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.
Solution focused brief therapy
In solution-focused brief therapy the first session clarifies the specific changes the client would like to see happening. It is not enough to state the change in the negative. Thus ‘I don’t want to be anxious any more‘ isn’t a solution-focused goal, whereas ‘I want to be calmer as I enter social situations’ is such. The latter statement will initiate an investigation into the client’s success in past situations before moving on to ways in which the client can add to their existing skills in creating a calm, focused state.
Brief therapists actively collaborate with their clients
Focusing on desired changes creates a forward momentum from the start. This, in turn, inspires trust in the process of psychotherapy and creates a partnership between therapist and client. Most studies of how therapy works cite the therapeutic alliance as the most important single factor in success. This is true in my own experience, as it is in most other therapists I know. However, that alliance is not forged just by listening to the client, important though that is. Rather, it is created in dialogue as the therapist explains, normalises, challenges, inspires, and directs the client towards action.
This points towards another factor identified in psychotherapy research: that the more experienced the therapist is, the more likely that success will follow. It is not the approach that creates success: it is the therapist using her hard-earned skills in communication gathered over years of practice that make it more likely to happen.
It is a simple fact that most of the success I have described will happen in the first few sessions, starting with the first. Still more interesting is that many clients will improve between the time they make their first appointment and the session itself. Which is one reason why I always ask new clients what changes they have already seen before meeting me. If changes have occurred I will divert time to asking about them, before expanding on the possibilities revealed, and encouraging clients to do more of the same.
What research shows about therapy
Research shows that the optimal number of sessions required (on average) is not large. One study which looked at therapy for depression showed that clients received all the benefit they were going to receive by the 8th session. Another 2001 study on counselling found that the majority of clients received nearly all the benefit they were likely to have between 7-10 sessions. Naturally, a minority of clients may benefit from long-term supportive therapy, but many do not. In fact it is not at all unusual for clients to find that they have achieved their goals within 3-6 sessions.
One reason for this is often overlooked: that clients are more savvy than is frequently realised. When it comes right down to it it’s the client who is the main instigator of change. All that we therapists need to do is help them along the street.