We continue to spotlight papers from other sources that we consider particularly interesting and useful for establishing the effectiveness of the Solution-Focused approach, understanding the process and providing insights for future practice and research. We follow the convention of naming these overview articles in line with the JSFP issue in which they appear, so this is number 8/2.

This time we have selected four review papers (each giving an overview of the research on different aspects of the Solution-Focused practices) and three process studies (looking at how solution-focused practitioners and clients work together to co-construct useful solutions). For each paper, we provide an overview and our good reasons for picking it. Readers can follow provided links to the online papers which, in four cases this time, have an open access.

For more research, reviews, and theoretical or practice-oriented papers, readers are directed to online reference lists hosted by the EBTA and SFBTA.

Solution-focused approaches for treating self-injurious thoughts and behaviours: A scoping review

Authored by: Jerome, L., Masood, S., Henden, J., Bird V., & Ougren J.

Published in: BMC Psychiatry, 24(646), 2024, https://doi.org/10.1186/s12888-024-06101-7

Availability: Open access

This paper sets out to provide the first overview of research into using Solution Focused Brief Therapy (SFBT) to treat self-injurious thoughts and behaviours (SITBs). These are considered to be amongst the strongest predictors of suicide.

The review includes 24 papers from around the world, with the majority coming from the USA and UK. Five of these papers included qualitative findings including two randomised controlled trials. The other papers included many practice-based reports of using SFBT to successfully treat SITBs.

The authors state that formalising evidence of both qualitative and quantitative research would help to promote the use of SFBT in this area. Some examples include SFBT being used for client hopes which are not connected specifically to SITBs which help overall mental wellbeing; the authors connect this to the idea that SFBT is a generic and adaptable approach which can be carried out without any agenda on the part of the clinician.

The current evidence of solution-focused brief therapy: A meta-analysis of psychosocial outcomes and moderating factors

Authored by: Vermeulen-Oskam, E., Franklin, C., van’t Hof, L. P. M., Stams, G. J. J. M., van Vugt, E. S., Assink, M., Veltman, E. J., Froerer, A. S., Staaks, J. P. C., & Zhang, A.

Published in: Clinical Psychology Review, 114, 2024, https://doi.org/10.1016/j.cpr.2024.102512

Availability: Subscription or purchase required

This meta-analysis extends previously published works by examining further potential moderators of the effectiveness of SFBT on psychosocial outcomes. For this purpose, 79 experimental or quasi-experimental studies concerned with SFBT as a (psycho)therapeutic intervention were included in the analysis covering various populations, cultures, settings, design characteristics, and outcomes. To be included (among other inclusion criteria), studies had to provide information on the core components used in the intervention, the SFBT was not to be applied in combination with other therapeutic approaches, and the language of publication was restricted to Dutch, English, French, or German. The population predominantly originated from the Middle East, followed by Europe, North and Middle America, and Asia. The quality of the included studies was examined.

A large overall effect size (g > 1) was found regardless if the analysis contained outliers or if the results were based on unique samples. These results indicate that SFBT is overall an effective intervention regardless of the type of issues, settings, or culture. The moderation analysis further showed for which aspects the effectiveness is higher. Results indicated that effectiveness increased (i.e., significantly larger effects were found) for non-clinical samples than clinical ones (for the latter the effect size was medium to large) and thus when applied for prevention rather than intervention purposes. It was more effective (i.e., rather large than medium effect size) when applied in group vs individual format, in community settings vs educational ones, and compared to no treatment than other treatments such as cognitive-behavioural therapy or psychodynamic approach. Age, gender, type of non-clinical samples, or referrals for the outcomes (self-report vs other report) were not significant moderators. Similarly, the intervention format (physical vs online), duration, core elements included, or publication in an impact-factor Journal did not significantly influence the effect found.

The study findings argue for the wide applicability of SFBT across various psychosocial issues, contexts, and cultures with the expectancy of positive outcomes, though higher effectiveness may be encountered in non-clinical than clinical settings when SFBT is applied in a pure format.

Efficacy of solution-focused interventions with caregivers of persons living with different conditions: A systematic review

Authored by: Kumar, A. Raman, K. J., John, J. P., & Bhaskarapillai, B.

Published in: International Journal of Social Psychiatry, 70(8), 2024, https://doi.org/10.1177/00207640241267842

Availability: Subscription or purchase required

This systematic review examined the effectiveness of solution-focused interventions among caregivers. Specific measurement tools were used to assess the quality of the 10 primary studies, including 3 RCTs, which fit the inclusion criteria, i.e., studies published in English after 2000 concerned with caregivers undergoing solution-focused interventions. The population included in the studies was represented mainly by parents from Western countries, caring for children with or without specific issues. The solution-focused approach was often applied as a part of an integral program addressed to caregivers. The effectiveness of the intervention was examined either in comparison with a control group (passive or treatment as usual) or by comparing pre-test with post-test results. Some studies also employed follow-up measurements. Six studies were concerned with caregivers’ satisfaction, six with caregivers’ stress, and four with caregivers’ self-efficacy. Only regarding caregiver’s stress the identified primary studies show consistent significant improvement following solution-focused interventions. Results were mixed in what concerned the effect of solution-focused interventions on caregivers’ satisfaction and self-efficacy: half of the studies indicated significant improvements maintained at follow-up, while the other half showed no significant differences compared to the control group or to pre-test results. The lack of difference compared to alternative treatments suggests that solution-focused interventions are as effective as existing alternative ones for aspects related to caregiving.

Effectiveness of solution-focused brief therapy: An umbrella review of systematic reviews and meta-analyses

Authored by: Żak, A. M., & Pękala, K.

Published in: Psychotherapy Research, Online first, 2024, https://doi.org/10.1080/10503307.2024.2406540

Availability: Open Access

This first umbrella review synthesizes what the evidence so far shows on the effectiveness of SFBT and what questions are worth pursuing next. Based on the analysis of 25 systematic reviews published worldwide, including 15 meta-analyses that fit the inclusion criteria, the umbrella review indicated that SFBT is overall a useful approach for various clients and issues with no consistent evidence of harm. Furthermore, following the assessment of evidence using the GRADE-UR tool, the findings indicated that with high confidence SFBT can be considered to be an effective therapeutic intervention for adults on depression, overall mental health, and progress towards goal. The high confidence in evidence of effectiveness also indicates that more studies are not likely to change these findings. In turn, more studies are needed to strengthen the currently found moderate confidence in the evidence of effectiveness for specific issues which indicates that SFBT is a potentially effective therapeutic intervention for clients overall regardless of the age on internalizing, social, medical, self-aspects and hope, or for issues specific to an age group such as school, couple, parenting or caregiving issues. Despite the focus of the solution-focused intervention on behavioural aspects, current evidence indicated overall a neutral effect on externalizing issues in all age groups. More studies concerned with one specific behavioral aspect using strong methodological design are needed to provide an accurate representation of the effectiveness of SFBT on externalizing issues.

The relevant moderators of effectiveness reported by the 15 meta-analyses examined are put forward as potential explanations for the observable difference in effect size reported by Eastern vs Western studies. Specifically, Eastern systematic reviews are based predominantly on primary studies using non-randomized controlled design, passive control, and group intervention – all these aspects being significant moderators of effectiveness associated with larger effect size. In turn, Western studies employ rather randomized controlled designs with active control groups and individual intervention – aspects associated with smaller effect size.

Based on the findings, the authors put forward future directions of research worth exploring such as the examination of efficiency: Does SFBT reach the same outcomes as other therapeutic approaches in fewer sessions? A need to provide sufficient information on the methodology, intervention, and demographic variables is also put forward to aid future systematic reviews in assessing the confidence in findings.

How questioning functions in co-construction

Authored by: De Jong, P., Healing, S., & Smock Jordan, S.

Published in: Journal of Systemic Therapies, 43(1), 2024, https://doi.org/10.1521/jsyt.2024.43.1.84

Availability: Subscription or purchase required

Building on the previous studies on micro-level communication patterns in conversations, in this paper Authors further explore how questions and formulations (paraphrasing and summarising) function together in the co-construction of new meaning. The study aimed at testing the previously unaddressed idea proposed by McGee, that responders follow the presuppositions in the questions they are asked. The Authors conducted a microanalysis of question-and-response and formulation-and-response sequences in a set of 6 face-to-face interviews looking if the interviewee’s responses follow the presuppositions in the interviewer’s question and formulations. Analysed interviews were recorded previously for an experiment where university students participated in either future/success-oriented or past/failure-oriented semi-structured interviews on their experimental task performance.

The results provided strong support for the idea of McGee’s model and demonstrated that it applies not only to questions, but also to the formulation-and-response sequences, indicating that, regardless of the focus of the interviews, interviewees followed interviewers’ presuppositions embedded in both, the questions asked, and formulations proposed. In addition, further analysis revealed that questions and formulations function hand in hand to form larger co-constructive sequences, where they preserve the same presuppositions of the opening or framing questions and invite the interviewee to construct a more detailed response to the opening question. Notably, these co-constructive sequences unfold similarly regardless of the type of embedded presuppositions or focus of the interviews.

The findings of this study are discussed in detail stressing their implications for social constructionism and solution-focused practice, suggesting that practitioners might want to zoom out from focusing on specific questions and see conversations from a co-constructive sequences level to understand better how questions and formulations work together when co-constructing solutions.

Doing mutual understanding in child and family therapy sessions: How three interlocutors calibrate new information

Authored by: Edman, K.

Published in: Discourse Studies, 26(2), 2024, https://doi.org/10.1177/14614456231207519

Availability: Open access

This paper presents a valuable addition to the body of knowledge on micro-level communication processes in therapeutic conversations, expanding the application of micro-analysis to triadic conversations in the context of family therapy.

The paper starts with an overview of previous research on the process of information calibration in conversations, arguing that three-step micro-sequences (A-initiations, B-responses, and C-follow-ups) are fundamental units in conversational interactions for mutual understanding to be reached. The Author points out that previous research has been mainly investigating interactions in dyads and there is a gap in the knowledge on how new knowledge is co-constructed in triadic conversations (e.g., when a parent and a child are present in the family therapy).

To fill this gap, four video recordings of family therapy sessions, involving a parent and a child, were analysed using the Micro-analysis of Face-to-face Dialogue proposed by J. B. Bavelas and colleagues to capture interactive function of behaviours that are recognizable through observation (speech, co-speech gestures, and embodied non-verbal behaviours). Two of the analysed sessions were solution-focused, while the other two were based on eclectic family therapy and CBT approaches.

Results revealed that the three-step process has been observed in most calibrations in triadic therapeutic conversations. In addition, several interactional patterns specific to the three-person conversations were identified, i.e., suspended, nested, branched, multi-paced, mixed interpretations, and tone calibration. All these patterns are described in detail with examples from the conversations, followed by a discussion of their practical implications and directions for future research.

Assessment of movement synchrony and alliance in problem-focused and solution-focused counseling

Authored by: Hoffmann, C., Gürtler, M., Fendel, J. Lahmann, C., & Schmidt, S.

Published in: Journal of Nonverbal Behavior, 48, 2024, https://doi.org/10.1007/s10919-024-00466-9

Availability: Open access

In line with the notions that solution-focused practice is more than just an exchange of words around solution-focused questions and with the embodiment perspective, emphasizing that communication is based on a reciprocal relationship between embodied agents, this experimental process study addressed an important and yet little-studied function of movement synchrony (part of non-verbal synchrony, reflecting relatedness of movement dynamics over time) in helping conversations.

Specifically, based on the theoretical discussion and previous research, this study aimed to assess the differences in movement synchrony and therapeutic alliance between single manualized problem-focused and solution-focused counselling sessions. Participants (N = 34) each attended two counselling sessions with different counsellors in randomized order. The sessions were recorded and then movement synchrony was measured using automated Motion Energy Analysis (MEA) and windowed cross-lagged correlation (WCLC) methods. The therapeutic alliance was measured using the Helping Alliance Questionnaire (HAQ).

Results showed that the rate of movement synchrony in the conversations was high and that overall movement synchrony and leading synchrony specifically was significantly higher in solution-focused counselling condition, but only in the initial problem description part and not in the subsequent intervention parts. In addition, no difference in therapeutic alliance between the two interventions or its relation to movement synchrony was found.

The study results are discussed and interpreted in detail, comparing them to other studies and commenting on possible reasons (including study limitations) for the fact that most of the hypotheses were not supported. Overall, the authors conclude that their study contributes to the growing body of literature on the importance of dyadic variables in therapeutic processes, suggesting that different approaches to counselling affect the nonverbal components of interaction and calling for more studies on the matter.