Short-Term Therapy in Treating Mental Problems

Introduction

For many people, psychotherapy takes a long time to complete (Hoyt, 2001). As psychoanalytic thinking became more complicated, therapists adopted techniques and strategies that require lengthy treatment sessions (Budman, Hoyt & Friedman, 1992). The aforementioned conventional treatment modality forces clients to undergo therapy sessions regularly without a clear end in sight. It can easily become a burden to a patient and his/her respective family. But aside from the cost, the long-term treatment procedure also takes a toll on the social life of a client. Thus, the most important component of social interaction outside the home is no longer comprised of building relationships with other people but multiple sessions with a therapist (Budman, Hoyt & Friedman, 1992).

The proposed alternative is brief therapy (De Jong & Berg, 2008). Brief therapy is a solutions-based approach that is particularly effective when it comes to less severe psychiatric problems (Ellis, 1996). The effectiveness of this approach is rooted in its focus on solutions as well as the belief that a client has access to inner resources that can be used to develop coping strategies (De Jong & Berg, 2008). These inner resources come in the form of knowledge and other forms of personal information that can then be used to change behavior and thought patterns (Hoyt, 2001). Brief therapy is also effective because instead of relying mainly on the expertise of the therapist, this framework acknowledges that a client is an expert when it comes to self-knowledge (Hoyt, 2001). Brief therapy enables a client to ease back into the real world and not limit that person’s ability to achieve a more productive life.

Brief Therapy vs. Long-winded Therapy

People suffering from severe emotional and psychological problems require professional help (Budman, Hoyt & Friedman, 1992). They need a therapist to help them deal with these issues. The bone of contention is not about the importance of therapy but rather on which therapeutic model can guarantee significant results. In the latter part of the 20th century, therapeutic models made popular by world-renowned psychoanalysts like Sigmund Freud are seen to be outmoded or at least impractical when applied to less severe psychiatric problems (Corsini & Wedding, 2011). Thus, some contend that particular problems can only be solved by the use of an alternative approach such as brief therapy (Budman & Gurman, 1998).

An excellent definition of brief therapy can be seen in the following statement – that brief therapy intends to help patients “make changes in thoughts, feelings, and actions to move forward or reach a particular goal as time-effectively as possible” (McGuire, 2001, p.178). Many professional therapists would agree to the first half of the definition because no one among them would not want to see positive change in the life of their clients, especially when it comes to negative behavior. But the point of argument can be seen in the end part of the definition wherein the claim was made, that solutions can be achieved through a time-bound process (McGuire, 2001). However, some believe that therapy cannot be effective if the therapist sets limits on the time frame of the treatment process (Budman & Gurman, 1998).

It has to be made clear that when it comes to brief therapy the therapist cannot predict a positive outcome but rather, the therapist is confident that positive results can be achieved after a few sessions (Budman & Gurman, 1998). The time-bound feature of brief therapy is a stark contrast to other forms of psychoanalytic treatment modality wherein goals are unrealistic and therefore there is no clear way to determine the end-point of treatment (McGuire, 2001, p.178). The reason was made clear in the following statement: “as analytic thinking became more complex, as the problems dealt with by analysts became more difficult, and as the goals of analysis became increasingly ambitious, the treatment became longer and longer (Budman & Gurman, 1998). The use of this framework became made it increasingly difficult to scale down the therapeutic process (Budman & Gurman, 1998).

Long-term therapy is based on the ideas originated by Sigmund Freud who asserted that the psychotherapist must seek to change the basic character of the patient (Budman & Gurman, 1998). Those who adhere to long-term treatment believed that there can be no significant psychological change that can happen in everyday life (Budman & Gurman, 1998). There is another reason why the process can take years to complete, there are psychotherapists who believed that therapy has a “timeless quality and is patient and willing to wait for change” (Budman & Gurman, 1998). However, there is a need to shorten treatment time because others argue that the length of time spent on one patient can be counterproductive (Budman, Hoyt & Friedman, 1992).

There are two major reasons why many objects to long term-treatment. First, of all the economic cost is a major consideration to families that have to pay for a treatment process that can go on for years. Secondly, the quality of life is severely affected (Nelson & Thomas, 2007). Consider for instance the time and energy required to go through a treatment process on a weekly basis. A person must not spend the most productive portion of his life inside the four walls of a clinic. But aside from those issues, there is another disturbing discovery when it comes to a lengthy treatment schedule. Patients and professionals alike remarked that there are psychotherapists who “unconsciously recognize the fiscal convenience of maintaining long-term patients” (Budman & Gurman, 1998, p.11). Without a doubt exploiting the problem of another person for financial gain is an unethical practice.

There is therefore a clamor for the development of brief therapy (Budman & Gurman, 1998). Those who believe that patients can expect improvement in behavior without resorting to long-term therapy have a clear understanding of what has to be done. One proponent said that psychotherapists must prefer “pragmatism, parsimony, and least radical intervention and must not believe in the notion of ‘cure’” (Budman & Gurman, 1998, p.11). Others who maintain this view added that there is a need to “emphasize patient’s strengths and resources; presenting problems are taken seriously – although not necessarily at face value” (Budman & Gurman, 1998). Finally, the psychotherapist must not accept the timelessness of therapy and believes that “being in the world is more important than being in therapy” (Budman & Gurman, 1998, p.11). The new approach is a breath of fresh air especially for those who felt trapped in a costly methodology that cannot assure timely and significant results.

Why Brief Therapy is effective

Brief therapy is made possible because of a particular point of view shaped by principles learned after years of studying patient-client interaction (Budman, Hoyt & Friedman, 1992). Experts are weighing in and remarked that “just about all forms of psychoanalysis are long-winded and inefficient (Budman, Hoyt & Friedman, 1992, p.36). It can be argued that activity does not translate to efficiency. It is also important to realize that the focus is shifted from the therapist to the client. But at the same time, a client is not the main focus, instead, there is a collaboration (Corsini & Wedding, 2011). In the conventional form of treatment, much emphasis was given to the abilities of the therapist. But in brief therapy much of the resources required to achieve change are already within the person – the only thing needed to do is to guide the patient to discover and utilize these resources (De Jong & Berg, 2008).

Brief therapy is also guided by the principle embedded in the following statement: “While both therapists and clients contribute to the change process, clients are the best experts on their lives” (Nelson & Thomas, 2007). It is based on the assumption that “borderline, psychotic, and some other clients are severely disturbed, for biological as well as environmental reasons, and usually requires somewhat prolonged therapy, but that a large number of neurotic individuals can be significantly helped in 5 to 12 sessions (Corsini & Wedding, 2011). After using brief therapy strategies marked improvements can see in the lives of those that are not “generally disturbed” (Corsini & Wedding, 2011, p.223). In other words, adherents to brief therapy methodology have also acknowledged some of the limitations of this framework (Budman, Hoyt & Friedman, 1992).

Bill O’Hanlon a world-renowned psychotherapist pointed out the major feature of brief therapy and he said that it is focused on developing solutions (Hoyt, 2001). He added that it is goal-oriented” (Hoyt, 2001, p.35). O’Hanlon also pointed out that “brief therapy is problem-driven – focused on resolving the presented problem that the person brought in – and that the therapist is responsible for creating and maintaining those focuses” (Hoyt, 2001, p.35). The ability to focus on a particular problem is the mechanism that saves time and brings a client to a level of awareness not possible with long-winded psychoanalytic methods (Budman, Hoyt & Friedman, 1992).

A few examples of brief therapy are listed as follows: a) solution-oriented therapy; b) possibility therapy; c) RET (Budman, Hoyt & Friedman, 1992). The core foundation of RET is the use of a number of relationship and experiential methods (Budman, Hoyt & Friedman, 1992). At the same time, it stresses self-help and homework (Budman, Hoyt & Friedman, 1992). For instance, it teaches the affected person how to understand and help himself in between sessions and after the therapy period has ended (Budman, Hoyt & Friedman, 1992). By encouraging patients to play a major part in their recovery is an important component of brief therapy because it conditions the patient to cope on his own without the help of a therapist (McGuire, 2001). Thus, there is a more effective way to develop coping strategies (Walter & Peller, 1992).

One of the most important principles behind RET is the belief that in every patient there is a “powerful innate tendency to construct and create self-changing, self-actualizing thoughts, feelings, and actions and therefore have the ability to reconstruct their self and social-defeating behaviors” (Budman, Hoyt & Friedman, 1992, p.37). In this regard, the mental health professional can be viewed as a mere guide that helps the patient to find his or her way back to normal life (De Jong & Berg, 2008).

Experts in the use of RET uses a number of forceful effective methods to change feelings and attitudes and this includes: “shame-attacking exercises, rational-emotional imagery, role-playing, the use of rational humorous songs, and strongly reiterated self-statements” (Budman, Hoyt & Friedman, 1992, p.38). RET is also based on the idea that practitioners must work hard to put clients into the position of becoming experts in their lives (De Jong & Berg, 2008). RET is also a time-saving process because the therapist is a guide that immediately brings out the issues and critical information needed to develop coping strategies (Walter & Peller, 1992).

The focus of brief therapy is simple – to help clients enjoy life and to have intimate relations with a few others (Ellis, 1996). A solution-oriented therapy is a type of brief therapy focused on the present and geared towards the future (Hoyt, 2001). It is based on the Ericksonian bias that a client has resources and abilities (Hoyt, 2001). The role of the therapist is to help a client access these resources (Hoyt, 2001).

In solution-oriented therapy, the therapist relies on a client’s frame of reference in three important ways (De Jong & Berg, 2008):

  • The therapist asks them what they would like to see changed in their lives; the therapist accept these client definitions of problems;
  • The therapist interviews clients about what will be different in their lives when their problems are solved;
  • The therapist asks clients about their perceptions of exceptions to their problems; the therapist respects these perceptions as evidence of the client’s inner resources and as sources of information about useful outer resources that exist in the context in which they live.

A more advanced state of brief therapy is called solution-focused brief therapy (Eron & Lund, 1996). It uses the same paradigm – it is intentional in helping a client discover the resources needed to solve the problem (Eron & Lund, 1996). However, a distinctive feature is a confidence to discover solutions (Walter & Peller, 1992). A therapist who used this method asserted that the primary question that has to be asked is this: “How do we construct the following solutions?” (Walter & Peller, 1992, p.5). In this modified treatment modality the therapist is confident that there are solutions; that there is more than one solution; that these solutions can be constructed; that therapists and clients can work together to construct the solutions; and finally that the process can be articulated and modeled” (Walter & Peller, 1992, p.5).

Another feature of solution-focused brief therapy can be seen in the way a therapist inquiries about “what people are doing when the problem does not occur than when it does occur … this search for exceptions to problems is the basis for much of the therapeutic conversation” (Eron & Lund, 1996, p.30). This enables the therapist to develop helpful strategies that can produce results.

Conclusion

It has been made clear that the use of long-winded treatment processes is expensive and counterproductive. It is much better to use brief therapy. Nevertheless, the therapist must be well aware of the strengths and limitations of this framework. It is most effective when it comes to less severe psychiatric problems. It is based on the idea that clients possess the resources needed to help them deal with psychological and emotional issues. In this particular therapeutic framework, the therapist is a mere guide.

References

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