Embracing psychotherapy minimalism

The very term “psychotherapy” connotes a maximalist approach to addressing mental health challenges. The vision of spending an unknown number of hours over months, if not years, to analyze and address problems in life is a considerable deterrent to help-seeking. The brief consultation, defined as one to three sessions, represents a minimalist approach to psychotherapy practice.

Clinicians in private practice can feel stagnant or overwhelmed by a caseload without sufficient turnover. A mix of short and long-term therapy clients adds diversity to the caseload, but time-limitations can be challenging to adhere to in the community practice setting.

Time-limited psychotherapy models vary widely, often ranging from eight to 26 sessions. Brief consultation is underutilized in the private practice setting. Some practitioners do offer a single consultation to assess the client’s needs and evaluate whether the services offered by the practice align with the client’s needs, but assessment alone is not intended to be therapeutic.

Problem-solving therapy emerged from cognitive behavioral therapy as an example of a brief consultation model that has been effective in clinical settings, such as primary care. However, there has been scant uptake of the PST model in private practice settings and few community therapists advertise brief consultation as a service.

From the client perspective, brief consultation is ideal for addressing specific concerns, decision making, or obtaining support at critical junctures. The goal of brief consultation is to narrowly focus on a specific problem and identify a roadmap for the client to implement. Brief consultation is appealing to the client who is not specifically dealing with a mental health problem or does not want to engage in on-going psychotherapy because of a lack of time or financial constraints. The one to three session model can be very impactful and leaves the door open for therapy in the future should the client wish to return.

Clinicians who offer brief consultation note that the service provides diversity in their clientele, which in turn can prevent burnout. This model does not rely upon psychiatric diagnosis and is typically fee-for-service rather than covered by health insurance.

Brief consultation does not require an on-going commitment, such as the need for an evening appointment, which can be difficult to sustain over time. Clinicians may derive greater satisfaction in practice by providing brief consultations for people who have problems that align with the therapist’s interests and passions.

Brief consultation does not include the term “psychotherapy” and is less likely to be perceived as stigmatizing by would-be clients. Examples of people with the types of problems that might benefit from brief consultation include an athlete or musician with performance anxiety, a person with cancer trying to make a decision that aligns with their values, or an attorney facing career burnout. There are numerous people who could benefit from brief consultation with a licensed therapist but do not necessarily need multiple sessions of psychotherapy.

Therapists should not blindly follow traditional formats for length of therapy without questioning whether it aligns with the needs of the client and the therapist. There are reasons that practices have a sizable proportion of clients who seek on-going therapy.

Longer-term clients are favorable for private practice therapists because it is easier to predict client behavior and avoid taking on too many high acuity patients who need crisis management. Longer-term interventions allow the therapist sufficient time to address complex problems. Revenue is easier to predict when the therapist’s caseload does not have a high degree of client turnover. At the same time, too many longer-term clients can lead to scheduling constraints. Therapists who need more flexibility in their schedule benefit from having a caseload that includes very short-term brief consultation clients.

Therapists who want to offer brief consultations should describe the service on their website and/or directory profile. It is important to describe both the ideal client and examples of problems that are best suited for the model. Differentiating the service from short-term psychotherapy is critical. Fees and expectations should be made explicit and clear. Although the point of brief consultation is not to provide traditional therapy, it is still important to use measures to gather background information and screen for depression and suicidality. Therapists who fail to do any risk assessment are vulnerable to malpractice lawsuits if the client hurts themselves or others.

Psychotherapy can offer an abundance of potential benefits, but not everyone seeks or needs ongoing therapy. Incorporation of a more minimalist approach to the therapy service line would fill an important unmet need.