Table Of ContentTHEORY AND PRACTICE OF BRIEF THERAPY
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Theory and Practice
of Brief Therapy
SIMON H. BUDMAN
Harvard Community Health Plan
and Harvard Medical School
ALAN S. GURMAN
University of Wisconsin Medical School
Foreword by Paul L. Wachtel
THE GUILFORD PRESS
New York London
© 1988 The Guilford Press
A Division of Guilford Publications, Inc.
72 Spring Street, New York, New York, 10012
All rights reserved
No part of this book may be reproduced, stored in a retrieval system, or transmitted,
in any form or by any means, electronic, mechanical, photocopying, microfilming,
recording, or otherwise, without written permission from the Publisher
Last digit is print number: 987
Library of Congress Cataloging in Publication Data
Budman, Simon H.
Theory and practice of brief therapy
Simon H. Budman & Alan S. Gurman.
p. cm.
Bibliography: p.
Includes index.
ISBN 0-89862-716-8
1. Psychotherapy, Brief. I. Gurman, Alan S. II. Title.
[DNLM: 1. Psychotherapy, Brief—methods. WM 420 B927t]
RC480.55.B83 1988
616.89'14—dc 19 87-24847
CIP
To Drs. Gene Lindsey and John Collins, for saving my life.
—S.H.B.
To Gerri, Jesse, and Ted, for enriching mine.
—A.S.G.
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Foreword
This excellent book conveys vividly an approach to brief therapy that is
comprehensive and based on sound and well thought-out principles. It
demonstrates as well as anything I have read how the findings of empirical
research can be brought to bear in devising effective therapeutic strategies,
and exposes as shallow and uninformed the claim that research has yielded
nothing of value to the clinician. Particularly noteworthy is that the research
that nourishes this work is not just therapy outcome research but research on
basic processes as well. Budman and Gurman's applications of the research
findings on bereavement and loss, for example, are extremely impressive.
I found particularly valuable their strong emphases on building on the
patient's strengths and on the importance of social support systems through-
out the life cycle. Budman and Gurman's approach appreciates the degree to
which people's lives are lived in a social context, and it does so without
sacrificing attention to the supposedly "deeper" issues which have served as
the excuse for many therapists to substantially ignore the world around us.
Especially significant is their addressing of the importance of events outside
the consulting room in bringing about therapeutic change. All too many
therapeutic approaches seem to assume that little outside the few hours a
week that the patient spends with the therapist really has an impact. Here, as
in other places, this book exposes the false dichotomy between what
happens in the session and what happens in daily life. As Budman and
Gurman show very well, the impact of the time spent with the therapist is
very largely in helping the patient to change his or her daily interactions,
which contribute so centrally to the maintenance of the problem. The
authors do this without minimizing or ignoring the processes going on in the
session itself or between patient and therapist. Their appreciation of the
importance of the corrective emotional experience—or perhaps more accu-
rately, their explicit and unhedged appreciation; it is often brought in
through the back door of authors' discussions—is salutary and unusual in
an era in which that concept is still inappropriately stigmatized.
The book is commendable for its honesty. It confronts the complexity
of the real world rather than attempting to fit all observations into the mold
of their theories. For example, though the book is about brief therapy—and
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viii Foreword
demonstrates very effectively how much more can be accomplished in a
brief time than is usually assumed by dynamically oriented therapists—in
the case of Shelley the authors present an instance in which therapy over
many years was required; albeit in the spirit of the approach described
throughout the book, rather than as a kind of Woody Allen continuous
immersion in therapy month after month (except August) and year after
year. It is a case, moreover, in which even all of this did not stem her decline
when contact with the therapist was interrupted. Such confrontation with
the actual complexity of what happens in the lives of people who have been
in therapy gives the reader much greater confidence in what the authors are
presenting and advocating.
The book will be of value to practitioners of long-term therapy as well
as those who explicitly think of themselves as brief therapists. It presents a
fresh and exciting approach that would be extremely worthwhile for the
clinician to learn even if insurance companies wanted to do nothing more
than to pay for full scale analyses. Much of what the book advocates is what
long-term therapists' common sense has been telling them for years, and the
points it articulates account for why therapists do all those things they'd
never tell their supervisors (who also secretly do them, without letting on to
their supervisees).
The book is beautifully written. It is clear; it is literate; and it is the only
book I have read that dares to explore the world historical dialectic between
Sophocles and Yogi Berra (see Chapter 11). In addition to its main arguments,
the book is filled with insightful asides. Some made me notice in a fresh way
what should have been obvious all along; for example, that the research on
psychotherapy outcome seems to focus almost exclusively on brief therapy,
even if not always presented as doing so. Other points made in passing
stimulated further thought and provoked me to generate my own hypotheses.
Their early discussion of premature termination, for example, made me
wonder if the reason so many "long-term" therapies end with the patient
having attended fewer sessions than in the typical brief therapy is that the
open-endednei^s of long-term therapy, its seeming prospect of endlessness, is
disturbing to some patients. In effect, they have to leave after 5 to 10 sessions
when the prospect looms of hundreds, but can stick it out for 20 or 40 when
they know that the plan is quite explicit and that 20 or 40 is all there will be.
All in all, this is one of those rare books that combines clarity with
profundity, depicting an approach that, in equally rare fashion, combines
flexibility with rigor. The theoretical discussions are consistently sensible,
complex, and clarifying, and the clinical vignettes are useful and to the
point. Budman and Gurman present a humane and comprehensive ap-
proach that should have a powerful influence on how therapy is practiced
for many years to come.
Paul L. Wachtel
Preface
To many observers, it appears that interest in brief therapy has greatly
increased over the past decade. Psychoanalytic, cognitive, interpersonal,
and behavioral clinicians, seemingly persuaded by theoretical factors, re-
search findings and/or the hard realities of third-party reimbursement pres-
sures, have examined ways in which treatment can be made maximally
effective in the shortest period of time. Such efforts have spawned the
variety of new short-term approaches described in the many psychotherapy
"treatment manuals" currently available.
In fact, most therapy is, and has for decades been, brief by any of
several criteria. While "brief therapy" has come on the scene in more
"acceptable" forms over the past decade, this has often been through the
"miniaturization" of "established," psychoanalytic long-term models. We
are convinced, however, that most therapists who do brief therapy (whom,
we believe, are most therapists) are rarely theoretical or technical purists.
Rather, they are pragmatic and eclectic, if not integrative, in method and
technique.
Furthermore, we are of the belief that most of the actual day-to-day
brief therapy that occurs emphasizes current developmental issues (often
more neutrally referred to as "situational") and the interpersonal and sys-
temic context of problems. Such a perspective seems to us to be not only
practically wise, but also to offer a much more optimistic view of the human
condition—hence, the likelihood of change—than many conventional short-
or long-term psychotherapeutic models. In like fashion, we see most of this
brief therapy as being more comprehensively "systemic," in the sense of
paying simultaneous attention to affect, cognition, and behavior and to
"the" patient's interactions with others in everyday life.
Thus, in a certain sense, the model of therapy presented here is not
particularly unique, but reflects what we see as the essential and common
elements in effective brief therapy-as-most-often-practiced. It is a distilla-
tion of what we believe to be the central features of any effective brief
therapy, even those aspects of the treatment that may not be completely
articulated by the therapist.
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