Short-term therapy is an important cost-effective approach for many psychiatric problems. It also has been shown by the nation’s pioneer health maintenance organization to reduce utilization of medical resources.
What to expect?
Reasonable anticipations of what short-term treatment should accomplish in the average person are (1) relief of symptoms, (2) restoration to the optimal level of functioning that existed prior to the present illness, and (3) an understanding of some of the forces that initiated the immediate upset.
How does it work?
A number of attempts have been made to subdivide short-term therapy into a number of distinctive categories. In general these fall into three groupings (1) crisis intervention, (2) supportive-educational short-term therapy, and (3) dynamic short-term therapy. The goals of crisis intervention usually differ from those in the other brief methods. Here, after from 1 to 6 sessions, an attempt is made to restore habitual balances in the existing life situation. Supportive educational approaches, the number of sessions varies, ranging from 6 to 25. In some cases less than six sessions may be ample, and occasionally even one session has proven productive (Rockwell & Pinkerton, 1982; Bloom, 1981). In dynamic short-term therapy the thrust is toward achieving or at least starting a process of personality reconstruction. Sessions here may extend to 40 or more.
The important operations consist of (1) establishing a rapid positive working relationship (therapeutic alliance), (2) dealing with initial resistances, (3) gathering historical data, (4) selecting a focus for therapy, (5) defining precipitating events, (6) evolving a working hypothesis, (7) making a tentative diagnosis, (8) conveying the need for the patient’s active participation in the therapeutic process, (9) making a verbal contract, (10) utilizing appropriate techniques in an active and flexible manner, (11) studying the reactions and defenses of the patient to the techniques being employed, (12) relating present-day patterns to patterns that have operated throughout the patient’s life, (13) watching for transference reactions, (14) examining possible countertransference feelings, (15) alerting oneself to resistances, (16) assigning homework, (17) accenting the termination date, (18) terminating therapy, (19) assigning continuing self-help activities, and (20) arranging for further treatment if necessary.
When is it used?
There are patients who by themselves have already worked through a considerable bulk of their problems and who need the mere stimulation of a few sessions with a proficient therapist to enable them to proceed to astonishing development, in such cases short term development is effective and efficient. In practice one may distinguish at least five classes of patients who seek help depending upon the severity of psychological problem. In general, classes 1 to 3 require only short-term therapy. Classes 4 and 5 will need management for a longer period of therapy.
Role of therapist:
A variety of short-term therapeutic methods have been proposed by different therapists. Moreover, all therapists have to deal with their own personalities, prejudices, theoretical biases, and skills, all of which will influence the way they work. In spite of such differences, there are certain basic principles that have evolved from the experiences of a wide assortment of therapists working with diverse patient populations that have produced good results. The practitioner may find he or she can adapt at least some of these principles to his or her own style of operation even though continuing to employ methods that have proven themselves to be effective and are not exactly in accord with what other professionals do. While many of the suggestions as to technique discussed in previous chapters are applicable, in the pages that follow 20 techniques are suggested as a general guide for short-term therapy.