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Making the Most of Brief Therapy

Therapy: Sometimes less can really be more

Maybe you know you would benefit from some therapy, but you know upfront that you can’t to do any treatment long term: your insurance puts a 10 - session cap on outpatient therapy, or while you want to see someone now, you know you are moving out-of-state in two months.

While those Mad Men images of years of 3-times-a-week psychoanalysis or your friends’ accounts of months and months of plowing through their our childhoods are still part of our larger social consciousness of therapy, the reality is that for most of us therapy is in fact brief. What the research shows, however, is that the average course of therapy is 5-8 sessions, and maybe not surprisingly that most people only go once.

So regardless of your circumstances, if you’re thinking brief therapy, here are some tips for maximize the time and benefits:

Have a specific problem / goal in mind. This is not the time to aim for the personality makeover. Narrow it down. You need have help sorting through the pros and cons of a changing jobs. You need to have a serious conversation with your boyfriend about his drinking and need ideas and support in how to best approach it. You have to give a major presentation at work in two months, are freaking out, and need techniques to help you manage your anxiety and get through it.

Yes, often the current problem is tip of some other mental iceberg that you may have – your constant struggle with making the “right” decision, your uncomfortableness and avoidance of confrontation, your ever-present perfectionism or overall anxiety. While you make talk about these larger issues to put them in that larger context, you want to focus for now on one specific item and goal.

Look for therapists with a brief approach. When you look at therapists’ profiles look for those who mention key words of behavioral, short-term, here-and now, solution-focused, interactive rather than insight-oriented, non-directive, psychodynamic, exploring sources of problems in the past, repairing childhood wounds. While these latter, more in-depth approaches are certainly effective and can often lead to the make-over, they are not what you need if time or money is in short supply. To use a car analogy, you’re more likely looking for a tune-up, a replacing of spark plugs to make sure you get to your mom's house in Ohio. The more expensive major engine rebuild will have to wait for later.

Once you've narrowed down your list, the next step is to screen potential therapists on the phone, email, as well as look carefully at their websites. State your needs and expectations upfront when you make your first contacts in order to save time and be sure you are both on the same page before you start.

Have an agenda for every session.

You don’t want to be the passive passenger on this brief journey, but an active and proactive participant. It’s you and the therapist working as a team against the problem. Think of your sessions like a meeting at work. Have a focus, decide what you most want to get out of each session, ask questions, get your topics on the table at the start of the hour. Don’t waste valuable time jabbering about the weather or last night’s Mets game.

Have an agenda for every session.

Get and do homework. The idea behind homework in the 3rd grade was to practice what you learned during the day so you could gain some mastery and be ready to learn new things the next day. The same is true about brief therapy. Just as you want to be proactive before sessions by preparing an agenda, you want to be proactive after by doing homework. Most brief therapists will give you homework to do between sessions – exercises, techniques to practice, conversations to have. Do them. And if they don’t offer homework, ask for it – What do you suggest I specifically work on this coming week? Therapy is about changing your everyday life, not having a comfortable place to complain while someone nods her head. Like 3rd grade, most of the work out of the session happens on the outside, putting your new skills and perspectives into real-world practice.

Observe your reaction, behaviors, emotions between sessions. The homework is as much diagnostic as prescriptive. The aim often is to have you break out of your patterns, do something different. While you do this, try and step back and observe your internal process – how did you feel, what were you thinking when you did _____? What you want to uncover is where you get stuck, what is difficult, where anxiety comes up, how your behaviors, thoughts and emotions shape each other. The more of this information you can gather and pass along to the therapist the better. This is like telling your family doc your detailed information on your history and symptoms so she doesn’t have to start from scratch. It will save time in the sessions and help the therapist fine-tune next steps.

Bring in others for problem-solving and support. If it takes a village to raise a child, it often takes at least one or two other to solve a problem. If you are struggling over having that serious conversation with your boyfriend, ask about bringing him in for session. Similarly, if you are having some particular problem with your mother and she happens to be visiting, see if she can come in while she’s in town.

If your problem involves others, having those others there with you in the room is a great way to cut to the chase and save time. More importantly, you have a safe and supportive place to get things off your chest, someone to help you both negotiate a solution, and a professional to help you both emotionally mop up. If the idea of it makes you anxious, talk it with your therapist ahead so you can lay out a game plan and quell your concerns.

But bringing in others can also be helpful even if it’s not about them. Having your husband come in so he can better understand your anxiety, for example, and how he can specifically help you when you are having a difficult day can go a long way in your making progress more quickly. He also may be able to offer his perspective that will be useful for your therapist in fine-tuning your plan.

The theme here is clear: Be specific, be clear, be proactive. Actively make this your therapy. Keep your eye on your goal.

More from Robert Taibbi L.C.S.W.
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