Solution-Focused Brief Therapy

As the name may suggest, solution-focused brief therapy (SFBT) is a goal-oriented therapy method. It focuses on the outcome of treatment rather than the cause of the mental health issues. A SFBT therapist inspires their client to think of possibilities and positive desires over what brought them there. The therapist asks their client to focus on the future while understanding that the past can’t be completely neglected.

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Like motivational interviewing, it can be used in tandem with other types of talk therapy. However, it is often used as a standalone therapy.

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Finding the Solution

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SFBT was developed in the 1970s by Steve de Shazer and Insoo Kim Berg at the Milwaukee Brief Family Therapy Center. Shazer and Berg set out to develop a therapy method that allowed patients to envision a life free of their mental health problems.

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Their idea was that when clients have something positive to work towards, they will be more inclined to participate in treatment. While necessary in some cases, reliving negative moments and trauma can lead to discomfort, despair, and defeat.

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Their idea was that when clients have something positive to work towards, they will be more inclined to participate in treatment.

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For all types of therapy, the goal is to “feel better,” which means different things to different people. What separates these modalities is how “better” is achieved. Shazer and Berg observed countless sessions, and found that prioritizing a goal rather than where a client is or has been was most effective.  

The Three Questions of SFBT

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SFBT emulates some of the core principles of motivational interviewing:

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• Empowerment
• Active participation
• Affirmation
• Focusing on power and positives

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The therapist uses these principles to guide the client to reach their own conclusions and create a solution. This guidance is done through active listening and asking the client three types of questions:

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• Miracle questions
• Scaling questions
• Exception questions

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Each question approaches the clients goals differently, and encourages them to focus on where they want to be.

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Miracle Questions

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Miracle questions get you to think about specific markers of what is “better.”

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The miracle question is fairly standard across the board for all SFBT clients. It’s open ended, and meant to help them think of possibilities that they hadn’t considered before.

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The question is generally this: “if a miracle happened while you were sleeping that took away your pain, and you didn’t even know about it—what change would you notice when you woke up that made you think ‘I’m all better?’”

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Miracle questions get you to think about specific markers of what is “better.” Could it be as small as waking up at the first alarm? Or making yourself breakfast? Or that you just feel light and excited about the day?

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Clients are encouraged to get specific about what changes they will notice if a miracle happened to them. It helps clients shift focus from how they’re feeling to how they want to feel.

Scaling Questions

Scaling questions allows the therapist and client to sort out more specifics of your now versus your future.

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They’re called scaling questions because the therapist often asks the client to gauge their anxiety or negative emotions on a scale of 1-10. This scale isn’t the rule, but it’s a simple one that most are familiar with.

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For example, the therapist may ask, “On a scale of 1-10, how is your anxiety right now?”

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If the client responds, “four,” then the therapist may ask, “why not a three?”

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Scaling questions ask the client to think more about the small differences that would make them feel better. What are the markers for moving up and down the scale? What are the exact differences between three and four? This creates more structure for the client to perceive what “better” is for them, and how to achieve it.

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Exceptions

Exception questions are another way to assess where a client stands in relation to their goals. They invoke positive memories or feelings from the past. Essentially, they encourage the client to think about when the problem wasn’t a problem.

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Some examples of exceptions are:

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• When did you last feel not anxious?
• When are you happiest?
• What is different about today from that happy moment?

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Exceptions help put the goal into perspective. It helps the client see that their problem isn’t constant. If they have felt relief before, they certainly can again.

Other Techniques

Miracle questions, scaling questions, and exceptions are the primary pillars of SBFT. though, many therapists will include other techniques outlined by Shazer and Berg.

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Coping questions identify the resources that a client already uses that may be effective—what they do to cope or alleviate negative feelings.

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Compliments build trust, and show the client that they are indeed capable of reaching their goals. The therapist tailors compliments to the client, but generally tries to focus them on the strengths of the client, their progress, and accomplishments.

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Effectiveness of SFBT

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SFBT is an evidence-based therapy. It has been proven just as effective as other evidence-based practices such as cognitive behavioral therapy. It’s even been proven to aid in physical rehabilitation.

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SFBT can help with a wide range of mental and behavioral health concerns, such as:

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• Depression
• Anxiety
• Self-esteem issues
• Interpersonal conflict such as family or marriage issues
• Behavioral problem in children
• Addiction
• Symptoms of trauma

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Though, it’s important to keep in mind that SFBT isn’t meant for everyone. It’s not the correct therapy for major psychiatric disorders like schizophrenia spectrum disorders or psychosis.

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Many people with severe mental health problems have deep-down reasons for their disorders that need to be addressed. Some traumas need resolution, and often, the client needs to discover why the event or events had the impact that it did.

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As with all therapies, it’s not for everyone. Even if someone tries it, they may decide with their therapist that this approach won’t be effective. Some find that SFBT may minimize or invalidate their pain, and would prefer a program that addresses it.

What to Expect From SFBT

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Because SFBT is indeed brief, it only lasts 6-10 weeks, generally. It is goal-oriented, so once that goal is reached, the client can move to a longer-term maintenance therapy.

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It’s also a client-led therapy. Your therapist will keep the client on track, but it is up to the client to decide their goals and what they are feeling at that moment. The therapist will ask the questions to get the client to think about everything, but only the client can know when their goal is reached.

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SFBT at Sequoia

At Sequoia, we integrate SFBT into our treatment program in order to deliver the most comprehensive care possible. We want you to feel positive about yourself and your future when you leave our inpatient facility.

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Because SFBT works so well as a supplement to other types of psychotherapy, clients will find elements of this goal-oriented approach across the multiple types of therapy they will experience. Utilizing several methodologies ensures that clients will get complete treatment, tailored to their exact needs.

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Contact us today to learn more about how we can help you achieve your goals. Our staff is here to guide you through your healing journey.

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