Overview of Brief Psychoanalytic Therapy
Brief psychodynamic psychotherapy or brief psychoanalytic therapy or brief psychotherapy is a time-limited treatment based on psychoanalysis and psychodynamic theory. Persons with depression, anxiety disorder, and posttraumatic stress disorder are the beneficiaries of Brief Psychoanalytic Therapy. For permanent solution of most psychoneurosis, we prefer psychotherapy like psychoanalysis. However, psychoanalysis has a long course. It may take four or five sessions per week over 3 to 8 years or longer. Other newer techniques like psychoanalytic psychotherapy requires one session in a week for several years. This type long therapy often produces obstacles for cure of the patients. Many cannot continue this for various reasons. Many professionals also experience hazards of this this type of long therapy. As a result, we need a therapy that will serve the purpose of psychoanalysis and will be shorter in duration. To meet these demands, Brief Psychoanalytic Therapy was introduced. If we can execute this therapy successfully, this will provide us many benefits. The patient will get quicker resolution of psychological distress at a shorter duration and smaller cost. The health professionals will have a shorter waiting list and they will be able to offer dedicated services for more patients. Brief psychoanalytic therapy needs a neurotic, motivated, and focused patient. Treatment of severe personality disorder is not possible by this therapy. The length of treatment in brief psychoanalytic therapy is usually about 12 to 40 sessions. However, many techniques can end the therapy in 12 to 16 sessions. To work in such a short time frame, it is necessary to have focused goals to address. Although short-term therapies use similar theories and approaches like long-term therapists, their techniques are different. Where usual psychoanalysis makes use of free association, brief therapy do not use this technique. Rather, they are straightforward and prefer to ask questions, to restate, to confront, and to deal quickly with transference issues. There are several methods of brief psychoanalytic therapy. Each methods have own treatment technique and specific criteria for treating patients. Most techniques are near about similar. Brief psychoanalytic therapy has gained widespread popularity among patients and health professionals.
Types of Brief Psychoanalytic Therapy
- Brief Focal Psychotherapy
- Time Limited Psychotherapy
- Short-Term Dynamic Psychotherapy
- Short-Term Anxiety-Provoking Psychotherapy
Brief Focal Psychotherapy
Goal of Brief Focal Psychotherapy: This therapy clarifies the defense behind the conflicts, the anxiety, and the impulse. This therapy links the present, the past and the transference of the patient.
Selection criteria for Brief Focal Psychotherapy: Patient must be able to think and have high motivation. The patients who show good response in trial interpretation are also selected for this therapy.
Rejection criteria for Brief Focal Psychotherapy: patients with frequent self-harm and suicidal attempts and destructive activity, dependence to drugs, chronic alcohol abuse, chronic obsession hampering day to day works, chronic phobic symptoms
Duration of treatment: Up to one year, nearly 20 sessions
Focus of Brief Focal Psychotherapy: Internal conflict present since childhood
Technique of Brief Focal Psychotherapy: at first, the therapist identifies the character of transference early, interprets it, and helps starting the negative transference. Then, they link the transferences to patient’s relationships to their parents. New relation should bond the patient and therapist deeply. The therapist and patient must be ready to bear the ensuing tension. Therapist should have keen attention on focus and set a termination date in advance. The patient should work through grief and anger about termination.
Termination of Brief Focal Psychotherapy: at a definite date set at beginning of treatment.
Time Limited Psychotherapy
This psychotherapeutic technique terminates exactly at 12 sessions.
Goal of Time Limited Psychotherapy: resolution of the present and chronically endured pain and the patient’s negative self-image
Selection criteria for Time Limited Psychotherapy: patient with high ego strength, patient who can engage and disengage, good therapist who is able to identify a central issue quickly
Rejection criteria for Time Limited Psychotherapy: persons with major depressive disorder, acute psychotic patients, and desperate patients who cannot tolerate object relations
Duration of treatment: 12 interviews
Focus of Time Limited Psychotherapy: Present pain and chronic pain present for long duration, Particular image, either low or high image of the self
Technique: The therapist determines patient’s central conflict correctly and explores childhood maturational crises with many psychological and somatic complaints. Here therapist lets positive transference to predominate early. Therapist specifies the central issue involving transference and makes the patient adhere strictly to the central issue involving transference. The therapist makes a maturational event for separation of patient. The therapist terminates therapy within 12 interview to avoid development of dependence. The therapist clarifies present and past experiences and resistances. The therapist support, encourage patient and educate patient to remove conflicts and gain self-esteem. Direct information, reeducation, and manipulation are the key gain those targets. The conflicts which are likely to be encountered include independence versus dependence, activity versus passivity, unresolved or delayed grief, and adequate versus inadequate self-esteem.
Termination of Time Limited Psychotherapy: Specific last session set at beginning of treatment
Short-Term Dynamic Psychotherapy
Goal of Short-Term Dynamic Psychotherapy: Resolution of conflict regarding unconscious sexual attraction to the parent of opposite sex, conflicts about loss of focus, or multiple foci
Selection criteria for Short-Term Dynamic Psychotherapy:
Psychological minded patient, patient who established meaningful relationship previously, patient who can tolerate affect, patient with high motivation, responsive in trial transference, without splitting, with flexible defenses, with no projection, and no denial
Duration of treatment: 5 to 40 sessions, usually 5 to 25, longer durations for seriously ill
Technique of Short-Term Dynamic Psychotherapy:
According to the needs, control and regressive tendencies of the patient the therapist deigns the therapy. The therapist does active intervention to avoid development of overdependence on a therapist. The therapist also reminds the patient’s intellectual insight and emotional experiences in the transference. These emotional experiences become corrective because of the interpretation by the therapist.
Termination of treatment: No specific termination date but patient is told that treatment will be short.
Short-Term Anxiety-Provoking Psychotherapy
Goal of Short-Term Anxiety-Provoking Psychotherapy: Resolution of conflict regarding unconscious sexual attraction to the parent of opposite sex
Focus of Short-Term Anxiety-Provoking Psychotherapy: Oedipal (triangular) conflict
Selection criteria for Short-Term Anxiety-Provoking Psychotherapy: patient with average intelligence, having past meaningful relationship, with high motivation, having chief complaint that indicate specific disease, patient can interact with evaluator, patient can express feelings and patient is flexible
Duration of treatment: a few months
Short-Term Anxiety-Provoking Psychotherapy has four major phases: patient therapist encounter, early therapy, height of treatment, and evidence of change and termination. Therapists use the following techniques during the four phases.
Patient Therapist Encounter
As the patient is intelligent enough, the therapist makes a quick and working alliance with the patient by using the patient’s quick rapport. The therapist builds positive feelings for the therapist that appear in this phase. The therapist uses open-ended and forced-choice questions judiciously to outline and concentrate on a therapeutic focus. The therapist tells the patient minimal expectations of outcome of the therapy.
When transference appears, the therapist clarifies it to the patient. This leads to the establishment of a true therapeutic alliance.
Height of the Treatment
Here therapist concentrates on the conflicts, which are our therapeutic focus. The therapist repeatedly asks anxiety-provoking questions and confrontations. This leads to avoidance of pre-genital characteristic and logical issues. Patient gives theories to defend and avoid dealing with the therapist’s anxiety-provoking techniques. Avoidances create transference neurosis. We repetitively demonstrate the patient’s neurotic ways or maladaptive patterns of behavior. We concentrate on the anxiety-laden material provided by the patient. We interpret the materials given by the patient and show the transference links to the patient. Then, we establish corrective emotional experience, encourage and support the patient, as the patient becomes anxious while struggling to understand the conflicts. We will continue to demonstrate the patient new learning and problem-solving patterns, repeated presentations and recapitulations of the patient’s psychodynamics until the patient understand the defense mechanisms used in dealing with oedipal conflicts.
Evidence of Change and Termination of Psychotherapy
This is the final phase of therapy. The therapist demonstrates changes in the patient’s behavior outside therapy. The therapist initiates talk about termination of the treatment.