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Solution-focused brief therapy (SFBT) is a strengths-based intervention that was developed by social workers in a community-based mental health clinic in the early 1980s and is now practiced globally within mental health, child and family services, and other communities-based settings. However, to date, no existing systematic reviews and meta-analyses have examined the effectiveness of SFBT in community services or the effectiveness of specific SFBT techniques on outcomes. This study analyzed how effective the number and types of SFBT techniques are for clinically relevant outcomes, such as depression, anxiety, behavioral health, health, and wellbeing, family functioning, and psychosocial outcomes. This study provides impact by showing how to efficaciously practice SFBT in mental health and community-based services.
Method
Six electronic databases were searched using keywords (Solution-Focused OR “Solution Focused” OR SFBT OR “Solution-Focused Brief Therapy” OR Solution-Oriented) AND (random* OR experiment*), dated until the year 2021. Only SFBT studies that contain participants of adolescents, adults, or families, conducted in community services, using an RCT design, focusing on any behavioral health, health, family functioning, or psychosocial outcomes were included. This study followed the Cochrane recommendations. Data analysis included 28 studies from 33 publications, where 340 effect sizes were calculated and included for meta-regression.
Results
All studies were conducted in community services and included racialized and diverse clientele. Of the studies that reported information on participants’ race/ethnicity (n=15, 53.57%), an average of 38.69% of participants were White, 28.31% were other races/ethnicities (e.g., American Indian/Alaskan Native, Native Hawaiian/Pacific Islander, mixed race, Iranian), 19.12% were Asian, 11.12% were Black, and 2.76% were Hispanic). Meta-regression with RVE revealed an overall statistically significant and medium treatment effect size across outcome domains (i.e., depression, anxiety, behavioral health, health, family functioning, and psychosocial adjustment), g = 0.654, 95% CI: 0.386 – 0.922, p < 0.001. Subgroup analysis for specific outcome domains revealed that SFBT was statistically significant with medium treatment effects for depression outcomes, g = 0.652, 95% CI: 0.146 – 1.116, p = 0.017, behavioral health function, g = 0.573, 95% CI: 0.216 – 0.930, p < 0.01, family function, g = 0.615, 95% CI: 0.097 – 1.130, p = 0.026, and psychosocial adjustment, g= 0.410, 95% CI: 0.001 – 0.820, p = 0.049. Results show how to use SFBT in practice by demonstrating that three or more techniques were needed to achieve results and that it is more effective to use change techniques across different categories ( i.e., collaborative relationships, strengths and resources, and future-oriented).
Conclusion
SFBT is an effective intervention in outpatient, community-based mental health for diverse adolescent and adult populations who have depression, behavioral health, and family functioning challenges, and in psychosocial adjustment. To achieve favorable outcomes, social work practitioners can benefit from having a comprehensive understanding of the SFBT approach across categories of change techniques and appropriately applying the techniques.