BRIEF TREATMENT

Brief Treatment from my view refers to therapy which is conducted in as time-effective manner as possible ranging from 1 to 20 sessions. The rapid rise of managed care not only makes utilization of brief treatment methods desirable, but necessary. As more and more providers of health care find their referrals increasingly limited by managed care companies, we are responding by attempting to adapt and adjust to the requirements of managed care.

"The Provider," a newsletter distributed to providers by MCC Behavioral Care, recently published "Eight Characteristics of Therapy under Managed Care," based on the work of Michael Hoyt and Carol Austad. The eight characteristics established by Hoyt and Austad were: (1) Specific problem solving; (2) Rapid response and early intervention; (3) Clear definition of patient and therapist responsibilities; (4) Time is used flexibly and creatively; (5) Interdisciplinary cooperation; (6) Multiple formats and modalities; (7) Intermittent treatment; and (8) A results orientation.

Clearly, such therapy is not always compatible with the traditional, open-ended psychotherapy that has so often been the treatment of choice. However, considering that the utilization of brief treatment methods is rapidly becoming a requirement of managed care, therapists are attempting in increasing numbers to respond to the demands this expanding trend involves. We make these adjustments for the most part in order to continue to serve our clients to the best of our abilities while also maintaining reimbursability by insurance companies. From my perspective, this is in some respects a time of reckoning (if we are able to put aside our indignation long enough to acknowledge the purpose of medical insurance in the first place)

Medical insurance was developed to assist subscribers in seeking treatment for illness, not subsidize explorations intended to facilitate growth or cover marital counseling. For a number of years that is exactly what insurance companies have found themselves doing all too often. Wide spread abuses of the system have contributed significantly to our current dilemma of our work policed by managed care.

Therapists being forced in some ways to develop skills in brief treatment can be viewed as a positive trend. Clients have a right to expect services to be performed in a time-effective and cost-effective manner just as do insurance companies. However, if we simply scramble to incorporate the slickest brief treatment methods available in order to get the job done as expediently as possible, we run the risk of offering, in many cases, little more than a quick and all too often temporary fix.

Holistic Treatment

Brief treatment expects much (as it should) from both the therapist and the client, and it is here that I believe holistic treatment emerges as a compatible ally. In addressing holistic treatment as it relates to psychotherapy, I would like to first examine how the advent of holistic treatment creates a shift in roles and relationships. Traditional healthcare (the allopathic approach) places responsibility for cure in the hands primarily of the caregiver. The holistic approach returns it to its rightful owner, the client. While the caregiver clearly must take an active role in the resolution of the problem presented, clients are not expected to passively accept the ministrations of the provider, but must themselves work diligently to restore well being. The central concept of the holistic approach, according to Richard Miles, (1978), is that the individual is responsible for the development and maintenance of his or her health and well being.

Miles contends that the holistic approach does not focus on problems or symptoms but rather on clarity of intention and the development and maintenance of well being and self-responsibility. In this context, problems may be viewed as important feedback messages to be dealt with on a conscious level as part of the life process. A basic definition according to Miles, of the holistic practitioner, is one who provides the client with clear information about the processes of body, mind and spirit. The client can then choose to follow with the provider's assistance, a course of action that will offer more productive and healthy life experiences. In choosing a particular course of action, the client assumes ownership and thus places responsibility where it must reside--within the individual.

In accepting the holistic model, one acknowledges that everything effects our health and well being. All aspects of ourselves including, physical, emotional, cognitive, spiritual and environmental, play a role in the quality of our lives. This first premise is easily accepted; however, when one moves on to its implication that we must attend to all of these elements, the challenge is then presented. Placing our lives in the hands of experts to render solutions can seem far less daunting then the work involved in prevention and self-care. For example, it seems simpler to follow the latest fad diet to the letter than to address the wide range of issues connected to unwanted weight gain. Further, one is reinforced when the weight fades away with the use of such a diet. All too often, however, satisfaction eventually is followed by disillusionment later, when the pounds return or when some other difficulty moves in to take their place.

Our practices are filled with individuals who ask us in one form or another to take their pain away. We would gladly oblige and often try. We even succeed from time to time. The bottom line, however, as we all know, is that if our efforts are to be sustainable over the long haul, our clients must learn what is required of them to meet their own needs. They must also possess the motivation to act upon this knowledge. In spite of impressive techniques, modalities, and theories, there is no one magic bullet--no one particular insight, behavior, drug, or technique that results in lasting wellness. First of all, the very nature of life prevents this; we are always confronted with change and new challenges. Second, as stated earlier, and in line with systems theorists, we are all made up of parts intermingling with other parts comprising various systems that continually impact and are impacted by our environment. Like the Mobile that John Bradshaw strikes during his presentation aired by PBS on the family, when one of our components shift, the others are also effected and respond. An argument here might be made that if we then simply impact one element of the system, then the others may also automatically benefit. While this is a distinct possibility, it also implies that while we might fix a system or person by adjusting one facet or problem, the entire system remains highly vulnerable to a break down in another part of the system. There is no avoiding this reality that we are all highly vulnerable, and while I welcome information to the contrary, I must operate within the context of this truth for now. Thus, in view of the fact that we are comprised of parts that make up our whole, with each segment being vulnerable to or positively impacted by the others, would it not then make sense to respond to the needs of all components to the best of our abilities?

Holistic treatment calls for the care of all aspects of a client; brief treatment requires that we offer services in as efficient, responsive, and timely manner as possible. Both of these requirements (at a glance) may not seem readily compatible, yet they still remain very clear obligations to me.

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