When I tell people I teach the SFBT social work course at the University of Denver, I usually get a good laugh. And I love that! I feel so seen as a psychodynamic, relational trauma-therapist, sometimes coined a “lifetime therapist.” I’m specifically referencing the word, “brief.” Trauma treatment is a lot of things and brief is not one of them! This is especially so when we are working with open wounds that are rooted in early childhood experiences of abuse and ruptures in attachments to caregivers. However, SFBT holds promise as effective in decreasing post-traumatic stress with its encouraging insistence in focusing instead upon post-traumatic growth. In addition, it is considered a strength-based treatment effective for a variety of populations.
SFBT is truly a social work model of providing intentional and compassionate care, honoring the tenent of self-determination (people know what is best for themselves). I also think of it as a framework for decency, presenting a wealth of tips and tricks on how we can talk to each other in a way that just makes us feel good. I loved my SFBT class and imagined using it more than I have. I explain to my students that my clinical training post-graduate school surprisingly contradicts many of the tenents and interventions of SFBT. I am honest in my explanation that though I do not use SFBT exclusively, I find it incredibly important and useful. Furthermore, I honor the SFBT practitioners that ascribe to the fidelity of the treatment as it was meant to be delivered. They have remained steadfast in their belief and training of SFBT despite the ebb and flow of the positive psychology movement, the misinformed insistence that deeper trauma processing (EMDR) is necessary for healing, and legislation making research findings difficult to submit for recognition. Federal funding was recently cut for the national registry providing oversight onto what constitutes as an evidenced-based treatment.
Most of us, especially mental health practitioners, can quickly embrace the philosophical underpinnings of SFBT. The main premise is that people have the internal resources they need to change or move further in the direction they desire. If external supports are limited, people hold the creativity, flexibility and learned experience to help navigate the current circumstances they find themselves in. There is a belief in the resiliency of humanity. I love that there is also a Buddhist principle incorporated into the philosophy as well: the idea that change is always happening. Life is already moving people toward change. SFBT is the vehicle to show clients that change is possible and that progress can happen in even a short amount of time. The interventions help to start the engine, but the therapist is not really needed once the car is in motion. This idea not only empowers the client, but is incredibly relieving for the therapist. A breath of fresh air, really!
The SFBT founders discovered how to shine light onto the seeds of the solution. This included searching for exceptions to the problems clients were presenting with. This idea was considered radical in the early 1990s! SFBT also helped shift the longstanding power dynamic of clinician vs. patient. It introduced the idea that clients are the experts of their own experiences. Interventions are surprisingly directive in that they are meant to evoke a series of responses that generate hope, possibility, and creativity. The client is pointed to reflect ongoing upon what they want out of therapy, where change is already happening, what future change may look/feel like, and how they have coped with previous difficulties.
SFBT’s evidenced-based interventions are comprised of a unique set of questions that correspond to different stages of therapy. There is precise focus upon language, using specific wording to elicit responses from clients likely to generate positive emotions. This includes practice visualizing and talking about a future in which the problem is gone or diminished in nature. Furthermore, SFBT therapists must really listen or“counsel with a constructive ear.”Within deep attunement, the therapist is searching for clues as they gather information about where or how to place their next intervention. There is an emphasis on silence, extending a radical trust that clients know their own answers. If they don’t, we assume our question was not asked correctly. In this way, the therapy is entirely client centered. This means there is no advice-giving, problem-solving, or hyperfocus upon negative emotions contributing to distress. SFBT is the intervention itself. Nothing else is needed aside from the client’s contributions and inherent wisdom. We help clients stretch their world, which in turn generates the hope that creates change. Positive psychology and hope theory greatly contribute to research findings regarding the effectiveness of SFBT.
In one SFBT immersive training, a participant arrived and thought to themselves, “What are all these social workers so happy about?” SFBT prevents stagnation in therapy and associated burn-out for therapists. If we believe that change is inevitable, we can’t feel helpless, frustrated or ineffective. When clients reflect upon their own resources and pursue change their way, there is decreased dependency upon us to provide solutions. When I shift gears into SFBT, even with longer-term clients, it is always such a refreshing pivot. There is more positive affect, laughter, and talk of possibility in response to my interventions. A SFBT colleague said to me, “I realized that it’s important to me that my clients leave sessions having experienced a myriad of positive emotions, feeling good!” It sounds simple, but the implementation of such is a profound game-changer from most therapeutic modalities that focus upon the excavation of trauma and leaning into the most tender of emotions. And yet, dipping one’s toe into joy and hope carries its own vulnerability.
Because of this, SFBT interventions are not always embraced by clients that have a rigid, painful narrative. This doesn’t mean SFBT is not appropriate. If anything, we understand how powerful this model will be for a client unable to visualize a future different than their current reality. In these cases, we must be diligent in shifting away from “problem-talk” and posing interventions to help create new neuropathways and what hope theory identifies as the “upward spiral effect.” Positive emotions and affect experienced in session generate positive thoughts. This increased flexibility in cognition frees up other important qualities that have gone dormant and are needed for even small behavior change. We shift conversation and associated emotions away from the well-worn grooves that give way to hopelessness, helplessness, and shame. In essence, SFBT is a way of communicating that increases likelihood for positivity, empowerment, and desired change. Over time with training and practice, these interventions become a natural byproduct of our recognition, admiration even, of a client’s innate resilience.
Of course, there are some limitations of SFBT, which is why I don’t feel inclined to abandon all my other training and use this model exclusively. I still value behavioral therapy when working with certain diagnoses. I am inspired by deeper trauma work and the re-processing, somatic modalities. I will continue to teach my clients about how or why they may struggle and give clinical recommendations or even “advice” as it feels appropriate. I like to create space for storytelling, even when that story is painful or feels repetitive. Yet, SFBT offers a unique dialectic here. The model makes space for the acknowledgment of what is (the traumatic experience, the story, the circumstances leading to therapy) while also holding and pointing to the power of possibility. SFBT asks, “What do you want instead of this?” The philosophy and interventions underscore the pillars of social work and celebrate our belief in humanity. I empower students to become fully trained in SFBT and enter that community exclusively because frankly, we need more social workers and clinicians facilitating evidence-based treatment with true fidelity. For established therapists, I advocate weaving SFBT interventions into what they are already doing as long as there is understanding this isn’t formal SFBT. I especially believe SFBT is necessary when feeling helpless in this work, forgetting the privilege we are granted very day in witnessing the power of transformation, even in seemingly subtle ways.
Here is a little SFBT activity to give you a taste of how we might tailor discussion to help clients identify what they want by also acknowledging the story of where they’ve been.
Begin by visualizing an art gallery with several different rooms. The first room represents the past. What color are walls? What kinds of paintings are hanging up? Is there a certain emotional tone to the space? Now, imagine a room representing your current circumstances, reflecting upon the same questions. If there is a blankness coming forth, that’s okay as that might be part of the experience. Now, visualize a future room that contains your “best hopes” for the future. In addition to colors, textures and art, is there anybody in the room? What emotional qualities do you hope to include in this space? What else?
Finally, one of my favorite SFBT interventions is the use of coping questions and “searching for exceptions.” Beginning a session in this way might sound like,
What’s better since we last met? When or what did you notice was better? How long did the better last? If things aren’t better, how did you prevent things from getting worse? What role did you play? What were you pleased with that you want more of? What did you notice you were somehow pleased with even as things were getting worse? What are you most proud of? How did you hold onto enough hope to come back and keep at this?
Can you see? There are no wrong answers. “Nothing” or “I don’t know” aren’t roadblocks or signs of client “resistance” because we aren’t trying to get the client to DO anything. We just get to ask another question. And so it goes!