or addressed previous difficulties and challenges.
In an inherently respectful and practical interview process, SF therapists and their
clients consistently collaborate in identifying goals reflective of clients’ best hopes
and developing satisfying solutions.

The practicality of the SFBT approach may stem in part from the
fact that it was developed inductively in an inner-city outpatient mental health
service setting in which clients were accepted without previous screening. The
developers of SFBT spent countless hours observing therapy sessions over the
course of several years, carefully noting any sorts of questions, statements or
behaviours on the part of the therapist that led to positive therapeutic outcomes.
Questions, statements, and activities associated with clients reporting progress were
subsequently preserved and incorporated into the SFBT approach.

Since that early development, SFBT has not only become one of the
leading schools of brief therapy, it has become a major influence in such diverse
fields as business, social policy, education, and criminal justice services, child
welfare, domestic violence offender’s treatment. Described as a practical, goal-
driven model, a hallmark of SFBT is its emphasis on clear, concise, realistic goal
negotiations.

SFBT has continued to grow in popularity, both for its usefulness

and its brevity, and is currently one of the leading schools of psychotherapy in the
world.

BASIC CONCEPTS OF SFBT

A postmodern, social constructivist approach, solution-focused

brief therapy is concerned with how individuals (or a family) view solutions to
problems. This therapeutic method is less interested in why or how a problem arose
than in possible solutions. De Shazer (1985, 1991, 1994) uses the metaphor of a
lock and key to explain this therapeutic approach. Client complaints are like locks
on doors that have not been opened. De Shazer and Berg (Berg, 1994; DeJong &
Berg, 2008; Metcalf, 2001) do not want to focus on why the lock is the way it is or
why the door won’t open; rather, they want to help the family look for the key to
the problem

Unique focus of sfbt

Solution-focused brief therapy (SFBT) differs from traditional

therapies by avoiding the past in favour of both the present and the future.
Therapists focus on what is possible, and they have little or no interest in gaining
an understanding of how the problem emerged. Behaviour change is viewed as the
most effective approach to assisting people in enhancing their lives. De Shazer
(1988, 1991) suggests that it is not necessary to know the cause of a problem to
solve it and that there is no necessary relationship between the causes of problems
and their solutions. Assessing problems is not necessary for change to occur. If
knowing and understanding problems are unimportant, so is searching for “right”
or absolute solutions. Any person might consider multiple solutions, and what is
right for one person may not be right for others. In solution-focused brief therapy,
clients choose the goals they wish to accomplish; little attention is given to
diagnosis, history taking, or exploring the emergence of the problem (Berg &
Miller, 1992; Gingerich & Eisengart, 2000; O’Hanlon & Weiner-Davis, 2003).

Positive orientation

Solution-focused brief therapy is grounded on the optimistic

assumption that people are healthy and competent and have the ability to construct
solutions that can enhance their lives. An underlying assumption of SFBT is that
we already have the ability to resolve the challenges life brings us, but at times we
lose our sense of direction or our awareness of our competencies. Regardless of
what shape clients are in when they enter therapy, solution-focused therapists
believe clients are competent. The therapist’s role is to help clients recognize the
competencies they already possess and apply them toward solutions. The essence
of therapy involves building on clients’ hope and optimism by creating positive
expectations that change is possible. SFBT is a non-pathologizing approach that
emphasizes competencies rather than deficits, and strengths rather than weaknesses
(Metcalf, 2001).

Solution focused brief therapy has parallels with positive

psychology, which concentrates on what is right and what is working for people
rather than dwelling on deficits, weaknesses, and problems (Murphy, 2008). By
emphasizing positive dimensions, clients quickly become involved in resolving
their problems, which makes this a very empowering approach. Because clients
often come to therapy in a “problem-oriented” state, even the few solutions they
have considered are wrapped in the power of the problem orientation. Clients often
have a story that is rooted in a deterministic view that what has happened in their
past will certainly shape their future. Solution-focused practitioners counter this
negative client presentation with optimistic conversations that highlight a belief in
achievable and usable goals. Therapists can be instrumental in assisting clients in
making a shift from a fixed problem state to a world with new possibilities. One of
the goals of SFBT is to shift clients’ perceptions by reframing what White and
Epston (1990) refer to as clients’ problem-saturated stories through the counsellor’s
skillful use of language.

Looking for what is working

The emphasis of SFBT is to focus on what is working in clients’

lives, which stands in stark contrast to the traditional models of therapy that tend to
be problem-focused. Individuals bring stories to therapy. Some stories are used to
justify the client’s belief that life can’t be changed or, worse, that life is moving
them further and further away from their goals. Solution-focused brief therapists
assist clients in paying attention to the exceptions to their problem patterns. They
promote hope by helping clients discover exceptions, or times when the problem is
less intrusive in their life (Metcalf, 2001). SFBT focuses on finding out what people
are doing that is working and then helping them apply this knowledge to eliminate
problems in the shortest amount of time possible. Identifying what is working and
encouraging clients to replicate these patterns is extremely important (Murphy,
2008). A key concept is, “Once you know what works, do more of it.” If something
is not working, clients are encouraged to do something different, which typically
involves drawing on their unique strengths and successes.

Basic assumptions guiding practice

Walter and Peller (1992, 2000) think of solution-focused therapy as

a model that explains how people change and how they can reach their goals. Here
are some of their basic assumptions about solution-focused therapy:

● Individuals who come to therapy do have the capability of behaving

effectively, even though this effectiveness may be temporarily blocked by
negative cognitions. Problem-focused thinking prevents people from
recognizing effective ways they have dealt with problems.
● There are advantages to a positive focus on solutions and on the future. If
clients can reorient themselves in the direction of their strengths using
solution-talk, there is a good chance therapy can be brief.
 ● There are exceptions to every problem, or times when the problem was
absent. By talking about these exceptions, clients can get clues to effective
solutions and can gain control over what had seemed to be an
insurmountable personal difficulty. Rapid changes are possible when clients
identify exceptions to their problems and begin to organize their thinking
around these exceptions instead of around the problem.
● Clients often present only one side of themselves. Solution-focused
therapists invite clients to examine another side of the story they are
presenting.
● No problem is constant, and change is inevitable. What people need to do
is become aware of any positive changes that are happening. Small changes
pave the way for larger changes. Oftentimes, small changes are all that are
needed to resolve problems that clients bring to therapy.
● Clients want to change, have the capacity to change, and are doing their best
to make change happen. Therapists should adopt a cooperative stance with
clients rather than devising strategies to control resistive patterns. When
therapists find ways to cooperate with people, resistance does not occur.
● Clients can be trusted in their intention to solve their problems. Therapists
assume that clients want to change, can change, and will change under
cooperative and empowering therapeutic conditions. There are no “right”
solutions to specific problems that can be applied to all people. Each
individual is unique and so, too, is each solution.

Walter and Peller (2000) have moved away from the term therapy
and refer to what they do as personal consultation. They facilitate conversations
around the preferences and possibilities of their clients to help them create a
positive future. By avoiding the stance of the expert, Walter and Peller believe they
can be interested, curious, and encouraging in jointly exploring the desires of their
clients.
THEORETICAL EXPLANATION

SFBT originated from social constructionism (Cantwell & Holmes,

1994), which claims that the individual’s idea about what is real including the idea
of the nature of his problems, competences and possible solutions is being
construed in daily life in communication with others. In other words, people confer
meaning to things in communication with others; in this language plays a central
role. Shifts in the perceptions and definitions of the client takes place within the
contexts, i.e., in a society. Individuals always live in ethnic, family, national, socio-
economic and religious contexts. They adapt their meaning conferment under the
influence of the society in which they live. As early as the third century B.C. the
ancient Greeks were aware of the distinction between observing and defining
reality. People who followed only one path were the Stoics: they learned to follow
only the reason, to banish one’s passions and to ignore pain. To reach an
imperturbable state when encountering pain, harm or difficulties was considered
the ultimate achievement: how not to be unhappy. One could attain this through not
heeding emotions. From the social constructionist perspective consideration is
given to how the therapist can contribute to the creation of a new reality for the
client. The capacity of the client for change is connected to his ability to begin
seeing things differently. These shifts in observation and definitions of reality occur
particularly in the solution-focused conversation on the desired future and usable
exceptions. The solution-focused questions are intended to define the goal and the
solutions, which (for the most part) are assumed to be already present in the client’s
life. The questions ‘that make a difference’ relate to the manner in which the client
is managing despite his problems, to what he feels is already going well and should
persist, and to what has improved since making the appointment. Questions
regarding goal formulation, exceptions, scaling and competences extract the
relevant information. Here a ‘different layer’ of the client is tapped, which usually
remains unexplored in problem-focused therapy. The therapist is not the expert with
all the answers, but allows himself to be informed by the client who creates his own
solutions. The therapist is expert though in asking the right solution-focused
questions (Bannink, 2006c) and in motivating behavior change by relating to the
motivation of the client. In addition, he uses his expertise in structuring the
conversation and in applying operant reinforcement principles. There are two
suppositions that require further research. The first is that the effect of SFBT may
be explained through the Bio-Information Theory of Lang (1985). According to
Lang’s theory a change in the emotional reaction to certain events and situations
implies changing the associative networks that lie at the basis of those emotional
reactions. The knowledge coded in the memory needs to be altered.

Since the response codes are the prime determining elements in

those networks, the biggest gains can be made through influencing precisely those
responses. In concrete terms this implies that a change in behaviour appears the
best way to modify emotional knowledge. However, since knowledge cannot be
erased just like that, new knowledge needs to be added; some additional learning is
required. That is why contra conditioning is applied; the client learns to connect
other behavioural tendencies to the experienced stimulus constellations by
homework suggestions like ‘pretend you have already reached your goal’ or ‘do
something different.’

The second supposition concerns recent insights in the field of

neurobiology and knowledge about the functioning of both cerebral hemispheres
(Siegel, 1999). The right hemisphere deals principally with processing non-verbal
aspects of communication, such as seeing images and feeling primary emotions.
The right hemisphere is involved in the understanding of metaphors, paradoxes and
humour. Reading fiction and poetry activates the right hemisphere whereas the
reading of scientific texts essentially activates the left hemisphere. There the
processes relating to the verbal meaning of words, also called ‘digital
representations,’ take place. The left hemisphere is occupied with logical analyses
(cause effect relations). Linear processes occurring are reading the words in this
sentence, aspects of attention and discovering order in the events of a story. Our
language-based communication is thus dominated by the left hemisphere. Some
authors are of the opinion that the right hemisphere sees the world more as it is and
has a better overview of the context, whereas the left hemisphere tends to
departmentalize the information received. The left hemisphere sees the trees, the
right hemisphere the forest. nonverbal and holistic capacities of the right
hemisphere. The success of solution-focused therapy might be (partly) explained in
the way it addresses both hemispheres of the brain.

Empirical evidence

In SFBT there are a growing number of outcome studies. When

determining the effectiveness of a therapy it is important to not only register
progress on arbitrary metrics, but also to monitor improvement on points that the
client himself finds relevant (Kazdin, 2006). He argues for the addition of clinical
relevance: the client himself should determine whether in his daily life he has found
the treatment useful. Gingerich and Eisengart (2000) gave an overview of 15
outcome studies of SFBT, in which they distinguished between statistically well
monitored and less well monitored research. One of the statistically well monitored
analyses demonstrated that SFBT yields results comparable to those of
interpersonal psychotherapy with depressed students. These outcome studies are
generally small sample studies, conducted by investigators with allegiance to
SFBT.

TECHNIQUES USED CONTEXT, BENEFITS AND

CONTRAINDICATIONS.

Through open and lively discussion over several years, the team
invented and experimented with several new techniques that eventually became
fundamental parts of SFBT, including questions about pre-session change,
exceptions, the miracle question, as well as the formula tasks (de Shazer 1985). As
each technique became part of SFBT practice, further observation and process
research documented its usefulness. This way of observing, inventing something
new, and gathering data to test the usefulness of specific practices is described in
several sources. Main interventions are taken from de Shazer, et al. (2007).

A positive, collegial, solution-focused stance

 One of the most important aspects of SFBT is the general tenor and
stance taken by the therapist. The overall attitude is positive, respectful, and
hopeful. There is a general assumption that people are strongly resilient and
continuously utilize this to make changes. Further, there is a strong belief that most
people have the strength, wisdom, and experience to effect change.

Looking for previous solutions

SFBT therapists have learned that most people have previously

solved many, many problems. This may have been at another time, another place,
or in another situation. The problem may have also come back. The key is that the
person had solved their problem, even if for a short time.

Looking for exceptions

Even when a client does not have a previous solution which can be
repeated, most have recent examples of exceptions to their problem. An exception
is thought of as a time when a problem could have occurred, but did not. The
difference between a previous solution and an exception is small but significant. A
previous solution is something that the family has tried on their own that has
worked, but for some reason they have not continued this successful solution, and
probably forgot about it. An exception is something that happens instead of the
problem, with or without the client’s intention or maybe even understanding.

Questions vs. directives or interpretations

Questions are an important communication element of all models of

therapy. SFBT therapists, however, make “questions” the primary communication
and intervention tool. SFBT therapists tend to make no interpretations, and they
very rarely directly challenge or confront a client

Present- and future-focused questions vs. past-oriented focus

The questions that are asked by SFBT therapists are almost always
focused on the present or on the future, and the focus is almost exclusively on what
the client wants to have happen in his life or on what of this that is already
happening. When questions are asked about the past, they are typically about how
the client overcame a similar difficulty or what strengths or resources of the past
they can bring to bear on achieving their preferred future.

Compliments

Compliments in therapy sessions can help to punctuate what the

client is doing that is working.

Gentle nudging to do more of what is working

It is rare for an SFBT therapist to make a suggestion or assignment

that is not based on the client’s previous solutions or exceptions. It is always best
if change ideas and assignments emanate from the client at least indirectly during
the conversation, rather than from the therapist because these behaviors are familiar
to them.

Specific Interventions:

Pre-session change

At the beginning or early in the first therapy session, SFBT

therapists may ask questions. These questions may lead to information about
previous solutions and exceptions, and may move them into a solution-talk mode.

Solution-focused goals

Like many models of psychotherapy, setting personal salient, clear,

specific, and attainable goals are an important component of SFBT. Whenever
possible, the therapist tries to elicit smaller goals rather than larger ones. More
important, clients are encouraged to frame their goals as the presence of a solution,
rather than the absence of a problem.

Miracle Question

Some clients have difficulty articulating any goal at all, much less a
solution-focused goal. The miracle question is a way to ask for a client’s goal in a
way that communicates respect for the immensity of the problem, and at the same
time leads to the client’s coming up with smaller, more manageable parts of the
goal. It is also a way for many clients to do a “virtual rehearsal” of their preferred
future.

BENEFITS

Solution-Focused Brief Therapy is different in many ways from

traditional approaches to treatment. It is a competency-based and resource-based
model, which minimizes emphasis on past failings and problems, and instead
focuses on clients’ strengths, and previous and future successes. There is a focus
on working from the client’s understanding of her/his concern/situation and what
the client might want different. The basic tenets that inform Solution-Focused Brief
Therapy are as follows:

● It is based on solution-building rather than problem-solving.

● The therapeutic focus should be on the client’s desired future rather than on
past problems or current conflicts.
● Clients are encouraged to increase the frequency of current useful
behaviors.
● No problem happens all the time. There are exceptions—that is, times when
the problem could have happened but didn’t—that can be used by the client
and therapist to co-construct solutions.
● Therapists help clients find alternatives to current undesired patterns of
behavior, cognition, and interaction that are within the clients’ repertoire or
can be co-constructed by therapists and clients as such.
● Differing from skill building and behavior therapy interventions, the model
assumes that solution behaviors already exist for clients.
● It is asserted that small increments of change lead to large increments of
change.
● Clients’ solutions are not necessarily directly related to any identified
problem by either the client or the therapist.
 ● The conversational skills required of the therapist to invite the client to build
solutions are different from those needed to diagnose and treat client
problems.

INDICATIONS AND CONTRAINDICATIONS OF SFBT

SFBT is suitable for a wide variety of clients, whereby it is of

importance that the client has a goal (or is able to formulate one during
psychotherapy). Although the number is not fixed in advance, an average of three
conversations appears to be sufficient. A contraindication is the situation where it
is impossible to establish a dialogue with the client (medication might be indicated
in the case of acute psychosis or deep depression). At a later stage medication often
helps a client undertake solution-focused conversations. If a client has a mental
handicap good progress can be made with SFBT, sometimes together with solution-
focused help from those caring for the client (Westra & Bannink, 2006). Another
contraindication concerns a well-executed SFBT which has yielded disappointing
results. In these situations, diagnostic research or a lengthier form of psychotherapy
might be indicated. However, if the therapist is not prepared or not able to let go of
his attitude as an expert, solution-focused therapy will not work. The final
contraindication relates to some institutions maintaining waiting lists for reasons of
financial security. SFBT is brief, so waiting lists can be reduced relatively quickly.

Many differences exist between SFBT and problem-focused types

of psychotherapy which focus on in-depth exploration of the life history of the
client and his family, problem description and data collection in a problem analysis,
diagnosis made by the therapist, formulation of goals, treatment plan and
interventions by the therapist, execution of interventions by the client and
evaluation of the treatment. The attitude of the therapist is ‘leading’: he is the expert
who advises the client.

Both psychotherapy and waiting lists should and can be shorter. No

longer the ‘moaning and complaining’ attitudes of clients should be reinforced, they
should be strengthened and stimulated to undertake positive action. SFBT is applied
in frontline mental health care. In this way many clients can be (sufficiently)
treated, without there being an extensive diagnosis. Also in chronic psychiatry
SFBT is increasingly applied (O’Hanlon & Rowan, 1999). Psychotherapy should
no longer be considered as a group of methods that makes use of psychologically
validated knowledge to reduce emotional problems. The time is ripe for a positive
objective. Instead of reducing problems it is possible to ask the solution-focused
question: ‘What would you rather have instead?’ The positively formulated answer
of most clients will be: happiness in a satisfying and productive life. Each client
will be able to outline his or her own definition of happiness with a description of
behaviours, cognitions and emotions. With the help of the therapist clients will be
able to explore ways that will bring them within reach of their goal. The client is
motivated to work hard, as a result of which the therapist has energy to spare at the
end of the day. Conversations with clients become positive, shorter and more
effective, thus SFBT is also cost-efficient. The implications of SFBT are that
training in diagnostic and treatment methods of psychopathology can become
shorter and be replaced by training in SFBT. In this scenario a lot could change for
the better in mental health care, for both clients and therapists.
REFERENCES

Bannink, E.P (2007). J Contemp Psychother. Solution-focused brief Therapy.DOI

10.1007/s10879-006-9040-y

Bavelas, J. B. , Jong, P.E, Frank. C, et.al (2011). Connecting the Lab to the Therapy
Room. Solution-Focused Brief Therapy, 144-162.
doi:10.1093/acprof:oso/9780195385724.003.0063

Corey, G.,(2011). Theory And Practice Of Counselling And Psychotherapy. 9th ed.
United States of America: Brooks/Cole Cengage Learning.

Sharf, Richard S. (2012) Theories of psychotherapy and counseling :concepts and

cases. 5th ed. Belmont, CA : Brooks/Cole Cengage Learning