Magazine article Clinical Psychiatry News

Short-Term Therapy: Let's Use It

Magazine article Clinical Psychiatry News

Short-Term Therapy: Let's Use It

Article excerpt

Perceptions of psychotherapy among the lay public have been influenced by movies and television more than any other force. The films of Woody Allen, for example, portray therapy as an interminable strip mining of the psyche and as cash-guzzling emotional interrogations that meander (sometimes for decades), searching for the rare breakthrough.

This makes for good entertainment but bad treatment. In fact, it is the short-term psychotherapies that prove effective for many patients and should be so for more. The aim of therapy is clear--alleviating the pain and suffering of emotional disorders in the shortest possible time.

These short-term therapies, two of which are brief psychodynamic therapy (BPT) and cognitive-behavioral therapy (CBT), help patients observe their problems, thinking, and actions, thus enabling patients to alter them. Then, in turn, they can alter their behavior in a positive way--which includes using better coping skills.

CBT, for example, has been proven to work for many patients with anxiety disorders, adjustment disorders, some somatization disorders, and some personality disorders. Hypnosis and guided imagery can effectively treat chronic intractable pain problems, smoking cessation, and overeating, as well as DSM-IV anxiety disorders.

The goal is to get patients to start replacing negative, distorted, and generalized thoughts and to begin reprocessing those thoughts with alternative sets of perspectives on the same old problems.

It is critical to isolate the disorder on problems requiring treatment, being careful not to get lost in dogmatic conceptual models of mental functions and hypothesized inner turmoil and conflict. Short-term psychotherapy is oriented to reaching goals in days, weeks, or months--not years.

This requires an active approach on the part of the therapist--whether it's using BPT, where the focus is on working through specific intrapsychic conflicts; or CBT, where clear treatment protocols exist. When patients throw up certain barriers, we need to address those resistances head-on--rather than interpret them. I often tell my patients, You've got this marvelous energy, but you've got to get out of reverse and get into drive. And they get it.

Recently, I had a 32-year-old patient tell me, My father always calls me when I'm busy. Those kinds of generalized statements quickly led her to rage against the father, who has always been supportive both emotionally and financially. …

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