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Briefer Therapies

Most of the old-time therapies were very time-consuming. Freud saw his patients for years. Wolpe's original version of desensitization therapy could last a year.

Rogers said the problem presented in the second or third session was not the same as the problem in the tenth session. Therapy sessions typically occurred once per week, so that implied client-directed self-exploration could go on for months at the least.

What are some attempts at briefer therapies?

In the 1970s Bernard Bloom of the University of Colorado developed an quicker approach to therapy. He called it an impasse service. It was aimed at breaking up impasses (blockages) in a person's life, using quick, concrete, problem solving.

Bloom initially tried a one-hour therapy, but this was not enough. He had to see most of his clients a second time. So he increased the time of therapy to two hours and found that a single session was enough to finish with each client (Goleman, 1981).

What was the key to briefer therapy, in Bloom's view?

Bloom reported that the key to such brief therapy was to identify a focal problem quickly, then offer an inter­pretation that expands a patient's awareness, with the goal of starting a problem-solving sequence.

For example, a student struggling to stay in school might not have consi­dered the possible advantages of dropping out for a few years to accum­ulate some work experience and maturity. Later, if desired, the student could come back to school as a more mature student.

This could be a radical change of perspective to someone struggling with such a decision. The implications of staying in school or dropping out might be fully aired in a two hour session.

Nick Cummings (1986) summarized the "parameters of brief therapy" as follows:

1. Hit the ground running. The first session must be therapeutic. The concept that you must devote the first session to taking a history...is nonsense.

2. Perform an operational diag­nosis...."Why is the patient here today instead of last week or last month, last year, or next year?"

3. Create a therapeutic contract... Every patient makes a therapeutic contract with every therapist in the first session, every time. But in 99% if the cases, the therapist misses it.

...For example, if a patient comes into the office and says, "Doctor, I'm glad you have this comfortable chair because I'm going to be here for a while,"...the therapist has just made a contract for long-term therapy.

If the patient says, "I want to come in here and save my marriage, but whatever I do, I'm going to end up getting divorced," the therapist has just made a contract for that patient to divorce....

I could give hundreds of examples. Listen for the therapeutic contract. After you discern the client's therapeutic contract, talk about it.

Then say, "Now that our goals are clarified, I would like to add the following to that contract: I will never abandon you as long as you need me. In return for that, I want you to join me in a partnership to make me obsolete as soon as possible."

What advice did Cummings give to psychologists who wanted to practice briefer therapies?

4. Do something novel the first session. This isn't easy, but find something novel, something unexpected, to do the first session. This will cut through the expectations of the "trained" patient and will create instead an expectation that problems are to be immediately addressed.

5. Give homework in the first session and every therapy session thereafter. The patient will realize, "Hey, this guy isn't kidding. I'm responsible for my own therapy."

6. If you take steps 1 through 5, you'll find that there is no such thing as a therapeutic drop-out. Patients know when to terminate better than we, as therapists, do. (Cummings, 1986)

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References:

Cummings, N. A. (1986). The dismantling of our health system: Strategies for the survival of psychological practice. American Psychologist, 41, 426-431.

Goleman, D (1981, August). Deadlines for change. Psychology Today, pp.60-69.


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