SFBT目标制定在心理健康干预中的实践应用

英文原文

Solution-Focused Brief Therapy (SFBT): Practical Steps Toward Change

When worry or stuckness takes up too much room, therapy that focuses on the past can feel heavy. Solution Focused Brief Therapy (often shortened to SFBT or SFT) shifts the conversation: what small, realistic next step would make a difference? It’s concise, goal-oriented, and built around clients’ strengths—helpful when clarity and forward motion are the priority.

What is Solution Focused Brief Therapy (SFBT) and How it Works?
• SFBT is a short-term, future-focused therapy that centers on goals, resources, and what’s already working—rather than a long search for causes.
• Typical SFBT work is brief: many studies report an average of about 4–6 sessions, though the range in research is wider (1–24 sessions). The aim is useful, measurable change in a short time.
• This therapy helps clients and therapists create a clear vision of a preferred future. From there, they find small, actionable steps forward, building on the client’s existing strengths and successes instead of focusing on their problems.

What are the Key Elements of Solution Focused Brief Therapy?
• Goal-setting (well-formed goals): clear, observable, and client-chosen outcomes.
• Miracle question: invites the client to imagine a day after a problem is solved, which clarifies what matters and helps set targets.
• Exception questions: explore times when the problem did not occur (or was less severe), revealing usable strategies already in the client’s life.
• Scaling questions: track progress by asking the client to rate where they are on a 0–10 scale and to identify next small steps to move the number.
• Language and stance: the therapist adopts a “not-knowing” curiosity and uses clients’ own words—this preserves client agency and keeps interventions culturally respectful.

What are the Benefits of SFBT?
• Efficiency: short courses of therapy can produce meaningful change, which can be useful for people looking for focused, practical help quickly. Group and brief formats sometimes show strong effects.
• Hope-centered and empowering: by focusing on solutions and existing strengths, clients often leave sessions feeling more capable and motivated.
• Versatility: SFBT is applied successfully in individual, family, couples, school, healthcare, and organizational settings.
• Evidence base: An umbrella review of existing systematic reviews and meta-analyses concluded there is high confidence that SFBT improves outcomes such as depression, overall mental health, and progress toward personal goals in adults; evidence is moderately confident for many other outcomes.

What is an Example of Solution Focused Brief Therapy (SFBT)?
Short clinical vignette (social anxiety):
A client reports dread about a work social.
Therapist asks, “If you woke up tomorrow and the problem was gone, what would you notice first?” (miracle question).
The client says, “I’d be able to stay 10 minutes longer and say hello to two colleagues.”
Therapist asks, “On a 0–10 scale, where are you now?”
Client: “3.”
Therapist: “What did you do once that made it a 3 and not a 1?” That exception points to a small, repeatable behavior (brief greetings) to practice before the next session. Scaling lets the client track progress and build confidence.

What is the Difference Between CBT and SFT?
• Primary focus: CBT (Cognitive Behavioral Therapy) focuses on identifying and changing unhelpful thinking patterns and behaviors through structured techniques and often homework; it directly targets cognitive distortions and skill practice. SFBT focuses on identifying solutions, exceptions, and small steps toward a preferred future—less emphasis on restructuring thoughts or deep analysis of underlying causes.
• Time and structure: CBT protocols frequently run longer (commonly 8–20+ sessions depending on the problem and protocol) and include skill rehearsal between sessions; SFBT tends to be shorter on average (often 4–6 sessions in studies) and centers on immediate, client-driven goals.
• When to choose which: CBT is robust for many diagnosable conditions (depression, PTSD, anxiety disorders) and for clients who benefit from skills training and cognitive restructuring; SFBT suits clients wanting rapid, practical change, goal-setting, or brief interventions in settings where time and resources are limited. Both can be complementary rather than mutually exclusive.

Final Thoughts
SFBT is not denial of difficulty; it’s a strategic redirection of attention toward what works and what’s next. For many people, that shift produces surprisingly fast and useful change—small steps that add up. If short, targeted work fits the situation, or if a client wants momentum and clarity quickly, SFBT is a practical option to consider. As with any therapy, fit matters—discuss goals and expectations with a licensed clinician to decide the best path forward.

中文翻译

焦点解决短期治疗（SFBT）：迈向改变的实际步骤

当担忧或停滞占据太多空间时，专注于过去的治疗可能会让人感到沉重。焦点解决短期治疗（通常缩写为SFBT或SFT）转变了对话方向：什么样的微小、现实的下一步会带来改变？它简洁、以目标为导向，并围绕来访者的优势构建——当清晰度和前进动力是优先事项时，这很有帮助。

什么是焦点解决短期治疗（SFBT）及其工作原理？
• SFBT是一种短期、面向未来的治疗，以目标、资源和已经在起作用的方面为中心——而不是长时间寻找原因。
• 典型的SFBT工作是简短的：许多研究报告平均约4-6次会谈，尽管研究范围更广（1-24次会谈）。目标是在短时间内实现有用、可衡量的改变。
• 这种治疗帮助来访者和治疗师创建对偏好未来的清晰愿景。从那里，他们找到微小、可操作的步骤前进，建立在来访者现有优势和成功的基础上，而不是专注于他们的问题。

焦点解决短期治疗的关键要素是什么？
• 目标设定（良好形成的目标）：清晰、可观察且由来访者选择的结果。
• 奇迹问题：邀请来访者想象问题解决后的一天，这澄清了什么重要并帮助设定目标。
• 例外问题：探索问题没有发生（或严重程度较低）的时刻，揭示来访者生活中已有的可用策略。
• 量表问题：通过要求来访者在0-10量表上评估他们所处位置并确定移动数字的下一个小步骤来跟踪进展。
• 语言和立场：治疗师采用“不知”的好奇心并使用来访者自己的语言——这保留了来访者的能动性并保持干预的文化尊重性。

SFBT的好处是什么？
• 效率：短期治疗课程可以产生有意义的改变，这对于寻求快速、专注、实际帮助的人很有用。团体和简短形式有时显示出强烈效果。
• 以希望为中心并赋权：通过专注于解决方案和现有优势，来访者通常在会谈后感到更有能力和动力。
• 多功能性：SFBT成功应用于个人、家庭、夫妻、学校、医疗保健和组织环境。
• 证据基础：对现有系统评价和荟萃分析的总体回顾得出结论，有高度信心认为SFBT改善了结果，如抑郁、整体心理健康和成人个人目标进展；对于许多其他结果，证据有中等信心。

焦点解决短期治疗（SFBT）的例子是什么？
简短临床片段（社交焦虑）：
一位来访者报告对工作社交活动感到恐惧。
治疗师问：“如果你明天醒来问题消失了，你会首先注意到什么？”（奇迹问题）。
来访者说：“我能够多待10分钟并向两位同事打招呼。”
治疗师问：“在0-10量表上，你现在在哪里？”
来访者：“3。”
治疗师：“你曾经做了什么让它成为3而不是1？”那个例外指向了一个微小、可重复的行为（简短问候）在下次会谈前练习。量表让来访者跟踪进展并建立信心。

CBT和SFT之间有什么区别？
• 主要焦点：CBT（认知行为疗法）专注于通过结构化技术和通常的家庭作业识别和改变无益的思维模式和行为；它直接针对认知扭曲和技能练习。SFBT专注于识别解决方案、例外和迈向偏好未来的小步骤——较少强调重构思想或深入分析潜在原因。
• 时间和结构：CBT协议通常运行时间更长（通常8-20+次会谈，取决于问题和协议）并包括会谈间的技能排练；SFBT平均往往更短（研究中通常4-6次会谈）并以即时、来访者驱动的目标为中心。
• 何时选择哪种：CBT对于许多可诊断状况（抑郁、PTSD、焦虑障碍）和受益于技能训练和认知重构的来访者来说很稳健；SFBT适合想要快速、实际改变、目标设定或在时间和资源有限的环境中进行简短干预的来访者。两者可以是互补的而不是相互排斥的。

最后思考
SFBT不是否认困难；它是将注意力战略性地重新导向什么起作用和下一步是什么。对许多人来说，这种转变产生了令人惊讶的快速和有用的改变——小步骤累积起来。如果短期、有针对性的工作适合情况，或者如果来访者想要快速获得动力和清晰度，SFBT是一个实用的选择。与任何治疗一样，适合性很重要——与持照临床医生讨论目标和期望以决定最佳前进路径。

文章概要

本文详细介绍了焦点解决短期治疗（SFBT）在心理健康干预中的目标制定实践。文章阐述了SFBT作为一种短期、未来导向的治疗方法，其核心在于帮助来访者设定清晰、可观察的目标，并通过奇迹问题、例外问题、量表问题等关键技术，引导来访者发现自身优势并采取小步骤实现改变。文章对比了SFBT与认知行为疗法（CBT）的差异，强调了SFBT在效率、赋权性和多功能性方面的优势，并通过临床案例展示了目标制定在社交焦虑干预中的具体应用。文章指出，SFBT特别适合寻求快速、实际改变和明确目标导向的来访者，在多种场景中展现出显著效果。

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