By Jeffrey L. Binder Phd
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Additional info for Key Competencies in Brief Dynamic Psychotherapy: Clinical Practice Beyond the Manual
132). An extension of this position is that assessment should be a high priority right from the beginning of any treatment, regardless of the anticipated length. An important component of assessment is the process of understanding the patient in order to guide and focus the type and content of interventions. Attention to Termination Issues and Effective Management of the Process It is commonly assumed that a distinguishing factor of time-limited therapies is the interpersonally tricky negotiation of the termination phase.
It is equally clear that managed care companies that put yearly reimbursement limits on less than 50 treatment sessions are adversely affecting a substantial proportion of patients. In particular, when arbitrary limits are placed on the duration of treatment, the most likely adverse effects will be an insufficient treatment of personality patterns (affecting general as well as interpersonal functioning). Therefore, although symptom reduction may be achieved, the person may remain vulnerable to recurrence of symptoms produced by continued malfunctioning or, at least, continued malfunctioning, with the detrimental effects it has on self, others, and society.
It should be kept in mind that the dose–effect data represent aggregate results reflecting the hypothetically average therapist. It is conceivable that the more skillfully you conduct therapy, the more efficient you can be. Whereas developing skill is a broad, ambitious goal, there is some empirical support for a specific, tangible way to improve therapeutic efficiency and effectiveness. Therapists who solicit feedback from their patients about the patients’ responses to treatment sessions can potentially enhance outcomes and, at least, improve efficiency by reducing treatment failures or dropouts, particularly with difficult patients.