( III ) E VALUATION OF S OLUTION F OCUSED T HERAPY Research studies

There have been several different types of research studies into SFT:

(a) Outcome studies conducted by researchers in clinics where the approach has been used; and (b) Independently conducted empirical studies using externally validated measures.

97 _{Examples include: residential child care in Australia (Durrant, 1993), groupwork with paediatric nurses}

in the UK (Goldberg & Szyndler, 1994), social work in child psychiatry in Ireland and the UK (Wheeler, 1995; Sharry, 1996), mature social work students in the USA (Baker & Steiner, 1995) adolescent and adult substance abusers (Berg & Gallagher, 1991; Berg & Miller, 1992; 1995), Home Based Services for children and families (Berg, 1994),child psychiatry in Finland (Furman & Ahola, 1993), community care social work in Ireland (Walsh, 1995; 1997), generic social work practice in Finland and the USA (Sundman, 1997; Maple, 1998), counselling practice in the USA (Littrell, 1998); fostering social work (Houston, 2000) and groupwork (Sharry, 2001) in Ireland, child protection in Australia (Turnell & Andrews, 1999), the USA (Berg & Kelly, 2000; de Jong & Berg, 2001) and social work practice teaching in the UK (Bucknell, 2000).

Outcome studies

At the Milwaukee clinic, outcome studies have been carried out since the development of SFT. They followed the MRI formula for outcome assessment, and consisted primarily of client feedback: the follow-up of clients, some months after treatment ended, to ascertain levels of satisfaction with the outcomes of therapy. de Shazer defends this approach, maintaining that since therapy usually starts with a client coming with a complaint, the only way of judging effectiveness is to ask the client if the complaint is still there. It also fits more comfortably with the constructivist paradigm to use the client’s subjective experience to ascertain whether the therapy worked, as opposed to an externally devised and assessed instrument of measure.

Reported research results from the USA (de Shazer et al., 1986; Kiser, 1988; 1990) and the UK (George et al., 1990) indicate that this approach enjoys a similar, but not superior, rate of success to other established brief therapy methods (Budman & Gurman, 1988). Between 66% and 72% of respondents met their goals for treatment or made considerable progress towards them, in an average number of sessions ranging from 4-6. While (direct comparisons) with the Budman and Gurman assessment of brief therapies are problematic, due to the wide range of approaches contained under the ‘Brief Therapy’ label, it indicates that this way of working has established an effectiveness at least similar to that of other short-term approaches.

Given that the Milwaukee outcome studies did not differentiate between therapists, or attempt to separate out impact of therapist qualities from client qualities from model qualities, it becomes more difficult in the light of the more recent studies on ‘common factors’ to justify a claim that SFT has any particular unique qualities on the basis of these research studies alone.

One study (Wheeler, 1995) on the use of the approach in child psychiatric social work in the UK used a different measurement, that of case outcomes in relation to the use of the method (i.e. were cases closed, referred on, or clients stop attending). An interesting result in this small survey, was a significant difference in referral-on rates between cases seen not using the approach, and those seen when using the approach. When using SFT, Wheeler’s referral-on rate reduced to 11% from 31% in a total sample of 73 cases. This suggests the approach may impact on the practitioner’s level of belief in client’s competence.

Independently conducted empirical studies

The second type of study is of a more traditional, scientific nature. In addition to individual empirical studies, the Journal of Family Therapy in May 1997 published five empirical studies of SFT. These studies were necessary in the view of editor John Carpenter for three different reasons: firstly because Solution Focused Therapy was the ‘flavour of the month’; secondly because it was

presented as deceptively simple98 and thirdly because there was a paucity of studies that formally evaluated the model.

(i) McDonald’s (1997) follow-up study of clients of an adult psychiatric clinic in Scotland, who received a form of SFT was based on reports from 36 of the 39 clients and from their GP’s. The results indicated a ‘good outcome rate’ of 64%, approximately in line with a previous evaluation by the same author, and with estimates of the overall efficacy of other psychotherapies;

(ii) Zimmerman et al. (1997) researched the use of the approach in couples work in the USA., where solution-focused couples therapy was combined with a ‘psycho-educational component.99 Using a comparison group, their pre- and post-test scores indicated that ‘treatment couples experienced some benefit from being involved in the solution-focused couple therapy groups’, with significant changes in all four subscales used as a measurement instrument. They suggest: ‘perhaps the positive focus and emphasis on strengths, skill-building and general ‘fellowship’ of the couples groups contributed to this improvement’ (Zimmerman et al., 1997: 139);

(iii) Eakes et al. (1997) conducted a pilot study of brief therapy with families, where one member had a diagnosis of schizophrenia, and was receiving medication. Using a control group and experimental group design, they pre- and post-tested the ten participant families using an instrument which measured family roles and relationships. Their form of therapy combined solution-focused work with a reflecting team approach. They found significant differences between the groups in relation to expressiveness, active-recreational orientation, moral-religious emphasis and family incongruence. The first two of these scales showed positive increases after family centred SFT, indicating a positive change towards more expressiveness and participation in social and recreational activities by the family members.

(iv) Beyerbach and Carranza’s (1997) study of dropout from solution-focused therapy in a private clinic in Spain compared relational communication of 16 sessions prior to dropout from therapy with relational communication of 16 sessions after which clients continued in therapy. They used two different coding schemes. Their findings indicate that dropouts are not a homogeneous group, but more importantly their study:

… provide some empirical evidence to support the idea that therapists should promote supportive, harmonious and non-conflictual therapeutic conversations. A viable relationship is built, they suggest, on a close

98 _{‘A simple formula incorporating the ‘Miracle Question’, the use of rating scales, giving compliments}

and homework tasks (which seems to imply that anyone can do it), one suspects that there is more to it than appears at first sight’ (Carpenter, 1997: 117).

99 _{The psycho-educational component consisted of a portion of the group session being devoted to some}

teaching on ‘myths that lead to relationship drain and guidelines for goal-setting … focusing on what works … pattern recognition and interruption strategies… evaluating pattern interruption failures … and planning for backsliding’ (Zimmerman et al., 1997).

following of the client’s lead rather than on strategizing. (Carpenter, 1997: 120)

(v) Sundman’s study of the introduction of solution-focused ideas into a social work agency in Finland, involved an experimental group of social workers who received ‘minimal’ training in the approach (which was a combination of the SFT and MRI models); a well-matched comparison group of social workers (a total of 25) and some 382 of their clients. Outcomes were measured in a variety of ways: initial questionnaires about their work with the selected clients; tape-recordings of randomly chosen meetings; and follow-up questionnaires completed jointly by worker and client. A total of 52% of the questionnaires were completed. While there were no significant differences between the experimental and comparison groups in terms of goal achievement, the study indicated that clients who received the solution-focused intervention ‘were more satisfied, more goal focused and more engaged in joint problem-solving with their social workers’ (Carpenter, 1997: 119).

Lee (1997) in a rigorous100 one group post-test design study evaluated the use of SFT in a children’s mental health centre in Toronto, and found a 64.9% success101

rate for an average of 5.5 therapy sessions over a range of 3.9 months. This study confirmed the success rates of SFT as roughly equivalent to those of other brief therapies (but less than that claimed by de Shazer of between 72-80%). Lee suggests that this may in part be due to the differing experience levels of therapists at the two centres and that

… the good success rate reported by clients in this study provides initial evidence that solution-focused therapy can be practiced by therapists with varying levels of experience and still generate a satisfactory outcome for the clients. (p. 13)

That no differences were found when analysed for other variables suggests that the