Brief Therapy Techniques Can Make All Therapists Better
Mantosh Dewan, M.D., is interim dean of the College of Medicine and the SUNY Distinguished Service Professor at SUNY Upstate Medical University, where Roger Greenberg, Ph.D., is a distinguished professor of psychiatry and behavioral sciences. They are the co-editors of The Art and Science of Brief Psychotherapies: A Practitioner’s Guide, Third Edition, which APA members may purchase the book at a discount.
Today, most psychiatric patients receive brief therapy, and the majority of research on the effectiveness of psychotherapy is on brief therapies.
Studies show that about 50% of patients show significant benefits after 10 to 20 sessions of psychotherapy, while an additional 25% to 30% respond within 50 sessions.
Brief therapies can be helpful in many ways. Any evidence-based model provides a theoretical framework to anchor the therapist, and a specific technique may be particularly effective with certain conditions (for example, exposure and response prevention for obsessive-compulsive disorder or interpersonal therapy [IPT] for postpartum depression) or with certain patients (for example, solution-focused therapy for high-functioning college students). More importantly, specific techniques from one brief therapy can be integrated to make another brief therapy—or even long-term therapy—more effective. How can it make your work better?
All successful therapies require a robust treatment alliance based on common factors (empathy, hope, and expectancy) and a clear contract. Patients seek “help,” but only 20% understand and are ready to actively participate in therapy. Several easy-to-use brief therapy techniques can help in this early phase. Eliciting the patient’s own motivation for change is a core motivational interviewing technique. Sometimes the “miracle question” borrowed from solution-focused therapy can do wonders (“Suppose a miracle occurs, and the changes you had hoped for are suddenly made. How would you realize the changes had occurred? What differences would you notice as a result?”) Cognitive-behavioral therapy uses psychoeducation to provide a clear and credible treatment rationale that enables patients to appreciate the therapeutic goals and strategies that will be employed and to feel they are on the right track.
The middle phase allows for the artful mixing of many approaches and techniques, especially when patients are “difficult” and when therapy is “stuck.” The insistent focus and active stance of the therapist are key ingredients of all brief therapies. When the patient is “all over the place,” dynamic therapy helps by recognizing themes. Patients with intolerable anxiety can relax by practicing mindfulness—a core skill of dialectical behavior therapy (DBT) that can be integrated within all therapies. Similarly, DBT skill building leads to little-known but surprisingly easy-to-learn techniques that can reduce or prevent frustration and anger. An interpersonal inventory as used in IPT can help construct an accurate picture of the supportive and damaging relationships in a patient’s life. Problem solving can be approached through IPT or cognitive therapy techniques.
Processing narratives using interpretations and experiential learning based on psychodynamic models can ease patient anxieties and guilt by promoting understanding of the origins of maladaptive behaviors and self-defeating thought patterns. It is helpful to use scaling questions (say, on a scale of 1 to 10), as solution-focused therapists do, to assess the levels of patients’ symptoms and plot their progress.
Of particular importance for accelerating progress in psychotherapy is the use of homework assignments (now called action plans), as suggested by cognitive-behavioral therapists. These develop skills in the real world and give a sense of mastery and confidence.
How termination is handled is important in brief therapy, and some schools deliberately set a firm end date or fix the number of sessions at the start. However, the conclusion of therapy is different for interpersonal therapists: They leave open the possibility that patients may return for additional treatment or booster sessions.
The techniques and skills noted in this article are among those described in our book The Art and Science of Brief Psychotherapies, Third Edition. More importantly, they are demonstrated on the book’s accompanying video by the leading experts in the field, including Judith Beck, Edna Foa, and Marsha Linehan. Some can be learned very quickly. We hope learning more about these techniques and how to integrate them in your work will be as rewarding for you as it has been for us. ■
