Brief Therapy in Adult Psychiatry

This paper provides an overview of the study conducted by A. J Macdonald (1994) on Brief therapy in adult psychiatry. With thorough analysis, it expresses concerns about the structure and lack of focus in controlling the research. It outlines strengths and limitations within its core assumptions to the research model in the context of the findings and the outcome of the research. Through considering multiculturalism, family socioeconomic status and other extraneous variables, it will lead to more valid and reliable research method to help in contributing to better knowledge on the effectiveness of brief therapy. Literature Review:

Brief therapy in adult psychiatry With increase in interest in Brief Therapy, researches were conducted in an attempt to verify its effectiveness within the field of psychotherapy. The purpose of the study conducted by Macdonald was to assess the effectiveness of a brief family therapy in adult psychiatric settings as there are limited studies available. Notion of family interaction and training in family began to rise with its importance and issues such as financial and staffing limitations to achieve more cost effective and short term therapies began to elevate which resulted in the use of brief therapy described by Fisch et al (1982).

Regardless of the intention, Macdonald failed in setting a clear base structure of the research as simplistic definition of brief therapy was only was only referred to Fisch et al. Therefore, lack of detail in introducing the research seemed vague and disorganised. The research questions addressed by this study were: Is family interaction effective in brief therapy and with follow up, has the problem diminished, or gotten worse? The independent variable in this study was family contact and the dependent variable was good, neutral and worse outcomes.

Good outcome refers to whether clients were able to overcome their problems. Bad outcome refers to a problem worsening after the treatment and neural outcome having no changes in their problem regardless of the treatments. Demographic variables considered potential covariates used to answer the question on whether family contact was associated to result in good, neutral or bad outcomes were: age, social class, duration of the problem, length of treatment, gender and clients’ motivation to change. This study was a quantitative research.

The sample consisted of forty one of forty four referrals to a multidisciplinary team providing brief therapy in adult psychiatry was followed up after one year. Statistical calculation followed the studies from Swinscow (1983) and Siegel (1956) and data was collected through questionnaires to distinguish good and bad outcome from each clients. Prior to the selection process, Macdonald briefly mentions about the Brief Therapy Team consisting of mental health professionals from several disciplines but lacks to explain their roles and why such method was utilized.

As there are numerous researches available on the effectiveness in using brief therapy team, it neutralized some biased opinions that one may hold depending upon the nature of the clients’ problems. Out of forty eight referrals from general practitioners and consultant psychiatrists, four did not attend and forty three sets of questionnaires were returned with one case having been lost in the process. Two cases were overlooked as client had left the area, therefore follow up information couldn’t be obtained.

The sample size for the following study seemed a little small to obtain more valid results and in addition, candidates were not controlled and looked after which caused unexpected errors within the sample size. A larger sample size with careful monitoring of clients and practitioners would have aided in the data analysis, particularly in obtaining accurate and valid results. In total of 41 cases, 26 clients and 37 general practitioners replied, however, with 15 cases only the general practitioner replied without the clients’ feedback.

With different feedbacks obtained from candidates, it seems less valid as their feedbacks may be biased and therefore, other variables may have affected the given results. Variables which could have contaminated the questionnaire results could be caused by whether the client had overcome the problem or not. Therefore, such given data must be interpreted cautiously. The case records do not reveal, for example, how precisely the resolution of target complaints was defined in the interview, how goal attainment was scaled, whether collateral interviews were conducted n individual, couple and family cases, or how demand characteristics might have colored the clients’ responses.

In addition, the classification of outcome was done by consensus of the clinical team, which leaves open the possibility of a positive bias. Still, some outcome data for this approach are better than none which leads to further investigation in order to fill in some gaps. However, with the use of feedback from both the client and practitioners, it could have reduced biased, subjective opinions, as their results could be simultaneously compared to verify the validity and reliability of the obtained results.

The client’s age ranged from 20 to 70 years old showing no significant age difference between male and female groups. Broad age group of adults in sample size gave more in depth and broader spectrum in understanding the effectiveness of therapy. Social class distribution of the sample differed from the local population. The duration of the problem was also classified into short, medium and long. The given result indicated correlation between the lengths of treatment with number of sessions. Assumptions that there are direct relationship between the outcome at one year and having been in therapy were raised for further investigation.

Due to the given result, number of sessions provides more accurate measure of treatment activity. In addition, looking from gender perspective, male and female groups’ number of sessions differed significantly. 14 male clients attended one to five sessions whilst 27 female clients responded with attending one to 13 sessions, showing significant differences. Current study also did not differ significantly from the general population of this region and the good outcome group did not differ from the main sample.

This directly indicated that brief therapy is seemingly helpful to all social classes not restricting on any particular social classes. However, from the findings, there seems to be a link between specified goals and satisfaction with outcome. However, same effect was reduced for negatively defined goals and least for non specific goals. Thus, it indicates that the process of goal setting alludes to help in reaching outcomes and that this is achieved with a greater strength if the client plays a major role in selecting and defining their goals.

The result also indicated, four cases resulted in worsening of the problems. The standing cases were highly likely to seek other additional advices since discontinuing brief therapy and therefore have developed new problems. Current study could have controlled and kept more close relationships with each client to avoid such situations as it’s hard to depict whether problem worsened purely due to additional advices or by the brief therapy itself or the lack of family support.

As one of the main limitation to a brief therapy is that clients may be underestimated with their time for discharge, which in return may cause other problems to rise. Outcome rates did not vary over time, suggesting that use of team method supported novice therapists and at the same time teaching families to avoid errors, which delivered rapid results with lowering costs in both training and treatments. The internal and external validity of this study is in question as the researchers acknowledge that the study was not truly controlled as it created errors which were hard to control.

They also conceded that contact logs were not controlled as two cases were discharged as they were unable to contact the clients to complete follow up questionnaires. In addition, as clients were referred depending on their range of problem with relevance to family issues but excluded patients with acute psychosis. Due to wide range of problem, it may have given better controlled outcomes if extraneous variable such as family socioeconomic status, single or dual parent homes were taken into an account to keep the sample candidates with similar environments.

With complexity and variety of problems that clients are faced with, it is hard to understand in depth of what aspect of the brief therapy helped each client to reach its outcomes. Also, questionnaires were distributed to both clients and the referrers but without having a complete commitment to return the sent questionnaires, we cannot overlook the negative reinforcement as some clients may not wish to be re-addressed of their past problems, which may have caused untruthful answers in the questionnaire itself.

Extraneous events such as family relationships, drug or alcohol use, and peer support could also help in explaining the outcomes. A potential limitation of the current model is its lack of focus in multiculturalism as social constructionism is congruent to it. As clients are encouraged to explore how their realities are being constructed, their cultural values and world view should be considered as it’s important for the practitioners to respect the clients’ underlying values.

Therefore, in future studies, multicultural values need to be considered carefully for further studies. Essentially, the instrumentation used by the researchers was very weak as questionnaires can be biased depending on how the client feels about their problems and how they approach the matter. Also, current study did not use diagnostic categories or standardized assessment procedures, and had no comparison group, therefore, it is difficult to know if its therapy was equally effective across types and severity of presenting problems.

However, the purpose of this study was meaningful in that discovering that good outcomes was linked with more therapy sessions and having specific goals and could be explored further and yield possible implications for practice. While this study used brief therapy team in an attempt to control for contaminating influences, it lacks the external validity to generalize beyond the sample. The correlational aspect of this study’s design does support that relationship exists between good outcomes with more therapy sessions and having specific goals for treatments but it does not substantiate a cause and effect affiliation.

It is recommended that this study be repeated using tighter control methods and a more representative specified sample, with more attention given to the pre-existing qualities of the subjects, as well as information on their current living environments and its relationships.