Editor’s Note – March/April 2020

Something’s afoot in the therapy world, and some clinicians will surely wrinkle their brows at it. Although it comes in various forms, the catchiest term for it is microtherapy, a single-session encounter that, according to a growing body of research, can effectively reduce symptoms for many clients. When I first read about the growing interest in microtherapy, I confess to my own knee-jerk skepticism. One session—really? Tell me how a single encounter can accomplish more than trading hellos, jotting down a list of symptoms, establishing a goal or two, and inspiring a bit of hope in the client? Actually, even that sounds like a lot to pull off in 50 minutes.

But as I dialed down my give-me-a-break attitude, a question opened up for me: What’s this thing called therapy anyway? To many of us, it’s by necessity a fairly extended process, requiring some months to establish a trusting clinician–client relationship, explore deeply entrenched issues, foster self-compassion, and practice new behaviors. People change slowly, and one of therapists’ primary roles is to provide steady, ongoing support for this personal evolution.

But what if these long-held beliefs about therapeutic essentials aren’t true—or at best, only partly true? In this issue, Lauren Dockett profiles the paths of a disparate group of innovators, freethinkers, and rebels who are trying out various versions of ultraspeedy approaches, undaunted by the prospect of challenging much of what’s long been considered essential to the therapeutic process. In contrast, Jonathan Shedler and Enrico Gnaulati offer a passionate defense of more traditional psychodynamic approaches, with their emphasis on an extended therapeutic connection, and a scathing critique of what they consider a movement built on faulty research and a failure of clinical insight. Stepping back to examine a growing shift toward integrated healthcare, Chris Lyford explores the rapid pace and format of therapy in a primary care setting.

And yet even if we accept that a brief intervention may be helpful to many people, can we accurately call it therapy? Is it merely coaching to address immediate challenges, or in the hands of a skilled practitioner, is it more than that? Also, this super-abbreviated work brings up some thorny social and economic issues. We know that increasing numbers of Americans are seeking mental health help—nearly 50 million at the latest count—and most of them can’t afford extended therapy sessions. At the same time (and I bet readers have thought of this already), fast-track therapy brings up bottom-line issues for clinicians, especially those in private practice. If prospective clients come to expect a single session rather than a several-month stint, can therapists continue to make a decent living?

There’s a lot to chew on here. And we can’t not chew, because microtherapy is more than just a debatable concept. It’s already catching on and will certainly grow. We have no answers, at least not at the moment. What we can say for sure is that fast-track therapy goes to the very heart of our work as healers. That’s why it matters.

Richard Simon

EDITOR