Cure me - and make it snappy

Can brief therapy do what it says - solve your problems in five sessions or fewer? Markie Robson-Scott wonders
Click to follow
The Independent Culture
Therapy - who needs it? The 72 adults in every 1,000 who experience "mixed anxiety and depressive disorder". But can we afford those years on the analyst's couch? And does it matter if we can't?

Not according to Chris Iveson, who co-runs the Brief Therapy Centre, newlyopened in London's Maida Vale. In light, bare rooms, clients sit on chairs - not a couch in sight - and discuss goals rather than past misery.

For instance, Rob, aged 40, is in crisis about his career within a multi- national corporation: should he change his life altogether or apply for the vice-presidency? After a couple of sessions with Iveson he made a decision "to develop an interview technique that did him justice". He rehearsed it, went for the job - and got it.

Iveson glows: "We ask 'would you rather understand the problem or resolve it?' " He says often clients come for no more than three sessions, sometimes fewer. They are, at the moment, all private clients, paying pounds 50 a go; but Iveson and his colleagues Evan George and Harvey Ratner hope that NHS referrals will come. The trio worked for many years at the NHS Marlborough Family Service in St John's Wood and also teach at the Institute of Family Therapy.

This "solution-oriented brief therapy" has its roots in Steve de Shazer's work at his centre in Milwaukee. Instead of looking at the past, the therapist asks "customers" to think of instances when they're unaware of their problem and things are going smoothly, and to build on those positive times.

"You become a detective, searching for your past successes," says Michele Weiner-Davis, an American de Shazerite and author of Fire Your Shrink. "Most people have the solutions within; often they begin to resolve problems after phoning to make the first appointment."

It sounds a radical ideology, but actually the Get Fixed Quick approach may be just a response to market forces. In the US, most medical insurance companies only cover limited therapies. The NHS, naturally, favours short-term therapy and has embraced research done by Michael Barkham of the Medical Research Council, which shows that two sessions, followed three months later by one follow-up, are very effective for one in three people.

Weiner-Davis claims people are disillusioned with the Freudian approach. She was trained, as a psycho-dynamic therapist, to believe that unearthing the past would help people to gain insight. Yet Weiner-Davis found clients saying, "I understand but I still don't know what to do". If we ask ourselves the right questions, she says, we can find answers.

Superficial? The Jungian analyst Andrew Samuels says yes. Yet he acknowledges that "It's been accepted that the longer analysis continues, the deeper it goes and people are beginning to question this. But to ignore what we know about the ultimate value to individuals of exploring their misery, is to throw away 100 years of hard-won knowledge." It can be a challenge to look inward; but it needn't feel like 100 years, people are taking up all sorts of counselling and therapy - and they can, of course, set their own time limits.

Iveson claims: "We see people making enormous changes; they haven't just sat and agonised. Four out of five find the problem significantly improved." The two basic elements, he says, are discovering your goals and then finding out what you've already done to achieve them. This applies to any problem, even something as apparently deep-rooted as eating disorder.

Lucy, one of his customers, had nearly died twice through self starvation: this time she was eating nothing solid, was vomiting, and taking laxatives every day. "Feeling empty made me feel better," she says. Lucy had been anorexic, off and on, since the age of 12, but within two sessions she was eating normally. "She had many ways of controlling her vomiting," says Iveson, "but she saw them as proof of the problem rather than evidence of her own strength."

Those in favour of long-term analysis find such a claim alarming. It is widely thought that anorexia and bulimia need long-term work. "When a therapist makes such clear-cut optimistic statements," says Samuels, "I ask for a great deal of careful research to be done. The risk of disappointing people already in distress is very great."

Then, of course, one who appears to be cured may be anything but. Another analytic psychotherapist has been seeing a patient who was bulimic and psychotic for nine years. The bulimia went after six years; she married and the therapist thought she was near the end of treatment - but she had a breakdown after her second child and has just finished another three years of therapy.

Still, Iveson insists that brief therapy has been proved "on the street", that it works for addicts and victims of child abuse as well as for the high-flyer seeking promotion. "Analysts aren't dishonest," says Iveson. "But long-term therapy does pay more than brief - and it's the long-term therapists who are our most vociferous critics."

However, Anthony Ryle, honorary consultant psychotherapist at Guy's Hospital who has developed his own system of 12 to 24 sessions of cognitive analytic therapy, insists that "no brief therapy is suitable for schizophrenics and substance abusers".

And some do prefer the in-depth, longer-term approach. Perhaps the psyche is not a thing to be hurried. Janet, an artist, wants a therapist "who'll stay over a long period and explore my pain.. Brief therapy is like a pill, making everything fine and happy. The therapist doesn't have to enter into a patient's conflicts."

Equally people have anxieties about the demands of analysis - financially and emotionally. "What happens to us has an impact," says Judy Schaeffer of the Brief Therapy Center, Milwaukee. "But rehearsing past events may not make them disappear. Old memories will come to haunt ... but they'll be haunting stronger people."

Brief Therapy Centre, 4d Warwick Court, Shirland Mews, London W9 (0181- 968 0070 and 0181-883 6848).