Brief Psychoanalytic Therapy (BPT)
Background and aims
In developing BP, I have tried to refine how a rather specific developmentally grounded psychoanalytic therapeutic technique might be characterized and applied in the orm o a brie therapy. Te core developmental principle is that i a psychotherapist whom a patient implicates in his or her repeating patterns o relationship offers emotional understanding and containment, then ofen, but not always, changes in those patterns can be effected. reatment provides an opportunity or a patient to acquire new capacities to tolerate and think about difficult states o mind through the patient’s experience o the psycho- therapist’s capacity to encompass and think about the patient’s patterns o relatedness in treatment. When a patient internalizes what he or she experi- ences interpersonally, in relation to the therapist, then this alters the patient’s own potential or managing emotional difficulties.
Therapeutic approach
In BP there is a relatively restricted ocus upon the transerence relation- ship between therapist and patient. Te approach involves a particular way o working in the transerence, with a special ocus on moment-to-moment shifs in patient–therapist relatedness. It is not assumed that in a 16-session treatment, one needs to modiy/ampliy/complement transerence-based interpretative work, providing one respects the altered temporal ramework. Which is not to say that only interpretative work happens in BP.
Te first principle o technique is that the psychotherapist should be open to listen to the patient, in such a way as to register on an emotional level what is happening between the patient and therapist in the present encounter. Te therapist’s ocus is upon the ways in which a patient relates to the psycho- therapist him/hersel—to discern how the patient presents him/hersel as someone to be related to in particular ways, and to be sensitive to the patient’s efforts to establish and maintain his or her own emotional balance in order to avoid certain interpersonal-cum-intrapsychic difficulties or conflicts. Te second principle, which in a way is already embedded in the first, is that this ocus on the transerence should be inormed by the therapist’s analysis o the countertranserence, that is, his or her own emotional responses to the patient’s engagement.
reatment strategies are not prescribed, but therapists can consult a manual that illustrates how the particular orientation o BP is likely to be expressed in a therapist’s interventions. In particular, interpretations tend to be anchored in the here and now, with a ocus on how the patient experiences the t herapist,
THEMES AND VARIATIONS IN BRIEF PSYCHODYNAMIC PSYCHOTHERAPY 30
and on what the patient is trying to do to maintain his/her equilibrium. Te
therapist mostly comments on what is happening in current emotional trans- actions, ofen on the basis o evidence that is available or explicit comment, rather than inviting the patient to reflect on conjectures. Te approach does
not entail a specific, mutually ormulated ocus to which one returns (afer all,
the transerence is the ocus), and there is no written summary to share with the patient at the conclusion o treatment.
Here is dialogue rom a BP transcript that we shall revisit in Chapter 6: � (���� �����): I think that you do it here, too, you always talk … I was still
speaking and you really ormulated an answer. Just now as we have spoken, when I was saying that it is difficult or you to stay with the things that you don’t know, in the hope o connecting with you and helping you to stay with that, you then say, you then come back with a counter-argument and it is a way o getting away rom that conusion, not-knowing, panic.
�� (�������): I agree and I’m not gonna counter-attack or argue. Te thing is I eel that I would have too much to lose to just be, to just go with the flow and just show my eelings. Te shell that I have is probably very, very thick and it just …
�: You see it’s not as i you don’t, you’re not in touch with eelings or you don’t know these eelings, because you tell me about them, but then you move away rom it. For example, you tell me there’s conusion, you tell me that there are these eelings that you don’t like and you don’t want to approach them in your mind, you move away rom them. You say that the sessions are ending and that there are eelings about that; what then happens is that we don’t go deeper, you can’t explore them urther. You quickly move away to what you know …
Here the therapist and patient are (mostly) strongly engaged in eyeball-to- eyeball give-and-take, as the therapist registers and tracks current interper- sonal engagement and the states o mind such engagement seems to involve and to avoid.
Commonalities
Now one might say (and many a clinician might believe) that each o these treatments are very similar in that they are relationship-orientated talking therapies. It is not uncommon or critics o dynamic psychotherapy to com- ment wryly on psychotherapists’ heated disagreements over trivial distinc- tions. Tere is a view that all talking psychotherapies are much o a muchness.
Indeed, there are important commonalities among the approaches I have described. In each, a therapist and patient meet together ace to ace and