Critical Analysis of Time-Limited Psychotherapy With Adolescents by Dr. Gaby Shefler (2000)

‘Time-Limited Psychotherapy With Adolescents’, a paper published by PhD researcher Gaby Shefler in 2000 highlights the significance of Short-term dynamic therapies as a psychotherapeutic approach to deal with a wide variety of patients seeking treatment, but whom needs cannot be met by the classic (in-depth) long-term approach, either due to time limitations or those who cannot afford a long therapeutic treatment. It has been argued to be best suited for those seeking instant remedy for resolving short term personal crisis, particularly the “emotional storm” quite typical in adolescents. Though controversial (as argued by many to be ‘very short’, ‘not providing full residual’, providing “space-limited” treatments, bearing the higher possibility of failure, etc), they have proven to be quite effective particularly in dealing with adolescents, who often see long-term attachment and involvement in an ambiguous relationship as a threat to their emerging sense of independence and separateness. In his worthwhile reading paper, Shefler presents us with two vignettes, and a detailed case excerpt of 17-year-old Israeli boy Ofer- struggling with negative self-image- who seeks professional help to tussle over his indecisive nature, and inability to take control over the events of his life. In his paper, Shefler begins by briefly presenting the central principles of short-term and time-limited psychotherapies, following which he elaborates on the clinical characteristics of adolescents in need of psychotherapy, and the primary characteristics of adolescents as patients. He touches upon problems faced during treatment and finally concludes his argument on why and how these short term treatments are significantly effective in treating adolescent problems, being successful in at least addressing the ‘central problems’ of clients. Illustrating the crucial need for short-term treatment approaches in this population, the author finally gives a detailed account demonstrating the treatment and follow-up of a 17-year old youth, using James Mann’s time-limited psychotherapy method to explain its effectiveness and the potential it has of widespread application in near future, particularly with adolescents.

The author explains all concepts and gives fitting references wherever required. Though the paper is well designed and structured, it cannot be denied that it is full proof of errors. In his ‘arguments of paradoxes’(as rightfully claimed so), it is quite ironic how the author argues the ‘success’ of therapy with only half-backed pieces of evidence. My primary assertion here is the high generalisation done to universalise the results of one case onto a whole set of the adolescent population. It is strange that while claiming his success, he never takes into account the two futile trails where the same 'successful' therapy misfired even before it could be actually implemented. Moreover, if the same generalisation principle is to be followed, the vignette he provides of his case with Yuval can infact arouse suspicion on his competency as a clinical therapist. The same can be argued where he describes in his case with Ilana, where had he convinced her more empathetically, she could have agreed, but owing to his excessive fascination with the magical charisma of a particular type of treatment, he did not even try. Owing to his double standards in evaluating the success of his therapy, he insists how because of his collaborated efforts, Ofer overcame his ‘dependence vs interdependence’ conflict which he experienced while making decision even in the most trivial and insignificant matters (causing him apprehension, anxiety and frustration in the form of loss of control over life) as he mentions “…The therapist took an active, directive stance and used empathic interventions, enabling Ofer to explore his ability to please himself in a secure and protected manner. The follow-up phone call supported the impression that Ofer had made gains in this area.” he inadvertently overlooks the fact how his patient had actually become overdependent on him. Though the author acknowledges how ‘...Perhaps it was Ofer’s way of continuing therapy with me, through Omri’, he never openly admits that Ofer was actually never able to bypass the ’second stage’ of self-reliance during psychotherapeutic treatment. Further, as the author mentions how “the therapist should be a person capable of making quick decisions and choices, and also able to get involved affectively and to separate quickly”, he himself gives enough evidence to reflect how he himself was inefficient to make quick and efficient decisions (most visible in the case of Yuval, where he could not even suggest an appropriate treatment; nor could he identify and subsequently overcome the ’dependence bond’ developed between him and his patient Ofer during the 3 months long therapy). He himself felt sorry to terminate a therapy that was so beneficial, clear-cut, and fun with such an endearing and responsive youth midway ignoring the hard fact that termination of therapies before resolution of the concerned problem can have disastrous results in the long run. Furthermore, he expressed he would have continued therapy with him had it been possible rather than motivating and making Ofer believe that he was fit and ready to move on. (He simply ignores the fact that even a small remark such as his could bring disastrous results in the life of someone especially one like that of Ofer, who had not recovered fully. Also, it seemed that if given choice Ofer would have had made the same choice to continue the therapy, something self-justifying the wrong timing of termination of therapy by the author). It is self-contradictory how he himself provides shreds of evidence that are in stark contrast, and go against his claims of both being an able therapist as well as having terminated the therapy ‘successfully’, and on a ‘firm and strong’ note.

The therapist never brings attention to a very important element contributing to Ofer’s problems- his over-admiration of his elder brother as a role model and ideal figure (and to some extent father too) (which was really harmful to not only for both self-identity and personality development but also in terms of future family relations, his feeling for self and independence). The biggest gaffe of all was complete overlooking of the fact by the therapist how Ofer was always guided and shown the path in dealing with each and every matter in life by his father and brother (even to the fact that his brother decided/guided him that with which girl he is to form sexual relations and with whom to not). He never considered the future impact of this incompetence of Ofer to draw the line and secure privacy. Furthermore, his failure to address other important issues such as- conflict between activity and passivity, the question of sexual identity, narcissistic personality and his relationship with other men- and his temporary remedial approach to the ‘secondary problems’ as part of therapy counts to be another major blunder of this otherwise ‘successful’ treatment.

To conclude, It can be overall said that though the article was well written, with all necessary and related concepts explained well and references made wherever required, there were, however, numerous instances as mentioned above, where the author fails to justify or back his stand. In my opinion, to say the least, it was, indeed nothing but just an- ‘article of paradoxes’

Link for Critical Analysis of Research Article

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3330592/pdf/88.pdf

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