with Cognitive Therapist, Art Freeman (edited)
what does brief therapy mean?
therapy is not a number of sessions. Brief therapy is a way of conceptualizing
therapy, a way of developing
a therapeutic relationship. It's got a number of aspects. It's
directive, it's active, it's focused, it's solution-oriented, it's
and it's lots of things done in the limited time that one can use.
What is your particular strategy or approach to brief therapy,
and how does that work?
My basic orientation comes out of my work in cognitive therapy.
And cognitive therapy and brief therapy are really synonymous.
always been a brief therapy. Looking at thinking and using our broad
family name, cognitive behavioral therapy, looking at the way people
think, looking at the way they behave, looking at the way they feel,
and how these all interact.
And just how does that work? How do you operate as a cognitive behavioral
therapist, brief therapist?
Well, one of the things we look at is how people understand their
world, how people develop their ideas, how people see themselves
in the context
of their world and helping them to understand where these ideas come
from, how they affect their interactions, and basically how they
can learn to take better control of their lives.
What are the roots or the basis of this approach, and what influenced
you to adopt this approach to therapy?
Well, I think cognitive behavior therapy has two distinct roots.
One is dynamic root that goes back to the work of Freud, more specifically,
the work of Alfred Adler. It also has a very strong behavioral root
looking at the work of Andrew Salter, Jacob Sin, Joseph Wolpe certainly,
cognitive behavior therapy really serves as a meeting point for people
from diverse schools because I think it has a strong dynamic component
and a strong behavioral component. What influenced me was that it
and we have lots of data that says it works, and that's the best
influence for why I do what I do.
Just how does change occur in this process?
That's a hard question John. Change occurs as we can understand the
basic schema as one aspect of it, the basic rules we live by. Each
of us learns
certain rules of life, cultural rules, social rules, religious rules,
family rules. And they influence how we think, how we behave, and
how we feel, so that change occurs as we start to understand something
of the rules we live by. No change also occurs as we directly change
because if you are doing something a certain way all of these years
and you change it, it may also change the strength of your belief
So it begins with one way to bring about change is through what you
call understanding or maybe insight, and then another is by actually
Right. We discovered that insight in and or itself is not sufficient
for change. That the fact that you have great insight doesn't mean
that you develop the skills to change. So I've developed great insight
my golf swing. The insight is I do it wrong. But unless I can learn
how to do it right, that insight isn't going to improve my game at
So just knowing why this is going on in your life isn't enough to
It's not sufficient. It's interesting and important, but not sufficient.
So as a brief therapist, how do you bring about change? What are
you focusing on?
I think two aspects are the directive nature of what I do, that the
idea I have is that if the client and I are in my consulting room,
us has to have an idea of where we are going, and I think that's
got to be the therapist because if the client knew where they were
they probably wouldn't be going to see us. That they would be doing
other things with their time and their money. So, that's one piece.
part is the activity of the client. They have to be willing and able
to make a commitment to change which is very simple. I am willing
to try to change. If they can't do that or won't do that, then I
brief therapy or long term therapy won't be very effective. So there
parts then. Your really being able to take charge and to direct the
change process . To structure it, and then the willingness on the
part of the
So, what we would call mandated clients wouldn't really work in this
approach, people who don't want to be there, people who the courts
I am often asked that. I am working with a client who doesn't want
to be there, doesn't like therapy, doesn't like therapists, the court
said to either go to therapy or go to jail, and they always pick
therapy interestingly. How do I make them change? And the answer
is you don't.
So a mandated client who comes in and says you know this drug habit
is getting the best of me, I need to change it. My abusive behavior
my spouse has got to stop. My anti-social activities have got to
come to an end so I can build my life. They are very workable. The
who comes in and says do me something, change me. I think you can
be in long term therapy with them forever, and there still won't
So motivation is the key there.
I think motivation is the key for all therapies.
How does this compare with other brief approaches?
It's a hard question to answer. It depends on whose brief approach.
There are many brief approaches. Some very close to what I do. I've
other brief therapists. I've read of other brief therapists. And
very often we are going the same thing and call it different things.
the elements to brief therapy are very, very similar. I think the
structure is essential. A real focus is essential. A real collaboration
The directive nature is essential. Doing non-directive free associative
work can be brief by definition. So I think there are lots of similarities.
I think what makes what I do maybe different from others, maybe not
all others, is the cognitive behavioral focus, and that doesn't exclude
Clearly, if someone is depressed you want to change their depression.
But the way into the system is understanding the way they think,
process information, and certainly how they behave.
I am intrigued by the notion of the structure. Just how to do you
structure an interview? Are there steps or stages that you go through?
Well, there is a beginning, middle, and end The beginning is involved
in developing rapport. It's essential. Good therapy is good therapy,
and a relationship is an essential piece. The brief therapist has
to be especially skilled at developing a relationship fairly quickly
you don't have months to develop the relationship.Then to develop
a problem list. Developing a problem list that is very focused is
of the bywords for what I do is that vague goals lead to vague therapy,
and vague therapy leads to vague results. So I try to avoid things
like I want to work on my self esteem. It's too vague. I am having
problems at home. Too vague. So very early in the session I want
to try to focus, to get definitions, understandings, but to really
mid part of the session is developing the theme. With about five
minutes left to go in the session, what I want to do is then bring
to a close. I don't want it to be abrupt - I'm sorry our time is
up for today. I want to give the client time to come back together,
the session. What did you learn? What are you taking home with you?
So that the session isn't just something that rolls along but that
got to take responsibility for maintaining a structure and a focus.
I think there is a lot of empirical data about cognitive therapy
starting with the late seventies, the work on depression. There has
been a huge
amount of work on anxiety. The other work on depression by Beck.
The work on anxiety by David Clark, Paul Sarcoscis at Oxford, the
on cognitive behavioral approaches with PTSD, Edna Foa, the work
disorders that Beck and others have done. So there is a huge body
of data that talks to the issue of cognitive behavioral approaches
brief and empirically validated.
You talked about this need for motivation, for change. Other than
that are there clients that this just doesn't work with, or are there
kinds of clients that it works better with than others?
If you would have asked me that question in 1978, I would have said
we work with depression because that's what we did. I would say at
point cognitive behavioral approaches are a general model for treatment,
that we've seen cognitive therapy work as a pain management technique,
as work with couples, families, in patients, out patients, children.
I would think that with modification a cognitive behavioral approach
would be useful with a broad range of clients, broad range of settings,
broad range of modalities. Does it work better with some than with
others? Yes, depending upon how you structure it. So, for example,
if I was working
with an individual with severe problems, I would be using more behavioral
than cognitive. It just talks to how you structure the broad repertoire
of cognitive behavioral work.
What about cultural differences?
Cognitive therapy cross culturally as a short term model has been
very popular. I've done a good bit of traveling, and one indication
I have had books on cognitive therapy translated into nine languages,
and it is always interesting that people in Sweden say they like
cognitive therapy because it fits into the Swedish cultural style,
in China say they like cognitive therapy because it first into China's
style, and the reason is cognitive therapy as a basic approach is
not content oriented but process oriented. So it's not that we have,
an Oedipus complex that may not be cross-cultural. The goal is to
help someone in their culture understand the rules or schema of their
and how it affects their lives. It's a process.