Solution-Focused Practices: Pick of the (Other) Papers 8/1

Continuing what we hope will become a traditional section of the JSFP, for this issue we (Andreea Żak and Rytis Pakrosnis - European Brief Therapy Association (EBTA) Research Task Group members and Mark McKergow - JSFP editor) have selected seven papers recently published in other journals which we think are particularly interesting and useful for the establishment of the effectiveness of the solution-focused approach, understanding the process and providing recommendations for future practice and research.


Efficacy and executive function of solution-focused brief therapy on adolescent depression
Authored by: Chen, H., Zhou, M., Han, L., Manoharasetty, A., Yu, Z., & Luo, H. Published in: Frontiers in Psychiatry, 2024, https://doi.org/10.3389/fpsyt.2024.1246986Availability: Open access This non-randomized controlled trial was performed in an outpatient setting in China and aimed to examine the effect of solution-focused brief therapy (SFBT) on depression and anxiety symptoms and executive functioning.The sample consisted of adolescents aged 12 to 18 years diagnosed with major depressive episodes based on DSM-IV criteria.Only adolescents not previously benefiting from psychotherapy and not presenting self-harming behaviors, suicide attempts, or any additional diagnosis were included.
The distribution into the SFBT or active comparison group (short-term psychodynamic psychotherapy) was based on participants' preferences.Despite a higher preference for participants to choose the psychodynamic than the SFBT approach, with a prevalence of 45 vs 37 per group, the dropout rates may indicate a preference to continue the treatment under the latter.The dropout rates were lower in the SFBT vs psychodynamic group on all measured aspects, i.e., 5 vs 10 participants ended treatment prematurely and 1 vs 4 discontinued measurements.Additionally, discontinued treatment due to worsening of symptoms requiring hospitalizations (2 vs 4) or due to early ending following recovery (1 vs 2) was also two times lower in the SFBT than psychodynamic group.Yet, the low rates per dropout reason don't allow clear inferences.
Finally, the data was examined on a similar amount of participants per group (28 in SFBT and 25 in the comparison group) with no significant differences between groups on age, gender, education or baseline medication.Both subjective (Patient Health Questionnaire-9, PHQ-9; Generalized Anxiety Disorder-7, GAD-7) and objective (verbal fluency task, VFT; brain activation measured through hemoglobin concentrations via near-infrared imagining spectrum) assessment methods were used at multiple times: baseline, 3 rd , 6 th and 10 th session.
Results showed that by the end of treatment both SFBT and psychodynamic treatment led to a significant reduction in the presence and severity of depression (via PHQ-9 scores) and anxiety symptoms in general (measured through GAD-7).Yet, the SFBT group registered a faster and steady decline throughout the treatment, while the psychodynamic group had improvements only after the 10 th session.Also, adolescents undergoing Solution-Focused Practices: Pick of the (Other) Papers 8/1 SFBT had significantly higher performance on executive task (VFT) and brain activity in areas relevant for depression at each measurement time compared to those receiving psychodynamic treatment.
A particular relevance of this study is the evidence provided for increased activity in the dorsolateral prefrontal cortex, which was found by previous studies to be hypoactive in adolescents with depression symptoms, while being also responsible for emotion regulation and cognitive control.A higher activation of this area was noticed after the 6 th session of SFBT, leading as such to a potential positive impact on depression symptoms.
The results of this study are important for showing with both subjective and objective measures the potential effectiveness of SFBT in adolescents diagnosed with depression.

Solution-focused brief therapy in community-based services: A metaanalysis of randomized controlled studies
Authored by: Franklin, C., Ding, X., Kim, J., Zhang, A., Hai, A. H Availability: Open access This rigorously conducted meta-analytic review of 28 randomised controlled trials (RCTs) aimed to shed light on the outcomes of the SFBT in outpatient community-based social work services for adults, adolescents, and families.Based on a critical overview of previous SFBT outcome reviews, authors conducted a meta-analysis including only RCT studies assessing the SFBT outcome on six specific clinically relevant domains, such as depression and anxiety, health and wellbeing, behavioural health functioning, family functioning, and psychosocial adjustment.In addition, they examined the impact of the number and types of SFBT techniques used on effectiveness.
Results revealed that the overall treatment effect of SFBT when compared to different types of inactive or active (usually CBT) controls, was statistically significant with medium effect sizes for four outcome domains (depression, behavioural health functioning, family functioning, and psychosocial functioning) and non-significant for remaining two outcome domains (health and wellbeing, and anxiety).Another intriguing result from this study was that the use of three and less, or 10 and more, SFBT techniques did not result in significant treatment effects, which were instead significant when 4 to 9 SFBT techniques were used across all three categories (i.e., cooperative relationship, client strengths/resources, and desired future).Based on these results authors hypothesised a possible technical dosage effect in SFBT suggesting that using too little or too many SFBT elements may be counterproductive to clients' change.For example, becoming techniquedriven and using too many techniques could contradict the general idea of SFBT as a collaborative co-construction process.Moreover, this study also Solution-Focused Practices: Pick of the (Other) Papers 8/1 showed that using elements from all three categories (cooperation, resource activation, and desired future) together is essential for the effectiveness of the SFBT.
Discussed results of this meta-analytic study raise important questions for the practice and training and encourage researchers to look closer at the process and the role of different elements of SFBT.
Published in: Patient Education and Counseling, 2024, https://doi.org/10.1016/j.pec.2024.108205 Availability: Open access This RCT examined the effect of solution-focused health-coaching on health-related quality of life of children with type 1 diabetes, diabetes management, diabetes-related family conflict and level of blood glucose.
102 families were included in the study and randomly allocated to the intervention or control group.Parents from both groups received standard routine care, while the intervention group received additional solutionfocused coaching provided by telephone every two-weeks for six months.Health-related coaching aims to facilitate change in behaviours with potential impact on the health condition.At the six months follow-up 18 families dropped out.
Results indicated no significant differences at the end of coaching and follow-up period on none of the outcomes of interest.Nevertheless, a steady improvement in the quality of overcoming treatment barriers across measurements was observed in the coaching group, as well as an increase in communication at follow-up as reported by both parents and children.Both these dimensions registered a decrease in the control group.Additionally, parents positively evaluated the solution-focused health coaching perceiving benefits for themselves as being able to set and follow through goals related to their child's diabetes management.82% of parents recommended the addition of health-coaching to manage child's diabetes, and 58% wished to continue the coaching after the research ended.These results indicate that individual benefits exist for the direct receivers of the intervention; children not being actively included in the telephone coaching.
The relevancy of this study consists in the evidence provided on the application of solution-focused approach in the medical setting, where not so many randomised clinical trials have been performed.Increase in publications can strengthen the understanding of the effectiveness of the approach on various medical or non-medical related aspects specific to various conditions, with the potential benefit of tailoring the intervention for particular needs.
Solution-Focused Practices: Pick of the (Other) Papers 8/1

Journal of Solution Focused Practices
This RCT is a continuation of a series of rigorous long-term research performed in Norway in the Helsinki Psychotherapy Study concerned with the effectiveness of SFBT on adult outpatients with anxiety and/or mood disorders as examined in comparison to short-term and long-term psychodynamic approach.
In this particular study, the research focused on the impact of the different treatment approaches on patients' perceived social support.The sample consisted of 326 adults aged 20 to 45 years with at least one year of work dysfunction, and not having any other additional diagnoses than anxiety and/ or mood disorders based on DSM-IV criteria.The attendance to SFBT, shortterm or long-term psychodynamic psychotherapy was assigned randomly.Dropout rate was larger in the long-term group than in the two short term groups both at the beginning of treatment due to change of mind about participation (26 vs 4 in the SFBT and 3 in the short-term psychodynamic groups) and premature ending of treatment (21 vs 11 in the SFBT and 10 in the short-term psychodynamic groups).A possible preference for shortterm treatments could be inferred, though more investigation on this aspect is needed.
Multiple yearly measurements were performed across a five-year time.The results indicated significant improvement in perceived social support (measured through the Brief Inventory of Social Support and Integration, BISSI) in the SFBT group since the first year after treatment, while the short-term psychodynamic group reported improvement only after the third year.By the fifth year, the SFBT group had more improvements than the short-term psychodynamic approach (12% vs 7%).While the long-term psychodynamic group had more improvement during the third year than the SFBT one (15% vs 8%), no additional improvement was registered in the former group by the fifth year.
These results add to the evidence for the quicker benefits of the SF approach registered in the clinical population while additionally showing steady progress over time.It is worth noticing that the yearly measurement led to comparisons of patients still undergoing long-term treatment with those which already ended the short-term therapy.Despite this, the results are evidence of continuous improvement in participants' lives even after the solution-focused intervention ended, in line with the assumptions guiding the SF approach of activating resources already existing in a client's life and increasing the client's awareness of how to further use them.Published in: African Journal of Clinical Psychology, 2023, https://www.daystar.ac.ke/ajcp/article/efficacy-of-solution-focused-therapyamong-women-with-post-traumatic-stress-disorder-due-to-intimate-partnerviolence-in-selected-informal-settlements-in-nairobi-county-kenyaAvailability: Open access This paper investigated the efficacy of Solution-Focused Therapy (SFT) used to alleviate symptoms associated with Post-Traumatic Stress disorder (PTSD), among 116 women over 18 years of age who had experienced intimate partner violence (IPV).The sample was recruited from the informal settlements located in Nairobi County, Kenya.The study used both qualitative and quantitative data following the Concurrent Triangulation mixed method design.A control group (no treatment) in a similar settlement close by were used to compare results.Participants were screened for PTSD using tools from DSM-5 and for IPV using the Women Abuse Screening Tool (WAST).A 10-week SF intervention was used, following a baseline assessment.Directly after the intervention, an assessment was carried out to assess reduction of symptoms.A final assessment was carried out 12 weeks after the end of the intervention to assess the lasting impact of the treatment effects.

Efficacy of Solution Focused Therapy Among
The results are startling; a significant reduction in the means of PTSD in the experimental group at the end of treatment which was maintained at the 12-weeks follow-up.There was no significant change in the PTSD symptomatology in the control group.Based on these results, the authors concluded that SFT was an effective intervention in alleviating the symptoms of PTSD in this population, who appear to be under-reported and underinvestigated.The work is well rooted in established SF practice and academic writing.The authors conclude that the efficacy of SFT in reducing the severity of PTSD when one has experienced Intimate Partner Violence renders the application of SFT tremendously valuable in clinical practice.
The Pie of Inspiration: Positioning the Therapist's and Client's Knowledge in Solution-Focused Brief Therapy Authored by: Zatloukal, L. Published in: Contemporary Family Therapy, 2023, https://doi.org/10.1007/s10591-023-09663-y Availability: Open access This rich-in-content and thought-provoking theoretical paper starts with a conceptual discussion on "knowledge" and its sources in connection with the "not-knowing" or constructive curiosity stance (leading to co-constructing something new and valuable for the client) -one of the essential ingredients of the therapeutic relationship and co-construction process in SFBT.The author distinguishes between the knowledge/expertise on content and the process and argues, as well as illustrates by a case example, that contentrelated expertise (e.g., strengths) should not be necessarily limited to what the client already has, knows, or is aware of but could also be brought into the Solution-Focused Practices: Pick of the (Other) Papers 8/1 Journal of Solution Focused Practices conversation from multiple sources, including the practitioner.This idea is based on the notion that clients are not limited to what they already know, but rather have the resources to obtain new resources.Thus, along with being constructively curious, the skill of utilising the content-related ideas from the practitioner and other sources in respectful, useful, and solution-focused ways could enrich SFBT practice and benefit the clients.
Building on the conceptual discussion the author then turns to practise and offers some insights and methods on how to utilise different sources of knowledge and still stay solution-focused by maintaining partnership and transparency in the relationship with clients.In particular, the "Pie of Inspiration" -a model for introducing into the conversation ideas from various perspectives not limited to the client and organising them is presented and followed by some practical examples of applying when working with adults and children.Finally, acknowledging possible pitfalls of therapists sharing their content-related knowledge, the author concludes by offering some guidelines for doing this in a solution-focused way.
This paper stimulates the discussion on the nature and limits of the processes in SFBT and raises new important questions for theory, practice, training, and research.
Women with Post-Traumatic Stress Disorder due to Intimate Partner Violence in Selected Informal Settlements in Nairobi County, Kenya Authored by: Njuki, M., Muriungi, S.K., & Tuikong, S. Solution-Focused Practices: Pick of the (Other) Papers 8/1 Submitted: May 05, 2024 BST, Accepted: May 24, 2024 BST This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CCBY-4.0).View this license's legal deed at http://creativecommons.org/licenses/ by/4.0 and legal code at http://creativecommons.org/licenses/by/4.0/legalcodefor more information.Solution-Focused Practices: Pick of the (Other) Papers 8/1 Journal of Solution Focused Practices