Brief Treatment and Crisis Intervention. A

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1 Editorial for the Inaugural Issue of Brief Treatment and Crisis Intervention Albert R. Roberts, PhD, Founding Editor-in-Chief I am delighted to welcome you to the journal, Brief Treatment and Crisis Intervention. A distinguished interdisciplinary editorial board will advise and collaborate with me in shaping each issue of the journal. We are all committed to publishing the most current and innovative research and clinical articles related to brief treatment and crisis intervention strategies. Who is a truly effective therapist or master clinician? 1. Is it the therapist who ends too soon, and tells the new client that being able to come to the office on time for this one and only session demonstrates that he or she is cured? 2. Is it the therapist who says to a new client: You need to come to see me once a week for three years or you will never fully recover? 3. Is it the therapist who tells a new client: I have successfully treated over six hundred patients, and all of them changed therapeutically and are happy with their lives. My role is to facilitate and bolster your efforts at setting goals, taking risks, confronting your problem(s), building on strengths, reframing, and changing behavior in one to 30 sessions, since every client is different? Our money is on therapist #3, who begins by instilling hope, emphasizing the need to set realistic goals, and underscoring the importance of encouraging effort and confronting one s problems. Of course, nothing is that simple; clients present with: numerous annoyances, daily hassles, and stressful life events; numerous and different combinations of single or comorbid mental disorders; different levels of resistance; different levels of motivation; different levels of communication skills; different levels of effort they are willing to put forth everyday in order to recover; different inner strengths and resiliencies; different pre-existing physical illnesses; different levels of involvement and willingness to experience emotional discomfort; different temperament and personality factors, and so on. The overriding purpose of this new journal is to provide mental health administrators, behavioral clinicians, crisis counselors, and clinical supervisors with the latest research, assessment protocols, treatment plans, evidence-based practice models, and practice innovations so they can be more effective brief therapists, crisis counselors, and supervisors. The opening article 1

2 ROBERTS by Drs. Janice and James Prochaska and associates identifies and applies their transtheoretical model stages of change to a traditional mental health center whose clinical staff has been compelled to change from a long-term psychodynamic orientation to a more accountable and planned brief therapy focus. The closing article by Dr. Bernard Bloom reviews 40 different clinical and research articles on the usefulness of the extreme case focused single-session treatment. He concludes that single-session treatment definitely has potential, and is worthy of continued investigation. However, additional controlled outcome studies are critically needed in order to determine under which specifiable conditions and with which psychological problems, single-sessions of psychotherapy are sufficient. A major concern in the field of psychotherapy and behavior change is therapeutic sufficiency. There have only been a small number of rigorous randomized clinical trials of brief and time-limited treatment in order to determine how many sessions are enough for therapeutic change. The articles in this premier issue and future issues will begin to document what forms of brief psychotherapy work, and under what conditions. The objective is to answer three important questions: 1. What constitutes an efficacious crisis intervention or other brief treatment? 2. What assessment tools and baseline data need to be used and collected to measure the magnitude of the presenting condition and clinical improvement? 3. How many sessions of brief treatment are needed to obtain significant and longlasting clinical improvements with particular diagnoses? By seeking help, clients are demonstrating some motivation as well as openness to possible behavior change. In 1981, Drs. Simon Budman and Bernard Bloom underscored the importance of the first session of therapy where the initial motivation needs to be bolstered through a biopsychosocial assessment, an individualized treatment plan, and an instillment of hope for quick improvement. Recently, a quiet revolution has transformed the ways in which mentalhealth policy makers, administrators, clinicians, and researchers function in today s society. We predict that behaviorally based presenting problems, treatment goals, step-by-step treatment plans, and evidence-based interventions are here to stay. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and many managed care organizations demand accountability in terms of measurable goals and objectives, individualized treatment plans, and outcome data. These standards of care and formalized treatment practices are vital to improving health care and mental health delivery systems. The board and I are committed to publishing articles on the latest principles and practices, brief treatment plans, and evidence-based brief treatment as well as research commentaries and brief research reports. Crisis intervention and other forms of short-term treatment are widely used throughout the world. They have become the most popular and efficient form of therapeutic intervention in both the United States and Canada (Corcoran & Roberts, 2000; Roberts, 2000). The cumulative and comparative research findings have documented moderate efficacy levels and numerous therapeutic benefits for clients completing brief forms of therapy (Garfield, 1998; Roberts, 2000). Crisis intervention and grief counseling became a separate clinical approach in the 1940s and 1950s with the work of Eric Lindemann (1944, 1956) in the aftermath of Boston s Coconut Grove Nightclub fire. The work of Dr. Lindemann, professor of psychiatry at Harvard Medical School, was further developed in the next two decades by his associate, Dr. Gerald Caplan (1960, 1961), at Massachusetts General Hospital 2 Brief Treatment and Crisis Intervention / 1:1 Summer 2001

3 Editorial and Harvard Medical School. For the most part, crisis intervention has been viewed as a distinct form of clinical intervention with the primary emphasis on helping persons in crisis return to their previous levels of functioning (Baldwin & Burgess, 1981; Parad & Parad, 1990). In more recent years, successful crisis intervention has been viewed as a way to not only solve problems, but also as an approach to brief therapy that can accelerate clients progress toward behavior change and bring about important psychological and emotional growth (Roberts, 1995, 1996). By the beginning of the 21st century, crisis intervention strategies have begun to integrate a strengths perspective bolstering resilience, protective factors, and solutionbased techniques rather than traditional crisis intervention, which primarily focused on helping the client to find new or latent coping methods in order to resolve the crisis (Greene, Lee, Trask, & Rheinscheld, 2000; Roberts, 2000). The second article in this premier issue was written by Professor Lewis and myself. It provides a timely and comprehensive review of the strengths and limitations of crisis assessment measures and instruments. In addition, the article by Dr. Gary Bowen and associates identifies and discusses the School Success Profile (SSP) as a computerized assessment inventory that is useful in building on students strengths and decreasing volatile incidents in the schools. The most common types of phobias are agoraphobia, social phobia, and specific phobias, such as extreme fears of snakes, mice, dentists, bees, and so on. The most frequently studied type of therapy for panic disorders is cognitivebehavioral therapy and systematic exposure. For the millions of persons suffering from phobias, behavioral exposure has consistently been found to be effective. The third article in this issue was written by Dr. Gordon MacNeil, and provides step-by-step behavioral treatment for agoraphobia and panic disorder. Next in the issue is Professors Gunnar Almgren and Maureen Marcenko s research article, which makes an important contribution to knowledge-building regarding factors that seem to precipitate foster children s overuse of hospital emergency rooms in the state of Washington. Following that is a unique clinical article by Lin Young and David Lester that combines their practice experience with Gestalt therapy and suicide prevention in both Australia and the United States. During the past two decades, there has been clear empirical evidence indicating that brief therapy is just as effective as long term/timeunlimited therapy with most clients, regardless of the therapist s theoretical orientation (Garfield, 1998; Koss & Butcher, 1986). The comprehensive reviews of the studies on brief therapy have indicated that regardless of the therapist s theoretical orientation, most clients were measurably improved at between 8 and 26 sessions (Garfield, 1986, 1998; Howard, Kopta, Krause, & Orlinsky, 1986). More specifically, comparative clinical research studies have found that approximately 50% of clients make their most significant improvements by their eighth session (Howard et al.). The most commonly utilized forms of brief therapy include: crisis intervention, family therapy, cognitive-behavioral therapy, planned short-term psychotherapy, behavior therapy, and brief dynamic therapy. A growing number of therapists are also using several other approaches to brief psychotherapy (Bloom, 1997) such as solution-focused therapy, narrative therapy, strategic therapy, eye movement desensitization and reprocessing (EMDR), critical incident stress debriefing (CISD), Ericksonian hypnotherapy, focused single-session psychotherapy, and couples therapy, just to name a few. Bloom examines 23 different theories underpinning short-term psychotherapy. The empirical support for the effectiveness of these different approaches is quite variable. In this premier issue, Dr. Bernard Bloom, the Research Commen- Brief Treatment and Crisis Intervention / 1:1 Summer

4 ROBERTS taries Editor, has written an article based on 40 reports of the use of single-session treatment. I invite the readers to view the findings of the 40 studies with extreme caution, particularly since most of the studies lacked a methodologically rigorous research design, no control group or random assignment, no matched comparison groups, often had a very small sample (e.g., N = 1), and used telephone follow-up questions on consumer satisfaction. In the apt words of Dr. Bloom (1997): case histories do not, of course, substitute for more objectively conducted empirical research studies (p. 66). There are numerous factors involved in doing effective therapy. Consequently, research on the effectiveness of brief therapy approaches is very complex, especially with everyday clients in a natural practice setting such as a community mental health center. However, despite the complexity of this endeavor, we should not cease trying to empirically evaluate different therapy approaches and interventions nor should we stop continuing to develop innovative approaches and techniques. Controlled research designs in which clients are randomly assigned to either the treatment group or a comparison group can result in clear evidence of the effectiveness of brief therapy. I would like to encourage all clinical researchers who have conducted randomized clinical trials with wait-list comparison groups to submit brief reports of their findings for publication in our journal. Further research should also evaluate the efficacy of different therapist s attributes, attitudes, interpersonal skills, and/or personality on treatment outcomes. In recognition of the prevalence of, and actual demand for using various approaches to brief treatment and crisis intervention, I welcome the readers to this arena for reviewing research findings, discussions, and reviews about the effectiveness of the different multidisciplinary and multitheoretical approaches to brief treatment and crisis intervention. The editorial board and I define brief very broadly to include planned short-term therapy, crisis intervention, cognitive-behavioral treatment, solution-focused therapy, critical-incident stress debriefing, crisis management strategies, psychoeducational groups, social skills groups, multifamily groups, single-session psychotherapy, hypnosis, and so on. We will publish scholarly articles on a wide variety of topics related to brief therapy such as outcome research studies, assessment protocols, meta-analyses, clinical case studies, clinical theory development, behavioral healthcare policy analysis, programmatic innovations, and clinical innovations. We want to welcome readers to Brief Treatment and Crisis Intervention, and invite you and your colleagues to submit manuscripts for publication consideration in the journal. The articles in this premier issue of Brief Treatment and Crisis Intervention cover a wide range of topics related to brief therapy. However, I believe that people with severe and persistent mental illness need a combination of long-term medications, individual psychotherapy, psychoeducational groups, and social skills training. References Baldwin, B., & Burgess, A. W. (Eds.). (1981). Crisis intervention theory and practice. Englewood Cliffs, NJ: Prentice-Hall. Bloom, B. L. (1981). Focused single-session therapy: Initial development and evaluation. In S. H. Budman (Ed.), Forms of brief therapy (pp ). New York: Guilford Press. Bloom, B. L. (1997). Planned short-term psychotherapy: A clinical handbook (2nd ed.). Boston: Allyn & Bacon. Caplan, G. (1960). Patterns of parental response to the crisis of premature birth. Psychiatry, 23, Caplan, G. (1961). An approach to community mental health. New York: Grune & Stratton. Corcoran, J., & Roberts, A. R. (2000). Research on 4 Brief Treatment and Crisis Intervention / 1:1 Summer 2001

5 Editorial crisis intervention and recommendations for future research. In A. R. Roberts (Ed.). Crisis intervention handbook: Assessment, treatment and research (2nd ed., pp ). New York: Oxford University Press. Garfield, S. L. (1986). Research on client variables in psychotherapy. In S. L. Garfield & A. E. Bergin (Eds.), Handbook of psychotherapy and behavior change (pp ). New York: John Wiley and Sons. Garfield, S. L. (1998). The practice of brief psychotherapy (2nd ed.). New York: John Wiley and Sons. Greene, G. J., Lee, M., Trask, R., & Rheinscheld, J. (2000). How to work with clients strengths in crisis intervention. In Roberts, A. R. (Ed.). Crisis intervention handbook: Assessment, treatment and research (2nd ed., pp ). New York: Oxford University Press. Howard, K. I., Kopta, S. M., Krause, M. S., & Orlinsky, D. E. (1986). The dose-effect relationship in psychotherapy. American Psychologist. 41, Koss, M. P. & Butcher, J. N. (1986). Research on brief psychotherapy. In S. L. Garfield & A. E. Bergin (Eds.), Handbook of psychotherapy and behavior change (pp ). New York: John Wiley and Sons. Lindemann, E. (1944). Symptomatology and management of acute grief. American Journal of Psychiatry, 101, Lindemann, E. (1956). The meaning of crisis in individual and family living. Teachers College Record, 57, Parad, H. J. & Parad, L. G. (Eds.) (1990). Crisis intervention book 2: The practitioner s sourcebook for brief therapy. Milwaukee, WI: Family Service of America. Roberts, A. R. (Ed.). (1995). Crisis intervention and time-limited cognitive treatment. Thousand Oaks, CA: Sage. Roberts, A. R. (1996). Epidemiology and definitions of acute crisis in American society. In A. R. Roberts (Ed.), Crisis management and brief treatment: Theory, technique, and applications (pp ). Nelson-Hall. (Distributed through Brooks- Cole, Pacific Grove, CA.) Roberts, A. R. (2000). An overview of crisis theory and crisis intervention. In A. R. Roberts (Ed.), Crisis intervention handbook: Assessment, treatment and research (2nd ed., pp. 3 30). New York: Oxford University Press. Brief Treatment and Crisis Intervention / 1:1 Summer