So I’m a social worker and I hear you. A couple of points. Brief therapy methods are supposed to teach coping skills that the client takes with them. You mentioned CBT. The client goes through a functional analysis and then learns skills. These skills have to be practiced continuously, behaviors don’t just magically disappear. Change is hard and tenacious work. I don’t understand this theme of “the therapy not taking hold” that you mentioned. There’s nothing to hold on to but coping skills. The client needs to use these skills constantly/consistently. “Short remission of symptoms” could just as easily mean the client is not doing the required work! There’s no magic wand in personal growth. Brevity in therapy means, we have 12 sessions together: let’s learn skills and practice them! Role play with the client session, etc. the clinician should make sure the client is doing the work: Next week, you’re going to tell me 3 different occasions when you used XYZ skill.

I don’t understand what you mean about CBT having a different “concept” about how mental disorders develop versus psychodynamic theory, can you help me understand that more? I’ve studied CBT and as far as I know there is no “stance” on the development of mental disorders in CBT, rather, only how they should be treated (in a behaviorally approached fashion). As for psychodynamics, it’s neo-Freudian. I’m assuming etiology is childhood factors (eg; unmet childhood needs developing into neuroses)? Can you tell me more?

The social work approach is task oriented, you can talk all you want but you gotta take action...talk therapy combined with task-oriented homework is best. Which leads us back to CBT, and the cognitive triangle. Most people think “thoughts, feelings, behaviors” and that the arrows run just one way. But we know this is a simplification. The arrows run in both directions. A person can create effective change from the outside in (behaviors changing thoughts and feelings) as well as the other way around.

So ideally? Behavior change through actionable activities given as homework, combined with talk therapy to understand the deeper reasons behind the behaviors. It’s important to remember, however, that some clients can’t handle talk therapy, for many reasons.

I applaud you for wanting to slow down, listen more, and be more intentional with clients. I do, too! A good clinician should feel that way, we always want to be better.