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Brief Intervention Strategies

A central concept in brief counseling is that there should be one major focus for the counseling rather than the more traditional psychoanalytic practice of allowing the client to associate freely and discuss unconnected issues (Malan, 1976). In brief counseling, the central focus is developed during the initial evaluation process, occurring during the first session or two. This focus must be agreed on by the client and counselor. The primary goal of brief psychoanalysis is to estimate what may have happened in the past that created a current issue. The counselor can also use confrontation to bringing an aspect of functioning, usually a defense, to the client's attention. The counselor then uses a variety of interpretation methods, such as dynamic interpretation, resistance interpretation, transference interpretation, or dream interpretation.

Several different approaches to brief psychoanalytic practice have evolved from traditional psychoanalytic theory and have been clinically applied to a wide range of psychological disorders, and a growing body of research supports the efficacy of these approaches (Messer & Warren, 1995). This is important for costs of future health care; cost-effective treatments are those that stimulate permanent and enduring change. The three fundamental cornerstones of brief psychoanalysis, including time limit, therapeutic focus, and the counselor's activity, may be adapted to the client and used to reflect and intensify dynamic aspects of the treatment's focus.

The central focus singles out the most important issues and thus creates a structure and identifies a goal for the treatment. In brief counseling, the counselor is expected to be fairly active in keeping the session focused on the main issue. Having a clear focus makes it possible to do interpretive work in a relatively short time because the counselor only addresses the circumscribed problem area. When using a brief psychoanalytic approach, the counselor has an orientation toward the future, but both client and counselor remain focused on the present with the goal to reduce anxiety and frame positive goals for the future (Macdonald, 2007).

The number of sessions varies from one approach to another, but brief psychodynamic counseling is typically considered to be no more than 25 sessions (Bauer & Kobos, 1987). Crits-Christoph and Barber (1991) included models allowing up to 40 sessions in their review of short-term dynamic psychotherapies because of the divergence in the scope of treatment and the types of goals addressed. For example, some brief psychodynamic models focus mainly on symptom reduction (Horowitz, 1988), whereas others target the resolution of the Oedipal conflict (McCullough et al., 1991). The length of counseling is usually related to the ambitiousness of the counseling goals. Most counselors are flexible in terms of the number of sessions they recommend for clinical practice. Often the number of sessions depends on a client's characteristics, goals, and the issues deemed central by the counselor.

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