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Counseling Outcome Research
Meta-Analysis of Solution-
Focused Brief Therapy for
Treating Symptoms of
Internalizing Disorders
Erika L. Schmit
1
, Michael K. Schmit
2
,
and A. Stephen Lenz
2
Abstract
We evaluated the effectiveness of solution-focused brief therapy (SFBT) for treating symptoms of
internalizing disorders with youth and adults across 26 between-group studies representing the
data of 2,968 participants. Separate meta-analytic procedures for studies implementing waitlist/no
treatment (n¼1,342) or alternative treatments (n¼1,626) yielded modest effect sizes for SFBT
when treating internalizing disorders. Limitations of our findings and implications for counselors
are discussed.
Keywords
SFBT, internalizing disorders, meta-analysis
Internalizing disorders are represented by
classes of psychiatric diagnoses such as dep-
ression and anxiety that are characterized by
incorporating psychological distress in a manner
that is embedded within an individual (Ameri-
can Psychological Association [APA], 2013).
Among adolescents and young adults, internaliz-
ing disorders are quite common, with their asso-
ciated symptoms having deleterious effects on
functioning across the life span (O’Neil, Conner,
& Kendall, 2011). In many cases, the feelings of
worthlessness and despondency that accompany
internalizing disorders have negative associa-
tions with life outcomes such as marital dis-
cord (Brock & Lawrence, 2014), educational
attainment (Esch et al., 2014), vocational
fulfillment (Innstrand, Langballe, & Falkum,
2011), risk for criminal adjudication (Balya-
kina et al., 2014), and general life satisfaction
(Nes et al., 2013). Researchers also have
indicated that when the symptoms of interna-
lizing disorders are unmitigated, individuals
are at notable risk for self-injury and suicide
completion (Kovess-Masfety et al., 2015).
Given these high stakes for impairment and
risk for self-harm, it is a prudent activity for
1
Department of Psychology, Counseling, and Special Edu-
cation, Texas A&M University–Commerce, Commerce,
TX, USA
2
Texas A&M University–Corpus Christi, Corpus Christi,
TX, USA
Submitted June 13, 2015. Revised December 2, 2015.
Accepted December 2, 2015.
Corresponding Author:
Erika L. Schmit, Department of Psychology, Counseling, and
Special Education, Texas A&M University–Commerce,
2200 Campbell St, Commerce, TX 75428, USA.
Email: erika.schmit@tamuc.edu
Counseling Outcome Research
and Evaluation
2016, Vol. 7(1) 21-39
ªThe Author(s) 2016
Reprints and permission:
sagepub.com/journalsPermissions.nav
DOI: 10.1177/2150137815623836
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counselors to identify and evaluate interven-
tions that promote adjustment and well-being.
Meanwhile, selection of an appropriate
intervention requires counselors to be knowl-
edgeable and clients to be aware of the inte-
raction between genetic predispositions and
environmental risk factors among those who
experience internalizing disorders. Some scho-
lars have suggested that genetic vulnerability to
internalizing disorders is not the primary cause
of the emergent symptoms alone, and instead
have referenced the interplay of genetic sensi-
tivity with environmental risk factors (APA,
2013; Mikolajewski, Allan, Hart, Lonigan, &
Taylor, 2013). Risk factors that promote emer-
gent symptoms include quality of the parent–
child relationship (Carpenter, Puliafico, Kurtz,
Pincus, & Comer, 2014), parental substance use
(Hser et al., 2015), socioeconomic status (Tay-
lor et al., 2014), and access to positive social
supports (Grav, Hellze`n, Romild, & Stordal,
2012). Given the contextually bounded nature
of emerging symptoms, some researchers have
suggested that a systemic approach to treatment
may be most appropriate (Retzlaff, Sydow,
Beher, Haun, & Schweitzer, 2013). Subse-
quently, viewing the pathology inherent within
internalizing disorders through a systemic lens
has been demonstrated as useful among youth
(Retzlaff et al., 2013), adolescents (Salum
et al., 2014), and adults (Harford et al., 2013;
Scott, Dennis, & Lurigio, 2015).
Despite the therapeutic gains associated
with a systemic approach, successes have also
been indicated when using interventions more
closely aligned with the cognitive–behavioral
paradigm (Arnberg & Ost, 2014; Hirshfeld-
Becker et al., 2010; Wagley, Rybarczyk, Nay,
Danish, & Lund, 2013). From this perspective,
mitigating the symptoms of internalizing dis-
orders is associated with the development of
a coping skills repertoire that features adap-
tive thinking and functional actions associated
with well-being. Somewhere, in-between both
paradigms lies solution-focused brief therapy
(SFBT), not quite an internally driven, thought-
oriented process nor systemic methodology of
lifestyle reform (Mckergow & Korman, 2009).
Rather, individuals emerge from despondency
and distress by focusing on potential solutions
to a problem, rather than on the problem itself.
SFBT
As an evidence-based approach (National Regis-
try of Evidence-based Programs and Practices,
2014), the processes that comprise SFBT (Berg,
1994; de Shazer, 1985) are intended to identify
and encourage individuals’ strengths and
resources by focusing on potential solutions
to a problem (Miller & de Shazer, 2000).
Within this process, counselors who use SFBT
embrace the assumptions that (a) clients desire
change, (b) strengths are internal to the indi-
vidual and promote change, (c) small changes
produce larger ones, and (d) each solution is
unique (Berg, 1994; de Shazer, 1985; Miller
& de Shazer, 2000). Throughout the therapeutic
relationship, counselors rely on specific tech-
niques such as identifying exceptions, scaling
questions, and encouraging clients to describe
activities that constitute progress, thereby pro-
moting future-directed thought orientation.
These techniques have demonstrated efficacy
in a variety of professions including counseling
(Knekt, Lindfors, Sares-Jaske, Virtala, & Harka-
nen, 2013), schools (Gingerich & Wabeke,
2001), coaching (Grant, 2012; Roeden, Maas-
kant, & Curfs, 2014), and in medicine (Bowles,
Mackintosh, & Torn, 2001).
In addition to the aforementioned tech-
niques, SFBT counselors strategically avoid
focusing on problems and, instead, they attempt
to find exceptions that highlight small suc-
cesses (Berg, 1994). For instance, an individual
may enter counseling due to their symptoms of
depression and the counselor may prompt cli-
ents to describe a time they no longer felt
depressed. It is through this process that clients
discover exceptions, detect coping strategies,
and conceptualize a possible solution by recog-
nizing their strengths and existing resources
that promote therapeutic change. Another com-
mon technique in SFBT includes the use of the
miracle question (Berg, 1994). Counselors may
ask the miracle question at the onset of therapy
to help clients visualize their future as if the
problem no longer existed, thus promoting
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future-oriented, strengths-based client discov-
ery. Although SFBT techniques have demon-
strated efficacy across various populations
and settings, it is not without criticism.
Gingerich and Eisengart (2000) examined
15 studies on the effectiveness of SFBT
and identified shortcomings in methodology;
however, they reported beginning in support
of its use with the five studies they found
to be well controlled. These shortcomings
included sample size, mixed treatments, no
random assignment, outcome measures, and
weak designs. Similarly, Bond, Woods, Hum-
phrey, Symes, and Green (2013) reviewed
studies examining the efficacy of SFBT with
children and families in which they too iden-
tified methodological weakness and suggested
the necessity of further robust outcome stud-
ies, findings somewhat indicated support in
using SFBT with internalizing and externaliz-
ing issues in children. Of the 38 studies, Bond
et al. (2013) found that only 5 of these studies
were sound in research quality. Conversely,
Estrada and Beyebach (2007) investigated the
capableness of SFBT among individuals with
deafness and depression and noted that indi-
viduals’ depression symptoms decreased after
four to eight sessions, indicating a moderate
effect.
Seemingly, SFBT appears to be an eff-
ective approach to address symptoms of int-
ernalizing disorders such as depression and
anxiety due to the encouraging and positive
nature of the therapy. However, the extent lit-
erature available regarding the efficacy of
SBFT to address symptoms of internalizing
disorder seems somewhat inconclusive, per-
haps, creating further ambiguity and confu-
sion among professional counselors. From a
conceptual perspective, individuals who suf-
fer from internalizing disorders tend to keep
problems inside; therefore, SFBT may be one
potential approach to mitigate client’s client
symptoms and promote functioning by uti-
lizing preexisting resources and strengths. In
this current study, we examined the effective-
ness of SFBT in addressing symptoms of inter-
nalizing disorders utilizing a meta-analysis
approach.
Purpose of the Study and
Research Questions
The purpose of this investigation was to eva-
luate the effectiveness of SFBT for treating
symptoms of internalizing disorders and explore
moderating variables in instances of heteroge-
neity among treatment effect sizes between
studies. To achieve these tasks, we conducted
a meta-analysis of between-group studies to
answer the following research questions: (a)
To what degree is SFBT effective for improv-
ing symptoms of internalizing disorders with
SFBT versus alternative treatments? (b) To what
degree is SFBT effective for improving symp-
toms of internalizing disorders with SFBT ver-
sus waitlist/no treatment control?
Method
We identified published and unpublished (i.e.,
dissertations and theses) quantitative studies
that evaluated the efficacy of SFBT for mitigat-
ing symptoms of internalizing disorders across
the life span. Sampling procedures were estab-
lished a priori (see Inclusion and Exclusion Cri-
teria and Search Strategies), and data from
studies that met our criteria for inclusion were
collected, coded, and aggregated using proce-
dures to control for influence of sample size
and study quality in order to provide an overall
global estimate of treatment effect. We utilized
meta-analytic statistical procedures (i.e., sepa-
rate analyses for distinct between-group studies
and transformed standardized mean difference
effect sizes [Hedge’s g] using inverse sampling
error variances; see Lipsey & Wilson, 2001) to
combine findings from primary studies to pro-
vide an overall, improved estimate of treatment
effect based on the increased statistical power
for aggregated findings that account for influ-
ence of sample size and sampling error.
Inclusion and Exclusion Criteria
Inclusion of studies within our analyses was
contingent upon the following criteria: (a) stud-
ies reported results of between-subjects quanti-
tative research designs; (b) studies were
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published in peer-reviewed journals, disserta-
tions, or theses; (c) SFBT was therapeutic strat-
egy for addressing symptoms of internalizing
disorders; (d) SFBT was provided by trained
mental health professionals (e.g., counselors
and counselors-in-training, psychologists, and
social workers); (e) participants completed
standardized assessments at pretest and posttest;
(f) inclusion of means and standard deviation
data that permitted calculation of standardized
mean difference effect sizes; (g) studies were
published during the 20-year period between
1995 and 2014; and (h) studies were published
in English. Studies were excluded from our anal-
ysis if they reported preexperimental, single-
case, or predictive research designs or omitted
pretest data. Data reported across multiple pub-
lications were not included.
Search Strategies
We implemented five searchstrategies to identify
and include the empirical studies demonstrating
efficacy of SFBT for mitigating the symptoms
of internalizing disorders: (a) electronic database
searches; (b) journal-specific searches; (c) identi-
fying studies through sfbta.org, the website of
Solution-Focused Brief Therapy Association
(SFBTA); (d) review of reference lists within
relevant publications and candidate articles;
and(e)consultationwithmembersofSFBTA
to identify additional studies. The first and sec-
ond authors independently searched PsycINFO,
Academic Search Complete, Medline, Google
Scholar, and Dissertations and Theses databases
for the publication period of 1995–2014. For the
purpose of this study, solution-focused therapy
(SFT) and SFBT are used interchangeably. We
identified the intervention within our search
using key words solution-focused therapy,solu-
tion focused therapy,SFT,solution-focused brief
therapy,solution focused brief therapy,and
SFBT; terms used to identify the intended pop-
ulation were child,children,adolescents and
adults. Additional search terms of research,
study,andoutcome were enacted to specify
search results.
Journal-specific searches were completed to
identify the eligible studies in Counseling
Outcomes Research and Evaluation,Interna-
tional Journal of Solution-Focused Practices,
Journal of Child Psychology and Psychiatry,
Journal of Consulting and Clinical Psychology,
Journal of Counseling and Development,Jour-
nal of Family Therapy,Journal of Marital and
Family Therapy,Professional School Counsel-
ing,Research on Social Work Practice,The
American Journal of Family Therapy,The
Family Journal, and The Counseling Psycholo-
gist. Once studies were designated for inclusion,
reference lists were reviewed for additional
inclusion of studies, when appropriate. Finally,
we contacted members in SFBTA via phone and
e-mail to solicit additional studies not identified
during the initial search procedure. All relevant
documents that met inclusion criteria were col-
lated into electronic file folders for coding;
redundancies were removed through a colla-
borative screening process. The first and second
author compared coding files to eliminate
redundancy.
Coding Procedures
The first and second author independently
coded information according to guidelines
detailed by Lipsey and Wilson (2001), indicat-
ing study descriptors, sample characteristics,
research methodology, treatment administered,
measurement, and study outcome. A systematic
coding procedure was developed a priori by
the third author in order to promote accuracy
and consistency between coders. Both coders
were doctoral-level graduate students in a
Counselor Education program accredited by
the Council for Accreditation of Counseling
and Related Educational programs; both had
advanced training in research methods and sta-
tistics and were given orientation and training
to systematic reviews, coding procedures, and
meta-analysis by the third author. The first and
second author reviewed each other’s data
coding in consultation with the third author
who systematically audited coding to identify
errors and promote accuracy. If inconsistencies
occurred between the first and second author’s
coded data, the third author provided oversight
during the collaborative recoding process. For
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instance, if one coder indicated a dependent
variable dissimilar from the other coder, the
third author was informed of this disagreement,
and he facilitated the collaborative recoding
process. Discrepancies in coding were recon-
ciled until a 100%agreement was reached
among all authors.
Statistical Methods
We combined standardized mean difference
effect size estimates of similar between-subjects
study designs (i.e., waitlist/no treatment control
with waitlist/no treatment control and alterna-
tive treatments with alternative treatments),
according to Erford, Savin-Murphy, and But-
ler’s (2010) recommendation of aggregating
and synthesizing similar design models dis-
tinctly from dissimilar designs.
Data were synthesized using Comprehen-
sive Meta-Analysis, Version 3.0, software pro-
gram (Biostat, Inc., 2015). Standardized mean
difference effect sizes were computed for each
outcome variable using Hedge’s g, an unbiased
effect size metric that accounts for influences
of sample size and sampling error (Lipsey &
Wilson, 2001). Thus, mean effect sizes for
each design type were computed as a ratio of
the summed effect sizes, multiplied by the
inverse sampling error variance, and divided
by the total effect size weights (ESoverall ¼
P½ES w=Pw, where w¼1/SE
2
; see
Lenz, Bruijn, Serman, & Bailey, 2014; Lipsey
& Wilson, 2001). We evaluated null hypoth-
eses associated with treatment effect by exam-
ining 95%confidence intervals. Large effect
sizes indicated greater effectiveness of SFBT
in favor of alternative treatment or waitlist/no
treatment control group comparisons. Interpre-
tation of effect sizes was evaluated initially
with reference to Cohen’s (1988) suggested
standards of small (ES .20), medium (ES
.50), and large (ES .80) effect, but then con-
textualized in terms of units of standard devia-
tion and participant context.
Publication bias. Publication bias was addressed
using funnel plots and computing fail-safe N
(N
f
). Funnel plots illustrating symmetrical
distributions of effect sizes across studies were
indicative of judicious reporting and skewed
funnel plots indicate reporting bias. The fail-
safe N(N
f
) metric predicts the number of
unpublished studies demonstrating no treat-
ment effect needed to negate finding. When
N
f
is low, it is possible that reported mean effect
sizes are biased and not characteristic of actual
treatment effectiveness.
Analysis of homogeneity. The homogeneity of
effect was evaluated using Cochran’s Qstatis-
tic and inconsistency index (I
2
). The Qstatistic
tests the hypothesis that all studies share a com-
mon effect size. When Qvalues are greater than
degrees of freedom and statistically significant
(p< .05), the null hypothesis related to common
effect size can be rejected. The I
2
statistic indi-
cates the proportion of observed variance
reflects differences in true effect sizes rather
than sampling error. When I
2
is greater than
50, homogeneity cannot be assumed and mod-
erator variables should be evaluated (Cooper
et al., 2009; Lipsey & Wilson, 2001).
Moderator analysis. Evaluation of the impact
of moderating variables in large sample meta-
analyses commonly relies upon meta-regression
analyses (Borenstein, Hedges, Higgins, & Roth-
stein, 2009; Lipsey & Wilson, 2001). However,
in smaller samples such as ours, visual scrutiny
of the differences between study characteristics
may explain deviations in individual study effect
sizes (Lenz, Henesy, & Callender, 2016). Thus,
we concede that our approach to moderator anal-
ysis is descriptive rather than based on statisti-
cal inferences. Within this study, variables of
assumed association were age-group, domicile
(United States vs. international locales), treat-
ment modality (individual vs. group), and the
number of SFBT sessions. To complete these
analyses, two strategies were implemented:
(a) effect sizes were graphically represented
with the magnitude displayed on the ordinate
axis and standard error surrounding the mean
effect of the categorical moderating variables
(age-group, domicile, treatment modality, and
the number of SFBT sessions) were repre-
sented on the abscissa and (b) subgroup mean
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effect sizes were computed for categorical vari-
ables and their associated mean effect sizes,
then compared to determine its impact on para-
meter estimates.
Results
Our search resulted in 116 candidate articles and
15 dissertations/theses that qualified for further
scrutiny. After applying inclusion/exclusion
criteria to each candidate, we selected 26 (20
peer-review publications and 6 dissertations)
articles for our analyses (see Table 1). Candi-
date articles not selected for inclusion were
omitted due to the absence of reported means,
standard deviations, and/or the lack of pretest
procedures. There were 3,439 participants at
pretest across studies. Prior to posttest mea-
sures, 471 participants dropped out of the
studies for various reasons resulting in a postt-
est sample size of 2,968 with 1,496 having
received SFBT as their primary intervention,
845 having received an alternative treatment,
and 627 receiving no therapeutic intervention.
Among studies that reported demographic
variables, youth and adolescents (n¼1,906;
55.5%) composed slightly more than half of
the sample. Gender (n¼22 studies reported)
of participants were men (n¼1,166; 33.9%)
and women (n¼1,834; 53.3%); gender of
12.8%of study participants (n¼439) were not
reported (n¼4 studies). The overall mean age
of the sample was 26.55 years (SD ¼10.97).
Participants resided in international (n¼
2,331; 67.8%) or U.S. domiciles (n¼1,108;
32.2%). All studies implemented a manualized
SFBT treatment protocol within the treatment
condition, and 11 of the 26 studies (42.3%)
administered study protocols in school-based
settings. Furthermore, SFBT interventions
wereconductedinboththeUnitedStates
(n¼12 studies; 46%) and international (n¼
14 studies; 54%) domiciles. Among the 26
studies included in our analyses, 12 (46.2%)
implemented viable alternative treatments and
14 (53.8%) utilized a waitlist/no treatment
comparison. Analyses comparing SFBT to
alternative treatments were based on data of
1,626 participants; analyses that compared
SFBT to waitlist/no treatment control were
based on the data of 1,342 participants.
Is SFBT Effective for Improving Symptoms
of Internalizing Disorders?
SFBT versus alternative treatments. Twelve stud-
ies included in this analysis of SFBT versus
alternative treatment comparisons (n¼1,626)
yielded a mean effect size of .24 (CI95
[.42, .06]), p< .01, indicative of a small
effect size, which suggests that the null hypoth-
esis can be rejected (see Figure 1). This finding
suggests that within the universe of studies
included herein, participants receiving SFBT
tended to report the fewer symptoms about
24%of one standard deviation less than those
receiving alternative treatments. Furthermore,
inspection of the confidence interval indicates
that the actual estimate of this effect lies
between .42 and .06. The effect sizes within
the distribution of studies were notably hetero-
geneous Q(11) ¼28.19, p< .01, and I
2
¼61,
indicating that approximately 61%of the total
variability was due to between-study heteroge-
neity, thus exploration of moderating variables
was warranted.
Scrutiny of moderating variables of interest
revealed no notable differences between studies
in association with mean number of SFBT ses-
sions. Inspection of the relationship between
age-group and the magnitude of effect size
revealed that both youth and adolescents (g¼
0.30) and adults (g¼0.25) reported similar
effects across studies. A similar treatment
effect was observed for United States (g¼
0.21) and international (g¼0.27) domi-
ciles. Evaluation of effect sizes between treat-
ment modality and the magnitude of the
effect size revealed that treatments conducted
in both individual (g¼0.19) and family
(g¼0.14) yielded similar effect; however,
when compared to group (g¼0.78), a sub-
stantially larger effect was noted. Interestingly
enough, one study (Wilmshurst et al, 2002) that
utilized a combination of treatment approaches
yielded a treatment effect of g¼0.07, favoring
an alternative family preservation program.
This sample yielded an N
f
of 51 indicating that
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Table 1. Characteristics of Individual Studies Used in Meta-Analysis.
Study Summary NAge (M) Sample Domicile Treatment Modality Treatment Setting Type of Comparison
Smock et al.
(2008)
Compared a six-session SFBT
approach to a problem-
focused psychoeducational
approach
38 31 Adults with substance
abuse issues and
depression
symptoms
United States Individual School based Alternative
treatment
Kramer, Conijn,
Oijevaar, and
Riper (2014)
Randomized controlled trial
comparison of web-based
SFBT to a waitlist control
263 19.5 Adults with
depressive
symptoms
International Individual Online Waitlist
Wilmshurst et al.
(2002)
Compared a eight-session SFBT
to a family preservation
program treatment
65
a
Children with
internalizing
symptoms
United States Individual and
Family
Residential Alternative
treatment
Knekt, Lindfors,
Sares-Jaske,
Virtala, &
Harkanen,
(2013)
Compared 12-session SFBT to
other short- and long-term
treatments
326 32.3 Adults with
depressive
symptoms
International Individual Community based Alternative
treatment
Knekt et al.
(2011)
Compared a 12-session SFBT to
other short-term treatments
367 32.3 Adults with
depressive
symptoms
International Individual Community based Alternative
treatment
Franklin, Moore,
and Hopson
(2008)
Evaluated the effectiveness of 5-
to 7-session SFBT treatment
59 10.93 Children with
internalizing
symptoms
United States Individual School based No treatment
De Leon-Yznaga
(2000)
Evaluated the effectiveness of
SBFT training for school
counselor
72
a
Adults with self-
efficacy concerns
United States Group School-based Waitlist
Cook (1998) Compared a 6-session SFBT to
classroom guidance treatment
approach
68 7–8 Children with a
distorted self-
concept
United States Group School based Alternative
treatment
Bozeman (1999) Compared a 3-session SFBT to a
past & problem-focused
treatment
52 38.2 Adults with
depressive
symptoms
United States Individual Community based Alternative
treatment
Froeschle (2005) Evaluated the effectiveness of a
16-session drug prevention/
intervention program using
SFBT techniques
32 13–14 Children with self-
esteem issues
United States Group School based Waitlist
(continued)
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Table 1. (continued)
Study Summary NAge (M) Sample Domicile Treatment Modality Treatment Setting Type of Comparison
Huang (2001) Compared 8-session SFBT
approach to medication
treatment only and SFBT and
medication treatment only
39 20–49 Adults with
depressive
symptoms
International Group Residential Alternative
treatment
Seagram (1997) Evaluated the effectiveness of a
10-session SFBT for youth
offenders
40 16–-19 Children with
depressive
symptoms
International Individual Correctional No treatment
control
Zhang, Yan, Du,
and Liu (2014)
Evaluated the effectiveness of a 6-
session SBFT on promoting
posttraumatic growth with
mothers in China
43 36.7 Women who were
exposed to
traumatic events
and raising a child
ASD
International Group Community based No treatment
Cepukiene &
Pakrosnis
(2011)
Evaluated the effectiveness of a 1-
session SFBT on foster care
adolescents
92 12–18 Children with
perceived somatic
and cognitive
difficulties
International Individual Residential No treatment
Daki and Savage
(2010)
Compared a 5-session SBFT
group to a homework support
treatment group
14 11.25 Children with
emotional and
academic
difficulties
International Group School based Alternative
treatment
Richmond,
Jordan,
Bischof, and
Sauer (2014)
Compared a 1-session SFBT
interview approach to a
structured problem-focused
clinical interview approach
30 26.27 Adult who
experienced
psychological
distress
United States Individual School based Alternative
treatment
Gostautas,
Cepukien_
e,
Pakrosni, and
Fleming
(2005)
Evaluated the effectiveness of a 2-
to 5-session SFBT on
adolescent in foster care and
health-care institutions
133 14.6 Adolescents with
emotion and mood
dysregulation
International Individual Residential No treatment
Grant (2012) Compared SFBT coaching to a
problem-focused coaching
approach on self-identified
personal problems
225 20.5 Adults with negative
affect experiences
International Individual Online Alternative
treatment
(continued)
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Table 1. (continued)
Study Summary NAge (M) Sample Domicile Treatment Modality Treatment Setting Type of Comparison
Rakauskiene and
Dumciene
(2013)
Evaluated the effectiveness of
SFBT with adolescents in a
school setting
553 16.8 Adolescents with self-
efficacy concerns in
addressing
personal issues
International Individual School based No treatment
Kvarme et al.
(2010)
Compared 6-session SFBT
treatment approach to a
standardized TAU approach
156 12–13 Socially withdrawn
adolescents with
self-efficacy issues
International Group School based TAU
Thorslund
(2007)
Examined the effectiveness of an
8-session SFBT for individuals
on long-term sick leave
30 45.4 Adults with
psychological
health issues
International Group Community based Waitlist
Corcoran (2006) Compared a 4- to 6-session SFBT
approach to TAU approach for
behavior problems
239 5–17 Children and
adolescents with
anxiety and
behavior issues
United States Family Community based TAU
Cockburn,
Thomas, and
Cockburn
(1997)
Compared a 6-session SFBT to a
standard rehabilitation
approach among adult in a
work hardening program
48 37.2 Adults with
psychological
distress and work
disability
United States Group
a
Alternative
treatment
Shin (2009) Compared a 6-session SFBT
approach to an individual
support as needed approach
for youth probationers in
Korea
40 17 Youth who were on
probation with self-
esteem issues
International Group Correctional Alternative
treatment
LaFountain &
Garner (1996)
Evaluated the effectiveness of
SFBT group in a school setting
311
a
Children with issues
of self-perception
United States Group School based Waitlist control
Littrell, Malia,
and
Vanderwood
(1995)
Compared a single-session SFBT
approach to a problem-
focused approach with and
without using a task
61 15.6 Students’ feeling on a
various personal
problems
United States Individual School based Alternative
treatment
Note. ASD ¼Autism Spectrum Disorders; TAU ¼treatment-as-usual; SFBT ¼solution-focused brief therapy.
a
Indicates data were not reported in the primary study.
29
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Study Relative
Weight
Effect Size with
95% CI SFBT vs. Alternative Treatment
Smock et al. (2008) 5.50% .16 [-.46, .78]
Knelt et al. (2011a) 11.64% .12 [-.16, .40]
Wilmshurst et al. (2002) 7.39% .07 [-.42, .56]
DeLeon-Yznaga (2000) 7.75% .04 [-.42, .51]
Corcoran (2006) 7.94% -.14 [-.60, .31]
Knelt et al. (2011b) 11.97% -.20 [-.45, .08]
Bozeman (1999) 6.61% -.27 [-.80, .27]
Rakauskiene & Dumciene (2013) 14.12% -.31 [-.48, -.14]
Grant (2012) 12.00% -.33 [-.60, -.07]
Littrell et al. (1995) 5.69% -.39 [-1, .22]
Cockburn et al. (1997) 5.79% -1.11 [-1.71, -.50]
Huang (2001) 3.60% -1.41 [-2.25, -.57]
Mean Effect Size -.24 [-.42, -.06]
1
5
.05.-1
-
Note. Negative effects size values indicate that treatment outcomes favored Solution-Focused Brief Therapy; positive effect size
values indicate that treatment outcomes favor alternative treatments.
Figure 1. Effect sizes and 95% confidence intervals for studies evaluating solution-focused brief therapy for improving outcomes on internalizing symptomology
using alternative treatments.
30
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51 unpublished studies with an effect size of zero
would be needed in order to negate our findings.
SFBT versus waitlist/no treatment control. Fourteen
studies included in this analysis of SFBT versus
waitlist/no treatment comparisons (n¼1,342)
yielded a mean effect size of .31 (CI95 [.53,
.09]), p¼.006, indicative of a small effect
size, which suggests that the null hypothesis can
be rejected (see Figure 2). This finding suggests
that within the universe of studies included
herein, participants receiving SFBT tended to
report the fewer symptoms about 31%of one
standard deviation less than those receiving wait-
list/no treatment control. Furthermore, inspection
of the confidence intervalindicates that the actual
estimate of this effect lies between .53 and
.09. The effect sizes within the distribution of
studies were notably heterogeneous Q(13) ¼
43.70, p<.001,andI
2
¼70.25, indicating that
approximately 70%of the total variability was
due to between-study heterogeneity, thus explo-
ration of moderating variable was warranted.
Scrutiny of moderating variables of interest
revealed no notable differences between studies
in association with mean number of SFBT ses-
sions. Inspection of the relationship between
age-group and the magnitude of effect size
revealed that adults (g¼1.03) yielded a
much larger treatment effect when compared
to youth and adolescents (g¼0.21). Evalua-
tion of the relationship between domicile and
the magnitude of the effect size indicated that
international domiciles (g¼0.39) yielded
approximately twice the treatment effect when
compared to participants located in the United
States (g¼0.2 0). A similar phenomenon was
observed with treatment modality, resulting in
a group format (g¼0.41) producing a
slightly larger treatment effect when compared
to individual (g¼0.23). This sample yielded
an N
f
of 74 indicating that 74 unpublished stud-
ies with an effect size of zero would be needed
in order to negate our findings.
Discussion
The findings from this meta-analysis examin-
ing the effectiveness of SFBT on symptoms
of internalizing disorders offered meaningful
outcomes for clients receiving services for
internalizing symptoms. Among the 26 studies
evaluated, mean effect sizes for decreasing
internalizing symptoms in youth and adults
were relatively small, indicating a modest
degree of effect when compared to other treat-
ment approaches or no treatment at all. In
other words, participants benefited slightly in
decreasing their symptoms of internalizing
disorders when compared to participants who
received alternate treatment or no treatment.
Our findings were similar to Bond et al.’s
(2013) study, whereby they identified SFBT
partially mitigated symptoms of internalizing
disorders among children. In addition, Cor-
coran and Pillai (2009) indicated questionable
effectiveness in their review on SFT. When
considering the severity of symptoms for
individuals with internalizing disorders, such
as those with anxiety disorders (Erford, Kress,
Giguere, Cieri, & Erford, 2015) and depres-
sion disorders (Erford et al., 2011), it is
imperative that counselors and other mental
health professionals implement effective treat-
ment approaches informed by judicious research
that offer a practical degree of meaningfulness.
When taking the premise of SFBT into
account, a small effect of .24 or .31 is indi-
cative of an impactful degree of change for
individuals’ with internalizing disorders and
seemingly analogous with the notion of small
changes leading to larger ones. In other words,
an individual may experience a 24%decrease
in depressive symptomology over the course
of six to nine sessions of SFBT, which consti-
tutes a significant transformation that can lead
to a more substantial elimination of symptom
manifestation over time. Additionally, many
counselors who utilize this approach may do
so in a short-term setting; further, substan-
tiating the need for small client change during
brief time spans. Within this framework, SFBT
may be considered a successful treatment for
decreasing symptoms of internalizing disorders,
especially for individuals seeking immediate
relief from life altering conditions. Thus, find-
ings indicated that SFBT may be effective in
producing short-term changes in individuals
Schmit et al. 31
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Study Relative
Weight
Effect Size
with 95% CI SFBT vs. Control
Seagram (1997) 6.07% .43 [-.18, 1.05]
Cook (1998) 7.53% .35 [-.12, .83]
Cepukiene & Pakrosnis (2011) 8.31% .11 [-.29, .52]
Kvarme et al. (2010) 9.35% -.03 [-.34, .30]
Froeschle (2005) 7.37% -.08 [-.57, .41]
LaFountain & Garner (1996) 10.35% -.25 [-.47, -.03]
Kramer et al. (2014) 10.17% -.30 [-.55, -.06]
Thorslund (2007) 5.31% -.32 [-1.02, .38]
Gostautas et al. (2005) 8.97% -.39 [-.74, -.04]
Richmond et al. (2004) 5.24% -.53 [-1.24, .18]
Franklin et al. (2008) 7.06% -.63 [-1.15, -.11]
Shin (2009) 5.86% -.87 [-1.51, -.24]
Daki & Savage (2010) 3.10% -1.12 [-2.19, -.06]
Zhang et al. (2014) 5.32% -1.74 [-2.44, -1.04]
Mean Effect Size -.31 [-.53, -.09]
15.05.
-
1-
Note. Negative effects size values indicate that treatment outcomes favored Solution-Focused Brief Therapy; positive effect size
values indicate that treatment outcomes favor waitlist/no treatment control.
Figure 2. Effect sizes and 95% confidence intervals for studies evaluating solution-focused brief therapy for improving outcomes on internalizing symptomology
using waitlist/no treatment control.
32
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with internalizing disorder symptoms. However,
more follow-up studies need to be conducted in
order to determine the long-term effects of this
treatment. For example, Roeden, Maaskant, and
Curfs (2014) found that SFBT was effective
when compared to treatment-as-usual with cli-
ents diagnosed with intellectual disabilities at
6-week follow-up. Given the scarcity of studies
examining long-term effects of SFBT available
in the extant literature, further exploration using
rigorous methodology seems prudent across var-
ious diagnoses and symptomologies in order to
benefit future research endeavors and clinical
practice.
On the other hand, one possible explanation
for modest findings when utilizing SFBT is the
short-term nature of the approach, which may
not address the needed depth for internalizing
symptoms related to disorders of depression or
anxiety. For example, individuals with depres-
sion might exhibit symptoms such as feelings
of hopelessness and self-injurious behaviors.
SFBT may not emphasize the necessary treat-
ment of these symptoms through its techniques
and therefore may only address surface issues
presented during treatment. Additionally, given
the popularity of SFBT, this approach may be
used ineffectively by counselors with over-
whelming caseloads and limited by the number
of sessions due to third-party payers regarding
individuals who suffer from internalizing disor-
ders, particularly when the potential solution
maybetofocusontheproblem.
Although heterogeneity among studies was
observed, meta-regression analyses revealed
no significant moderating variables due to a
lack of sufficient sample size. However, visual
analyses within subgroups offered insight as
to the differences observed. Within analyses
utilizing alternative treatments, moderating
variables of age-group and domicile produce
similar treatment effects; however, treatment
modality, particularly group yielded 4 times
the treatment effect when compared to individ-
ual or family. For instance, in Quick and Gizzo’s
(2007) study on solution-focused group therapy
with adults, findings indicated a positive out-
come on problem control. Additionally, Fitch,
Marshall, and McCarthy (2012) examined a
solution-focused group and found supportive
results in students’ increased self-regulation
learning.One possible explanation for high treat-
ment efficacy in group settings is the experience
of group dynamics such as universality and pro-
social interaction, offering individuals with
internalizing disorders opportunities to experi-
ence positive exchanges in a safe environment.
Among analyses employing no treatment con-
trols, the moderating variables of age-group,
domicile, and treatment modality yielded note-
worthy findings. For instance, treatment effects
observed with adults produced 5 times larger
effects when compared to youth and adoles-
cents. One possible explanation may be due
to level of maturity needed to integrate con-
cepts related to finding exceptions and being
satiated with small changes. For many, particu-
larly youth who are developmentally immature
may favor instant gratification over incremen-
tal progression, possibly rendering the notion
of small changes as moot. Similarly, interna-
tional domicile produced twice the treatment
effect when compared to domiciles in the United
States. For example, in a meta-analysis con-
ducted by Kim et al. (2015), SFBT was found
to be moderately effective with decreasing inter-
nalizing disorders in Chinese clients. In some cul-
tures, receiving mental health services may be
considered taboo, thus individuals who sought
treatment may have done so with a larger degree
of motivation, which may exp lain the notab le dis-
similarities in treatment effects.
Limitations and Recommendations for
Future Research
Our meta-analysis yielded primary findings
that must be interpretedwithinthecontextof
publication bias, number of studies obtained,
and unreported demographic variables. We
attempted to limit such constraints by employ-
ing rigorous practices during the search, selec-
tion, coding, and analysis procedures. First,
we attempted to search for and include unpub-
lished studies within our meta-analysis, result-
ing in six dissertation studies. Berkeljon and
Baldwin (2009) discussed publication bias as
a threat to validity in meta-analyses, which
Schmit et al. 33
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can skew results due to the trend of publishing
studies with only positive results. Detecting
other unpublished research regarding SFBT
may promote a clearer depiction of the empiri-
cal status of SFBT.
Likewise, our attempts to control for study
quality through inclusion/exclusion criteria
(i.e., between-subjects design only) may have
disqualified other noteworthy studies, which
resulted in smaller study sample size. Due to
our sample size limitation and the fact that not
all moderating variables were reported, this
impacted the outcome of our meta-regression
results. Although we feel confident that our
search efforts and inclusion/exclusion proce-
dures yielded a delicate balance of rigor and
inclusivity of studies, we encourage future
researchers to device additional experimental and
quasi-experimental, between-subjects research
to further enhance and update our current find-
ings. Additionally, not all studies included com-
plete demographic information which was
challenging when attempting to code moderator
variables. We encourage future researchers to
report essential demographic variables such as
age, gender, and ethnicity, as well as other signif-
icant characteristics relevant to the studyin order
to aid the application of future studies, particu-
larly, meta-regression analyses.
Further, our findings revealed a majority of
studies occurred outside the United States
(67.8%), warranting caution when generalizing
to domiciles beyond study sample characteris-
tics. Perhaps more research examining these vari-
ables will aid in identifying if SFBT is effective
across cultures. Future research is needed exam-
ining the efficacy of SFBT for treating symptoms
of internalizing disorders using experimental and
quasi-experimental methods. Furthermore, the
studies incorporated within our meta-analysis
investigated treatment effects until conclusion
of treatment. Additional studies involving
follow-up and longitudinal growth may deter-
mine treatment gains in a long-term manner.
Implications for Counselors
This study provides some useful implications
for counselors working with clients who are
experiencing the symptoms of internalizing
disorders. Although the treatment effect sizes
were modest for SFBT versus comparison
types, the degree of effect noted is heartening
given the brief, short-term nature of SFBT in
practice settings. Furthermore, it is possible
that brief SFBT intervention effects will accu-
mulate to further gains in symptom relief
and therefore, overall functioning over time.
Based on our findings, we submit that SFBT
may be a more prudent treatment selection for
counselors working with adults rather than
children or adolescents, given that effect sizes
associatedwith adults were comparatively larger
across treatment comparison types. Although we
detected some effect with younger clients, it is
likely that the conceptual framework of SFBT
may be better suited for individuals with a
higher level of cognitive development who can
self-motivate and self-regulate their actions in
toward desired behaviors. Furthermore, our find-
ings indicated that across comparison types,
SFBT provided in a group format may be super-
ior to individual or family modalities. This is
heartening for counselors when considering that
group formats lend themselves well to maxi-
mizing service delivery resources in myriad
settings such as schools, community-based
agencies, addictions treatment facilities, and
rehabilitation settings. It is possible that coun-
selors can magnify treatment effects in group
setting by facilitating social learning pro-
cesses that expand clients’ coping based on
discourse depicting change, solutions, and
strategies. Regardless of client demographic
or modality of intervention, several SFBT
authorities (Berg, 1994; de Shazer, 1985;
Miller & de Shazer, 2000) unequivocally cau-
tion against solutioning with clients in the
absence of formal education, training, and
supervision. Therefore, we suggest those
counselors who are interested in delivering
SFBT to their client population engage in for-
mal training experiences through continuing
education or as part of the programming avail-
able through Solution-Focused Brief Therapy
Associates (www.sfbta.org) or the Institute for
Solution-Focused Brief Therapy (www.solu-
tionfocused.net).
34 Counseling Outcome Research and Evaluation 7(1)
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Conclusion
The results from this meta-analysis yielded
small effects when compared to alternative
treatments or no treatment control. Given the
short-term nature of the SFBT model, many
counselors may find it favorable to other treat-
ment modalities. Results from this study will
help clinicians to make an informed decision
when identifying SFBT as an evidenced prac-
tice model for internalizing disorders. We urge
readers to use this research within the context
of its limitations and suggest future studies to
include characteristics such as culture, rigor
of study methodology, and longitudinal data.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of
interest with respect to the research, authorship,
and/or publication of this article.
Funding
The author(s) received no financial support for
the research, authorship, and/or publication of
this article.
References
*Indicates studies included in meta-analysis
American Psychiatric Association. (2013). Diagnos-
tic and statistical manual of mental disorders (5th
ed.). Washington, DC: Author.
Arnberg, A., & Ost, L. G. (2014). CBT for children
with depressive symptoms: A meta-analysis.
Cognitive Behaviour Therapy,43, 275–288.
doi:10.1080/16506073.2014.947316
Balyakina, E., Mann, C., Ellison, M., Sivernell, R.,
Fulda, K., Sarai, S., & Cardarelli, R. (2014). Risk
of future offense among probationers with co-
occurring substance use and mental health disor-
ders. Community Mental Health Journal,50,
288–295. doi:10.1007/s10597-013-9624-4
Berg, I. K. (1994). Family based services: A
solution-focused approach. New York, NY: W.
W. Norton & Company.
Berkeljon, A., & Baldwin, S. A. (2009). An introduc-
tion to meta-analysis for psychotherapy outcome
research. Psychotherapy Research,19, 511–518.
doi:10.1080/10503300802621172
Biostat, Inc. (2015). Comprehensive meta-analysis
[Computer software]. Englewood, NJ: Author.
Bond, C., Woods, K., Humphrey, N., Symes, W., &
Green, L. (2013). Practitioner review: The effec-
tiveness of solutions focused brief therapy with
children and families: A systematic and critical
evaluation of the literature from 1990-2010.
Journal of Child Psychology and Psychiatry,
54, 707–723. doi:10.1111/jcpp.12058
Borenstein, M., Hedges, L. V., Higgins, J. P. T., &
Rothstein, H. R. (2009). Introduction to meta-
analysis. West Sussex, England: John Wiley.
doi:10.1002/9780470743386
Bowles, N., Mackintosh, C., & Torn, A. (2001).
Nurses’ communication skills: An evaluation
of the impact of solution-focused communica-
tion training. Journal of Advanced Nursing,
36, 347–354. doi:10.1046/j.1365-2648.2001.
01979.x
*Bozeman, B. N. (1999). The efficacy of solution-
focused therapy techniques on perceptions of
hope in clients with depressive symptoms (Doc-
toral dissertation). Retrieved from ProQuest Dis-
sertations & Theses Global (99621340).
Brock,R.,&Lawrence,E.(2014).Maritalpro-
cesses, neuroticism, and stress as risk factors
for internalizing symptoms. Couple and Family
Psychology,3, 30–47. doi:10.1037/cfp0000007
Carpenter, A. L., Puliafico, A. C, Kurtz, S. M. S.,
Pincus, D. B., & Comer, J. S. (2014). Extending
parent-child interaction therapy for early child-
hood internalizing problems: New advances for
an overlooked population. Clinical Child and
Family Psychology Review,17, 340–356. doi:
10.1007/s10567-014-0172-4
*Cepukiene, V., & Pakrosnis, R. (2011). The out-
come of solution-focused brief therapy among
foster care adolescents: The changes of beha-
vior and perceived somatic and cognitive diffi-
culties. Children and Youth Services Review,
33, 791–797. doi:10.1016/j.childyouth.2010.
11.027
Cohen, J. (1988). Statistical power analysis for the
behavioral sciences (2nd ed.). Hillsdale, NJ:
Lawrence Erlbaum.
*Cockburn, J. T., Thomas, F. N., & Cockburn, O.
J. (1997). Solution-focused therapy and psy-
chosocial adjustment to orthopedic rehabilita-
tion in a work hardening program. Journal of
Schmit et al. 35
at TEXAS A&M UNIV CORPUS CHRISTI on May 2, 2016cor.sagepub.comDownloaded from
Occupational Rehabilitation,7, 97–106. doi:
10.1007/bf02765880
*Cook, D. R. (1998). Solution-focused brief therapy:
Its impact on the self-concept of elementary
school students (Doctoral dissertation). Retrieved
from ProQuest Dissertations and Theses Global
(9841647).
Cooper, H., Hedges, L., & Valentine, J. C. (2009).
The handbook of research synthesis and
meta-analysis. New York, NY: Russell Sage
Foundation.
*Corcoran, J. (2006). A comparison group study of
solution-focused therapy versus ‘‘treatment-as-
usual’’ for behavior problems in children. Jour-
nal of Social Service Research,33, 69–81. doi:
10.1300/j079v33n01_07
Corcoran, J., & Pillai, V. (2009). A review of the
research on solution-focused therapy. British
Journal of Social Work,39, 234–242. doi:10.
1093/bjsw/bcm098
*Daki, J., & Savage, R. S. (2010). Solution-focused
brief therapy: Impacts on academic and emotional
difficulties. The Journal of Educational Research,
103, 309–326. doi:10.1080/00220670903383127
*De Leon-Yznaga, S. (2000). The effects of solution-
focused brief therapy training on the self-efficacy
of elementary and secondary school counselors
(Doctoral dissertation). Retrieved from ProQuest
Dissertations and Theses Global (9967068).
de Shazer, S. (1985). Keys to solution in brief ther-
apy. New York, NY: Norton.
Erford, B. T., Savin-Murphy, J. A., & Butler, C.
(2010). Conducting a meta-analysis of counseling
outcome research: Twelve steps and practical pro-
cedures. Counseling Outcome Research and Eva-
luation,1, 19–43. doi:1 0.1177/21501378093 56682
Erford,B.T.,Erford,B.M.,Lattanzi,G.,Weller,J.,
Schein, H., Wolf, E., ... Peacock, E. (2011). Coun-
seling outcomes from 1990 to 2008 for school-age
youth with depression: A meta-analysis. Journal
of Counseling and Development,89, 439–457.
doi:10.1002/j.1556-6676.2011.tb02841.x
Erford, B. T., Kress, V. E., Giguere, M., Cieri, D., &
Erford, B. M. (2015). Meta-analysis: Counseling
outcomes for youth with anxiety disorders. Jour-
nal of Mental Health Counseling,37, 63–94. doi:
10.17744/mehc.37.1.mgj66326868u33g2
Esch, P., Bocquet, V., Pull, C., Couffignal, S.,
Lehnert, T., Graas, M., ... Ansseau, M. (2014).
The downward spiral of mental disorders and
educational attainment: A systematic review on
early school leaving. BMC Psychiatry,14,
237–249. doi:10.1186/s12888-014-0237-4
Estrada, B., & Beyebach, M. (2007). Solution-
focused therapy with depressed deaf persons.
Journal of Family Psychotherapy,18, 45–63.
doi:10.1300/j085v18n03_04
Fitch, T., Marshall, J., & McCarthy, W. (2012). The
effect of solution-focused groups on self-
regulated learning. Journal of College Student
Development,53, 586–595. doi:10.1353/csd.
2012.0049
*Franklin, C., Moore, K., & Hopson, L. (2008).
Effectiveness of solution-focused brief therapy
in a school setting. Children & Schools,30,
15–26. doi:10.1093/cs/30.1.15
*Froeschle, J. (2005). The efficacy of a drug preven-
tion/intervention program on adolescent girls
(Doctoral dissertation). Retrieved from ProQuest
Dissertations & Theses Global (3161340).
Gingerich, W. J., & Eisengart, S. (2000). Solution-
focused brief therapy: A review of the outcome
research. Family Process,39, 477–498. doi:10.
1111/j.1545-5300.2000.39408.x
Gingerich, W. J., & Wabeke, T. (2001). A solution-
focused approach to mental health intervention in
school settings. Children and Schools,23, 33–47.
doi:10.1093/cs/23.1.33
*Gostautas, A., Cepukien_
e, V., Pakrosni, R., & Flem-
ing, J. S. (2005). The outcome of solution-focused
brief therapy for adolescents in foster care and
health care institutions. Baltic Journal of Psychol-
ogy,6, 5–14. doi:10.1037/e557292013-002
*Grant, A. M. (2012). Making positive change: A
randomized study comparing Solution-Focused
vs. Problem-Focused coaching questions. Jour-
nal of Systemic Therapies,31, 21–35. doi:10.
1521/jsyt.2012.31.2.21
Grav, S., Hellze`n, O., Romild, U., & Stordal, E.
(2012). Association between social support and
depression in the general population: The HUNT
study: A cross-sectional survey. Journal of Clin-
ical Nursing,21, 111–120. doi:10.1111/j.1365-
2702.2011.03868.x
Harford, T. C., Chen, C. M., Saha, T. D., Smith, S.
M., Ruan, W. J., & Grant, B. F. (2013). DSM-
IV personality disorders and associations with
externalizing and internalizing disorders: Results
36 Counseling Outcome Research and Evaluation 7(1)
at TEXAS A&M UNIV CORPUS CHRISTI on May 2, 2016cor.sagepub.comDownloaded from
from the national epidemiologic survey on
alcohol and related conditions. Journal of Psy-
chiatric Research,47, 1708–1716. doi:10.1016/
j.jpsychires.2013.07.016
Hirshfeld-Becker,D.R.,Masek,B.,Henin,A.,Bla-
kely, L. R., Pollock-Wurman, R. A., McQuade,
J., ... Rosenbaum, J. B. (2010). Cognitive
behavioral therapy for 4- to7-year-old children
with anxiety disorders: A randomized clinical
trial. Journal of Consulting and Clinical Psy-
chology,78, 498–510. doi:10.1037/a0019055
Hser, Y., Lanza, H. I., Li, L., Kahn, E., Evans, E., &
Schulte, M. (2015). Maternal mental health and
children’s internalizing and externalizing beha-
viors: Beyond maternal substance use disorders.
Journal of Child and Family Studies,24,
638–648. doi:10.1007/s10826-013-9874-3
*Huang, M. K. (2001). A comparison of three
approaches to reduce marital problems and
symptoms of depression (Doctoral dissertation).
Retrieved from ProQuest Dissertations & Theses
Global (3039774).
Innstrand, S., Langballe, E., & Falkum, E. (2011). A
longitudinal study of the relationship between
work engagement and symptoms of anxiety and
depression. Stress and Health,28, 1–10. doi:10.
1002/smi.1395
Kim, J. S., Franklin, C., Zhang, Y., Liu, X., Qu, Y., &
Chen, H. (2015). Solution-focused brief therapy
in China: A meta-analysis. Journal of Ethnic &
Cultural Diversity in Social Work,24, 187–201.
doi:10.1080/15313204.2014.991983
*Knekt, P., Lindfors, O., Sares-Jaske, L., Virtala, E., &
Harkanen, T. (2013). Randomized trial on the effec-
tiveness of long- and short-term psychotherapy on
psychiatric symptoms and working ability during a
5-year follow-up. Nordic Journal of Psychiatry,
67, 59–68. doi:10.3109/08039488.2012.680910
*Knekt, P., Lindfors, O., Laaksonen, M. A.,
Renlund, C., Haaramo, P., Harkanen, T., ...
Helsinki Psychotherapy Study Group. (2011).
Quasi-experimental study on the effectiveness
of psychoanalysis, long-term and short-term
psychotherapy on psychiatric symptoms, work
ability and functional capacity during a 5-year
follow-up. Journal of Affective Disorders,132,
37–47. doi:10.1016/j.jad.2011.01.014
Kovess-Masfety, V., Pilowski, D., Goelitz, D.,
Kujipers, R., Otten, R., Moro, M., ... Carta, M.
(2015). Suicidal ideation and mental health disor-
ders in young school children across Europe.
Journal of Affective Disorders,177, 28–35. doi:
10.1016/j.jad.2015.02.008
*Kramer, J., Conijn, B., Oijevaar, P., & Riper, H.
(2014). Effectiveness of a web-based solution-
focused brief chat treatment for depressed adoles-
cents and young adults: Randomized controlled
trial. Journal of Medical Internet Research,16,
e141. doi:10.2196/jmir.3261
*Kvarme, L. G., Helseth, S., Sørum, R., Luth-Han-
sen, V., Haugland, S., & Natvig, G. K. (2010). The
effect of a solution-focused approach to improve
self-efficacy in socially withdrawn school
children: A non-randomized controlled trial.
International Journal of Nursing Studies,47,
1389–1396. doi:10.1016/j.ijnurstu.2010.05.001
*LaFountain, R. M., & Garner, N. E. (1996).Solution-
focused counseling groups: A key for school coun-
selors. School Counselor,43, 256–268.
Lenz, A. S., Bruijn, B., Serman, N. S., & Bailey, L.
(2014). Effectiveness of cognitive processing ther-
apy for treating posttraumatic stress disorder. Jour-
nal of MentalHealth Counseling,36, 360–376. doi:
10.17744/mehc.36.4.1360805271967kvq
Lenz, A. S., Henesy, R., & Callender, K. (2016).
Effectiveness of seeking safety for co-occurring
PTSD and substance use. Journal of Counseling
& Development,94, 51–61.
Lipsey, M. W., & Wilson, D. B. (2001). Practical
meta-analysis. In L. Bickman & D. J. Rog (Eds.).
Thousand Oaks, CA: Sage.
*Littrell, J. M., Malia, J. A., & Vanderwood, M.
(1995). Single-session brief counseling in a high
school. Journal of Counseling & Development,
73, 451–458. doi:10.1002/j.1556-6676.1995.
tb01779.x
McKergow, M., & Korman, H. (2009). In between-
neither inside nor outside: The radical simpli-
city of solution-focused brief therapy. Journal
of Systemic Therapies,28, 34–49. doi:10.1521/
jsyt.2009.28.2.34
Mikolajewski, A. J., Allan, N. P., Hart, S. A., Loni-
gan, C. J., & Taylor, J. (2013). Negative affect
shares genetic and environmental influences with
symptoms of childhood internalizing and exter-
nalizing disorders. Journal of Abnormal Child
Psychology,41, 411–423. doi:10.1007/s10802-
012-9681-0
Schmit et al. 37
at TEXAS A&M UNIV CORPUS CHRISTI on May 2, 2016cor.sagepub.comDownloaded from
Miller, G., & de Shazer, S. (2000). Emotions in
solution-focused therapy: A re-examination.
Family Process,39, 5–23. doi:10.1111/j.1545-
5300.2000.39103.x
National Registry of Evidence-based Programs and
Practices. (2014). SAMSA’s national registry if
evidence-based programs and practices:
Solution-focused group therapy. Retrieved from
http://www.nrepp.samhsa.gov
Nes, R. B., Czajkowski, N. O., Roysamb, E., Orsta-
vik, R. E., Tambs, K., & Reichborn-Kjennerud,
T. (2013). Major depression and life satisfaction:
A population-based twin study. Journal of Affec-
tive Disorders,144, 51–58. doi:10.1016/j.jad.
2012.05.060
O’Neil, K. A., Conner, B. T., & Kendall, P. C.
(2011). Internalizing disorders and substance use
disorders in youth: Comorbidity, risk, temporal
order, and implications for intervention. Clinical
Psychology Review,31, 104–112. doi:10.1016/j.
cpr.2010.08.002
Quick, E. K., & Gizzo, D. P. (2007). The ‘‘doing
what works’’ group: A quantitative and qualita-
tive analysis of solution-focused group therapy.
Journal of Family Psychotherapy,18, 65–84.
doi:10.1300/J085v18n03_05
*Rakauskiene, V., & Dumciene, A. (2013). Altera-
tion of adolescent self-efficacy when applying
brief counseling at school. Social Behavior and
Personality,41, 893–900. doi:10.2224/sbp.
2013.41.6.893
Retzlaff, R., Sydow, K. V., Beher, S., Haun, M. W.,
& Schweitzer, J. (2013). The efficacy of systemic
therapy for internalizing and other disorders of
childhood and adolescence: A systematic review
of 38 randomized trials. Family Process,52,
619–652. doi:10.1111/famp.12041
*Richmond, C. J., Jordan, S. S., Bischof, G. H.,
& Sauer, E. M. (2014). Effects of solution-
focused versus problem-focused intake ques-
tions on pre-treatment change. Journal of
Systemic Therapies,33, 33–47. doi:10.1521/
jsyt.2014.33.1.33
Roeden, J. M., Maaskant, M. A., & Curfs, L. M. G.
(2014). Effectiveness of solution-focused coach-
ing of staff of people with intellectual disabil-
ities: A controlled study. Journal of Systemic
Therapies,33, 16–34. doi:10.1521/jsyt.2014.
33.2.16
Salum, G. A., DeSousa, D. A., Bosa, V. L., Schuch,
I., Goldani, M., Isolan, L. R., ... Manfro, G. G.
(2014). Internalizing disorders and quality of life
in adolescence: Evidence for independent asso-
ciations. Revista Brasileira de Psiquiatria,36,
305–312. doi:10.1590/1516-4446-2014-1362
Scott, C. K., Dennis, M. L., & Lurigio, A. J. (2015).
Comorbidity among female detainees in drug
treatment: An exploration of internalizing and
externalizing disorders. Psychiatric Rehabilita-
tion Journal,38, 35–44. doi:10.1037/prj0000134
*Seagram, B. C. (1997). The efficacy of solution-
focused therapy with young offenders (Doctoral
dissertation). Retrieved from ProQuest Disserta-
tions & Theses Global (NQ22928).
*Shin, S. K. (2009). Effects of a solution-focused
program on the reduction of aggressiveness and
the improvement of social readjustment for
Korean youth probationers. JournalofSocial
Service Research,35, 274–284. doi:10.1080/
01488370902901079
*Smock, S. A., Trepper, T. S., Wetchler, J. L.,
McCollum, E. E., Ray, R., & Pierce, K. (2008).
Solution-focused group therapy for level 1 sub-
stance abusers. Journal of Marital and Family
Therapy,34, 107–120. doi:10.1111/j.1752-0606.
2008.00056.x
Taylor,J.,Grant,K.,Amrhein,K.,Carter,J.,Farah-
mand, F., Harrison, A., ... Katz, B. (2014). The
manifestation of depression in the context of
urban poverty: A factor analysis of the Chil-
dren’s Depression Inventory in low-income
urban youth. Psychological Assessment,26,
1317–1332. doi:10.1037/a0037435
*Thorslund, K. W. (2007). Solution-focused group
therapy for patients on long-term sick leave.
Journal of Family Psychotherapy,18, 11–24.
doi:10.1300/j085v18n03_02
Wagley,J.N.,Rybarczyk,B.,Nay,W.T.,Danish,
S.,&Lund,H.G.(2013).Effectivenessof
abbreviated CBT for insomnia in psychiatric
outpatients: Sleep and depression outcomes.
Journal of Clinical Psychology,69, 1043–1055.
doi:10.1002/jclp.21927
*Wilmshurst, L. A. (2002). Treatment programs for
youth with emotional and behavioral disorders:
An outcome study of two alternative approaches.
Mental Health Services Research,4, 85–93. doi:
10.1023/a:1015200200316
38 Counseling Outcome Research and Evaluation 7(1)
at TEXAS A&M UNIV CORPUS CHRISTI on May 2, 2016cor.sagepub.comDownloaded from
*Zhang, W., Yan, T., Du, Y., & Liu, X. (2014). Brief
report: Effects of solution-focused brief therapy
group-work on promoting post-traumatic growth
of others who have a child with ASD. Journal
of Autism and Developmental Disorders,44,
2052–2056. doi:10.1007/s10803-014-2051-8
Author Biographies
Erika L. Schmit is an assistant professor in the
Department of Psychology, Counseling, and Special
Education at Texas A&M University–Commerce,
Commerce, TX.
Michael K. Schmit is a doctoral candidate in the
Department of Counseling and Educational Psychol-
ogy at Texas A&M University–Corpus Christi, Cor-
pus Christi, TX.
A. Stephen Lenz is an assistant professor in the
Department of Counseling and Educational Psychol-
ogy at Texas A&M University–Corpus Christi, Cor-
pus Christi, TX.
Schmit et al. 39
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