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Research Brief on Brief Therapy
C. Alexander Simpkins Ph.D.
Annellen Simpkins Ph.D.
Over the past twenty years there has been a movement toward shortening the duration of treatment (Garfield & Bergin, 1994). Many individual research projects, as well as meta-studies of research projects (Lambert and Bergin,1992), have found that brief therapy can be just as effective if not more effective than long-term or unlimited term therapy. In their overview of psychotherapy research, Lambert and Bergin stated that brief therapy has a significant effect on clients, with fifty percent showing improvement by the eighth session.
But critics of time-limited therapy have emerged since, with research findings that seem to refute the many studies supporting brief therapy. They believe that limiting the number of sessions of treatment is an unfair form of rationing therapy to clients, which often deprives them of completing the process in depth. One of the proponents of this view, Ivan J. Miller (1996) has denied the validity of a number of the studies of brief therapy, asserting that these projects do not prove the superiority or equivalence of short-term therapy.
Dr. Erickson, in his usual clear-sighted manner, has offered a shift in perspective that dissolves the disagreement. He described his treatment as a short-term, long-term method. He saw patients for a limited number of sessions, but he stimulated in them a long-term learning process, directed to their individual needs and motivations. The initial stimulus was carefully considered and strategically planned by him, then introduced and fostered during the sessions. Deeper comprehensive learning, once initiated, grew and evolved over time. ÒIn his work, Erickson opened the door for change and in that way he had a major impact on brief therapyÓ (Fisch in Zeig 1982, 157). Numerous stories tell of patients who returned years later to tell Erickson of the many discoveries and changes they had made over the years.
Lawrence Kubie agreed that change takes time. ÒThere are many patients who during the course of treatment seem to their relatives, friends, and therapists as well to be making no progress at all, but who some years later show that they have gained an enormous amount.Ó (Kubie, 1973 881) Change isnÕt necessarily standardized or linear.
Studies of short-term therapy with long-term follow- ups at six months, five years, ten years, and twenty years support this perspective. Patients showed increasing improvement after termination over ten years and continued improvement up through twenty years. Only half of the change took place during the time of treatment itself. (Liberman in Frank, 1978) Short-term interventions have long-term effects.
Researchers face challenges in correctly accounting for the slow process of maturation from brief psychotherapeutic interventions. Experimental methods, which are always striving to be standardized in order to be rigorous, run the risk of being too limited, thereby missing the truly significant data. But researchers who are interested in measuring how therapeutic change occurs are resourcefully creating sensitive and broad research methods.
These new research methods attempt to realistically represent the individual change process as it occurs in real-life therapy. For example, a method known as the cohort-sequential design uses groups to study long-term effects of change without the expense and time of a longitudinal study (Anderson, 1993). This method allows researchers to approximate longitudinal data analysis by combining information from different overlapping subjects at different stages along a time continuum. This is frequently used for developmental studies, but could, according to Anderson, be adapted to examine change following treatment.
A new method to help therapists predict how many sessions a client will need was tested by Lambert, Hansen, & Finch (2001). They analyzed data from over 10,000 patients to understand the association between length of treatment and improvement and then passed this information on to therapists.
With these and other creative innovations in methods and designs, we hope that research can help discover how to make treatment optimal. Then psychotherapists can achieve therapeutic goals, while protecting the needs of the patient, without taking longer than needed for effectiveness.
Anderson, E.R. (1993) Analyzing change in short-term
longitudinal research using cohort-sequential designs. Journal of Consulting and Clinical Psychology, 61. 929-940.
Fisch, R. (1982). EricksonÕs impact on brief psychotherapy.
In J.K. Zeig. Ed. Ericskonian approaches to hypnosis and psychotherapy. New York: Brunner/Mazel.
Garfield, S. & Bergin, A. E. (1994). Introduction and
historical overview,. )In S.L. Garfield & A.E. Bergin (Eds.), Handbook of psychotherapy and behavior change (4th ed, pp. 3-22). New York: Wiley.
Kubie, L.S. (1973). The process of evaluation of therapy in
psychiatry. Arch. Gen. Psychiatry. 28. 880-884.
Lambert, M.J. & Bergin, A.E. (1992) Achievements and
limitations of psychotherapy research. In D.K. Freedheim, H.J. Freudenberger, J.W.S. Kessler, S.B. Messer, D.R. Peterson, H.H. Strupp, & P.L. Wachtel. (Eds.) History of psychotherapy: A century of change. Washington, DC: American Psychological Association.
Lambert, M.J. & Hansen, N.B., Finch, A.E.(2001). Patient-
focused research: Using patient outcome data to enhance treatment effects. Journal of consulting and clinical psychology. 69, 2, 159-172.
Liberman (1978) The maintenance and persistence of change:
Long-term follow-up investigations of psychotherapy. In J.D. Frank, R. Hoehn-Saric, S.D. Imber, B.L. Liberman, & A.R. Stone. Effective ingredients of successful therapy. New York: Brunner/Mazel.
Miller, I.J. (1996). Time-limited brief therapy has gone
too far: The result is invisible rationing. Professional psychology: research and practice. 27, 6, 567-576.