Clinical implications of research on brief dynamic psychotherapy II. How the therapist helps or hinders therapeutic progress.

In this second of a two-part article, we describe how the therapist's interpretations promote therapeutic progress. Any therapist behavior that is in accord with the patient's plan will be helpful to the patient, but interventions that are at cross purposes with the patient's plan will not be helpful. The implications of the plan concept for brief dynamic therapy are described and contrasted with other key technical, concepts such as transference interpretations, therapeutic alliance, and interpretive activity. The importance of understanding the patient's plan and intervening in accord with it are illustrated in several case vignettes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Personality styles and brief psychotherapy.

Reviews the book, Personality styles and brief psychotherapy by Mardi Horowitz, Charles Marmar, Janice Krupnick, Nancy Wilner, Nancy Kaltreider, and Robert Wallerstein (1984). This book by Horowitz and his colleagues falls in the category of psychodynamic psychotherapy, and in fact lies very close to the heart of traditional, but updated, forms of psychoanalytic psychotherapy. Clinicians who have attempted to master ego-analytic psychotherapy will recognize key concepts in this book that are germane to traditional therapy. These include: stressful events that precipitate psychopathology in specific personality types; the concept of wish, defense, and the dynamic compromise behavior/attitude; patterns of defensive organization and cognitive style typical of personality types; therapeutic tactics related to those personality patterns; and the triad of insight-transference relationship, current relationships, and parental relationships. Horowitz's book has value for a number of overlapping purposes. It should be included in a course on short-term therapy, it is an up-to-date and sophisticated review of personality theory, it is important in the empirical refining of psychodynamic technique, short- or long-term, and it is essential for an understanding of how psychotherapy research is indeed beginning to have a significant impact on psychotherapy theory and technique. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Teaching time-limited dynamic psychotherapy for post-traumatic stress disorder and pathological grief.

The authors' experience with a model of time-limited dynamic therapy for posttraumatic stress disorder (PTSD) and pathological grief has evolved over more than a decade of work that preceded formal manuals delineating treatment principles. Their accumulated experiences in training using this model suggests that a minimum of 2 yrs training in psychodynamics and psychopathology, supervised long-term dynamic psychotherapy experience, and some familiarity with brief therapy approaches is essential prerequisite knowledge. Because training needs to be sequential, they suggest the use of previous cases illustrating nuances of techniques with different personality styles, different levels of adaptive functioning, and implications of each of these factors for conducting treatment. They suggest liberal use of previously recorded cases in the context of ongoing tracking of adherence to a manual. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Brief psychodynamic and cognitive therapy regarding acute treatment.

Cognitive–behavioral therapy (CBT) and psychodynamic psychotherapy either in their pure forms or possibly synthesized as a form of eclectic therapy appear to be the 2 most commonly utilized forms of psychotherapy, both having levels of empirical support. As the majority of outpatient therapy in America appears to be very brief, 1 reasonable assumption is that treatment is often sought for resolution of acute episodes. A relevant question for practice and clinical training is what are the potential implications with brief psychodynamic and cognitive therapy for this type of treatment? This brief commentary will address the following: (a) the current general differential empirical status of each approach; (b) distinctions between acute treatment and traditional brief therapy and current common treatment patterns; and (c) the general clinical mechanisms for change for each approach and their potential implications regarding acute treatment and clinical supervision. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Brief Integrative Therapy Comes of Age: A Commentary.

On the basis of a review of 4 contemporary models of brief integrative psychotherapy-short-term restructuring psychotherapy, cognitive behavioral analysis system of psychotherapy, time-limited dynamic psychotherapy, and a therapy integrating cybernetic systems, existential-phenomenology, and solution-focused narrative approaches-a set of common factors is articulated and a distinction between unitary and dialectical common factors is introduced. That therapy is essentially experiential and that a necessary agent of change is the patient's experience, particularly of new, positive interpersonal experiences, is a major area of agreement among the models. The paper concludes with a discussion of a transformational model of mutual influence, which supports a therapeutic stance that goes beyond responsiveness, to explore therapist initiative in the co-construction of dyadic interpersonal patterns. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The general practice of psychology.

Psychology has developed a variety of specific techniques that are applicable to specific emotional problems, thus enabling brief psychotherapy to be particularly effective. In the past it was said that therapist and patient had only one chance to solve present and future emotional distress, a criterion applied to no other form of intervention. By combining dynamic and behavioral therapies into intervention designed to ameliorate the presenting life problem, using a multimodal group practice, professional psychology can define its own area practice. This general practice of psychology postulates that throughout the life span the client has brief, available, effective interventions designed to meet specific conditions as these may or may not arise. When such techniques are available, brief psychotherapy is the treatment of choice for about 85% of those seeking help, leaving long-term therapy for those clients who are best benefited by a protracted intervention. (11 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The practice of brief therapy.

Examined therapist, patient, and system attitudinal factors in brief therapy practice. Attitudinal factors in brief and long-term therapy are contrasted, and technical treatment issues, patient selection, dangers, and future issues in brief therapy are discussed. Salient technical issues in brief psychotherapy include the maintenance of a clear and specific focus, a high level of therapist activity, flexible use of interventions, and encouragement of client activities outside therapy. Rather than presenting brief therapy as a specific school or model of treatment, an attempt is made to integrate various approaches that can make therapy beneficial within a well-planned, limited amount of time. (58 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relation of patient pretreatment characteristics to the therapeutic alliance in diverse psychotherapies.

The prediction of the therapeutic alliance from patient pretreatment characteristics was investigated with a sample of elderly depressed outpatients treated in behavioral, cognitive, and brief dynamic psychotherapy (N?=?60). For the sample as a whole, a higher degree of patient defensiveness was related to a lower patient contribution to the alliance as reflected in patient commitment and working capacity. Also, the availability of environmental support was positively associated with greater patient commitment across treatment conditions. The association of patient pretreatment characteristics with alliance was similar across behavioral and cognitive therapy and less similar across brief dynamic and behavioral or cognitive therapy. The nature of the therapeutic alliance in diverse treatment modalities is discussed, and implications for selection criteria and technical strategies for engaging the difficult patient are explored. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapy integration in Portugal.

In answering five questions regarding the status of psychotherapy in Portugal, predominant theoretical orientations, standing of psychotherapy integration, and cultural issues, the author draws a brief sketch of the situation of psychotherapy in Portugal. It is stressed the increasing number of patients seeking therapy as well as the increasing number of professionals providing it, and a growing dialogue between psychologists and psychiatrists. In terms of theoretical orientations, the dominant ones are the analytic/dynamic and the cognitive-behavioral with an increasing number of therapists leaning towards integration. In terms of cultural issues relevant to psychotherapy, it could be said that a significant number of patients deal with issues related to the question of balancing "cooperation/proximity" and "agency/competitiveness," as well as matters of unassertiveness. From the standpoint of the author, major lessons learned from being in Sepi are flexibility, humility, sharing, and something close to the "bearable lightness of being..." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Brief psychotherapies: Principles and practices.

Reviews the book, Brief psychotherapies: Principles and practices by Michael F. Hoyt (2009). Despite the evident desire of many clients to address their issues in as time-efficient manner as possible (even one session), most therapists are trained to deliver psychotherapy via longer-term models of practice. Although more graduate programs than in the past are beginning to offer training in brief therapy, in many instances this is a one course elective without related practical experience. Hoyt’s book provides a wide-angle overview of the field of brief therapy, as well as an up close look at one of its most prominent models (Solution-Focused Therapy). In doing so, it could serve as a centerpiece for courses in brief psychotherapy. Time sensitive therapy fits in a time sensitive world—a world in which both the clients and funders of services want problems to be addressed in as focused a way as possible. This book teaches therapists a great deal about how to navigate in that world. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapy sensitive to spiritual issues: A postmaterialist psychology perspective and developmental approach.

Like many psychological topics, psychotherapy that is sensitive to spiritual issues can be viewed from both materialist and postmaterialist perspectives. After a brief discussion of some scientific and philosophical considerations distinguishing materialist and postmaterialist views, a 4-level model of consciousness and its theoretical and practice implications for spirituality sensitive psychotherapy is described. Well-being therapy, which reflects a postmaterialist perspective, is described and illustrated with case material. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Models of brief psychodynamic therapy.

Reviews the book, Models of brief psychodynamic therapy by Stanley B. Messer and C. Seth Warren. This book is suitable for supplementary reading in a graduate psychotherapy course, and is intended for graduate students in the field of clinical and counseling psychology. It is also intended as a concise reference work on brief psychodynamic therapies for clinicians who are or wish to practice in the newer mode of limited goals and limited sessions. The authors consider drive theory based psychotherapy treatment, as well as integrative and eclectic models of brief psychodynamic therapy. In consideration of each of the various approaches, Messer and Warren have primarily concerned themselves with four issues as a focal point of their analysis: (a) the theory of pathology involved; (b) the development of a clinical focus; (c) patient selection considerations, including indications and contraindications; and (d) typical techniques associated with the treatment involved. This text is an excellent addition to the literature, primarily for adjunct reading in graduate courses on psychotherapy. It also affords the opportunity for psychodynamically oriented clinicians to address a need for an overview and grounding in brief treatment models. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A Behavioral Approach to the Case of Ms.S.

This article provides a behavioral formulation and treatment plan for the case of Ms. S (see record 2005-02680-005). Given the complexity of Ms. S and the status of current research, interventions proposed emphasize empirically supported principles of change over any specific protocol. This particular behavioral approach incorporates aspects of dialectical behavior therapy and functional analytic psychotherapy in addition to more traditional behavior therapy. The utility of the therapeutic relationship in this approach is described (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Split-Ego Experience of Africans: Ubuntu Therapy as a Healing Alternative.

Countries of a multicultural nature, such as South Africa, tend to experience challenges whenever psychotherapy is involved, because most training in psychotherapy is based on Western and European models of illness, health, and healing. Applying the Western- and European-based principles of illness and health to non-Western or non-European clients tends to result in conflict, which is explored in this article. Most African communities operate on the principle of ubuntu, a concept that broadly refers to communality, oneness, cooperation, and sharing. The article proposes an alternative psychotherapy called ubuntu therapy that is based on the ubuntu concept and is aimed at incorporating the African culture into psychotherapy. This article explores the values and traditions inherent in the ubuntu concept and their influence on the conceptualization of mental health problems. On the basis of these values, a model of conducting ubuntu therapy is presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A case of depression: Introducing David.

A brief overview of the client, David, is presented. David participated in a short-term emotion-focused therapy for the treatment of depression. In this paper the client’s presenting problems and history are described to provide a context for the brief excerpt that follows. The excerpt is taken from his first session of psychotherapy and was used by the four different therapists to develop a case formulation illuminating their specific orientation so that these could be contrasted and compared. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Words were originally magic.

Reviews the book, Words were originally magic by Steve de Shazer (see record 1994-97917-000). This book is written from both a philosophical and clinical perspective. It deals with the importance of language in psychotherapy. The author sets the foundation relative to language structure, meaning, and therapeutic change modalities in preparation for the discussion of brief problem focused psychotherapy. Case examples from actual therapy sessions are then presented in illustration of therapy process and outcome. The reviewer believes that this book has significant relevancy for current practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of core conflictual relationship themes before psychotherapy and during early sessions.

This report shows (a) that the Core Conflictual Relationship Theme (CCRT) can be rated reliably either from therapy sessions or from a special pretreatment interview in a group of depressed patients, and (b) that the CCRTs obtained before treatment are similar to the CCRTs extracted from the early sessions of brief dynamic psychotherapy. The data suggest that, at least in the early sessions of treatment, the therapist's influence did not significantly alter the patients' CCRTs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Becoming solution-focused in brief therapy.

Reviews the book, Becoming solution-focused in brief therapy by John L. Walter and Jane E. Peller (see record 1992-97355-000). With this book, the authors' goal was to produce a manual to aid therapists in learning the model of constructing solutions in brief therapy. Theoretical assumptions about personality development and psychotherapy technique which are crucial to implementing the model are presented. Walters and Peller work within a framework which assumes that problems are maintained by individuals functioning in family and organizational systems and that these individuals have the resources to change personal behavior. Interactional patterns between individuals in various systems are the focus of attention. The book is a clear and consistent portrayal of a therapy approach which is growing in application. It is readable and practical. In summary, this is an effective book which demonstrates alternate theories (exceptions) which could provide an almost miraculous solution to some troubled clients. Advanced graduate students and active practitioners will find this a helpful book in learning the model of constructing solutions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A Modest Proposal: Guidelines for Lengthening Psychotherapy.

Despite growing evidence regarding the efficacy of brief treatment (Sloane, Staples, Cristol, Yorkston & Whipple, 1975; Smith, Glass & Miller, 1980) and survey data that indicate that most outpatient psychological therapy in this country is relatively short term (Pardes & Pincus, 1981), some therapists still view brief treatment as second class, palliative care. It is to that staunch and hardy population of mental health practitioners that this article is directed. For those who see red at the mention of brief therapy, I offer a series of guidelines that will assist them in truly differentiating themselves from colleagues who are too naive, too involved with their own self-interests, or too poorly analyzed to realize the fallacious quality of brief therapy. The following guidelines are meant only as a tentative framework for the lengthening of psychotherapy. It is hoped that the reader can use these in designing other equally effective interventions toward the same end. A therapist who truly wishes to sit with patients until they are cured may approach this goal by implementing the guidelines above. Perhaps patients who are uncured will grow and develop. Most assuredly they will become older. An important question for therapy researchers evaluating such long-term treatment should be whether those patients who die over the course of such lengthened therapy should be considered successes or failures. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of The complex secret of brief psychotherapy.

Reviews the book, The complex secret of brief psychotherapy by James Paul Gustafson (1986). This book attempts to synthesize the major findings of the last century in the field of psychotherapy, and to make these findings available to the clinician who is doing brief psychotherapy. Gustafson uses the major portion of the book to review briefly the work of nineteen individuals and groups who have contributed to his thinking about the effective doing of and the effective teaching of brief psychotherapy. Most theorists or schools are presented through the prism of one case study, followed by a brief discussion of the method employed, and then the presentation of a case in which this particular approach was utilized. This book has a number of things to recommend it. The author is engaged in psychotherapy research, and the appendix contains extensive material on his formulations of cases, work with patients, and follow-up interviews. All of the case material in the book, including the author's own cases and those he chooses to present from the work of others, is very valuable. For the advanced clinician, this material forms a solid resource. For the beginning clinician, case material of this kind can be very intriguing and very helpful. The book might be somewhat difficult conceptually for the beginning clinician, though, or for the clinician beginning to do brief psychotherapy. In addition, the writing style is problematic. Gustafson's ideas are generally sound and worthy of consideration, but are at times presented poorly. His conceptualizations can be difficult to follow, and his writing style does not adequately convey such difficult material. (PsycINFO Database Record (c) 2010 APA, all rights reserved)