Brief Psychotherapy

Brief therapy, sometimes also referred to as short term therapy (usually 10 to 20 sessions) , is a generic label for any form of therapy in which time is an explicit element in treatment planning.

1. BRIEF PSYCHOTHERAPY Ms. Hemangi Narvekar Clinical Psychologist National Institute for Empowerment of Persons with Multiple Disabilities (NIEPMD), Chennai

2. CONTENTS Introduction Why Brief Therapy? Characteristics Types Of Brief Therapies Application Strengths & Weaknesses Summary

3. INTRODUCTION Brief therapy, sometimes also referred to as short term therapy ( usually 10 to 20 sessions) , is a generic label for any form of therapy in which time is an explicit element in treatment planning. Milton Erickson was a practitioner of brief therapy, using clinical hypnosis as his primary tool. Richard Bandler , the co-founder of neuro -linguistic programming, is another firm proponent of brief therapy.

4. INTRODUCTION Brief therapy differs from other schools of therapy in that it emphasizes a focus on a specific problem and direct intervention. In brief therapy, the therapist takes responsibility for working more pro-actively with the client in order to treat clinical and subjective conditions faster. It also emphasizes precise observation, utilization of natural resources, and a temporary suspension of disbelief to consider new perspectives and multiple viewpoints.

5. Why Brief Therapy? Tight economic conditions in community clinics, counseling centers, hospitals—and especially among insurers—have guaranteed that most psychotherapy is swift and targeted. Limited time and financial resources among patients also helps to ensure that much therapy is brief. A third, and more personal, reason for learning brief therapy is that it opens the door to creative, as well as efficacious, ways of assisting individuals and couples.

6. Why Brief Therapy? Therapies that are designed as short-term therapies promise relief from symptoms with minimal time and without having to dig up one's entire childhood. This can be very appealing and can make a lot of intuitive sense. Some people fear that they will open up if they engage in a deeper therapy. Sometimes a person with these kinds of fears wants to treat just the surface if at all possible. One of the most important is that short-term therapies are effective in treating a wide range of emotional disorders (Barlow 2001; Koss and Shiang 1994; Steenbarger 1992).

7. Characteristics of Brief Therapy

8. Characteristics of Brief Therapy

9. Characteristics of Brief Therapy

10. When it is appropriate to conduct brief psychotherapy? DISCUS

11. Therapy Process

12. SOLUTION FOCUSED BRIEF THERAPY Solution focused brief therapy (SFBT), often referred to as simply 'solution focused therapy' or 'brief therapy', is a type of talking therapy that is based upon social constructionist philosophy. The title SFBT , and the specific steps involved in its practice, are attributed to husband and wife Steve de Shazer and Insoo Kim Berg and their team at the Brief Family Therapy Center in Milwaukee, USA . It focuses on what clients want to achieve through therapy rather than on the problem(s) that made them to seek help. The approach does not focus on the past, but instead, focuses on the present and future.

13. SOLUTION FOCUSED BRIEF THERAPY Solution focused therapists believe that change is constant. By helping people identify the things that they wish to have changed in their life and also to attend to those things that are currently happening that they wish to continue to have happen , SFBT therapists help their clients to construct a concrete vision of a preferred future for themselves. The SFBT therapist then helps the client to identify times in their current life that are closer to this future, and examines what is different on these occasions. By bringing these small successes to their awareness , and helping them to repeat these successful things they do when the problem is not there or less severe, the therapists helps the client move towards the preferred future they have identified .

14. Basic Assumptions ƒThere are significant advantages in focusing on the positive and on solutions for the future. ƒ Individuals who come to therapy do have the capacity to act effectively. This capacity, however is temporarily blocked by negative cognitions. ƒThere are exceptions to every problem. ƒClients tend to present one side of the problem. Solution focused therapists invite clients to view their problems from a different side. ƒSmall change fosters bigger change. ƒClients want to change, they have the capacity to change and they are doing their best to make change happen. ƒAs each individual is unique, so too is every solution.

15. Brief Psychodynamic Therapy Psychodynamic therapy focuses on unconscious processes as they are manifested in the client's present behavior. The goals of psychodynamic therapy are client self-awareness and understanding of the influence of the past on present behavior. In its brief form, a psycho dynamic approach enables the client to examine unresolved conflicts and symptoms that arise from past dysfunctional relationships and manifest themselves in some or other way.

16. Brief Psychodynamic Therapy This type of therapy is generally conducted over the course of only a few sessions, or even just one session in some cases. Sometimes an individual struggling with a specific problem only needs to make a few important connections to overcome that problem. For instance, if a client is suffering from acute anxiety with no known source, the identification of an event or circumstance that gave rise to this anxiety and a strategy for coping can be accomplished in one session . While resolution of problems should not be expected in one session for all those seeking treatment, there are several instances where identifying and dealing with a specific problem can be a relatively brief investment .

17. Brief Psychodynamic Therapy In the treatment, defenses are seen as a means of resisting change—changes that inevitably involve eliminating or at least reducing problem behaviours . The following strategies are recommended for avoiding ineffective adversarial interactions around the client's use of defenses: • Working with the client's perceptions of reality rather than arguing • Asking questions • Sidestepping rather than confronting defenses • Demonstrating the denial defense while interacting with the client to show her how it works Brief psychodynamic therapy has been applied in situations like: Rape Accident (traffic, physical injury, etc.) Act of terrorism Acute psychological disturbances (like anxiety or depression) Traumatic family event (discovery of a secret, divorce, etc .)

18. Brief Cognitive Behavioural Therapy The cognitive–behavioral model assumes clients are deficient in coping skills. To achieve the therapeutic goals , CBT incorporates three core elements: • Functional analysis - This analysis attempts to identify the antecedents and consequences of behavior , which serve as triggering and maintaining factors. • Coping skills training - A major component in CBT is the development of appropriate coping skills . • Relapse prevention - These approaches rely heavily on functional analyses, identification of high risk relapse situations, and coping skills training , but also incorporate additional features .

19. Brief Cognitive Behavioural Therapy Engaging in brief, cognitive-behavioral therapy is an effective treatment for helping people with P roblematic caffeine use A nxiety disorders A lcohol dependence D epression Schizophrenia W eight loss

20. Brief Humanistic & Existential Therapies Humanistic and existential therapies are united by an emphasis on understanding human experience and a focus on the client rather than the symptom. Psychological problems are viewed as the result of inhibited ability to make authentic, meaningful, and self-directed choices about how to live. The opening session is extremely important in brief therapy for building an alliance, developing therapeutic rapport, and creating a climate of mutual respect .

21. Brief Humanistic & Existential Therapies Client-centered therapy can be used immediately to establish rapport and to clarify issues throughout the session. Existential therapy may be used most effectively when a client has access to emotional experiences or when obstacles must be overcome to facilitate a client's entry into or continuation of recovery . Gestalt approaches can be used throughout therapy to facilitate a genuine encounter with the therapist and the client's own experience. Transpersonal therapy can enhance spiritual development by focusing on the intangible aspects of human experience and awareness of unrealized spiritual capacity.

22. Brief Family Therapy For many individuals, interactions with their family of origin, as well as their current family, set the patterns and dynamics for their problems. Furthermore, family member interactions with the client can either perpetuate and aggravate the problem or substantially assist in resolving it. Family therapy offers an opportunity to: • Focus on the expectation of change within the family • Test new patterns of behavior • Teach how a family system works and how the family supports symptoms and maintains needed roles • Elicit the strengths of every family member • Explore the meaning of substance abuse within the family

23. Brief Family Therapy Short-term therapy is an option that could be used in the following circumstances : When resolving a specific problem in the family and working toward a solution When the therapeutic goals do not require in-depth, multigenerational family history, but rather a focus on present interactions When the family as a whole can benefit from teaching and communication to better understand some aspect of the disorder Family therapy can involve a network beyond the immediate family, may involve only one family member in treatment or a few members of the family system, or may even include several families at once.

24. Brief Couples Therapy The purpose of couples therapy is to restore a better level of functioning in couples who experience relationship distress. The reasons for distress can include poor communication skills, incompatibility, or a broad spectrum of psychological disorders. The focus of couples therapy is to identify the presence of dissatisfaction and distress in the relationship, and to devise and implement a treatment plan with objectives designed to improve or alleviate the presenting symptoms and restore the relationship to a better and healthier level of functioning.

25. Brief Couples Therapy Couples therapy can assist persons who are having complaints of intimacy, sexual, and communication difficulties. Couples should have a desire to modify and/or change dysfunctional behaviors. Honesty and emotional openness is a necessary component for treatment. This couples assessment process usually includes in-depth information gathering concerning the presenting problem, and assessment of occupations, schooling, employment, childhood development, parental history, substance abuse, religion, relational, medical, legal, and past psychological history, in the form an interview. The psychotherapist can then devise the best course of treatment planning.

26. Brief Group Therapy Short-term group therapy is a logical choice for reasons of cost-effectiveness. The prospect of simultaneously treating an entire group of patients in a brief period is appealing. Some of the reservations associated with short-term group therapy are patient-based. Preference for individual rather than group therapy is common among psychiatric outpatients. The prospect of disclosing private, often painful, aspects of one's life to a group of strangers is usually unsettling. Anxiety about such issues as control, individuality, understanding, privacy, and safety are common. Patients require convincing that the more public nature of the group situation, where individualized attention from the therapist is inevitably less, provides definite benefits.

27. Brief Group Therapy Careful attention to patient preparation is a requirement of referral to all forms of group therapy, short-term group therapy in particular. Another reason that Brief Group Therapy is so effective is because of the economic changes that people are living through. Oftentimes, clients have only a limited number of sessions they are able to attend for reasons such as time or money so longer group sessions would not be as useful.

28. APPLICATIONS The brief therapy approach can be brief and this makes it an approach that can be well integrated into the typically fast-paced lifestyle of the contemporary client . As such , brief therapy has been successfully applied to a variety of client concerns, including drug and alcohol abuse, depression, relationship difficulties, relationship breakdown , eating disorders, anger management, communication difficulties and crisis intervention to name but a few. In addition, brief therapy approaches have been effectively applied to a vast array of client groups, including children, families, couples and mandated clients .

29. STRENGTHS a) Because brief therapy is compact and most of the therapeutic work occurs between sessions, clients are more active and responsible for the improvements that occur. b) Because clients are more active, the focus is more on their capabilities than deficits. c) Since it is more focused, with more specific goals, clients more clearly understand their difficulties, the reasons for their difficulties, and the changes that need to occur. d) Because there is not the time to fully analyze all difficulties originating from childhood, brief therapy is strength based, focusing more on identifying and appreciating capabilities rather than deficits or problems. Problems are not ignored but are secondary to capabilities. e) Related to this, at the end of therapy, clients more clearly recognize what they have achieved. This leads to a heightened sense of mastery and increase in hope.

30. WEAKNESSES The main weakness of brief therapy is that it doesn’t go in-depth into clients issues. Also it is not applicable to severe and complex problems/disorders. Another drawback is that it works well with short-term goals. For example, if a person has just been diagnosed with a serious medical problem, they might best be helped by structured techniques to manage fear, or guided imagery to boost immune functioning, or techniques to reframe panic-inducing perceptions. These are short term goals . On the other hand, if that same person wants to reevaluate how they've lived their life so far, or if unresolved feelings from the loss of a parent have been opened up, or if they want to grieve the losses of health and safety and future that they might be feeling, a short-term therapy that targets surface thoughts or behaviors is not well suited for those goals. Goals like this involve self exploration, and self exploration requires a longer and more organic (less structured) inner process.

31. SUMMARY Brief therapy is a systematic, focused process that relies on assessment, client engagement, and rapid implementation of change strategies. Indicators for the use of brief or very brief psychotherapy include: a state of emotional turmoil or distress that is related to a core conflict which is contributing to the distress . The literature that demonstrates that psychotherapy is effective really concludes that brief psychotherapy is effective because the average number of sessions in the studies is less than 26 (e.g. Smith Glass & Miller, 1980; Elkin et al., 1989 ).

32. REFERENCES Budman , S. H., & Gurman , A. S. (1988). Theory and Practice of Brief Therapy. New York: The Guilford press. Dewan , M. J., Steenbarger,B . N., Greenberg , R. P. (Ed.) (2018). The Art and Science of Brief Psychotherapies: A Practitioner's Guide.USA : American Psychiatric Association Publishing. Brief Interventions and Brief Therapies for Substance Abuse. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK64947