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Brief Strategic Therapy

Many of you have written asking me about the specifics of therapy. There has been a real shift in the ground rules for therapy in the last ten years.

Most clients no longer have the luxury of going into therapy and spending months, or possibly years, talking about their issues or problems, as in the past. Therapy has become brief and solution-focused. .Insurance companies have dictated the type and length of therapy. Most insurance companies want a therapist to assess and treat a client in six- to nine sessions, max.

Therapy used to be approximately fifty minutes per session. Now therapy is typically 30 to 45 minute sessions. The format has really changed, and when you come in you are typically asked to identify specifically what you would like to change. Although there is a brief history taken, the focus is on identifying a measurable problem and the steps to change it.

This means that people who come into therapy to improve their self-esteem must be able to pinpoint what part of their self-esteem needs improvement and how will they know if it’s better (measurable). In the 80s and early 90s, a client might have engaged in therapy for two years to improve their self-esteem. Family-of-origin issues would have been explored, current relationships would have discussed, and clients (who would have been called patients back then), would have demonstrated their low self-esteem in the session. The therapist would have guided and directed them. New behaviors would have been encouraged.

In today’s world, someone experiencing self-esteem issues might be given a homework assignment for session #2 to identify what strengths they see themselves having. Session #3 might be to learn feeling identification so that they might use their feelings as a foundation for change. In session #4, they might employ some cognitive behavioral techniques to learn how to redirect their thinking in a way that empowers them to stand up for themselves or believe in themselves. Sessions #5 might focus on assertiveness training so that a client with low self-esteem can learn how to be clear and direct about their needs and feelings. Session #6 might be a review session, going over the many techniques a client has learned, as well as discussing the possible relapse behaviors a client might experience as they move forward in their life.

As you can see, there is little room for idle talk in this type of therapy because it is so goal-directed. Brief therapy is psychoeducational. It teaches clients skills that they can easily use in their lives.

For clients who have been previously in therapy it can feel impersonal and business-like, because therapy is no longer a place to let your hair down, pause, and reflect on your life. When I meet with a client who wants long-term therapy, I explain to them that most insurance companies require that you call the insurance company and get sessions approved and that their insurance doesn’t pay for the old style of therapy (long-term therapy). If they choose supportive or psychoanalytic counseling, they will be expected to pay out of pocket. Some clients understand this and are willing to pay out of pocket, and other clients understandably are disgruntled at being told what type of therapy will be provided.

Therapy is an exciting process. No matter what method you chose, it is an opportunity to learn tools that will enhance your functioning. After all, investment in ones self is the most important investment you can make!

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