Interview with Alasdair Macdonald

© 2005, Coert Visser

Alasdair Mcdonald is a Consultant Psychiatrist who is the Research Coordinator and former President and Secretary of the European Brief Therapy Association. He works  as a trainer and supervisor and as a management consultant.

Alasdair, we'd first like to ask you a few questions about your current research. Could you describe it briefly?

This study reports the outcomes from our solution-focused brief therapy out-patient clinic in adult mental health. A questionnaire was sent to clients and their family doctors one year after they ceased to attend. The seventy-five clients on whom this latest study is based represent twenty-eight clinic sessions per year. If we had been able to work for three full days weekly at the same rate we would have seen 160 clients annually. If the same good outcome rate was achieved this would make a substantial difference to our Psychotherapy Department, which received in excess of 200 new referrals in one year. It is an uncontrolled naturalistic study of brief therapy in a psychotherapy service. It is therefore open to the biases inherent in such studies, such as referral bias and differential responding by satisfied clients. However, it represents a study of effectiveness in a real-life setting.

What are the most important findings of the research? Are these findings roughly in line with previous research?

Seventy-five clients were referred, of whom fifty-three were seen and forty-one traced at follow-up. Thirty-one (76%) reported a good outcome, with an overall average of 5.02 sessions, 20% attending only one session. Combining these data with our two previous studies, 170 referrals were received of whom 136 attended and 118 were traced. Good outcome was reported by eighty-three clients (70%) with a mean of 4.03 sessions per case. There was no significant difference between the groups in solving additional problems or seeking further professional help. New problems were significantly less common in the 'good outcome' group. In common with other therapies, long-standing problems did less well. This study confirms previous reports in terms of overall benefit. Seventy-six percent of clients report the achievement of some or all of their goals. This echoes similar studies from other countries, including Germany, Spain and the USA.

Were there any results that surprised you or intrigued you?

In all three studies there were no significant differences in outcome between socioeconomic groups. This is important because the higher socio-economic groups usually have more resources and better access to treatment services, so they have more choices. It is important to make treatments available which will be effective for those from relatively deprived groups.

One thing that surprised me was that negative goals are not related to poor therapy outcome. What are your thoughts on this?

Choosing negative goals is not associated with a poor outcome. This is counter-intuitive, since it is easier to do something new than to stop something and put nothing in its place. However, our clients did put new things into place so maybe goal-setting is not in itself a key variable.

If you look at research findings in general, would you say research indicates SF to be the most effective approach to therapy?

More generally, solution-focused therapy has a more substantial research base than some other psychological treatments. Results from different countries all show similar levels of benefit. There appears to be no link between diagnosis and response to treatment, an issue which is currently leading to challenges to the 'Evidence-based Practice' movement in the USA and elsewhere (Wampold and Bhati 2004).

Are there examples of problems for which SF does not seem to be the most effective approach?

Specialist teams eg for alcohol or domestic violence, seem to have better outcomes, which suggests that it is possible to refine the sft model further for specific client groups and situations.

What further research is needed?

Further research into sft could examine such issues more closely. We also need more comparison studies against other treatments such as that of Knekt and Lindforss (see below).

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Dr. Alasdair Macdonald, president of the European Brief Therapy Association (EBTA) has been a consultant psychiatrist since 1980. He also uses his solution-focused skills as a freelance management consultant and trainer. His main research interest is in the study of process and outcomes in SFBT. Alasdair has over 30 scientific publications on his name and a number of other published pieces. For more information on Alasdair and his work we refer you to his website.

Coert Visser (coert.visser@planet.nl) is a consultant, coach and trainer using a positive change approach. This approach is focused on simply helping individuals, teams and organizations to make progress in the direction of their own choice. Coert wrote many articles and a few books. More information: www.m-cc.nl / www.m-cc.nl/solutionfocusedchange.htm / Dutch network / Dutch blog, http://solutionfocusedchange.blogspot.com

References:

• Macdonald AJ (2005). Brief therapy in adult psychiatry: results from 15 years of practice. Journal of Family Therapy, 27, 65-75.
• Knekt, P, Lindfors O (2004) A randomized trial of the effect of four forms of psychotherapy on depressive and anxiety disorders: design, methods and results on the effectiveness of short-term psychodynamic psychotherapy and solution-focused therapy during a one-year follow-up. Studies in social security and health, no. 77. The Social Insurance Institution, Helsinki, Finland. (www.kela.fi/research)
• Wampold BE, Bhati KS (2004) Attending to the omissions: a historical examination of evidence-based practice movements. Professional Psychology, Research and Practice, 35(6), 563-570.