When a person is going to do therapy He does it because he wants to solve a problem that is affecting his daily life and the solution to this is to change something in order to find a solution to what is bothering him.
But even if this exists will for change For the patient, the moment of carrying it out is usually complicated, resistance to change is an inherent fact of the human being since all change generates fear and this fear, in turn, generates resistance.
This resistance to change This is what is causing the patient's problem to continue and even get worse, since fear itself causes the person to resist changing anything in case it gets worse instead of better.
It is this fear and resistance that is the focus of the Brief Strategic Therapy (BBT):When a person tries to change on their own but always stumbles upon the same problem, it is because the resistance to change is causing a mental rigidity that does not allow them to consider other solutions and, therefore, the solutions they have sought and put into practice up to now are what is maintaining the problem.
Let's see it with an example that will make it clearer.
«Marta suffers from agoraphobia.At first she was afraid of being in crowded places because she thought she would have an anxiety attack and not be able to get out. The solution to this was to stop going to these places. Then she realized that when she was on the subway or on the plane the same thing happened to her. She was afraid of having a panic attack and not being able to escape. She stopped using the subway and the plane. Soon after, she began to be afraid of having a panic attack in any large, closed place. She stopped going to the theater, the movies, and shopping malls. Little by little, Marta stopped going to places. Now she can hardly leave the house without being overcome by the fear of a panic attack that she cannot control.
In this case, the successive solutions that Marta has been putting into practice are the ones that are maintaining and aggravating the problem. This is precisely where Strategic Brief Therapy comes in.
History
Before continuing with Marta's case and seeing how it is approached from the TBE, let's see what this therapy is based on.
Milton Erickson
The origins of TBE are found in the systemic perspective and the work of Milton Erickson and Paul WatzlawikThis perspective focuses not only on the person but also on all the systems that surround him or her on a daily basis: the family, social relationships, the environment, society, etc.
Based on these systems the person has built his perception of realityThat is to say, each person has a way of understanding things based on what he has experienced in his life and what has been socially instilled in him. The person, therefore, behaves based on this way of perceiving reality.
But it also turns out that this way of understanding life is quite staticso the person is often not able to see for himself how reality can be interpreted in a different way.
Giorgio Nardone He adapted this knowledge from the systemic perspective and combined it with his knowledge of other psychological perspectives to create TBE, a type of brief therapy (in most cases, problems are solved in 10 sessions or less) and focused on change perspective in a natural way, leading the person to change their point of view in a subtle but very efficient way.
Bases
As we have already seen, TBE deviates quite a bit from traditional psychology and psychiatry, trying not to do anything psychopathological diagnosisThat is, he avoids patient labels and if he uses them he does so simply to specify one of the possible solutions.
In TBE, the patient's behavior is understood not as pathological but as «functional» or «dysfunctional» based on its ability to solve the problem.
In summary, we could say that, according to TBE, the patient's psychological problems are basically due to his own system of perception of realitywhich leads to the generation of dysfunctional behaviors that lead to the problem being perpetuated.
In Marta's case we have a belief system where avoidance is the solution to problems, if I turn my back on them and don't confront them, they will be solved. This belief causes a series of dysfunctional behaviors that are perpetuating the problem: avoidance generates more anxiety, in this case.
Thus, the TBE states that, to solve a problem, it is not necessary to explore what caused it initially, but what is causing the problem to persist in the present. To deal with the problem, we focus on how the problem itself works.
Yes it will be interesting to explore the past of the patient insofar as it is necessary to know what attempts at solution have been made to solve it, since based on this it will be understood what beliefs are behind the maintenance of the problem, and they can be addressed to provide a solution.
TBE, therefore, is a very dynamic psychological model, in which interventions are not determined by the patient's pathology but by the solutions As solutions are applied in therapy, the effects obtained are seen and the intervention is modified based on this: what works is maintained and what does not work is changed immediately.
How does therapy work?
TBE focuses on solutions to the problem. The plural is important because There is no single solution to the same problem, but it is modified depending on the patient, the moment in which he finds himself and the social system that surrounds him, that is, it focuses on the present and the future rather than the past.
In the first sessions the therapist will accompany and guide the patient in the mental construction of a new realityThe patient will be asked to imagine what his or her life would be like without the problem that brought him or her to the consultation and, based on this new mental scenario, the most appropriate strategies will be constructed to achieve this.
How are these strategies built? Well, basically by focusing the patient's attention and efforts on two things:
- The exceptions: that is, those moments when you would expect the problem to be there, but it wasn't for some reason.
- The solutions Implementation: determine what solutions the patient and his/her environment have tried and check how these are perpetuating the problem.
In Marta's case:
Exceptions:
- One day there was a fire threat in her home and had to be evacuated. Before she knew it, Marta was on the street, surrounded by people and without any fear of suffering an anxiety attack.
- Another day her sister, whom she was doing a long time She called her, saying that she was in town for two hours while she waited for the train to leave for her hometown. Marta was then able to go to the station and spend a short time with her sister, practically without fear.
Solutions:
- Problem avoidance by Marta herself.
- Intensification of the problem from her entourage: when her friends or relatives want to see Marta, they go to her house, preventing her from moving. Her husband is the one in charge of doing the shopping and taking the children to school every day, so that she doesn't have to go out. In fact, at first, Marta's boss gave her permission to work from home, until she was fired.
As we can see, in Marta's case, both she and her environment have encouraged the problem to perpetuate, since she has been given spaces of avoidance that have been comfortable for her. This often happens, since it is very painful for family and friends to see a person they love suffer, but they are often not aware of how this can be harmful. aggravating the problem.
As for the exceptions, although there are only two, a certain pattern can be intuited: when there is an emergency or an important motivation, Marta is able to «forget» her problem for a moment and even overcome to him for a certain period of time.
It is from these exceptions and solutions that we will begin to build the strategies to modify behavior. In this case, Marta was given these two initial instructions:
- DailyUntil the next session, she would have to leave her house for 10 minutes and walk wherever she wanted. During those ten minutes of walking she would wear a watch to keep track of time. Every time a minute passed she had a task to do: during odd minutes she had to tap both palms on a wall. During even minutes she had to turn 360º around herself and continue walking.
- When he got home after his walk, he had to write down on a map how far he had come.
In the following session, Marta said that she had been doing it for two weeks, although on one day she didn't do it because she became afraid and blocked herself.
Despite that, when asked how the days he had managed to get out had gone, he said that, although I left home He was a little scared, but he quickly got over it because he was focused on the tasks he had to do in those 10 minutes. For the next session he was given the same task, but this time without a maximum time limit, that is, he could now leave the house and walk as far away from home as he could, repeating the previous instructions every minute.
When she returned after fifteen days, Marta said that at first she did it, but then she started leaving the house and after a while walking quietly He realized that he was forgetting about the exercises every minute because he was thinking about other things and, in addition, seeing the distances on the map, he was getting further every day without problems.
So, little by little and with this type of exercises, and some others aimed at strengthen the new behaviorMarta began to go out again and to get into situations that, in recent years, she had not even dreamed of repeating.
Of course, the solution that worked for Marta does not have to work in all cases of agoraphobia, or even in some of them. TBE designs a concrete intervention and tailored to each patient, as if making a tailor-made suit.
Can this be helpful for my problem?
TBE is used for all kinds of problems psychological, demonstrating great effectiveness, especially in the case of phobias and the depressionsbut can be applied to all the others.
It applies both in individual therapyas in couples or family therapy and at all ages.
The advantages of this type of therapy is that they offer a Quick and effective solution. Often the biggest change that occurs in the patient is found between the first and second session and in a few 10 sessions the patient is discharged.
If you are interested in this type of therapy and want to check if it can help you, you can contact our specialized psychologists.