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Chapter 28. Brief Psychotherapies

Mantosh J. Dewan, M.D.; Brett N. Steenbarger, Ph.D.; Roger P. Greenberg, Ph.D.
DOI: 10.1176/appi.books.9781585623402.300832

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Excerpt

Brief therapy is a generic term referring to a class of psychotherapies that seek to accelerate change through the active, focused interventions of therapists and enhanced patient involvement in treatment. In the past several decades, various brief approaches to therapy have evolved, ranging from single-session treatments and strategic interventions of several sessions to short-term psychodynamic modalities that frequently exceed 20 sessions. At the same time, a wealth of outcome studies have informed the practice of brief therapy by identifying patients and presenting concerns likely to benefit from these approaches. The overarching message from this research is that the value of short-term work is significant but also highly dependent on the characteristics of patients and their therapists.

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FIGURE 28–1. Differences among brief therapy models.
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TABLE 28–1. Differences between short-term psychodynamic and traditional therapies
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TABLE 28–2. Differences between interpersonal therapy and short-term psychodynamic therapy
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TABLE 28–3. Comparison of learning and relational models of brief therapy
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TABLE 28–4. Differences between exposure and cognitive restructuring brief therapies
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TABLE 28–5. Contextual models of brief therapy
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TABLE 28–6. Differences between strategic and solution-focused brief therapies
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TABLE 28–7. Structural elements common to the brief therapies
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TABLE 28–8. Patient selection criteria predictive of success in brief therapy (DISCUS)
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Brief therapy consists of a group of approaches to psychotherapy that include short-term psychodynamic, interpersonal, behavioral, cognitive, strategic, and solution-focused modalities.

The various brief therapies differ in their average treatment duration, their targets for change, and their assumptions regarding change processes.

Several common ingredients link the brief therapies, including a circumscribed treatment focus, increased therapist and patient activity, an emphasis on generating novel experiences, and patient inclusion criteria.

Brief therapies overall are effective but are most likely to benefit patients who are ready for change and who present concerns that are recent, nonsevere, and simple, not patients with severe, chronic disorders.

Although a sizable proportion of patients can benefit from short-term treatment, the relation between time and change is complex, mediated by the nature of the outcomes measured, the time at which progress is assessed, and the degree of patient impairment.

Brief therapies appear to be effective to the degree that they intensify the common factors that account for change across all therapies.

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CME Activity

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Sample questions:
1.
The general trend toward the development of brief psychotherapy models involved several points of conceptual differentiation from the original model of psychoanalysis. Which of the following is not characteristic of the role or stance of the therapist in brief models compared with therapist behavior in psychoanalysis?
2.
Psychodynamic brief therapies retain the theoretical and conceptual heritage of psychoanalysis with some important operational modifications. Which of the following is not a specific feature of short-term psychodynamic psychotherapy?
3.
Interpersonal psychotherapy (IPT) is another brief therapy model with a specific theoretical basis and technical approach. Which of the following is not considered an appropriate therapy focus in the IPT approach?
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