The time-focused commitment: Using time as a tool
This cautionary and somewhat inflexible pronouncement could be used by less confident practitioners as a justification for not using a time-conscious approach in their work. It is probably correct that some experience of long-term psychological therapy, whether as client or practitioner, can contribute to a practitioner’s ability to discern focal themes and decide upon the possible stage of personal development reached by a client. Nevertheless, many less experienced practitioners work in settings where time for psychological therapy is necessarily limited by a variety of factors. In this chapter, encouragement is given to all practitioners and their clients to enter optimistically into a therapeutic engagement where advantage is taken of this very limitation. The time-focused commitment is described, in Chapter 2, as the optimum option for many clients. This blunt opinion is not shared by the majority of psychotherapists and counsellors at this time, in spite of continuing evidence as to the powerful effect of the first ten to twenty sessions of psychological therapy. The power of this ‘dose effect’ (Howard et al. 1986; Kopta et al. 1992) is most likely to influence the practice of cognitive-behavioural therapists, respectful of the growing body of research underpinning short-term approaches to psychological therapy. Nevertheless, the most rigorous theoretical argument for a twelve-session therapeutic engagement is made by Mann, a psychoanalytical practitioner, who has also been described as a ‘decided existentialist’ (Peake, Borduin and Archer 1988:43). He argues that consciousness of time is a major influence upon all forms of psychological
distress and provides the pivotal issue upon which effective psychotherapeutic engagement is dependent. His work, and the less specific application of time limits explored by Alexander and French (1946), has informed the manner in which the time-focused commitment is outlined below.