A Systematic Review and Meta-Summary of Change Process Research on Solution Focused Brief Therapy

Background:  Systematic reviews suggest that solution-focused brief therapy (SFBT) is a promising intervention in youth and family services but no systematic reviews on process change studies have been completed. Process change studies examine “how and why” an intervention works. This study reviewed the change process research on SFBT and analyzed data using meta-summary.  Meta-summary was chosen because process studies use various research designs, and this method is recommended for synthesizing studies with quantitative, qualitative or mixed-method designs.   

Methods: Five electronic databases were searched (PsychINFO, ASC, PUBMED, Medline, and ERIC) using two sets of key words one representing “SFBT” the other for “change process research.” Dissertation abstracts, grey literature were searched through Google Scholar.  Hand searches of key journals and experts in the field were contacted.  Search strategies resulted in 272 studies.  Title/abstract review and full article review was conducted by two reviewers. Thirty-three studies met inclusion criteria for data abstraction using a codebook.

Data Analysis: Thirty-three studies with 964 participants were analyzed.  Meta-summary was used for the data analysis (Sandelowski, & Barroso, 2007).  Summary statistics showed that 42.4%(n = 14) of the studies used micro- or sequential-analytic method and 39.4%(n = 13) of the studies used process-outcome methods. Four studies (12.1%) used qualitative methods and two studies (6.1%) used comprehensive or task analysis. A coding scheme was used to group various SFBT techniques across the studies. As recommended by the meta-summary approach, frequency effect sizes were calculated (Voils et al., 2008).

Results: Twenty-five studies (75.8%) examined SFBT as an individual intervention, six studies (18.1%) examined SFBT for couples and families, and two studies (6.1%) used SFBT as an intervention both for individuals and family/couple. The current studies have several limitations due to the quality and sample sizes of studies. Approximately half of the studies had small, clinical, convenience samples (n=16). There was missing data on race and only fourteen studies (42%) reported clients’ racial background and they were predominantly Caucasian.

Thirteen studies examined co-construction of meaning as a process of change and reported supportive findings (effect size: 0.39). Conversely, two studies reported negative findings for the co-construction process. Sixteen studies showed supportive results for different types of SFBT techniques (effect size: 0.45). For the strengths and resources oriented techniques, 2 studies reported no relationship; for studies using multiple techniques, 3 studies reported no relationship.

Conclusions and Implications: This review showed that the co-construction of meaning and SFBT techniques, in particular the strengths-oriented techniques, are associated with change in SFBT.  Confidence in these results can be improved when these studies are replicated using larger RCTs. This study is important to social work because it is the first systematic review to examine how and why change happens in SFBT. Understanding SFBT’s process of change will allow social workers to serve the youth and family populations more effectively. This review also showed that the next steps for improving the research may be to design mechanism of change studies that examine the co-constructive processes in SFBT in relationship to the resolution of presenting problems.