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Forty-one of forty-four referrals to a multidisciplinary team providing brief therapy in adult psychiatry were followed up after one year.Questionnaires were sent to attenders and their general practitioners. A good outcome was reported in 29 cases (70%) while four cases (10%) were worse. Good outcome was linked with more therapy sessions and having specific goals for treatment. Lower social class did not predict poor outcome, unlike other forms of psychotherapy. Benefit was not linked to age, sex, place of residence, duration of problem, source of referral, those attending, inpatient status or lapse from treatment. Longstanding problems did slightly less well. The 'worse' group were younger and all four were female. Training of the team took place during therapy a t little extra cost without any detriment to outcome. These findings have implications for the team's approach and for the provision of psychotherapy services in general.

A report of a one-year follow-up of thirty-six referrals treated with solutionfocused brief therapy by a supervised team in a mental health setting is described. A good outcome was reported for twenty-three cases (64%). These results are comparable with our previous work and with one other statistically validated outcome study on solution-focused therapy. IntroductionAs financial stringency begins to affect healthcare in all countries, there is an increasing need for outcome studies in order to guide the work of individual practitioners and to allow rational decisions about expenditure on services. Our team has practised solutionfocused brief therapy in the context of adult mental health for six years. In a previous study of our first three years' work (Macdonald, 1994), we reported a good outcome for 70% of our referrals and we now report results from a further cohort of referrals seen over a subsequent three-year period. Therapeutic approachWe work as a multi-disciplinary team using live supervision for both trainees and experienced therapists. We serve a scattered rural population and usually see attenders once a month. Our referrals come from general practitioners and colleagues in the mental health services. The team does not act as the first point of contact for those with an acute psychosis but all other referrals are seen at least once. The problems presented by our attenders are similar to those seen at local psychiatric outpatient clinics.A letter is sent to all referrals describing the team approach and a Consultant Psychiatrist/Psychotherapist, Garlands Hospital, Carlisle CA1 3SX, UK. notifying them of their rights in relation to videotaping. This follows the suggestions of Birch (1990) about the value of presession contacts and consent procedures in setting a context for therapy. The letter invites clients to contact us for an appointment and suggests that they will have started making changes before they see us. We send a written copy of the closing intervention to the attenders after each session which reinforces our comments during the interval between meetings and is generally appreciated by attenders.We use a solution-focused brief therapy model (de Shazer, 1994;Macdonald, 1994). Sessions revolve around goals chosen by the attenders. Exceptions to the existing problem are emphasized in discussion, and scaling of problems from 1-10 is used to provide a neutral way of assessing change and to assist discussion about small steps on the way to the goal. The 'miracle question': 'What if a miracle happens and the problem is solved?' is used to develop a picture of a new and better future towards which attenders can move. Follow-up designAs in our 1994 study, we sent follow-up questionnaires by post to attenders and their general practitioners one year after their last session (see Appendix). The questions were derived from Watzlawick et al. (1974) andde Shazer (1985) and sought information about the problem, goal achievement, any new problems and any further advice sought from other professionals. Com...

SummarySolution-focused brief therapy (SFBT) can be widely implemented in psychiatric practice as a short form of psychotherapy that reinforces the client's autonomy and focuses on what the client wants instead of on the problem. It was developed by an iterative process of removal from existing therapy of any features not found to promote good outcomes for the attenders. Research indicates that SFBT is effective and cost-efficient, and when used in practice makes the psychiatrist's work more satisfying. It can be used as a primary intervention, for example during crisis intervention, as a formal psychotherapy and as an addition to pharmacotherapy.

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