Brief dynamic psychotherapy technique Evaluation and setting

The evaluation is particularly important in brief individual psychodynamic psychotherapy because of the need for rapid and accurate assessment. In contrast to longer-term treatments, brief individual psychodynamic psychotherapy does not offer the luxury of time to re-evaluate and correct mistakes. Although at times we think of psychotherapy as beginning as soon as the doctor sees the patient, this is a hyperbole, used to underscore the importance of interpersonal and transferential elements in the initial meeting with the patient. In fact, it is extremely important, particularly in brief individual psychodynamic psychotherapy, to distinguish the diagnostic interviews from the ongoing treatment. The interventions and technical procedures performed during the evaluation phase, usually one to four sessions, are substantially different from the technical aspects of brief individual psychodynamic psychotherapy itself. The evaluation phase includes the diagnosis, consideration of the interaction among the patient's ego strength, physical health, and selection variables, and the treatment recommendation, including considering the option that no treatment is indicated.

As in all medical treatments, brief individual psychodynamic psychotherapy is given to patients rather than to diseases. The ability to participate in brief individual psychodynamic psychotherapy process requires the patient to be able to access his or her fantasy life in an active and experiencing manner (i.e. psychologically minded) and, importantly, is able to get up and leave this process behind at the end of a session and not be lost in reverie or uncontrolled fantasies or fears. Note that this does not mean the patient requires a 'high IQ'. In fact, a high IQ, when accompanied with rigidity, intellectualization, and rumination, as is often seen, can be a contraindication to a brief psychodynamic treatment since these defences can be quite formidable. The availability of interpersonal support in the patient's real environment and the patient's ability to experience and simultaneously observe highly charged affective states are necessary to a successful treatment. Individuals who are in an emergent crisis (e.g. imminently suicidal, psychotic, recent major life trauma) and therefore are very concerned and focused on the real events in their life cannot enter into a brief psychodynamic psychotherapy without first having a period of supportive treatment. A true life crisis does not allow the patient the opportunity to explore fantasies.

Negotiation with the patient is an important part of reaching a treatment decision in brief individual psychodynamic psychotherapy. The patient must rapidly feel a part of the treatment and committed to the process. The process of setting a time limit for the brief individual psychodynamic psychotherapy at the beginning of the treatment can be an important element in decreasing the drop-out rate from this form of treatment,(7) particularly with the patient who is concerned about dependency, 'becoming addicted' to the therapist, or who needs to maintain a substantial sense of control. With these patients, brief dynamic psychotherapy, with a time limit set at the beginning of the therapy, may allow the patient to begin treatment rather than avoid help. For brief individual psychodynamic psychotherapy it is particularly important to remember that what is dealt with in treatment can only be what the patient is able to bring into focus, what the patient can tolerate talking about, and what he or she can tolerate the therapist talking about.(8) Although this is not different than in other psychodynamic treatments, the limited time of brief individual psychodynamic psychotherapy means that there is limited ability to interpret multiple defences that might open new areas of exploration.

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Adult Dyslexia

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