Expectation: principles and practice of very brief therapy

Abstract

What is very brief therapy? A number of years ago I did a library search on the subject of brief therapy and found a book by that title. It was written by an analyst and he wrote about the advantages of doing brief therapy which he defi ned as only taking one year of fi fty sessions! Most modern day therapists would consider brief therapy to be ten or fewer sessions. My private practice consists of doing very brief therapy which I defi ne as one or two sessions. That is, I treat every session as if it were the last one. I heard the late Steve deShazer once talk about some research done at the Brief Family Therapy Center of Milwaukee. They are located in the inner city, and their clients can be diffi cult. The receptionist read the completed intake form and informed the client, ‘Oh, it usually takes ten sessions to help people with these concerns’. The next client would be told, ‘For what you have written here it usually takes our staff fi ve sessions to help people’. The staff did not know what their clients were told. On follow-up about one year later there was about an 85% satisfaction rate by the clients in the study. Those who were told ten sessions started doing signifi cant work around the eighth or ninth session; the fi ve session people did this around the fourth session. The only difference was the expectation of the client. My reasoning at this point was that if ‘expectation’ could effectively reduce the number of sessions from ten to fi ve, why not use this idea to reduce effective change work to one or two sessions? So, I now tell all of my clients that I rarely see people more than once or twice, but I will see them for as many times as they fi nd seeing me helpful. I should also add that I am retired with a good pension, and that there is thus no economic incentive for me to prolong therapy. I work for myself on a cash only basis (no insurance accepted). And, my sessions are always open-ended with no given time limit. Does this work? I, indeed, see most of my clients for one session. Although encouraged to keep in touch, I generally get feedback erratically, and up to years later. If you are into instant gratifi cation, do not do work in this manner. I do get referrals from former clients – sometimes years later!