Background

Brief individual psychodynamic psychotherapy evolved from psychoanalysis in the mid-twentieth century. Brief individual psychodynamic psychotherapy, like other psychodynamic treatments, is based on the principle that meanings play an important role in behaviour and illness. Although psychoanalysis is now a lengthy procedure usually requiring a number of years to complete, the early psychoanalytic literature, including Freud's first cases, contain histories of successful short analyses. In fact, during the first 30 years of psychoanalysis, it was unusual for treatments to extend beyond 1 year. (3) Ferenczi was the first analyst explicitly to advocate shortening psychoanalysis. He argued that it was impossible to be a neutral and non-directive therapist because any time the therapist spoke it interrupted and impacted on the patient's free associations. He advocated 'active therapy' a more directive, focused, and briefer treatment. Ferenczi collaborated with Rank in publishing The Development of Psychoanalysis,(4) which articulated the advantages of brief dynamic psychotherapy. Rank was the first explicitly to set a time limit on treatment.

Following the Second World War, the interest in psychoanalysis resulted in greater demand for psychotherapy and increased pressure to develop briefer treatments. In the mid-1940s in their report on the research project of the Chicago Institute of Psychoanalysis, Alexander and French advocated shortening treatment by decreasing the frequency of sessions in order to minimize regression. They proposed to focus treatment on the present rather than the past, using historical conflicts to inform the therapist in providing the best corrective emotional experience for the patient in the present.

In the United States, the community mental health movement of the 1960s, the increasing cost of mental health care, and most recently, the current rise of managed care; have stimulated efforts to find briefer forms of psychotherapy. Contemporary brief individual psychodynamic psychotherapy is heavily influenced by the British School's development of brief focal psychotherapy. Balint sponsored a workshop of experienced psychoanalytic psychotherapists, which initially focused on clinical evaluation and attempted to understand which patients might be suitable for briefer treatment. After Balint's death, Malan carried on the work of the group. At the Tavistock clinic, Malan developed and applied the principles of psychodynamic treatment to brief treatment, delineating methods for evaluating process and outcome variables. He emphasized the importance of therapeutic planning and the identification of a focal conflict.

Concurrently, Sifneos, at the Massachusetts General Hospital, was studying brief psychotherapy. (5,6) Many of his conclusions are similar to those of Malan. However, there are some differences. Sifneos developed 'short-term anxiety-provoking psychotherapy' as a technique and theory with strict inclusion and exclusion criteria for choosing patients. Davanloo broadened the focus of the brief psychodynamic psychotherapies to include more than one conflict. He also expanded the inclusion criteria to individuals with character pathology and chronic phobic and obsessional neuroses, and advocated actively confronting resistances. As in the other psychodynamic psychotherapies, Mann's time-limited psychotherapy identified a central issue related to the meaning of time, as the focus of the treatment. Mann related this to the patient's difficulties in confronting loss and separation and the reality of time and death. In the last two decades, brief psychotherapy has been increasingly research based. Strupp, Luborsky, and Horowitz have all introduced manualized psychodynamic treatments with substantial contributions to our research understanding of this treatment modality.

Cognitive therapy and interpersonal psychotherapy represent brief psychotherapeutic techniques greatly influenced by psychoanalysis, but with distinctly different approaches. Originally developed as short-term individual psychotherapies for the treatment of depression, they have now been applied much more broadly. While sharing many common elements with the psychodynamic model, these re-educative psychotherapies differ in their emphasis on model-specific case formulations, procedurally guided interventions, and education. They do not focus on transference and childhood experience.

Anxiety and Depression 101

Anxiety and Depression 101

Everything you ever wanted to know about. We have been discussing depression and anxiety and how different information that is out on the market only seems to target one particular cure for these two common conditions that seem to walk hand in hand.

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