Introduction

Interest in brief dynamic psychotherapy has flourished in recent years. The psychodynamic psychotherapies, including brief psychodynamic psychotherapy, aim to change behaviour through new understanding and the recognition of maladaptive patterns of behaviour enacted since childhood but not previously observed. Through this process, perceptions, expectations, beliefs, and, therefore, behaviours and feelings are altered. (1)

Historically, 'brief psychotherapy' and 'long-term psychotherapy' were used synonymously with 'supportive' and 'explorative' psychotherapy respectively. However, this is no longer accurate. Brief and long-term describe only the duration rather than the technique, focus, or goal of treatment. (2) The time limits of brief dynamic psychotherapy give it a unique character and distinguish it from long-term psychotherapy and psychoanalysis. Because of its limited goals, the brief dynamic psychotherapist must confront his or her ambitiousness and perfectionism as well as any exaggerated ideal of personality structure and function.

Psychotherapy in general, and brief individual psychodynamic psychotherapy in particular, is perhaps the most elegant form of micro-neurosurgery. Psychotherapy strives to alter behaviour with verbal interchange—fundamentally to change neurone A that used to connect to neurone B so it will now connect to neurone C. As in all of medicine, both non-specific and specific curative factors affect the outcome of this work. The non-specific curative factors—abreaction, the provision of new information, and maximizing success experiences—guide all forms of medical treatment including brief psychotherapy. Brief individual dynamic psychotherapy also has specific technical interventions and procedures above and beyond the non-specific curative factors. As in other medical therapies, there are contraindications and dangers in the use of this treatment.

In the present era of concerns about cost-effectiveness, managed care, and closely watched outcome measures, it is not sufficient to state 'the psychotherapy was a success but no change occurred.' Although the therapist in the individual psychodynamically derived psychotherapies does not 'require' behavioural change, the end result of the therapist's technical expertise is to achieve behavioural change, including changes in well being, physical health, social supports, and societal productivity as well as symptomatic relief. Behavioural change is not the 'tactical' concern of brief dynamic psychotherapy, however, it is the 'strategic' goal.

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