Solution-Focused Brief Therapy (SFBT): Principles, Applications, Limitations, and Considerations

 

Introduction

 

Solution-Focused Brief Therapy (SFBT) developed by Steve de Shazer and Insoo Kim Berg, is a goal-directed, collaborative approach to psychotherapeutic change. Rooted in social constructivist thinking, SFBT represents a significant departure from traditional models by focusing intensely on the client's desired future and identifying existing strengths and resources, rather than dwelling on the history and provenance of the client's problems.

 

The primary objective of SFBT is to achieve attainable and reasonable relief for the client as quickly as possible, avoiding the prolonged suffering that can result from extended discussion and analysis of problems. This modality is designed to help clients "build solutions" by developing a detailed description of their preferred future and identifying exceptions and past successes. SFBT's efficiency and flexibility have made it a preferred choice of intervention in many constrained healthcare settings, with treatment often lasting fewer than six sessions and sometimes requiring only two.

 

The central philosophy of SFBT is that the solution already exists within the client's existing life patterns and cognitive resources. Therapists are advised to intervene as little and as briefly as possible, allowing the client to be the "frontrunner" in exploring the resources and skills necessary to reach the desired outcome. The efficiency derived from this strengths-based, goal-directed collaboration translates directly into cost savings, enhancing the utility of SFBT in both agency and medical settings^[1].

 

 

Principles of SFBT

 

SFBT is an empirically derived model, built upon observing what works in real therapy sessions rather than purely abstract theories[2]. The treatment process begins immediately, often during the first interview, which is considered the most important session where the majority of the work is done. No detailed problem history is typically taken^[3].

 

Core Philosophy and Goal Orientation

 

SFBT emphasizes shifting the client's narrative from pathology to possibility. This approach is founded on the principle that the only element an individual can be sure of changing is oneself^[3].

 

• Future Focus: Therapy sessions focus primarily on the present and future, only touching upon the past to communicate empathy and accurate understanding of the client's concerns. The core work involves helping clients envision their desired future where the issue is resolved.
   
• Strengths and Resources: SFBT deliberately concentrates on the client's strengths, resilience, and existing resources, enabling the creation of a client-specific pathway toward realizing their vision.
   
• Client-Driven Solution: The therapist guides the client to explore what they want to gain from therapy, but the resulting solution and pathway are constructed and implemented by the client alone.
   

Key Techniques and Questioning Models

 

The SFBT approach is applied directly by asking clients carefully crafted questions, guiding the therapy based on the client's responses^[2].
 

• The Miracle Question: This foundational technique gives clients permission to think about an unlimited range of possibilities for change. It initiates the process of developing well-formed goals by encouraging creative thinking and exploring possible futures, moving the focus away from current and past problems toward a more satisfying life . The counselor poses this question and compliments the client for their strength and courage in coping^[4].

 

• Pre-Session Change: The first interview pays attention to changes the client may have already made prior to the first session, thereby demonstrating that the change process has already begun^[3].

 

• Exception Questions: Once goals are established, the focus moves to examining "exceptions"—times when the client was successfully coping or when the problem was less severe or absent^[3]. Amplifying these exceptions leads to efficient and effective change.
   
• Coping Questions: These questions are designed to help the client shift focus toward what they are actively doing to survive painful or stressful circumstances, thereby highlighting existing resilience and resources^[5].

 

• Scaling Questions: Clients are asked to rate their experiences (e.g., problem impact, progress, or confidence) on a scale (typically 0 to 10)^[6]. This numerical rating helps the therapist gauge progress, learn about the client’s motivation, and define the next smallest, achievable step toward their goal^[7].

 

• Compliments: The counselor utilizes compliments to affirm the client's demonstrated strength, courage in coping, and positive responses to the miracle question, reinforcing constructive behavior and encouraging continued effort^[4].

 

 

Clinical Applications

 

SFBT has been validated as an effective therapeutic approach across a wide array of psychological, social, and medical issues.

 

Efficacy Across Diverse Settings

 

An umbrella review of 25 systematic reviews and meta-analyses confirms that SFBT demonstrates significant positive outcomes across different issues, populations, and cultural contexts, with no evidence of harm^[8].

 

• Overall Effectiveness: SFBT was found to be effective in 86.3% of outcome studies across diverse contexts, including psychotherapy, coaching, school counseling, and community interventions^[9].
   
• Magnitude of Effect: SFBT demonstrates a large effect (g = 1.17) on improving psychosocial functioning, with even larger effects reported specifically in areas of well-being (g = 1.74) and marital functioning (g = 3.02)^[9].
   
• Broad Applicability: Research underscores the efficiency, adaptability, and broad applicability of SFBT, supporting its use for treating depression, substance use, chronic illness, and fostering resilience in school settings^{[9, 10]}.
   
• Brief and Cost-Effective Care: The time-sensitive approach and short duration (often fewer than six sessions) make SFBT a choice intervention for medical settings and agencies seeking cost-effective, efficient care delivery.

 

Innovations in Delivery

 

Contemporary healthcare trends emphasize innovative delivery models to reduce costs and improve accessibility. Telehealth possesses significant potential to revolutionize healthcare by challenging the long-held assumption that care must be inextricably linked to the provider's location. Telehealth-based models, including interactive videoconferencing and remote monitoring, can lead to reduced service demand, greater efficiency, and the mitigation of provider shortages^[11].

 

The expanding domain of digital mental health includes smartphone apps, virtual reality (VR), and generative Artificial Intelligence (AI). These technologies are emerging as tools to augment and personalize care, though they require rigorous evaluation and implementation science to ensure their effectiveness is realized outside of controlled settings^[12].

 

 

Limitations

 

While widely validated for its efficiency and efficacy across many issues, SFBT faces criticisms regarding its applicability, particularly for severe and complex presentations.

 

Structural and Clinical Criticisms

 

The strength of SFBT—its brevity—is also the source of its most significant limitation: a perceived lack of depth^[13].

 

• Severe Mental Health Issues: Clients experiencing severe mental health issues, such as psychosis, active suicidal ideation, or substance dependency, may require a more structured and intensive intervention. Relying solely on SFBT in these acute situations could be inadequate and potentially harmful^[13].
   

• Evidence Variability: The conclusions regarding SFBT's effectiveness are based on evidence that is sometimes highly variable, suggesting that some benefits may be overstated and should be interpreted with caution^[1].

 

Implementation Barriers

 

The achievement of maximum benefits from innovative care delivery models, such as telehealth, is not straightforward^[11]. Significant implementation barriers include:

 

• Financial Systems: The current healthcare financing system is often not designed to support new telehealth models, and the existing healthcare culture is deeply ingrained within traditional workflow processes and provider attitudes^[11].

 

 

Potential Damages and Ethical Considerations

 

Ethical practice in SFBT centers on the careful matching of the intervention to the client's clinical severity and avoiding the pitfalls of therapeutic oversimplification.

 

The primary ethical consideration is the risk of providing inadequate support to vulnerable populations. Therapists using SFBT must meticulously assess each client's needs to determine whether SFBT alone can provide the required level of support. This mandates that clinicians integrate elements of more intensive, structured approaches—such as cognitive-behavioral therapy (CBT), dialectical behavior therapy (DBT), or psychodynamic approaches—when a client's presentation involves high acuity or complex needs, rather than relying exclusively on a brief model^[13].

 

Although the research demonstrates no evidence of harm associated with SFBT itself^[8], the risk lies in its misapplication. This requires clinicians to prioritize the ethical imperative of meeting the client's complex needs over the financial or systemic pressures to deliver the most brief or resource-efficient intervention^[13].

 

 

Conclusion

 

Solution-Focused Brief Therapy (SFBT) is confirmed as an effective, evidence-based therapeutic approach distinguished by its speed, efficiency, and strong focus on clients' strengths and desired future outcomes. Through core techniques like the Miracle Question and Scaling Questions, SFBT enables clients to identify and amplify existing solutions, promoting positive outcomes across a wide spectrum of psychological and social issues.

 

SFBT's success is defined by its ability to provide rapid, meaningful relief, making it highly valuable in time-sensitive and resource-constrained medical and community settings.

 

While the evidence supports its broad application, SFBT is limited in its capacity to treat severe mental illnesses when used as a stand-alone modality. The future development of SFBT, particularly through the use of telehealth and digital mental health innovations, must prioritize overcoming implementation barriers related to cultural, financial, and regulatory systems to ensure this efficient, strengths-based approach is accessible to all.

 

 

References

 

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3. Another question frequently used by SFBT practitioners is the “scaling question.” It asks clients to rate their experiences... on a scale from 0 (lowest) to 10 (highest). Retrieved from https://positivepsychology.com/solution-focused-therapy/
4. Hayes, S. C., et al. (n.d.). The Six Core Processes of ACT: Acceptance, Defusion, Present Moment, Self-as-Context, Values, Committed Action. Contextual Behavioral Science. Retrieved from https://contextualscience.org/six_core_processes_act
5. Coping questions attempt to help the client shift his/her focus away from the problem elements and toward what the client is doing to survive the painful or stressful circumstances. Retrieved from http://www.pacwrc.pitt.edu/curriculum/301EngggClntsFrmAnSBSFPrspctv/Hndts/HO_9_Solution_focused_skills_and_questions.pdf 
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7. The meta-analysis revealed that the EMDR treatments significantly reduced the symptoms of PTSD (g = −0.662), depression (g = −0.643), anxiety (g = −0.640), and subjective distress (g = −0.956) in PTSD patients. Retrieved from https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0103676
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11. The first interview in solution-focused therapy is the most important. For many clients this is when the majority of the work is done. No detailed history is taken. Retrieved from https://us.sagepub.com/sites/default/files/upm-binaries/41972_9780857028907.pdf
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29. The Adaptive Information Processing (AIP) model posits that traumatic or highly disturbing experiences are stored in memory networks in a fragmented, maladaptive state. Retrieved from https://www.psychologytoday.com/us/blog/relationship-and-trauma-insights/202012/the-eight-magical-phases-emdr-therapy-demystified
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32. Telehealth can challenge the assumption that healthcare is inextricably linked to the provider's location. Retrieved from https://www.researchgate.net/publication/23499621_Telehealth_The_Promise_of_New_Care_Delivery_Models
33. The counselor utilizes compliments to affirm the client's demonstrated strength, courage in coping, and positive responses to the miracle question. Retrieved from https://www.aipc.net.au/articles/solution-focused-techniques-in-counselling/
34. Thought bubbles Just as bubbles float by. SimplePractice Resources. Retrieved from https://www.simplepractice.com/resource/cognitive-defusion-techniques/
35. Clinicians are also more likely to practice within the usual and customary standard of care when they are connected to their peers. EMDRIA. Retrieved from https://www.emdria.org/blog/ethics-and-emdr-therapy/
36. Findings from meta-analyses, systematic reviews, and randomized controlled trials (RCTs) underscore its efficiency, adaptability, and broad applicability—from treating depression and substance use to supporting individuals with chronic illness and fostering resilience in schools. Retrieved from https://solutionfocused.net/research-in-solution-focused-therapy/
37. SFBT demonstrated significant positive outcomes across different issues, settings, and cultural contexts, with no evidence of harm. Retrieved from https://pubmed.ncbi.nlm.nih.gov/39324877/
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59. The higher-order factor analysis indicated four schema domains. Wikipedia. Retrieved from https://en.wikipedia.org/wiki/List_of_maladaptive_schemas

60. Schema modes are organized into four categories: child modes, coping modes, parent modes, and the Healthy Adult mode. PMC. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC10628052/
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66. Schema therapy was superior in reducing borderline symptoms. Schema Therapy Training. Retrieved from https://schematherapytraining.us/2025/07/03/is-schema-therapy-evidence-based/

67. Hybrid models that utilize both traditional telehealth and asynchronous digital health reflect the latest evidence and represent a promising approach to increase access and quality of care. PMC. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC12079407/
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70. The enduring power of the psychodynamic approach lies precisely in this underlying structural focus. Counseling Center Group. Retrieved from https://counselingcentergroup.com/psychodynamic-psychotherapy-vs-cbt/
71. TFP leverages the patient-therapist relationship to help patients recognize unhealthy interpersonal patterns. APA Monitor. Retrieved from https://www.apa.org/monitor/2025/04-05/treating-borderline-personality
72. The ego psychology emphasizes the role of the ego in adaptation, reality testing, and defense mechanisms. NCBI Bookshelf. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK606117/
73. To cope with internal anxiety and external threats, individuals utilize defense mechanisms, which are psychological strategies introduced by Freud to protect the ego. ICSW Blog. Retrieved from https://www.icsw.edu/icsw_blog/what-is-psychodynamic-therapy
74. Free Association: Clients are encouraged to express thoughts and feelings without censorship. ICSW Blog. Retrieved from https://www.icsw.edu/icsw_blog/what-is-psychodynamic-therapy
75. Solution-focused (brief) therapy (SFBT) is a goal-directed collaborative approach to psychotherapeutic change. Retrieved from https://en.wikipedia.org/wiki/Solution-focused_brief_therapy
76. Patients with low reflective functioning benefited more from TFP or SPT. APA Monitor. Retrieved from https://www.apa.org/monitor/2025/04-05/treating-borderline-personality
77. The most widely utilized measures, such as the Acceptance and Action Questionnaire (AAQ), the Acceptance and Action Questionnaire-II (AAQ-II), and the Avoidance and Fusion Questionnaire for Adolescents (AFQY), treat PF as a single factor. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC10797814/
78. The purpose is to achieve attainable and reasonable relief for the client as quickly as possible, avoiding the prolonged suffering that can result from extended discussion and analysis of problems. Retrieved from https://www.ebsco.com/research-starters/health-and-medicine/solution-focused-brief-therapy-sfbt
79. The solution comes from the client. Therapists are advised to intervene as little, and as briefly, as possible. Retrieved from https://www.ebsco.com/research-starters/health-and-medicine/solution-focused-brief-therapy-sfbt
80. The “Miracle Question” is the opening piece of the process of developing well-formed goals. It gives clients permission to think about an unlimited range of possibilities for change. Retrieved from http://www.pacwrc.pitt.edu/curriculum/301EngggClntsFrmAnSBSFPrspctv/Hndts/HO_9_Solution_focused_skills_and_questions.pdf
81. The core work involves helping clients envision their desired future where the issue is resolved. Retrieved from https://www.ebsco.com/research-starters/health-and-medicine/solution-focused-brief-therapy-sfbt
82. Efficacy of PDT vs. control conditions. PDT was found to be superior to all control conditions in improving depressive symptoms, with a medium effect size (g=–0.58, 95% CI: –0.33 to –0.83, n=12, I2=63%, N=1,017) and no evidence for publication bias (see Table 1). Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC10168167/

83. The concept of defense mechanisms, psychological strategies that individuals use to cope with anxiety and protect the ego. Retrieved from https://www.icsw.edu/icsw_blog/what-is-psychodynamic-therapy