These psychoanalysts were the first to promote the idea of therapists serving as active change agents and to suggest that patient experience, not insight, is a primary factor in achieving benefit. They specifically noted the importance of the therapist in facilitating what they termed the “corrective emotional experience.” Here patient re-exposure to painful early experiences was actively fostered by therapists who responded in a more supportive, accepting, and constructive manner than did significant figures from the patient’s past.
Subsequent research reviews by Fisher and Greenberg8,9 showed that Alexander and French were onto something important. It turns out that patient insights are not as central to change as many analysts assumed. Other prominent writers coming out of a psychoanalytic tradition (eg, Davanloo, Luborsky, Malan, Mann, Sifneos) have similarly supported the value of abbreviated variations of psychoanalysis. Interpersonal psychotherapy, which was first manualized in 1983, focuses on relationship issues but, unlike psychodynamic treatments, it does not make the therapeutic relationship a central focus.10,11 Instead, it shortens treatment by concentrating attention on role changes and the problems patients are having in their current relationships. Altering relationship expectations, examining patterns of communication with others, dealing with interpersonal crises, and using social supports are the main topics. In general, unlike short-term dynamic therapies, this approach downplays connections to the past and seeks symptom relief through more pragmatic interactions about how current relationships might be better handled.
The arrival of behavioral treatments in the 1950s also moved the literature to an appreciation of the possibilities of briefer treatments. Initially spearheaded by Skinner12 and Wolpe,13 this work focused on the role of therapist as teacher and placed the emphasis on altering learned behavior patterns and developing new skills for coping with anxiety. The learning model was eventually melded with cognition by Ellis14 in his rational-emotive psychotherapy and ultimately developed by Beck and his followers into today’s cognitive therapy—a powerful, well-researched, respected, and manualized treatment.15,16 Cognitive therapy is active and focused; it teaches patients to replace dysfunctional thought patterns with new, more adaptive ways of thinking. A tight treatment focus, an active therapist, and between-session assignments are designed to speed treatment progress.
Another line in the development of briefer psychotherapy treatment approaches emphasizes the role of the therapist as collaborative problem solver. In these so-called strategic therapies, exemplified by such writers as de Shazer,17 Erickson and Haley,18 and Walter and Peller,19 the therapist actively helps patients interrupt and redirect self-defeating, poorly chosen attempts to solve their current problems. Through such techniques as reframing problems and creating directed tasks, patients are moved toward new ways to act and ways to generate alternative behaviors from those that are maladaptive. The chief goals are to improve independent functioning and alleviate symptoms. It is assumed that future treatments may be needed to prevent relapse and maintain treatment gains.
The need for brief therapy work
All the treatments outlined in this article are responsive to the need to provide more services in less time because of the high demand for mental health services and the limited, inadequate supply of therapists. Briefer psychotherapies are also dictated by the restrictions imposed by insurance companies and the tight economic resources that are common in clinics, hospitals, and counseling centers. By necessity, treatments have had to become swifter and more targeted.
In addition, psychotherapies have had to objectively demonstrate their benefits to compete in the marketplace of available services. Or as Greenberg20 has so concisely put it: “In the future there will be no income without outcome.” Indeed, brief psychotherapies have played an important role in demonstrating the worth of “talking cures” in an era of evidence-based practice. An avalanche of research has been spurred as a result of most psychotherapy now being conducted based on brief formats. In fact, since short-term approaches are the most studied, they account for most of the literature on psychotherapy outcomes.
All the approaches outlined above have been subjected to scientific scrutiny. The accumulated evidence from hundreds of studies and many meta-analyses leaves no doubt about the effectiveness of brief psychotherapy treatments.1-3,21-24
