Study Review

Solution Focused Brief Therapy

A strengths-based approach that emphasises positive attributes and behaviours and how these can be applied to overcome difficulties

Outcome Overall

This rating shows how effective the intervention is at achieving the evaluated outcome.

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Strength of

This rating shows how confident we can be about a finding, based on how the research was designed and carried out.

Children’s externalising behaviours Overall effectiveness: 1 (maximum 2) Strength of evidence : 0 (maximum 3)
Children’s internalising behaviours Overall effectiveness: 1 (maximum 2) Strength of evidence : 0 (maximum 3)

Headline points

  • This summary comes from the original systematic review: Woods, K., Bond, C., Humphrey, N., Symes, W., & Green, L. (2011). Systematic review of Solution Focused Brief Therapy (SFBT) with children and families. London: Department for Education
  • A strengths-based approach, which has provided the theoretical foundation for Signs of Safety
  • Some evidence that SFBT produced child behaviour outcomes that were better than treatment-as-usual
  • Limited evidence of the effectiveness of SFBT in the context of child protection

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What is this?

Solution Focused Brief Therapy (SFBT) is a strengths-based approach to working with children and families. It emphasises positive attributes and behaviours and how these can be applied to overcome difficulties. SFBT focuses on “life without the problem” rather than a detailed analysis of the problem itself. It aims to help people define specific goals and create practical strategies for achieving them.

How is it meant to work?

SFBT has been applied in numerous contexts, including school, family, individual and group settings. It is a flexible and person-centred approach that aims to encourage the recipient do more of what works well for them. This is often achieved through a short-term intervention (e.g. 5-7 sessions) focused on client goals.

What are the evaluated outcomes?

  • Children’s externalising behaviours
  • Children’s internalising behaviours

How effective is it?

SFBT’s wide use with other interventions, delivered by the same or different practitioners, and with different problem areas and clients, is a challenge when it comes to judging its effectiveness. The evidence base is also of poor quality.

Children’s externalising behaviours

Overall, SFBT had a positive effect on children’s externalising behaviours. This is based on very low strength evidence.

Children’s internalising behaviours

Overall, SFBT had a positive effect on children’s internalising behaviours. This is based on very low strength evidence.

There is some evidence to suggest that SFBT produced outcomes that were better than treatment-as-usual or another control condition. Eight studies included in the review showed improvements in relation to children’s internalising and externalising behaviours.

In addition, there was some emerging evidence indicating that the intervention was effective in other areas, for example reducing recurrence of child maltreatment (or improving functioning of young people with developmental impairments). Further research is needed into the effectiveness of SFBT in these cases.

Where has it been studied?

SFBT has been studied more extensively in the USA than in the UK. One of the most relevant USA-based studies involved using solution focused interview techniques to develop a child welfare practice model called Solution Based Casework. The studies drawn on for this summary originated from the USA, UK and a variety of other countries such as Australia, Canada, Cyprus, China, Korea, Lithuania, Norway, Romania and Sweden.

Who does it work for?

SFBT is often a short-term intervention, so it’s well-suited to practitioners who have ‘voluntary’ client groups addressing specific, single-issue problems. Statutory social work intervention – where children are considered to be suffering, or likely to suffer, significant harm – defines clients as “mandated” and the local authority professional is the instigator of the work. So to ensure this work is person-centred, some negotiation around goals might be required.

While statutory child protection work might include specific issues that could benefit from SFBT intervention (for example, management of child behaviour), families receiving a social work intervention often have multiple difficulties which require longer-term work and a range of approaches.

When, where and how does it work?

SFBT’s use with other interventions, with various groups and with different outcomes, means that not only can it be difficult to separate the effects, but it also increases the likelihood of different modes of delivery. In fact, SFBT is one of the theoretical underpinnings of Signs of Safety model in the UK.

If we look at Solution Based Casework (SBC), we can see that it emphasised partnership with the family, targeted specific skills needed to reduce risk, provided a case planning framework that included the use of safety plans and family and individual goals.

What are the costs and benefits?

The review found that there is a lack of reliable evidence on the cost-benefit of SFBT. See the technical summary below (under ‘further resources’) for more information on how individual studies have sought to calculate costs and benefits for SFBT.

How is it implemented?

Nine studies were rated by the systematic review as being of a high or medium quality and also showed a positive change in outcomes compared with the comparison group. The implementation information included here is based on these nine studies.

What did they do?

Where details of the intervention were given, the number of sessions ranged between five and 16, with six being the most common number specified.
Individual sessions lasted between 30 minutes and two hours. In some cases they were delivered on a weekly basis. The sessions were either delivered for individuals, family groups including parents, or for groups of children and young people.
In some cases, SFBT was combined with other elements, such as motivational interviewing, action learning theory, cognitive behavioural, interactional and mutual aid approaches and mentoring.

Who can deliver it?

Practitioners who delivered the solution focused brief therapy interventions that were evaluated included:

  • Social workers (including clinical social workers)
  • School counsellors
  • Therapists
  • Teachers
  • Master’s-level psychology students

What were the training and supervision arrangements?

Where training arrangements were specified, they varied considerably:

  • Psychology students took part in training workshops at a conference, watched training videos and read about solution-focused techniques
  • Therapists had either four days of advanced training or attended a one-day training session
  • Teachers trained via two half-day workshops conducted by the school counsellor

Some interventions also involved training teachers or community members who supported the intervention but were not directly involved in carrying out the SFBT elements.

Supervision arrangements were only specified for one of the interventions. In this case, all practitioners had clinical supervision every two weeks.

What else supports good implementation?

Some examples of measures that supported good implementation included:

  • Training child welfare workers and their supervisors together in the SFBT model
  • Good learning conditions for practitioners, including the supportiveness of their supervisor, team and organisation
  • Creating an SFBT manual or protocol for practitioners setting out the techniques to be used, their sequence and ways of tailoring the approach for individual clients
  • Having introductory sessions with participants before the individual or group-based SFBT sessions started
  • Establishing group rules and expectations before group work started
  • Including creative tasks in the intervention (e.g. working with pictures, diagrams, drawing or collage) or interactive activities (e.g. throwing a ball) to help children or young people to engage
  • Informing parents or teachers about the intervention and how they could support the child’s progress between sessions (in one intervention, participants’ school teachers received a four-hour training session)
  • Monitoring fidelity. In one case this involved analysing recorded cases to ensure they demonstrated key features of the model. In another case the principal investigators videotaped and reviewed two sessions for each practitioner.

Case study

The NSPCC developed its ‘Face to Face’ service for looked-after children and children on the edge of care. The service was originally offered to looked-after children aged 5-18, and eligibility was later extended to children on the edge of care. It was designed to respond to research with young people indicating their preference for a service that would listen to them and make them feel better, without being too “heavy”.

Participating children and young people were offered up to eight sessions of support from a social worker who had received at least two days of training in the solution-focused approach. The young person could choose the location of the work and how frequently they wanted their sessions (e.g. weekly or fortnightly). They identified their best hopes for the work and then worked toward this aim with the support of their NSPCC practitioner. The child or young person then decided when they had accomplished what they had hoped to and were ready to end the work.

The NSPCC carried out an evaluation of this service, using the Outcome Rating Scale (ORS). This is a validated measure which assesses people’s wellbeing. Young people completed the ORS at every session they attended, and again three months after they last accessed the service.

The evaluation found that the proportion of children or young people experiencing clinical distress reduced from 58 per cent at the first session to 15 per cent at the last session. And more than two thirds of children reported that Face to Face had helped them to address the main concern that had been impacting on their wellbeing. However, these improvements may not be attributable to the intervention, as this study did not include a comparison group.

In summary...

  • SFBT focuses on strengths rather than problems and has been used on its own and in combination with other interventions, across a wide variety of settings
  • There is limited evidence of the effectiveness of SFBT in the context of child protection
  • Some studies demonstrated improvements in children’s externalising and internalising behaviours
  • The evidence available for review was very low strength
  • There was some indication that SFBT may be effective when combined with other interventions in a limited number of studies
  • Two studies offered “emerging evidence” that SFBT is effective in reducing recurrence of child maltreatment. Both were conducted in the USA and it is unknown if the effects would be replicated in a UK context
  • More rigorous cost benefit analysis is needed

Further resources

This summary comes from an original systematic review called:
Systematic review of Solution Focused Brief Therapy (SFBT) with children and families (Kevin Woods, Caroline Bond, Neil Humphrey, Wendy Symes). Published 2011.