11/21/ Second, most meta-analysis of SFBT did not collect studies
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- April Thompson
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1 - + Four Reasons for conducting this research + First, as the amount of SFBT research has increased, differences among the results of research have begun to appear. When facing a large volume of quantitative research with inconsistent results, meta-analysis is an accepted scientific approach to integrating these disparate findings into an overall result. + Stams, Dekovic, Buist, and de Vries (2006) executed a meta-analysis on 21 studies on SFBT and found that the overall was a small to near medium effect (d =.37). Among the results of these studies, there was strong heterogeneity among the s, indicating that moderators existed. The moderator analyses results indicated that when compared to a group who received no treatment, those who received SFBT were found to have a statistically significant medium (d =.57). The moderator analysis further highlighted that studies published prior to 2000 did not produce as strong of effects (d =.29) as those published after 2000 (d =.87). In addition, there were specific populations that benefited more from receiving SFBT: adults (d =.87), clients who received services while being institutionalized (d =.60), participants with externalizing problems (d =.61), those who received SFBT in a group format (d =.59), and participants who received six weeks or less of SFBT (d =.46). + Kim (2008) also performed a meta-analysis on 22 studies that met inclusion criteria. Before calculating s, he separated the involved psychological problems into three categories: externalizing behavior problems, internalizing behavior problems, and family and relationship problems. The research found that when SFBT was applied to externalizing behavior problems, internalizing behavior problems, and family and relationship problems, it had an of 0.11, 0.26, and 0.26, respectively. Overall, the of SFBT was small. + Corcoran and Pillai (2009) further reviewed 10 studies that met inclusion criteria, and found that 2 studies reported large s, 3 reported medium, and 1 small. The remaining 4 s were all smaller than Only 2 of the studies included the follow-up results of SFBT. In their research, no particular moderators emerged regarding studies with high versus low s. + Kim and Franklin (2009) reviewed 7 studies examining the effect of SFBT in school settings, estimates were calculated for each study. Their review found mixed results but SFBT did show promise as a useful approach in working with atrisk students in a school setting. + More recently, Kim, Franklin, Zhang, Liu, Qu, and Chen (in press) conducted a meta-analysis on 9 studies that took place on Mainland China in order to understand the effects of SFBT in Chinese culture. In their research, 6 studies were conducted in schools, 3 studies were conducted in hospitals, SFGT studies and studies of SFBT used in individual therapy were mixed. The result showed that SFBT had a large effect on the internal problems of young people (the overall was 1.26). + Mata-analyses (including moderator analysis) on the effectiveness of SFBT mostly combined individual and group therapy. However, meta-analytic researches on the effectiveness of only SFGT haven t been found. + Also, scarce research in the past has examined the follow-up effect of SFGT. + In the meta-analysis conducted by Corcoran and Pillai (2009), only 2 studies mentioned follow-up results. Good follow-up results indicate that a counseling approach can not only resolve clients current problems, but can also empower clients with the ability to autonomously settle their own issues when they leave the counseling room. + Second, most meta-analysis of SFBT did not collect studies involving Chinese samples. + Though sharing same cultural and ethnic roots, Mainland China and Taiwan have developed into two quite different societies with distinct features over the past sixty years due to the larger socio-historical backgrounds. + We conducted a literature review of all articles on SFBT using the academic fulltext database Chinese National Knowledge Infrastructure (CNKI) in Mainland China. The result showed that, as of September 30, 2014, a total of 155 journal articles on SFBT were retrieved and reviewed. The similar searching method was conducted by using the PerioPath Index to Taiwan Periodical Literature System and the National Digital Library of Theses and Dissertations in Taiwan. The result showed that 116 journal articles and 91 dissertations were obtained up to September 30, Kim et al. (in press) specifically investigated the effects of SFBT only in Mainland China. If the large number of SFBT research in Taiwan can be joined when metaanalysis is conducted, those limitations will be overcome to some extent. + Third, SFBT has gradually become a common and accepted treatment option for many mental health professionals, particularly in school setting. Also, SFBT is achieving effective outcomes when compare to other therapeutic and educational intervention in school-based research. + With its emphasis on client strengths and short-term treatment, portable and adaptable SFBT would appear to be well suited to school mental health contexts, given the wide array of problems presenting in school settings, including student behavioral and emotional issues, academic problems, and social skills (Kelly, Kim, & Franklin, 2008). + Kim & Franklin (2009) reviewed the research literature examined the effectiveness of solution-focused approach conducted in schools and considered the mixed results of 7 studies included. They thought that caution was warranted in drawing any definitive conclusions about the efficacy of solution-focused approach in school settings. + Zhang, Liu, Franklin, Qu, Chen, and Kim (in press) reviewed the solution-focused approach literature in China. Their research found that published articles in the educational field (counseling in schools, colleges, and for adolescents) have the highest numbers in China as Hsu and Tsai (2008 &2011) found in Taiwan. The results indicated that the school settings was an important applied field for solution-focused approach in ethnic Chinese school settings, so the effectiveness of SFBT, especially SFGT, is worth to be studied. 1
2 + Fourth, several moderators were identified in the previous metaanalytic reviews.. Can these factors also impact the effectiveness of SFGT in ethnic Chinese School settings? + type of outcomes was the most commonly seen factor. Other important factors included the year of publication, the ages of research participants, etc. In group psychotherapy, intervention effects were often influenced by the group size. In their research, Kim & Franklin (2009) also mentioned that future studies need to examine more carefully which school-based populations and problem areas that solution-focused approach is best suited to help. + Research purposes + In light of the research conducted in ethnic Chinese school settings, the lack of investigations pursuing the follow-up effects of solution-focused approaches, and the effectiveness of SFGT as described above, we aim to adopt a meta-analysis methodology to perform a comprehensive quantitative analysis on all the research materials from Mainland China and Taiwan, and from these research materials investigate the immediate and follow-up results as well as any moderating factors of receiving SFGT for those samples with an ethnic Chinese background. + The source of all materials analyzed in our meta-analysis are the following: + CNKI, VIP journal integration platform, the Wanfang data knowledge service platform, the PerioPath Index to Taiwan Periodical Literature System and the National Digital Library of Theses and Dissertations in Taiwan. Studies were retrieved from them using the Chinese key word jiaodian-jiejue, which translates to solution-focused. + All materials analyzed in this meta-analysis took place in schools + They all had an experimental or quasi-experimental designs. (Studies that used single-subject, single-group posttests only designs, or single group pretest/posttest designs, were excluded.) + All research included in this meta-analysis used pure SFGT as its only intervention method (i.e., SFGT was not combined with other counseling approaches, such as pastoral counseling, etc.). + Questionnaires or scales used in included studies had to have good psychometric properties. + A total of 24 valid studies published between 2000 and 2014 were included. + In total, there were 20 dissertations, and 4 journal articles. Of these 24 studies, 15 were conducted in Taiwan and 9 were conducted in Mainland China + Participants in these studies were divided by school year into four groups: elementary school students, junior high school students, senior high school students, and college students. + The outcome variables of these research outcomes ranged widely, and included measures of interpersonal relationships, learning adjustment, depression, selfacceptance, self-efficacy, etc. We resorted them into three categories: externalizing behavior problems, internalizing behavior problems, and family and relationship problems + The SFGT group sizes of these materials ranged between 5-36 people per group, with groups in 23 research including 12 people or fewer and one research including 36 people. + The number of group counseling sessions in these research ranged between 4 14 sessions, with 6 sessions (9 research) and 8 sessions (11 research) being most common. + Immediate effects were collected promptly after the completion of the group counseling treatment. Follow-up data for SFBT was provided by 16 of the 24. Follow-up effects were collected during a second posttest, taking place sometime after the first posttest. The interval between the posttest and the follow-up posttest was 2 weeks for one study, half a year for another, and 4 weeks (or 1 month) for the rest. Study Resources N Population Group Session number Outcomes size Weng(2000) T 16 P 8 4 emotion life adjustment Huang(2003) T 15 C 7 6 career self-efficacy Su(2003) T 16 J 8 8 anger trait anger reaction Lin et al.(2003) T 16 P 8 10 beliefs about parental divorce self-concept Luo et al.(2004) T 15 H 7 8 interpersonal relationship Li(2004) T 16 J 8 8 learning adjustment Cai(2005) T 16 P 8 7 negative emotion Chen(2005) MC 72 J 36 8 interpersonal relationship Xie(2006) T 14 P 7 8 interpersonal relationship social skills social self-esteem Zhang(2006) MC 43 H 10/11 8 career maturity career self-efficacy Lian(2007) T 20 H 10 8 internet addiction tendency Lin(2007) T 12 P 6 14 shy social anxiety self-esteem Huang(2007) T 16 P 8 8 depression self-concept behavior disturbance Deng(2007) MC 21 H 11 8 interpersonal communication ability He(2008) T 10 C 5 6 career belief career decision-making self-efficacy Liang(2010) T 16 P 8 6 self-acceptance personality trait Hong(2011) T 24 H 12 6 well-being career self-efficacy Sun(2011) MC 48 C 12 6 self-esteem self-efficacy self-acceptance Zhang(2011) MC 30 C 8 6 achievement motivation general self-efficacy Xi(2011) MC 12 C 6 6 depression Li(2012) T 19 J 10 8 internet addiction tendency self-esteem emotional quotient interpersonal relationship Zhang(2012) MC 16 H 8 8 anxiety depression social support Han(2012) MC 20 C 10 6 interpersonal relationship interpersonal communication skills interpersonal communication ability Li(2014) MC 48 C 12 6 coping style Note: Experimental groups(twenty-four participants respectively) in Sun(2011) and Li(2014) were divided into two subgroups (12 participants per subgroup) based on the consideration of group size. For the same reason, the experimental group in Zhang(2006) was also divided into two subgroups (one subgroup 10 participants, the other 11 participants).mc=mainlandchina, T=Taiwan. P= elementary school students, J=junior high school student, H= high school student, C= college student, the same below. + For this meta-analytic review, s and 95% confidence intervals were calculated using Comprehensive Meta-Analysis software 2.0 (Borenstein, Hedges, Higgins, & Rothstein, 2005) and SPSS 20.0 was used for correlation analysis. + Because the sample sizes of these SFGT studies were usually small, Hedge s unbiased estimator d was calculated. Both Kim (2008) and Corcoran and Pillai (2009) recommend that only one value be calculated per study in order to ensure the statistical independence of the data. So, for each study with multiple s an average (M d ) was calculated to show an overall effect. + After s for each study was calculated, accompanying variances were calculated for each study and used to calculate weights by taking the inverse of the variance score. + + For evaluating the publication bias of a meta-analysis, this meta-analysis used the fail-safe number (N fs ), which is the number of unpublished or future studies averaging null results that would be necessary to reduce our overall to a nonsignificant value (Orwin, 1983). + To evaluate the stability of the results of a meta-analysis, a sensitivity analysis should be performed. In this meta-analysis, the sensitivity analysis was conducted in the following way: The twenty-four included studies were compared and larger s were excluded (the top 10% of s). The overall of the remaining studies (category I) was then compared to the overall of all of the research. Next, smaller s were excluded (the bottom 10%), and their overall (category II) was compared to the overall of all the research. This procedure was repeated for both immediate effects and follow-up effects. 2
3 effect Immediate Follow-up overall SE Z 95%CI N fs ** 8.37 ** Note:Here K is the number of studies. immediate effect:k=24,n=551;follow-up:k =16,N=280;** p <.01,* p <.05,the same below + Whether or not the result of meta-analysis is stable depends on both internal and external threats. The main external threat is the existence of publication bias. This meta-analysis calculated N fs to evaluate publication bias. Rosenthal et al. (1991) suggested that the fail safe number, N fs, should exceed the critical value of 5k + 10, where k refers to the number of studies included in the meta-analysis. + The immediate effect of SFGT, to reduce the overall of 1.03 to.20, the N fs was 100; for follow-up effect of SFGT, to reduce the overall of 1.09 to.20, the N fs was 73. Both of these were less than but near the critical value. Hence, this meta-analysis has only small publication bias threats. The results showed that SFGT had significant immediate and followup effects, and that, according to Cohen s (1992) standard for evaluating s (0.2 small, 0.5 moderate and above 0.8 large), the s were large in both cases. Effect category K N overall immediate I II follow-up I II SE Z 95%CI ** 9.02 ** 7.32 ** 8.46 ** According to the aforementioned sensitivity analysis, this meta-analysis respectively conducted a meta-analysis on the sub-groups I and II for both the immediate and follow-up effects. From the resulting values of each overall, confidence interval, and corresponding Z-score for the respective groups, the meta-analysis results of the remaining research was consistent with our original results, thus showing that the internal threat is small. + The homogeneity test found that the immediate effect of SFGT was strongly heterogeneous, Q (23) = 37.68, p =.02. Whereas the follow-up effects of SFGT did not appear significantly different, Q (15) = 14.67, p =.34. This suggested that the immediate effect of SFGT was regulated by other factors. Therefore, this meta-analysis investigated the relationship between some factors and for all materials. + First, the relationship of group size and publication year to the immediate effect of SFGT was separately examined by using a correlation analysis method. The results showed that group size and the immediate effect of SFGT did not achieve significant correlations (r = -.19, p =.36).One reason may be that the group size of each study is close in number: Except for one study whose group size was 36 people, the others were all around 5 12 people. + Publication year also had no significant correlation with the immediate effect of SFGT (r =.22, p =.30).. Combined with the results of Stams et al.(2006), we infer that 2000 year may be a cut-off point in the development of SFBT. Up to this point, the techniques of SFBT become more mature population K N overall effect size P J H C SE Z 95%CI 5.40 ** 3.29 ** 5.14 ** 7.12 ** Second, the studies were divided into several groups based on school year and analyzed separately. The results showed that the immediate effect of SFGT was significant for each group, except for junior high school students. The group of junior high school students showed a moderate while all other groups achieved s above.80. One reason may be because within this Metaanalysis materials investigating junior high school students were smaller in number, and thus the results were less stable. This is a potential avenue of research for future scholars to explore. Category K N overall SE Z 95%CI I ** R ** Third, The category of externalizing behavior problems had too few entries to properly analyze. The other two, internalizing behavior problems, and family and relationship problems both demonstrated average effects above.80. The result was that SFGT had a significant, large overall when treating internalizing behavior problems such as self-esteem and self-efficacy issues, depression, and so on. SFGT seems less effective at dealing with the family and relationship problems of junior high school students than at dealing with their internalizing behavior, indicating the existence of unknown moderating factors. Because there were only 9 studies examining family and relationship problems included in our meta-analysis, we could not further examine moderating variables. This is of course another avenue for future research. 3
4 + This meta-analysis reviewed the effectiveness of SFGT in ethnic Chinese school settings in Taiwan and Mainland China. The results found that SFGT yielded an overall immediate and follow-up combined effect of 1.03 and 1.09, respectively. The results showed that SFGT s immediate and follow-up effects were positive and large. These s can be considered large, which means, as a counseling intervention, SFGT has a significant immediate and follow-up effect. + The effectiveness of SFGT wasn t affected obviously by group size or the year of publication. SFGT seems less effective at dealing with the family and relationship problems of junior high school students than at dealing with their internalizing behavior. For different school level groups and outcome variables, SFGT had positive and significant effects. In other words, SFGT does very well in schools overall, but had a weaker effect for junior high school students than other students. SFGT is effective in ethnic Chinese school settings + First, ASCA s statement of group work in schools. About the group works in schools, American School Counselor Association Ethical Standards for School Counselors states that professional school counselors should screen prospective group members and maintain an awareness of participants needs, appropriate fit and personal goals in relation to the group s intention and focus; and facilitate group work that is brief and solution-focused, working with a variety of academic, career, college and personal/social issues (Gysbers& Henderson, 2012, p409). + Second, SFBT is proved to effectively treat plenty of adolescents issues, especially for the students who encounter problems in schools match the description of involuntary clients with high-risk characteristics (Hsu & Chen, 2015). + Also, solution-focused approach is very flexible, for it uses different ways of helping and can be used by teachers and other professionals within the school. Its systematic character can facilitates cooperation and promote professional efficacy of school officials, counselors, and supervisors in schools, including the ethnic Chinese areas (Hsu & Tsai, 2008; Hsu & Chen, 2015). + Third, the philosophies of solution focused approach emphasize respecting and positively developing one's innate human potential fit the educational goals of schools. The non-pathological, developmental conceptualizations employed by SFBT will quickly build a strong counseling relationships with Taiwanese young adult clients, because many Taiwanese/Chinese individuals have some hesitation about seeing a counselor or therapist due to the fear of being labeled (Hsu, 2009; Hsu & Wang, 2011). + Fourth, the reason why solution-focused approach is welcome in ethnic Chinese school setting is that the efficacy of SFBT s short-term, actionoriented approach fit the culture and exceptions of ethnic Chinese school settings. The therapists help clients to envision first few steps that the clients consider to be most important and then taking immediate action to experiment the applicability and usefulness of developed solutions. This model advocates for a short-term and concrete treatment plan which matches the Chinese people s expectations for seeking professional help, especially in school settings (Hsu & Tsai, 2008; Hsu, 2009). + Five, from the results of our meta-analysis we can see that the combined follow-up effect of SFGT also achieved a large. This shows strong support for the long-term positive effects of SFGT, which is very meaningful for its application. + Influenced by postmodernism, solution focused approaches presuppose that clients are the experts of their own lives. In these approaches the counselors and their clients are cooperating while on the path to build solutions steps-by-step. The counselors position is to lead clients from one step behind, to let clients define their own goals with full recognition of where their own strengths and resources lie, and to help them practice how to figure out what methods are needed to achieve resolution. + Sharry (2001) stated the therapeutic factors of SFGT as group support, group learning, group optimism, opportunities to help others, and group empowerment. When SFGT is functioning well, its group dynamics will use these therapeutic factors along with the joint efforts of the group to simultaneously. + In other words, one focus of solution focused approaches is to develop the ability of the client to self-help, not just to solve the current dilemma, and, praise worthily, this ability can be enhanced and exist long-term (Hsu, 2014b; Macdonald, 2007). + From the cultural views, Chinese culture may simply be complementary and compatible with SFBT. + Hsu (2014) used the Chinese traditional opinion of Yin-Yang to explain the idea of system balance in SFBT. If the white Yang part (like exceptional time) expands, the black Yin part will shrink, so if the white Yang part increases, then the entire system will change + Chinese place importance on saving face, and are largely unwilling to speak of their emotions, past traumas and private events in front of others. SF s intentions instead of confrontation are a kind of saving face stance which means giving the other person a graceful way to back off (Berg, 2003). + Utilizing the strengths and recourses (similar to increasing the white Yang part) to facilitate changes in clients will be more easily accepted by Chinese people than the traditional Western counseling approaches that focus on tragic childhood experiences or exploring character flaws (Hsu, 2009). + SFBT s normalizing and reframing skills focus on the positive side of the clients complaints, validate the clients worry and anger, and reflect their consideration, and effort when struggling to solve encountered problems. If used appropriately, these reframing skills are likely to reduce potential shame, guilt and self-blame experienced (Hsu, 2009). + SFBT beliefs differ from traditional Confucian beliefs, such as that people should continuously pursue upward mobility, that individual achievement should be emphasized, and that one should continually reflect on one s sophistication while maintaining a humble demeanor (Li, Lin, & Hung, 2006). + SFBT therapists usually actively direct clients to exploring past successful exceptions, coping strategies and progress in therapy facilitate greater willingness of Chinese people (especially for the teenagers) to reflect upon the reality they face, increase their readiness to engage in more productive and mature behaviors, prevent the situation from worsening, and be cognizant of their own limitations and attributions to the existing difficulties, which leading to increased sense of self-efficacy and confidence when facing other authority figures and stressful circumstances. This usually works better than a hard-hitting approach in most situations in Chinese society and in line with pragmatic cultural practice (Hsu, 2009; Hsu & Wang, 2011). 4
5 + One core of Chinese value is interdependence and collectivism. The intentions and values behind SFBT interventions are quite different from most Western counseling approaches which typically focus on clients personal stance and development of clear interpersonal boundaries in significant relationships where the conflicts reside (Hsu & Wang, 2011;Kuo, Lai, Hus, 2011). + Being respective clients own goals and perceptions, SFBT therapists actively embraces the relationship-based cultural values and increases clients understanding of the interdependent nature and reciprocal influence between themselves and significant others with a goal to develop win-win solutions, instead of challenging the hierarchy of the social relationship. + Although the SFBT was developed and validated in the United States, its philosophical frame is rather inclusive and client-centered which leave plenty of room for culturally sensitive practice. We believe Solution-focused approach not only provides therapists in Taiwanese/Chinese societies a practical guide in assisting young clients in schools to deal with their challenges in groups, but also helps to widen the cross-cultural application of the U.S.-based SFBT +FEEDBACK & QUESTIONS 5
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