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Spending Less Time On The Couch


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SPENDING LESS TIME ON THE COUCH

Simon H. Budman is one psychologist who isn't suffering the constraints of managed mental-health care. As the director of mental-health training at Harvard Community Health Plan--New England's largest HMO--he says he's "catching the wave" of change. That's because Budman, age 47, is also the founder and president of Innovative Training Systems Inc., a consulting company based in Milford, Mass. Hired by managed- mental-health-care companies, hospitals, and community health centers, the company trains old-school therapists in Budman's methods of "time effective" treatment.

Goal-oriented and practical, Budman's techniques are in line with the solution-focused therapy now advocated by companies. His dozen or more clients include Virginia-based Value Behavioral Health, with 14 million subscribers, including IBM, and Options Mental Healthcare, based in Norfolk, Va.

Fueling the interest in Budman is a fundamental shift in the practice of psychology to meet today's very real economic pressures. It is only the privileged few who can afford the long-term treatment stereotypical of psychoanalysis. Instead, most Americans increasingly find themselves limited by a company to 6 to 10 sessions with a therapist. And whereas Sigmund Freud and his disciples sought to cure a person of some underlying pathology, today's shrinks are being pressured to focus on solving an immediate problem--dissension between a husband and wife, for example.

HOMEWORK. Budman's goal is to provide the most quality in the least amount of time--and at the least expense. Instead of open-ended therapy that drags on for years, he advocates a quick diagnosis and a succinct treatment plan with a specific goal agreed upon by the client and therapist. A key part of Budman's strategy is "homework," or activities outside of the counseling sessions (table). He also believes treatment should be episodic--meaning that people come for a few sessions to deal with one issue, such as an impending marriage, and come back later to deal with death or divorce.

Budman admits that many psychoanalysts would "abhor this kind of treatment." Johanna K. Tabin, a psychoanalyst in Glencoe, Ill., says of short-term proponents: "I don't believe the effects of this kind of therapy are long-lasting." Stuart A. Pizer, a psychologist in Cambridge, Mass., notes that while Budman's views are admirable, they don't work for patients suffering from more complex problems. "Cutting these people off is just plain cruelty," he adds. Still, many therapists will have no choice: If they want to earn a living, they have to adapt--and Budman's training teaches them how.

The debate about how much therapy is necessary will only increase as managed care becomes the status quo. But the reality is that most companies have already adopted the model. As they seek to balance their quest for big savings with quality care, Budman's message is one that both employers and many therapists will embrace.

SCHOOL FOR SHRINKS

Simon Budman teaches therapists short-term, goal-oriented therapy. Here are some of his techniques that make use of out-of-office time:

MARITAL PROBLEMS

Tells couples that focus on the negative to catch what their spouses do right and write it down

DEPRESSION

Advises a depressed single mother of two who feels overwhelmed to spend 15 minutes unwinding after work before dismissing the babysitter

SOCIAL ANXIETY

Sends a manager who is terrified of giving spontaneous reports in business meetings to Toastmasters, the speaking groupNaomi Freundlich in New York


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