The Ethical Challenges of Brief Therapy
Most people who come to outpatient psychotherapy are not interested in long-term treatment, psychoanalytic or otherwise, and at least half are able to profit from therapy in 10 sessions or less (Asay & Lambert, 1999; Lambert & Bergin, 1994). Of the remainder, approximately 15% to 30% are significantly more likely to benefit if therapy lasts more than 25 sessions (Asay & Lambert, 1999; Cummings & Cummings, 2000). Therefore, the first of many ethical challenges for psychotherapists is to competently differentiate between clients who may be helped by brief therapy and those for whom brief interventions are contraindicated. Once a reliable differential diagnosis is made, clinicians must also possess the necessary skills to administer therapies of varying lengths or have competent referral sources. To qualify as competent, brief therapy must rest on a foundation of education in the treatment modality and prior successful supervised experience. Too often, professionals trained in traditional therapies appear either to assume that this training is sufficient to allow them to use brief models effectively or to worry about incompetence in this modality without taking steps to remedy it. For example, Levenson and Davidovitz (2000) found that nearly all psychotherapists in their survey (89%) reported using time-limited interventions and that half of those offering such services had no formal brief therapy training at all. As one participant commented, “As a provider for a large health-maintenance organization I am required to do a lot of brief therapy. But I am ashamed to admit that I often don’t know what I am doing, because I have never had any training in it” (Levenson & Davidovitz, 2000, p. 335).
Because practicing beyond the limits of one’s competence is prohibited by the ethical standards (American Psychological Association [APA], 2002) and subject to discipline by licensing boards and because less skilled therapists who fail to maintain focus in sessions are more likely to produce negative outcomes (Lambert & Bergin, 1994), this deficit can be dangerous to client and therapist alike. Even if a therapist gains initial competence in brief interventions, continuing education in these models is essential as well because competence erodes quickly. According to Dubin (1972) and Jensen (1979), half of what a professional learns in graduate school is obsolete within 10 years of graduation.