What is Brief Psychotherapy and How Does it Work?

Brief psychotherapy is a term that is used for a variety of psychological therapies focused on the solution and that are given in the short term.

It differs from other therapeutic schools in that it emphasizes: 1) focusing on a specific problem and 2) direct intervention. In brief psychotherapy the therapist takes responsibility to work more proactively with the client to treat the clinical problem more quickly.

All the psychological currents (behavioral, cognitive, psychoanalysis, systemic …) have developed a model of brief therapy each one of them with  objectives and presumptions of their particular model.

Brief Psychotherapy

This general interest in developing shorter therapy models responds to the need to find quicker solutions for people who  suffer and suffer from its symptoms, so that they can be resolved in the shortest possible time.

Brief Psychotherapy

From brief psychotherapy we can talk about the birth of two great models that have been gaining strength and that currently represent the two main  pillars of this form of therapy:

  • Brief therapy focused on solutions.

  • Strategic brief therapy.

Brief therapy focused on solutions

origins

Solution-focused brief therapy (TCS) was developed by Steve de Shazer and his collaborators in the late 1970s.

This model has its background in brief therapy at the Mental Research Institute (MRI) in Palo Alto, CA. With this, the traditional MRI brief therapy  has had a great influence on the development of brief therapy focused on solutions.

In the same way, the short therapy of the MRI obtains its influences from Bateson’s systems theory, social constructivism and the work of the  psychiatrist Milton Erickson.

The biggest difference between MRI brief therapy and solution-focused therapy is that, while the first focuses on intervention on what  sustains the problem, CTS focuses on building solutions.

As we can see, CTS does not come from nowhere but is the result of a theoretical and practical arsenal of great influence in psychotherapy.

The practical and targeted nature of the TCS, has made it not only one of the most important schools of brief therapy  , but has also exerted an enormous influence in other fields such as the education system, in the services of criminal justice, in the field of  business, social policy, etc.

Key concepts

Steve de Shazer and his wife, Insoo Kim Berg, emphasized that solution-focused therapy is not simply a set of therapeutic techniques, but  that beyond techniques represents a way of thinking.

Knowing the techniques well and applying them is not enough for the change in the clients to take place, but they must be subject to solid  concepts and beliefs (de Shazer, 1985).

The assumptions of the TCS are as follows:

  • Focus on solutions, strengths and healthy behaviors

From the TCS it is assumed that all clients have the knowledge and resources to make their lives better and, therefore, they have the  solutions to their problems.

Therefore, instead of focusing on what they can not do, it focuses on what they can do. They do not focus on defining and diagnosing the problem but on the  resources the person has to solve the problem.

For a brief therapist focused on solutions, it is not so important to explore and investigate the problem and the cause of it, but to rescue  the person’s resources, strengths and healthy behaviors, which can be very helpful. when it comes to finding solutions to the  problem.

  • Search for exceptions

The TCS starts from the idea that if the problem is not present at all times and in all situations, it means that in the moments that do not occur, it  is because the person has carried out a series of strategies that makes the problem do not appear This leads us to the concussion that the same person  has the key so that the problem does not arise.

It is then focused on the exceptions, that is, when the symptoms are not present, and what the person does so that they are not present in order to  enhance it.

For example,  a couple that goes to therapy for being in continuous conflict. Instead of focusing on what it is that leads to conflict, it focuses on the times when they are not in conflict. 

(T: Therapist, P: Couple)

T- When you are not in conflict, how are you?

P- Well, with our things

T- What things are those?

P- Well we like to go to the mountains on Sundays or watch monologues on the internet

T- And how are you among you when you go to the mountain or when you see monologues?

P- Well, we had a good time

T- And what do you do to have fun?

As we see, the questions are always positive and looking for solutions.

It is therefore about developing positive thinking in clients. It’s about helping them develop a constant mental dynamic of  building solutions.

Tools and techniques

  • Question Miracle

It is a very powerful technique to generate the first steps that lead to the solution of the problem. It helps clients to describe in a very precise  and detailed way each of the steps they must take to generate the change.

For example,  the case of a husband who has lost his wife and because of it falls into alcoholism. The excessive consumption of alcohol leads him to maintain an aggressive and conflictive behavior with his children.

The miracle question is posed as follows:
T: You come home tonight and go to bed with all the worry and problems that you have in your head. In the middle of the night, unexpectedly, a miracle occurs; all your problems and worries have disappeared. You are waking up little by little, what would be the first sign that would make you realize that a miracle has taken place and that your problems have disappeared?

C: I guess I would get out of bed and face the day with strength and encouragement instead of staying in bed letting the hours pass.

T: So, getting out of bed and facing the day with strength would be the first sign that would indicate that you feel good?

C: Yes, I suppose I would greet my children with a smile and ask them how they have slept, instead of being ogre-faced and yelling at them.

T: How do you think your children would respond?

C: They would be surprised. I guess they would be happy to see me well after so long ..


These types of questions make the client leave his circle of negativity and mentally situate himself in the possibility of starting to do positive things. They themselves build in their minds the detailed sequence of what they can do to solve their problem. This leads them to see an exit and to  motivate themselves to change.

  • Questions about the scale

It is also a technique very focused on achieving the objectives. It consists in negotiating, for example, with the family and the adolescent what each of the parties would have to do  to reduce the average, one … points each week.

In the case of a mother who complains about her daughter’s misbehavior, she is asked to:

On a scale of 1 to 10 where 1 is the worst and 10 the best:

  • What number of the scale corresponds to your daughter’s behavior at this time?

  • What number would correspond two weeks ago?

  • What would you have to do so that next week instead of being a 3 would be a 3.5 or a 4?

  • (To the daughter) What would you have to do so that next week instead of being a 3 it would be a 3.4 or a 4?

  • Is there something different that both can do so that next week instead of being a 3 is a 3.5 or even a 4?

  • Handling the problematic situation

This technique is designed for those very pessimistic families that do not respond effectively in the two previous techniques.

It consists of validating the client to ensure that things are not worse than they could be. For this you should ask questions of the type:

  • Why are things not worse?

  • What have you done to make the situation worse?

  • Fantastic! How did you come up with such an idea? What would you have to do to keep this happening?

Strategic brief therapy

origins

Paul Watzlawick and Giorgio Nardone are the promoters of the strategic brief therapy that has its ancestral origins in the Hellenic traditions, the  rhetoric of the sophists and the art of Chinese stratagems.

Strategic brief therapy descends from the brief therapy of the Mental Research Institute (MRI) in Palo Alto, CA.

It is a model of therapy that has shown surprising efficacy and efficiency in many pathologies ( panic, phobias, obsessions and compulsions,  eating disorders, etc.).

The collaboration of Paul Watzlawick and Giorgio Nardone led to founding the Center for Strategic Therapy (CTS) of Arezzo.

This collaboration has led to numerous publications such as The Art of Change (1992); Fear, panic, phobias (1995) in which Nardone  presents protocols for phobias, compulsions, obsessions, panic attacks and hypochondria, which turned out to be the most effective and quick therapy for these  pathologies.

Another publication of great therapeutic interest was Prisons of food (2002) for the intervention of anorexia and bulimia.

In summary, the research and clinical practice carried out at the CTS in Arezzo have produced a significant increase in the effectiveness and  efficiency of therapeutic interventions. In the CTS of Arezzo, 86% of the cases and an average treatment duration of 7 sessions were resolved.

Key concepts

  • Work on how the problem works

The first objective of a strategic therapy is to cause a break in the vicious circle. For this, a strategic therapist is interested in understanding how  the problem works instead of why it exists, working on solutions instead of on causes.

As Nardone expresses: “I usually explain to my clients that the TBE is like a game of chess, where all the possible moves are known in advance, it is only necessary to observe which of them the other player performs to know his strategy (in our case, how the problem works) and thus be able to win the game to the problem “.

  • Promote the search and encounter of tried solutions

The solutions that the client has carried out to try to solve their problem without success are analyzed.

It is then seen that all these tried solutions have not served him and that, therefore, he must carry out different conducts than those carried out  until now that can solve the problem.

  • Use suggestive language and strategic interventions

The goal is for the client to begin to perceive reality in a different and more functional way. With a new perception of reality it is possible to  change behaviors and unlock mechanisms and reactions.

  • Tools and techniques

In strategic brief therapy, the techniques and tools used are not as specific as in short therapy focused on solutions.

In this type of therapy the creativity and flexibility of the therapist is of great importance.

The techniques and tools that are used for the TBE are:

  • Communication techniques

A very persuasive language is used to convince the client about the interventions that are going to be carried out, however strange they may seem.

There is a great use of paradox and stories of anecdotes and metaphors.

  • Displacement

It is not an attempt at immediate suppression, but a temporary displacement of the symptom, which provides the patient with a first glimpse of  possible power over the symptom.

For example: A lady who every time her husband does not like her gives her a headache, tachycardia and her legs are swollen, she is asked that when she is upset with her husband she will concentrate all her pain only on her arms on even days and on the odd the right leg.

  • Prescriptions of the symptom

It consists in assigning a task to the patient where the frequency, the intensity of the symptom, the situations in which it occurs, will accentuate, so that it  identifies and regains control over the symptom.

Also Read: Parkinson’s Disease: Symptoms, Causes and Treatment

For example,  a person with compulsions of revision and order who can not control creating a high degree of anxiety, is prescribed to be forced to perform compulsions for 60 minutes, not a minute or a minute less.

  • Paradoxes

They are behavioral interventions where a behavior different from the symptomatic one is not proposed but the continuity of it is prescribed in a fixed time  . And the mandate is more of the same.

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