A Meta-Analysis of Solution-Focused Brief Therapy for School-Related Problems in Adolescents

Abstract

Purpose: This meta-analytic study aimed to assess the overall effectiveness of solution-focused brief therapy (SFBT) for adolescents’ problems in the school context. Methods: According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the study searched the various electronic databases between January 1, 1990, and April 30, 2022, to find studies that met the research criteria in both English and Turkish language. Results: Nine experimental trials (five randomized and four nonrandomized) which met all selection criteria were included in the analysis with a total sample size of 309 (154 from the experiment and 155 from the control group). The findings reported a result favoring the effectiveness of SFBT for adolescents’ school-related problems (g = 1.80, 95% CI [.94–2.66]). Discussion: We believe that this study has advanced our understanding of the valid evidence base for the effectiveness of SFBT by showing promising outcomes on the potential effectiveness of SFBT in treating adolescents’ school-related problems.

Keywords

solution-focused brief therapy school-related problems adolescents

Over the last century and a half approximately, many theories have been proposed that can guide mental health professionals in treating individuals’ psychologically based problems. One of these is solution-focused brief therapy (SFBT), which has become an integral part of the mental health literature for about 40 years. Although the origin of SFBT is relatively controversial, the generally accepted notion is that it evolved out of the brief-family therapy model in the early 1980s. In its reaching today, Bill O'Hanlon, Steve de Shazer, and Insoo Kim Berg have taken an important role. Today, as an evidence-based intervention, SFBT guides mental health professionals based on social constructivism, positive psychology, systems theory, the strengths perspective, and the power of language (Franklin, 2015; Kim & Franklin, 2015). The popularity of SFBT continues to grow internationally.

SFBT is different from traditional approaches in many ways. SFBT is a psychotherapy approach focusing on solution-building rather than problem-solving (de Shazer, 1985). The main therapeutic task is to help the client imagine how he would like things to be different and what it would take to make that happen. Solution-focused therapists aim for clients to discover solutions through future-oriented questions. The SFBT, differing from behavior therapy and skill-building intervention approaches, asserts that solution behaviors already exist for clients. It is a competency-based model focusing on previous successes and strengths (de Shazer, 1988). SFBT, whatever the nature of the problem, includes unique intervention techniques: the miracle question, the nightmare question, looking for exceptions to the problem, the taking of a small step, getting the client to do something different, the giving therapeutic compliments, setting goals, assigning homework tasks, and the use of scaling (Berg & de Jong, 1996; de Shazer & Berg, 1997; O’Hanlon & Weiner-Davis, 1989).

Both scholars and mental health professionals have widely studied and applied the change processes and techniques of SFBT. The literature has indicated that SFBT is an effective treatment for a wide variety of behavioral and emotional outcomes and, in addition, appears to be briefer and less costly than alternative approaches. These include patients with psychotic symptoms (Rhodes & Jakes, 2002), individuals with mental health problems such as depression and anxiety (Maljanen et al., 2012), youth probationers with social readjustment problems and aggressive behaviors (Shin, 2009), parents using substance involved in child welfare system (Kim et al., 2022), individuals with reading difficulties (Daki & Savage, 2010), young and adult individuals who have substance use problems (Franklin & Hai, 2021), children and adolescents with behavior difficulties (Hsu et al., 2021), and parents with psychological distress whose children were cancer diagnosis (Zhang, Ji, et al., 2018). For example, a meta-analysis study by Zhang, Franklin, et al. (2018) tested the effectiveness of SFBT in medical settings by synthesizing nine randomized controlled trials. Except for functional health outcomes, the findings reported an overall significant effect of SFBT for both relatively health-related behavioral and health-related psychosocial outcomes. Likewise, the systematic and critical evaluation research, which included studies published between 1990 and 2010, aimed to examine the use and application of SFBT in clinical practice with children and families. The findings demonstrated that existing research provided early intervention support for the use of SFBT, particularly concerning internalizing and externalizing child behavior problems at a mild-to-moderate level (Bond et al., 2013).

SFBT has also received considerable attention in adolescents. Adolescence is a unique period in its multitude of concurrent and rapid changes that are characterized by physiological, cognitive, and emotional changes, differentiating roles with friends and families, and school transitions (Steinberg, 1996). The turbulent and formative unique structure of adolescence leaves individuals vulnerable to mental, behavioral, and physiological problems (Lim et al., 2019; Polanczyk et al., 2015). Previous studies evidenced the effect of SFBT on a variety of problem areas in adolescents: depression (Javanmiri et al., 2013), behavior and perceived somatic and cognitive difficulties (Cepukiene & Pakrosnis, 2011), rumination and learned helplessness (Ünal & Siyez, 2020), insufficient coping skills with peer bullying (Çopur & Kubilay, 2022), poor anger control and communication skills (Siyez & Tuna, 2014), perceived low self-esteem and self-efficacy (Alguzo & Jaradat, 2021; Kvarme et al., 2010), and problematic internet using and poor sleep quality (Kaya, 2017).

Adolescence also is a unique stage for laying the foundations of academic career development (Koivusilta et al., 2010). On the other hand, adolescents often face school experiences that may put their career development, such as school truancy, exam anxiety, and poor academic achievement (Chen et al., 2016; Walburg, 2014). Moreover, these school-related negative experiences deteriorate adolescents’ mental health (Deighton et al., 2018). The literature demonstrated that SFBT is one of the keys to treating adolescents’ school-related problems. For example, a study tested the effectiveness of SFBT with adolescents suffering from exam anxiety aged 16 to 18 (Altundağ & Bulut, 2019). The process of SFBT consisted of four group sessions, and there were 16 adolescents, of all, eight in the experimental group and eight in the control group. The findings demonstrated that adolescents exposed to SFBT reported significantly lower scores in exam anxiety, compared to the control group.

Given the increased recognition of the predictive effect of school-related problems on adolescents’ physical and mental health, it is plausible that school mental health professionals want to consider the effectiveness of SFBT for these problems within school settings. However, the literature lacks presenting a comprehensive picture. Furthermore, there is no meta-analytic study focusing on only adolescents to test the effectiveness of SFBT. Generally, we see that meta-analytic studies that aimed at assessing the effectiveness of SFBT for adolescents gathered around mental health problems among the general population in which adolescents included, such as internalizing and externalizing problems (Hsu et al., 2021; Schmit et al., 2016). For example, a study conducted by Kim et al. (2015) supported this evaluation. This study aimed at assessing the overall effectiveness of the SFBT for behavioral and mental health problems among Chinese populations. The findings indicated the positive impact of SFBT on Chinese clients with mental health-related problems. Likewise, Hsu et al.'s (2021) study with twenty trials investigated the overall effectiveness of SFBT for behavior problems in children and adolescents under 18 years of age. The findings found a small to medium positive effect size favoring SFBT for child and adolescent behavioral problems. Meta-analytical studies focusing on academic results, on the other hand, focused on students at all educational levels, with studies involving a relatively high risk of bias (Gingerich & Peterson, 2013; Franklin et al., 2022). In conclusion, we believe this meta-analytic study will fill a gap in the confluence of adolescents and SFBT in the school-related problems context.

The Present Study

Mental health professionals and scholars have applied SFBT as an intervention method to help clients who have had various problems since the 1980s. Accordingly, the literature has demonstrated the effectiveness of SFBT in treating various problems of adolescents (Kim et al., 2015; Schmit et al., 2016). More specifically, there has been a growing body of empirical studies supporting the efficacy of SFBT in treating adolescents’ school-related problems such as test anxiety and academic failure (Bal & Kaya, 2017; Enea & Dafinoiu, 2009; Newsome, 2004). Mental health professionals such as especially school counselors and school social workers may not only wonder how effective SFBT generally is for adolescents’ school-related problems but also need to determine the most effective interventions to serve this population for school-related problems. In this context, there is a need for exhaustive evidence-based treatment findings. Therefore, this meta-analytic study aimed at reviewing the overall effectiveness of SFBT among adolescents with problems in the school context by synthesizing the previous experimental findings in the literature. For this aim, a meta-analysis of the controlled experimental studies was conducted to answer the following research question: How effective is solution-focused short-term therapy in improving adolescents’ school-related problems (e.g., exam anxiety, academic achievement, school burnout, and school truancy)? We expect that this study's findings will fill a gap in the current literature on SFBT by reviewing the controlled published experimental studies, which include the basic techniques and tenets of the SFBT, on adolescents who have a variety of problems in the school context. As a result, this study may provide further consideration of SFBT as a potentially effective intervention for adolescents. It may also have important implications for both preventive and intervention planning worldwide.

Method

Selection Criteria

In light of the study's aim, some criteria were developed while constituting the meta-analytic study pool. The inclusion criteria of this meta-analysis study were as follows: (1) studies that examined the effectiveness of SFBT for directly school-related problems; (2) experimental or quasi-experimental-designed studies; (3) studies reporting pre-test and post-test measures; (4) studies that presented the necessary outcome values (e.g., sample size, mean, and standard deviation) to calculate a mean difference effect size; (5) studies that included sessions based on only SFBT; (6) studies in which the process of SFBT was conducted by mental health scholars or professionals and academics; (7) studies that were published in peer-reviewed journals, dissertations, or theses; (8) studies that were conducted among individuals aged 11–18; (9) studies that were published during the 32-years approximately, from January 1, 1990, to April 30, 2022; and (10) studies that were published in Turkish or English. Studies that did not focus on only SFBT intervention were excluded (e.g., the mixed sessions that involve both SFBT and cognitive-behavioral therapies). One-group retrospective chart reviews, one-group pre-test, and post-test designs, and case studies were not included. Individual and online SFBTs that provided the control condition would have been included in the meta-analysis, but it was not reached. Studies that focused on both adolescents and other samples such as children or adults but which did not include a specific measure outcome for adolescents were excluded. Studies that did not allow for a standardized effect size calculation were excluded. Data reported across multiple publications were excluded.

Search Strategy

In this meta-analytic study, we aimed to reach all studies in which the effectiveness of the SFBT for school-related problems in adolescents was tested and met the research criteria. We followed a few ways to reach the final total studies. Firstly, we scanned the probable studies in some national and international electronic databases (Web of Science, PsycINFO, PubMed, ERIC, ProQuest Dissertations & Theses Global, Yok-Tez, and other national databases). We used the keywords “solution-focused therapy,” “solution-focused approach,” “solution-oriented therapy,” “solution-oriented approach,” “solution-focused intervention,” and “solution-oriented intervention” while conducting this. Given the development of SFBT in the early 1980s (de Shazer, 1985, 1986), the literature search involved a time frame from January 1, 1990, to April 30, 2022. Our search resulted in a total of 955 candidate studies. Second, the duplicates were searched for. The reached 186 duplicates were excluded. At the end of this step, there were 769 studies. Thirdly, the title and abstract of the candidate studies were reviewed, and those that did not meet at least one of the selection criteria were discarded. Thus, we proceeded to the next step by eliminating 731 studies. In the last step, the remaining 38 full-text were reviewed in detail, and those (29 studies) that did not fully meet the research criteria were excluded. In conclusion, nine studies remained to be included in the abstraction and analysis. The evaluation of an external reviewer was appealed to enhance the objectivity of the screening process. Both the author of the study and the external evaluator independently searched the databases, and then the results were compared to reach the final studies. The details of the literature search process for the target studies were presented in Figure 1.

Figure 1.

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram of the literature search.

Statistical Methods

The data from nine controlled experimental studies were synthesized to evaluate the overall effectiveness of SFBT for adolescent problems in the school context through the Comprehensive Meta-Analysis software Version 2.0 (Borenstein et al., 2005). To calculate the overall effect size, there are generally two main methods, which are, fixed and random (Hedges, 1992). In the present study, all analyses were conducted in light of the random effect model. The aim of this study coincided with the random effect model which assumes the true effect could vary from study to study due to the differences (heterogeneity) among studies. It highlights each study may have a different effect size because of the various effects such as the participants’ demographic characteristics. The effect sizes in the studies that are performed are assumed to represent a random sample of all possible effect sizes. In the random effect model, the pooled estimate would be the mean or average effect. However, the findings concerning the fixed model were also displayed to uncover the difference between both. Firstly, we computed the standardized mean difference effect sizes for each study variable using Cohen's d. Second, the mean effect size values concerning the included studies and the overall effect size were analyzed using Hedges’ g, with a 95% confidence interval. Interpretation of effect sizes was evaluated initially concerning Cohen's (1988) suggested standards of small (ES ≥ .20), medium (ES ≥ .50), and large (ES ≥ .80) effects.

The risk of the possible publication bias was tested using the funnel plot, trim-and-fill method, fail-safe N test, Begg and Mazumdar's rank correlation analysis, and Egger's regression test. The funnel plot visualizes the association between effect size and sample size. The visual that involves the symmetric distribution of the studies means a lack of publication bias. Conversely, an asymmetry distribution indicates that there is a high publication bias risk (Egger et al., 1997). It is not reasonable to evaluate publication bias according to only the funnel plot. The funnel plot should be assessed along with the trim-and-fill method. The trim-and-fill method refers to identifying funnel plot asymmetry arising from publication bias and then correcting it (Duval & Tweedie, 2000). Fail-safe n refers to the robustness of a significant result by calculating how many studies with effect size zero could be added to the meta-analysis before the result lost statistical significance (Rosenthal, 1979). The low Fail-Safe N indicates that publication bias is possible. This is because the observed result in a meta-analysis could be overturned by a small number of unpublished or un-retrieved studies that were missed during the search process. The high Fail-Safe N indicates that publication bias is unlikely. According to Rosenthal (1979), when the Fail-Safe N value is greater than 5k + 10, publication bias is unlikely. The k value is the number of studies (or effect sizes) included in the meta-analysis. Begg and Mazumdar's rank correlation test (Begg & Mazumdar, 1994) and Egger's regression intercept test (Egger et al., 1997) indicate that indicates there is no publication bias when a p-value of greater than the significance level (e.g., .05).

The impact of statistical heterogeneity of the study was investigated using the Q and I² statistics (Higgins et al., 2003). When the Q value is greater than the chi-square values at k–1 degrees of freedom value (k = the number of effect sizes), it is assumed that there is heterogeneity. The I² explains the percentage of variation across studies. It describes the inconsistency of the studies’ results. The I² value varies between 0 and 1. The higher the I² value corresponds to the greater heterogeneity. In this context, a 0% score explains unavailable observed heterogeneity, a 25% score low heterogeneity, a 50% score medium heterogeneity, and a 75% score high heterogeneity (Higgins et al., 2003).

To rate the study quality, the included experimental studies were rated according to Gingerich and Eisengart's (2000) review, which was based on Chambless and Hollon's (1998) modifications of the American Psychological Association's standards and the American Psychological Association's standards for assessing empirical support (Task Force on Promotion and Dissemination of Psychological Procedures, 1995) (see Kim, 2008). The study quality rating was conducted by the author of the study and an independent external academic. When there was a disagreement, raters reached a joint consensus by discussing rates. To rate the degree of experimental control employed by the studies that the present meta-analysis involved, the used six standards were as follows: (1) use of a randomization group design; (2) comparison with treatment-as-usual, placebo, or less preferably, standard control; (3) definition of a specific problem or disorder; (4) use of validated and reliable outcome measures; (5) use of treatment manuals or procedures for monitoring and fidelity checks; and (6) sample large enough to detect an effect (more than 25 per group). According to the extent to which the experimental studies met these six criteria, they were categorized into three groups by basing on the criteria set by Gingerich and Eisengart's (2000) review. The first group which is rated as highly controlled and described as good includes five to six standards. The second group which is rated as moderately controlled and defined as fair corresponds to four standards. The third group which is rated as lowly controlled and described as poor meets three or fewer standards.

Results

Study Characteristics

Several steps were followed to reach the final study pool. The flow diagram of the study screening process was displayed in Figure 1. Firstly, a total of 955 records were identified through database searches by using the title options. Of these, 186 duplicates were removed. Then, selection criteria were applied to each candidate. There were 731 records excluded for not being related to the selection criteria. In the last step, the remaining 38 full-text were reviewed in detail, and those (29 studies) that did not aim at testing the effectiveness of SFBT for adolescents’ school-related problems were excluded. In conclusion, nine studies remained to be included in the abstraction and analysis (Akan, 2019; Altundağ & Bulut, 2019; Ateş, 2016; Bal & Kaya, 2017; Enea & Dafinoiu, 2009; Newsome, 2004; Özdağ, 2021; Saadatzaade & Khalili, 2012; Sarıcı-Bulut, 2008).

The abstracted information for each study, which provided the raw data, was presented in Table 1. For each of the selected studies, we displayed the author, year, publication type, outcome variable, comparison treatment, the country of the study, the place in which the study was conducted, the sample size of both experiment and control groups with gender distribution, the effect result of SFBT, and the quality rating of the studies. This meta-analysis research involved nine controlled studies. Of these, six were published article studies, two were unpublished master's theses, and one was an unpublished doctoral dissertation. Based on the SFBT, three studies focused on decreasing exam anxiety, one study for school burnout, one study for school truancy, one study for school exhaustion, one study that aimed at increasing academic motivation, and one study that focused on increasing academic achievement. Control groups in all studies did not receive any treatment intervention. While five studies were random, the participants in the four studies were not randomly distributed into experiment and control groups. Six studies were conducted among the Turkish population, one study among the ABD population, one study among the Romanian population, and one study among the Iranian population. All experimental studies were carried out in a school setting. The meta-analytic research was represented by a sample size including 309 (154 from the experiment and 155 from the control group) adolescent participants aged 11–18. Except for one, all studies demonstrated the significant effect of SFBT on the experiment group.

Table 1.

Characteristics of Individual Studies Used in Meta-Analysis.

No	Study (Author, year)	Publication Type	Outcome Variables	Comparison Treatment	Randomize	Country	Setting	N	Age range (years)	Experiment Group		Control Group		SFBT Pre–Post	Quality Rating
No	Study (Author, year)	Publication Type	Outcome Variables	Comparison Treatment	Randomize	Country	Setting	N	Age range (years)	Female	Male	Female	Male	SFBT Pre–Post	Quality Rating
1	Akan (2019)	Unpublished master's thesis	Academic motivation	No treatment	No	Turkey	School	18	Sixth-grade students	4	5	4	5	+	4
2	Altundağ and Bulut (2019)	Published study	Exam anxiety	No treatment	Yes	Turkey	School	16	16–18	6	2	4	4	+*	5
3	Ateş (2016)	Published study	School burnout	No treatment	Yes	Turkey	School	30	14–18	8	7	6	9	+*	5
4	Bal and Kaya (2017)	Published study	School exhaustion	No treatment	Yes	Turkey	School	16	Sixth-grade students	0	8	0	8	+*	4
5	Enea and Dafinoiu (2009)	Published study	School truancy	No treatment	No	Romania	School	38	16–17	19		19		+*	4
6	Newsome (2004)	Published study	Academic achievement	No treatment	No	ABD	School	52	12–14	7	19	7	19	+*	5
7	Özdağ (2021)	Unpublished master's thesis	Exam anxiety	No treatment	Yes	Turkey	School	36	17–18	11	7	11	7	+*	5
8	Saadatzaade and Khalili (2012)	Published study	Academic achievement	No treatment	No	Iran	School	44	High school students	0	22	0	22	+*	4
9	Sarıcı-Bulut (2008)	Unpublished doctoral dissertation	Exam anxiety	No treatment	Yes	Turkey	School	59	11–14	12	17	12	18	+*	6

Note. “+*” significantly indicates that treatment outcomes favored Solution Focused Brief Therapy; “+” indicates that treatment outcomes favored Solution Focused Brief Therapy, but not significant.

The Effect Size

Under the random-effect model, the overall effect size from the pooled random-effects analysis was found to be 1.80 (Hedges's g value). This finding demonstrated a very large treatment effect favoring SFBT. The magnitude of the overall weighted effect size was statistically significant (p < .001) with a 95% confidence interval, which provides the precision of the overall effect size, ranging from 0.94 to 2.66 (z = 4.091). As a result, the findings evidenced that adolescents who received the SFBT intervention reported significantly fewer problem signs in the school context compared to those in the control group Effect sizes for SFBT across all studies included in our meta-analysis were represented graphically in Figure 2 (forest plot).

Figure 2.

Meta-analysis diagram showing the effect direction of the studies (forest plot). Note. Positive effect size values indicated that treatment outcomes favored solution-focused brief therapy; negative effect size values indicated that treatment outcomes favor alternative intervention for the control group.

The Publication Bias

We tested the possible publication bias risk using the visualized funnel plot, trim-and-fill method, fail-safe N test, Begg and Mazumdar's rank correlation analysis, and Egger's regression test. First, the funnel plot showed a relative symmetry finding substantially (see Figure 3). Second, the trim-and-fill method showed that there were three black circles representing missing studies. Given that the present research included nine studies, this result can be considered normal. Third, the finding of fail-safe N indicated that the number of missing studies that would bring the p-value to > alpha was 312. Given that the 233 value was higher than 55 (5k + 10), publication bias was not unlikely. Fourth, Begg and Mazumdar's rank correlation analysis was found to be .56 (p = .037). In addition, Egger's regression intercept test was not significant (p = .063). As a result, we could conclude that all evaluation results agreed on the finding that there was no publication bias except for the finding of Begg and Mazumdar's rank correlation analysis.

Figure 3.

The funnel plot. Note. Blank circles display the investigated studies. There are no black spots that display unpublished studies that are needed to improve publication bias.

The Heterogeneity

The heterogeneity of the effect sizes was interpreted according to the Q and the I² statistics. The Q statistic was found to be 81.516 (p < .001; df = 8). Given that the k−1 degree of freedom value according to the chi-square distribution table was 15.507 at the .05 significance level, the findings reported that the Q value was greater than the k–1 value. On the other hand, the I² percentage was found to be 90.186. As a result, both the Q and the I² values revealed evidence of high heterogeneity. The findings uncovered a significantly high heterogeneity, with I² indicating that 90% of the variability in the estimated treatment effect was due to heterogeneity rather than chance (see Table 2).

Table 2.

The Effect Size Values and the Heterogeneity Results.

Model	n	Mean Effect Size	Standard Error	z-Value	95% Confidence Interval		df	Q	p	I²
Model	n	Mean Effect Size	Standard Error	z-Value	Lower Limit	Upper Limit	df	Q	p	I²
Random model	9	1.800	0.440	4.091	0.938	2.662	8	81.516	.000	90.186
Fixed model	9	1.411	0.134	10.554	1.149	1.674	8	81.516	.000	90.186

*p < .05, **p < .01, ***p < .001.

Study Quality

According to the six criteria, the included experimental studies were assessed in terms of study quality (the risk of bias). The results were presented in the last column of Table 1. Of the included studies, five were rated as good, and four were rated as fair. No study met three or fewer standards. As a result, this meta-analytic study generally included better-designed experimental studies.

Discussion and Applications to Practice

This meta-analytic study aimed to review the overall effectiveness of SFBT among adolescents with school-related problems by synthesizing the previous experimental findings in the literature. This study was conducted with nine controlled experimental studies with a total sample size of 309 adolescents (154 from the experiment and 155 from the control group). The findings reported a result favoring the effectiveness of SFBT for adolescents’ school-related problems. To our best knowledge, this meta-analytic trial was the first study to review the overall effectiveness of SFBT both in studies using only adolescent samples and for school-related problems comprehensively. We hope the present meta-analytic research will allow mental health professionals, especially school counselors and school social workers, and those interested in SFBT to evaluate the empirical evidence quickly and with more precise information.

The current study has provided strong evidence that SFBT is an effective positive treatment for adolescents’ school-related problems, with a high effect size (g = 1.80). When considering that there was high heterogeneity and no publication bias, this finding was more significant. The existence of heterogeneity largely eliminated the random sampling error. However, this result may raise doubts about the assurance that the SFBT will have a similar effect when applied to other participants due to differences such as culture, gender, age, etc. Therefore, future studies can help us better understand what factors influence the intervention by examining these differences through meta-regression or subgroup analysis. The individual quality of all studies included in the meta-analysis was moderate and higher. In general, we could say that the present effect size (g = 1.80) was higher compared to other studies aiming at testing the effect of SFBT on various problems in different populations. Of these, the study of Hsu et al. (2021) was .43 for externalizing and .18 for internalizing problems (children and adolescents), Kim (2008) from .13 to .26 (the mixed participants), Schmit et al. (2016) from .24 to .31 (youth and adults), and Zhang, Franklin, et al. (2018) and Zhang, Ji, et al. (2018) from .28 to .34 (the mixed participants).

Adolescence is critical to academic career development (Negru-Subtirica & Pop, 2016). The unique nature of adolescence, which involves a wide range of concurrent and rapid changes, has the potential to interrupt this development. In this context, many adolescents face school-related problems for various reasons (Chen et al., 2016; Hinshaw, 1992; Walburg, 2014). The present study that aimed to test the overall effectiveness of SFBT in adolescents demonstrated a promising outcome in decreasing problems in the school context. The present meta-analytic study identified nine experimental studies conducted in school settings that tested the treatment effectiveness of SFBT for school-related problems, from exam anxiety to academic achievement. Of the identified nine studies, 8 (74%) indicated significant positive benefits from SFBT. Only one trial reported no significant observable benefit but positive trends. Given the literature, although no study directly supports the present findings, we can relatively draw parallels with studies that have proven that SFDT is effective for students’ various problems in school settings. The most important among these is a systematic qualitative review trial conducted by Gingerich and Peterson (2013), including 43 experimental studies, 14 of these with child academic and behavioral problems. This study tested the overall effectiveness of the SFBT for children's academic and behavioral problems (four studies with academic problems and 10 studies with behavioral). Of 14 studies, 11 trials were conducted in school settings. The study presented an assessment of SFBT which is an effective treatment for academic and behavioral outcomes in a mixed sample involving children and adolescents.

The solution-focused approach is strongly compatible with adolescence. Given both the nature of the SFBT and adolescents’ basic characteristics, we can consider that the effectiveness of solution-focused brief group therapy for adolescent problems is not surprising. This relationship can be evaluated from several aspects. First, the way adolescents direct their lives is congruent with the short interventions (Geldard & Geldard, 2009). Generally, adolescents prefer single-session and short-term interventions (Mabey & Sorensen, 1995). Second, adolescents are reluctant to confide in adults in general. When young people have a problem, they first reach out to their friends. Adolescents adopt a mutually self-disclosed communication style with each other. The client's active role in the SFBT may provide that client regards the counselor as his/her friend. Three, working through the problem and trying to explore solutions are important parts of the process of counseling adolescents (Geldard & Geldard, 2009). Four, the mutual conversation between counselor and client contributes to adolescents’ developmental needs. For example, the autonomy need. The fact that the SFBT evaluates the client in an active position provides that the client controls the process, which may enhance the client's autonomy. Lastly, adolescents tend to think more about the future than young adults, middle-aged, and older adults. They are more open to focusing on the future than the past (Mello et al., 2022). Therefore, it is reasonable to expect that adolescents would generally be more willing to experience a therapy that involves positive strengths than adverse childhood experiences.

Communication with peers and friends begins to gain importance as social life gains momentum in adolescence (Steinberg, 1996). Furthermore, when they have a problem, the first person who is consulted is their friends (Geldard & Geldard, 2009). Therefore, adolescent clients may aim more at fighting their problems in the interactive-based group atmosphere that SFBT constitutes in school settings. Despite not directly, we view the meta-analytic studies conducted in school settings highlighting the effectiveness of SFBT for adolescents’ various problems as significant in terms of supporting the present findings. Franklin and associates (2007, 2008) are called key scholars in examining the effectiveness of SFBT in school settings. They provided the support that SFBT was effective in behavior problems in the school among children and adolescents. One of these experimental studies was done in 2008. Among 67 children with classroom-related behavior problems within a school setting, the effectiveness of SFBT was tested using a pretest/posttest follow-up design with a comparison group. The findings demonstrated that SFBT was effective in improving internalizing and externalizing behavior problems in the school (Franklin et al., 2008). Likewise, a study was conducted by Gong and Hsu (2017). This study aimed to examine the effectiveness of solution-focused brief group therapy in school settings, with 24 experimental studies conducted in Taiwan and China. The meta-analytic findings demonstrated that SFBT was effective for improving both internalizing behavior problems and family and relationship problems among junior high school students, senior high school students, and college students, except for elementary school students.

The findings of the present study should be evaluated in light of several limitations. First, the number of studies that were included in the meta-analytic pool was relatively small, and more than half of them were conducted in the Turkish population. Moreover, this study did not test the moderating effect of the potential variables on the effectiveness of SFBT for school-related problems, such as adolescents’ age or grade, gender, the number of sessions, and cultural differences. Therefore, we recommend caution for generalizing the findings. Second, although this study reported the effectiveness of SFBT for adolescents, it did not provide a direct assessment of to what extent the results differed from child and emerging adult populations. Third, without limiting a specific problem area such as academic failure, or exam anxiety, this study analyzed how SFBT was effective by generalizing adolescents’ school-related problems. We encourage academics to focus on adolescents’ specific problems. Fourth, although this study investigated publication bias followed by no impact on results, the inclusion of only studies in Turkish and English shows a limitation. There is always a chance that the results are subject to human errors during searching and data extraction despite all precautions. Therefore, it is impossible to guarantee that every potential study was identified during the search process. Fifth, quasi-experimental studies that lacked randomization were included in the study to promote external validity. This picture may have increased the likelihood of biased effect sizes compared to a review of only randomized experiments. Future studies may test the effectiveness of SFBT in adolescents by using only randomized studies. Sixth, this study did not consider follow-up measures when testing the efficacy of therapy. Therefore, there was no sufficient evidence to report whether or not the positive treatment effects of SFBT sustain. Future controlled experimental studies should implement follow-up measures. The last limitation is that this meta-analytic pool consisted of only experimental studies based on the application of SFBT to group work. Therefore, we should deliberate on the generalization of the finding to the individual therapy process.

Despite these limitations, the present meta-analytic study has some strengths. First, to our best knowledge, this research is the first meta-analytic study to examine the overall effectiveness of SFBT both in the only adolescent population and for school-related problems comprehensively. Second, this meta-analytic examination that includes the nine controlled studies that were conducted in school settings indicated strong evidence of the effectiveness of SFBT for adolescents’ school-related problems, which are common in this period. The fact that the study focuses on problem areas especially school counselors and school social workers often face also improves the importance of the findings. It would also provide more definite and quick empirical evidence for mental health professionals interested in SFBT. Three, the present meta-analytic review presents a wide-ranging overview and the most up-to-date research to date, with the overall high quality of the included studies.

We believe that this study has advanced especially school social workers’ existing understanding of the valid evidence base for the effectiveness and efficiency of SFBT. SFBT, which is a strengths-based intervention, involves specific interventions that help people explore their resources and past successes and identify goals, future hopes, and solutions to their problems (Franklin, 2015). In this context, SFBT coincides with social work practice interventions consistent with the strengths perspective, which aims at supporting students’ learning and well-being in school settings. Besides, it here is important to underline two issues concerning policymakers before addressing intervention implications. First, it is highly recommended that each school has a school counselor or school social worker at least. Second, it is recommended to give SFBT training to school mental health professionals in particular.

This study also provided some practical implications for working with adolescents experiencing school-related problems. First, a group-focused SFBT intervention approach that is briefer and congruent with adolescents’ nature seems a unique key for school counselors and school social workers in treating adolescents’ school-related problems. In this context, the best guarantee of successful results with SFBT on school-related problems is to apply it faithfully by its theoretical framework as intended. Second, it is recommended to perform SFBT group interventions, especially in the school setting. This application may also help strengthen the bond between school and adolescents. Three, the present findings reported SFBT worked effectively in school-related problems in school settings regardless of follow-up outcomes. Therefore, school mental health professionals should test whether or not treatment effects sustain. Four, as mentioned above, although the mean effect of SFBT on the experimental group was significant, it does not mean that every participant in the experimental group may show a positive change. Therefore, school mental health professionals, after the end of group intervention, should also continue to follow the development of adolescent students’ school-related problems through follow-up evaluations such as individual counseling, observation reports, and parents’ and teachers’ records.

To assess the overall effectiveness of SFBT for adolescents’ school-related problems, we tried to find out and review all controlled studies that had the potential to participate in the meta-analytic pool. The abstracted data of the studies that we identified by using selection criteria were presented. As a result, this meta-analytic study showed promising outcomes on the potential effectiveness of SFBT in treating adolescents’ school-related problems. We believe that this study has advanced our understanding of the valid evidence base for the effectiveness and efficiency of SFBT.

Footnotes

Data Availability Statement

The datasets analyzed during the current study are available from the corresponding author upon reasonable request.

Declaration of Conflicting Interests

The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethical Approval

All procedures conducted in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or ethical standards.

Funding

The author received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Ali Karababa

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