Solution-Focused Therapy Is A Worldwide Treatment For Depression, Anxiety, And Other Psychological Disorders

University of Navarre's Mark Beyebach discusses the benefits of solution-focused brief therapy (SFBT).

By Mark Travers, Ph.D. | December 2, 2021

A new article published in Frontiers in Psychology suggests that solution-focused brief therapy (SFBT) is one of the most effective ways to treat a wide range of psychological issues and that psychologists and mental health practitioners around the world are becoming more aware of its merits.

I recently spoke with Mark Beyebach, a researcher at the Public University of Navarre in Spain and lead author of the research, to discuss these findings in more detail. Here is a summary of our conversation.

What inspired you to investigate the topic of regional differences in solution-focused brief therapy and what did you find?

SFBT was developed at the Brief Family Therapy Center in Milwaukee, within an American tradition of brief therapy rooted in Milton Erickson's work and the Mental Research Institute brief therapy team in Palo Alto, California. It quickly expanded beyond family therapy and beyond the United States, but it is still sometimes perceived as an "American" and "Western" approach to therapy. This resembles the situation of Positive Psychology, a different but related field that is often criticized as being WEIRD — applicable only in Western, Educated, Industrialized, Rich, and Democratic countries.

So my team and I wanted to test whether these perceptions and criticisms were correct. We performed an extensive bibliometric search and retrieved 365 outcome studies on SFBT, 169 of them randomized controlled trials. We not only found that research on SFBT interventions has indeed expanded beyond North America and Europa, but that in fact the research production in non-WEIRD countries has surpassed the production of WEIRD ones. For instance, a lot of outcome research on SFBT is being conducted in China, Iran, and Turkey, to cite a few.

The other relevant finding is that outcome research on SFBT is being done not only in the field of psychotherapy, but also in school counseling, coaching, child protection, and organizational interventions. And SFBT is applied not only in individual interventions but also in interventions with families, couples, and especially groups.

Can you give a description of solution-focused brief therapy?

SFBT is a pretty simple but also quite radical approach. As mentioned, it developed within the tradition of family therapy, but reversed the usual perspective: instead of focusing on problematic behavioral patterns in order to change them, it places the focus on positive behavioral patterns, labeled "exceptions." For instance, instead of trying to educate the parents of a disruptive kid that their disagreements in handling their child are reinforcing his problems, SFBT would spot the exceptions, the occasions when the child displays adequate behavior in situations in which problem behaviors are expected, and would then invite the parents to figure out how they contributed to those exceptions. Once parents discover what works for them, they are invited to do more of it.

A later development within SFBT was to look out for exceptions not from the perspective of the absence of the problem (as "exceptions to the problem rule"), but from the vantage point of the goals of the clients: clients are invited to describe their preferred future with great detail and then asked to identify on what occasions bits and pieces of this preferred future are already happening. This leads to a conversation on how they made that happen and on possible next small steps to be taken.

How common is solution-focused therapy and what is it primarily used to treat?

SFBT is relatively well-known. It is one of the approaches used most by North American and European family therapists and it is also frequently used in individual and group therapy for some of the most common psychological problems, like anxiety and depression. One of the main conclusions of our review is that SFBT is applicable beyond that, in a huge variety of situations and in diverse contexts. In our view, this is a bonus of the flexible and tailor-made nature of the approach: there are no predetermined treatment goals and no preconceived ideas about what a client with a given problem should do to solve it. Instead, SFBT is a collaborative conversation that tries to capitalize on the strengths and resources of each particular client and is therefore highly responsive to clients' circumstances and preferences. In our opinion, this built-in flexibility and the respect for clients' worldviews and language may explain why SFBT seems to fit in with diverse cultures, maybe even to the point of making specific cultural adaptations unnecessary.

What are the practical takeaways from your research for someone interested in exploring solution-focused therapy as a mode of treatment?

The practical takeaway is that SFBT could in principle be used in all kind of psychotherapeutic, social and school interventions. In our view, SFBT provides a very interesting complement to the usual focus on problems, psychopathology, and deficits by providing specific interviewing techniques that allow therapists to build on the strengths of their clients and to promote their empowerment.

After conducting your research, are you more likely to view solution-focused brief therapy as an important if not primary intervention strategy?

My team and I have been studying SFBT in our own context (Spain) for many years, providing different types of evidence of its effectiveness and also some tentative clues as to how it works. And there are a number of excellent meta-analyses published by other teams that have yielded good size effects for SFBT. What our new study adds to the evidence base is that SFBT is being used and researched globally, in very different cultures, in many different contexts, and in different formats.

What other treatment modalities do you think are in need of cross-cultural testing/validation?

Restricting my answer to my scope of expertise, I certainly would love to see data on the cross-cultural validation of two other therapeutic approaches that are frequently used in combination with SFBT: Brief Strategic Therapy and Narrative Therapy. Narrative Therapy, with its emphasis on the cultural construction of narratives and discourses around mental health and psychological problems, sorely needs cross-cultural research.

Do you have plans for follow-up research?

In our study we have analyzed the expansion of the SFBT outcome research without analyzing the differential effectiveness or efficacy of the tested SFBT interventions. However, when we read the research papers we had extracted, we were struck by how often SFBT was found to achieve significantly superior outcomes, not only in comparison to waiting-list, placebo, no-treatment, or "treatment as usual" control conditions (something to be expected) but also when compared to alternative treatments. The latter is surprising given that when two bona fide psychological treatments are compared they are usually found to be equally effective, as researchers like Bruce Wampold have demonstrated. So right now we are conducting a more fine-grained analysis of the results of the SFBT outcome research papers to see what the data says on the effectiveness of SFBT interventions. We hope that this follow-up study will complement the existing meta-analyses by providing a more global perspective on the outcomes of SFBT as it is practiced worldwide.