We have trouble predicting what elements of a session clients will remember and use. Psychotherapy is an art because we do not yet have a sufficient language to describe all the subtle factors that shape how messages can be tailored to be received most optimally. Clients are idiosyncratic individuals, looking to feel understood, affirmed, normal yet special. Safeguarding against this risk requires considerable therapeutic finesse. The nature of the therapeutic relationship is riddled with ambivalence.
Clients seek an expert evaluation, yet they resent being held to a standard.
These pushes and pulls often make a straightforward, rational therapy plan unworkable. Managed care systems' insistence on brief, directive therapy compels greater empirical assessment of the limits of very time-limited therapy. Professionals who have aligned themselves with longer term therapy models are now endeavoring to demonstrate how many palliative brief therapies fail to effect lasting changes in clients. Providers must keep their defensiveness in check, and stay focused on the mutual objectives that guide their work. How managed care is dividing the helping professions.