therapy, also called "Solution-Focused Brief Therapy," uses practical strategies to help clients make significant, positive changes in their life as a result of their therapy in a relatively short period of time. Brief therapy focuses on what is going on in the client's life at the time of the therapy and does not delve into the subconscious or early childhood experiences. It contrasts markedly with psychoanalytic approaches that may take years and that will explore the entire lifespan of the client. It focuses on current difficulties and uses changes in behavior as goals (Miller and de Shazer, 2000).
Two distinctive ways of thinking about such a therapeutic approach include gestalt therapy and cognitive therapy. In gestalt therapy, the therapist attempts to help the client gain greater awareness of his or her emotions and behaviors as they presently exist in the client. Rather than interpret the client's experiences, the therapist works with the client so that the client comes to understand him or herself better. This school of thought views good adjustment as someone who is able to satisfy his or her needs. (Doermann, 1995)
Cognitive therapy, by comparison, works to change how the client thinks about him or herself. This approach assumes that the client has developed negative assumptions about him or herself and that the client gives himself these messages as he thinks about himself in a variety of situations. These negative self-perceptions interfere with everyday living. (Ford-Martin, 1995)
Freud believed that distress of the human psyche stemmed from early childhood experience, but therapists have plenty of evidence that most people experience multiple troubling and stressful events over the span of a life. In one study of 1,000 adults, 69% of the respondents reported a traumatic event ranging from being the victim of a violent crime to the traumatic loss of a loved one. The authors found that people who sought treatment after such events were suffering a significant level of stress and were not managing well with their crisis. (Calhoun and Tedeschi, 1998) So it is clear that any individual might have need of brief therapy at some time in his life.
Therapists who use brief therapy have specific tasks to accomplish with their clients. They have to learn skills and techniques used with solution-focused therapies. It helps for them to be open to new ideas regarding how to guide people to actively make changes in their lives. They need to be able to use several approaches with skill and flexibility, as a client may become stuck and need an innovative way to move forward. (Littrell, 1998)
A variety of tools are available to the therapist for use, and often clients are sent home with "homework to do before the next session. The homework might involve introspection, such as writing in a journal, or taking action, such as getting a job application, filling it out and turning it in to a prospective employer. Some therapists provide their clients with solution-based workbooks that help them systematically work through their current difficulties. (Schultheis, 2002)
Therapists who use brief therapy techniques must be personally flexible as well. They have to be able to perceive, understand and accept the client's current belief systems as a starting point. Plans of action the client will accept may be influenced by religious, cultural or spiritual beliefs alien to the therapist but important to the client.
Sometimes, therapies using brief therapies techniques use approaches that might not be as well suited to other treatment plans. For instance, hypnosis can play a role in brief therapy. Hypnosis can sometimes bring about rapid improvement for the client, and may help the client think about what is happening more efficiently. Hypnosis also sometimes reveals how the client's thinking may be shaped or driven by issues such as shame, fear of abandonment, or guilt. Some studies have been done on the use of hypnosis with brief therapy approaches such as cognitive therapy (Spencer, 2000)
Another emerging area of interest is the concept of using humor therapeutically. Some experts are suggesting that the use of humor be included as part of a therapist's training. (Franzini, 2001) The author points out that just because laughter occurs does not make it therapeutic, but that it can be used as one way to lead a client to re-thinking his situation. In addition, developing and maintaining a healthy sense of humor is part of living a psychologically healthy life. The author acknowledges that there is little empirical research as yet on the use of humor in therapy.
Another form of short-term therapy takes place as a "wilderness experience," usually for adolescents. This approach uses the challenges of living outdoor in wilderness areas. The teen has to learn to rely on his own resources and it is believed that the young person gains confidence about his ability to affect his own life in important ways. Currently there are no requirements for the training of people who provide these experiences (Rosoi, 2000), but often the people have backgrounds in such fields as outdoor education. While that is crucial, wilderness interventions may work more effectively trained therapists are included in the program.
WHEN IS BRIEF THERAPY APPROPRIATE?
The primary goal of Gestalt therapy is increased self-awareness and self-understanding. The patients work with the therapy to discover conflicts in their life, and then work on finding ways to resolve them. The assumption is that these needs are part of some unmet need. In Gestalt therapy, the client, with the therapist's guidance, identifies what people in their lives are tied to these unmet needs. They then confront those people (or the memories of them) to work toward some kind of resolution. (Doermann, 1995) Such a therapeutic approach requires the active cooperation of the client; it doesn't work well with people who are severely mentally ill. In addition, there are currently no national standards for providing Gestalt therapy. (Doermann, 1995)
Cognitive therapy takes a different approach. It addresses patterns of unwanted behaviors and uses rational processes to make behavioral changes. It can be used effectively for a variety of problems including phobias, substance abuse, post-traumatic stress disorder (PTSD), anxiety and panic disorders, some personality disorders, eating disorders, and as a supplemental therapy in the treatment of attention deficit hyperactivity disorder (AD/HD). It can also be used to help a client cope with chronic pain, chronic illness and sleep disorders. Cognitive therapy typically does not deal with emotional issues. (Ford-Martin, 1995)
Cognitive therapy can also be used with children, although approaches have to be modified to meet a child's needs. Authors report its effective use in children working with anger and aggression, AD/HD, anxiety, chronic physical health problems, and some issues of adolescence. (Friedberg, 2002), (Field, 2000) Both authors give specific examples of how to use cognitive therapy in childhood.
Research has demonstrated use of cognitive therapy with children and adolescents. Bernstein (2001) looked at treating anxious, school-phobic teens with cognitive therapy was well as medication, finding significant improvement when the two were combined. In another study, Mendlowitz (1999) looked at using cognitive therapy in a family therapy setting to help children aged 7 -- 12 cope with depression and anxiety. Carranza (2000) used family interactions in such therapy to evaluate attachment between parents and children. It seems likely that others will do more studies regarding cognitive therapy with children.
WHEN BRIEF THERAPY IS NOT APPROPRIATE
Cognitive therapy has specific limitations recognized by most of those who use that therapeutic approach. Some clients lack sufficient self-insight to make good use of cognitive therapy. Candidates for cognitive therapy have to be focused and know what they want to accomplish. In addition, they have to be ready to be an active participant in their therapy. Some people who come to therapy do not come looking to make specific behavioral changes. If they want insight into their own emotional makeup or how their past experiences affect them now, short-term therapy may not be the best route for them. Cognitive therapy is unlikely to work for clients who are psychotic, cognitively impaired or who have a traumatic brain injury. (Ford-Martin, 1995)
Gestalt therapy does not have to be used in a short-term way, and clients who want to understand their psychological makeup, or come to grips with a painful past, may need more time than is typically allotted to brief therapy. Some people may have difficulty with the intense nature of Gestalt therapy.
Some disorders straddle the line between physical and psychological difficulties. One such example is AD/HD. The great majority of people with AD/HD benefit from some combination of medication and therapy, often short-term. (Magill-Lewis, 2000)
It is difficult to do good, well-controlled research into therapy-related issues. There are two main reasons. First, it's difficult to get large N's of participants who all meet narrow diagnostic parameters when individual therapy is involved. Second, it's difficult to control variables that might affect outcome. With this in mind, Gingerich and Eisengart (2000) reviewed the available literature to see what current research can…