Michael F. Hoyt

On time in brief therapy.

Time is of the essence in brief psychotherapy. The message, by definition, is brevity: Do it now, no time to waste, be efficient and parsimonious, seize the moment, be here now, get on with it. At core, brief therapy is defined more by an attitude than by the specific number of treatment sessions. The brief therapist operates with the belief and expectation that change can occur in the moment, that the patient has within himself or herself the power to be different or to remain the same (Goulding & Goulding, 1978, 1979). With skillful assistance, the patient will recognize his or her response-ability and thus move from being a victim to a creator of his or her psychological reality (Hoyt, 1977; Kaiser, 1965; Schafer, 1973).

The Challenge of Single-Session Therapies

The psychotherapeutic facilitation of “decisive moments of life,” such as that described above, is not necessarily a function of treatment duration. Even a single session of therapy can sometimes provide a pivotal moment, invoking the “magic force dwelling in beginnings” that guards us and helps us to live.

Two Cases of Brief Therapy in an HMO

More than 100 million Americans are now covered by HMOs and other forms of managed care such as IPAs, PPOs, EAPs, student health ser-vices, and armed forces psychiatric services (Austad & Berman, 1991; Bennett, 1988; Boaz, 1988; Feldman & Fitzpatrick, 1992; Goldman, 1988; Zimet, 1989).1 Although there are important differences within and between these different approaches to regulating the costs, utilization, and/or site of services, psychotherapy provision arrangements in man-aged health care settings all have as their ideal the principle of optimal use of time and resources. Brief therapy is the backbone of these approaches, the way to provide some services to many rather than many services to a privileged few. Therapists working within HMOs and other managed care settings know the challenge of our Sullivanian epigram through dally experience.

Mental-Imagery Methods in Short-Term Dynamic Psychotherapy

Short-term dynamic psychotherapy (STDP) involves the rapid identification and repeated interpretation of a patient’s focal dynamic conflict. Examples are given of how the mental imagery of patient and therapist can be used in each stage of STDP--selection, initial focusing, working through, termination, and post-therapy evaluation. Because of the potential power of imagery methods, it is emphasized that therapists use them within a coherent theoretical structure and that care be taken to help patients integrate experiences revealed through their mental imagery into their self-concept.

Conjoint Patient-Staff Interview in Hospital Case Management

The authors describe an innovative method for psychiatric consultation-liaison with hospital management cases in which, after separate preparatory interviews, the patient and nursing staff are seen together. This conjoint approach enables the consultant to observe directly, confront, and correct misperceptions and maladaptive transactions that interfere with the functioning of the health-care team.

Active Interventions in Brief Therapy and Control Mastery Theory

Control Mastery Theory (Engel & Ferguson, 1990; Weiss & Sampson, 1986) is a recent modification of more traditional psychoanalytic thinking. There are a number of technical and theoretical ways in which the Control Mastery model differs from classical Freudian thinking. Three important features of the Control Mastery model are particularly relevant to this case. First is the idea that people do not just act in their own self-interest but often act in ways that are prosocial and altruistic, some-times doing harm to themselves, in an attempt to deal with guilt over what Engel and Ferguson (1990) called “imaginary crimes.” Second is the idea that patients have an unconscious “plan” regarding what they need to grow and deal with their problems. Therapeutic interventions will be useful if they are “proplan” and will be ineffective or even counterproductive if they run counter to the patient’s plan. Third is the idea of “passing the test,” the notion that patients will create situations in therapy to see if the therapist will retraumatize them or will instead provide a safe and salutary response different from that which they experienced earlier in their lives.