BRIEF REPORT

Brief Report: Effects of Solution-Focused Brief TherapyGroup-Work on Promoting Post-traumatic Growth of MothersWho Have a Child with ASD

Wei Zhang • Ting-ting Yan • Ya-song Du •

Xiao-hong Liu

� Springer Science+Business Media New York 2014

Abstract The study evaluated the impact of solution-

focused brief therapy (SFBT) group-work on the post-

traumatic growth (PTG) of mothers who have a child with

ASD. A quasi-experimental design was used in which 43

mothers participated. 18 mothers in 2 SFBT groups (n = 9

in each group) received a 6-session SFBT group therapy

while 25 mothers in a control group received no treatment.

The Post-traumatic Growth Inventory was used to measure

the PTG levels of the participants at baseline, post-treat-

ment and 6-month follow-up assessments. Mothers who

attended SFBT group-work reported higher PTG scores

both at post-treatment (t = 4.065, p = .001) and 6-month

follow-up (t = 2.980, p = .006) assessments. Further

investigations to prove whether SFBT in groups can

increase the positivity of clients would promote the use of

SFBT.

Keywords Mothers � Post-traumatic growth � Solution-

focused brief therapy � Group counseling

Introduction

Whilst the adverse effects on mothers of raising children

with autism spectrum disorders (ASD) are well known,

researchers are increasingly acknowledging that some

mothers may change in beneficial ways (Hastings et al.

2005). Traumatic losses, such as the realization that their

child will not develop typically, may lead such mothers to

find new insights into life and to develop a greater sense of

spirituality, patience, compassion and strength (Bayat

2007; Ekas and Whitman 2011; Phelps et al. 2009). These

positive outcomes can be summarized as post-traumatic

growth (PTG), which emphasizes positive psychological

changes as a result of struggling with challenging life cir-

cumstances (Tedeschi and Calhoun 1996). Positive psy-

chological changes are also related to favorable health

outcomes (Aspinwall and Tedeschi 2010). Measuring PTG

might be helpful in assessing therapies (Hagenaars and van

Minnen 2010), such as those designed to discover and

strengthen mothers’ abilities to adapt to their situations

(Hastings et al. 2005).

Solution-focused brief therapy (SFBT) is a therapeutic

approach that emphasizes client strengths and focuses on

helping the clients to construct future solutions rather than

to solve their past problems (Bannink 2007). During the

past two decades, SFBT has become a popular therapeutic

model for counseling professionals. Practitioners across

disciplines, especially social work, have endorsed SFBT

because of its flexibility and its short-term nature (Kim

2007). The use of SFBT has also been applied as a group

intervention, to make it cheaper to administer and to

encourage social support between clients. Group SFBT has

been used successfully with out-patients with mood and

anxiety disorders (Knekt et al. 2008) and with children who

have parents in prison (Springer et al. 2000). However,

several limitations are apparent on the studies of SFBT and

group SFBT, including the limited use of reliable and valid

outcome measures (Lloyd and Dallos 2006) and the

absence of control groups (Gingerich and Eisengart 2000).

Valid outcomes of group SFBT have tended to measure the

improvement of behavioral problems, anxiety or

W. Zhang � T. Yan � X. Liu (&)

Nursing School of Second Military Medical University,

800 Xiangyin Road, Shanghai 200433, China

e-mail: xiaohongsmmu@126.com; xhliu@smmu.edu.cn

Y. Du

Shanghai Mental Health Center, Shanghai, China

123

J Autism Dev Disord

DOI 10.1007/s10803-014-2051-8

depression (Kim 2007; Knekt et al. 2008). By contrast little

is known about whether group SFBT can improve positive

outcomes such as PTG. The purpose of this quasi-experi-

mental study was to explore the impact of group SFBT on

promoting PTG in mothers of children with ASD and

whether this impact could last for 6 months.

Methods

Research Design

A quasi-experimental design was used to examine the

differences of PTG between 18 mothers who received

SFBT group-work and 25 mothers who did not. The SFBT

was delivered by the first author and one social worker.

Both were national qualified counselors and had experience

in working with children with ASD and their parents. The

PTG was measured before and after intervention and then

6 months later. The study was approved by the Ethical

Review Board of the Second Military Medical University.

Sample Procedure

A center providing services for developmentally disabled

children in Shanghai helped in recruiting participants. To

participate in this study, the mother had to affirm that her

biological child had been formally diagnosed with an ASD

in the past one year. Mothers were excluded if they had

received or were receiving mental health services or psy-

chological treatment. Written consent to participate was

obtained. Considering the efficacy of group-work and

based on the recommendation of the professionals, the

number of the mothers in each SFBT group was limited to

10. A total of 45 mothers were randomly allocated to an

intervention group, which comprised 2 SFBT groups of 10,

or to a control group of 25. One mother in each SFBT

group left the intervention before it was half completed.

The profile of the remaining 43 participants (18 mothers in

2 SFBT groups and 25 mothers in the control group) and

their children are summarized in Table 1.

Schedules of SFBT Group-Work

The intervention schedules and content were developed in

cooperation with 10 key people. The key people were

either experts on SFBT/group counseling or those who had

a long experience in working with families raising children

with ASD. The SFBT regimen comprised 6 sessions. Each

session lasted about 90 min and was held weekly. The

intervention was structured in a way that focused on the

present and future orientation of the mothers. Through the

use of purposeful language and questioning, the interven-

tion aimed to help the mothers discover their potential to

find appropriate means of coping with their problems. The

topics covered in each session are listed below and were

linked together in a structured manner.

Session 1: Knowing each other This session comprised

self-introductions and group games, followed by a free

discussion to allow the mothers to get to know each other.

Mothers were encouraged to share their concerns over their

children in this session, and to realize the impossibility of

their children with ASD becoming ‘‘normal’’ by commu-

nicating with each other.

Session 2: Mothers’ problems In this session the focus

was purposefully moved from the children to the mothers

themselves. Questions were asked to ascertain the main

problem each mother wanted to change, for example,

‘‘what do you hope to change by participating in this group

for the next 5 weeks’’. Aspirations of the whole group were

discussed, for example, most of the mothers in one group

wanted to decrease the stress to themselves of raising a

child with ASD.

Session 3: Individual goals Each mother’s goal was

defined. Miracle questions and scaling questions (De Jong

and Miller 1995) were used for this purpose. An example

of miracle questions is ‘‘Suppose a miracle solved your

problem, what is the first thing that would let you know

that a miracle had happened?’’. Each mother was then

asked to make a scale where 10 represents her best

Table 1 Descriptive statistics of the participants

Characteristics SFBT Groups

(n = 18)

N (%)

Control group

(n = 25)

N (%)

Child gender

Male 15 (83.3 %) 19 (76.0 %)

Female 3 (16.7 %) 6 (24.0 %)

Child age M = 4.5 years

(SD: 2.11)

M = 4.9 years

(SD: 1.98)

Mother age M = 36.65 years

(SD: 8.04)

M = 34.88 years

(SD: 9.17)

Having job or not

Yes 4 (22.2 %) 9 (36.0 %)

Not 14 (77.8 %) 16 (64.0 %)

Mother education

High school and below 3 (16.7 %) 3 (12.0 %)

Associate 10 (55.6 %) 14 (56.0 %)

Bachelor 4 (22.2 %) 6 (24.0 %)

Master and above 1 (5.5 %) 2 (8.0 %)

Other child

None 16 (88.9 %) 21 (84.0 %)

Yes 2 (11.1 %) 4 (16.0 %)

J Autism Dev Disord

123

imaginary outcome and 0 the worst outcome, then to

position herself on the scale now and after achieving her

goal. Scaling was revisited each week. The goals were

concrete and observable. Examples included, ‘‘the fre-

quency of quarrelling with my husband over the child will

decrease to once a week’’, ‘‘I will stop mourning having a

child with ASD instead of a normal child’’, ‘‘I will stop

breaking things when I am annoyed’’.

Session 4: Strength analysis Questions were asked about

the mothers’ strengths (e.g., outgoing, optimistic and good

at seeking information) and resources (e.g., emotional and

financial support from the family members, friends and

institutes). The session then moved on to exception-finding

questions (Corcoran and Pillai 2009) such as ‘‘Is there a

time when your problem (e.g., loss of temper) doesn’t

occur, or occurs less often or less strongly?’’. These

questions were used to elicit the mothers’ potential to

amplify and reinforce positive changes.

Session 5: Coping Each mother was asked to review her

strengths and resources (session 4), then to tell the rest of

the group her coping strategies, for example, ‘‘If you were

successful with your problem (session 2), can I ask you

how you would have done it?’’. Coping strategies such as

telling the truth to their neighbors about their children,

setting up new goals (e.g., to become a specialist in edu-

cation for disabled children) and learning humor to

addressing embarrassment were reported. Discussions

within the group of how to improve the coping strategies of

each mother were encouraged.

Session 6: Review and plan Each mother was asked to

write down her improvements over the 5 previous sessions.

Mothers were then asked to talk about their improvements

and future plans with the other mothers.

Throughout the sessions if the practitioners noticed

progress they would articulate that progress and congrat-

ulate the mother.

Measures

The Chinese version of the Post-traumatic Growth Inven-

tory (PTGI-C) was used to assess PTG. One item ‘‘my

belief in God is stronger than it was before’’ was deleted

from the original PTGI (Tedeschi and Calhoun 1996)

because of culture differences. This yielded a 20-item

PTGI-C with satisfactory reliability and validity (Wang

2011). PTGI-C keeps the 5 domains of the original PTGI:

(1) appreciation of life, for example, ‘‘I appreciate each

day’’, (2) personal strength, for example, ‘‘I know that I can

handle difficulties’’, (3) new possibilities, for example,

‘‘new opportunities are available which wouldn’t have

been otherwise’’, (4) relating to others, for example, ‘‘I

learned a great deal about how wonderful people are’’ and

(5) spiritual change, for example, ‘‘I have a better under-

standing of spiritual matters’’. The response to each item

was scored on a 6-point Likert scale, ranging from 0 (not at

all) to 5 (very much indeed). The score of 0–5 for each

domain was achieved by calculating the average score of

the 3–5 items in that domain. The total score of the 5

domains was the final PTGI score out of 25. In this sample

the Cronbach’s alpha indexes of 5 domains ranged from .79

to .87. The inventories were completed within 1 week after

the start date and the final session. The 6-month follow up

inventories were collected within 2 weeks.

Results

The 18 mothers attended all of the sessions with the

exception of one mother who missed session 2. An inde-

pendent-samples t test (SPSS 20.0 IBM) was used to

examine the differences in PTGI scores between the

intervention group (comprised of the 2 SFBT groups) and

the control group. The results are listed in Table 2. The

PTGI scores of both groups were the same at the start

(p [ .05). At the end of the intervention both the total

PTGI and its five domains were significantly higher for the

intervention group compared to the control group

(p \ .05). The total PTGI scores were 19.65 and 15.69

(p = .001). Subsequent analyses at 6-month follow-up

found that the total PTGI difference was maintained, with

scores of 18.73 and 16.07 (p = .006). The differences in

the 5 domains varied. Thus the growth in ‘‘new possibili-

ties’’ and ‘‘relating to others’’ were still significant

(p \ .05) whilst the growth in ‘‘appreciation of life’’,

‘‘personal growth’’ and ‘‘spiritual change’’ became non-

significant (p [ .05). A second t-test analysis was used to

check for the difference in PTGI scores between the two

SFBT groups. No significant difference was found between

these two SFBT groups at the 3 time points (p [ .05).

Discussion

Previous studies show that SFBT reduces problem behav-

iors and mental disorders (Kim 2007). The current study

found that SFBT group-work could improve the PTG of

mothers raising a child with ASD. After 6 sessions of

SFBT group-work, the mothers’ total PTG and its five

domains were increased compared to those of the mothers

who received no intervention. We hypothesize that the

SFBT group-work promoted the PTG of the mothers in

several ways. Firstly, the SFBT had a direct effect on the

PTG of the mothers. For example the SFBT promoted a

shift away from wishful thinking (the child becoming

J Autism Dev Disord

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‘‘normal’’) towards solution-focused strategies, which

empowered mothers to explore ‘‘new possibilities’’. Sec-

ondly, social support promotes subjective well-being

(Benson 2012) and facilitates PTG (Prati and Pietrantoni

2009). Thus the group-work might have functioned as a

social support group for the mothers, resulting in their

improved PTG. Lastly, in a group setting, the members

pointed out positive changes in each other and learned from

the others, providing opportunities for PTG to develop.

Although the intervention was short-term the benefits

lasted for 6 months, especially in the domains of ‘‘new

possibilities’’ and ‘‘relating to others’’ but not ‘‘apprecia-

tion of life’’, ‘‘personal strength’’ or ‘‘spiritual change’’.

This demonstrates that 6-session SFBT group-work might

not be sufficient to wholly promote the mothers’ PTG, and

extra sessions might have benefited the mothers.

This study was limited by its small sample size, the

reliance on the mothers’ self-reports of their PTG and the

lack of procedural integrity assessments. Future research

could expand our preliminary findings by using a larger

sample and by including objective outcome measures.

Besides, the study did not measure social support (Ekas

et al. 2010) and the severity of the children’s symptoms

(Benson 2006), which could have had a role in the PTG.

With regard to social support the 25 mothers in the control

group received no intervention, so in future studies the

control group could meet but receive a placebo-like

intervention. Finally, since caring for someone with ASD is

a lifelong experience, research with a longer follow up is

needed in future studies.

Despite the above limitations and future research con-

siderations, SFBT group-work does appear to be an inter-

vention model that might aid social workers during their

working with the mothers. The mothers in this study all

gave positive feedback about their experiences of SFBT

and stated having learned something from the other group

members. The present SFBT involved 2 counselors, each of

whom spent 6 90-minute sessions with 9 mothers. There-

fore when resources are scarce SFBT group-work could be

selected as a strategy to promote PTG. However it is

through the continued assessment and evaluation of group

SFBT that the modality might develop into an effective

approach utilized by counselors and social workers to

improve the positive outcomes of clients in many

situations.

Acknowledgments We thank Shanghai Science and Technology

Commission (No:11411952401) funded this study. We thank staff of

Shanghai Loving Children Rehabilitation Training Centre for their

support and assistance in recruiting and provide the field for inter-

vention. We also thank all participants of the study. We acknowledge

Peter Russell and Alison E. While’s help with the manuscript.

Conflict of interest The authors declare that they have no conflict

of interest.

Table 2 Comparison of the post-traumatic growth (PTG) between the 18 mothers receiving solution-focused brief therapy (SFBT) group-work

and the 25 mothers in the control group at three time points

Domain of PTGI Pre-intervention Post-intervention 6-month follow-up

M SD t p M SD t P M SD t p

Appreciation of life

Intervention 3.44 .607 -.625 .538 4.25 .362 2.535 .030 3.94 .756 1.901 .068

Control 3.60 .661 3.56 .695 3.44 .649

Personal strength

Intervention 3.42 .560 1.124 .273 4.30 .246 3.529 .003 3.88 .648 1.984 .057

Control 3.19 .600 3.58 .584 3.48 .455

New possibilities

Intervention 3.09 1.169 -.412 .687 3.28 .606 3.177 .006 3.52 .927 2.746 .011

Control 3.25 .568 2.22 .807 2.64 .806

Relating to others

Intervention 3.39 .917 .687 .501 3.40 .663 2.237 .041 3.67 .569 3.156 .004

Control 3.17 .527 2.67 .713 2.94 .680

Spiritual change

Intervention 3.16 .983 -.988 .329 4.43 .472 3.056 .008 3.72 .666 .930 .360

Control 3.39 .534 3.66 .597 3.53 .464

Total PTGI

Intervention 16.51 3.914 -.060 .952 19.65 1.405 4.065 .001 18.73 2.761 2.980 .006

Control 16.59 1.695 15.69 2.667 16.04 2.186

J Autism Dev Disord

123

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