Therapy: The Quick Fix

Though he was the father of the most time-consuming of therapies, psychoanalysis, legend has it that Sigmund Freud cured the composer Gustav Mahler's impotence during a stroll around a lake.

The notion that a psychological difficulty could be remedied in a single session sounds gimmicky, and yet, some say short-term therapy is the best way to deal with a stark reality: About 40 percent of people who consult a therapist never go back. Advocates of single-session, or planned short-term therapy, which typically lasts three to five sessions, maximize the potential of brief encounters. (Short-term therapies may incorporate techniques from cognitive-behavioral therapy, which usually lasts about 10 sessions.)

"A patient's motivation is highest at the first session. We can capitalize on that," says Monte Bobele, a leading advocate of the technique and a professor of psychology at Our Lady of the Lake University in San Antonio. Instead of discussing all aspects of past and present life, brief psychotherapy seeks to empower clients while generating a few simple solutions. "We have a slogan at my clinic: 'Every case has the potential to be a single-session case,'" says Bobele. "This assumption completely changes the way we think about patients. We have a much greater sense of urgency."

Bobele treated one middle-aged woman whose health problems were spiraling out of control. During the course of her one and only session, he suggested she make a daily blood-pressure measuring schedule and stick to it. She soon reported feeling much better and was monitoring her diabetes. A few months later, she had quit smoking and drinking. "Making one small change had a snowball effect," says Bobele.

Evidence abounds that planned short-term psychotherapies are generally as effective as long-range varieties, regardless of the therapist's theoretical orientation. Researchers suspect that therapists engaged in brief psychotherapy make a more conscious effort to ensure that the clinical work will affect the client's way of thinking and behaving.

But critics question how long such a "Band-Aid" approach could last, and are troubled by how well it plays into the hands of those eager to cut healthcare costs.

"Therapists are not magicians," says Paul Brinich, a psychology professor at the University of North Carolina at Chapel Hill. "It's not sufficient to focus on the symptoms without understanding their origins—after all, no good physician would reduce a patient's fever without trying to understand its cause."

Because the roots of their problems are personal and private, patients can't be expected to open up to a stranger in a few hours' time, Brinich says. "The attempt to make treatment shorter is understandable, but I haven't figured out a way to speed up people's ability to trust and reveal the conflicts in their lives."

The exception, Brinich says, is when a patient has a problem that stems from a lack of knowledge as opposed to an inner conflict. "A recently-widowed father came to me, distressed because his two-year-old continued to knock down his CDs. After explaining a bit about child development, I advised him to move the discs out of reach. It worked like a charm."

Drive-By Therapy

A Single Session Could Help If You:

• Have a very specific problem, such as a new health diagnosis.
• Wonder if a particular situation and your reaction to it is normal.
• Have dealt successfully with life problems in the past.
• Have faith that your troubles could be addressed by a brief intervention.

Longer-Term Therapy Is a Better Bet If You:

• Want to understand your patterns of behavior and how they developed.
• Have had repeated difficulties with family and romantic relationships.
• Would like to accomplish more, but consistently shoot yourself in the foot.
• Are suicidal, psychotic, or suffer from a condition requiring medication.

Psychology Today's Therapy Directory can help you find professionals who specialize in treatment of varying lengths.