Solution-focused brief therapy (SFBT) is a

The Practice of Solution-Focused Brief Therapy in Mainland China Xuanwen Liu, Ying Ping Zhang, Cynthia Franklin, Yuanzhou Qu, Hong Chen, and Johnny S. Kim Solution-focused brief therapy (SFBT) is a strengths-based approach that was developed by American social workers and a team of interdisciplinary colleagues in the early 1980s. This article provides a review of SFBT in mainland China, showing the cross-cultural and transdisciplinary use of SFBT by diverse professionals within China. In particular, this article discusses how SFBT has spread from the United States to China and how the practice of SFBT has grown in mainland China. This is the first article in English to review the Chinese literature and further summarize the use of SFBT in mental health and health care fields within China. Practice implications for the future use of SFBT with Chinese people are also discussed. KEY WORDS: Asian population; Chinese population; cross-cultural issues; solution-focused brief therapy Solution-focused brief therapy (SFBT) is a strengths-based practice approach that was developed under the leadership of two American social workers, Steve de Shazer and Insoo Kim Berg, and other colleagues at the Brief Family Therapy Center in Milwaukee, Wisconsin, during the early 1980s ( de Shazer, 1985). The SFBT approach embodies social work s strengths perspective and provides techniques to help find workable solutions to client problems ( De Jong & Berg, 2008). The focus of SFBT is on identifying past successes and exceptions to problems and to discover new ways to solve problems ( Franklin, Biever, Moore, Clemons, & Scamardo, 2001). Reviews of SFBT within the United States suggest that SFBT is being used to address the health and mental health challenges of many cultural groups, but there are no studies that specifically investigate the effectiveness of SFBT with ethnic groups ( Franklin & Montgomery, 2013). The practice literature suggests that SFBT may be an appropriate and efficacious intervention for Asian populations ( Hsu, 2009; Lee & Mjelde-Mossey, 2004; Miller, Yang, & Chen, 1997; Mishima, 2012; Tetsuro, 2002). Few reviews, however, exist on the practice of SFBT with Asians or other ethnic groups. Franklin, Trepper, Gingerich, and McCollum (2012) published a book that reviewed the research on SFBT from many different countries, such as the United States, Europe, Canada, Australia, and Japan. This book is limited in its scope, but the international reviews within the book showed that SFBT is being successfully applied in different countries and is an effective approach with mental health clients. Kim (2013) also published a book on the use of SFBT with different multicultural groups, but this book does not review the international literature on SFBT that exists in Asian countries. Literature reviews on SFBT that address the applications of this approach in different countries and among diverse Asian populations are definitely needed. In particular, previous reviews on SFBT have not included the provinces and jurisdictions of China. China has used SFBT for many years, but the practice and research literature on SFBT has been limited to those who could read Chinese. Chinese Americans and immigrants make up the largest group of Asians in the United States population (3.3 million people), and culturally relevant interventions that address the health and mental health needs of the Chinese are important to investigate ( Fong & Urban, 2013). Thus, the purpose of this article is to review the SFBT practice literature from mainland China. To our knowledge, this is the first article in English to review the Chinese literature and summarize how SFBT is being practiced within China. Information on SFBT in mainland China will help practitioners and researchers to better understand the applications of SFBT with Chinese populations. doi: 10.1093/hsw/hlv013 2015 National Association of Social Workers 84

SPREAD OF SFBT FROM THE UNITED STATES TO CHINA The literature suggests that SFBT first came to Hong Kong and Taiwan and then subsequently spread to mainland China. You and Zhu (2001) chronicled the history of SFBT in Hong Kong, highlighting the fact that in the early 1980s, Insoo Kim Berg was invited by a nonprofit organization to introduce SFBT through workshops and other trainings. In 1986, both Steve de Shazer and Insoo Kim Berg were invited by Yang Memorial Methodist Social Service to teach the SFBT model and provide more training to social workers and mental health professionals in Hong Kong. Early efforts were also made by an agency, Practice Centre, to introduce SFBT as an approach to address personal and family problems ( Yeung, Chu, & Ho, 1994). The You and Zhu (2001) article also indicates that as early as the 1990s, SFBT had been used in Hong Kong for relationship counseling (Chan, 1990), client depression (Wong, 1994), adolescent and youth suicide (He, 1999), and marginalized youths (Hsiao, 2001). The cross- cultural adaptation of SFBT was also discussed from a linguistic perspective (Yeung, 1999), and the need for better translations of SFBT literature were raised as an important concern. These efforts led to some of the literature on SFBT being translated (Berg, 1997; You & Zhu, 2001) and local experiences on using SFBT being summarized ( He, Zhu, & Yang, 1996; Wu & He, 1995; J. Yang, You, & Liang, 2001). In addition, a training manual for teachers was also published in Hong Kong, showing adoption of SFBT by educational systems (He, 1999). In 1996, Peng-Hwa Chen from Normal University in Taiwan learned about SFBT while attending an American Psychological Association conference in the United States and started teaching her doctoral students about SFBT. Insoo Kim Berg was subsequently invited to Taiwan, where she conducted trainings and supervision for interested practitioners (Hsu, 2009). Scholars from Taiwan, especially academics such as Wen Hsiao and Weisu Hsu from Normal University, have been very influential in SFBT training of practitioners in mainland China, because the translation of SFBT literature usually follows the Taiwanese version (jiaodian-jiejue). One of the earliest texts from Taiwan to be translated in mainland China is Application of Solution Focused Brief Counseling (Hsu, 2009), and this book is also used extensively in the training of practitioners. It should also be noted that the Taiwanese literature is most influential in mainland China because studies on SFBT have been frequently published in counseling journals in Taiwan. For example, Counseling and Guidance is a popular journal in which counselors share their experience, and by August 2012, this journal had published 65 articles on SFBT. Furthermore, the Journal on Educational Psychology, which is a more rigorous journal that emphasizes more research-oriented articles, had published 64 articles on SFBT. In 2002, Beijing Normal University and one of its affiliate companies invited Wen Hsiao from Taiwan to hold an introductory workshop on SFBT. Subsequently in 2008, Weisu Hsu from Taiwan was invited to hold trainings, and she has now conducted more than 30 workshops, not only in Taiwan, but also in mainland China. Xuanwen Liu from Zhejiang Normal University has also been a leader in promoting SFBT scholarship, teaching, and training. Other active practitioners include Hong Luo in Zhejiang from the Institute of Technology. REVIEW OF THE LITERATURE: SFBT IN MAINLAND CHINA To understand how SFBT is applied in mainland China, our research team conducted a literature review of all articles on SFBT using an academic full-text database, Chinese National Knowledge Infrastructure (CNKI), and the key word jiaodianjiejue (focus-solution). As of 2012, we had found a total of 113 journal articles on SFBT in mainland China, which we then retrieved and reviewed. The bulk of the publications on SFBT are published by 102 first authors via 86 journals. Of these, no author has published more than three articles on SFBT as first author, and two journals have published more than five articles on SFBT (six in Chinese Mental Health Journal; eight in Journal of Mental Health Education in Primary and Secondary Schools). The most active researchers on SFBT in mainland China are at the Department of Psychology at Zhejiang Normal University. This team has published 13 articles, accounting for over a tenth of the total SFBT articles published. According to the CNKI database, L. Wang (2002) published the first article on SFBT from mainland China, and there has been a steady progression in the literature since that time. Between 1998 and 2003, only two studies were published on SFBT by authors from mainland China, whereas Taiwan had 32 articles published. However, articles Liu et al. / The Practice of Solution-Focused Brief Therapy in Mainland China 85

coming out of mainland China increased from 2004 to 2012 to 111, whereas articles coming out of Taiwan totaled 70. The literature review also suggests that most of the publications on SFBT are introductory works that exist for practice training. There are fewer than 20 case studies and only one quality literature review ( Dong & Huang, 2011). Nine articles reviewed were research studies with rigorous experimental designs that allow for assessing causal relationships between SFBT intervention and an identified outcome. Most of the more rigorously designed studies also appeared after 2005, with six using experimental designs with randomization and three using a quasi-experimental design. This discovery in Chinese literature is similar to what has been found in systematic reviews conducted on SFBT in the United States and Europe. Specifically, more rigorous SFBT outcome studies have emerged over the past decade (Gingerich, Kim, Stams, & Macdonald, 2012; Kim, 2008). SPECIFIC APPLICATIONS OF SFBT ACROSS FIELDS OF PRACTICE The review of SFBT literature in China also revealed that SFBT covers a wide range of fields. Published articles in the educational field (counseling in schools, in colleges, and for adolescents) have the highest numbers (n = 60), followed by the mental health and health care field (n = 11). The published literature on the applications of SFBT in other fields is sporadic (n = 9). See Table 1 for a review of how SFBT is being applied in different fields of practice in mainland China. Field SFBT in School and College Mental Health SFBT has been discussed in Chinese literature as being a natural fit for school mental health counseling and is also believed to be an efficient and effective approach for common behavioral and social problems confronted in schools, such as behavioral difficulties, social skills deficits, and attendance problems (Chen, 2005; Shen, 2005; Zhong, 2008). It is interesting to note that the discussion in Chinese literature concerning the positive and effective use of SFBT in school settings is similar to the literature in the United States (for example, Franklin et al., 2001; Franklin & Gerlach, 2006; Kim & Franklin, 2009; Metcalf, 2008), which suggests that SFBT is an adaptable approach for school social work and mental health counseling. Specific applications of SFBT in Chinese schools include its use to improve classroom behavioral management in primary and secondary schools (Liu, Zhang, & Wang, 2010). This application is similar to how SFBT has been used in American schools in classroom management programs, such as the Working on What Works intervention ( Kelly, Kim, & Franklin, 2008). Moreover, ideas and techniques from SFBT, such as positive orientation, exploring the clients own resources, and transforming complaints into goals, are reported in both the Chinese and American literature to be helpful for engaging and motivating students toward academic and behavioral change in school settings (B. Yang, Liu, & Zhang, 2005). SFBT has further been used in China to help students in career counseling. Y. Zhang (2006), for example, reported on a solution-focused group intervention for career counseling using a mixed-method approach Table 1: Fields of SFBT Application in Mainland China Not specified a 40 Education sector School and adolescent counseling (including mental health and delinquency) 31 College counseling 22 Mental health and health care Health care (for adults) 12 Other Athletes 2 Social work (for adults) 3 Armed forces 2 Number of Papers Jail and prison (for adults) 1 Total 113 Note: SFBT = solution-focused brief therapy. a Articles about practice and techniques of SFBT without specific applications to a particular field of practice. 86 Health & Social Work Volume 40, Number 2 May 2015

that consisted of a quasi-experimental design and qualitative research to evaluate the group intervention. Results showed that students in the SFBT group improved in career self-efficacy and career decision making, and these results showed a large effect size. Other Chinese literature shows that SFBT is being used in the mental health counseling of students on college campuses to resolve such difficulties as interpersonal adjustment problems, anxiety, social skills problems, and mild depression ( Huang & Wu, 2010; L. Li & Wang, 2007; Mao, 2011; Xu, 2010). SFBT has also been adopted in moral education and career counseling in college, where it has been used to help improve the capacity of counselors for communication with students in an effort to improve outcomes on career development ( Zeng & Yu, 2009). Zhou and Luo (2011) further introduced SFBT into college English instruction in an effort to improve students self-confidence and effectiveness in learning English. This literature suggests that SFBT is beneficial in mobilizing students positive emotions, decreasing anxiety about being able to learn, and engaging students in learning. SFBT in Mental Health and Health Care SFBT has also been used in mental health and health care settings as an adjunct treatment to medications and in medication and services compliance (L. Li, Jin, Sun, Qiu, & Xie, 2012; F. Yang & Hao, 2005). Other literature from China demonstrates that SFBT can successfully be used as adjunctive treatment for chronic health conditions. Cui, Ke, Li, Li, and Jiang (2008), for example, conducted a randomized controlled study involving 60 cases of patients with type 2 diabetes mellitus, where half received an experimental intervention that combined health education with SFBT and the control group received just the conventional health education. The result from this study indicated that knowledge and skill of self-care, compliance with doctors, and clinical service satisfaction were significantly higher for those who received health education combined with SFBT than those in the control group, while blood sugar and blood pressure levels were significantly reduced. The authors of this study also suggested that SFBT could be a bridge for communication between patients and medical professionals, which may improve patient trust and relationships with medical personnel. In addition, SFBT has been used to help patients with parent child relationship problems in a health care setting. J. Wang (2007), for example, reported that SFBT worked well in counseling a mother with a parent child relationship problem that interfered with the child s medical treatment. The Chinese literature suggests that SFBT is a useful intervention for mental health and chronic health conditions, and these findings are also consistent with a recent systematic review of SFBT that concluded that there is solid evidence that SFBT is an effective treatment for adult mental health disorders and may also work to improve the behavioral and psychological effects of health problems (Gingerich & Peterson, 2013). A most interesting finding from this Chinese review is that the literature from China discusses the effective use of SFBT to increase medication compliance and improved communications between patients and health care professionals. This is similar to other studies that have been conducted in Europe and Japan with equivocal positive results (compare Cui et al., 2008; Mishima, 2012; Panayotov, Strahilov, & Anichkina, 2012). This means that the literature across cultures reports that SFBT is successfully being used to improve medication compliance, relationship management, and patient satisfaction, and these findings provide practitioners with more confidence that SFBT may be a useful intervention in health care settings. Social Services and Other Fields SFBT has been applied in youth and family and eldercare services in China. In fact, the most cited article on SFBT in mainland China is from youth and family services. A study by F. Yang and Hao (2005) used a quasi-experimental design to investigate the impact of SFBT with adolescents who have Internet addiction. Results revealed that the SFBT intervention was able to improve the emotional and psychological outcomes of youths. It is interesting to note that Z. Li (2008) also suggested that SFBT was used to promote better professionalization and counseling competencies for youth workers. This is similar to how SFBT has been used in the United States to increase the competencies of Child Protective Services workers and teachers who work with at-risk families and youths (Berg, 1994; Franklin, Streeter, Kim, & Tripodi, 2007). H. Zhang and Sun (2010) further used SFBT to help older retirees and reported that SFBT increased client optimism and also improved clients capacities to find concrete solutions and resources that they needed to solve their social problems. Moving beyond child and family services, SFBT has been used to decrease stress and improve the Liu et al. / The Practice of Solution-Focused Brief Therapy in Mainland China 87

performance of young recruits in the military and to reduce the stress of athletes on the Chinese national diving team. In the military, a solution-based intervention was developed to assist soldiers with stress reactions and adjustment problems, and this was reported to be a helpful approach to increasing the adjustment of young soldiers to the military (M. Wang & Zhang, 2009). In 2008, the Chinese national diving team adopted SFBT during the Beijing Olympics to help reduce stress response symptoms experienced by diving athletes ( Z. Zhang et al., 2009). Zhao, Zhang, and Guan (2009) provided athletic counseling for five athletes on the Chinese national diving team using SFBT; athletes reported reduced stress symptoms in a short period of time. DISCUSSION To our knowledge, this is the first article to appear in English about the practice of SFBT in mainland China. Since the first published SFBT article in 2002, the literature has grown, and the quality of articles has progressed from early descriptions of the approach to a growing number of randomized controlled trials and quasi-experimental studies examining the effectiveness of SFBT in a variety of populations (for example, Chen, 2005; F. Yang & Hao, 2005; F. Yang, Zhu, & Luo, 2005; Z. Zhang et al., 2009). The applications of SFBT in mainland China suggest that SFBT is a useful adjunct treatment that may be used to complement other approaches in education and health care. It is also useful in helping to address school adjustment, behavioral problems, and career decision making of young people. SFBT is also frequently used as an adjunct to medical treatment for mental health and chronic health conditions, where it has been reported to successfully improve symptoms of depression and anxiety and increase medication compliance. Although SFBT has been applied across the life span to help people from childhood to old age, the Chinese literature reviewed suggests that the majority of applications have been with adolescents and young adults within primary schools, secondary schools, and colleges. SFBT is also used in health care settings and appears to be most consistently used with client populations with internalizing disorders (that is, anxiety, depression, acute stress). The fact that SFBT is used most frequently with internalizing disorders and for school-age mental health interventions is also consistent with the U.S. literature. In a meta-analysis conducted on SFBT, Kim (2008) found that SFBT appeared to show the greatest treatment effect with internalizing disorders, and some of the largest effect sizes were found for studies conducted in schools. In two subsequent systematic reviews, one on the effectiveness of SFBT in schools ( Kim & Franklin, 2009) and another on school social work ( Franklin, Kim, & Tripodi, 2009), researchers found SFBT to be a promising intervention for improving the emotions and behaviors of at-risk youths in schools. Finally, in a recent systematic review of SFBT outcome studies, Gingerich and Peterson (2013) found that SFBT is an efficacious treatment for adult mental health clients with depression and is also probably an effective treatment with children and adolescents. The present review shows a convergence of applications from different countries and across ages and field settings, and it further helps practitioners evaluate the strengths of using SFBT with the Chinese. Practice Implications for Chinese Populations This review shows that SFBT may successfully be used with Chinese populations and in many different fields of practice. This is particularly important for practitioners in the United States because Chinese Americans and immigrants make up the largest group of Asians in the U.S. population (3.3 million people), and culturally relevant intervention approaches that address the health and mental health needs of Chinese populations are needed (Fong & Urban, 2013). Some Chinese literature has suggested that the practical, strengths-oriented, and optimistic way that SFBT approaches problems works well with the Chinese and also helps them maintain familial piety and dignity while confronting their personal mental health issues (Hsu, 2009). Chinese researchers have pointed out, however, that because of linguistic differences between Chinese and English, some SFBT techniques cannot be used well with the Chinese. For example, the miracle question often leaves Chinese clients not knowing what to say (Yeung, 1999). In addition, too much complimenting, which was a trademark of Insoo Kim Berg s (Berg, 1994) therapeutic style, has had to be modified to fit better with Chinese preferences for humility. According to the literature in mainland China, SFBT can be used in different modalities. In school settings within China, SFBT is often introduced in the form of group counseling or class group 88 Health & Social Work Volume 40, Number 2 May 2015

activities. In mental health and health care, it is often used in individual counseling to improve the results of mental health treatment. It is interesting to note that SFBT has also been used in China in the training of teachers and youth workers. It has also been studied and shown to be effective in improving communication between health care professionals and their patients to promote better relationships and problem solving ( Cui et al., 2008). These trends in practice with the Chinese also follow uses of SFBT in North America, Europe, and other regions, suggesting that SFBT may be used in a variety of ways to build solutions with clients across different practice settings ( Franklin et al., 2012). Conclusion This review found that SFBT is being used in mainland China and is a useful approach across many different practice fields and, most notable, in school mental health and health care settings. 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Trend and outlook for development of solution focused interview in Hong Kong. Retrieved from http://myweb.polyu.edu.hk/~sszeno/swforum_ articles/previous_articles/010906.htm Zeng, Y., & Yu, X. (2009). Application of solution focused brief therapy in college student counseling. Education Management, 6, 137 138. Zhang, H., & Sun, H. (2010). Application of solution focused brief counseling in aged career and counseling. Chinese General Practice, 4B, 1239 1241. Zhang, Y. (2006). Effectiveness of solution-focused career group counseling on vocational school students for career development maturity and self-efficacy (Unpublished master s thesis). Zhejiang Normal University. Zhang, Z., Zhao, G., Liu, Y., Zheng, F., Luo, R., & Yao, Q. (2009). Psychological training and monitoring of China diving team in preparation for Beijing Olympics. Science of Sport, 11, 8 14. Zhao, G., Zhang, Z., & Guan, X. (2009). A review of solution focused brief counseling in athletic counseling. Science & Technology in Chinese Sports, 3, 61 67. Zhong, Z. (2008). Solution focused brief counseling: From small changes to snowball effect. Ideological and Theoretical Education, 18, 79 85. Zhou, Q., & Luo, H. (2011). Application of solutionfocused model in college English teaching. College English, 1, 236 240. Xuanwen Liu, PhD, is professor, Hangzhou Normal University, Hangzhou, China. Ying Ping Zhang, MA, is research associate, Zhejiang Normal University, Jinhua, China. Cynthia Franklin, PhD, is professor, University of Texas at Austin. Yuanzhou Qu, MA, is independent researcher, Beijing. Hong Chen, PhD, is division president, Education and Psychology Division, Kaiming Press, Beijing. Johnny S. Kim, PhD, is associate professor, Graduate School of Social Work, University of Denver. Address correspondence to Johnny Kim, School of Social Work, University of Denver, Denver, CO 80208; e-mail: johnny.kim@du.edu. Original manuscript received May 16, 2013 Final revision received June 7, 2013 Accepted June 24, 2013 Advance Access Publication February 19, 2015 90 Health & Social Work Volume 40, Number 2 May 2015