I’m going to start off by saying it’s difficult to put brief therapy – especially VERY BRIEF THERAPY, aka VBT – into a short presentation.
After all, the current treatment “landscape” of brief therapies includes: Eye Movement and Desensitization and Reprogramming (EMDR); Clinical Hypnosis; Motivational Interviewing. And what else? Polyvagal, Hakomi, Transpersonal, Energy Psychology, Bodywork, Neuro-Linguistic Programming (NLP), etc.
So there are many versions of therapies that make some claim to significant behavior change or symptom relief or insight in ONE or a few sessions. What are some factors that go into facilitating such therapies?
You and what ideas you allow to influence you:
Consider this: In the space of a few hours – at the most – a play or movie can take you through many emotional states. And you could have an experience that changes you. At least make you think. If you consider this example, you realize there are some significant principles that are at work in brief therapy: conflict may be amplified; time and spatial relationships are deliberately distorted; drama unfolds; intensity is embraced.
And what theories and models and the history of theories and models do you expose yourself to become a Very Brief Therapist?
I want to zero in on two contributions, two seminal changes in the field. The Crisis and War Therapies (for example, Erich Lindemann); and, starting with the work of Milton Erickson, those who extended his work such as the Mental Research Institute (MRI), Jay Haley, Bandler & Grinder (NLP) and Berg and De Shazer (SFBT)
What’s so important about these two nodes in the course of therapy practice?
One. They started with the idea that you could resolve a psychological problem quickly.
Two. By quickly they meant in a few sessions, perhaps even one, perhaps….gasp…even none! Though none did not mean no intervention.
Three. They used a developmental frame that focused on returning individuals to their highest level of prior functioning or on individuals accessing potentials – think strengths.
Four. They were very focused on communications. That is, both tactically and strategically using words in specific ways, and consciously deleting null communications. For example, except for using this communication as a paradoxical intervention, it is doubtful a VBT therapist would say “You’re stuck,” because that is antithetical to VBT conceptualization.
Five. While the Crisis and War Therapies worked with crisis thrust upon both the patient and the therapist as a given (trauma and combat), Milton Erickson and others considered the deliberate use of natural crisis OR therapeutic manipulation to create a crisis…..as allies in healing and growth. Recall general systems theory and what you learned about unbalancing families’ homeostasis as the route to a recrystallization of improved family functioning.
Most of you are already doing short term therapy. You are not inviting the patient to stretch out on the couch or defining the therapy as face-to-face at least once a week for a considerable length of time. Probably the longest “short term therapy” anyone is practicing in the context of state funded therapies is adherent DBT.
So what are some core concepts the Very Brief Therapist considers?
“Cure.” Now, this depends on how you conceptualize the problem, but essentially the complaint stops.
“Presenting problems are taken seriously (although not necessarily at face value).” This position is the antithesis of psychodynamic formulations where the symptom is a screen for an unconscious conflict. In VBT the problem might be a communication that is ‘outside of consciousness,’ but generally the patient’s complaint is the problem to be ameliorated.
“Time limited.” Without getting into nuance, think of the patient in therapy for three or more years. VBT is the opposite.
“…sometimes helpful and sometimes harmful.” Short term therapies tend to mute the possibilities of therapy “casualties.” A corollary of this is that “the least radical intervention” might result in the least harm aka the First Ethical Principle, “First Do No Harm.”
What are some basic interventional sequences in VBT? First of all, you want to retain as much therapist maneuverability as possible. Avoid taking a position early on. Track that presenting problem. Ask the patient what they think is the nature of the problem and its possible solution. BTW, on that one, they may be right on; but they may also be tipping their hand that they have consciously or unconsciously staked out a “never change” or “stuck” position you need to avoid.
And certainly in the first session, you want to avoid being rushed. Or at least appear to be rushed or pushed by the patient to rush. If crisis is a bridge to change, productive anxiety is a key. Allay or somewhat heighten anxiety at your direction.
Avoid taking sides. You may need to conduct separate interviews with couples and families. And you may need to quickly give directions. Giving directions – when you are prepared to test your case conceptualization or implement you main intervention – is a central VBT concept.
Retain your ability to be directive. As an example, instead of “How does that sound,” ask for “show me how that sounds” or “show me what you – or you two, or three, or four – do.” Some of you may already know how to do this from family therapy.
When appropriate, take the one-down position. Sincerely avoid the expert role when to do so enhances your leverage.
Avoid letting the patient set restrictive conditions. You must initially retain the ability to invite who you need, communicate with who you need, have the number and frequency of sessions needed (it may surprise the patient you will not meet every week!), and avoid holding secrets. In VBT do not get boxed into repeating the last therapist’s treatment – unless your formulation indicates that was an appropriate treatment (though likely not VBT). I generally say something very one-down along the lines of “I might fail you if I agreed to that and leave you in the same position, possibly worse off.”
With this very brief introduction to very brief therapy, I leave you with a suggested bibliography:
Fisch, R., Weakland, J.H. and Segal, S. (1985). The Tactics of Change: Doing Therapy Briefly
Hayley, Jay, Edit. (1985). Conversations with Milton H. Erickson, M.D. Volume I-III
Hayley, Jay. (1977). Problem Solving Therapy: New Strategies for Effective Family Therapy
Lankton, Stephen. (1980). Practical Magic: A Translation of Basic Neuro-Linguistic Programming into Clinical Psychotherapy
Madanes, Cloe. (1985). Behind the One Way Mirror: Advances in the Practice of Strategic Therapy