Coping.org:
Tools for Coping
with Life's
Stressors
|
|
|
|
|
|
Search WWW Search www.coping.org |
1.
Theoretical Basis
The
Eclectic Structural Brief Therapy (ESBT) Model of therapy is based on the Model
of Recovery from Low Self-Esteem (Messina, 1999-2001) which details:
A
recovery plan for adults to follow to overcome their low self-esteem
A
detailed explanation of the personality traits of low self-esteem which
are involve the cognitive, emotional and behavioral consequences of
experience low self-esteem
Ways
to overcome the introjected scripts which induce low self-esteem
Therapeutic
model of establishing and maintaining healthy boundaries in interpersonal
relationships
2.
Length of Session
ESBT
is based on a flexible length of time. Their model does not rigidly adhere to
the traditional 50-minute hour. Some therapists might utilize 15, 30, 45 or 60
minutes per session and then others might utilize whole day sessions with a
family or group of clients to achieve the desired therapeutic goal. The length
of time for each session is determined by the needs of the clients.
3.
Frequency and Regularity of Sessions
Scheduling
of sessions is flexible for better use of resources. The traditional weekly
session, which was thought to help reduce resistance, is not needed in the ESBT
model. Sessions might be daily, once or twice a month, or at longer intervals
depending on the needs of the clients. In between sessions the clients would be
encouraged to maintain contact with the therapist by use of email in which
homework and reading assignments would be discussed. Also any problems which
come up which the clients would like a third person perspective can be shared
through such emails. There is no standard or predictable regularity and
frequency of sessions in the ESBT model.
4.
Duration of Treatment
Treatment
length is flexible based on the needs of the clients. Some clients can be seen
for just one session. Others might need up to 12 or more sessions within a year.
The traditional length of treatment of from 1 to 3 years might be the same in
this model but the number of sessions is not as important as the work being done
by the clients to achieve the goals set out in therapy. In the ESBT model
sessions could be scheduled at an as needed basis over many years and a longer
time span because of the nature of the structured tasks which the clients takes
on as part of the clients’ therapeutic plan.
5.
Location of Therapy
ESBT
clinical sessions are located where the clients can gain the most benefit. This
could be in the office, the clients’ home, the hospital, a church, an agency,
by email, on the phone, or in a therapeutic setting for desensitization purposes
e.g. mall, airport, automobile, elevator, or airplane.
6.
Initiation of Therapy
In
the ESBT model clients are immediately engaged in taking responsibility for
their own progress. This is done by clarifying immediately what brings the
clients into treatment at this time by asking clients: “Why now?” questions
to clarify the focus for the treatment, which is most responsive to their needs.
This model emphasizes Nicholas Cummings’ (1988) caveat that a strong
therapeutic alliance between the therapist and client must be established during
the first contact to offer the client a sense of hope that relief from suffering
is possible. As Cummings (pp. 312-313) explains: “In making a therapeutic
contract with the client, we want to make clear that we are there to serve as a
catalyst, but the client is the one who will do the growing. The contract is
stated as follows: ‘I will never abandon you as long as you need me, and I
will never ask you to do something until you are ready. In return for this, I
ask you to join me in a partnership to make me obsolete as soon as
possible.’”
7.
Termination of Therapy
In
the ESBT model the concept of termination is redefined as an interruption. The
therapist informs the clients that further treatment is always available through
the clients’ life cycle on an as needed, and usually intermittent, basis. In a
traditional therapy model, therapy is concluded with the clients being viewed as
a “completed product” never to return. In contrast, the clients in the ESBT
model are introduced to the concept of “relapse” and are made aware that
there are transitional times in people’s life, which might induce relapse. At
those times the clients are encouraged to return for treatment to get “back on
track” as soon as possible.
8.
Goals of Therapy
The
goal of ESBT model treatment is to assist clients to achieve greater insight and
understanding on how they are contributing to their current problems by their
own thoughts, emotions and actions. The intervention of the therapist might
assist the clients to experience an emotional release of painful emotions,
reinforcement of healthy coping skills, desensitization of fear-inducing
stimuli, or confrontation and altering of personal problem behaviors.
9.
Therapeutic Process
The
ESBT model is a flexible therapeutic process based on a theoretical integration
of a number of therapeutic models and perspectives:
Limited
and collaboratively set realistic goals similar to Reality Therapy (Glasser
1965 & 2000)
Collaborative
relationship between therapist and clients similar to Person Centered
Therapy (Rogers, 1961)
Rapid
and early assessment done by therapist utilizing techniques from Systemic
Family Therapy (Bowen, 1978; Haley, 1985; Minuchin & Fishman, 1981;
Satir, 1983; Whitaker, 1976)
Focused
interventions similar to the Multi-model Behavioral Therapy (Lazarus, 1995)
Staying
centered in the “here and now” with the clients similar to
Existentialist Therapy (May & Yalom, 1995)
Directed
activity accomplished by the clients similar to Cognitive Therapy (Beck,
1976; Ellis & MacLaren, 1998;
Meichenbaum, 1997)
Ventilation
of emotions similar to the Gestalt Therapy (Perls, 1969)
Teaching
how to identify and refute irrational thinking similar to Rational Emotive
Behavior Therapy (REBT) (Ellis & Harper, 1997; Ellis & MacLaren,
1998)
Identifying,
challenging and confronting psychological defenses similar to Psychodynamic
Therapy (Freud, 1955)
Encouraging
personal responsibility taking and accepting the social consequences for
one’s actions similar to Adlerian Therapy (Adler, 1930, 1931, 1938)
Creative
and efficient use of time
Selection
process by which suitable clients who are “light bulbs ready to be turned
on” are enrolled in this treatment model (Budman & Gurman, 1988)
There is now a vast literature on brief psychotherapy.
Leaders in brief therapy include: Bennett (1983, 1986); Budman (1988); Cummings
(1986, 1988); de Shazer (1982, 1985, 1988); Haley (1985); the MRI Group of
Weakland, Fisch, Segal, and Watzlawick (1974, 1978, 1982); Strupp & Binder
(1984); Talom, (1990); and Wells (1990). Reviews of the research (Bloom, 1992;
Rosenbaum, Hoyt & Talmon, 1990; Hoyt, 1995; Rosenbaum, 1994) repeatedly have
found brief therapy as effective as time-unlimited traditional therapies,
regardless of diagnosis or duration of treatment.
Eclectic Structural Brief Therapy ESBT is a form of Brief
Psychotherapy. Budman and Gurman (1988) pointed out that contrary to the
romanticized beliefs about "long term" therapy, and the negative views
of brief therapy that exist among many psychotherapists that there is very
little research on the efficacy of long term therapy and hardly enough to
justify the claims of its advocates. They go on to state that the
efficaciousness of brief psychotherapy is based on outcome and process research.
They point out that many consumers of psychotherapy benefit substantially from
therapy experiences that last "only" between 2-5 months.
Budman
and Gurman (1988) emphasize what makes brief therapy effective, is that it is
pragmatic and eclectic. This comes from values of the brief therapists about
what therapy can and cannot accomplish. Brief therapists believe that therapy
results in the resolution of the current problem and not in the major
modification of character structure. The metaphor would be comparing the
building of a custom designed house from the ground up (long term therapy) or
the fixing of a leaking sink (brief therapy).
To
clarify the differences between long-term and short-term therapists, Budman and
Gurman (1988) compare the values of the two types of therapists:
A
Long-Term Therapist:
Seeks
change in basic character
Believes
that significant psychological change is unlikely in every day life.
Sees
presenting problems as reflecting more basic pathology.
Wants
to "be there" as clients make significant changes.
Sees
therapy as having a "timeless" quality and is clients and willing
to wait for change.
Unconsciously
recognizes the fiscal convenience of maintaining long-term clients.
Views
psychotherapy as almost always benign and useful.
Sees
clients being in therapy as the most important part of clients’ life.
A
Short-Term Therapist:
Prefers
pragmatism, parsimony and least radical intervention and does not believe in
notion of "cure."
Maintains
an adult developmental perspective from which significant psychological
change is viewed as inevitable.
Emphasizes
clients’ strengths and resources; presenting problems are taken seriously
(although not necessarily at face value).
Accepts
that many changes will occur "after therapy" and will not be
observable to the therapist.
Does
not accept the timelessness of some models of therapy.
Fiscal
issues often muted, either by the nature of the therapist's practices or by
the organizational structure for reimbursement.
Views
psychotherapy as being sometimes useful and sometimes harmful.
Sees
being in the world as more important than being in therapy.
|
|
The Tools for Coping
Coping.org
is a Public Service of James J. Messina, Ph.D. & Constance M. Messina, Ph.D.,
Email: