Some people think psychotherapy is like getting their teeth cleaned. For others, it’s like getting their teeth pulled.

There are some who value a comfortable, long term relationship with a therapist: someone who doesn’t judge, someone who lets them be who they are and go at their own pace. They go periodically to get things off their chest. Their therapist doesn’t have much to say, but they don’t go to hear her talk; they go so they can. There may be some uncomfortable moments; but, going makes them feel better. Therapy is supposed to clean out all those toxic thoughts before they eat away. It relieves the pressure building so they don’t explode. It’s maintenance, not renovation. Successful therapy, for them, means they always have someone they can talk to about anything. Rogerian Person-Centered Therapy is this way. So is Psychoanalysis.

There are others who don’t look at therapy that way. They would never consider seeing a therapist unless they absolutely needed to. They come in with a problem and expect it solved. They want some advice on how they can handle that toxic boss, the nagging spouse, the episode of depression, the heavy drinking, or those pesky panic attacks. Successful therapy, for them, means they don’t have to come anymore. They might as well be saying, if a tooth is diseased, don’t clean it, pull it before it corrupts the whole body. Those people are asking for Solution Focused Brief Therapy.

Solution focused brief therapy may be a description of any therapy that is solution focused and brief, but it’s also a specific brand name approach that they teach in therapist school and write books about. The hypnotist, Milton Erickson started it all. Insoo Kim Berg and Steve de Shazer later elaborated. You don’t get hypnotized when you go to Solution Focused Brief Therapy, at least not in the usual sense of the word. Instead, your therapist will ask you what we call the miracle question:

If you woke up one morning and a miracle had occurred so that your problem was gone, how would you know it?

You might say something like, “When I come home, I won’t dread seeing my wife.”

The next question will ask you to rate this dread on a ten-point scale. This will help you see progress better.

Then you’ll get some other questions like: When is your dread less severe? “When I haven’t been drinking.” How have you coped with dread so far? “If I screw up, I just tell her.” What are the parts of your life that is free of dread? “I don’t feel it at work. I give them my best at work.” The answers to these questions can suggest particular tasks for you to do towards helping you feel less dread. You’ll have homework that your therapist will ask about if you return.

In Solution Focused Brief Therapy you’ll get a therapist who asks a lot of pointed questions designed to get to the heart of the matter. She won’t just wait for you to get there. She’ll bring you there and hold you accountable for doing something to help yourself. There will be no exploration of how the dread started. Your therapist won’t ask you about your childhood. The whole technique is about harnessing your existing strengths towards a solution to the problem. It’s not like getting a tooth pulled in terms of pain; only in terms of the aggressiveness of the therapist’s intervention.

Should you be asking for Solution Focused Brief Therapy? It depends on what you need. If you’re totally miserable, in crisis, ready to cash in your chips or go for broke, then you probably don’t need to dick around, exploring your childhood. You need a therapist who’s willing to be directive. You don’t have time to waste. You need a solution, fast; so, you should be in a therapy that focuses on solutions. It doesn’t really have to be brief, per se; but it has to be fast acting. If it works, great. If it doesn’t, you need to know soon so you can try something else.

You should also as for it if you don’t think you’ll be going for long. If going to a therapist is hard for you, or if you can barely afford it, then you’ll want to make the most of the little time you have.

You don’t necessarily need brand-named Solution Focused Brief Therapy. There are lots of therapeutic techniques that are solution focused and expected to be brief. Cognitive Behavioral Therapy and Motivational Enhancement are two that come to mind. But you do need a therapist who is willing to pull teeth if he has to. Not all are.

If you are not that bad off; or, if you had been suffering, but now you’re doing better and want to maintain your gains, then the kind of therapy you need, if you need any, is more like getting your teeth cleaned. It’s often a good idea to keep a therapist on retainer, so to speak, and check in from time to time. It’s a good idea for everyone to have someone to talk to. It may not have to be a therapist. If you have one, mental health hygiene can be performed by a good friend, a non-reactive spouse, a calm parent, or a trusted self-help group. If you don’t have one, or if they ones you have aren’t up to the task, then you may need a therapist, but not the kind that’ll pull out every tooth.

Don’t let your insurance company decide what you need if you can help it. Your insurance company would like you to only engage in brief, solution focused therapy because they think it saves them money. They are like those people who skimp on maintenance: people who don’t change their oil, don’t paint their house, and don’t clean their teeth. Insurance companies are always penny wise and pound foolish because they’re hoping that by the time all the neglect of your physical and mental health has run its course, you’ll be off their rolls and on Medicare.

There are often therapists who specialize in one method or the other. The therapist who thinks of therapy as a cleaning is going to be relatively quiet, unobtrusive, and reflective. You’re going to be doing most of the talking, not him. It doesn’t really matter what he thinks or what he says, what matters is that you talk freely, without fear and without anyone controlling you. The therapist who thinks of himself as a kind of mental health hygienist is very willing to do that.

The other kind of therapist, the brief, solution focused therapy kind, is not going to be happy listening to you talk about how dysfunctional you are, week after week, without trying to do something about it. It’s not that he’s impatient with you, it’s more like he feels it’s his responsibility to take action. He doesn’t want to be accused of fostering dependency. Just listening doesn’t seem like he’s working hard enough. Moreover, he has lots of ideas. Because the duration of therapy is brief, solution focused therapists see lots of people and ask those people to try lots of things, so they know what works and what doesn’t.

The best kind of therapist, I believe, is the kind who can both pull teeth and clean them, depending on what’s needed. A reflective eclectic, in other words. Someone with a lot of tools at his disposal and knows how and when to use them.

Click here to go to the Institute of Solution Focused Brief Therapy