Eclect ic St ru ct ural

Brief Th er apy ( ESB T) a s

on www .cop in g.or g

James J. Messina, Ph.D.

C6436 Individual Counseling
Theories and Practices
A Therapy Truism
 How many therapists does it take to
change a light bulb?

 Just one, but the light bulb has to want

to be changed.
 Rationale for ESBT-Brief Model
 How do therapists motivate clients to overcome
their resistance
 Clients stay in treatment for from six to ten
sessions
 Clients report maximum gains after three to six
sessions
 Brief therapy models have been found to have no
significant difference in their effectiveness than
those of long term therapy models (Budman &
Gurman, 1988; Cummings, 1986; Budman &
Stone, 1983).
 Therapists who hold to a Brief
Therapy model
 Have values & beliefs about what can & cannot be
accomplished in therapy
 Believe effective therapy results in the resolution of current
problems & not in the major modification of personality or
character structure
 Believe their job is to fix leaks rather than build a custom
designed house form the ground up.
 Establish challenging but limited goals for treatment
 Work toward insight but also facilitate behavior change
 Believe their primary goal is to initiate a healing process that
can continue throughout the clients’ lives (Gelso & Johnson
1983)
 Why People Seek out Brief
Therapy
 Most people do not desire lengthy process to
uncover all subconscious and conscious drives
which affect their mental health.
 They seek out therapy because they are in some
form of crisis, which affects their mental well,
being
 They want to find coping strategies, which will
assist them to alleviate their currently
experienced pain
 Brief Therapy Helps Clients
 Identify whether or not they are “light bulbs”
wanting to be changed
 See if a match exists in their temperament and
personality styles with the therapists
 See if right mix of motivation and simpatico between
clients and therapist so change can occur in a brief
period of time
 If there is not a match, therapists need to
encourage them to not pursue therapy until a
readiness and willingness to do what it takes to
change so that they can become “turned on light
bulbs.”
 Literature on Brief Therapy
 Leaders in brief therapy include: Bennett (1983,
1986); Budman (1988); Cummings (1986, 1988);
de Shazer (1982, 1985, 1988); Haley (1985); the
MRI Group of Weakland, Fisch, Segal, and
Watzlawick (1974, 1978, 1982); Strupp & Binder
(1984); Talom, (1990); and Wells (1990).
 Reviews of the research (Bloom, 1992; Rosenbaum,
Hoyt & Talmon, 1990; Hoyt, 1995; Rosenbaum,
1994) repeatedly have found brief therapy as
effective as time-unlimited traditional therapies,
regardless of diagnosis or duration of treatment.
 I. Long-Term Therapists
 Seek change in basic character
 Believe that significant psychological change is
unlikely in every day life.
 See presenting problems as reflecting more
basic pathology.
 Want to "be there" as clients make significant
changes.
 II. Long-Term Therapists
1. See therapy as having a "timeless" quality &
works if clients are willing to wait for change.
2. Unconsciously recognize fiscal convenience of
maintaining long-term clients.
3. View psychotherapy as almost always benign
and useful.
4. See clients being in therapy as the most
important part of clients’ life
 I. Short Term Therapists

1. Prefer pragmatism, parsimony and least radical

intervention & do not believe in notion of "cure."
2. Maintain adult developmental perspective from
which significant psychological change is viewed
as inevitable.
3. Emphasize clients’ strengths and resources;
presenting problems are taken seriously
4. Accept many changes will occur "after therapy"
and will not be observable to the therapist.
 II. Short Term Therapists
1. Do not accept timelessness of some models
of therapy.
2. Fiscal issues often muted, either by the
nature of the therapist's practices or
structure for reimbursement.
3. View psychotherapy as being sometimes
useful and sometimes harmful.
4. See being in the world as more important
than being in therapy.
 I. Assumptions about Clients
in Brief Therapy Model
 The clients have experienced "faulty learning
at some point in early life.
 The clients and their/her environment interact
and influence each other reciprocally.
 The interpersonal environment of the clients
is never neutral. It influences the clients
positively or negatively.
 II. Assumptions about Clients
in Brief Therapy Model
 Although personality, character, social supports
etc. are all very important in people’s life
patterns, chance encounters and chance events
are also prominent factors in shaping life's
course.
 People understand experience, at least in part,
on the basis of their stage of development.
 There will be little to no therapy achieved until
the clients are ready to change.
 I. Critical Therapist Factors in
Brief Therapy- Therapist must:
 Maintain clear, specific focus & structure
 Maintain active therapeutic role by suggesting activities or
insights, collaborating and problem solving using tasks,
homework assignments, by asking questions
 Remain aware of the value of "time" in process,each
session be valued as vital to the desired outcomes.
 Make time between sessions spent in carrying on the
therapeutic process by homework assignments: readings,
journal writing, practice of new behaviors such as exercise,
joining self-help groups, public speaking, volunteering &
trying new interactional patterns in the family, marriage and
work or school setting if applicable.
 II. Critical Therapist Factors in
Brief Therapy - Therapist must:
 Try new strategies, do something different, novel to
motivate & challenged clients to deal with the presenting
problems successfully
 Be flexible, eclectic in a variety of treatment modalities for
individual, couple, family, group
 Use innovative session duration and re-scheduling
 See end of treatment as interrupting vs. terminating
encourage clients recognize therapy is a process over whole
life cycle and can return on an as needed basis.
 Be clear with the clients: relapse is a part of recovery to
return to therapy is not failure but good common sense.
 Recognize disincentives:bias of training programs, too many
therapists, financial survival need
 I. Clients factors in Brief
Therapy
 Common belief that 85% to 90% of all clients are
appropriate for brief therapy
 Koss and Shiang (1994) indicate that individuals who
appear to benefit most from brief therapy are:
 Whose problems had a sudden or acute onset
 Were previously reasonably well-adjusted
 Could relate well with others
 Had high initial motivation when entering the therapeutic process
 Brief therapy may be inappropriate for individuals whose
personal characteristics are in contrast to those noted
above & some types of psychological disturbances;
substance abuse, psychosis, and personality disorders.
 II. Clients factors in Brief
Therapy: Clients must:
 Have an average intellectual ability & capable of
understanding the issues involved able to read and write in
order to many of the assignments
 Be psychologically minded & open to psychologically oriented
insight, interpretations and suggestions
 Have some social support system in place where they can
turn for support & understanding during their time in the
therapeutic process.
 Be motivated for change: light bulbs that are ready.
 Have social orientation relate problems in social context
 Have clear present problem or principle complaint, which can
be identified in therapy.
 Have ability to collaborate with therapist in the process.
 III. Clients factors in Brief
Therapy: Clients must have:
 Have been able to have established at least one meaningful
relationship in their lives
 Have capacity for rapid emotional involvement & equally
rapid emotional separation.
 Have good ego strength.
 Have the ability to express feelings.
 have the expectation that therapy will be successful.
 Be excluded based on the belief that therapists do not try
to treat the untreatable
 Therapists think all therapy "trial therapy" for 3 sessions &
either: transfer inappropriate clients, use alternative or
adjunctive modality of treatment, or offer no treatment
Characteristics of Eclectic
Structural Brief Therapy (ESBT)
1. Theoretical Basis
2. Length of Session
3. Frequency and Regularity of Sessions
4. Duration of Treatment
5. Location of Therapy
6. Initiation of Therapy
7. Termination of Therapy
8. Goals of Therapy
9. Therapeutic Process
Impact of Low Self-Esteem
S o u rc e s o f L o w S e lf-E s te e m
d y s fu n c t io n a l e n v ir o n m e n t s , d is a s t e r o u s r e la t io n s h ip s , c o d e p e n d e n c y ,
p h y s ic a l a b u s e , e m o t io n a l & v e r b a l a b u s e , s e x u a l a b u s e , a d d ic t io n s ,
d is a b ilit y , p e r s o n a l fa ilu r e s , c h r o n ic illn e s s , n e g le c t , p u t d o w n s

T h in k in g d is to rte d F e e lin g s d is to rte d B e h a v io rs d is to re d

by d e n ie d , r e p r e s s e d , u n h e a lt h y , ir r e s p o n s ib le ,
ir r a t io n a l b e lie fs & e x a g g e ra te d o r c o m p u ls iv e , u n p r o d u c t iv e ,
o ld b e h a v io r a l s c r ip t s e x p lo s iv e fe e lin g s s e lf- d e s t r u c t iv e

LO W SELF ESTEEM

C o m p u ls iv e P e rs o n a lity T ra its
L o o k in g G o o d , A c t in g O u t , P u llin g I n ,
E n t e r t a in in g , E n a b le r , T r o u b le d P e r s o n ,
P e o p le P le a s e r , R e s c u e r , N o n fe e lin g

U n re s o lv e d L o s s Is s u e s U n r e s o lv e d A n g e r Is s u e s

S e lf-D e s tr u c tiv e B e h a v io r s P e r s o n a l A d ju s tm e n t P r o b le m s

C o n tr o l Is s u e s F a u lty C o m m u n ic a tio n s

In te r p e r s o n a l R e la tio n s h ip P r o b le m s
Healthy Adult Self-Esteem
N e c e s s a r y C o n d it io n s f o r G r o w t h

S e lf N u r t u r in g N u r t u r in g E n v ir o n m e n t N u r t u r in g R e la t io n s h ip
u n c o n d it io n a l s e lf lo v e & a c c e p t a n c e r e c o g n it io n & a c c e p t a n c e u n c o n d it io n a l lo v e & a c c e p t a n c e
a c c e p t s e lf a s u n iq u e d e fin e d & e n fo r c e d lim it s g o o d c o m m u n ic a t io n s
o p e n & h o n e s t in p e r s o n a l fe e lin g s r e s p e c t & fr e e d o m t o b e s e lf w a r m t h , c a r in g & lo v e o f o t h e r s

H e a lth y S e lf-E s te e m
S e lf-w o r th S e lf-D e s e r v e d n e s s

P r o d u c tiv e P e r s o n a lity P e r s o n a lly R e s p o n s ib le

C r e a tiv e P r o b le m S o lv e r A ltr u is m

L e a d e r s h ip H e a lth y C o p in g S k ills

H e a lth y S e lf-c o n c e p t O p tim is m

 Self-Esteem Recovery Model
S o u rc e s o f R e c o ve ry
I n d iv id u a l, c o u p le , fa m ily , g r o u p c o u n s e lin g , T r e a t m e n t
P e e r s u p p o r t , 1 2 S t e p P r o g r a m s , B u d d ie s a t S E A ,
A A , N A , G A , O A , A la n o n , A C O A , C o D A

R a tio n a l T h in k in g H e a le d R a tio n a l F e e lin g s H e a lth y R a tio n a l B e h a v io rs

le a r n w h a t is r e a lit y & n o r m a l, le a r n h o n e s t a n d o p e n id e n t ify & a c t o n r a t io n a l t h o u g h t s a n d fe e lin g s ,
d is p e l ir r a t io n a l, c r e a t e a ffir m a t io n s e x p r e s s fe e lin g s a c c e p t r e s p o n s ib ilit y - L e t G o t o G o d

C h a n g e d O ld P e rs o n a lity T ra its
r e w r it e o ld s c r ip t s , r e d e fin e s e lf

Im p r o v e d S e lf - E s t e e m

L e t g o o f L o s s Is s u e s R e s o lv e A n g e r Is s u e s

E lim in a te S e lf- D e s tr u c tiv e B e h a v io r s Im p r o v e d p e r s o n a l fu n c tio n in g

S e lf-c o n tr o l - le ttin g g o o f o th e r s Im p r o v e d C o m m u n ic a tio n s

Im p r o v e in te r p e r s o n a l r e la tio n s h ip s
 I. ESBT model Flexible Process
of Theoretical Integration
 Limited and collaboratively set realistic goals similar to
Reality Therapy (Glasser 1965 & 2000)
 Collaborative relationship between therapist and clients
similar to Person Centered Therapy (Rogers, 1961)
 Rapid and early assessment done by therapist utilizing
techniques from Systemic Family Therapy (Bowen, 1978;
Haley, 1985; Minuchin & Fishman, 1981; Satir, 1983;
Whitaker, 1976)
 Focused interventions similar to the Multi-model Behavioral
Therapy (Lazarus, 1995)
 Staying centered in the “here and now” with the clients
similar to Existentialist Therapy (May & Yalom, 1995)
 II. ESBT model Flexible
Process of Theoretical
Integration
 Directed activity accomplished by the clients similar to
Cognitive Therapy (Beck, 1976; Ellis & MacLaren,
1998; Meichenbaum, 1997)
 Ventilation of emotions similar to the Gestalt Therapy
(Perls, 1969)
 Teaching how to identify and refute irrational thinking
similar to Rational Emotive Behavior Therapy (REBT)
(Ellis & Harper, 1997; Ellis & MacLaren, 1998)
 III. ESBT model Flexible Process
of Theoretical Integration
 Identifying, challenging and confronting
psychological defenses similar to Psychodynamic
Therapy (Freud, 1955)
 Encouraging personal responsibility taking and
accepting the social consequences for one’s actions
similar to Adlerian Therapy (Adler, 1930, 1931, 1938)
 Creative and efficient use of time
 Selection process by which suitable clients who are
“light bulbs ready to be turned on” are enrolled in
this treatment model (Budman & Gurman, 1988)
 I. Goal of Techniques ("art" of
the science of therapy) in ESBT
 Strengthen treatment gains
 Generalize learning from session to real experience
 Allow for learning of new skill or enhancing of an
old skill
 Empower clients who are demoralized, wounded &
feel like outcasts
 Enable clients to personalize therapy so that the
outcomes are uniquely theirs
 II. Goal of Techniques ("art" of
the science of therapy) in ESBT
 Helps clients own the outcomes of therapy as
something, which they have done on their own
 View selves as competent self-healers who can
gain new coping skills and enhance old ones
 Enables renewed self-confidence, increased self-
worth and enhanced self-esteem
 Types of Techniques in ESBT
 Init ia ting : aimed at exploring clients'
presenting problems gain understanding
 Chal le ngi ng: aimed at assisting clients to
change their thoughts, emotions and actions
 Concluding : aimed at evaluating clients'
progress and degree of change.
 Initiating Techniques of ESBT
 Conduct a Pre-session telephone call
 Mail out psycho-social-medical history forms
 Ascertain in the initial session if clients are ready for
treatment or if someone else is pressuring them into
treatment.
 Ask clients how soon they expect to be helped and what
they see to be the obstacles
 Train clients in problem analysis and goal setting
 Explain the length and nature of ESBT treatment
 Keep clients in the "here and now"
 Operate on assumption length of treatment only 1 session
Major Initiating Message in
ESBT

“Our parents did the best they could

knowing what they did at the time. We,
as adults, must now take responsibility
for our own lives and learn what
"normal" is so that we can have
healthier, more productive lives.”
 Challenging Techniques in
ESBT
 Homework
 Have the client envision change
 Use novelty, uncommon therapy
 Use one-down position "Columbo"
 Use humor in treatment
 Focus clients' roles past & current family
 Utilize metaphor or paradox
 Use Crystal Ball Technique
 Ask challenging questions of clients
 Encourage Bibliotherapy
 I. Homework in ESBT
 Self-esteem development (Family Systems: Satir, 1983,
1988)
 Life style of recovery (Reality Therapy: Glasser, 1965, 2000)
 Family of origin behavioral introjected scripts (Gestalt: Perls,
1969) and irrational beliefs (REBT: Ellis & Harper, 1997)
 Handling loss (Existential: May & Yalom, 1991)
 Personal growth (Behavioral: Lazarus, 1995, 1997; REBT:
Ellis & Harper, 1997; Cognitive: Beck, 1976 &
Meichenbaum, 1997)
 II. Homework in ESBT
 Handling relationships (Family Systems: Satir, 1983, 1988)
 Communications (Person Centered: Rogers, 1961)
 Anger work-out (Gestalt: Perls, 1969)
 Handling control issues (Reality Therapy: Glasser, 1965,
2000; Adlerian: Adler, 1930, 1931, 1938 & Dreikurs, 1964)
 Healing the inner child for self healing (Psychodynamic:
Freud, 1955; Family Systems: Bowen, 1978; Haley, 1985;
Minuchin, 1974, 1981; & Whitaker, 1976)
TE A Syste m
 Th oug ht s

 Emo tions

 Acti ons
TEA Sy st em
AL ERT Sys te m
 ASSE SS
 LESSEN

 EASE O UT

 REL AX

 TAKE STE PS
ANG ER Sys te m
 AC CE PT
 NAM E I T

 GE T IT O UT

 ENER GI ZE

 REL EASE
LET GO Sys te m
 LIGH TEN NE ED
 EXER CISE R IGH TS

 TAKE STE PS

 GI VE U P CO NTR OL

 ORDER LI FE
CHIIL D Sys te m
 CA LM
 HE AL

 INF ORM

 LIGH TEN

 DIREC T
RE LAP SE S ystem
 RECO GNI ZE
 EXE RCIS E

 LEAR N

 AC T

 PR OTE CT

 SUPP ORT

 EVA LUATE
RELAPSE System
SEA’S SYSTEM
MIND-BODY CONNECTION
 BRAIN ra tiona l
reasoni ng
 HEART -GU T
involun ta ry
org an ic syst ems
 hea rt r at e
pr essur e g as tr ic
acid adr ena line
 IMMU NE SYST EM
 Concluding Techniques
 Post-treatment sculpting
 Journal review
 Clients conduct therapy session with self
 Contract clients to try it on own no therapy
 Inventory where client is at their time
 Give client a progress report
 I. Haley’s (1985) tips to
consistently fail in brief therapy:
 Do not attend to the presenting problem of the
clients.
 Dealing with the clients’ past is essential so deal
with it extensively.
 Focus only on symptoms.
 Predict a worsening of the symptoms or symptom
substitution.
 Over focus on clients’ diagnosis & criteria necessary
for diagnosis.
 You must use only ONE theoretical framework.
 Don't be directive.
 II. Haley’s (1985) tips to
consistently fail in brief therapy:
 Assume change must be observable to be real
change.
 Insist on years of treatment to bring about
change.
 Evoke guilt in the clients.
 Ignore the clients’ wanting quick results.
 Don't define goals in therapy.
 Don't collaborate with your clients.
 Assume all responsibility for success or failure the
clients in therapy.
 Don't evaluate your effectiveness.