Psychiatric Times - Category 1 Credit
You must keep your own records of this activity. Copy this information and include it in your continuing education file for reporting purposes.
CME LLC is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
CME LLC designates this educational activity for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
CME LLC is approved by the California Board of Registered Nursing, Provider No. CEP12748, and designates this educational activity for 1.5 contact hours for nurses.
The American Nurses Credentialing Center (ANCC) accepts AMA PRA Category 1 Credits™ toward recertification requirements.
The American Academy of Physician Assistants (AAPA) accepts AMA PRA Category 1 Credits™ from organizations accredited by the ACCME.
Sponsored by CME LLC for 1.5 Category 1 credits.
Original release date 02/09. Approved for CME credit through April 2009.
After reading this article, you will be familiar with:
• The history of brief psychotherapy • Why there is a need for brief psychotherapy • The approaches of the various psychotherapies • The type of patient most suitable for brief psychotherapy.
Who will benefit from reading this article?
Psychiatrists, psychologists, primary care physicians, nurse practitioners, and other health care professionals. To determine whether this article meets the continuing education requirements of your specialty, please contact your state licensing and certification boards.
Brief psychotherapy is not the name of a specific model or theory of treatment. Rather, it describes an approach that attempts to make psychotherapy as efficient and practically helpful as possible within a limited time frame. The aim of brief therapy is to speed up the process of change, amplify patient involvement, and foster more focused psychotherapy sessions. Over the years, several approaches to brief psychotherapy have evolved. Some advocate a handful of sessions; others involve more than 20 sessions (eg, psychodynamic therapy).
A growing body of empirical evidence highlights not only the fact that short-term psychotherapy produces positive outcomes but also that the likelihood of success can be linked to certain patient and therapist characteristics. The value of brief psychotherapies for a variety of conditions has been well documented.1-3
A brief history of short-term approaches Some may be surprised to learn that treatments of brief duration have roots in psychoanalysis, which is often portrayed as the model that requires the longest time in treatment. In Studies on Hysteria, Freud4 described 3 of his cases that only lasted between 1 and 9 weeks. Furthermore, his successful treatment of famed composer Gustav Mahler’s impotence in a single, 4-hour session is a demonstration of the value of focus and brevity.5 Other psychoanalysts, such as Ferenczi and Rank,6 also made deliberate attempts to abbreviate the length of psychotherapy. However, it was Alexander and French7 who most systematically moved analysts toward briefer therapies in their classic work Psychoanalytic Therapy: Principles and Applications.
1. Dewan MJ, Steenbarger BN, Greenberg RP, eds. The Art and Science of Brief Psychotherapies: A Practitioner’s Guide. Washington, DC: American Psychiatric Press, Inc; 2004.
2. Dewan MJ, Steenbarger BN, Greenberg RP. Brief psychotherapies. In: Hales RE, Yudofsky SC, Gabbard, eds. The American Psychiatric Publishing Textbook of Psychiatry. 5th ed. Washington, DC: American Psychiatric Publishing; 2008:1155-1170.
3. Dewan MJ, Steenbarger BN, Greenberg RP. Brief psychotherapies. In: Tasman A, Kay J, Lieberman JA, eds. Psychiatry. Vol 2. 3rd ed. New York: Wiley; 2008:1889-1903.
4. Breuer J, Freud S. Studies on hysteria (1893-1895). In: Strachey J, ed, in collaboration with A. Freud. The Standard Edition of the Complete Psychological Works of Sigmund Freud. Vol 2. London: Hogarth; 1955:
5. Jones E. The Life and Work of Sigmund Freud. Vol 2. New York: Basic Books; 1957.
6. Ferenczi S, Rank O. The Development of Psychoanalysis. Newton, C, trans. Classics in Psychoanalysis Monograph Series; no. 40. New York: Nervous and Mental Disease Publication Co; 1925.
7. Alexander F, French TM. Psychoanalytic Therapy: Principles and Applications. New York: Ronald Press; 1946.
8. Fisher S, Greenberg RP. The Scientific Credibility of Freud’s Theories and Therapy. New York: Columbia University Press; 1985.
9. Fisher S, Greenberg RP. Freud Scientifically Reappraised: Testing the Theories and Therapy. New York: Wiley; 1996.
10. Stuart S. Brief interpersonal psychotherapy. In: Dewan MJ, Steenbarger BN, Greenberg RP, eds. The Art and Science of Brief Psychotherapies: A Practitioner’s Guide. Washington, DC: American Psychiatric Press, Inc; 2004:119-156.
11. Weissman MM, Markowitz JC, Klerman GL. Comprehensive Guide to Interpersonal Psychotherapy. New York: Basic Books; 2000.
12. Skinner BF. About Behaviorism. New York: Random House; 1974.
13. Wolpe J. Psychotherapy by Reciprocal Inhibition. Stanford, CA: Stanford University Press; 1958.
14. Ellis A, Harper R. A Guide to Rational Living. North Hollywood, CA: Wilshire Book Co; 1961.
15. Beck AT. Cognitive Therapy and the Emotional Disorders. New York: International Universities Press; 1976.
16. Beck JS. Cognitive Therapy: Basics and Beyond. New York: Guilford Press; 1995.
17. de Shazer S. Investigating Solutions in Brief Therapy. New York: WW Norton; 1988.
18. Erickson M, Haley J, eds. Advanced Techniques of Hypnosis and Therapy: Selected Papers of Milton Erickson, MD. New York: Grune & Stratton Publishers; 1967.
19. Walter JL, Peller JE. Becoming Solution-Focused in Brief Therapy. New York: Brunner/Mazel; 1992.
20. Greenberg RP. Psychoanalytic trials and tribulations: a review of outcomes of psychoanalytic treatment. Contemp Psychol. 2004;49:145-147.
21. Greenberg RP, Goldman ED. Antidepressants, psychotherapy or their combination: weighing options for depression treatments. J Contemp Psychotherapy. In press.
22. Lambert MJ, Ogles BM. The efficacy and effectiveness of psychotherapy. In: Lambert MJ, ed. Bergin and Garfield’s Handbook of Psychotherapy and Behavior Change. 5th ed. New York: John Wiley & Sons, Inc; 2004:139-193.
23. Lipsey MW, Wilson DB. The efficacy of psychological, educational, and behavioral treatment: confirmation from meta-analysis. Am Psychol. 1993;48:1181-1209.
24. Smith ML, Glass GV, Miller TI. The Benefits of Psychotherapy. Baltimore: Johns Hopkins University Press; 1980.
25. Baxter LR Jr, Schwartz JM, Bergman KS, et al. Caudate glucose metabolic rate changes with both drug and behavior therapy for obsessive-compulsive disorder. Arch Gen Psychiatry. 1992;49:681-689.
26. Brody AL, Saxena S, Stoessel P, et al. Regional brain metabolic changes in patients with major depression treated with either paroxetine or interpersonal therapy: preliminary findings. Arch Gen Psychiatry. 2001;58:631-640.
27. Greenberg RP, Fisher S. Mood-mending medicines probing drug, psychotherapy, and placebo solutions. In: Fisher S, Greenberg RP, eds. From Placebo to Panacea: Putting Psychiatric Drugs to the Test. New York: John Wiley & Sons, Inc; 1997:115-172.
28. Greenberg RP. Essential ingredients for successful psychotherapy:
effect of common factors. In: Dewan MJ, Steenbarger BN, Greenberg
RP, eds. The Art and Science of Brief Psychotherapies: A Practitioner’s
Guide. Washington, DC: American Psychiatric Publishing; 2004:231-
29. Wampold BE. The Great Psychotherapy Debate: Models, Methods, and Findings. Mahwah, NJ: Erlbaum; 2001.
30. Horvath AO, Symonds BD. Relation between working alliance and outcome in psychotherapy: a meta-analysis. J Counseling Psychol. 1991;38:139-149.
31. Martin DJ, Garske JP, Davis MK. Relation of the therapeutic alliance with outcome and other variables: a meta-analytic review. J Consult Clin Psychol. 2000;68:438-450.
32. Prochaska JO, Norcross JC. Stages of change. In: Norcross JC, ed. Psychotherapy Relationships That Work: Therapist Contributions and Responsiveness to Patients. New York: Oxford University Press; 2002: 303-314.
33. Lambert MJ, Archer A. Research findings on the effects of psychotherapy and their implications for practice. In: Goodheart CD, Kazdin AE, Sternberg RJ, eds. Evidence-Based Psychotherapy:Where Practice and Research Meet. Washington, DC: American Psychological Association; 2006:111-130.
34. Blatt SJ, Quinlan DM, Zuroff DC, Pilkonis PA. Interpersonal factors in brief treatment of depression: further analyses of the National Institute of Mental Health Treatment of Depression Collaborative Research Program. J Consult Clin Psychol. 1996;64:162-171.
35. Karon BP, Vandenbos GR. The consequences of psychotherapy for schizophrenic patients. Psychotherapy:Theory, Research, and Practice. 1972;9:111-119.
36. Vandenbos GR, Karon BP. Pathogenesis: a new therapist personality dimension related to therapeutic effectiveness. J Pers Assess. 1971; 35:252-260.
37. Burlingame GM, Fuhriman A, Paul S, Ogles BM. Implementing a time-limited therapy: program differential effects of training and experience. Psychotherapy:Theory, Research, Practice, Training. 1989;26: 303-313