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The benefits of less therapy

June 24, 2013
by Gary A. Enos, Editor
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Letter from the Editor

With apologies to those oh-so-adorable children sitting in a circle in the ubiquitous AT&T commercials, more is not always better. I was reminded of that recently when I asked members of our active Addiction Professionals group on LinkedIn whether they ever defy insurance rules and decide to engage in “marathon” therapy sessions with patients.

I anticipated a barrage of anti-insurance invective in response. And there was some of that, with one individual suggesting that to get back to ethical patient care, we needed to “legislate away private health insurers.” But the vast majority of respondents as of late May actually embraced the standard 50-minute session and saw longer sessions as largely unproductive. In fact, some group members even used the occasion to voice their support for brief therapy in general.

“The ‘more therapy is better therapy’ concept has not been proven, but research has shown that brief therapy is a very effective process,” wrote one respondent.

“I very rarely extend a session,” wrote another clinician. “If I do I base it on client need. I have also had success with brief therapy.”  

Other LinkedIn group members highlighted the importance of avoiding what one respondent called the “bomb syndrome,” where a patient will say virtually nothing of substance for most of the session and then drop some staggering piece of news in the waning moments. One clinician recalled his own experience in treatment, when his counselor threatened to cut his individual sessions to 15 minutes because he meandered his way through the first three-quarters of a typical session anyway.

Another clinician made a compelling point about the message that is delivered when a therapist remains true to a schedule. “Ending sessions on time is generally what happens,” she wrote. “I usually have another client waiting, or need a meal myself. Most people require the boundaries established within treatment to help them develop boundaries within their life.”

To be certain, some respondents have taken steps to combat managed care’s downward pressure on time in treatment. A number of clinicians talked of their recent moves to forego insurance payment entirely and move to fee-for-service billing.

But even in those cases, no one seemed to argue that longer sessions by definition would be preferable to shorter ones. As one respondent wrote, “Research indicates that the longer time a client is connected to therapy is more important than the intensity of the counseling sessions. … Marathon sessions do not create breakthroughs.”

These are the kinds of everyday topics that are consistently brought to light in our Addiction Professionals group. Many members use the group to evaluate new practices they may be considering for their organizations, or to gain advice about clinical challenges they regularly encounter.

Also available via LinkedIn is our Addiction Professionals subgroup on process addictions, offering guidance and new information on this steadily growing component of clinical practice covering areas such as pathological gambling and sex addiction.

By the time the May/June print issue reaches your mailbox, it is likely that membership in the main Addiction Professionals group will surpass 10,000. Please join this growing community of clinicians and other addiction field leaders who are engaged in meaningful and relevant dialogue.

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