Two Views of Time-Limited Treatment

                                                      A Social Work article

                                         Two Views of Time- Limited Treatment

                                                                      By

                                                   Allison D. Murdach LCSW

                                                         2942 Hardeman St.

                                                       Hayward, Cal. 94541

                                                      Phone: 510-581-6794

                                                  allisonandjo@hotmail.com

      Abstract: This article focuses upon the work of the two pioneers in the development of time-limited methods in social work, Jessie Taft and Bertha Reynolds. The claim is made that their efforts in this area illustrate two types of clinical discourse—here called the “experiential” and the “experimental”—that have existed  sometimes happily and at times in conflict  in the field from the 1930’s to the present. It is suggested that the experimental type of discourse currently appears to be dominant in social work, but that despite this the experiential approach continues to gain adherents.

                                                           (End of Abstract)

Key Words: Time-limited Treatment, Clinical Discourse, Social Work History, Evidence-based Practice, Practice Wisdom.

     A recent article by Kotrla (2005) successfully highlights the importance and necessity of time limited treatment in mental health, especially in substance abuse programs.  However, it is also important to be aware of the history of this concept in social work.  This knowledge can help shed light on the current dialogue in the field between the evidence-based practice movement and practice approaches based upon insight, personal experience, and existential wisdom (Klein & Bloom, 1995). 

     In what follows we will briefly review the contributions of the two pioneers who developed time-limited methods in social work: Jessie Taft (1882-1960) and Bertha Reyn0olds (1885-1978).  Their approaches to this issue not only developed in different ways, but their particular interpretations of this type of social work practice also  symbolized and stimulated vastly different interpretations of social work method.

                                         Taft and Reynolds: Early Experiences  

     The notion of time-limited treatment was first developed, not in social work, but in psychoanalysis by Freud (1963; Reid, 1988).  After being quickly dropped by Freud in favor of long term therapy, it was taken up by Ferenczi and Rank when they began to move away from Freud’s circle and then more fully developed by Rank as he developed his own theories and treatment methods (Lieberman, 1985).  Jesse Taft and Bertha Reynolds both separately underwent Rankian psychoanalysis in the 1920’s, and subsequently began to apply concepts of time-limited treatment developed by Rank to social work practice in the late 1920’s and early 1930’s (Robinson, 1962; Reynolds, 1991). 

      Taft and Reynolds were colleagues who knew and respected each other’s work.  They viewed time-limited methods, not as limitations or constraints, but as opportunities to both promote personal growth for clients and expand social work practice knowledge.  However, their initial efforts to describe the use of time limits, published almost simultaneously in the early 1930’s (Taft, 1933; Reynolds, 1934), show that Taft and Reynolds each developed a strikingly different approaches to the investigation and description of the use of this method in social work treatment. 

                                                   The Views of Taft

     Taft had undergone psychoanalysis from Rank himself and was impressed by the ways in which he had used time limits in therapy to help patients undergo what he called a kind of “re-birthing” process in which the trauma of childbirth was resolved and the neurosis alleviated (Lieberman, 1985).  According to Taft, this emphasis upon definite limits on the duration of the therapeutic process forces patients to use their wills to struggle against the will of the analyst and in order to gain individuation and internal freedom. Based on her admiration for Rank and her positive experiences in therapy, Taft drew extensively from her personal experience in psychoanalysis in order to incorporate these ideas into her version of social work practice (Taft, 1933; Robinson, 1962).  Her conclusion after several years of using these methods in child and family counseling was that time limited treatment is effective in assisting social work clients resolve their psychological difficulties by gaining insight and understanding about the origins and development of their inner conflicts(Taft, 1933).      Even more significant is the fact that the assumption underlying her approach to time limited treatment is that its “briefness” is the option of the helper and thus could be determined in the clinical encounter and adapted as needed to varying lengths, extending from days to weeks and even months if deemed necessary by the helper (Robinson, 1962).

                                                The Views of Reynolds    

     Reynolds received  psychoanalytic treatment from Dr. Frankwood Williams, a Rankian therapist, and not directly from Rank (Reynolds, 1991).  Possibly because of her prior experience in experimental child guidance programs, Reynolds developed a research oriented approach in her efforts to understand the concept of brief interventions.  In her discussions we find no references, as in Taft’s work, to notions of Rankian rebirth and struggle. Instead she presents us with an objective description of the merits and uses of time-limited contacts in social work treatment.  According to Reynolds, rather than rely upon theory, philosophy, or personal experience, it is necessary to pose research questions to be answered experimentally in order to validate the effectiveness of the time-limited approach (Reynolds, 1934). To this end, Reynolds conducted two studies of brief interventions set up by private child welfare agencies.  In the first she sought the answer to the question: can case closings be planned in advance?  In the second, she explored the question: can client self-determination be effectively enhanced through the use of “short-contact interviewing”, even contacts as short as a single interview or a few interviews over the course of several days? (Reynolds, 1934, 1991).  To answer these questions, Reynolds stressed the importance of focused investigation in order to gather data in order to choose between competing hypotheses.  She reviewed over one hundred cases closed by the social agencies for which she worked at the time in order to gather the necessary data.  The last step in this research process was the analysis of this data and its implications in order to draw conclusions to serve as guides to further action, as well as help with the refinement and improvement of existing practice (Reynolds, 1934, 1991).  Her conclusions from these two studies were similar to Taft’s:  brief contact treatment was effective, even in the course of a single contact or contacts extending over two or three days as mandated by the agency (Reynolds, 1991).  However unlike Taft, Reynolds based such conclusions, not upon her personal experience, but on evidence gathered through scientific observation, testing, and verification.  She also demonstrated that what was then seen as “extremely” brief contacts could be clinically proven to be effective even if the helper had no flexibility in adjusting the duration of the relationship. (Reynolds, 1991).                                                                                                                                                                                                                                                                                                                          

                                                      Two Clinical Discourses

     What is the significance of these contrasting approaches to the study of time limits in social work treatment?  Both Taft and Reynolds demonstrated the value and viability of time-limited methods in social work treatment in the early 1930’s, even though these methods did not become fully adopted by the profession as a whole until the 1980’s (Reid, 1988, 2002).  Both Taft and Reynolds were thus pioneers in this regard, since they each regarded time-limited treatment as an organizational opportunity to be used to bolster client motivation and improve client functioning (Taft, 1962, Reynolds, 1991). The principal difference between their approaches is the way in which each conducted and then analyzed the results of their interventions.  Their efforts to publicize their results in this regard helped to launch the beginnings of two important clinical discourses in social work practice.  The first (Taft’s) I will call “experiential” because of its stress upon direct clinical experience and practice wisdom as sources for all genuine knowledge about social work intervention. The second approach (Reynold’s) I will dub “experimental”, because of its stress upon basing practice upon evidence gathered by observation, hypothesis testing and experimentation.  Historically these approaches developed into two of the principal mainstays of social work practice and have had various labels over the years, such as “functional” and “diagnostic” (Kasius, 1950), “heuristic” and “positivistic” (Tyson, 1994) and, more recently, “authority based” and “evidence based” (Gambrill, 1999). 

     Foucault has stressed that such styles of clinical discourse are communication systems that can become guiding frameworks for clinical thought, perception and action, that basically rest upon differing views of reality (Foucault, 1975).  For Taft, it was the clinical interaction with the client which was the basic ground of all truth in the helping encounter.  She therefore never ceased to stress the crucial importance of direct, personal experience in generating the evidence on which practice wisdom must be based.  It is not true that Taft ignored experiment because for her the clinical interaction itself was the experiment, and the only trustworthy source of clinical realities (Robinson, 1962). Reynolds, on the other hand, stressed such values as rationality, prediction, precision, control, objectivity, neutrality, and a commitment to helping the poor and marginalized by promoting constant social progress through clinical study and research (Reynolds, 1934, 1991),

     Drawing upon the work of C. P. Snow, we might even say that the basic assumptions guiding the clinical discourses utilized by Taft and Reynolds represented two particular “cultures” (Snow, 1963, pp. 16-17) that emerged in the 1930’s and which are still experienced  today in various versions of social work practice. Taft can be seen as powerfully representing a culture characterized by an artistic or “literary” sensibility, distinguished by passion, belief, insight, personal experience, commitment, and a pervasive empathy for all seekers of personal growth and inner freedom.   Reynolds, in contrast, can be viewed as a strong advocate for the culture of “science”, as exemplified by her emphasis upon scientific method, experimentally derived knowledge, and well tested evidence.  While finding a middle ground between these viewpoints has proved difficult, since the adherents of each culture felt their particular worldview was the correct one, adherents of each viewpoint have lately become reconciled to the fact  that larger world views incorporating both cultures are now necessary to advance the state of social work practice (Reid, 2002).

     Nevertheless, these dichotomies have gradually ceased to be meaningful in social work as each approach has gradually been seen to compliment the other rather than oppose its principals.  In addition, both the experiential and experimental approaches are now seen, not as opposites, but as essential to the joint advancement of social work method (Reid, 2002).  Still, it still helpful to recall that the origins of this debate in the work of Taft and Reynolds rested upon contrasting views that remain important for social work today.

                                                            Conclusion                                                                                                                                                                                                  

     The experiential approach pioneered by Taft ruled the roost in social work practice until the 1950’s. At that point it began to be questioned both by advocates of crisis theory and other social work thinkers concerned about research studies that demonstrated the ineffectiveness of traditional (i. e. experientially based) social work treatment methods.  Spurred by these findings, various social work writers and theorists then resurrected the experimental approach of Reynolds, including her methods used to demonstrate the value of time-limited treatment (Reid, 1988; Reid and Epstein, 1972).  This development in turn inspired research efforts that reintroduced Reynold’s version of “short-contact” interviewing into social work theory and treatment, thus confirming her earlier conviction that these brief, task-oriented methods represented a cutting edge contribution to the whole field of the human services, particularly in the areas of health, mental health, and rehabilitation (Kotrla, 2005).

     Nevertheless the work inspired by Taft and Reynold’s original examination of time- limited methods lives on.  Today the voice of Taft is represented in social work by the many advocates of post-modern, critical, and social constructionist  perspectives in social work practice, while today’s versions of Reynold’s approach is heard loudly and clearly in the evidence-based practice movement in social work, which currently appears uppermost in the field.  Though some issues remain unresolved and others have been eclipsed by the passage of time, attempts to blend these two social work cultures still continue apace (i.e., Klein & Bloom, 1995).  It therefore might benefit current social work practitioners to reconsider the approaches to time limits by the two authors discussed here to revisit the locus of the original seeds of both some key conflicts and major achievements in the profession.  In this way the grounds for further reuniting of these ideas might be discovered in new concepts at once as practical and pregnant with  suggestions as the original efforts of these two pioneers. 

                                                         References

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Gambrill, E. (1999). Evidence-based practice: an alternative to authority-based practice.

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     New York: Family Service Association of America.

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Kotrla, K. (2005).  Social work practice in health care: the need to use brief interventions.

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Lieberman, E, J.(1985).Acts of will, the life and work of Otto Rank. New York:Free Press.

Reid, W.J. & Epstein, L. (1972).Task-centered casework. New York: Columbia U.Press.  Reid, W. J. (1988). Brief task-centered treatment.  In R. A. Dorfman (Ed.), Paradigms

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Reynolds, B. C. (1991). An uncharted journey.  Silver Spring, MD: NASW Press.

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Comments

  • allisonmurdach  On September 23, 2010 at 7:56 am

    This article was written several years ago and submitted to some social work journals but not accepted for publication. Since I believe the issues the article discusses are still important, I would appreciate your comments. Thank you.

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