Problem-Solving Therapy vs SFBT
A side-by-side comparison of recorded mechanisms, evidence review status, related condition topics, and philosophical roots.
At a glance
Source checks, condition-specific assessments and expert review are separate steps. Each assessment applies only to its stated population and use. Topic links do not establish comparative effectiveness.
Problem-Solving Therapy
- Tradition
- Cognitive-Behavioral
- Founder
- D'Zurilla / Goldfried / Nezu (1971)
- Review status
- 2 condition assessments available
- Official sources
Guidelines and official sources (10)
9 clinical guideline checks · 1 evidence registry check
Read the recommendation and its scope. A source may discuss an approach without recommending it.
- Depression in adults: treatment and management (NG222)
Recommendation for the stated population
NICE includes problem-solving among treatment options. The format and choice depend on depression severity, clinical needs and patient preferences.
Scope: Adults with depression; guided self-help or individual problem-solving options.
- Problem-Solving Therapy for Depression
Discussed in the source
The archive records a 1998 strong rating and a 2015 status awaiting re-evaluation. These are evidence-registry classifications, separate from NICE’s recommendations.
Scope: Depression; historical Division 12 treatment ratings.
- Assessment and Management of Patients at Risk for Suicide
Recommendation for the stated population
VA/DoD includes problem-solving-based psychotherapies within its weak recommendation for suicide-focused CBT to reduce suicidal ideation. This recommendation concerns ideation and does not establish fewer suicide attempts or deaths for generic PST.
Scope: Suicide-focused, problem-solving-based CBT for adults aged 18 and over with a history of self-directed violence.
- Management of Major Depressive Disorder
Recommendation for the stated population
VA/DoD suggests problem-solving therapy among seven unranked psychotherapy options (weak for). Treatment strategy also depends on severity, chronicity, prior response and preference.
Scope: Adults with uncomplicated MDD choosing psychotherapy.
- Management of Major Depressive Disorder
Discussed in the source
VA/DoD strongly recommends first-line evidence-based psychotherapy, referring to the list that includes problem-solving therapy. This is a class-level recommendation, with no preferred individual approach.
Scope: Pregnant or breastfeeding adults with mild-to-moderate MDD.
- Clinical Practice Guideline for Management of Stroke Rehabilitation
Insufficient evidence for or against
VA/DoD finds insufficient evidence for or against solution-focused psychological interventions, explicitly including problem-solving therapy. The finding is specific to post-stroke depression prevention.
Scope: Preventing the onset of depression following stroke.
- Clinical Practice Guideline for the Treatment of Depression Across Three Age Cohorts
Recommendation for the stated population
APA conditionally suggests the specified individual problem-solving treatments for these populations.
Scope: Older adults with MDD and executive dysfunction, or minor/MDD depression with dementia.
- mhGAP: brief structured psychological treatment for depression
Recommendation for the stated population
WHO includes problem-solving therapy among the structured psychological interventions that should be offered. The recommendation is strong, with moderate-certainty evidence.
Scope: Adults with moderate-to-severe depression, within the mhGAP non-specialist-care context.
- Mental Health Gap Action Programme (mhGAP) guideline for mental, neurological and substance use disorders
Discussed in the source
WHO conditionally supports digital interventions based on approaches including problem-solving therapy, with low-certainty evidence. This is not a recommendation for every full problem-solving therapy program, and the reviewed trials did not establish benefit for attempts or deaths and were underpowered for those outcomes.
Scope: Digital support for people with suicidal thoughts.
- Self-harm: assessment, management and preventing recurrence (NG225)
Recommendation for the stated population
NICE says to offer a tailored intervention and explicitly names CBT and problem-solving therapy. This does not endorse every generic protocol or establish a reduction in suicide deaths.
Scope: Adults who have self-harmed; a structured, person-centred CBT-informed intervention tailored to their needs.
- Depression in adults: treatment and management (NG222)
- Focus
- Skill-building
- Format
- Individual
- Duration
- Short-term
Condition-specific assessments
Each conclusion applies to the population and use described. These source-based assessments do not certify the full entry or replace expert clinical review.
Suicidality & Self-Harm
Population and scope: Adults who self-harm receiving a tailored CBT-informed problem-solving intervention; suicide-focused problem-solving therapy for adults with a history of self-directed violence.
Guideline recommendation
NICE NG225 1.11.3 explicitly includes problem-solving therapy within its offered CBT-informed intervention tailored to adults who self-harm. VA/DoD 2024 recommendation 6 weakly suggests suicide-focused CBT, including problem-solving-based therapies, to reduce ideation after self-directed violence. The scope is a tailored or suicide-focused intervention, not every generic PST programme. The VA recommendation concerns ideation and does not establish fewer suicide attempts or deaths for generic PST.
Source assessment dated
Depression & Mood Disorders
Population and scope: Adults with uncomplicated MDD choosing psychotherapy.
Guideline recommendation
VA/DoD 2022 recommendation 7 weakly suggests PST among unranked options. This treatment recommendation does not establish superior efficacy or address depression prevention across other clinical populations.
Source assessment dated
SFBT
- Tradition
- Postmodern
- Founder
- de Shazer / Insoo Kim Berg (1985)
- Review status
- 2 source checks available
- Official sources
Guidelines and official sources (2)
1 clinical guideline check · 1 professional reference check
Read the recommendation and its scope. A source may discuss an approach without recommending it.
- TIP 39: Substance Use Disorder Treatment and Family Therapy, Chapter 3
Discussed in the source
SAMHSA TIP 39 discusses solution-focused brief therapy and supporting research. This is a treatment-improvement reference rather than an unspecified registry endorsement.
Scope: Families affected by substance-use problems.
- Clinical Practice Guideline for Management of Stroke Rehabilitation
Discussed in the source
The guideline discusses SFBT among pooled psychological interventions and makes a neutral recommendation for the broader prevention category. It does not separately grade SFBT as a treatment for established depression.
Scope: SFBT included in the review of interventions to prevent depression following stroke.
- TIP 39: Substance Use Disorder Treatment and Family Therapy, Chapter 3
- Focus
- Strengths-based
- Format
- Indiv + Family + Group
- Duration
- Very short (1-8)
How they work
Problem-Solving Therapy
Core mechanism: Structured problem-solving skills (define, generate, evaluate, implement) counteract hopelessness and behavioral inaction in depression
Ontology: Depression maintained by poor problem orientation (negative appraisal of problems) and deficient problem-solving skills
SFBT
Core mechanism: Identifying exceptions, preferred futures, and existing strengths amplifies what already works; solution-building vs. problem-solving
Ontology: Problems are not continuous; exceptions exist. Focusing on problems maintains problems; focusing on solutions builds solutions
Related condition topics
These editorial cross-references organize reading. A shared link does not mean both approaches are effective, recommended, or interchangeable for that condition.
1 shared · 1 Problem-Solving Therapy-only · 3 SFBT-only
Linked to both entries
Linked only in the Problem-Solving Therapy entry
Linked only in the SFBT entry
What each assumes — and misses
Problem-Solving Therapy
Philosophical roots: Dewey (reflective problem-solving); cognitive-behavioral tradition; D'Zurilla (social problem-solving model); pragmatism
Blind spots: Structured skill focus can leave emotional and relational material untouched; later versions add emotion-focused coping for problems that cannot be solved, but the frame still fits situational difficulty better than grief or existential impasse
Therapeutic voice: Let's list every possible solution, even the ones that seem impractical. We'll evaluate them after.
SFBT
Philosophical roots: Wittgenstein (language games: meaning is use); de Shazer and Insoo Kim Berg (solution-focused, developed jointly at the Milwaukee Brief Family Therapy Center); social constructionism (Gergen); pragmatism (what works matters more than why)
Blind spots: May minimize genuine suffering by focusing prematurely on solutions; limited depth for complex trauma or personality work
Therapeutic voice: Tell me about a recent time when the problem wasn't happening. What was different?
Choosing between them
Problem-Solving Therapy (Cognitive-Behavioral) and SFBT (Postmodern) come from different traditions, which means they assume different things about what a person is, what causes suffering, and what the therapeutic relationship is for. The choice between them is often less about "which works better" and more about which set of assumptions fits the client and the therapist.
For deeper coverage: see the full Problem-Solving Therapy and SFBT pages, or use the interactive comparison tool to add more modalities to this comparison.