Solution-Focused Therapy: How It Works and What to Expect

What Is Solution Focused Therapy?

Solution focused therapy, also called solution focused brief therapy (SFBT), is based upon the view that individuals have their own vision of how they would like their lives to be, and what would be different in their preferred vision of the future. The client is encouraged to create and describe their vision of a desired future and then to think about how they might strengthen their current abilities in order to reach the desired outcomes.

The therapist guides the client in identifying what works well for them now, or what has worked in the past for similar challenges. At times, new approaches to problems are encouraged as a way to experiment with possible responses to new challenging circumstances.

What Is the Theory Behind Solution Focused Therapy?

Solution focused therapy is not like other forms of traditional psychotherapy frameworks in that it’s not centered around a formal theory or model. However, it falls under the umbrella of constructivism, which assumes that individuals are meaning-makers and ultimately responsible for creating their own reality. As such, SFT helps a client to design and implement their own solutions while focusing on their strengths and resiliencies rather than putting emphasis on their problems.¹

What Can Solution-Focused Therapy Help With?

Consistent with its development in a family therapy clinic, SFT is particularly helpful for resolution of the problems faced by families, such as parenting teens and treating addictions.^2,3 In theory, SFT may be used to address a wide variety of problems but it is best suited for problems that have simple step by step solutions that can be worked out.

To benefit from SFT, clients must be willing to create and describe their vision of a better life. Often these clients have already tried solutions on their own, with little success. They come to SFT with a readiness for some new approaches and some hopefulness that they can improve their lives by trying something different.

SFT is less about self growth or insight than other therapy models. Its goals are not self-actualization, greater self-confidence, or personality change. The SFT therapist’s role is to get the person on track to a better life for themselves, and to leave them to continue on that track once the brief therapy is concluded.

Solution Focused Therapy Techniques

A variety of techniques are used in SFT in order to identify client strengths, determine what worked for the person in the past, and encourage finding solutions to the current problems. These techniques can be grouped as coping questions, scaling questions, the “miracle question,” and the consultation break.⁴

Goal Development Questions

Unlike other therapies, SFT work begins right away, with most of the goal planning occurring during the first session. In this phase, future-oriented questions are posed to assist clients identify their main goal, particular steps necessary toward the goal, and specific examples of how they’ll notice improvement once therapy ends. Goal-related questions can help the person envision their desired outcomes, provide direction for future sessions, and serve as a means for them to monitor progress throughout the course of treatment.¹

Pre-Session Change Question

The pre-session change question usually takes place in the beginning of a session where the clinician asks a client something like, “From the time you called to set up this visit to today (or since the last session and now), what have you noticed that’s already slightly improving?” This opens a pathway for examining the problem prior to the session while also focusing on any changes (for better or worse) made since. This acknowledges and explores someone’s successful (or failed) attempts as the conversation moves toward finding solutions.

Looking for Exceptions

This is a common strategy used by solution focused therapists which entails asking the client about a time in their life when a problem or certain aspects of it were supposed to occur but didn’t, or at least not to the extent they had expected. Oftentimes, people are surprised to find that there might be small exceptions where they had some degree of control in an outcome. This can increase their sense of self-efficacy in their ability to plan further small steps moving forward.

Present & Future-Focused Questions

Solution-focused questions center around the present and the future. This aligns well with the basic premise of SFT, which holds that problems can be best resolved by focusing on what’s already working and how someone can improve their situation, instead of fixating on the past and root cause. The therapist may ask, “What will you be doing within the next week that would demonstrate that you’re continuing to make progress?” This type of question helps to set the tone for the rest of the sessions.

Compliments

Direct or indirect compliments play a vital role in SFBT treatment. These serve to highlight the client’s qualities, strengths, and resources which helps to enhance the solution building process. Furthermore, validating someone’s efforts and recognizing how challenging their problems are, conveys that the therapist truly cares and understands while also encouraging the client to make positive changes. Equally, indirect compliments like “How did you manage that?” are communicated in an appreciative tone, which can elicit the person to self-compliment by simply replying to the question.

Past Coping Questions

One of the key questions of SFT is, “How did you cope in the past?” or, “What has worked for you before, when faced with a similar situation?” Previous solutions might be effective again, in spite of different circumstances. A client might be encouraged to experiment with using an approach that worked in the past, even though the current situation is not exactly the same.

Scaling Questions

Scaling questions are sometimes used to help the client monitor their own progress, describe their level of hopefulness, or evaluate their situation as a more objective person might. For example, a client in a couples’ session may be asked, “On a scale from 1 to 10, how hopeful are you that this relationship can improve?” Scaling questions are also very useful for teenage clients who may have more difficulty describing their feelings or expressing their level of concern in more emotional terms.

The Miracle Question

The miracle question is a specific question which is used to identify the first simple, realistic steps toward a solution that could be taken immediately by the client. The question is intentionally asked in a long drawn out manner in order to engage the client’s more relaxed problem-solving state of mind.

To state it simply, the technique involves asking the client to imagine that their problem is miraculously solved overnight. How will they know that the problem is solved? “How would you feel? What would you think? What would you do that’s different from what you did today?” The assumption is that even one simple desirable change in behavior or attitude often leads to further desirable changes.

Consultation Break

A common technique in SFT is to take a break during the second half of each session and review what has been discussed so far. Shortly before the break, the client is asked if there is any further information that they would like to provide. During the break, they are left alone for a few minutes to reflect on what was already said. Upon returning, the therapist offers an encouraging and therapeutic message about the client’s ability to accomplish their goal.

Benefits of SFBT

One of the biggest benefits of SFBT is that it’s a short-term therapeutic approach. Since the goal is to find solutions as soon as possible, it typically lasts up to eight weeks, making this modality a time and cost-efficient option particularly for those with a specific goal in mind needing a bit of help to attain it.¹

Moreover, unlike traditional therapy, SFBT does not dwell on past experiences or problems to reveal a deeper meaning or find answers. Instead, SFBT helps people identify practical and actionable steps that can be taken immediately to improve their day-to-day functioning and find quick answers to work on current problems.¹

Solution-Focused Therapy Examples

Solution-focused therapy can be used in a variety of circumstances, but works best when there is a specific problem that can be solved.

Here are some examples of the SFBT process:

SFBT for a Couple’s Conflict

After months of increasingly intense arguments, Robin and Ted make an appointment with a couples therapist who practices SFT. The therapist asks each of them to say what they’re hoping to accomplish by coming to the session. Robin states a hope that the arguments stop, or at least become far less frequent. Ted frames the problem as longer term, nearly hopeless, and leading him to consider separation.

The therapist might use a scaling question and ask each of them to rate, on a scale from 1 to 10, the likelihood that this relationship can be saved. Robin rates the chance of a good outcome at 7, while Ted gives a rating of 6. Both are surprised at how close their expectations actually are to each other.

This similarity in outlook for the relationship sparks each of them to work harder at creating a vision of their happier life together. That vision becomes the starting point for the therapist to work with them to map out the steps toward the desired outcome.

SFBT for a Family Struggling With a Teenage Daughter’s Behavior

Riley’s parents contact a therapist for SFT to address the “behavior and attitude problem” of their 15-year-old daughter. She has been frequently angry, disrespectful, and refusing to cooperate with any of their requests. The therapist would not ask for details of Riley’s behavioral problems or try to determine what might be “wrong with her.”

Instead, the SFT therapist would ask each parent the miracle question: If they were to wake up the next day and discover that the problem had been solved during the night, what would they notice to be different? What would they do differently? By changing one small behavior at a time in their own routines, the expectation is that Riley’s behavior would also change over time.

How to Find a Solution-Focused Therapist

Due to the skepticism about SFT being broadly useful, many therapists do not practice SFT on a regular basis. This makes it more crucial to ask a potential therapist about their preferred approaches to therapy if SFT is what the client is seeking. If you are interested in finding a therapist who provides SFBT, consider using an online therapist directory where you can sort by location, insurance, and specialty.

Who Is Able to Practice Solution Focused Therapy?

Certification for the practice of SFT is not required, but it is possible to obtain. The International Alliance of Solution Focused Therapy Institutes (IASTI) offers training in SFT techniques and certification at three levels: Practitioner, Advanced Practitioner, and Master Practitioner. Certification requires that competence be demonstrated and that a final exam is passed for each level.⁵

Cost of Solution Focused Therapy

The overall cost of SFT is generally less than the cost of other therapy models due to the fewer number of sessions needed to meet the specific goals which have been mapped out. Cost on a per-session basis is basically the same as for any other model of therapy, such as cognitive-behavioral or person centered therapy. The per session cost varies more based upon the provider and the geographic location than upon the model of therapy.

Does Insurance Cover SFBT?

Most mental health insurance plans do cover SFT, as the approach is evidence-based. To be certain of coverage, each client must contact the customer service for their own insurance plan and ask about the benefits for outpatient psychotherapy. There may be copayments, co-insurance payments, a deductible, or an annual maximum benefit amount.

Key Questions to Ask a Therapist When Considering SFT

Most of the questions relevant to SFT are the same as those relevant to any form of therapy: It would be helpful to ask about the therapist’s education and training, years of experience, and particular experience with the type of problem one is facing. There are some additional questions that might be helpful in determining whether a particular therapist practices SFT in a way that is consistent with the basic principles of this model.

Key questions to ask a solution focused therapist include:

• What type of training have you had with solution focused therapy?
• How many years of experience do you have doing solution focused therapy?
• How effective is this form of therapy, in your opinion?
• On average, for how many sessions do you meet with any one client or couple?
• What percentage of your therapy clients are participating in SFT with you?
• Do you focus on developing solutions to a client’s problems, rather than teaching skills or working on self-awareness?
• Have you had good outcomes in doing this form of therapy?
• Based upon the problem that I’m describing, do you recommend this form of therapy for me?

What to Expect at Your First SFBT Appointment

At the first therapy session, the first priority will be for the client to state the reason that they have come to the appointment, or the problem for which they seek help. The therapist will acknowledge the difficulty and will quickly move on to asking about solutions that may have worked in the past for similar situations. The client may describe what was happening at an earlier point in their life when they were having a similar problem, or how they coped with other challenges in the past. The therapist will encourage the client to recognize their own strengths or resilience in the face of adversity.

Secondly, the client will be encouraged to describe a vision of their future life in which this problem no longer exists. This vision is used to create the step-by-step methods to move the client from the current situation to their own better future. The client may be advised to use the previously identified coping skills to come up with a possible first step toward the desired outcome. This first step is often something that could be tried the very next day.

Lastly, practical matters such as billing, insurance, and confidentiality of information may be discussed. Scheduling is an important part of this first meeting since the model is intended to be short-term and efficient. The second half of this first session is also the opportunity for the therapist to offer an encouraging message about the client’s ability to reach their desired outcome.

Is Solution Focused Therapy Effective?

As of 2011, more than 48 studies of the effectiveness of SFT had been conducted, and also two independent meta-analytic reviews. SFT research studies have been limited by small sample sizes and lack of randomized designs.⁶ The majority of studies of the effectiveness of SFT have been done by comparing SFT to other therapy models, particularly psychodynamic models and problem-focused models. The overall conclusion to date is that SFT does have a small to moderate level of effectiveness, and is at least as effective as other established treatments.⁷

The first meta-analytic review (21 studies) was conducted in 2006.⁷ This review indicated that SFT was of greater benefit in treating behavioral problems than it was for marital problems, or for emotional distress such as anxiety or depression.

The behavioral problems included in this overview were:

• Oppositional defiant disorder
• Attention deficit hyperactivity disorder
• Delinquent behavioral disorders

A second meta-analytic review was conducted in 2008 and looked at the effectiveness of SFT for behavioral problems, anxiety and depression, and family/relationship problems.⁸ The results of this review were somewhat inconsistent with the earlier 2006 analysis. SFT was shown to be more effective for depression, anxiety, and self-esteem issues, while it was less effective for behavioral problems and relationship problems.

Risks of Solution Focused Therapy

Overall, the risks of SFT are minimal, with the greatest risk being a lack of effectiveness for particular problems or clients. For example, if a client has a problem that is related to a more serious form of mental illness, SFT is unlikely to address the various symptoms and issues caused by that illness. In those circumstances, the therapist is obligated to offer an alternative therapy model or to make a referral to another therapist.

Criticisms of Solution Focused Therapy

There are several criticisms of SFT which relate to its range of effectiveness and its limited focus upon small measurable goals. It is not a theory-based model, but is based upon the experience of clinicians working with both individuals and families and observing what has and has not worked in a brief time frame.

Since it is not based upon a theory, there is no framework for understanding the problems that are presented, and no attention to the history of those problems. Presenting problems with more serious consequences or risks can be easily overlooked. A client may accomplish the simple outcome desired but still be at risk for related problems due to the narrow focus of the method.

A second common criticism of SFT is that the insight that might be gained from understanding the therapist-client relationship is completely dismissed in SFT. Both psychoanalytic and existential therapists have been critical of this neglect of the relationship as a source of potential insight and greater self-awareness.⁹

How Is Solution Focused Therapy Different From Other Therapy Techniques?

SFT has been compared to other forms of therapy in terms of its relative effectiveness and the actual methods used. In terms of the methods, it is similar to other short term therapies such as problem-solving therapy, yet very distinct from cognitive behavioral therapy and psychoanalytic therapy. The relative effectiveness of SFT versus other approaches has not been well established due to limitations in the design of outcome studies to date.⁶

Solution Focused Therapy Vs. Cognitive Behavioral Therapy

SFT differs from cognitive behavioral therapy (CBT) in several ways. While SFT puts minimal time into describing the presenting problem and instead focuses upon possible solutions, CBT requires a clear, detailed description of the problem(s).

A second difference is in the assumption of the therapist as the expert in behavioral change according to CBT, while the SFT therapist puts the client in the position of expert. The client is assumed to have the basic knowledge and abilities to solve their own problem while the therapist acts as a guide to help formulate a well mapped solution.

A third difference is in the breadth of the outcome and the related time frame for achieving the outcomes of therapy. While the average length of SFT is 7 sessions, the average length of CBT is typically closer to 25 sessions.

Solution Focused Therapy Vs. Problem Solving Therapy

SFT is very similar to problem solving therapy (PST) in the length of time expected to achieve the outcomes. PST is often limited to a maximum of 10 sessions, compared to an average of 7 for SFT. A difference is in the attention given to describing and understanding the presenting problem. In PST, it is assumed that a thorough understanding of the problem and its history is critical to its solution.

One of the methods used in PST is to reframe the problem, possibly as an opportunity for self-growth instead of just a hurdle to overcome. The PST therapist may help the client discover a new meaning for the problem in a way that facilitates thinking of new solutions.¹⁰

Outcome studies which have compared SFT to PST have suggested that the two methods are equally effective, and that SFT may accomplish the same results in less time.⁷

Solution Focused Therapy Vs. Short Term Psychodynamic Psychotherapy

There are major differences between SFT and short-term psychodynamic therapy (SPP) in terms of methods, time involved, and general goals of treatment. In SPP, there is much greater emphasis upon the therapist-client relationship, the client’s developmental history, and the potential for increased self-awareness.

In a large-scale randomized study, SFT was compared to both short term psychodynamic psychotherapy (SPP) and long-term psychodynamic psychotherapy (LPP).¹¹ The presenting problems were mild to moderate anxiety, depression, and inability to work. The average treatment length for SFT clients was 10 sessions, while the SPP clients received 19 sessions, and the LPP clients received 232 sessions. The SFT and SPP were about equally effective and both produced results sooner than the LPP. However, when clients were re-evaluated three years after beginning treatment, the LPP clients showed the greatest benefits.¹²

History of Solution-Focused Therapy

Solution-focused therapy was developed in the late 1970s by Insoo Kim Berg and Steve de Shazer at the Brief Family Therapy Center in Milwaukee, Wisconsin. Korean-born Berg had been trained in the psychodynamic therapy model. She and her partner Steve de Shazer recognized the problem of limited time, energy, and money in treating families who came to the center for help.

Along with a team of colleagues, Berg and de Shazer developed SFT based upon their observations of therapy sessions over the course of several years. They took note of the questions and the behaviors which were associated with clients’ reports of progress. The most effective of the questions and techniques were incorporated into the SFT approach.⁴

The methods of SFT continued to develop gradually over the next three decades, and they continue to change to meet the needs of different client groups in schools and workplaces. It is currently practiced in North and South America, as well as Asia and Europe.