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841688FISXXX10.1177/1044389419841688Families in SocietyKim et al.
research-article2019
Invited Article
Families in Society: The Journal of
Contemporary Social Services
Is Solution-Focused Brief Therapy 2019, Vol. 100(2) 127 –138
© The Author(s) 2019
Evidence-Based? An Update Article reuse guidelines:
sagepub.com/journals-permissions
https://doi.org/10.1177/1044389419841688
10 Years Later DOI: 10.1177/1044389419841688
journals.sagepub.com/home/fis
1 2 3
Johnny Kim , Sara Smock Jordan , Cynthia Franklin ,
4
and Adam Froerer
Abstract
Nearly ten years ago, Families in Society published an article (Kim, Smock, Trepper, McCollum, &
Franklin, 2010) that discussed the empirical status of solution-focused brief therapy (SFBT) and
its progress toward being accepted as an evidence-based intervention in the United States. In
the last decade, new growth of experimental design studies using SFBT with diverse populations
has occurred. The current article provides an update on the evidence-base of SFBT, showing
favorable results on emotional, behavioral, and interpersonal issues. Resources for practitioners
on SFBT training are also included.
Keywords
evidence-based/evidence-informed practice, clinical practice, evaluation/outcomes/accountability,
cultural competence
Manuscript received: February 5, 2019; Revised: March 2, 2019; Accepted: March 8, 2019
Disposition editor: Sondra J. Fogel
Introduction with clients to build their own solutions
Developed in the early 1980s, solution-focused (Franklin, Zhang, Froerer, & Johnson, 2017).
brief therapy (SFBT) evolved out of the brief The purposeful use of language and how to ask
family therapy models by an interdisciplinary questions are very important for how SFBT
team of therapists, led by two social workers, works and are interrelated with the co-con-
Steve de Shazer and Insoo Kim Berg (Lipchik, struction process, cooperative helping rela-
Derks, LaCourt, & Nunnally, 2012). SFBT is tionship, and solution-building (Berg & De
widely taught and used in social work practice Jong, 1996; De Jong & Berg, 2001). For exam-
(Franklin, 2015), and it is therefore very timely ple, social workers using SFBT facilitate con-
that this article will appear in the 100-year
anniversary of Families in Society that cele- 1PhD, associate professor, University of Denver
brates family-centered social work and the 2PhD, associate professor, University of Nevada, Las
contributions of social work practice. SFBT is Vegas
3PhD, professor and associate dean, The University of
a therapy model whose core therapeutic pro- Texas at Austin
cesses are working with the co-construction of 4PhD, PhD, associate professor and associate program
meaning, the strengths of the client, the estab- director, Mercer University, Macon
lishment of a cooperative helping relationship, Corresponding Author:
setting collaborative goals with client, the use Johnny Kim, University of Denver, Denver, CO, 80208.
of positive emotions (i.e., hope), and working Email: johnny.kim@du.edu
128 Families in Society: The Journal of Contemporary Social Services 100(2)
versations with clients that describe, in great based registries and almost 10 years since the
detail, what their life will look like when the publication of our original study, and much
problem is no longer present in their lives. has changed since that time both in the
SFBT became known for questions such as the evidence-based status of SFBT and on the
miracle question, scaling questions, best U.S. national front concerning the evidence-
hopes, and relationship questions that were based registries. Thus, the aim of this article is
used to facilitate the relationship and the co- to update the status of SFBT as an empirically
construction process with clients. recognized evidence-based intervention and
In the beginning, SFBT was studied in a revisit the question, “Is SFBT evidence-
family services agency where clinicians were based?”.
trying to discover the best brief therapeutic
techniques for client change. It was in this State of SFBT Research
spirit of inquiry that the first small scale qual-
itative observations, program evaluations, and Since our initial article in 2010, several RCTs
quasi-experimental studies were completed and quasi-experimental studies have been
on SFBT (Lipchik et al., 2012). Over the past completed on SFBT; the addition of these
15 years, however, more rigorous quantitative studies and their overall positive results con-
research methods using randomized con- tinue to increase our confidence in the evi-
trolled trials (RCTs) have greatly increased, dence base of SFBT. Take, for example, the
resulting in SFBT being recognized as an growth of SFBT research from 2000 to 2013
evidence-based intervention. The empirical as demonstrated by two narrative reviews of
evidence on SFBT moved forward quickly as SFBT outcome studies. Gingerich and Eisen-
more researchers across disciplines became gart (2000) could only identify 15 outcome
interested in SFBT. Hastening research was studies that were completed with experimen-
the evidence-based practice movement in tal designs. Of these studies, the authors were
mental health and psychotherapy, which hard pressed to find quality studies of any sort
emphasized empirically supported treatments. and few RCT studies. They rated the studies
A decade ago, we set out to describe an evalu- with five receiving a strong rating, four receiv-
ative process for how SFBT was considered ing a moderately strong rating, and six receiv-
for inclusion in three national evidence-based ing a weak rating. In comparison, Gingerich
practice (EBP) registries in the United States. and Peterson (2013) identified 43 SFBT out-
At that time, it was unclear to us how therapy come studies that met the criteria for their
models and programs were deemed evidence- review. This was both a sizable change in
based and how SFBT would be rated by some number and quality of the studies. These
of the recently developed U.S. evidence-based authors indicated that (74%) of the studies
registries. This seemed to us to be very impor- reported significant positive benefit from
tant larger systems work that would benefit SFBT.
social workers and other clinicians who were It is also important to note that several RCT
worried that SFBT sessions would not be studies have been conducted across different
reimbursed by funding agencies and that they populations and countries than are reported in
may not even be allowed to use SFBT with these reviews. Unfortunately, many studies are
clients. This culminated in the first article not in English and are not available for inclusion
published in Families in Society by Kim, in systematic reviews. An evaluation list of
Smock, Trepper, McCollum, and Franklin published studies, however, identified 143 ran-
(2010) that explored whether SFBT was evi- domized clinical trials on SFBT as of March
dence-based and also reported what we 2017 (http://blog.ebta.nu/wp-content/uploads/
learned from our work in having SFBT sub- 2017/12/SFTOCT2017.pdf). The substantial
mitted to U.S. federal registries. growth in experimental design studies makes
It has been 10 years since we began sub- it advantageous to study SFBT using meta-
mitting SFBT research studies to evidence- analysis methods that may also help research-
Kim et al. 129
ers better communicate to practitioners the diverse nations and populations including
overall efficacy of SFBT. Chinese, Korean, North American, Europe-
ans, Latino, and African Americans in study
Meta-Analysis Studies on SFBT samples. This indicates that SFBT is feasible
to use with a broad range of clientele.
Meta-analysis is a secondary data analysis Researchers in the United States and China
method where researchers systematically col- worked to have some of the Chinese studies
lect data from multiple outcome studies that that were reviewed in these tables translated
answer a specific research question (e.g., how and reviewed in English (Kim et al., 2015),
effective is SFBT with internalizing mental and some Chinese researchers have also trans-
health outcomes?) and offers an effect size, a lated some of the studies for us (Gong & Xu,
quantitative number that statistically calcu- 2015). Certainly, more of this translation work
lates how large of a treatment effect the inter- will lead to an even greater appreciation for
vention (e.g., SFBT) has on identified the broad evidence base of SFBT.
outcomes (Franklin, 2015). One important There were also several different outcomes
benefit of meta-analysis is the interpretation measured within the meta-analyses including
of the effect size, which is usually described those associated with depression, stress, anxi-
as being small, medium, or large, as well as ety, behavioral problems, parenting, substance
whether the difference between the groups is use, and psychosocial and interpersonal diffi-
statistically significant. Practically, when culties. One meta-analysis also looked at out-
therapies are effective, it is not uncommon to comes when being used in health care and had
find a small effect size in effectiveness trials effective results for health-related psychoso-
conducted with community-based samples cial outcomes (Zhang, Franklin, Currin-
and large effect sizes in controlled efficacy McCulloch, Park, & Kim, 2018). These
studies (Kim, 2008). What is most important, problem areas are all clinically significant
however, is for the therapy to be able to show areas of importance to most social workers and
a positive effect across multiple studies on other clinicians. While the measures used
similar populations and outcomes. It is equally across the studies for the same types of out-
important to judge the quality of the studies, comes are different, and not necessarily com-
and RCTs are the gold standard for evaluating parable, some trends can be observed. SFBT
whether a therapy is evidence-based. In Table has been frequently studied with internalizing
1, we briefly describe eight meta-analyses that mental health outcomes such as depression,
have been completed on SFBT, and overall stress, and anxiety with consistent results
these studies provide support for the effective- across many of the meta-analyses despite the
ness of SFBT. The table may also help practi- variance in measures used to evaluate out-
tioners better understand the evidence base of comes. One meta-analysis study was specifi-
SFBT with different populations and out- cally focused on the symptoms of internalizing
comes. disorders and showed that SFBT had a small
Results from Table 1 show that most SFBT effect size (Schmit, Schmit, & Lenz, 2016).
studies were conducted in applied, commu- However, studies from China also showed that
nity settings even when the purpose of the it had a very large effect size (Kim et al., 2015),
individual study was to test its efficacy. The and this difference might suggest a population
individual meta-analysis studies analyzed a effect or a setting effect, or may highlight other
range of outcomes studies from nine to 33 cultural factors that contribute to the differ-
across the different meta-analyses. The over- ence in the size of the effect. Several of the
all effect sizes for studies ranged from small meta-analyses also show that SFBT is effec-
to large indicating that in general SFBT was tive when behavioral problems and substance
an effective intervention with study popula- use are outcomes, but there appears to be more
tions. Populations varied from families, chil- mixed results with externalizing outcomes in
dren, adolescents, and adults and included comparison to internalizing outcomes.
Effect sizes0.57*(medium)1.51*(large)0.78*(large)0.54*(medium)1.07*0.99*(large)1.06*(large)Too few entries for calculation0.94*(large)1.03*(large)1.09*(large)(continued)
Outcomes (measures)
Child behavior problemsTherapeutic goal attainment (Parents plus Goals Scale)Parental satisfactionParental stress reductionImmediate Overall Effect covering a wide range of outcomes including interpersonal relationships, Internet addiction, depression, etc. (measures not reported)Follow-Up Overall Effect covering wide range of outcomes (measures not reported)Internalizing Behavior Problems–Emotions, career self-efficacy, anger traits, career maturity, career self-efficacy, Shyness, Depression, career beliefs, etc. (measures not reported)Externalizing Behavior Problems–Anger reactions, Internet-addiction tendencies, etc. (measures not reported)Family and Relationship Problems–Beliefs about parental divorce self-concept, interpersonal relationships, interpersonal relationships, social skills, social anxiety, interpersonal-communication abilities, etc. (measures not reported)Immediate Overall EffectFollow-Up Overall Effect
Populationchild-focused problemsvarious age groups (school age children and adults).school students
Families with Chinese of Ethnic Chinese
17 33 24
Number of studies
Study design
RCTs, quasi-experimental, single group trialsRCTs & quasi-experimental designRCTs & quasi-experimental design
years
Publication 2001-20152000-20142000-2014
SFBT Meta-Analyses Effect Size Summary.
Table 1.ReviewCarr, Hartnett, Brosnan, and Sharry (2017)Gong and Xu (2015)Gong and Hsu (2017)
130
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