Time-limited Therapy Research Articles

The death instinct: A psychological killer

SUMMARY This paper considers the impact that a once-a-week therapy had on a patient with a borderline-narcissistic type of personality organisation. The patient described, a 50-year-old woman, came to treatment following a depressive breakdown. The three-year period of psychotherapy seemed only to have made her de-compensate even further; her defensive organisation continued to weaken. Yet, with the announcement of the end of treatment, a recovery started to occur. The theory of the life and death instincts, from its conceptualisation and development by Freud, through its later evolution, is used as a conceptual framework to understand the powerful struggle within this individual between those forces pulling towards growth and development, and those pulling towards destructiveness and deterioration. The case is discussed not only with this theory in mind, but in the context of personality structure and of what happens when a patient's defensive organisation is diminished through therapy. The ‘pros and cons’ of psychotherapy are considered, with special attention being paid to its implications for time-limited therapy within the NHS.

Transference, insight, and the course of time-limited therapy.

This study examined (a) the interactive role of therapist-rated transference and insight (in first session and first quarter of treatment) in predicting the outcome of time-limited therapy and (b) the course of therapist-rated transference and insight in more and less successful cases. The sample consisted of 33 completed cases. Although neither transference nor insight alone predicted outcome, the interaction of transference and emotional insight was significantly related to both client- and therapist-rated outcome. The course of negative transference and overall amount of transference differentiated more successful from less successful cases. In more successful cases, transference increased during the first three quarters of treatment and then declined, whereas in less successful cases, transference continued to increase throughout treatment.

The efficacy of activity group therapy in a residential treatment center

Time limited Activity Group Therapy (14 sessions) was conducted for children and adolescents in an inpatient setting by a graduate class taking Family and Group Psychotherapy Methods. The professor of the course was present at each session to supervise and act as facilitator and therapist when necessary. Mental Health Workers (MHWs) from the facility were also present and incorporated into the sessions. The description of the group sessions including the types of activities, group structure, and leadership approaches are presented. The outcome data suggest that patients derived considerable therapeutic benefit and demonstrated improved psychosocial functioning as a result of their group experiences. The training and educational benefits garnered by both the graduate students and the MHWs as a result of the partnership between the treatment facility and the university are discussed.

Changes in reactive depression and sense of self in a time-limited psychodynamic therapy

Attention to the self can take place even within the context of a brief or time-limited psychodynamically oriented therapy. The case presented here demonstrates how one can, and why one should, treat the whole person and not solely the symptoms of depression following a significant loss. The aspect of the client's sense of self that was most prominent was her need to depend excessively on her boyfriend rather than being more autonomous within a mature give-and-take relationship. She was treated in a 12-session time-limited therapy developed by James Mann that deals with the human inevitability of experiencing significant interpersonal separations and losses. In line with this model, the therapy focused on the client's chronically endured emotional pain, employing an empathic, exploratory, and interpretive style. The termination stage of therapy allowed the client to reexperience feelings of loss and separation with the opportunity to come to terms with them in a new, more constructive way. © 1997 John Wiley & Sons, Inc.

Treatment length and termination contracts in dynamic psychotherapy: A comparison of findings from two independent studies of brief dynamic psychotherapy

The associations between use of specific techniques and treatment outcome were very similar in two independent studies of brief dynamic psychotherapy in Edmonton. Canada, and Oslo. However, the associations between treatment length and outcome were the opposite in the two studies. The Edmonton study used a fixed time limit, while the Oslo study used open-ended treatment, which may have contributed to the difference. Patients with a high quality of object relations (QOR) were able to make optimal use of the expected treatment length in both time-limited and formally open-ended brief therapy, with regard to treatment-specific changes found at follow-up. In contrast, low QOR patients tended to do relatively better with fewer sessions than 20 in time-limited therapy (Edmonton) but more than 35–40 sessions in formally open-ended therapy (Oslo). These findings elucidate the complex interaction among patient characteristics, treatment length, type of outcome, and contractual factors in psychotherapy.

Options for brief psychotherapy: Cognitive and psychodynamic variations

Short-term psychotherapy options from psychodynamic and cognitive orientations are sampled, reviewed and summarized in order to help practitioners make informed choices in theory, technique and practice. Doing brief therapy can be risky with out an appreciation of: 1) the decisions that must be made at each phase of treatment, 2) the attendant fiscal and ethical pressures which push for shorter treatment and 3) the variety of empirically validated options. A grasp of developmental issues also helps predict and apply manageable goals, technique and scope of individualised treatment. Psychotherapists doing effective brief psychotherapy must understand the qualities common to all forms of effective treatment so that nothing essential is left out. Comparison of the common and contrasting needs and pressures in doing time-limited therapy in the United Kingdom and United States are also addressed.

Transference, insight, and the course of time-limited therapy.

Transference, insight, and the course of time-limited therapy.

Changes in reactive depression and sense of self in a time‐limited psychodynamic therapy

Attention to the self can take place even within the context of a brief or time-limited psychodynamically oriented therapy. The case presented here demonstrates how one can, and why one should, treat the whole person and not solely the symptoms of depression following a significant loss. The aspect of the client's sense of self that was most prominent was her need to depend excessively on her boyfriend rather than being more autonomous within a mature give-and-take relationship. She was treated in a 12-session time-limited therapy developed by James Mann that deals with the human inevitability of experiencing significant interpersonal separations and losses. In line with this model, the therapy focused on the client's chronically endured emotional pain, employing an empathic, exploratory, and interpretive style. The termination stage of therapy allowed the client to reexperience feelings of loss and separation with the opportunity to come to terms with them in a new, more constructive way. © 1997 John Wiley & Sons, Inc.

Time-limited brief therapy has gone too far: The result is invisible rationing.

Time-limited brief therapy has gone too far: The result is invisible rationing.

Therapists' Attitudes Toward Short-Term Therapy

ABSTRACT In order to evaluate the impact of training on attitudes and values regarding time-limited therapy, an attitudes instrument (The Beliefs and Attitudes Towards Therapy Questionnaire (BAT-Q)) was administered to 167 experienced therapists before and following workshops on brief therapy techniques. Data analysis of the results of the pre- and post-training administrations indicated that, following training, clinicians were typically more positively disposed towards time-limited therapy. The most significant changes occurred in attitudes regarding the purpose of psychotherapy in general and the value of brief techniques in the treatment of serious long standing psychopathology. Such attitude and value changes are critical in helping therapists make the transition from time-unlimited to time-limited interventions.

Time-limited brief therapy has gone too far: The result is invisible rationing.

Time-limited brief therapy has gone too far: The result is invisible rationing.

Teaching Interpersonal Psychotherapy to Psychiatric Residents

Time-limited therapies are increasingly important components of clinical practice. The author describes his experience in teaching interpersonal psychotherapy and brief psychotherapy generally to PGY-3 psychiatric residents in two residency programs. Although residents lack psychotherapeutic experience, they appear to compensate f or needed security in the therapeutic role with enthusiasm and vigor, and to adjust relatively easily to the demands of conducting an active, time-limited approach. Videotaping sessions and having appropriately trained supervisors are important factors for program success.

Cognitive-Behavioral Group Psychotherapy for Agoraphobia and Panic Disorder

Agoraphobia is a complex disorder characterized by substantial personal, social, and occupational disability. This paper presents a cognitive-behavioral model of group psychotherapy for agoraphobia treatment wherein group members are taught active coping skills to reduce anxiety and behavioral avoidance. Therapy occurs in the context of a supportive group, which aids in reducing the social isolation and alienation attendant on this severe anxiety disorder. The model of treatment is amenable to both time-limited and open-ended group therapy formats.

Time Limited Therapy and the Elision of an Epistemology of Wondering

The debate about the “place” of time limited therapy in our work as therapists regularly falls into a discussion about theory and evidence of usefulness. Often overlooked are the philosophical assumptions that underlie and fuel this debate. I seek to articulate several of these assumptions, ones pertaining to the know-ability of truth, the place of authority, and the agency of change. I propose that we not “elide” an epistemology of wondering.

Developing and marketing time-limited therapy groups.

Developing and marketing time-limited therapy groups.

A model of time-limited group therapy for men: Its use with recovering addicts

An array of men's issues from a newly emerging paradigm is reviewed—problems such as the dysfunctional development of masculine identity, “fatherlessness,” and gender role strain. The effects of social and psychological pressures on men are documented, and the need for gender-specific treatment is advocated. A brief evaluation of other group approaches to therapy for men is offered. An argument is made in favor of a more directive model of treating men in group for gender issues. The phases, components, and techniques of a new model of therapy for men are described in detail. The model focuses on the treatment of four primary emotions—grief, anger, fear, and shame—the socialization of which have caused great harm to men.

The Impact of the Termination of Brief Psychotherapy, and its Implications for Counselling Practice

As a clinical psychology trainee, the ending of my last placement signalled the contractual ending of therapy for many of the clients I had been working with. For some, this phase of treatment appeared to be a non-traumatic, anticipated event. For others however, termination proved to prompt strong feelings of grief, anger and disappointment These reactions highlighted for me the significance of the termination phase in time-limited therapy. The critical issue seemed to be how and when to say goodbye, so that the parting would be constructive and none of the earlier positive gains lost.This paper sets out to address this issue. Clients’ affective reactions to the termination of brief psychotherapy shall be reviewed. Implications of these findings for practice and further research will then be examined. It is not within the scope of this review, however, to include therapists’ affective reactions to endings nor to evaluate the literature on forced or premature termination.

Time-limited therapy in university counseling centers: Do time-limited and time-unlimited centers differ?

Time-limited therapy in university counseling centers: Do time-limited and time-unlimited centers differ?

Time-limited therapy in university counseling centers: Do time-limited and time-unlimited centers differ?

Time-limited therapy in university counseling centers: Do time-limited and time-unlimited centers differ?

Interpersonal perception in group therapy: a social relations analysis.

Although group therapists have emphasized the importance of interpersonal perception and feedback during therapy, there has been little systematic research on how group members form impressions of one another. D.J. Kiesler's (1983) interpersonal circle provides a framework for studying interpersonal perception and relations. Twenty-seven women and 18 men from 9 time-limited therapy groups reported their impressions of their fellow group members using the Impact Message Inventory, and they also completed 2 self-report scales. A social relations analysis of this data indicated that Subjects' perceptions included both assimilation and consensus. There was also a relationship between how Subjects saw themselves before therapy and how they were seen by other group members. The results demonstrated the utility of the social relations model for group therapy research and provided modest support for Kiesler's interpersonal circle.