December 02, 2013 at 11:20 AM
The last blog post focused on the value of the intensive treatment format. The main point was that if the client comes to solve a problem, why not just get it done, instead of dragging therapy out for months? The post led to much back-channel discussion, continued here. (And this time please just post your comments below, OK? Makes for a better discussion. Thanks.)
There are some situations in which intensive therapy is particularly helpful. The following case examples are composites representing typical but not actual clients.
The client is at risk of hospitalization or residential placement.
“Sidney” was a 50-year-old emergency room nurse with a history of alcoholism (sober for many years), who was suffering from intrusive memories of various on-the-job horrific events. She was finding it ever more difficult to get through the day, and was tentatively planning to check herself in somewhere and get some help. However, she was not to the point of engaging in dangerous or self-destructive behaviors.
She was able to schedule two 2-day blocks of therapy a couple of weeks apart, without missing any work. She recovered from her distress, and never had to place herself in residential care.
It is important for the client to be able to speak for herself, to obtain protection from abuse.
“Jen” was a 6 year old girl who had been abused and terrorized by her father for several years. She was the subject of an ongoing custody battle and had just been assigned a guardian at litem (GAL; someone to represent her interests to the court), who was to interview her soon. Jen’s mother worried that Jen would be too intimidated to tell the GAL about her fear of her father, and then the abuse would continue. (The mother had tried to advocate for her daughter’s safety, but as is all too common, the mother was disregarded.)
Jen’s mother brought her for two days of intensive work, which largely focused on her history of abuse by her father. The trauma memories did not fully resolve (though they normally do), presumably because Jen did not yet feel safe from further abuse. Even so, she made good progress, and felt more able to assert herself on behalf of her safety.
The timing of the two-day session was strategic, in that the appointment with the GAL was scheduled for a couple of days after the therapy, and before the next scheduled visit with the abuser. Jen was indeed able to describe the problem to the law guardian, and she was believed, which led to some protection.
The client is at risk of disruption or loss of employment.
“Reg” was a 38-year-old police officer who was transferred to a desk job due to having unduly “roughed up” a suspect. He could only resume his former duties upon completing treatment to address his anger and acting-out behavior, and receiving a letter from the therapist attesting to this. Reg did a 3 day therapy retreat, plus a couple of brief weekly follow-up appointments, and was able to resume his former duties within a few weeks of his initial transfer.
The client has an upcoming court date.
“Frankie” was a 14-year-old boy who was severely abused as a young child. His parents’ rights were terminated and he was adopted by his maternal grandmother at age 7. He had been a loving and obedient child, and did well in school. In the past couple of years had begun to display occasional angry outbursts, and his school performance had become uneven. One day in anger he pushed his grandmother, she fell down, and then she got up and called the police. She was so upset that she told the police officer lies that made Frankie’s actions sound much worse. Frankie was arrested, arraigned, released on bail, and told to appear in court in a few weeks.
Two weeks later, Frankie completed several days of therapy. He was remorseful about having pushed his grandmother, and he worked hard in treatment. He was able to show up in court with a supportive letter from the therapist, as well as the support of his grandmother. She testified that he had begun to do his homework more consistently, and had not lost his temper since completing treatment. While he would probably not have been incarcerated for a first offense regardless, he was able to make a good impression in court by completing his therapy so quickly and already showing improvement.
The client has an upcoming challenging situation.
“Jessica” was a 19-year-old college sophomore who had left college mid-way through the spring semester on a medical leave due to stress, anxiety, and depression. She then moved back to her parents’ home, picked up a part-time job, and attended a weekly therapy session. With a month to go before the fall semester started, she was no longer acutely depressed, but neither did she feel ready to face the stress of college. After three days of intensive therapy, she did feel ready. Even so, she continued to work with her local therapist on a weekly basis, and lined up a therapist at college as well, just to ensure continued support in case it was needed.
Not every therapy client – intensive format or otherwise – does so well, but many do. The point here is to highlight some life situations for which the intensive therapy format is uniquely beneficial. In each of these situations, a slower treatment approach, even if effective, would have incurred a high cost meanwhile. There are times that quick completion of therapy can make a big difference in someone’s life.