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What You Won't Get From "Brief" Therapy

Different individuals have different images and expectations from therapy, largely dependent on their past experiences and how therapy is depicted in the media. Few people understand the ways therapy can differ in reality, but being able to interpret therapy buzzwords can go a long way to helping a person establish a more realistic expectation of what they will get when they start therapy.

Among these buzzwords is the term “brief” therapy. This is a buzzword that is often used interchangeably with “short-term” therapy or “solution-focused” therapy. All three of these terms refer to therapy that is expected to occur over a period of several weeks instead of several months or years. It gained popularity when health maintenance organizations (HMOs) limited the number of therapy sessions they would pay for, so a plethora of research studies were released showing its efficacy. What this blog aims to do is to put “brief” therapy and its evidence-based practice into context.

Probably the best of the interchangeable buzzwords in terms of being descriptive is “solution-focused” therapy. This is therapy undertaken when a person has a very specific problem that has arisen very acutely, with very little history or nuance to it. The teenager is anxious because they have SATs coming up, or the adult is angry because their marriage is ending, or the elderly person is depressed because they no longer have the level of physical functioning they used to. These can seem like very straight-forward problems that potentially have quick solutions: teaching calming exercises for test-taking; gaining perspective on a problematic marriage; identifying strategies for maintaining dignity and independence in old age. These kinds of things can be very quickly accomplished, and at times they are sufficient for helping an individual get through a difficult period of their life.

Yet, these kinds of problems rarely crop up in a vacuum. The anxious teenager often has larger performance anxiety or perfectionistic tendencies. The angry adult might have displayed anger management issues for the duration of their marriage, alienating their partner. The elderly person may not have the social or financial resources to turn to for maintaining their independence. In these circumstances, while short-term therapy can offer a new functional skill, it doesn’t address the underlying problem.

Imagine that you go to your primary care doctor. You had tripped over an electrical cord and now your lower leg hurts. The primary doctor determines that the problem is the pain in your leg and prescribes a pain medication, which works on your pain every time you take it. However, what was not addressed was the reason WHY your leg hurts after tripping, and most reasonable individuals would consider this approach to be neglectful. Maybe you have a basic bruise, or maybe the bone is broken or a ligament is torn. Each of these causes requires a different treatment approach, but none of those treatment approaches are prescription-level pain medication.

Many therapists now recognize - as health insurance companies have come to recognize - that short-term therapy is more often insufficient to treat an individual’s psychosocial needs. Therefore, identifying that you are in need of therapy can often be an acknowledgement that there is something deeper that needs to be addressed. This can be a hard pill to swallow. It can lead to fear and worry that you are fundamentally flawed or that your problems are hopeless. Imagine if you went to doctor after doctor for your leg pain over the course of a year, and all any of them did for you was write another prescription. After a while you would wonder whether you have to accept that your leg will always hurt, or whether the entire medical profession is incompetent, when what is true is that the treatment that has been repeatedly offered has been insufficient to address the real problem: not you, not your complaint of pain, but your injured leg which has nothing to do with your character. Now imagine if the reason these doctors kept simply writing prescriptions is because your insurance won’t let them do x-rays, and even if a broken bone or a torn ligament was found, it wouldn’t cover a cast or surgery or physical therapy anyway. Oh, and once you hit your 5th day of pain medication, you’ve used up your pain medication benefits for the year. You might feel as though your pain is being dismissed, rather than being treated, right?

Long-term therapy - when it is warranted - can be a high-investment process but it is also a high-yield process. Resolving things like perfectionism, existential anger, low self-esteem, rejection sensitivity, loss of dignity, or many more deeper issues takes time in order to be sustainable. The therapist who can commit to walking through these longer-term issues with you is one who can see (and help you see) progress in small steps, can empathize with the disappointment of setbacks, and can connect and engage in the life you are living in all of its wholeness.

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