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BOOK REVIEW
Brief Psychotherapies: Principles and Practices. By Michael F. Hoyt
Phoenix: Zeig, Tucker & Theisen, 2009, 259 pp. ISBN: 1-58391-289-4. $27.95
(softcover)
Reviewed by Arnold Slive, Our Lady of the Lake University, San Antonio, Department
of Psychology
Koss and Butcher (1986; also see Koss & Shiang, 1994) have concluded from
their major review of the research literature on psychotherapy outcome that brief
and long-term methods are equally effective, and that brief methods are more
cost-effective…Why not try a short-term approach first? (p.3)
So says Michael Hoyt in his new book describing the history, philosophy,
principles and methods of brief psychotherapy. Despite the evident desire of many
clients to address their issues in as time efficient manner as possible (even one session)
most therapists are trained to deliver psychotherapy via longer term models of practice.
While more graduate programs than in the past are beginning to offer training in brief
therapy, in many instances this is a one course elective without related practical
experience. Hoyt’s book provides a wide-angle overview of the field of brief therapy as
well as an up close look at one of its most prominent models (Solution-Focused therapy).
In doing so, it could serve as a centrepiece for courses in brief psychotherapy.
Hoyt’s career has been closely associated with the brief (or “time sensitive”)
therapy movement, at least in its social constructivist, solution oriented forms. He was a
significant contributor to Talmon’s seminal Single Session Therapy (1990) and wrote or
edited several influential works that are used by this writer and others in teaching brief
therapy to graduate students (Hoyt, 1994, 1996, 1998). This new book can be viewed, in
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part, as a description of his personal and professional journey toward becoming one of
the most incisive and enthusiastic authors in this arena.
An expanding body of literature makes the case that many, if not most, clients
want their therapy to be as brief as possible. For example, Weir et al. (2007) report that
of approximately 115,000 clients attending counseling sessions in State of Victoria,
Australia Department of Human Services clinics over a three year period, 42% attended
for one session, even when routinely invited to make another appointment. Another 18%
attended two sessions. These authors found no significant differences in outcomes for
these clients as compared to the 40% who were seen for more sessions. Barrett, Chua,
Crits-Christoph, & Gibbons (2008) note that research on length of therapy suggests that
of 100 perspective clients contacting a mental health clinic, only 50 will attend the initial
evaluation, 33 will attend only the first treatment session and only 17 will be continuing
with treatment after 3 sessions. Some may complain that the psychotherapy world is
overly influenced by managed care thinking: briefer, because it is less costly, is better.
However, to a significant degree, briefer may be better because it is what a large portion
of our clients want. It fits their mindset. So should we not be developing models of
practice that are a best fit for how so many our clients want to address their issues?
This is why Hoyt’s book is significant. In one coherent volume, he lays out the
principles for therapists to develop a time sensitive mindset and provides practical advice
based on years of learning and experience for how to efficiently go about their work with
clients, how to draw on clients’ existing resources to creatively solve their problems.
Hoyt sprinkles his text with numerous references, making a strong case for the frequency
with which brief therapy is performed as well as for its efficacy. If one works from the
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assumption that therapy is about key moments, with all the rest being preparation and
consolidation, then much of the art and skill of therapy is about inviting and taking
advantage of those moments. Based on his career of therapy experience as well as his
careful reading of relevant literature, Hoyt presents his ideas in one volume for how to
create those moments and take advantage of them.
Hoyt’s opening chapter is a cogent, thorough description of the precepts of brief
therapy, research supporting it, and its history. This chapter is worth the price of the
entire volume. He describes beliefs that support brief psychotherapy and those that are
contrary to brief, time sensitive approaches. Brief approaches are pragmatic, and Hoyt
discusses practical ideas, not necessarily tied to particular theories (though in later
chapters he discusses, in detail, social constructivist concepts and solution-oriented
therapy). Rather, Hoyt in his pragmatism is an advocate for a multi-theoretical
perspective—do what works and what works will change from client to client and context
to context. This introductory chapter provides a highly useful and non-judgmental
historical overview of brief psychotherapy approaches that include examples from the
work of Freud, the short-term psychodynamic therapies, Milton Erickson and approaches
influenced by Erickson’s work, and single session models.
As noted above, Hoyt’s take on psychotherapy is based on largely pragmatic ideas
that promote time sensitive practice combined with a social constructivist philosophical
stance. In a nutshell:
…my approach to psychological intervention can be subsumed under the general
rubrics of brief therapy and constructive therapies. For me the hallmarks of brief
therapy are the development of a collaborative alliance and the emphasis on
clients’ strengths and competencies in the service of the efficient attainment of co-
created goals. Brief therapy has come to mean, generically, any therapeutic
approach that is problem-driven; that is focused on resolving the presenting
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complaint, with the therapist responsible for creating and maintaining the focus.
In this sense, brief therapy can include psychodynamic, solution-oriented,
problem-focused, and lots of family therapy and systemic and interactional
approaches—all having a goal-directed emphasis on resolving the presenting
problem…The goal of the approach or technical method, is to help the client
resolve a problem, to get ‘unstuck’ and to move on…In addition to meaning
‘efficient’ and ‘to the point,’ I would add that brief therapy is also used
sometimes to refer particularly to time sensitive intervention based on certain
(generally social constructionist) theoretical principles, not on the length of
treatment. Directly or indirectly, these approaches involve a wide variety of
creative methods that operate at the level of cybernetics and hermeneutics,
strategies and ‘language games,’ all more-or-less intended to influence how
clients recursively interact and construe (or ‘story’) their experience (pp. 115-
116).
This volume serves as an elaboration of the above ideas.
The penultimate chapter is a highly detailed account of Hoyt’s use of the Solution
Focused Therapy model in couples therapy. This is the closest to a “how to” in the book.
It makes extensive use of a case example to demonstrate the use of Solution-Focused
techniques and offers decision rules for the incorporation of other models in a ways that
do not undermine the basic tenets of the Solution-Focused model. It pulls together
through the discussion of one cogent example many of the concepts and strategies
described in the previous chapters.
Two other chapters deserve special comment. One, entitled “The Temporal
Structure of Therapy”, describes the brief therapy process as a series of stages. It
recommends specific questions for each of the stages. Many students will appreciate the
structure this provides which will reduce some of the anxiety of beginning therapists.
Another chapter, “Psychotherapy in Organized Healthcare,” based largely on Hoyt’s
experience working in an HMO, makes the important point that not only do many clients
want therapy to be focused and brief; so do those who fund the services. Hence, another
reason that most therapy is brief is that therapists have no other choice.
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One of the delights of this book is that Hoyt is a collector of literary references as
well quotes from his mentors and influential leaders in the field. These quotes are
sprinkled throughout the text and help to lock in his key points, sometimes with lightness
and humor. A few examples follow. In describing how diagnosis is often (though not
always) counterproductive in the everyday psychotherapy of less severely impaired
patients, Hoyt says, “A supervisor once told me I’d better diagnose quickly, before I get
to know too much about the person!” In describing how brief psychotherapists utilize
client resources in the solution of problems, he quotes Shakespeare: “Our remedies often
in ourselves do lie.” In his discussion of constructivism, he reminds us, by quoting Mary
Catherine Bateson, that while theories are pragmatically useful no theory provides the
answer: “It turns out that having a theory is very helpful, but you have to hold that theory
lightly and flexibly.”
While this discussion of brief therapy is more than sophisticated enough for even
the most advanced therapists, its style and scope suggest that it is intended as a text for
the teaching of beginning and intermediate brief therapists. It contains many case
examples. Reading it from cover to cover provides the background, the mindset, and
enough practical strategies and techniques for a neophyte therapist to begin to develop a
framework for practice. It even contains study questions that students will find
challenging and will enhance the classroom learning experience. I know because I’ve
used some of the questions in my classes.
Hoyt has made a significant and needed contribution to the brief therapy
literature. Time sensitive therapy fits in a time sensitive world—a world in which both
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the clients and funders of services want problems to be addressed in as focused a way as
possible. This book teaches therapists a great deal about how to navigate in that world.
References
Barrett, M., Chua, W., Crits-Christoph, P., & Gibbons, M. (2008). Early withdrawal
from mental health treatment: Implications for psychotherapy practice. Psychotherapy
Theory, Research, Practice, Training, 45, 247-267.
Hoyt, M.F. (Ed.). (1994). Constructive therapies 1. New York: Guilford Press.
Hoyt, M.F. (Ed.). (1996). Constructive therapies 2. New York: Guilford Press
.
Hoyt, M.F. (Ed.). (1998). The handbook of constructive therapies. San Francisco: Jossey-
Bass.
Koss, M.P., & Butcher, J. N. (1986). Research on brief psychotherapy. In A.E. Bergin &
S.L. Garfield (eds.), Handbook of Psychotherapy and Behavior Change (3rd ed., 627-670).
New York: Wiley.
Koss, M.P., & Shiang, J. (1994). Research on brief therapy. In A.E. Bergin & S.L. Garfield
(eds.), Handbook of Psychotherapy and Behavior Change (4th ed., pp. 664-700). New York:
Wiley.
Shane, W., Wells, M., Young, J. & Perlesz, A. (2008). The Implementation of Single
Session Work in Community Health. (Unpublished manuscript). The Bouviere Centre &
Latrobe University, Victoria, Australia.
Talmon, M. (1990). Single – session therapy. San Francisco: Jossey-Bass.
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