Toward an integrated brief psychotherapy

The authors argue for an integrated model of brief psychotherapy that includes psychoanalytic and cognitive-behavioral approaches, as well as pharmacotherapy when necessary. The use of such a model gives the clinician the opportunity to tailor the treatment to the individual patient using differential therapeutics. In implementing a differential therapeutic approach, dynamic psychotherapy can be conceptualized using a health-sickness or psychopathology continuum, which is then superimposed upon a psychotherapy continuum ranging from expressive to supportive interventions. The use of such a psychotherapy continuum helps clinicians tailor the treatment approach to the specific patient. The authors first review psychotherapy outcome studies from the last two decades that suggest that an integrated approach may be advantageous. They then present findings from process studies that highlight the importance of the patient/therapist relationship. In the final sections of the article, the authors discuss how to use an integrated approach to brief psychotherapy, including the use of medication when appropriate. The authors also discuss the use of trial therapy during the initial session to help the therapist determine whether a supportive or expressive approach will be most appropriate for the individual patient and present two case vignettes illustrating the expressive and supportive approaches to trial therapy.