ABSTRACT

Again, it depends on the particular service delivery system that you are involved in . Some will say that whoever is willing to come to therapy can be treated, and they will not require a psychiatric diagnosis, at least not if the problem can be resolved relatively quickly. Sometimes there is an apparent psychiatric diagnosis, but then we enter into a doublespeak, where we may tell the clients that we need to put one person's name down on the form to get treatment authorized, although it involves all of them equally. So, we wind up having to explain unilateral versus systemic thinking. We also get into doublespeak if insurance requires pathologybased diagnoses and we think therapeutically more in terms of learning or growth. Carlson: One of the keys to doing therapy in a managed care organization seems to be planned or best use of available resources within the facility, within the therapist, and within the patients themselves. Hoyt: I think we are seeing a shift toward what I have been calling constructive therapies, those that are collaborative and competency based. This very much keeps with the HMO idea of health maintenance-looking for health, resources, and strengths, not just pathology, defects, and weaknesses. I think there are some very good advantages. One is that it is much more user friendly. Clients like to be seen as whole people, not just as diagnoses or defects. I also think it is more user friendly for therapists. It helps reduce the problems of burnout, when you are looking not only for problems but rather at the entire person or family. There has not yet been enough systematic research on the newer forms of brief therapy, but we already have seen that many of the solution-focused, solution-oriented, narrative, and other competency-based therapies get good results. Carlson: What attracts you to solution-focused therapy? Hoyt: It's simple, optimistic, respectful, versatile, and effective. It appreciates clients' own resources and worldviews. I am interested in helping clients to achieve their goals, so I like to use whatever works. This is not an either/or situation; it is a both/and situation. I also find a lot of value in other approaches, particularly those that can be termed constructive-including narrative, strategic, Ericksonian, and others yet to be determined. Carlson: Do the brief therapies have common characteristics? Hoyt: In their own ways, and to varying degrees, they all seem to emphasize certain features:

I. rapid and positive alliance; 2. focus on specific achievable goals; 3. clear definition of client and therapist responsibilties, often with tasks

or assignments to be carried out between sessions; 4. emphasis on strengths and competencies, with an expectation of

change; 5. novelty and assisting the client toward new perception and behaviors; 6. here-and-now (and next) orientation 7. time sensitivity.