Use of Solution‐Focused Brief Therapy Within Adult Community Mental Health: A Scoping Review

ABSTRACT

Background

Solution‐focused brief therapy is a growing practice within adult community mental health that focuses on enhancing the person's sense of hope in achieving their desired outcome. The aim of this scoping review was to better understand the breadth of empirical literature related to the use of solution‐focused brief therapy in community adult mental health practices.

Materials and Methods

We conducted a scoping review according to PRISMA‐ScR guidelines. PsychINFO, MEDLINE and CINAHL were searched on 3rd February 2025. Original research papers focusing on adults receiving solution‐focused brief therapy in a community mental health context that were published in English were included. Studies in emergency departments, general practice, or inpatient mental health units were excluded. The following characteristics of each study were extracted: author(s), year, design, country, aims, population, intervention tested, outcomes measured and major findings.

Results

After removal of duplicates, the search returned 1468 citations. Of these, 20 studies were identified. Study designs included randomised trials, quasi‐experimental studies, observational studies and qualitative narrative analysis. All studies demonstrated the effectiveness of the use of solution‐focused brief therapy within adult community mental health settings, achieving positive health outcomes. In some randomised trials, a more rapid or more effective response was found when compared with other interventions.

Conclusion

This scoping review mapped the empirical evidence available for the use of solution‐focused brief therapy in adult community mental health settings. A small number of empirical investigations were identified overall. Solution‐focused brief therapy was associated with positive outcomes across various domains including psychiatric symptoms and improving psychosocial functioning. More empirical research focusing on process, comparative studies and broader populations within adult community mental health would strengthen the evidence base and generalisability of solution‐focused brief therapy.

Summary

• There was empirical evidence on the use of solution‐focused brief therapy in adult community mental health.

• Positive outcomes were seen across numerous measures in several countries.

• In some randomised trials, solution‐focused brief therapy yielded an earlier or more effective response when compared with other interventions.

• More empirical research focusing on process, comparative studies and broader populations within adult community mental health would strengthen the evidence base and generalisability of solution‐focused brief therapy.

1. Introduction

Solution‐focused brief therapy, often referred to as the solution‐focused approach or solution‐focused therapy, was developed at the Brief Family Therapy Centre, Milwaukee, United States, in the 1980s by Steve deShazer, Insoo Kim Berg and colleagues (Franklin et al. 2024). Since its inception, solution‐focused brief therapy has been further developed and evolved in several contexts including mental or behavioural health, psychotherapy, health and social care, coaching and business (Iveson and McKergow 2016). To help conceptualise recent understandings of solution‐focused brief therapy in adult mental health research, a conceptual framework of solution‐focused brief therapy (Jerome et al. 2023) has been developed. The framework offers a coherent understanding of solution‐focused brief therapy techniques, the mechanisms by which they work and how the key principles can be used in adult mental health setting (Jerome et al. 2023). The underlying assumptions (Jerome 2026) of solution‐focused brief therapy include the following: that change is happening constantly and the client has the resources and skills to help them achieve the change they want (their preferred future). The practitioner's role is to ‘lead from one step behind’ acknowledging the client is the expert in their life and in the session (Shah et al. 2024) and to trust in the person that they will have best hopes and will focus on what matters to them (Shah et al. 2024). The practitioner strives to ‘leave no footprint’ in the client's life as they trust and believe in the person being capable of change. This is both empowering for the client and honours their agency (Jerome 2026). DeShazer and Berg found that for clients to function better and be satisfied with therapy, it was not necessary to analyse and focus on the details of problems (Vermeulen‐Oskam et al. 2024). Instead of focusing on the problem, solution‐focused brief therapy works with the person to build a description of their preferred future, incorporating the person's strengths in the change they want. This nonnormative approach seems simple; however, the principles and assumptions require a paradigm shift for mental health practitioners. It is different from the usual approach in clinical mental health of directing an interaction involving risk assessment, formulation of the person's difficulties and problems and ‘prescribing’ (in collaboration with the client) actions and goals to be followed by the client (Shah et al. 2024). The foundations of solution‐focused brief therapy include asking someone about their best hopes and their subsequent desired outcome from the conversation or meeting. This approach uses the client's language, in co‐constructing conversations, focusing on detailed descriptions related to the desired outcome. Some types of description might include what the person already notices that fits with their desired outcome (Kort et al. 2021), the history of them having experienced the change or outcome, the person's resources (instead of deficits) and their preferred future in which the desired outcome is occurring in their everyday life (Connie and Froerer 2023).

Several systematic reviews and metanalyses have supported the effectiveness of solution‐focused brief therapy (Franklin et al. 2024; Vermeulen‐Oskam et al. 2024; Zak and Pękala 2025). An umbrella review of systematic reviews and meta‐analyses (Zak and Pękala 2025) reported that solution‐focused brief therapy can be used with high confidence, in relation to its impact, on adults progressing towards personal treatment goals; and as ‘an effective therapeutic intervention’ for adults' overall mental health and symptoms of depression. It was also reported that regardless of the age or age group, it was potentially effective for issues such as ‘internalising, social, medical, self‐aspects and hope’ (Zak and Pękala 2025).

Neipp and Beyebach (2022) highlighted the effectiveness of solution‐focused brief therapy in various contexts. They reported that the majority (86.3%) of 251 solution‐focused brief therapy studies had positive outcomes. They also found that there was no harm in using solution‐focused approaches. Their data suggested it was ‘ethically safe’ to research solution‐focused brief therapy in new practice settings whilst comparing it with treatment as usual. Most of the studies that used solution‐focused brief therapy achieved superior results compared with controls, including when comparing solution‐focused brief therapy with alternative therapies whether with treatment as usual, no treatment, or waiting list (Neipp and Beyebach 2022). Whilst there has been a paucity of outcome research for the use of solution‐focused brief therapy in adult community mental health settings, an example of a report on the use of solution‐focused brief therapy in areas of adult mental health reported ‘good outcome’ in 70% of people (MacDonald 2005).

There have been many factors contributing to the success of solution‐focused brief therapy (Jerome 2026). Firstly, it has been based on what is important to the client and what they choose to work on; therefore, the approach is adaptable and generic. Also, the assumption that change will happen and the focus on the present (instead of causes of the problem) empowered and motivated clients to make change for the better. Instead of the practitioner highlighting the need for the client to change deficits in themselves, the client feels empowered and motivated by the acceptance of their worldview and the practitioner's assumption they have the resources to make the changes to head towards their preferred future. Jerome (2026) expanded further that the power of a person hearing and describing what they want because of questions about their best hopes could create lasting change. These areas in conjunction with the realisation that problems do not happen all the time offered a context to shift perceptions from feeling overwhelmed by problems to being capable and able of managing despite the problem and subsequently seeing possibilities of a better future (Jerome 2026). Zak and Pękala (2025) highlighted further benefits of solution‐focused brief therapy included its shorter duration; thus, it was more cost‐effective for people seeking therapy (Gingerich and Peterson 2013) and public health systems (Medina et al. 2022). Additionally, practitioners were at lower risk of burnout when practicing solution‐focused brief therapy (Medina and Beyebach 2014).

Use of solution‐focused brief therapy would be ideal in the community mental health setting given the effectiveness, positive outcomes, benefit to all socioeconomic groups (Kim and Franklin 2015) and ethno‐racial backgrounds (Lee 2003). In Australia, offering such an effective approach to people in the community would be in keeping with recommendations from the Royal Commission into Victoria's Mental Health System (the Commission) (State Government of Victoria 2024). This philosophy has been shared by the World Health Organisation (World Health Organization 2022). The Commission stated their vision was promoting mental health and well‐being services, predominantly reoriented to community support, care and treatment (State Government of Victoria 2024). The Commission highlighted the benefit of people choosing care close to their families, carers, homes and communities, that is, community mental health. Furthermore, in the future, community‐based mental health and well‐being services ‘will offer the full range of supports that people living with mental illness or psychological distress need in order to recover and lead contributing lives’ (State Government of Victoria 2024). Solution‐focused brief therapy offered in community adult mental health would be ideal to support these people. For this paper, the definition of community mental health is when clinical service activities are undertaken in the community (not in institutional, hospital or inpatient settings) to promote mental health well‐being and recovery. It is designed to meet mental health needs in the community within a geographical area that offers public, clinical services (American Psychological Association 2018).

According to Australian Bureau of Statistics (ABS) (Australian Bureau of Statistics 2020), 42.9% of Australians aged 16–85 years have experienced a mental disorder in their lifetime, with 17.4% of Australians aged 16–85 years having seen a health professional for their mental health in the 12 months prior to ABS study interview. Adult community mental health and well‐being services (for people aged 26 years and older) in Victoria, Australia, have offered treatment and support to some of these people. Solution‐focused brief therapy could be one of those treatments and supports offered, given that adults benefited more from solution‐focused brief therapy than children and adolescents (Vermeulen‐Oskam et al. 2024).

The motivation for this scoping review originated from the use of solution‐focused brief therapy in an adult community mental health and well‐being service in metropolitan Melbourne, Victoria, Australia. Observations of outcomes from the use of solution‐focused practice in this cohort have been positive. There have been several nonempirical sources of evidence of the use and effectiveness of solution‐focused brief therapy in adult community mental health internationally (Bakker et al. 2010; Taylor et al. 2010). The researchers have undertaken this scoping review to better understand the breadth of empirical sources of evidence on the use of solution‐focused brief therapy in adult community mental health.

Through this scoping review, the researchers intended to assess the extent of empirical literature related to the use of solution‐focused brief therapy in adult community mental health practice. Through reviewing existing research and identification of emerging trends, gaps in the literature could be identified. It will offer a broad picture and insights to enhance understanding in practitioners, researchers and policymakers and ideally support future research in solution‐focused brief therapy in adult community mental health whilst also informing policymakers when considering solution‐focused brief therapy in models of care and resource allocation.

1.1. Objectives

The aim of this scoping review was to assess the extent of empirical literature related to the use of solution‐focused brief therapy in community adult mental health practice.

2. Method

2.1. Design

A scoping review protocol was used to understand the breadth and nature of the published research related to the use of solution‐focused brief therapy in community adult mental health settings. This scoping review was guided by the methodological framework developed by Arksey and O'Malley (2005). The results have been reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses extension for scoping reviews (PRISMA‐ScR) (Tricco et al. 2018). The scoping review protocol was not registered.

2.2. Eligibility Criteria

Original research papers written in English and focused on individual adults receiving only solution‐focused brief therapy (with or without comparators) in a community mental health context were included in this scoping review. To address the aim of this scoping review, the following structure was used: Population: patients who received solution‐focused brief therapy in community settings; intervention: solution‐focused brief therapy; comparator: nil or other forms of therapy; outcomes: would be determined by the results of the scoping review. Studies of the use of solution‐focused brief therapy in emergency departments, general practice, hospitals and inpatient mental health units were excluded because the researchers specifically wanted to understand the use of solution‐focused brief therapy in adult community mental health. Populations of children, groups, couples or families were excluded because the researchers specifically wanted to understand the use of solution‐focused brief therapy in adult community mental health for individual adults. Review papers, letters, editorials, commentaries, discussion papers, textbooks, book chapters, opinion papers, theses, conference abstracts, single case studies, case studies and case reports were also excluded.

2.3. Search Strategy

The following databases were searched on 28th January 2025: PsychINFO via OVID, MEDLINE via OVID and Cumulative Index to Nursing and Allied Health Literature (CINAHL) via OVID. Date limiters were set to include studies published after 1970. Forward (searching for articles that cited included studies) and backward (search of reference lists of included studies) citation searching was conducted. The full search strategy is available in Appendix S1.

2.4. Study Selection

EndNote X8 (The Endnote Team 2016) was used to identify and remove duplicates. Citations were uploaded into an online screening application, Rayyan (Ouzzani et al. 2016), that enabled blinded, independent screening of titles and abstracts against the inclusion criteria by two authors. Full‐text articles assessed as potentially eligible for inclusion in this scoping review were independently screened against the inclusion criteria. Disagreements were resolved through discussion and consensus.

2.5. Data Charting

Data were extracted by two authors (XX and XX [redacted for anonymity]). Characteristics of each study were extracted individually by authors and then compared. The following characteristics of each study were charted using a tool designed for this review: author(s), year of publication and country of origin, study design, aims of the study, population, interventions tested, outcomes examined and major findings.

3. Results

3.1. Selection of Sources of Evidence

After removal of duplicates, the search returned 1468 citations. Of these, 1426 citations were excluded based on reviewing titles and abstracts against the inclusion criteria that resulted in 42 full text citations to be further screened for eligibility. Of these, 22 studies were excluded. Nine studies were excluded based on the population studied, seven studies were excluded as they were the incorrect publication type and six studies were excluded based on their study design. In total, 20 publications were identified for inclusion. See Figure 1 for the PRISMA flow diagram.

FIGURE 1.

PRISMA flow diagram.

A hand search of reference lists of included articles was also completed. No records meeting eligibility were found through this search.

3.2. Characteristics of Included Studies

A summary of the 20 studies included in this scoping review are presented in Table 1. All 20 studies presented data from adult population groups who had accessed community mental health settings or outpatient settings. Of the 20 studies, 15 used the same data collected as part of the Helsinki Psychotherapy Study (Knekt et al. 2004, 2010, 2013, 2015, 2016, 2017; Knekt, Lindfors, Laaksonen, et al. 2011; Knekt, Lindfors, Renlund, et al. 2011; Knekt, Lindfors, Härkänen, et al. 2008; P. Knekt, Lindfors, Laaksonen, et al. 2008; Laurila et al. 2024; Lindfors et al. 2012, 2015; Maljanen et al. 2016; Marttunen et al. 2008; Valkonen et al. 2011). Majority of studies (75%) were published between 2008 and 2017, which coincided with the Helsinki Psychotherapy Study, whilst 35% of studies were published within the last decade. The countries of origin were Finland (Knekt et al. 2010, 2013, 2015, 2016, 2017; Knekt, Lindfors, Härkänen, et al. 2008; Knekt, Lindfors, Laaksonen, et al. 2008, 2011; Knekt, Lindfors, Renlund, et al. 2011; Lindfors et al. 2012, 2015; Marttunen et al. 2008; Valkonen et al. 2011; Laurila et al. 2024), Canada (Mireau and Inch 2009), India (Koorankot et al. 2022), United States of America (Cooper et al. 2024) and United Kingdom (Macdonald 1997; MacDonald 2005). Seventy percent of the studies included were based on samples with a higher prevalence of females than males (i.e. more than 51% of the sample), and 25% of the studies did not report on participants’ gender. Other demographic characteristics (such as ethnicity, education, relationship status) were reported less frequently, and therefore, no summation of these characteristics could be made. Sample size of the studies ranged from 14 to 367 participants. Fourteen of the studies were randomised trials (Knekt et al. 2010, 2013, 2015, 2016, 2017; Knekt, Lindfors, Härkänen, et al. 2008; Knekt, Lindfors, Laaksonen, et al. 2008; Lindfors et al. 2012, 2015; Maljanen et al. 2016; Marttunen et al. 2008, Koorankot et al. 2022; Laurila et al. 2024; Cooper et al. 2024), two quasi‐experimental studies (Knekt, Lindfors, Laaksonen, et al. 2011; Knekt, Lindfors, Renlund, et al. 2011), three were observational studies (Macdonald 1997; MacDonald 2005; Mireau and Inch 2009) and one was a qualitative narrative analysis (Valkonen et al. 2011). Outcomes reported included psychiatric symptoms (n = 7) (Knekt et al. 2013, 2016; Knekt, Lindfors, Härkänen, et al. 2008; Knekt, Lindfors, Laaksonen, et al. 2011; Mireau and Inch 2009), psychosocial functioning (n = 6) (Knekt et al. 2013, 2015, 2016, 2017; Knekt, Lindfors, Laaksonen, et al. 2008), work ability (n = 5) (Knekt et al. 2013, 2016, 2017; Knekt, Lindfors, Laaksonen, et al. 2008, 2011), sense of coherence (n=1) (Knekt et al. 2016), quality of life (n = 1) (Knekt et al. 2015), use of auxiliary treatment (n = 1) (Knekt, Lindfors, Renlund, et al. 2011), level of personality organisation (n = 1) (Knekt et al. 2017), indicators of physical health and lifestyle (n = 1) (Knekt et al. 2010), self‐concept (n = 1) (Lindfors et al. 2012), cost effectiveness (n = 1) (Maljanen et al. 2016), self‐reported ‘good outcome’ (n = 2) (Macdonald 1997; MacDonald 2005), views and experiences of psychotherapy (n = 1) (Valkonen et al. 2011), perceived social support (n = 1) (Laurila et al. 2024) and predictors of remission (n = 1) (Marttunen et al. 2008).

TABLE 1.

Data extraction.

Author, year, country of origin	Study design	Aims	Setting	Population, sample size	Intervention(s) tested	Outcomes measured	Major findings
Koorankot. J., Moosa A.,· Adam Froerer A., Rajan S K., 2022, India	Randomised trial	To examine the effects of solution‐focused questions versus problem‐focused questions on affect and processing speed in individuals suffering from depression	Outpatients	Aged 18–50 years, diagnosed with depression (DSM‐V criteria) and referred to undergo psychological interventions. N = 60 Equal female and male	Solution‐focused question group (n = 20): Exposed to solution‐focused questions for approximately 30 min versus problem‐focused questions (n = 20): Exposed to problem‐focused questions for approximately 30 min versus delayed experimental (n = 20): Subsequently offered supportive psychotherapeutic conversation Questions adapted from Neipp et al (2015)	Psychiatric symptoms: To measure affect (positive affect broadens perspective, builds resources for adaptive coping): Positive and Negative Affect Schedule (PANAS) Processing speed (indicative of adaptive coping): Wechsler adult intelligence scale‐IV (WAIS‐IV)	For inducing the desired changes in affect and processing speed in individuals with depression solution‐focused questions are preferable to problem‐focused questions. Solution‐focused question group—positive affect improved; negative affect decreased significantly; improved coding and significant improvement in symbol search test performance compared with problem‐focused questions and delayed experimental group Problem‐focused questions were less capable of influencing the affect Limitation—Authors stated ‘requires validation through replication before generalising the findings in a broader application‐oriented perspective’
Laurila, M., Lindfors, O., Knekt, P & Heinonen, E., 2024, Finland	Randomised trial	To examine whether the changes in perceived social support differ between three different individual psychotherapy approaches	Outpatients	Patients aged 20–45 years, living with depressive or anxiety disorders (DSM‐IV criteria) 459 considered eligible 133 refused to participate. n = 326 25% male, 75% female	Solution‐focused therapy (SFT) (n = 97) (limit 12 sessions over no more than 8 months) versus short‐term psychodynamic psychotherapy (SPP) (n = 101) (20 weekly sessions for 5–6 months) versus long‐term psychodynamic psychotherapy (LPP) (n = 128) (2–3sessions per week for up to 3 years)	Perception of social support: Brief Inventory of Social Support and Integration (BISSI) (self‐report of social network size, satisfaction in social support and relations, perceived availability of emotional support from family, friends and professionals)	Minor difference appeared in slightly faster rate of improvement in SFT versus SPP in the BISSI subscales of satisfaction with support and support from family during 1 and 2‐year follow‐up points. All three groups showed an improvement in perceived social support. Whilst there was no statistically significant difference between the three therapy groups; improved results were seen in the LPP group versus the SPP group at 1 and 3 years; however, no difference seen between the LPP and SFT groups, despite average treatment dosage for SFT being less than SPP.
Cooper, Z. W., Mowbray, O., Ali, M. K and Johnson, L. C. M., 2024, United States	Randomised trial	To examine efficacy of SFBT intervention for depression and co‐occurring health disorders and for addressing anxiety and improving overall bel‐being	Outpatient Rural Federal Qualified Health Centre	Patients with > 10 on PHQ‐9 within past 5 months 373 patients 142 eligible. 40 in the control group (33 completed baseline intervention) and 40 in the treatment group (35 completed baseline intervention)	Solution‐focused brief therapy (n = 35) (limit three sessions of 20 30 min over 3 weeks using SFBT questioning) versus treatment as usual (n = 33) (limit three sessions of 20‐30 mins over 3 weeks using problem focused assessment)	Symptoms of depression: Nine‐Patient Health Questionnaire (PQH‐9) Health outcomes: Body mass index Blood pressure HbA1c measurement Symptoms of anxiety: Generalised Anxiety Disorder 7 (GAD‐7) Well‐being: Flourishing Index SFBT attributes: The SFBT scale	The SFBT intervention group showed clinically significant reduction of depressive symptoms and anxiety symptoms compared with treatment as usual. The SFBT group showed improved well‐being compared with treatment as usual. No significant difference observed in physical health outcomes.
Knekt P., Lindfors O., Keinänen M., Heinonen E., Virtala E. and Härkänen T., 2017, Finland	Randomised trial	To investigate the prediction of the level of personality organisation (LPO) on changes in psychiatric symptoms and work ability in short‐ versus long‐term psychotherapies during a 5‐year follow‐up Adult, English speaking, co‐occurring medical diagnosis	Outpatients	Patients aged 20–45 years, living with depressive or anxiety disorders (DSM‐IV criteria) 459 considered eligible 133 refused to participate. n = 326 25% male, 75% female	SFT (n = 97) (limit 12 sessions over no more than 8 months) versus SPP (n = 101) (20 weekly sessions for 5–6 months) versus LPP (n = 128) (2–3 sessions per week for up to 3 years)	Psychiatric symptoms (depressive and anxiety symptoms) Beck Depression Inventory (BDI) Hamilton Depression Rating Scale (HDRS) Symptom Checklist Anxiety Scale (SCL‐90‐Anx) Hamilton Anxiety Rating Scale (HAMA) Global Severity Index SCL‐90‐GSI Work Ability Index (WAI) Work‐subscale (SAS‐Work) of the Social Adjustment Scale SAS‐SR Psychosocial functioning Perceived Psychological Functioning Scale (PPF) Global Assessment of Functioning (GAF) Personality organisation: Level of Personality Organization Scale	SFT and SPP, in patients experiencing neuroses, were associated with a more rapid reduction of symptoms and increase in work ability, whereas LPP was more effective for longer follow‐ups in patients with poor and good levels of personality organisation. At 60 months, patients who received SFT had significantly higher scores for WAI (39.6 vs 38.2) than the LPP group.
Knekt, P., Virtala, E., Harkanen, T., Vaarama, M., Lehtonen, J., Lindfors, O., 2016, Finland	Randomised trial	To compare the effectiveness of solution focused therapy and short‐term and LPP at a 10‐year follow up with regard to psychiatric symptoms, work ability, personality and social functioning, need for treatment and remission.	Outpatients	Patients aged 20–45 years, living with depressive or anxiety disorders (DSM‐IV criteria) 459 considered eligible 133 refused to participate n = 326 25% male, 75% female	SFT (n = 97) (limit 12 sessions over no more than 8 months) versus SPP (n = 101) (20 weekly sessions for 5–6 months) versus LPP (n = 128) (2–3 sessions per week for up to 3 years)	Psychiatric symptoms: Symptom Checklist (SCL‐90) Psychosocial functioning (personality and social functioning): Structural Analysis of Social Behaviour (SASB) Defence Style Questionnaire (DSQ) Inventory of Interpersonal Problems (IPP) Social Adjustment Scale (SAS‐SR) Work ability: Social Adjustment Scale (SAS‐SR) Sense of coherence Sensory of Coherence Scale	A statistically significant change from baseline to the end of the 10‐year follow‐up was seen in all measures and in all therapy groups. No notable differences in effectiveness between SFT and SPP were observed. At 10‐year follow‐up: General psychiatric symptoms and depressive symptoms were significantly more effectively reduced in the LPP group than in the SPP group. Work ability was significantly more improved in the LPP than in the SPP group. Employment percentage was not significantly improved in any therapy group, and no differences between the groups were seen.
Maljanen T., Knekt P., Lindfors O., Virtala E., Tillman P., Härkänen T. and The Helsinki Study Group, 2016, Finland	Randomised trial	To compare the cost‐effectiveness of two short‐term therapies, SFT and SPP, with that of LPP in the treatment of depressive and anxiety disorders during a 5‐year follow‐up.	Outpatients	Patients aged 20–45 years, living with depressive or anxiety disorders (DSM‐IV criteria) 459 considered eligible 133 refused to participate. n = 326 25% male, 75% female	SFT (n = 97) (limit 12 sessions over no more than 8 months) versus SPP (n = 101) (20 weekly sessions for 5–6 months) versus LPP (n = 128) (2–3 sessions per week for up to 3 years)	Cost effectiveness measured by: Direct costs due to treatment of mental disorders. Indirect costs caused by mental disorders. Direct costs due to non‐mental disorders consisting of cost of treatments for somatic disorder. Indirect cost due to non‐mental disorders.	Short‐term therapies are more cost‐effective than long‐term therapy. This is mainly because the therapy costs of short‐term therapies are much lower than the therapy costs of long‐term therapy. This significant difference was mainly due to greater costs of the LPP sessions, indicating a mean difference of more than 11,000 euros compared with the costs of the SFT or SPP sessions.
Knekt, P., Heinonen, E., Harkapaa, K., Jarvikoski, A., Virtala, E., Rissanen, J., Lindfors, O., The Helsinki Psychology Study Group, 2015, Finland	Randomised trial	To compare the effectiveness of solution focused therapy and short‐term and LPP over a 5‐year period with regard to psychosocial functioning and life quality.	Outpatients	Patients aged 20–45 years, living with depressive or anxiety disorders (DSM‐IV criteria) n = 326 25% male, 75% female	SFT (n = 97) (limit 12 sessions over no more than 8 months) versus SPP (n = 101) (20 weekly sessions for 5–6 months) versus LPP (n = 128) (2–3 sessions per week for up to 3 years)	Psychosocial functioning: Social Adjustment Scale (SAS‐SR) Sense of Coherence Scale (SOC) Self‐Performance Survey Life Orientation Test (LOT) Life quality: Life Situation Survey (LSS)	SFT and SPP showed faster improvements in psychosocial functioning and quality of life than LPP (LOT and Self‐Performance Survey was neutral). First‐year follow‐up: SFT showed a statistically significantly more considerable improvement in psychosocial functioning in comparison to LPP. Life quality improved faster in both SFT and SPP groups than LPP. Five‐year follow‐up: LPP showed statistically significantly more improvement with SOC and perceived competence. No differences found in Life Quality found between SFT, SPP and LPP No direct differences noted between SFT and SPP.
Lindfors O., Knekt P., Heinonen E., Härkänen T. and Virtala E., 2015, Finland	Randomised trial	Compared the effects of two short‐term therapies and LPP on patients’ personality functioning during a 5‐year follow‐up.	Outpatients	Patients aged 20–45 years, living with depressive or anxiety disorders (DSM‐IV criteria)n = 326 459 considered eligible 133 refused to participate. Mean dropout rate over nine measurement occasions during the follow‐up was 16% in the SFT, 14% in the SPP and 11% in the LPP group 25% male, 75% female	SFT (n = 97) (limit 12 sessions over no more than 8 months) versus SPP (n = 101) (20 weekly sessions for 5–6 months) versus LPP (n = 128) (2–3 sessions per week for up to 3 years)	Psychiatric symptoms (depressive and anxiety symptoms) BDI Symptom Check List Global Severity Index) Symptom Check List Anxiety Scale Psychosocial functioning SASB Defence Style Questionnaire (DSQ) Interpersonal Problems (IIP) Level of Personality Organization (LPO) Scale	SFT showed earlier reduction of interpersonal problems. Both SFT and SPP better than LPP during the first year of follow‐up. No differences between the short‐term therapies. Personality functioning improved in all therapy groups.
Knekt, P., Lindfors, O., Sares‐Jaske, L., Virtala, E, Harkanen, T., 2013, Finland	Randomised trial	To compare the effectiveness of solution focused therapy and short‐term and LPP over a 5‐year period with regard to psychiatric symptoms and work ability.	Outpatients	Patients aged 20–45 years, living with depressive or anxiety disorders (DSM‐IV criteria) n = 326 25% male, 75% female	SFT (n = 97) (limit 12 sessions over no more than 8 months) versus SPP (n = 101) (20 weekly sessions for 5–6 months) versus LPP (n = 128) (2–3 sessions per week for up to 3 years)	Psychiatric symptoms (depressive and anxiety symptoms) BDI HDRS Symptom Check List anxiety scale (SCL‐90‐Anx) HAMA Symptom Check List Global Severity Index (SCL‐90‐GSI) Psychosocial functioning Perceived Functioning Scale (PPF) Work ability WAI Social Adjustment Scale, work subscale (SAS‐Work)	One‐year follow‐up: WAI and PFF improved more in SFT and SPP in the first 7 months SPP treated patients recovered faster from both depressive and anxiety symptoms and SFT treated patients recovered faster from depressive symptoms than patients receiving LPP. Three‐year follow‐up: Patients treated with LPP had a stronger treatment effect for both depressive and anxiety symptoms compared with SPP and SFT. WAI and PFF more improved in patients treated with LPP Four‐ and 5‐year follow‐up: All excess effects on psychiatric symptoms of LPP treated patients seen at 3‐year follow‐up point had disappeared at 5‐year follow‐up with exception of HAMA in comparison to SFT. WAI and PFF continued to be more improved in LPP in comparison to SPP and SFT. Number of sick‐leave days was smaller in the LPP group than in the SFT group at the 4‐year follow‐up point. No differences between the short‐term therapies were found for any outcome variable at any measurement point.
Lindfors, O., Knekt, P., Virtala, E., Laaksonene, M. and the Helsinki Psychotherapy Study Group, 2012, Finland	Randomised trial	To compare change in self‐concept following treatment of either solution focused therapy, SPP and LPP after a 3‐year period	Outpatients	Patients aged 20–45 years, living with depressive or anxiety disorders (DSM‐IV criteria) N = 326 25% male, 75% female	SFT (n = 97) (limit 12 sessions over no more than 8 months) versus SPP (n = 101) (20 weekly sessions for 5–6 months) versus LPP (n = 128) (2–3 sessions per week for up to 3 years)	Self‐concept SASB	Statistically significant improvement found for all therapy groups for both of the primary indicators AF (self‐attack/self‐love axis) and AU (self‐control–self‐free axis) and for the eight secondary indicators (self‐free, self‐affirm, self‐love, self‐protect, self‐control, self‐blame, self‐attack, self‐neglect). Significant improvement was mostly noticed at the 7‐month follow‐up for both the short‐term therapy groups. Primary indicators: During the first year, SFT and SPP had more beneficial effect on AF and AU than did LPP. During the second year, no significant differences were found between any of the therapy groups. During the third year, LPP showed significantly more improved values in AF than in SFT. Secondary indicators: During first year, SFT performed better than LPP in five of the eight cluster scores showing faster improvement toward a more affectionate and accepting self‐concept. SFT showed earlier improvement (at 7 months in self‐affirmation in comparison with LPP and SPP, greater improvement in self‐blame compared with LPP, and greater improvement in self‐protect compared with SPP. During the third year, LPP showed increased self‐acceptance. SPP also shown to have more long‐term improvement in self‐attack than SFT.
Knekt, P., Laaksonen, M. A., Raitasalo, R., Haaramo, P, Lindfors, O., 2010, Finland	Randomised trial	To compare spontaneous change in lifestyle in patients with anxiety and depression during and after treatment when receiving either SFT, SPP and LPP.	Outpatients	Patients aged 20–45 years, living with depressive or anxiety disorders (DSM‐IV criteria) n = 326 25% male, 75% female	SFT (n = 97) (limit 12 sessions over no more than 8 months) versus SPP (n = 101) (20 weekly sessions for 5–6 months) versus LPP (n = 128) (2–3 sessions per week for up to 3 years)	Indicators of physical health and lifestyle Alcohol consumption BMI Serum cholesterol (total and HDL) Smoking Leisure time exercise	Alcohol consumption in the SFT group lower than SPP. After 7 months increased with the SPP group with significantly higher levels at later follow‐up points in comparison with the SFT and LPP groups. Decrease in smoking in the SFT group in comparison with the SPP group. No differences found leisure‐time exercise between therapy groups. Serum cholesterol increased significantly in the SPP group and higher values were found in SPP than in the LPP group at 36 months. BMI increased 3% in all three therapy groups.
Knekt, P., Lindfors, O, Harkanen, T., Valikoski, M., Virtala, E., Laaksonen, M. A., Martunen, M., Kaipainen, M., Renlund, C., 2008, Finland	Randomised trial	To compare the effectiveness of solution focused therapy and short‐term and LPP in the treatment of mood and anxiety disorders over a 3‐year period.	Outpatients	Patients aged 20–45 years, living with depressive or anxiety disorders (DSM‐IV criteria) n = 326 25% male, 75% female	SFT (n = 97) (limit 12 sessions over no more than 8 months) versus SPP (n = 101) (20 weekly sessions for 5–6 months) versus LPP (n = 128) (2–3 sessions per week for up to 3 years)	Psychiatric symptoms (depressive and anxiety symptoms) BDI HAMD SCL‐90‐Anx HAMA Symptom Checklist Global Severity Index (SCL‐90‐GSI)	A statistically significant reduction of symptoms was noted in all three therapy groups for BDI (51 %), HAMD (36 %), SCL‐90‐Anx (41%) and HAMA (38%) during the 3‐year follow‐up. During the first year; SFT was noted to be more effective than LPP with faster reduction of depressive symptoms. In first 3–7 months; SFT was noted to more rapidly decrease depressive symptoms than SPP. During the second year; no significant differences were found between the SFT, SPP and LPP. During the third year, LPP was more effective than short‐term therapies. No statistically significant differences were found in the effectiveness of the short‐term therapies.
Knekt, P., Lindfors, O., Laaksonen, M., Raitasalo, R., Haaramo, P., Javikoski, A., 2008, Finland	Randomised trial	To compare the effectiveness of solution focused therapy and short‐term and LPP on workability and functional capacity over a 3‐year period	Outpatients	Patients aged 20–45 years, living with depressive or anxiety disorders (DSM‐IV criteria) n = 326 25% male, 75% female	SFT (n = 97) (limit 12 sessions over no more than 8 months) versus SPP (n = 101) (20 weekly sessions for 5–6 months) versus LPP (n = 128) (2–3 sessions per week for up to 3 years)	Work ability WAI Work‐subscale of the Social Adjustment Scale (SAS‐work) Perceived Psychosocial Functioning Scale Psychosocial functioning (functional capacity) 10 item self‐report scale	Work ability was statistically significantly improved across all three therapy groups at the 3‐year follow‐up. No differences in the work ability scores were found between SPP and SFT. The SFT and SPP showed more improved work ability scores than LPP at the 7 months. At 2 years, no significant differences were found between therapies. After 3 years of follow‐up, LPP was found to be more effective than SFT/SPP.
Marttunen M., Välikoski M, Lindfors O., Laaksonen M. A. and Knekt P., 2008, Finland	Randomised trial	To ascertain which factors determine remission after treatment with either SPP or SFT after a 1‐year follow‐up; focusing on the mutual importance of predictors of remission and on their importance in relation to the form of therapy after a 1‐year follow‐up	Outpatients	Patients aged 20–45 years, living with depressive or anxiety disorders (DSM‐IV criteria) causing social dysfunction in their ability to work n = 191	Patients randomly assigned SFT and SPP (n = 198) Seven withdrew (four from SFT, three from SPP) Of the remaining n = 191 there were 163 diagnosed with depressive disorder. Multiple diagnoses allowed. Maximum 12 sessions, over no more than 8 months.	Sociodemographic status sex, age, marital status, education Psychiatric symptoms (depressive and anxiety symptoms) Beck Depression Inventory (BDI) HAMD SCL‐90‐Anx HAMA Symptom Checklist Global Severity Index (SCL‐90‐GSI) Psychiatric history Interview or questionnaire Psychosocial functioning Psychosocial functioning self‐report Social Adjustment Scale (SAS‐SR) Inventory of Interpersonal Problems (IIP) SOC	There was no difference in the effect of the two forms of therapy, and the predictive factors did not differ between SPP and SFT. Several background factors, particularly a high sense of coherence, low symptom severity and high education, predicted successful therapy.
Knekt, P., Lindfors, O., Renlund, C., Sares‐Jaske, L., Laaksonen, M. A., Virtala, E., 2011, Finland	Quasi‐experimental design	To determine whether the use of auxiliary treatment could be used as an indicator of effectiveness for solution focused therapy and short‐term and LPP and psychoanalysis over a 5‐year period	Outpatients	Patients aged 20–45 years, living with depressive or anxiety disorders (DSM‐IV criteria) n = 367	Therapies SFT (n = 97) (limit 12 sessions over no more than 8 months) versus SPP (n = 101) (20 weekly sessions for 5–6 months) versus LPP (n = 128) (2–3 sessions per week for up to 3 years) versus psychoanalysis PA (n = 41) (four sessions per week for up to 5 years) Auxiliary treatments Psychotropic medication (positive result if at least one psychoactive medication was reported as used regularly) Psychotherapy: Form (individual short or long term, group, couple, family, other) and number of sessions over and above the study treatment Psychiatric Hospitalisation (admission and number of hospital days)	Use of auxiliary treatment: Psychotropic medication Psychotherapy Psychiatric Hospitalisation	(Data from Tables 2 and 3) Start of psychotropic medication use did not statistically significantly differ between treatment groups. During the first year of follow‐up, 42% in the SFT, 35% in the SPP, 30% in the LPP and 19% in the PA group received some type of auxiliary psychiatric treatment. Start of auxiliary therapy was more common in SFT and SPP than in the LPP or PA group. Percentage of auxiliary psychotherapy at 5‐year‐follow‐up point was 26.1% in the SFT, 30.1% in the SPP, 12.8% in LPP and 16.6% in the PA groups.
Knekt, P., Lindfors, O., Laaksonen, M. A., Renlund, C., Haaramo, P, Harkanen, T., Virtala, E., 2011, Finland	Quasi‐experimental study	To compare the effectiveness of SFT and short‐term and LPP and psychoanalysis over a 5 year period with regard to psychiatric symptoms and work ability	Outpatients	Patients aged 20–45 years, living with depressive or anxiety disorders (DSM‐IV criteria) n = 367	SFT (n = 97) (limit 12 sessions over no more than 8 months) versus SPP (n = 101) (20 weekly sessions for 5–6 months) versus LPP (n = 128) (2–3 sessions per week for up to 3 years) versus psychoanalysis PA (n = 41) (four sessions per week for up to 5 years)	Psychiatric symptoms (depressive and anxiety symptoms) BDI HDRS Symptom Check List anxiety scale (SCL‐90‐Anx) HAMA Symptom Check List Global Severity Index (SCL‐90‐GSI) Psychosocial functioning GAF scale Work ability WAI Social Adjustment Scale, work subscale (SAS‐Work) Perceived Functioning Scale (PPF)	A reduction in psychiatric symptoms and improvement in work ability and functional capacity was noted in all treatment groups during the 5‐year follow‐up. The short‐term therapies were more effective than psychoanalysis during the first year. Long‐term therapy was more effective after 3 years of follow‐up. Psychoanalysis was most effective at the 5‐year follow‐up.
Macdonald A J, 2005, United Kingdom	Observational study	Outcomes from solution‐focused brief therapy (SFBT) outpatient clinic in National Health Service (NHS) in the United Kingdom in Adult Mental Health 1 year after they ceased attending	Adult Community Mental Health clinic	Main study: n = 41 (1997 and 2002) 34% male, 66% female Pooled results from 1994/1997/2003: n = 118 clients	Solution‐focused brief therapy as described in De Shazer (1994) and DeJong and Berg (2002). Main study: mean 5.02 sessions Pooled results from 1994/1997/2003: mean 4.03 sessions	Questionnaire ‐ Problem resolution ‐ Goal achievement ‐ Emergence of new problems ‐ Consultation with other mental health professionals ‐ Experience of brief therapy ‘Good outcome’ means either that attenders themselves reported that they had achieved goals or that the general practitioner reported that if no information from attenders was available.	31 clients achieved a good outcome; 10 clients were unchanged (from patient or GP). The ‘good outcome’ group had higher mean number of sessions than the unchanged group (5.36 ± 7.05 vs 4 ± 3.44, p = 0.05). Problem type was not significantly correlated with outcome. No significant difference in: the proportion of good outcome unchanged clients in positive goals or negative goals (stop or reduce some undesired activity), solving other problems, emergence of new problems, consultations with other mental health professionals favourable comments regarding therapy.
Macdonald A J, 1997, United Kingdom	Observational study	Reporting results from a cohort of referrals seen over a 3‐year period One‐year follow‐up of 36 referrals treated with solution‐focused brief therapy for a 3‐year period	Adult Community Mental Health clinic	N = 36 Replies from attenders = 20 Replies from GP = 34 Gender not reported	Solution‐focused brief therapy number of monthly sessions ranged from 1 to 12 (mean 3.28 SD 2.39).	Questionnaire addressing: Problem resolution Goal achievement Emergence of new problems Consultation with other mental health professionals Experience of brief therapy ‘Good outcomes’ are described as attender reported problem was better or GP reported problem was better if information from attenders not available. Attender responses preferred in all cases if there was a choice.	‘Good outcome’ in 23 cases, worse outcome in three cases and 10 cases unchanged No significant difference overall between outcomes reported by patients versus those reported by general practitioners. The ‘good outcome’ group was significantly more likely to have solved other problems in addition to their presenting problem and had significantly fewer new problems. The ‘good outcome’ group did not differ from those who were worse or unchanged in terms of district of residence, whether discharged or lapsed from attendance, whether in hospital at the time of referral or social class distribution or consultation with other mental health professionals. There were more long‐term problems in the ‘worst’ and ‘unchanged’ groups.
Mireau R. and Inch R., 2009, Canada	Observational study	To evaluate the effectiveness of brief solution‐focused counselling (BSFC) to ensure that clients continued to benefit from the counselling being offered, despite the reduction in number of sessions being offered.	Adult Community Mental Health Clinic	Adult Counselling Team clients in Mental Health Service in Saskatoon, Canada Aged 18–69 years old Active clients, n = 182 29% male, 71% female	BSFC (10 sessions)	Symptom distress Outcome Questionnaire (OQ‐45) by administering only the Symptom Distress Subscale (pre therapy, fourth session and final session). Resource use: Client Registry and Resource Utilization System (CRRUS)–Mental Health and Addiction Services, Saskatoon Health region. Scaling questions (De Jong & Berg, 2002) that discuss informal measurements of change (every session). Asked clients directly at termination what they found to be helpful about their counselling experience.	After the initial session clients reported that they liked the idea of focusing on strengths. After the fourth session demonstrated a significant drop in symptoms from the initial session. Clients who attended only one session reported significantly lower symptom distress at session one than did clients who attended two or more session. Clients were more likely to plan to end their counselling relationship in the BSFC program than did those clients enrolled in non‐time‐limited services. Article suggests that using BSFC allows for more clients to be seen, and the dropout rate can be reduced whilst maintaining an acceptable quality of service. 15%–20% more clients seen than non‐time limited strategies. Clinician experience was that BSFC carries benefit for the counsellor and the client.
Valkonen J., Hänninen V and Lindfors O., 2011, Finland	Qualitative, narrative analysis	The aim of this study was to examine and interpret the experiences of users of psychotherapy in relation to the outcomes of their therapy.	Outpatient	Patients aged 20–45 years, living with depressive or anxiety disorders (DSM‐IV criteria) randomized to either SFT or LPP N = 14 (7 from SFT and 7 from LPP) 43% male, 57% female	The present study focused on the recorded interview data from patients with depressive disorder who were allocated to: short‐term SFT. Average length 6.8 months (102–238 days) with 9 to 12 sessions. or LPP. Sessions 2–3 times a week, average length was 33.7 months (729–1141 days) and average number of sessions 292 (194–378).	Interviewed before, during and after therapy by same interviewer. Used Kernig's semi‐structured interview technique for personality assessment Depression measured with BDI Pre‐therapy views and post‐therapy experiences of either LPP or short‐term SFT were analysed. The interviewees’ personal views about their depression and therapy were approached with the concept of inner narrative	Three ‘basic stories’ or orientations were found: life historical, situational and moral. These offered people different contexts from which to evaluate the outcomes of their therapy. In general, short‐term SFT supported the progress of situational inner narrative. A change in a person's inner narratives was found to be a satisfying outcome for someone in this study. Ideally, people need to be given enough information to choose the form of therapy that will be suit their needs. People experiencing depression, who use psychotherapy to help them form the best possible life narrative for themselves, need to be seen as having agency in their social and cultural context.

Abbreviations: BDI, Beck Depression Inventory; BMI, body mass index; BISSI, Brief Inventory of Social Support and Integration; BSFC, brief solution‐focused counselling; CRRUS, Client Registry and Resource Utilization System; DSM, Diagnostic and Statistical Manual of Mental Disorders; DSQ, Defence Style Questionnaire; GAD‐7, Generalised Anxiety Disorder 7; GAF, Global Assessment of Functioning; GP, general practitioner; HAMA, Hamilton Anxiety Rating Scale; HDL, high‐density lipoproteins; HDRS, Hamilton Depression Rating Scale; IPP, Inventory of Interpersonal Problems; LOT, Life Orientation Test; LPP, long‐term psychodynamic psychotherapy; LPO, level of personality organization; LSS, Life Situation Survey; OQ‐45, Outcome Questionnaire; PA, psychoanalysis; PANAS, Positive and Negative Affect Schedule; PFF, Perceived Psychological Functioning Scale; PQH‐9, Nine‐Patient Health Questionnaire; SASB, Structural Analysis of Social Behaviour; SAS‐SR, Social Adjustment Scale; SAS‐Work, Work subscale of the Social Adjustment Scale; SCL‐90‐GSI, Global Severity Index; SCL‐90‐Anx, Symptom Checklist Anxiety Scale; SFBT, solution‐focused brief therapy; SFT, solution‐focused therapy; SOC, Sense of Coherence Scale; SPP, short‐term psychodynamic psychotherapy; WAI, Work Ability Index; WAIS‐IV, Wechsler adult intelligence scale‐IV.

Intervention fidelity reporting and transparency in the use of solution‐focused brief therapy was varied across the studies. All studies reported a description of techniques or questions used for solution‐focused brief therapy with varying detail; the majority used questions around presession change, goal setting, use of miracle questions, scaling questions, exploration of exceptions to the problem, use of therapist feedback and some form of out of session task. Ten percent of studies used a manualised version of solution‐focused brief therapy. Seventy‐five percent of studies reported no use of a manual, and 15% were unstated. The number of solution‐focused brief therapy sessions ranged from 1 to 18; length and frequency of sessions were inconsistently reported. Therapist competence was reported in 90% of studies, and the use of quality controls such as live supervision, session recordings and fidelity monitoring tools was reported in 15%.

3.3. Results of Individual Sources of Evidence

The following gives a summary of the key outcomes indicated by the 20 studies included in this scoping review:

3.3.1. Psychiatric Symptoms

Seven studies investigated the effectiveness of solution‐focused therapy in improving psychiatric symptoms (Cooper et al. 2024; Koorankot et al. 2022; Knekt et al. 2013, 2016; Knekt, Lindfors, Härkänen, et al. 2008; Knekt, Lindfors, Laaksonen, et al. 2011; Mireau and Inch 2009). Six studies described psychiatric symptoms as anxiety and depressive symptoms, and one study investigated depressive symptoms only (Koorankot et al. 2022).

All seven studies reported on a reduction of psychiatric symptoms or symptom distress experienced for groups receiving solution‐focused therapy or brief solution‐focused counselling. Of these studies, four used the same data as part of the Helsinki Psychotherapy Study (Knekt et al. 2013, 2016; Knekt, Lindfors, Härkänen, et al. 2008; Knekt, Lindfors, Laaksonen, et al. 2011), comparing the use of solution‐focused therapy, long‐term psychodynamic psychotherapy, short‐term psychodynamic psychotherapy or psychoanalysis across varying follow up points. The group receiving solution‐focused therapy showed an earlier reduction in psychiatric symptoms than the group receiving long‐term psychodynamic psychotherapy at the first year (Knekt, Lindfors, Härkänen, et al. 2008) and remained as effective as short‐term psychodynamic psychotherapy at the third and fourth years and 10 year follow‐up (Knekt et al. 2013; Knekt et al. 2016). The group receiving solution‐focused therapy reported greater improvement in reducing psychiatric symptoms than psychoanalysis at first year mark, as effective at 3‐year mark and surpassed by psychoanalysis at the 5‐year mark (Knekt, Lindfors, Laaksonen, et al. 2011).

3.3.2. Psychosocial Functioning

Six studies investigated the effectiveness of solution‐focused therapy in improving psychosocial functioning; all of which were designed to compare solution‐focused therapy, short‐term psychotherapy and long‐term psychotherapy (Knekt et al. 2013, 2015, 2016, 2017; Knekt, Lindfors, Laaksonen, et al. 2008; Lindfors et al. 2015). For these studies, Knekt et al. (2004) explained that social functioning was measured from the following: perceived competence from a modified Self‐Performance Survey; dispositional optimism with the Life Orientation Test (LOT) and social functioning with the Social Adjustment Scale (SAS‐SR). Coping was measured with the Sense of Coherence Scale (SOC), and quality of life was measured with the Life Situation Survey (LSS).

The studies concluded that short‐term therapies (including Solution Focused Therapy) improved perceived psychosocial functioning more than long‐term therapy at the 7 months follow‐up point, showing statistically and significantly improved values for the Perceived Psychological Functioning Scale (Knekt et al. 2015; Knekt, Lindfors, Härkänen, et al. 2008). Solution Focused Therapy was associated with faster improvements in psychosocial functioning at 1 year follow up than the Long‐term Psychodynamic Psychotherapy group and earlier reduction of interpersonal problems (Lindfors et al. 2015). During the second year of follow up, studies reported Solution Focused Therapy was as effective as Short‐term and Long‐term Psychodynamic Psychotherapy (Knekt et al. 2015; Knekt, Lindfors, Härkänen, et al. 2008). One study reported Solution Focused Therapy had statistically significant improvement in psychosocial functioning and personality functioning at the 5 year follow up point and was as effective as Short‐term Psychodynamic Psychotherapy (Lindfors et al. 2015). One study reported Solution Focused Therapy to be as effective as Short‐Term Psychodynamic Psychotherapy and Long‐term Psychodynamic Psychotherapy in improving psychosocial functioning at the 10 year follow up point (Knekt et al. 2016).

3.3.3. Work Ability

Three studies reported on work ability for people who received Solution Focused Therapy. One study reported that Solution Focused Therapy had a significantly improved work ability index score compared with Long Term Psychodynamic Psychotherapy at 1 year, specifically for a group with good level of personality organisation (Knekt et al. 2017). Solution Focused Therapy was reported to be as effective as Short‐Term Psychodynamic Psychotherapy at one, three, four and five year follow up (Knekt et al. 2013) and 10 year follow up (Knekt et al. 2016) with no significant difference in employment percentage.

The work ability of patients was measured in the above studies using: self‐reported current ability to work by a modification of the Work Ability Index; the work subscale of the Social Adjustment Scale (SAS‐SR) to measure performance in work; perceived psychological functioning and sick leave from work; and incidence of more than 20 sick leave days during the preceding 3 months.

3.3.4. Use of Auxiliary Treatment

Two studies focused on the use of auxiliary treatment in participants receiving Solution Focused Therapy, Short‐Term Psychodynamic Psychotherapy and Long‐Term Psychodynamic Psychotherapy (Knekt, Lindfors, Renlund, et al. 2011). Auxiliary treatment was assessed by collecting data on the use of psychotropic medication, psychotherapy and psychiatric hospitalisation during participation in the study. One study (Knekt, Lindfors, Renlund, et al. 2011) reported that the start of psychotropic medication use did not statistically significantly differ between treatment groups (Solution Focused Therapy, Short‐Term Psychodynamic Psychotherapy, Long‐Term Psychodynamic Psychotherapy). Another study (Knekt et al. 2016) reported no difference in auxiliary treatment delivered to patients receiving either Solution Focused Therapy, Short‐Term Psychodynamic Psychotherapy or Long‐Term Psychodynamic Psychotherapy; however, use of psychotropic medication with people who received Solution Focused Therapy was lower in the first 5 years of follow up compared with Short‐Term Psychodynamic Psychotherapy.

3.3.5. Self‐reported ‘good outcome’

Two studies (Macdonald 1997; MacDonald 2005) reported ‘good outcomes’ based on self‐report from attenders that they had achieved their goals, with reports being collected from general practitioners should self‐report from attenders not be obtained. Good outcome was reported for 31 attenders (n = 41) for the first study (Macdonald 1997) and 23 attenders (n=36) for the second study (MacDonald 2005). A good outcome was seen to be more prevalent in those that received a higher number of sessions. Those reporting a ‘good outcome’ were significantly more likely to have solved other problems in addition to their presenting problem and had significantly fewer new problems.

3.3.6. Life Quality and Well‐Being

One study (Knekt et al. 2015) found Solution Focused Therapy improved quality of life faster than Short‐term and Long‐term Psychodynamic Psychotherapy over a 5‐year period. Quality of life was measured using a Life Situation Survey. Another study (Cooper et al. 2024) reported that those receiving solution‐focused brief therapy reported greater improvement in well‐being over a treatment as usual group measured using the Flourishing Index.

3.3.7. Sense of Coherence

One study (Knekt et al. 2016) reported Solution Focused Therapy to be as effective as Short‐term and Long‐term Psychodynamic Psychotherapy in building a sense of coherence. Sense of coherence and coping were measured using the SOC.

3.3.8. Level of Personality Organisation

One study (Knekt et al. 2017) reported Solution Focused Therapy to be as effective as Short‐term Psychodynamic Psychotherapy across all measures at each measurement point when effectiveness was investigated with two levels of personality functioning (LPO); good LPO (‘neurotic’ (< 4.5)) and poor LPO (‘higher level borderline personality organisation’ (≥4.5)). Level of personality functioning was described or measured personality organisation, psychological defense style, self‐concept and amount of interpersonal problems.

3.3.9. Indicators of Physical Health and Lifestyle

One study (Knekt et al. 2010) reported that lifestyle changes were more common in patients receiving short‐term therapies. Of note, a greater decrease in alcohol consumption and decrease in current smoking was reported in the Solution Focused Therapy group compared with the Short‐term Psychodynamic Psychotherapy group.

Lifestyle changes were measured from data collected in a questionnaire on areas including smoking, alcohol consumption, body mass index, leisure time exercise and pregnancies; and serum levels (e.g. thyroid hormone, glucose, cholesterol and minerals) were performed. Self‐report questionnaires (perceived general, health, medication, disease symptoms and hospitalisation) helped determine somatic health. Also, more data was elicited from population registers (medication and hospitalisation).

3.3.10. Self‐concept

One study (Lindfors et al. 2012) reported statistically greater improvement in self‐concept for Solution Focused Therapy at the 7 month follow up. Self‐concept was measured using the Structural Aspects of Social Behavior (SASB) introject questionnaire. During the second year, Solution Focused Therapy was as effective as Short‐Term Psychodynamic Psychotherapy and Long‐Term Psychodynamic Psychotherapy.

3.3.11. Views and Experience of Psychotherapy

One study (Valkonen et al. 2011) reported that Solution‐Focused Therapy supported the progress of situational inner narrative. A change in a person's inner narratives was found to be a satisfying outcome for some people in this study.

Situational inner narrative was captured through a qualitative, narrative analysis of therapy users’ pre‐therapy orientations and post‐therapy assessments of therapy (Valkonen et al. 2011).

3.3.12. Perceived Social Support

One study (Laurila et al. 2024) reported on improvement in the person's perception of their social support for groups receiving Solution Focused Therapy; and was as effective as Long‐Term Psychodynamic Psychotherapy and Short‐Term Psychodynamic Psychotherapy.

Laurila et al. (2024) measured a person's perception of social support using the brief inventory of social support and integration (BISSI). It contained five subscales: social network size, satisfaction in social support and relations, perceived availability of emotional support from family, perceived availability of emotional support from friends and perceived availability of emotional support from professionals.

3.3.13. Predictors of Remission

One study (Marttunen et al. 2008) reported predictive factors related to Solution‐Focused Therapy and Short‐term Psychodynamic Psychotherapy were similar. Background factors including a high sense of coherence, low symptom severity and high education predicted successful therapy (Marttunen et al. 2008).

Sense of coherence was based on SOC, symptom severity (based on Symptom Checklist‐90 [SCL‐90] and Global Severity Index [GSI]) and education (Marttunen et al. 2008).

3.3.14. Cost‐Effectiveness

One study (Maljanen et al. 2016) compared the cost effectiveness of solution‐focused therapy and short‐term psychodynamic psychotherapy with that of long‐term psychodynamic psychotherapy and found that solution‐focused therapy and short‐term psychodynamic psychotherapy were more cost‐effective.

Cost‐effectiveness was measured as direct and indirect costs due to mental health problems and was estimated and related to the effectiveness of the treatments. Regardless of who bore these costs, all costs were included. Costs due to somatic diseases were also included in the secondary analysis.

4. Discussion

This scoping review mapped the empirical evidence available for solution‐focused brief therapy in adult community mental health settings, resulting in 20 published studies. This reflected the broader pattern noted in recent umbrella and scoping reviews, which reported comparatively fewer solution‐focused brief therapy outcome studies in adult mental health than in youth, school, medical or community services (Pakrosnis and Zak 2024; Zak and Pękala 2025). Within this limited evidence base, depression and anxiety were the primary presenting issues, and samples were predominantly recruited from Scandinavia. This highlighted both a concentration of research activity in certain regions and a gap in empirical work with consumers experiencing conditions such as psychosis, bipolar affective disorder, personality disorders or experiencing suicidality.

Across the included studies, solution‐focused brief therapy was associated with positive outcomes, although the magnitude and specificity of those outcomes varied by study design and context. The Helsinki Psychotherapy Study contributed 14 of the 20 included papers, offering large, rigorously conducted comparative data on psychiatric symptoms (including symptoms of depression and anxiety) and psychosocial functioning (including quality of life and social functioning). These studies consistently demonstrated meaningful improvements in symptom reduction and role functioning, often emerging earlier in the course of therapy relative to comparators such as short and long‐term psychodynamic psychotherapy. However, the dominance of this single dataset narrows the representation of the evidence and may have limited generalisation.

The remaining studies reported solution‐focused brief therapy delivered in time‐limited designs (often one to four sessions) and reported improvements in depression and anxiety (Mireau and Inch 2009; Cooper et al. 2024; Koorankot et al. 2022) and self‐reported ‘good outcome’ (Macdonald 1997; MacDonald 2005). When considered alongside broader solution‐focused brief therapy outcome research, such findings are consistent with meta‐analytic evidence showing that solution‐focused brief therapy is generally effective across a wide range of outcomes, including depression, anxiety, social functioning and goal attainment (Vermeulen‐Oskam et al. 2024; Franklin et al. 2024). The only umbrella review also reported high confidence in solution‐focused brief therapy's effectiveness for adult depression, overall mental health and goal progress, with moderate confidence across other psychosocial domains (Zak and Pękala 2025). These converging findings strengthened the view that solution‐focused brief therapy reliably produced clinically beneficial change even when implemented briefly.

A notable feature of the included studies was the variability with which solution‐focused brief therapy was described and operationalised. Some papers offered a clear account of essential solution‐focused brief therapy components such as goal negotiation, preferred‐future descriptions, attention to exceptions, scaling and end‐of‐session feedback, whilst others provided minimal detail. This mirrors concerns raised in recent methodological reviews, which highlighted inconsistent reporting of intervention fidelity, therapist training and the specific solution‐focused brief therapy techniques employed (Jerome et al. 2023; Pakrosnis and Zak 2024). There also remains limited process‐focused research examining how solution‐focused brief therapy conversations unfold in adult community mental health settings, despite the likelihood that interactional processes such as language use, alliance‐building behaviours and the co‐construction of preferred futures may substantially influence outcomes.

The comparison trials also reported a trend where solution‐focused brief therapy often achieved early improvements with fewer sessions. In the Helsinki studies, consumers received up to 12 solution‐focused brief therapy sessions over 8 months, compared with substantially longer psychodynamic treatment protocols. Despite this reduced exposure, solution‐focused brief therapy outcomes were comparable at many key follow‐up points, and in some cases reported greater improvement in early symptom change, early functional gains or in quality of life. These findings resonated with broader literature that reported solution‐focused brief therapy as a cost‐effective option within systems facing resource constraints (Maljanen et al. 2016; Vermeulen‐Oskam et al. 2024). These features align well with the realities of community mental health services, where brief, recovery‐oriented, collaborative approaches are often required to manage high caseloads, complex risk presentations and intermittent engagement. Shorter intervention duration reduces not only direct service costs but also the indirect burden associated with extended engagement in care, making solution‐focused brief therapy an appealing model in high‐demand public mental health systems.

Across the limited number of studies that reported treatment adherence or dropout, attrition rates for solution‐focused brief therapy were generally low and broadly comparable with those observed in other treatment arms. In the Helsinki Psychotherapy Study, only a small proportion of participants discontinued treatment or were lost to follow‐up, with similar overall withdrawal rates between solution‐focused therapy and short‐term psychodynamic psychotherapy (Knekt, Lindfors, Härkänen, et al. 2004). Mireau and Inch (2009) reported that clients who received brief solution‐focused counselling were more likely to end therapy through planned termination and less likely to drop out than those in a non–time‐limited service. Macdonald's adult psychiatry cohorts showed high rates of follow‐up information and positive outcomes even among clients whose contact with services had lapsed (Macdonald 1997; MacDonald 2005). In the randomised trial by Cooper et al. (2024), attrition was also modest, with 69 of 80 participants completing outcome assessments and only one participant in the solution‐focused brief therapy arm lost to follow‐up after commencing treatment. Collectively, these findings suggested that solution‐focused brief therapy does not appear to be associated with higher dropout than alternative interventions in adult community mental health settings, although inconsistent reporting limits firm conclusions and points to a need for more systematic measurement of engagement and retention in future trials.

The mechanisms that may underpin these rapid gains remain an area of ongoing inquiry. Recent process‐oriented research reported that the use of future‐orientated conversations with a focus on strengths, resources and co‐construction of meaning contributed substantially to early improvements (Franklin et al. 2024). However, empirical evidence on the mechanisms of this remained sparse within adult community mental health samples. Future studies would benefit from explicitly analysing the processes through which solution‐focused brief therapy facilitates therapeutic change.

Several gaps and opportunities for future research emerged from this review. Evidence is needed regarding solution‐focused brief therapy with more diagnostically diverse adult populations, including psychotic disorders, bipolar disorder, personality disorders, suicidal crises and consumers with complex psychosocial presentations. This is particularly important as adult community mental health teams frequently support consumers with complex comorbidity and fluctuating levels of distress, yet such complexity was not adequately reported in the studies included in this review. Studies recruiting in culturally and socioeconomically diverse contexts would also strengthen the evidence base. There was a distinct lack of comparative trials evaluating solution‐focused brief therapy against other established approaches commonly used in community mental health settings, such as cognitive behavioural therapy or narrative therapy. Moreover, the broader solution‐focused brief therapy literature has called for improvement in intervention fidelity reporting, greater transparency in the use and sequencing of solution‐focused brief therapy techniques and clearer documentation of therapist competence, supervision and protocol adherence (Pakrosnis and Zak 2024; Vermeulen‐Oskam et al. 2024). Longitudinal research would help to clarify the durability and trajectory of change beyond the early improvements evident in many included studies.

This scoping review had limitations that should be considered when interpreting the findings. Only studies written in English were included, and the search was limited to three databases. The exclusion of theses, single‐case designs, qualitative studies and non‐English papers meant that some relevant evidence may not have been captured. The heavy weighting towards the Helsinki Psychotherapy Study markedly shaped the overall dataset and limited the scope of synthesis across diverse study designs and populations.

The strengths of this review were the thorough and systematic search technique, clear inclusion and exclusion criteria and comprehensive data extraction. This scoping review presented the first consolidated overview of solution‐focused brief therapy within adult community mental health. Despite the modest evidence base, the available studies consistently demonstrated that solution‐focused brief therapy has been reported to produce meaningful improvements in psychiatric symptoms, psychosocial functioning, well‐being and social outcomes, often within comparatively brief timeframes. These findings have provided a foundation for further research to inform clinical practice and support the ongoing integration of solution‐focused brief therapy into community mental health services.

5. Conclusion

This scoping review on the use of solution‐focused brief therapy highlighted its effectiveness in adult community mental health settings across various domains and earlier improvement with a shorter duration of therapy.

The authors recommend further research in the use and effectiveness of solution‐focused brief therapy in adult community mental health. This could include process‐focused research examining how solution‐focused brief therapy conversations impact people in adult community mental health settings. Also, comparative trials evaluating solution‐focused brief therapy against other established approaches commonly used in community mental health settings, such as cognitive behavioural therapy or narrative therapy.

It will be important to ensure intervention fidelity reporting, transparency in the use and sequencing of solution‐focused brief therapy techniques and clear documentation of therapist competence, supervision and protocol adherence. Longitudinal research would help to clarify sustainable change trajectory beyond the early improvements noted in current evidence.

Research across a broader range of patient groups, with varying mental health diagnoses, within a variety of countries and culturally and socioeconomically diverse contexts would also strengthen the evidence base and could help increase confidence in the generalisability of solution‐focused brief therapy.

Conflicts of Interest

The authors declare no conflicts of interest.

Supporting information

Appendix S1: Search strategy.

The supplementary file outlines the full electronic search strategy conducted in MEDLINE, CINAHL and PsycINFO, including all search terms, subject headings, Boolean operators, limits and date ranges applied for this scoping review.

Data Availability Statement

The data that support the findings of this study are available in the supplementary material of this article.