---
title: "Strategic vs. CBT vs. solution-focused: when to choose which approach"
canonical: "https://strategictherapy.eu/strategic-vs-cbt-vs-solution-focused/"
lang: en
description: "Strategic therapy, CBT and solution-focused therapy all work briefly but target different things. What each asks you to change, and what the trials show."
author:
  name: "Maurizio Iengo"
  url: "https://strategictherapy.eu/author/strategictherapy/"
  title: "Psychologist"
  registration: "Ordine degli Psicologi della Regione Campania 9624"
date_published: 2026-09-19
date_modified: 2026-09-19
publisher: "Strategic Therapy"
section: "Foundations"
keywords: "strategic therapy vs CBT vs solution-focused"
---

# Strategic vs. CBT vs. solution-focused: when to choose which approach

> Three brief models, three different targets. What each one asks you to change, and what the head-to-head trials have and haven't shown.

## In short

- CBT targets cognitions and avoidance, strategic therapy the attempted solution, solution-focused therapy the exceptions the client already reports.
- The three overlap heavily in technique, particularly in directive homework.
- The one head-to-head trial series favouring strategic therapy is in binge eating disorder, and its primary outcome showed no group difference at discharge.
- Comorbid personality disorder weakened strategic therapy's advantage over supportive treatment in social phobia.

Three clinicians, three brief models, one client. Ask each what they would change first and you get three different answers. The differences tell you more than any textbook comparison.

## Three different opening questions

The CBT-trained clinician asks what this client is thinking and what she is avoiding as a result. Target: the belief and the safety behaviours protecting it from disconfirmation.

The solution-focused clinician asks when the problem is already slightly less present, and what is different in those moments. Target: an exception the client has already lived, amplified. The problem’s machinery is never analysed at all.

[The strategic therapist](https://strategictherapy.eu/?p=34) asks what the client is already doing about this, and how the doing is making it worse. Target: the maintaining solution.

These are not stylistic variations. A client will experience the first twenty minutes of each quite differently, before any named technique appears.

## Where they overlap

More than the theory suggests. All three are brief by design and all three use structured homework instead of open-ended exploration. [A strategic prescription](https://strategictherapy.eu/?p=41) and a CBT behavioural experiment can look identical on paper. The reasoning differs: one tests a belief, the other interrupts a loop.

Solution-focused and strategic work share brevity and present focus but diverge on where leverage is sought. One searches the client’s history for what is already working. The other searches the present for what is actively failing.

## What the head-to-head evidence actually says

CBT has the deepest evidence base of the three, replicated across more conditions than either alternative, and any comparison implying otherwise would be misleading. Solution-focused therapy has a substantial literature of its own; Gingerich and Eisengart’s review found broadly positive results across dozens of studies of mixed methodological quality.

The one place strategic therapy has been tested head-to-head against CBT under randomisation is binge eating disorder, and the result deserves reporting in full rather than in the favourable half that usually circulates.

The STRATOB trial randomised 60 Italian women with binge eating disorder and comorbid obesity to brief strategic therapy or CBT. On the primary outcome at discharge, Castelnuovo and colleagues (2011) found no significant difference between groups. At six months the strategic arm had improved more on that outcome, and remission favoured it clearly, while weight change showed no group difference at either point. At one-year follow-up, Jackson and colleagues (2018) reported the strategic arm superior on binge frequency, weight and global functioning.

So: a genuine randomised result, favouring strategic therapy, in a single trial of 60 women in one country, with no separation at all on the primary outcome at the end of treatment. It is the strongest thing this model has, and it says nothing directly about panic, obsessions or couples.

## The argument nobody has settled

Duncan (1992) argued that improvement attributed to strategic technique may mostly reflect common factors: empathy, respect, the client’s sense of being taken seriously. The challenge applies to all three models and none has answered it well.

## A limit that should not be rounded off

Rakowska’s randomised trial on social phobia is instructive precisely because it reports a failure alongside a success. Brief strategic therapy outperformed minimal supportive therapy for clients with social phobia alone. For clients who also met criteria for a personality disorder, the advantage disappeared. That boundary is real, and something similar probably applies to the other two approaches.

## Choosing in the room

A problem dominated by one identifiable belief and clear avoidance fits CBT’s structure most directly. A client who struggles to name what is wrong but can describe when it is better meets solution-focused work where she already stands. A case dominated by a visible, repeating, worsening sequence, whether that is [reassurance-seeking](https://strategictherapy.eu/?p=45), [escalation between partners](https://strategictherapy.eu/?p=46) or [a parent’s overinvolvement with an anxious child](https://strategictherapy.eu/?p=47), is where strategic work moves fastest.

Knowing which question to ask first is most of the decision.

## Frequently asked questions

### Can strategic therapy and CBT be combined in one case?

In practice many clinicians do, pairing a strategic first-session formulation with cognitive and exposure techniques later. The models differ in emphasis more than they are strictly incompatible.

### Is solution-focused therapy a gentler strategic therapy?

They share brevity and a present focus, but the opening question differs. Solution-focused work builds from exceptions the client already reports, strategic work from the mechanism maintaining the problem.

### Which has the strongest evidence base?

CBT, by a wide margin, across the largest number of conditions. Strategic and solution-focused therapies have smaller literatures weighted toward observational studies and single-team trials.

## References

1. Castelnuovo G., Manzoni G. M., Villa V., Cesa G. L., Molinari E. (2011). Brief strategic therapy vs cognitive behavioral therapy for the inpatient and telephone-based outpatient treatment of binge eating disorder: The STRATOB randomized controlled clinical trial. https://doi.org/10.2174/1745017901107010029
2. Jackson J. B., Pietrabissa G., Rossi A., Manzoni G. M., Castelnuovo G. (2018). Brief strategic therapy and cognitive behavioral therapy for women with binge eating disorder and comorbid obesity: A randomized clinical trial one-year follow-up. https://doi.org/10.1037/ccp0000313
3. Gingerich W. J., Eisengart S. (2000). Solution-focused brief therapy: A review of the outcome research. https://doi.org/10.1111/j.1545-5300.2000.39408.x
4. de Shazer S., Berg I. K., Lipchik E., Nunnally E., Molnar A., Gingerich W., Weiner-Davis M. (1986). Brief therapy: Focused solution development. https://doi.org/10.1111/j.1545-5300.1986.00207.x
5. Rakowska J. M. (2011). Brief strategic therapy for patients with social phobia with or without personality disorder