This is the 2007 version. Click here for the 2017 chapter 13 table of contents.

Briefer Therapies

Most of the traditional therapies were very time-consuming. Freud saw his patients for years, and later analysts followed his example. Wolpe's original version of desensitization therapy could last for a year. Rogers said the problem presented in the second or third session was not the same as the problem in the tenth, implying that self-exploration could go on for quite a while.

What are some attempts at briefer therapies?

In recent decades more therapists have experimented with brief therapies. In the 1970s Bernard Bloom of the University of Colorado developed an approach to therapy he called an "impasse service." It was aimed at quick, concrete, problem solving. He 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 and 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 job experience and maturity, then coming back to school as an older, 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.

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

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."

In what sense did Cummings want to become "obsolete as soon as possible"?

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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