SFBT – Solution Focussed Brief Therapy

I’ve recently been on a course on SFBT – Solution Focussed Brief Therapy. It was interesting. It makes initial construct sense to me… So some of my patients, family, colleagues and friends have already been practiced on … and they don’t even know it! It’s a different way for me to ask questions. A different bias to how I understand others. I already knew that not many people like being told what to do – even if they’ve asked for my opinion! True.

The main thing I got from the course is the re-phrasing of key questions so that whoever I’m talking to starts to come up with their own solutions. Less “I tell you what to do”… more “you tell me how you know when it changes.” I ask questions that facilitate you to come up with some of your own answers and strategies.

SFBT is not going to change any of the core physiotherapy diagnostic or treatments that I provide, but it’s already assisting me to understand people even better, so that I know how my skill my be of help or assistance.

Whenever I’m learning something new, it always seems to throw up more questions than answers. I have only found one research study(1) that specifically examines SFBT in musculo-skeletal physiotherapy (back & neck pain). It compares it to one exercise-based treatment intervention. The study shows that the exercise-based intervention (McKenzie) is more costly (due to increased number of appointments), but is also more cost effective. Although it is impossible to generalise results from one limited study, it says to me that there is no evidence to replace exercise-based physiotherapy with SFBT. I can find no information on combined treatment effects of both, as yet.

An article by Reiter(2) discusses how SFBT builds hope & expectancy. He cites Lambert (1992): Hope and expectancy has been reported associated with 15% variability of outcome from psychotherapy.  I would now know like to know how SFBT can affect placebo (percieved or actual improvement response) and nocebo (percieved or actual harmful or undesirable reponse) in physiotherapy.

So initial construct validity means I will try SFBT. I will suck-it-and-see in relation to musculo-skeletal physiotherapy, and in home/ family life. However, lack of robust evidence means I will also proceed with empirical caution and enquiry.

Further information on SFBT can be found on the internet – wikipedia gives a good overview.

1. Manca et al (2007) Randomised trial of two physiotherapy interventions for primary care back and neck pain patients: cost effectiveness analysis. Rheumatology 46(9): 1495-1501

2. Reiter (2010) Hope and expectancy in solution-focused breif therapy. Journal of Family Psychotherapy. 21(2): 132-148

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