Brief Therapy

Brief Therapy Definition

Brief therapy is a type of counseling that is time limited and present oriented. Brief therapy focuses on the client’s presenting symptoms and current life circumstances, and it emphasizes the strengths and resources of the client. The therapist in brief therapy is active and directive. Termination of counseling is a major focus from the initial session.

History of Brief Therapy

Brief therapy began to gain attention in the 1950s, following the increase in popularity of behavior therapy and family therapy. Behavior therapy emphasizes the correction of immediate problem behaviors and employs numerous behavioral techniques to facilitate change in the individual. Family therapy emphasizes the individual in the context of the family. In both therapies, the therapist is direct and active. These two therapies differ from earlier dominant therapies rooted in psychoanalytic thought that focus on the individual’s insight and past, and in which the therapist is nondirective and passive. Thus behavior therapy and family therapy set the stage for the acceptance of active short-term therapeutic approaches.

The popularity of brief therapy increased in the 1980s, following empirical research on the process and outcomes of psychotherapy. Researchers used meta-analysis, a statistical method allowing the results of many studies to be compared, to make the following conclusions about psychotherapy: (a) most clients stayed in therapy for six to eight sessions, (b) 75% of clients who reported improvement experienced benefits within the first 6 months of therapy, and (c) time-limited psychotherapy had outcomes similar to those of long-term therapy.

In addition to these research findings, societal changes increased the need and demand for brief therapy. Insurance companies, Health Maintenance Organizations (HMOs), and Preferred Provider Organization (PPOs) routinely place restrictions on the number of sessions an individual can attend. Some people, unwilling to go through insurance, elect to pay outright for their psychotherapy. Many individuals do not have the time or personal income for long-term therapy. Finally, the demand for therapy has increased while the supply of therapists (in the face of reduced fees and increased workloads) has decreased. Therefore, in many community and university counseling centers, there are not enough therapists to see clients for long-term courses of therapy. Brief therapy has become an attractive method for meeting the increased demand for counseling services in a way that is timely and cost-efficient.

Types of Brief Therapy

There are many approaches to brief therapy. Typically, existing long-term therapies have been adapted to a short-term context.

Single-Session Therapy

Theory of Single-Session Therapy

In single-session therapy, the therapist and client meet only once. The goal of single-session therapy is to encourage new learning, enhance coping, and promote growth. Typically, a single session is used to help a client shift perspective or acquire skills. Single-session therapy is most effective for individuals with specific problems who (a) need a change in perspective, (b) need an evaluation or referral, (c) feel stuck about processing a past event, (d) are looking for reassurance, or (e) have a specific problem that is within their power to solve. In contrast, individuals in inpatient care, individuals needing continuing support to process traumatic past events (e.g., childhood sexual abuse), individuals with eating disorders or chronic pain, and individuals with conditions caused by biological or chemical mechanisms (e.g., schizophrenia) are not as likely to benefit from single-session therapy or any of the brief therapies.

Techniques of Single-Session Therapy

Diverse techniques are employed in single-session therapy. For example, the therapist may contact the client by phone before meeting to obtain detailed information about the presenting problem and to ask the client to complete specific tasks before the session. A second popular technique is to focus on ambiguity during the session. Focusing on ambiguity allows the therapist to introduce new ways of looking at the same problem. Clients often practice possible solutions during the session. Rehearsing ideal outcomes or practicing new skills can help a client feel more able to transfer skills from the therapy session to everyday life. After the session is over, the therapist informs the client that he or she can return for another session if necessary.

Cognitive-Behavioral Brief Therapy

Theory of Cognitive-Behavioral Brief Therapy

Cognitive-behavioral brief therapy focuses on schemas. Schemas are templates that individuals use in order to make decisions, guide responses, or explain situations. Schemas develop from life experiences and become a standard of normal behavior. Thus, whenever a critical event occurs, the individual uses a schema to decide how to react. Schemas may not be based on accurate information, so relying on some schemas may result in cognitive distortions. For example, if a child were punished whenever interrupting an adult, that child may develop beliefs that make him or her hesitant to interrupt, even as an adult.

Techniques of Cognitive-Behavioral Brief Therapy

The focus in cognitive-behavioral brief therapy is to identify and replace distorted cognitions based on schemas. Goal setting is central to cognitive-behavioral brief therapy. It serves as a mechanism for measuring treatment effectiveness. Each goal should have specific objectives, be worded positively, and be realistic. Cognitive-behavioral brief therapy focuses on meeting each goal, as opposed to focusing on client insight or the process of therapy.

Short-Term Dynamic Psychotherapy

Theory of Short-Term Dynamic Psychotherapy

Short-term dynamic psychotherapy focuses on affect phobia. Affect phobia is an internal phobia in which individuals are afraid to experience a particular feeling (e.g., anger, shame). According to short-term dynamic theory, affect is the basic motivation that drives individuals, and affect phobias are the culprit of most behavior problems.

Triangles are used to diagram conflicts and people in short-term dynamic psychotherapy. The triangle of conflict is used to conceptualize the way an individual avoids a feeling and the triangle of person is used to conceptualize the recipient of that feeling. The triangle of conflict uncovers defenses, anxieties, and adaptive feelings. Each point on a triangle is called a pole. The defense pole consists of behaviors (e.g., avoidance), thoughts (e.g., “I’m incompetent”), or feelings (e.g., fear). These defenses can be adaptive and helpful, but they become harmful when they result in maladaptive behaviors. The anxiety pole consists of inhibitory feelings that lead individuals to become vigilant about their own or others’ behaviors. There are four major categories of inhibitory feelings: anxiety, shame/guilt, emotional pain, and contempt/disgust. The feelings pole represents normal adaptive behaviors that are motivated by underlying basic feelings and impulses (e.g., grief, anger, excitement, sexual desire). These feelings can be healthy, but individuals avoid them when the feelings are associated with a negative experience. The triangle of conflict helps the therapist to identify defensive patterns used by the client to avoid feelings, identify how and why a client is using inhibitory feelings, and help the client understand the underlying affect that is being avoided.

The triangle of person helps the therapist recognize the relationships where patterns of avoidance occur. These can include past relationships, current relationships, or the relationship between the client and therapist.

Techniques of Short-Term Dynamic Psychotherapy

The goal of short-term dynamic psychotherapy is to restructure defenses, affect, and attachments. There are several main objectives. First, the client should acknowledge and understand the defensive pattern. Second, the client should be motivated to change the defensive pattern. Third, in order to desensitize the affect phobia, the client must experience and express appropriate feelings. Fourth, the therapist must listen to the client and help identify healthy feelings that can help the client to behave more effectively and experience relief from his or her symptoms.

Gestalt Brief Therapy

Theory of Gestalt Brief Therapy

From a Gestalt perspective, individuals are experiencing difficulty because they have become fragmented by disowning different parts of themselves. Therefore, the aim of Gestalt brief therapy is to reintegrate the fragmented parts of the individual. Once the reintegration process has occurred, the individual can successfully interact with him- or herself, others, and the environment. In Gestalt brief therapy, the focus is on growth and process. Nonverbal cues are a key part of Gestalt brief therapy. In fact, if the verbal content of the client is in conflict with the nonverbal content of the client, the nonverbal content is usually considered more important. For example, if a client reports feeling relaxed but fidgets constantly, then the therapist would assume that the client is not relaxed. The therapist may also point out this incongruence during the session.

Techniques of Gestalt Brief Therapy

Gestalt brief therapy uses Duey Freeman’s therapeutic circle as a guide for brief therapy. There are six stages in Gestalt brief therapy. First, therapy must begin with a present or here-and-now focus. Gestalt brief therapy helps the client to increase awareness of immediate feelings, experiences, and situations. Second, an issue is identified. The therapist does not direct the client to identify a particular issue. Instead, the therapist simply helps the client increase awareness of the here and now, and trusts the client to talk about an issue that is important.

Third, the therapist may conduct an “experiment” during the session. Gestalt therapy considers techniques to be experiments. For example, the therapist may make a client aware of nonverbal cues throughout the session. Perhaps the most popular experiment is the empty chair technique. In this experiment, a client is asked to initiate a dialogue between the two parts of the self that are in conflict, or with another person with whom the client is experiencing conflict. Each time the client switches perspectives, the client switches chairs and talks to an empty chair as if the other part of the self or the other person were in the chair.

Fourth, the therapist identifies and discusses the behavior that is causing the problem. This moves the discussion from the present to the past, but in Gestalt brief therapy, the past is discussed in the context of how the client is currently experiencing issues from the past in the present. Therefore, the emphasis is not on discussing the past, but experiencing the past. Fifth, the client and therapist explore alternative behaviors. These alternate behaviors may be external or internal. Sixth, the therapist and client discuss how life is different when trying these alternate behaviors. The therapist assists the client in the integration of these new behaviors into daily life.

Future Directions

The increase in cost-conscious managed medical care (i.e., HMOs, PPOs) and the need to deliver services to a growing population suggest that therapists will continue to be interested in brief therapy. As brief therapy increases in popularity, therapists will become more highly trained in brief therapy and research will be conducted that will better demonstrate which brief therapies are the most effective for which psychological problems. Importantly, there are some instances in which longer-term therapy will be more beneficial (e.g., treatment of severe traumas, eating disorders, personality disorders, schizophrenia). In general, though, brief therapy is cost effective and efficacious.

References:

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