There is pressure now for all treatments to be introduced in shortened form so that they can be planned and delivered within a specified time frame. This is not always appropriate – a collaborative treatment naturally sets its own timetable and external control in the form of rigid time control is not conducive to genuine collaboration.

Nevertheless, it is always useful to try and distil the essentials of a psychological treatment wherever possible as it can help to remove redundancies. This chapter therefore concentrates on the four core stages of nidotherapy that, if absolutely necessary and in less complex cases, may be concentrated into four sessions with a great deal of therapist homework to be carried out in between sessions. For more complex cases it will not be possible to complete a nidotherapy programme with this level of input but this period should be sufficient to at least create a nidotherapy strategy that enables others to continue the therapy afterwards. Longer-term therapy will be needed for fractious and temperamental patients who need to be cajoled and encouraged into treatment when it suits them, so many contacts may appear to be wasted at first. If encouraging and positive feedback is given whenever progress is made it may also build up a trusting alliance.

The duration of each of these stages can vary between 1 hour and many weeks, and contact with the patient can be supplemented by other sessions for training staff who are dealing with the patients concerned or with others such as relatives or friends. It is important to appreciate that if the sessions are to be reduced in number the amount of work to be carried out by the therapist will be increased. Most of this will be necessary between sessions but it can take many forms and it is better to think of the intervening periods between sessions as continuing treatment. Although the description of each component may suggest that only one session is needed, the reader should accommodate a much more flexible time frame when reading about each intervention. It is also assumed that the preliminary work described in chapter 2 has been carried out and that the patient is judged suitable for a nidotherapy intervention. Each of the sessions is accompanied by a checklist that may be useful as an aide-memoire.