Brief therapy

How to maximise use of time & money

Scarce resources?

Trends seem to come and go in therapy. Brief therapy is an example. The recognition that the extent of psychological and emotional difficulty far exceeds the resources available to address it has come into focus at various times, and one response has been to develop briefer ways of working. Other responses have included the development of different modalities of therapy, such as group and family therapies, and therapies from different theoretical orientations.

Both of these other responses have appeared to offer the promise of less therapeutic involvement, be it less intensive (less frequent) or less extensive (shorter), although that promise may be somewhat illusory. At times, and now may be one of those, it can be a challenge for public services to offer involvement of any significant duration, and that may lead to a specific focus on brief work seeming redundant.

Play it by ear?

Coming from a different angle, many if not most therapies are brief. This is borne out by various research studies. Put together with a current lack of focus on brief therapy, it would appear that a great deal of brief therapy is taking place, but that presumably much of it is unplanned, or in the absence of professional planning, administratively or managerially planned.

Set a focus

There is a range of models of brief therapy, often derived from longer forms of the same theoretical perspective. One way of differentiating these is whether they are exclusive (offered to carefully selected clients only) or inclusive (potentially offered to all people suitable for therapy in general). Typically exclusive approaches would select for particular patient characteristics and presenting problems, and inclusive approaches typically have a broad palate of dimensions to consider (such as interpersonal, developmental and existential issues) as their focus.

Upfront planning

Brief therapy has a number of assets. These include

the formation of a very clear contract (focus, goals and number of sessions) with the client
an explicit emphasis on the rapid development of a therapeutic alliance with the therapist
a shared focus or perspective for the work
greater therapist activity and responsibility for the outcome
an enhanced opportunity to make the maximum use of time

As an example of the latter, focusing explicitly on the ending for much of the work can serve to intensify and make available important client experiences of separation and loss. However, in the current New Zealand context, with few if any specialist brief therapy resources such as clinics or centres, it may be that client demand has to become a significant driver of the development of this valuable resource.