Short-Term Psychodynamic Psychotherapy: An Analysis of the Key Principles

Views: 793
Ratings: (0)

In this book, Dr. Penny Rawson succeeds in showing short-term psychodynamic psychotherapy to be an authentic and accepted method of therapy. She roots the concept in tradition and also introduces the reader to the relevant contemporary literature. In examining several cases in detail she draws out the key principles involved to present these in a clear and concise manner and demonstrates aspects of the method in practice. This book is both an excellent introduction and in depth exposition so it is highly relevant to the experienced practitioner or student. It will appeal to people both lay and professional who have an interest in an approach to therapy that is condensed but not diluted.'This book concentrates on short term psychodynamic psychotherapy. It aims to discover and analyse the key principles involved. It also aims to enrich the understanding of an approach to therapy that is already of benefit to many in our community, but that could reach very many others if it were better known and understood.'- From the Introduction.

List price: $31.99

Your Price: $25.59

You Save: 20%

 

11 Slices

Format Buy Remix

CHAPTER ONE: Why this book? A personal and contextual perspective

ePub

Whathat is focal and short term psychotherapy? This is a question that I am frequently asked by professional counsellors, therapists and lay people and this is what inspired me to write this book.

I am asked the question because it is an approach that I practise and believe in. It is an approach that I teach and write about and have appeared on TV to talk about in Carlton TV’s programme “What Therapy”—November 1990 and again in March 1995.

“So, what is it?” I know that the approach I have come to practise is called focal and short-term psychotherapy—but how to explain it to other professionals. How do they not know of its existence? Very many people are practising a brief approach—but often due to external pressures. These are often caused by economic factors. GPs may restrict their counsellors to six sessions per client, and colleges and employee assistance schemes often restrict therapists to six or eight sessions or less. The Tavistock Clinic has an Adolescent Unit where sessions are restricted to four. All of these do so for economic reasons, i.e. scarcity of counsellors /therapists in relation to the client demand.

 

CHAPTER TWO: Setting the parameters

ePub

Terminology and definitions

Before I move onto the expansion of my chosen methodology for the study, it seems appropriate to clarify some of the terminology with definitions. This is as important for the knowledgeable practitioner as it is for the lay person. The field of psychotherapy is not an exact science where there are clear definitions agreed as a basis for development of argument.

I am therefore declaring the definitions, which will set the parameters for my arguments. Firstly, I am making no distinction here between the terms “psychotherapy” and “counselling”. I therefore use the words counselling/therapy/psychotherapy interchangeably. In terms of counselling, I refer to psychodynamic counselling that is, according to Feltham and Dryden, a method of counselling that draws on the psychoanalytic tradition and expects to employ “concepts of the unconscious” such as “resistance and transference” and uses techniques such as “free association” dreams and “interpretation” (1993, p. 147).

 

CHAPTER THREE: Theoretical framework and methodology

ePub

If my conclusions in this book are to carry real weight in the therapeutic community then they must be seen to evolve from a rigorous study that can withstand academic scrutiny. This chapter therefore is primarily aimed at those who wish to reassure themselves in this way. It outlines the methodology and theoretical framework used to direct the analysis of the literature and selected case studies. It sets the scene for the cycles of analysis that follow and which systematically build up a picture of what makes short term therapy short. I hope that the reader who prefers to get straight to the discoveries will feel free to move swiftly to the next chapter, but for those who want to know how I came to these particular cycles of analysis I continue here.

In this study I seek to derive and analyse the key principles in short-term psychodynamic therapy as it emerges from the selected case work and the literature. To achieve this, a pluralistic approach, within a qualitative framework, has been adopted.

 

CHAPTER FOUR: Findings from the initial cycles of analysis

ePub

This chapter reports the findings from the first phase of the analysis. It is organized as follows:

Section A. Summary of fieldwork

Section B. The empirical data

i) Key themes from the analysis of my selected cases

ii) Key themes from a combination of my own cases and those of colleagues

Section C. The data emerging from the literary sources

i) Key proponents

ii) The developmental context of brief psychodynamic therapy

iii) The key themes emerging from the literature

Section D: Empirical data: key themes from analysis of the cases against themes from literature

Section E. Reflections on the initial findings

Section F. A reflective process to select key themes for further analysis

Section A. Summary of fieldwork

The first stage was to undertake case work that would become the focus of detailed analysis. Eleven cases were examined in total, eight from my own college practice, two from a colleague within the same college and one case from another therapist (AM) in private practice. The rationale for the way that the case material has been used and presented has been discussed in the last chapter. In summary Case “I” is to be seen in full in Chapter 6 and extracts from the other cases are used in the detailed examination of the key themes. Three commentaries written by the clients also appear in full in Chapter 6, Clients M, C and “I”.

 

CHAPTER FIVE: Part One:Analysis of the emergent key themes: findings from the in-depth cycle of analysis

ePub

The last chapter showed the findings from the cycles of analysis leading to the selection of key themes. In the first part of this chapter the findings from the in-depth cycle of analysis are reported. Each of the key themes listed below is examined in turn to elaborate clearly what is understood by each of these from the case work, key proponents and literature. Although some inchoate conclusions emerge spontaneously these are in no way comprehensive since that is not the purpose of this section.

Although in the early cycles of analysis, the casework was examined before turning to the literature, in this section I have chosen to outline the work of the key proponents and the findings from the literature first. This is to emphasize that the clinical team’s empirical work stands on and within a tradition and at times moves on and beyond the confines of that same tradition in keeping with a dynamic process.

The second part of this chapter gives a summary of the findings from the analysis of key themes and preliminary conclusions which will be examined further in later chapters.

 

CHAPTER FIVE: Part Two: Summary of the findings from the in-depth analysis of the key themes and provisional conclusions

ePub

This section summarizes the main findings and provisional conclusions about each of the key themes studied above and highlights the significance of the subsidiary themes.

5.2.1. What is understood by short-term?

The examination of the empirical work suggests that between four to six sessions is the median to aim for, in the short-term approach described. The average number of sessions in this small sample was 6.6. This differs from the key proponents who expect to have considerably more sessions and despite the lack of a general consensus in the literature many expect the median to be from 15-25 sessions. The brevity of my examples suggests that within this clinical work there exist clues as to the shortening of therapy.

Since there is no consensus as to the number of sessions in the literature, Budman and Gurman conclude that the terms “time sensitive” or “cost-effective” are useful in describing short-term therapy.

5.2.2. Psychodynamic roots

The form of therapy referred to in this book is, as Malan puts it, a “technique of brief psychotherapy based on that of psychoanalysis” (1976, p. 281). The casework supports this view by revealing examples of transference, resistance and transference repetitions. However whilst highlighting the psychoanalytic backcloth this approach goes beyond its roots and also adopts a flexible and integrated use of other therapeutic skills and assumptions borrowed from other traditions to shorten the process. It also shows different ways of dealing with some of the psychoanalytic concepts such as the use of a teaching approach to circumvent the resistance. This is one example of teaching and in analysing both cases and literature the sensitivity of the therapist was also evidenced. Both of these were subsidiary themes highlighted in the clinical work and in this further examination were seen in both the case work and in the literature.

 

CHAPTER SIX: Client commentaries: C, M and 1 and a complete case example: Case I

ePub

What clients C, M and I said about their experience of short-term therapy

Having analysed the individual elements of short-term therapy and the key components that make for the shortening process, this chapter gives three examples of how the process is experienced by clients: see commentaries 6.1 Client C, 6.2 Client M and 6.4 Client I. Extracts of these have already been used to illustrate earlier points. Here the commentaries are included in full, without further comment, and allowed to speak for themselves. Clients C and M’s commentaries are followed by a case example where many of the key elements are seen to be integrated in a real situation.

Case I has been selected for inclusion here, in its entirety, because it is a case already in the public forum as a result of a court case. This therefore minimizes problems related to confidentiality referred to earlier.

Client I’s commentary is also included in full after the case report.

The case demonstrates how the key principles outlined in Chapter 5 are used in an integrated way to achieve a very positive outcome in a limited number of sessions. It is one of the longer cases examined and therefore enables a wider range of skills to be demonstrated than would be possible in one of the cases with maybe only four sessions, which have been used to demonstrate various points in the earlier sections.

 

CHAPTER SEVEN: The analysis within the wider context of the latest thinking in the field

ePub

The last chapter included client commentaries and an example of a complete case to show how my discoveries fit within the real context. The reader has now had the opportunity to partially assess the veracity of my findings by reading Case I in full. Since other possibilities and avenues may subsequently have emerged, it is important to turn attention again to the task in hand. That is to find and analyse the key principles of short-term psychodynamic psychotherapy and what it is that especially contributes to the shortening of the process.

Summary of key themes

In order to refocus I am summarizing below the headings under which the themes have been studied and the principles that have emerged from my analysis so far:

What is understood by short-term? Psychodynamic roots; Flexibility; Activity; Focus; Therapeutic alliance; Importance of the first session.

Summary of the subsidiary themes and their place within brief therapy

The subsidiary themes were initially elicited from the clinical work and were subsequently also seen in the literature. These are features which do not so much stand alone as permeate the clinical work. As I reflected on the findings from both cases and literature it became clear that a further heading is required as below.

 

CHAPTER EIGHT: Inconsistency in the “universal characteristics” seen in the literature

ePub

The last chapter located my findings within the latest literature in respect to the key themes and it pointed to gaps. This chapter returns to the literature, both recent and less recent, to examine a number of different broad statements that Austad refers to as “assumptions that guide most short-term work” that are revealed there (1995, p. 27). These too point to the need for the more comprehensive overview that my findings provide. They also raise a number of questions.

Some of the descriptions, found in particular in the later literature, imply a general consensus as to the key elements of brief therapy but, although there is some overlap, each includes and excludes different features. For example Pollack et al. refer to “the standard techniques of brief dynamic psychotherapy” and include: “the maintenance of a focus, early and repeated work in the transference and a high activity level on the part of the therapist” (1991, p. 203). Christoph, Barber and Kurcias, on the other hand, refer to “a prototypic view of definition” (1991, p. 3). They suggest that if a therapy is to be termed “brief dynamic therapy” it must have the following five criteria: psychoanalytic origins, with regard to both concepts and techniques; a time limit; patient selection; and increased therapist activity in order to maintain a focus. Hoyt in his summary of the “most frequently cited generic components of brief treatment” adds some different facets. He refers to a rapid working alliance, focality, activity and patient participation, stress on patient strength, expectation of change; his “here-and-now (and next) orientation” has already been challenged in the previous chapter (1995, p. 284).

 

CHAPTER NINE: Concluding chapter: Brief psychodynamic psychotherapy: A contextual framework and key principles

ePub

The previous chapter examined a variety of broad statements, which are to be found in the literature, with regard to the essential ingredients of brief therapy, but there is not a consistent view. This chapter gives a brief overall picture of the process leading to my conclusions and issues arising from these.

In order to try and avoid some of the pitfalls observed with the aforementioned generalizations I need to find a way of articulating my findings in a concise and accessible way. My conclusions also need to be set in the context of the research process and certain limitations of the study clarified. However I do not plan to reiterate the limitations that have already been pointed out in the methodology section such as the limited number of cases in the empirical work or bias in view of these coming from my colleagues clinical practices and my own, but rather draw attention to some more general limitations. These limitations are of a broader nature and wider application but are none the less relevant. I point to some of the strengths of the process also. Then follows a final formulation of my findings. This takes into account the whole process of the investigation, from the empirical work undertaken and the work of the key early proponents, to setting these findings against the views of the newer proponents and more recent revisions of the pioneers. Following this concise and clear exposition of the key principles and shortening factors in brief therapy, which answered my initial questions, a new insight as to this shortening process unexpectedly emerged. I share with the reader some reflections on the process that led to the final conjecture.

 

APPENDIX

ePub

MALAN, David (1963) (1976)

FRC Psych, formerly Consultant Psychiatrist, Tavistock Clinic (1992, p. iii).

WOLBERG, Lewis (1965) (1980)

Clinical Professor of Psychiatry. New York University School of Medicine. Founder and Emeritus Dean, Postgraduate Center for Mental Health, New York (1980, p. i).

MARMOR, Judd (1980)

Franz Alexander Professor of Psychiatry, University of Southern California School of Medicine, Los Angeles, California (1979, p. 149).

ROGAWSKI, Alexander (1982)

Clinical Professor, Department of Psychiatry and Biobeha-vioural Science, School of Medicine, University of California at Los Angeles; Professor of Psychiatry (Emeritus), School of Medicine, University of Southern California, Los Angeles, California (1982, p. 331).

KOVACS, Arthur (1982)

Ph.D … California School of Professional Psychology, Los Angeles (1982, p. 142).

BUDMAN, Simon (1983)

Director of Mental Health Research at the Harvard Community Mental Health Plan and a faculty member in the department of Psychiatry at the Harvard Medical School. Boston Massachusetts (1983, p. 939).

 

Details

Print Book
E-Books
Slices

Format name
ePub (DRM)
Encrypted
true
Sku
9781780497099
Isbn
9781780497099
File size
0 Bytes
Printing
Disabled
Copying
Disabled
Read aloud
No
Format name
ePub
Encrypted
No
Printing
Allowed
Copying
Allowed
Read aloud
Allowed
Sku
In metadata
Isbn
In metadata
File size
In metadata