The Rush to Be Brief: The Rush to Be Brief

By Lipcbik, Eve | Family Therapy Networker, March/April 1994 | Go to article overview

The Rush to Be Brief: The Rush to Be Brief


Lipcbik, Eve, Family Therapy Networker


Be wary of short cuts in short-term therapy.

THE YOUNG THERAPIST HAD BEEN TAUGHT BEHAVIORAL AND psychodynamic theory in graduate school and, after graduation, had concentrated on training in family therapy. She had just launched her private practice when she began to feel that the increasing influence of managed health care was changing all the rules of the game. Anxious to present herself as a state-of-the-art therapist capable of doing brief but effective work, she decided to get training in solution-focused brief therapy. Far from being hostile to the idea, she liked the challenge of brief therapy, knew she was a good therapist and felt reasonably confident that she could quickly master the new skills that would make her more marketable. But to her surprise and disappointment, she found that an approach that had sounded so simple in theory and looked so effortless on videotape, was not at all easy to put into practice.

Her client today, for example, a mournful-looking young woman named Lorna, her eyes already red from crying, seemed unwilling to engage in any "solution talk." When the therapist asked Lorna what brought her into therapy, it was a struggle for the young woman to control her sobbing long enough to explain that her live-in boyfriend of two years had packed his bags and left her apartment three days ago. She had pleaded with him to return, but he finally admitted that he didn't love her and was, in fact, already deeply involved in another relationship.

The therapist, remembering her recent training, asked Lorna if there were any times, any moments, when she didn't feel grief. "Never," Lorna moaned.

"Not even a tiny bit, sometimes?" the therapist persisted.

"Not for one second. Not even when I'm asleep. Not that I ever sleep. Or eat," Lorna said between sobs. The therapist moved on to "the miracle question," a solution-focused technique for exploring hypothetical solutions. Could Lorna imagine what her life would be like if a miracle happened? Lorna insisted she wouldn't even consider a miracle that didn't include her boyfriend's coming back.

In spite of her increasing anxiety about Lorna's unproductive responses to her questions, the young therapist remembered to try to get Lorna to focus on better times in the future. "What will have to happen for you to start feeling better?" the therapist asked. Lorna looked at her uncomprehendingly and began crying even harder. The session finally ended with Lorna walking out of the office looking distraught. She never returned for a second session.

Another therapist had taken a couple of workshops in brief solution-focused therapy because his agency had just been placed on the referral list of a managed care organization that set a six-session limit on therapy. Both the company reviewers and his agency supervisors, worried about the steady decline in reimbursements, had made it clear that therapists who wanted to stay employed would have to upgrade their skills. But the therapist felt uncomfortable with the new methods he was learning. They seemed forced and unempathic compared with his usual warm, nondirective style. Nonetheless, he was grimly determined to succeed.

One of his first new cases involved a couple referred by the managed care company. George, the husband, was a tight-lipped actuary and Gloria, his wife of 20 years, was a voluble and, at the moment, quite angry, physical therapist who had threatened to leave George if he didn't come to therapy with her. Gloria accused George of being insensitive and noncommunicative; she was sick of "doing everything, while he did nothing" to keep the marriage together. George insisted that he tried his hardest to make her happy, but nothing he did ever pleased her, and he was ready to give up. They both agreed, however, that they wanted to make their marriage work.

The therapist started out by asking about exceptions times when their marriage seemed more satisfying and they agreed that they got along better on vacations. …

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