March 13, 2009
Psychiatric Times.
No. 3
CME
Brief Psychotherapies: Potent Approaches to Treatment
Roger P. Greenberg, PhD and Mantosh J. Dewan, MD
Dr Greenberg is professor and head of the psychology division and Dr Dewan is professor and chair, department of psychiatry and behavioral sciences, at the State University of New York Upstate Medical University in Syracuse.
Also, we should mention the issue of stages of change so well described by Prochaska and Norcross.32 Patients enter treatment with wide variations in their readiness for change, which ranges from those who deny the need for change to those who are primed to make changes. Those who deny the need may require weeks of exploration before they are able to commit to taking actions suggested by a briefer approach. Needed therapist attributes
In some ways, briefer treatments may require a higher level of skill to rapidly identify central issues, accelerate the formation of a meaningful treatment relationship, inspire hope, and provide a framework in which patients will feel free to try new solutions for old problems. Benefits from psychotherapy may be greatly diminished if a therapist blindly adheres too strictly to a therapy manual.29 Successful psychotherapy, at its base, is an interpersonal encounter and not just a rote application of impersonal techniques to a passive recipient. The importance of listening to patients is highlighted by Lambert and Archer.33 Patients’ prognosis was greatly improved when the therapist elicited feedback from patients about how therapy was progressing. Apparently, getting honest feedback promotes needed change in the therapeutic process. This enhances the treatment relationship, intensifies patient involvement in the process, and increases patient satisfaction. Research also indicates that treatment benefit is significantly related to qualities that competent therapists bring to the encounter. The more a clinician is perceived to be empathic, caring, open, and sincere, the better the outcome.34 Over several decades, the empirical literature has documented that treatment has the power to harm as well as to help. It can make patients worse than they would have been without therapy. Of particular interest is the indication that specific therapist qualities can foster a decline. The concept of therapist pathogenesis is of note.35,36 Pathogenesis refers to the degree to which therapists allow their own needs to supercede those of the patients who are dependent on them. A series of studies with very disturbed patients underscores the relationship between the level of therapist pathogenesis and negative treatment outcomes.35,36 Training implications
In 2002, the Psychiatry Residency Review Committee (RRC) recognized a need to train psychiatrists in a series of core competencies. The RRC mandated that psychiatric residency programs include training in 5 different forms of psychotherapy, one of which is brief psychotherapy. This mandate has sparked added interest in learning about brief psychotherapy and has led to the publication of materials about how clinicians can get started in learning the basics of brief psychotherapy approaches.1 While reading is a start, evidence suggests that the attainment of proficiency requires more. The need for carefully designed courses and the chance to develop skills through supervised practice experiences is crucial. In general, additional therapist training has been shown to correlate with greater improvement in patients’ symptoms and decreased rates of attrition and recidivism.37 Extended training opportunities must take into account not only the techniques of specific treatment models but the discovery that there are common factors that underlie and power all successful psychotherapy treatments. CME POST-TEST
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