The Emerging Benefits of Short-Term Therapy
Not everyone needs months of talking to improve their mental health
What if you could get the benefits of ongoing, month- or yearlong therapy in less time — maybe even in just one session?
While there’s no formal definition, “short-term therapy” typically refers to treatments consisting of no more than 12 sessions, explains Ryan Howes, PhD, a clinical psychologist in Pasadena, California. “The idea with longer-term therapies is that it’s a good thing for people to come to revelations on their own through self-exploration and discovery. But some people find it refreshing to have a therapist say, ‘This is what you’re doing, this is why you’re doing that, and here’s how to get out of it.’”
These brief treatments appear to be beneficial for certain people and diagnoses, and most experts say they’re worth a try.
One of the newest and most extreme forms of short-term therapy consists of a single-session intervention (SSI). Jessica Schleider, PhD, director of the Lab for Scalable Mental Health and an assistant professor of clinical psychology at Stony Brook University, studies SSI with teenagers. The participants follow 30- to 45-minute online modules that teach them a new skill or way of thinking, such as increasing hope, boosting independent decision-making skills, or improving perceived control over their emotions
So far, Schleider and her co-authors have found that these web-based sessions delivered in a lab or in high schools help decrease depression and anxiety. What’s more, in a meta-analysis published in the Journal of the American Academy of Child and Adolescent Psychiatry in 2017, Schleider and study co-author John Weisz, PhD, a psychology professor at Harvard, looked at 50 randomized trials of single-session interventions and compared the results of these studies to results of full-length youth psychotherapy.
“The effect [of single-session interventions] on teens’ mental health was not all that different from the effect of 16 sessions,” Schleider says. “This is great because it means we can do something — a well-targeted, brief intervention can have a real impact on their symptoms.”
For people who prefer meeting a therapist IRL but for only a handful of sessions, there’s intensive short-term dynamic psychotherapy (ISTDP). This type of therapy is laser-focused on the goal of resolving a disorder, such as anxiety or depression. “You won’t talk about your week, the hopes and dreams you had as a kid, or why you are blocked from crying. And if you get off-topic, your therapist will bring you right back to it,” Howes explains. The therapist in these sessions may seem confrontational, he adds. “Every time you resist or rationalize or intellectualize, they will point it out and say, ‘Why are you not going to your emotions?’”
This may not be everyone’s cup of tea. But for those who are motivated, research suggests that four sessions of ISTDP may help treat generalized anxiety disorder, and four to five hour-long ISTDP sessions may help those with bipolar disorder. And the effects for both appear to last at least four years.
Another goal-oriented treatment that’s less intense but still short-term is solution-focused brief therapy (SFBT). Used most often for behavioral, relationship, and family problems rather than psychiatric disorders, the thinking behind SFBT is that the person knows what they need to do in order to change — but they need help realizing that, as well as making a concrete plan to reach their goals.
“You won’t talk about your week, the hopes and dreams you had as a kid, or why you are blocked from crying. And if you get off-topic, your therapist will bring you right back to it.”
During sessions, the therapist asks questions to unearth ways the patient successfully handled problems in the past. Then they figure out how to use that past success to work toward the current goal. Research suggests SFBT may be helpful for improving behavior problems in children, helping mothers with depression, and treating substance abuse.
While these brief interventions may work for some, they may not be best for everyone and every condition.
“Short-term therapies appear to work better for patients with lesser psychiatric complexity,” says Olavi Lindfors, PhD, a psychology professor at the University of Helsinki and development manager at Finland’s National Institute for Health and Welfare. “Many patients seem to need to work through their personality-related and interpersonal problems to better understand them and to find new ways to deal with emotional distress. Short-term treatments are not sufficiently lengthy and intensive to address these things.”
“You can miss a lot,” Howes says. “When you work with someone long-term [and in person], they come in talking about one problem, such as drinking. So we focus on that, and we may realize their drinking is really about their underlying depression.” Over time, a therapist may unearth several issues that you would not uncover in just one session — and that may crop up again in the future if they’re not addressed.
Particularly when someone has problems related to relationships, Howes says long-term therapy has advantages. “It’s good to build a relationship with the therapist, and that relationship becomes part of the healing process. Therapy becomes a laboratory where you can work on skills, such as being assertive, and then apply those to your everyday life,” he explains.
On the other hand, if someone is highly motivated to change, fewer therapy sessions may be all they need, Lindfors has found. “One benefit to short-term formats is the ‘I’m here to work!’ mindset it can engender in the client,” explains Tori Olds, PhD, a licensed psychologist at Deep Eddy Psychotherapy in Austin, Texas. “When a client knows they will be in therapy for years, it is easy to use therapy as a venting session without much focus on what their goals are. But when the therapist and client know their time is limited, they may be more likely to jump right into the meat of it and be deeply focused on the goal.”
Research by the Helsinki Psychotherapy Study scientists supports this. “A relatively active, extroverted, and engaged style of working in short-term therapy seems to benefit patients, while in long-term therapies, a more cautious and nonintrusive style of the therapist is more beneficial,” Lindfors says.
Age may also be a factor, which is one reason Schleider’s single-session interventions target teens. “Over half of all lifetime mental health problems emerge by age 14,” she says. “If you can work with folks when their problems are emerging, their patterns are less ingrained, and the symptoms less long-lasting, change is easier to produce.”
At this point, mental health experts are not saying short-term approaches should replace traditional therapy. “Nothing we do is trying to say these brief interventions are superior or should be administered in lieu of other treatments out there,” Schleider explains. Ultimately, the experts agree, a diversity of treatments is needed to help more people get access to mental health. For some, short-term therapy may provide some improvement in their symptoms until they can access other therapies.
“There is nothing sacred about the weekly hour-long format with a therapist,” Olds says, “Healing and growth and psychoeducation should be accessible in as many formats as possible.”