Focal psychodynamic therapy: what it is and how it is used

Focal psychodynamic therapy: what it is and how it is used

There are many therapies that, starting from the psychoanalysis closest to Sigmund Freud, have tried to address in various ways the suffering of patients and how to improve their psychological state.

Among these currents, still included in the psychoanalytic approach, we find the focal psychodynamic therapy , characterized by being a brief therapeutic alternative that focuses on the patient’s priority problems.

Although it has a clear relationship with the rest of psychodynamic therapies, this one also presents some nuances that differentiate it from the more classical psychoanalysis, giving it some advantages and limitations. Next we will see what this peculiar therapy is about.

Focal psychodynamic therapy: what is it?

Focal psychodynamic therapy, also called brief psychodynamic therapy, is a form of treatment in which a target, called a focus, is visualized and worked on for the rest of the sessions that make up the therapy. As it has very specific objectives, the scope of the therapy is limited in the resolution of these objectives.

This psychotherapy was developed by the group of Michael Balint, Paul H. Orstein and Enid Balint . It makes use of techniques such as selective forgetfulness and selective attention to the interpretation of the patient’s problems.

In this way, and according to the authors, it is possible to make the patient more insightful about the real cause of his or her suffering. Thus, once the patient understands the origin of his or her discomfort, it is possible to generate more lasting therapeutic changes.

Therapy, as we were saying, focuses on addressing a single problem or conflict in the patient, trying to reach a rapid resolution. Therefore, one could say that this psychotherapy takes into account the saying ‘he who embraces much, presses little’, i.e., he prefers to focus on a single issue and make sure he resolves it before trying to change the whole internal world of the person.

Within this therapy, which is included in the psychoanalytic current, , the focus is on a specific problem , on which the efforts and attention of both the patient and the therapist will be focused during the sessions. This focus must be specific, unambiguous and clearly delimited. Brief therapies do not aim to remodel the broad personality of the patient, but to resolve one or a limited set of the problems suffered by the patient, in a short period of time.

The internal world of each patient can be very extensive, which is why trying to solve everything that is dysfunctional can be a titanic task. A treatment that aims to fix everything that makes the patient feel unwell must necessarily be long. In addition, the changes will be slow , which may mean that the patient does not have a real perception of improvement and ends up abandoning the therapy, frustrated by not seeing the desired changes.

Along the same lines as the previously mentioned authors, many others point out the convenience of focusing or centering the therapeutic work on a certain area, symptom or problem of the patient, giving it the highest priority during treatment. This is why this type of therapy is called focal.

The psychotherapist, at the beginning of the therapy, has the great responsibility of deciding which is the focus that requires the highest priority, so that it is properly addressed throughout the treatment. However, it is the work of the patient-therapist tandem to accept and elaborate a therapeutic plan that can achieve the therapeutic goal originally set.

Duration and application

As its name suggests, focal or brief psychodynamic therapy is of short duration. Although there are discrepancies between professionals, the most common is not to exceed 25 sessions , although ideally there should be a total of 14 sessions in which the therapy will be carried out. The first session would consist of the interview with the patient, with the second to number 13 being the treatment itself and, number 14, the closing session. These sessions would be held once a week.

This therapy is highly recommended for patients who are suffering from some kind of discomfort, but who are still functioning well both socially and at work/academically and in life in general. It serves to make the person see what has led him/her to have a series of symptoms and relate them to his/her emotionality.

Therefore, this therapy cannot be applied to serious personality disorders or psychiatric problems . The reason for this is basically because the object of focal psychodynamic therapy is very limited and brief, something that is not convenient for the treatment of this type of disorder, given that they can become chronic and require very deep and extensive changes in the person.

However, there are several studies that have applied this therapy to eating disorders, such as anorexia nervosa. By using this therapy, problems concerning its relationship to food can be resolved, especially aspects related to calorie control.

Also, and especially related to their emotionality , this therapy works briefly on aspects such as their feelings about how they think others see them , their childhood and their thoughts when they observe themselves in a mirror or put on clothes.

Requirements for working with her

In order for focal psychodynamic therapy to be carried out as efficiently as possible, it is necessary for both the patient and the practitioner to meet a number of requirements. If this is not the case, it will be necessary to consider other types of therapeutic options or to refer to another professional , such as a psychiatrist or family doctor when necessary.

Among the characteristics and requirements that the patient should have in order to be able to apply a focal psychodynamic therapy, it is necessary that the patient has a good awareness of psychopathology, or of suffering from a problem. He must also understand that he has the responsibility and commitment of the evolution of this problem in the context of therapy. That is to say, it depends on his degree of motivation and desire to want to reach the resolution of the problem.

The patient should have adequate impulse control , which is expected for his/her age and educational level, and which is neither excessive nor scarce. He/she should also have an adequate tolerance to frustration, and manifest a degree of anxiety that is within levels that do not overwhelm his/her behaviour or mental health. In case his anxiety is too high, it is recommended to apply a longer therapy, and that several aspects of the person are taken as the center, whether they are experiences or personality traits.

Finally, among the most convenient characteristics that the patient must present in order to carry out this therapy, are the having an adequate intellectual level , as well as non-pathological capacities of symbolization and abstraction. It is also desirable to have a self-esteem that is neither too low nor too high.

Of all the characteristics that the patient should present, it can be understood that this type of therapy is recommended for patients with moderate discomfort. For example, a patient with a disorder as severe as schizophrenia or bipolar disorder would not be suitable candidates for this type of therapy. In addition to suffering from disorders that cause a high degree of discomfort, these should be addressed in conjunction with psychopharmacology.

On the other hand, for the therapy to be carried out in the most appropriate way, it is necessary, of course, that the therapist has a series of requirements that allow him/her to carry out this therapy. Among them is having been a patient in a long-term psychoanalytic therapy. With this, the therapist will be able to grow as a professional, knowing how to clearly differentiate between his or her own discomfort and that of the patients, and arranging for good management of the countertransference.

Although the most suitable patient profile for this therapy is someone who is not suffering from a serious mental disorder, this does not mean that it is an easy therapy to apply. The therapist must have a lot of clinical experience in prolonged psychodynamic treatments, which will serve as a previous base to be able to apply the brief version of these treatments. It is recommended that, at the beginning, he or she be supervised by another professional with more experience.

As for more personal attitudes, the professional must have a good observation of details , as well as being organized and knowing how to elaborate a good planning of the therapy. Only with the detailed observation of the patient’s discomfort will it be possible to detect which aspect of it should become the focus of the therapy. Along with this, he must have a good tolerance to frustration because, unfortunately, the whole inner world of the patient cannot always be fixed.

Differences between classical psychoanalysis and focal psychodynamic therapy

Although within the psychoanalytic current, focal psychodynamic therapy differs from more classical psychoanalysis for several reasons. Below we see the main differences between both types of therapies.

Within classical psychoanalysis, especially in relation to long-term therapies, the aim is to make profound changes in the personality and degree of well-being of the person. On the other hand, in focal psychodynamic therapy, whose duration is short, it is limited to changes in aspects that can be modified in the short term, which can mean an improvement in the person’s wellbeing and which he or she can see shortly after starting treatment.

Also, both types of therapies differ in the number of weekly sessions . Classic psychoanalysis requires a visit to the couch about three or four times a week, while in the case of focal therapy it is only necessary to do so once.

The more classic psychoanalysis chooses to maintain a prudential distance from the patient’s family, to avoid possible interruptions throughout the therapy. On the other hand, in focal psychodynamic therapy the aim is to have the maximum contact with the patient’s social world, as long as this is convenient and facilitates an improvement in the person’s well-being.

Bibliographic references:

  • García-Arzeno, M. E. (1997). Brief or focused psychoanalytic psychotherapy. Cuban Journal of Psychology. 14(1), 121-126.
  • Sánchez-Barranco, A. and Sánchez-Barranco, P. (2001) Short dynamic psychotherapy: clinical and conceptual approach. Journal of the Spanish Association of Neuropsychiatry. 21(78). 1013-1031.

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