How therapy works

What is Brief therapy?

Brief therapy does not necessarily mean ‘fast therapy’. What it does mean is a focus on creating personal change for the client in each and every session. Changes in thought, attitude, emotional expression and actions to take. Maximising those possibilities on the assumption that each session may be the last (yet clients can have as many sessions as they need).

Why some clients prefer single appointments

In a study by the psychologist, Moshe Talmon in the 1980s it was revealed that the most common number of psychotherapy sessions (the modal number) was one. That’s right – a single session was the most common in the largest group of clients. It had been thought that the reason one was the most common number was that clients were ‘shopping’ or ‘dropping out’. But a follow up study on clients who elected for single session therapy revealed that this wasn’t the complete story. And that many such clients were perfectly happy with their visit, stating that they found some (or most) of the answers they were looking for.

Often this took the form of a simple realisation that changing a thought or an activity was all they needed to do. 

Freud and Brief therapy

A famous example of single session therapy took place in August 1910, when the composer Gustav Mahler visited Sigmund Freud. Time was short and Freud, who was on holiday in the Netherlands, took Mahler for a walk around the town of Leiden as they discussed the reduction in Mahler’s sex drive. We don’t know precisely what was said, but we do know that Mahler was happy with the advice Freud gave him, and that his marriage improved as a result.

Brief therapy assumptions

Practitioners in Brief Therapy like me work on the assumption that every session – including the first – could be the last. Therefore every session focuses on helping the client change. Either what they want to change (for example, their anxiety), or how they can change (for example, moving away from the thoughts that create anxiety).

Sometimes we might have a conversation about why change is necessary (for example, because doing so will improve their relationships). ‘Why’ conversations can be helpful, insofar as they connect clients to their values in life, and push them towards further changes.

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Psychotherapy in practice

Here is a summary of things I have learned about therapy over the years:

1. 1. 1. No one technique or type of therapy works all the time
      2. The experience of the therapist is more important than any other qualification
      3. The most important skill a psychotherapist has lies in the art of therapeutic conversation, listening, clarifying, normalising, asking questions, attending to clients’ responses, providing insight and encouragement, and offering guidance.
      4. Therapists who can work on different levels – thoughts, emotions, relationships, the body/brain, behaviour and the environment are more likely to be effective
      5. Therapists who adapt to the client with different styles of communication: listening, teaching, nurturing, challenging, directing and humorous – are also more likely to be effective
      6. Analysis of past events or ‘the unconscious mind’ is only marginally useful
      7. It is not what the therapist says that is important; it is what the client does with the information given
      8. Most of the changes the client hopes for will come in the first few sessions

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