The Frontier of Brief Psychotherapy: An Example of the Convergence of Research and Clinical Practice(Topics in General Psychiatry)

When I was a psychiatric resident not long after the end of World War II, any patient with the wits to get himself to a psychiatric clinic was taken into long-term dynamically oriented psychotherapy. Regardless of his diagnosis or clinical need, he was seen once, twice, sometimes even more frequently a week in fifty-minute sessions. Face-to-face with the therapist, he was urged to free associate and to express his dreams, fantasies, and emotions to a usually passive listener in what often appeared to be a caricature of psychoanalysis. It was not psychoanaly- sis, of course (although the differences were sometimes hard to define), but the aims were the same-to resolve psychic conflicts through in- sight and to bring about an internal psychological change that would allow the individual to work more effectively and to make healthier and happier relationships. Enough patients improved with these techniques to reinforce our penchant for using them. We were somehow able to ignore the fact that because of the limitations of time many patients withered on the waiting list. And we were able to blame our frequent therapeutic f ilures, not to mention the damaging regressions our narrowly re- stricted techniques often induced, on the patient's unwillingness to cooperate. Procrustes's couch was as inflexible as his bed. Old customs die hard, and the mindless application of long-term therapy is still found in clinical situations where it is inappropriate or contraindicated. But change is in the air.

Table of Contents:
I The Place of Brief Psychotherapy in Psychotherapeutic Services.- 1 What Should Psychotherapists Be Doing?.- 2 The Practical Application of Brief Therapeutic Methods.- II Previous Work.- 3 BRIEF THERAPY SINCE 1960: I The Work of Sifneos.- 4 Brief Therapy Since 1960: II.- III The Present Work.- 5 Results of the Second Study of Brief Psychotherapy.- 6 The Psychodynamic Assessment of Outcome.- 7 Criteria for Rejection.- 8 The Clinical Material.- IV The Principles of Brief Psychotherapy.- 9 Selection.- 10 The General Aims of Psychoanalytic Therapy.- 11 Planning and Technique.- 12 Clinical Examples.- V Extending the Limits of Brief Psychotherapy.- 13 The Use of More Than One Focus.- 14 Partial Foci in More Disturbed Patients.- 15 Deeper Therapy in More Disturbed Patients.- 16 Some Contraindications.- VI Conclusion.- 17 The Present Position.- References.