This article reviews the basic theory behind Solution-Focused Brief Therapy. The author discusses the theory’s pros and cons.
Begin your reading at the paragraph that begins, “SFBT assumes that “solutions lie in…” and read until the paragraph that begins, “Perhaps the most radical assumption of the SFBT…“
Discuss your thoughts about SFBT. Discuss examples where SFBT might be useful in your personal life. What limitations if any exist with this theoretical model? Be specific. Give examples.
this is the article
Solution-focused brief therapy–one model fits all?
This article expresses concern about the indiscriminate acceptance of the solution-focused brief therapy (SFBT) model by some social workers and social agencies in spite of the dearth of empirical support for its claims to provide clients with more rapid and more enduring change than other treatment models.
This article expresses concern about the indiscriminate acceptance of the solution-focused brief therapy (SFBT) model by some social workers and social agencies in spite of the dearth of empirical support for its claims to provide clients with more rapid and more enduring change than other treatment models. The article reviews the core assumptions and techniques of SFBT and outlines the strengths and limitations of the model in the context of the findings of psychotherapy process and outcome research and from the perspective of mainstream social work. The authors argue that social workers should avoid rigid adherence to narrow models of therapy and that social work
students need to be exposed to multiple theories and techniques to be adequately prepared for practice. Agencies are encouraged to offer services based on a variety of treatment models in order to more adequately serve their clients and also to better position themselves to contribute to research that would further inform the profession about the combinations of model, client and worker characteristics that lead to the most efficient and effective outcomes.
IN THE LAST FIFTEEN YEARS, solution-focused brief therapy (SFBT) has been the topic of numerous books, articles, workshops, and training sessions throughout the United States and Canada. Social service and mental health agencies have not only provided extensive training in this model to practitioners, but some have even proclaimed themselves “solution-focused” agencies. A number of factors may account for the meteoric rise in popularity of SFBT In a review of the solution-focused literature, Miller (1994) found common claims that the model yields (a) more rapid client change, (b) more enduring client change, (c) a higher frequency of single– session cures, and (d) a higher degree of client satisfaction. It is not difficult to understand how these claims, along with the intuitive appeal of the model’s emphasis on client’s strengths and resources and the fact that the model is easy to understand and apply, have led many social workers to embrace SFBT. Also, practitioners and agencies are well aware that the claim of being the briefest of the brief therapies, and therefore incurring lower costs per client, has natural appeal for health management organizations in the United States and for taxpayer-supported agencies and employee assistance plans in Canada.
This article arose from concerns about the widespread, indiscriminate acceptance of SFBT. In general, whenever claims of superior and universal effectiveness are made, it is important to take a more detailed, critical look at the empirical support for a model. More specific concerns included: (a) the seeming lack of fit between this model and the needs of client groups with severe and/or longstanding problems, (b) the lack of compatibility between some aspects of the model and generally accepted social work principles, and (c) the possible deleterious effects of placing social work students in agencies that promote the use of this (or any) model exclusively.
In this article we present (a) an overview of SFBT, (b) a review of the outcome research on SFBT, (c) a review of the cumulative findings of psychotherapy process and outcome research, (d) a critique of the strengths and limitations of SFBT, and (e) implications for social work practice and education.
Overview of SFBT
Steve de Shazer, the prime mover behind the development of SFBT, began to define ideas for this model prior to the start of his tenure at the Mental Research Institute (MRI) in 1972 (de Shazer, 1985). It is clear, however, that despite the obvious difference in focusing on solutions as opposed to problems, SFBT owes much to the MRI’s strategic model of therapy. SFBT and strategic therapy share an emphasis on brevity, a de-emphasis on client history, a focus on clearly defined behavioral goals, and the use of interventions involving reframing and shifts in interpersonal interactions (de Shazer, 1991; Nichols & Schwartz, 1998).
De Shazer also acknowledges the influence of Milton Erickson and his use of hypnosis (de Shazer, 1988). While de Shazer does not deliberately attempt to induce trance, he acknowledges that aspects of his model seem to function almost like trance induction. For example, he sees the consulting break serving this function, since the client seems to become more receptive to the therapist’s recommendations while waiting for the therapist to consult with the team. De Shazer’s “miracle question,” in which the client is asked to describe how his life would be different if the problem were miraculously solved is a modification of Erickson’s “crystal ball” technique. Methods in SFBT that communicate the inevitability of change and ideas about developing a “yes set” by offering therapeutic compliments about what the client is already doing well are also reflective of Erickson’s approach (Chang & Phillips, 1993).
Many other individuals have been associated with the development of SFBT. These include Insoo Kim Berg, Eve Lipchik, Michele Weiner-Davis, Scott Miller, John Walter, and Jane Peller, all of whom have worked with de Shazer and with each other at the Brief Family Therapy Center (BFTC) in Milwaukee.
Core Assumptions and Approach to Intervention
SFBT assumes that “solutions lie in changing interactions in the context of the unique constraints of the situation” (de Shazer, Berg, Lipchik, Nunnally, Molnar, Gingerich, & Weiner-Davis, 1986, p. 208). The need to sometimes change the client’s “interpretation of behavior” is noted, as is the idea that “complaints involve behavior brought about by the clients’ `world view”‘ (de Shazer et al., 1986, p. 210). It is believed that new meanings can be created for at least some aspect of the presenting problem (de Shazer et al., 1986). SFBT also assumes that the symptom or the problem is often the result of people trying to solve a problem but having “developed unfortunate habit patterns” (de Shazer et al., 1986, p. 209).
Only a small change is thought to be necessary, and change is seen as more likely to occur if it is a small change and clearly defined. Small changes are thought to naturally lead to other changes and therefore to “changes in the system-as-a-whole,” (de Shazer et al., 1986, p. 209).
The SFBT approach, rather than focusing on the symptom or problem, aims to help the client “set up some conditions that allow for the spontaneous achievement of the stated (or inferred) goal” (de Shazer, 1985, p. 14). Setting a concrete goal is thought to elicit the expectation of change, as well as providing a criterion for success. Following from this emphasis, specific techniques for identifying concrete goals (and de-emphasizing the problem) have been developed. These questions include, “How will you know that the problem has been solved?”, “What will be different when the problem is solved?”, “How will others know that the problem has been solved?” Behaviorally-specific answers to these forms of the “miracle question” become the goal of therapy.
SFBT therapists begin with limited information about the client in order to “minimize pre-set ideas” (de Shazer et al., 1986, p. 214). Gathering information about the past is seen as “problem talk” that needs to be kept to a minimum. Insight into the formation of the problem is not perceived as useful and the therapist does not even have to know the details of the complaint, but only needs to know “How will we know when the problem is solved?” (de Shazer et al., 1986, p. 210). Furthermore, a minimalist approach is valued.
It is best to assume that a wet bed is simply a wet bed, teeth-grinding is teeth-grinding, voices are voices, and nothing more. We have more complex explanatory metaphors available upon which to build a treatment approach should the first, most minimal approach fail. (de Shazer, 1988, p.150)
Another frequently stated assumption of SFBT is that “there are always exceptions to problems” (Nylund & Corsiglia, 1994, p. 5). In the first session, after the clients have described the complaint, the therapist’s task is to “initiate the search for exceptions to the rules of the problem, virtually, immediately” (Molnar & De Shazer, 1987, p. 351). From that, the therapist encourages “consideration of the differences between the situations in which the problem behaviors occur and the situations in which the exceptions”(p. 351) occur. De Shazer acknowledges that there are cases in which the client cannot identify an exception (de Shazer, 1988, p. 93). The therapist then tries to help the client construct a hypothetical solution using behavioral descriptions from questions about how her life would be different if the problem were solved.
SFBT assumes that clients have the resources necessary to change (Nylund & Corsiglia, 1994). De Shazer says, “Every client carries the key to the solution: The therapist needs to know where to look” (de Shazer, 1985, p. 90). This attitude can be seen as similar to Erickson’s view that people contain “untapped and often unconscious resources” (Nichols & Schwartz, 1998, p. 383). This view can also be seen in what has been described as the “Buddhist view of change” (Nunnally, de Shazer, Lipchik, & Berg, 1986, p. 90), a perspective that sees change as constant and stability as an illusion.
Perhaps the most radical assumption of the SFBT model is the idea that solutions do not need to have a lot in common with the problem and that “the process of solution from one case to another is more similar than the problems each intervention is meant to solve” (de Shazer, 1985, p. xv). De Shazer frequently uses the metaphor of the skeleton key – a key that works in many different kinds of locks. He suggests that the “simple formula tasks” that comprise SFBT are like a skeleton key in that they can produce “satisfying change in a wide variety of situations” (de Shazer, 1985, p. xv).
Although de Shazer (1985) has indicated that an observing team is not necessary, a break in the session is seen as essential so that the individual therapist may think about an appropriate intervention or consult with the team. The therapist or team develops compliments and “clues.” Compliments are statements “based on what the client is already doing that is useful or good or right in some way” (de Shazer et al., 1986, p. 216). They are aimed at encouraging the clients to see themselves as “normal persons with normal difficulties” and to develop a “yes set.” Clients are encouraged to perceive that the therapist is “on their side” and this perception is expected to lead to willingness to accept “clues” about solutions. Clues “are focused therapeutic suggestions, tasks, or directives about other sorts of things that the clients might do that will likely be good for them and will lead in the direction of solution” (de Shazer et al., 1986, p. 217). De Shazer (1985) insists that clients really do want to change and that so-called “resistance” has to do with clients’ reactions to therapists’ ideas about how to change that do not fit well with the client’s worldview. His rather arbitrary classification of therapist-client relationships into three categories: (a) visitor relationships, (b) complainant relationships, and (c) customer relationships, serves to support his argument that “clients” really do want to change.
Changes in SFBT over Time
De Shazer acknowledges that the model is an evolving one (de Shazer, 1988; 1994) and that he and his colleagues have shifted from attempting to directly change behavior to focusing more on changing the interpretation of behavior and to the “linguistic, interactional, and conversational aspects of doing therapy” (de Shazer, 1994, p. 96). He has begun to view therapy as “an activity involving several language games” (de Shazer, 1991, p. 76) where a language game is understood as a system of shared meaning and shared behavior.
A dramatic change in de Shazer’s concept of “fit” denotes a significant change in the importance he attributes to the relationship between the therapist and client. In 1985, “fit” referred entirely to the appropriateness of the connection between the complaint and the therapist’s intervention.
It is the fit between the therapist’s description of the complaint pattern and form and the map of the intervention which seems central to the process of initiating therapeutic change. (p. 60)
He emphasized that although clients’ complaints are complex constructions, all that is necessary is that the intervention points the client in the direction of a solution, by fitting within his worldview, “but with a difference that – at least potentially — makes a difference, i.e. [sic] leads to a satisfactory conclusion” (p. 63).
In 1988, his concept of “fit” was much altered. He said,
Throughout the session, the therapist needs to be developing a fit with the person or people she is interviewing…. Fit is a mutual process involving both therapist and the people he is conversing with during which they come to trust each other, pay close attention to each other, and accept each other’s worldview as valid, valuable, and meaningful. (p. 90)
De Shazer seems to have moved from seeing the crucial change agent as the correct “clue” or intervention to recognizing that the quality of the relationship between the therapist and client is also important.
De Shazer (1991) also acknowledges that his thinking has been deeply influenced by the shift in philosophical perspective “from structuralism to post-structuralism.” He recognizes that his early work reflected the traditional (structural) custom of drawing a boundary around “the client and problem . . .” “thus separating that system from the therapist and his team” (de Shazer, 1991, p.56). He argues that more recent work reflects a redefinition of the unit of analysis as “involving client-plus-therapist– plus goal (or solution)-plus-team,” (p. 57) and therefore SFBT is now seen as a “mutual endeavor involving therapists and clients together constructing a mutually agreed upon goal” (p. 57). His work has shifted from “fancy tasks” to “simpler ones based on what the clients have already said that they know how to do” (de Shazer, 1994, p. 272).
Research on SFBT
As discussed in the introduction to this article, the literature on SFBT is replete with claims of more rapid and more enduring client change compared to other approaches (Miller, 1994). These claims are in stark contrast to the fact that there is no empirical evidence of SFBT’s superior effectiveness or brevity. In fact, there is limited evidence for its efficacy because no methodologically sound studies on SFBT have been conducted.
SFBT proponents cite three studies of outcome to support the effectiveness of the model. Two of these studies (DeJong & Hopwood, 1996; Kiser, cited in DeJong & Hopwood, 1996) were conducted at the Brief Family Therapy Center in Milwaukee, and the other (Andreas, cited in McKeel, 1996) was conducted in Sweden with a sample of only twenty-five clients. In all of these studies, clients were simply asked at termination and at a six- or nine-month follow-up whether their treatment goal had been met, and if not, whether any progress had been made. In reviewing the two studies from Milwaukee, DeJong and Hopwood (1996) claim “success” rates at follow-up to be about 80%, but a client’s report of having made “some progress” was counted as success. In the DeJong and Hopwood study, only 45% of clients reported at follow-up that their goal had been met, and only 25% of clients rated their progress as “significant” at termination.
McKeel (1996) is one of the few within the SFBT camp to stress the shortcomings of these “studies.” He acknowledges that the outcome assessments are “simplistic,” that no control groups were used, and that for these and other reasons, these studies have not been accepted for publication in peer-reviewed journals. Nichols and Schwartz (1998) are much more caustic in commenting that the outcome assessments in these studies are “about as substantial as the usual response to the waiter’s question, `How was everything?”‘ (p. 389).
One process-outcome study of SFBT that examined the effectiveness of a particular intervention, the Formula First Session Task (FFST), has been published. Adams, Piercy, and Jurich (1991) compared three treatment conditions: (a) the FFST followed by problem-focused therapy, (b) the FFST followed by solution-focused therapy, and (c) a problem-focused intervention in the first session followed by problem-focused therapy. After one week, the families receiving the FFST were rated significantly higher on measures of family compliance, clarity of treatment goals, and improvement in presenting problems, but there were no significant differences among groups on family optimism or other outcome variables after ten sessions.
As with the claims about superior outcomes, there is also no support for the claim of being the briefest of the brief therapies. The average length of treatment in SFBT is about five sessions (McKeel, 1996; Miller, 1994). Although this may seem brief, in fact this is approximately the same average length of treatment found across all models of treatment (Garfield, 1994; Miller, 1994). DeJong and Hopwood (1996) found a lower mean number of sessions (three) in their study of SFBT, but they also noted an association between more sessions and increased progress. It is also noteworthy that Miller (1994) challenges the solution-focused claims about uniqueness with regard to single session successes. He cites Jerome Frank’s reviews of research and his conclusions that many different treatment models yield good results for single-session cases.
Psychotherapy Process and Outcome Research
Given the lack of research that has been conducted on SFBT, consideration of the major cumulative findings in psychotherapy process and outcome research provides information that can be helpful in assessing the strengths and limitations of SFBT. Progressively sophisticated psychotherapy outcome research over the past fifty years has yielded a few major, generally accepted findings. First, psychotherapies in general, have positive therapeutic effects compared to no treatment (Lambert & Bergin, 1994). Second, apart from a few exceptions (e.g., the superior effectiveness of cognitive-behavioral interventions with panic and phobic disorders), there are nonsignificant outcome differences among the various types of psychotherapy (Lambert & Bergin, 1994). Third, the quality of the therapeutic alliance or relationship (characterized generally by warmth, empathy, respect, acceptance, trust, and collaboration) is the best predictor of client outcome (Horvath & Symonds, 1991; Orlinsky, Grawe, & Parks, 1994). These cumulative findings have lent support to Jerome Frank’s (1961) long-held belief that factors that are common across therapeutic models, particularly the therapeutic relationship, contribute much more to positive outcomes than specific factors of theory and technique. Lambert and Bergin (1994) have developed a conceptualization of factors common across therapies that have shown positive associations with outcome in research. They have grouped these common factors into “support,” “learning,” and “action” categories. The empirical evidence is strongest for relationship factors, which are grouped under support factors (together with catharsis, etc.), but there is evidence to support a number of learning factors (e.g., advice, cognitive learning, feedback, insight) and action factors (e.g., facing fears, mastery efforts, success experience). Lambert and Bergin’s (1994) review of the research findings on common factors suggests an integrated focus on affect, cognition, and behavior, and the authors argue for a logical sequencing for these factors in therapy:
Together they provide for a cooperative working endeavor in which the patient’s increased sense of trust, security, and safety, along with decreases in tension, threat, and anxiety, leads to changes in conceptualizing his or her problems and ultimately in acting differently by refacing fears, taking risks, and working through problems in interpersonal relationships. (pp. 163-164)
Given the findings of non-significant outcome differences across different schools of therapy and of the importance of the therapeutic relationship and myriad other factors that are generic to different therapeutic approaches, it is no surprise that “there is a major trend toward eclecticism or integration of diverse techniques and concepts into a broad, comprehensive, and pragmatic approach to treatment that avoids strong allegiances to narrow theories or schools of thought” (Lambert & Bergin, 1994, p. 143). Consequently, one of the major trends in research has been to explore the effect of matching client and situational factors with different interventions. For example, in line with his model of systematic eclecticism, Beutler (1991) has found some promising results in matching clients’ coping style (i.e., externalizing/nonexternalizing) and resistance (high/low) to different types of therapy. This study found that cognitive therapy yielded better results for depressed clients with an externalizing coping style and low resistance; whereas supportive, self-directed therapy yielded better results for depressed clients with a non-externalizing style and high resistance.
One other body of psychotherapy research has direct implications for SFBT. Koss and Shiang (1994) have reviewed the research specific to brief therapies. It should be pointed out that consistent with the overall literature on brief therapy, they define any therapy with an upper limit of twenty-five sessions as brief. The research that Koss and Shiang review overlaps considerably with the larger reviews of research by Lambert and Bergin, (1994) and thus the same overall findings reported above hold true for this research. The review by Koss and Shiang points out, however, that brief therapy (even up to twenty-five sessions) is “less effective for patients with more severe disorders such as those of personality, substance abuse, and psychosis” (p. 681).
Critique of SFBT
SFBT represents in many ways a radical departure from the MRI model of strategic therapy from which it developed. It is clear that from a mainstream social work perspective, the solution-focused model represents improvement over the MRI and other strategic models. First, in contrast to the view of problems as serving a function and of clients as being resistant, the solution-focused model has declared the death of resistance as a therapy concept (de Shazer, 1984), assumes that “clients really do want to change” (de Shazer et al., 1986, p. 209), and contends that problems “are a matter of `bad luck”‘ (de Shazer et al., 1986, p. 210). Second, in contrast to the strategic stance of “therapist-as-expert-manipulator” (Nichols & Schwartz, 1998, p. 355) and the power imbalance and mystification of the therapy process that resulted from this, the solution-focused model envisions therapy as a collaborative, client-centered endeavor in which “clients, not therapists, identify the goals to be accomplished” (O’Hanlon & Wiener-Davis,1989, p. 44), and clients find their own solutions. Third, in contrast to the “esoteric conceptual frameworks” (Liddle, 1991, p. 328) and the “intellectual intimidation and pomposity” (Liddle & Saba, 1981, p. 38) that strategic models engendered, solution-focused theory is “easily understandable and translates readily into schematic techniques” (Nichols & Schwartz, 1998, p. 382).
SFBT is more strengths oriented, collaborative, and accessible than earlier models of strategic therapy, and such emphases are clearly more compatible with the traditions of mainstream social work practice. It should be pointed out, however, that although SFBT departs radically from earlier models of strategic therapy, many of its strengths are also evident in other models of therapy. First, although there are differences in emphasis, all models of psychotherapy and their brief treatment analogues emphasize forward movement and change. For example, cognitive therapy emphasizes developing new “self talk” (Safran & Segal, 1990); behavior therapy emphasizes reinforcers for positive behavior (Jacobson, 1987); and even psychodynamic therapy emphasizes the resolution of past conflicts, deficits, and trauma so that the client can be free to engage in new behavior and new relationships. Speaking from the perspective of self-psychology, Marian Tolpin (1996) talks about “the forward edge” of therapy, by which she means the therapeutic support and validation for new experience and new behavior. Second, the emphasis on client strengths and collaboration is certainly not unique to SFBT. This emphasis has been part of social work practice since the functional school arose in the 1930s, has always been a part of humanistic therapies (e.g., client centered therapy), is a cornerstone of feminist and narrative models, and has become much more prevalent in both cognitive-behavioral and psychodynamic models.
Limitations and Problems
In addition to the obvious problem that there is very little empirical support for the effectiveness of SFBT, a review of psychotherapy research suggests numerous shortcomings of the model. Also, many principles of SFBT are not consistent with generally accepted social work principles.
First, there is the fact that brief therapies, even up to twenty-five sessions, have been shown to be less effective than longer-term therapies with regard to clients with severe problems. This research, along with clinical wisdom, challenges SFBT’s precepts that one does not need to know anything about how the problem developed, that clients do not need to have their stories heard and their feelings supported, and that even the most difficult problems, including trauma, neglect, and abuse, can be overcome quickly, often in a single session. Particularly when applied to treating clients with severe, long-standing disorders, such beliefs and practices are at best naive and at worst harmful. We do not deny that rapid improvement may be possible with some clients, but in our view that depends on the interactive effect of many factors: the client’s subjective experience of the past, the duration of past negative experiences, the strengths of the individual, and the extent of the person’s social and environmental supports that might mediate the effects of the negative experience. In other words, how readily an individual can move forward into new solutions depends on the impact of past experience on current functional capacities. Some clients may be able to “move on” without an exploration of the past, while others may not.
This raises a second major concern about SFBT; namely, its neglect of client history and broader assessment. Berg and De Jong’s (1996) account of the single– session “success” with a teen mother whose children were in child welfare care and who was dealing with a physically abusive partner is an example of naivete. This case example illustrates SFBT’s disregard of a gender-sensitive perspective and of large-systems factors such as “the legal system, child welfare, the extended family, and medical system” (McConkey, 1992, p.4). De Shazer’s (1991) account of doing marital work with a couple where the husband had been diagnosed with paranoid schizophrenia is at best naive. In discussing this case, de Shazer notes that “it is all too easy to join in the exploration of history,” (p. 137) and instead he fosters a “progressive narrative” to help the husband control hallucinations and delusions. De Shazer’s purposeful refusal to consider the micro-systemic (i.e., biological/genetic) components of mental illness and the usefulness of the medication that was prescribed by a psychiatrist raises ethical as well as clinical issues. We would argue that SFBT’s neglect of broad-based assessment is in opposition to social work’s person-in-environment perspective and to clinical wisdom.
A third, more general limitation of SFBT is that it perpetuates the problematic tendency of earlier strategic/systemic models toward rigid adherence to narrow models and the belief that one model can be all things to all people. Whether it is due more to the demands of the managed care industry or to a continuing trend in family therapy to use theory “as a quasi-religious dogma” (Wood & Geismar, 1989, p. 91), it appears that many practitioners and even entire agencies have “converted” to a solution-focused model of practice. This is in opposition to the common-sense acknowledgement that “no single modality or orientation is comprehensive enough to deal well with the variety of problems patients bring to psychotherapy” (Pinsof, 1994, p. 103). Such common sense has been verified empirically by outcome studies in individual psychotherapy that show consistently that there are nonsignificant outcome differences among the variety of psychotherapies (Lambert & Bergin, 1994). These findings are the impetus behind the trend in the field of individual psychotherapy away from the “competing schools” phenomenon and toward eclecticism and integrationism (Stricker, 1994; Norcross, 1995). Such a trend is also in keeping with the theoretical openness that is endorsed by a generalist social work perspective (Sheafor & Landon, 1987).
A fourth drawback of SFBT is that it maintains the emphasis of strategic models on theory and technique as opposed to the relationship between the worker and client. An increased emphasis on collaboration and a more strengths-oriented, positive view of clients has not translated (at least, not in the literature) into a focus on emotional support and the development of a warm, empathic therapeutic relationship. From within the solution– focused camp, Lipchik (1997) acknowledges that “relationship has not been emphasized much” (p. 160). This lack of emphasis on the therapeutic relationship is reinforced by SFBT’s focus on brevity. It is clear from research on the therapeutic alliance, however, that such a lack of attention to the therapeutic relationship suggests poorer outcome for clients. Making brevity the priority also runs contrary to the traditional social work emphasis on the importance of the worker-client relationship. The value of the therapeutic relationship is not simply as a facilitator of change; for some clients, it provides the change. For example, a woman who is the victim of repeated wife assault and a part of a multigenerational experience of family violence may or may not be able to envisage a novel solution which is not in her repertoire of experience. She may not know what it is like to be treated calmly, respectfully, and kindly; to be listened to and to be heard unless she experiences something different. For many clients, the “something different” occurs first within the therapeutic relationship.
SFBT’s focus on brevity, neglect of broad-based assessment, and lack of emphasis on the therapeutic relationship are interrelated with its tendency to become “solution-forced” or “problem-phobic” (Nylund & Corsiglia, 1994) in terms of not allowing clients to tell their painful stories. These aspects of the model not only limit the worker’s felt understanding of the client’s experience and the development of a good therapeutic relationship, but they also limit client catharsis, which is associated with positive client outcome (Lambert & Bergin, 1994). According to Messer and Warren (1995), the tendency of SFBT to deflect painful narrative away from “problem talk” to “solution talk,” may be seen as part of a larger, cultural issue.
At a cultural level we seem to distance ourselves from emotional pain and despair by trivializing the depth and extent of subjective suffering. It is all too easy to accept our patients’ superficial solutions to life’s difficulties because it makes our job easier. In fact, our patients undoubtedly pick up on the ways in which we cannot hear about or tolerate their pain and accommodate us through pathological reenactments of their early relationships with caretakers who could not contain or tolerate their feelings. As psychotherapists, we will only hear that which we are prepared to bear. We suspect that some brief therapists may never hear the full extent of their patients suffering. (p. 332)
Reflecting back to Lambert and Bergin’s (1994) empirically-based argument for an integrated focus on common factors associated with affect, cognition, and behavior, it is clear that SFBT de-emphasizes affective factors.
Implications for Social Work Practice and Education
This critique of SFBT should not be construed as a total dismissal of the model. The model’s general emphasis on collaboration and client strength, as well as many of the techniques to facilitate the development of solutions, have clear utility for the field. The criticisms are largely about the narrowness of the model and rigid adherence to it. Furthermore, two other qualifications to this critique should be made. First, it is likely that many solution-focused therapists are much more flexible in how they work with clients than what most of the literature and conference presentations would suggest. Second, many of the critiques of the model have emerged from within the solution-focused camp itself (e.g., Efron & Veenendal, 1993; Lipchik, 1997; Miller, 1994; Nylund & Corsiglia, 1994). For example, the writing of Lipchik (1997) and Butler and Powers (1996) criticizes the solution-focused model for neglecting the therapeutic relationship and suggests that their own use of the model has evolved to incorporate such an emphasis.
There is hope for the evolution of the solution– focused model toward more flexibility, although one should not underestimate “the constraints of managed care or dogmatic adherence to doctrine” (Nichols & Schwartz, 1998, p. 392). The managed care industry and those with provider status need to be educated to the fact that the solution-focused model does not have a corner on the market (and, in fact, has no verifiable claim) with regard to effective brief treatment. In terms of the dogmatic adherence to doctrine, practitioners have an ethical obligation to be aware of (a) the lack of an empirical base for the solution-focused model, (b) the empirically-driven trends in the field toward eclecticism and integrationism and a focus on the therapeutic relationship, and (c) the fact that brief approaches are less effective for severe, long-standing client problems.
These latter points speak to recommendations both for practice and for the education of social workers. Practitioners should take care to do some degree of broadbased assessment and be open to using multiple theoretical approaches, depending on client characteristics and needs. Although there is still limited empirical evidence to suggest criteria for matching types of clients and problems to therapeutic approaches, our review of the research yielded some evidence to support the intuitive notion of using factors such as degree of resistance and coping style. For instance, it makes sense that an action-oriented person is more likely to benefit from a behavioral approach whereas a more introspective and psychologically– oriented client may respond better to a cognitive or psychodynamic approach. Matching treatment model to client coping may also decrease treatment attrition and increase adherence (Weerasekera, 1993).
With regard to the education of prospective social workers, the profession should be concerned about the level of skill development for a generation of B.S.W and M.S.W. students who may be educated with an exclusive focus on the limited and scripted nature of SFBT in their agency practicum experience. Given the absence of research demonstrating the superiority or even efficacy of SFBT in terms of process and outcome, one wonders about the durability of this practice model. We would argue that it is important for social work students to be exposed both in the classroom and the field agency to generic phases of the helping process (e.g., engagement, assessment, formulation, intervention, and termination) and to multiple theories and associated techniques. In fact, there is “some limited evidence that in-depth training in multiple modalities may improve the therapeutic efficacy of individual practitioners” (Roth & Fonagy, 1996, p. 3S7). It makes sense that if social work students are trained in a broad base of theories, methods, and techniques, they will be better equipped to adapt to clients’ needs and coping styles regardless of the popularity of any given model at a particular time.
A final suggestion relates to agency practice and to research. An argument could be made for agencies with adequate resources to adopt a multi-model structure where workers, following adequate training in a variety of therapeutic approaches, are assigned to one of several teams offering interventions based on different treatment models. For example, three treatment teams might be organized around three types of brief treatment: SFBT, cognitive/behavioral, and psychodynamic. Such multi-model agency programs could more effectively incorporate research designs that would permit examination of both the main effects of different models on outcome and the interaction effects of dyadic characteristics of the therapist– client relationship on outcome. Such “practice-relevant research” would further inform clinicians and agencies about what models are most effective for what types of clients and for which kinds of problems.
In this article, we have challenged the indiscriminate acceptance of SFBT by social workers and social agencies in North America. We raise these concerns in view of the paucity of research supporting the efficacy of SFBT and in view of current findings on process and outcome in psychotherapy. We argue that social workers need to have knowledge of a variety of treatment models and that agencies that offer multiple approaches best serve their clients. At the same time, such multi-model agencies provide ideal settings for researchers to increase the profession’s knowledge of the most effective combinations of client, therapist, and treatment approach.