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

There are not a few therapies that, based on 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 within the psychoanalytic approach, is focal psychodynamic therapy , characterized by being a brief therapeutic alternative and focusing on priority problems of the patient.

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

  • Related article: ” Types of psychological therapies

Focal psychodynamic therapy: what is it?

Focal psychodynamic therapy, also called brief psychodynamic therapy, is a form of treatment in which a target, called the focus, is visualized and the rest of the therapy sessions are worked on . By having very specific objectives, the scope of therapy is limited in their resolution.

This psychotherapy was developed by the group of Michael Balint, Paul H. Orstein and Enid Balint . In it, techniques such as selective forgetfulness and selective attention are made regarding the interpretation of the patient’s problems.

In this way, and according to the authors, it is possible to make the patient have a greater insight on the real cause of their suffering. Thus, once the patient understands the origin of their discomfort, it is possible to generate more lasting therapeutic changes.

The therapy, as we were saying, focuses on addressing a single problem or conflict in the patient, trying to reach its prompt resolution. Thus, it could be said that this psychotherapy takes into account the saying of ‘whoever covers a lot, does not squeeze’, that is, prefers to focus on one issue and make sure that it is solved before trying to change the whole internal world of the person .

Within this therapy, which is included within the psychoanalytic current, focus is understood as 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 defined. Brief therapies do not aim to reshape the patient’s broad personality, but to resolve one or a limited set of problems that the patient suffers, 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 tries to fix everything that generates discomfort to the patient has to be, necessarily, long. In addition, the changes will take place slowly , which can cause the patient to have no real perception of improvement and end up leaving therapy, frustrated by not seeing the desired changes.

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

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

Duration and application

As its name suggests, focal or brief psychodynamic therapy has a short duration. Although there are discrepancies between professionals, the most common is that they do not exceed 25 sessions , although ideally they should be a total of 14 sessions in which the therapy will take place. The first session would consist of the interview with the patient, being from the second to number 13 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 type of discomfort, but who are also working properly both socially, occupationally / academically and in life in general. It is used to show the person what has led him to have a series of symptoms and relate them to his emotionality.

Therefore, this therapy can not be applied to severe 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 disorders, since they can become chronic and require very deep and extensive changes. on the person.

Although, there are several studies that have applied this therapy in eating disorders, such as anorexia nervosa. Through the use of this therapy, problems related to its relationship with food can be solved, especially aspects related to calorie control.

Also, and especially related to their emotionality, this therapy works on brief aspects such as their feelings towards how they think others see them , lived childhood and thoughts when looking at themselves in a mirror or wearing clothes.

Requirements to work with her

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

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

The patient must have adequate impulse control , expected for his age and educational level, which is neither excessive nor scarce. You must also have an adequate tolerance for frustration, and manifest a degree of anxiety that is within levels that do not overflow your behavior or mental health. In case your anxiety was too high, it is recommended to apply a longer therapy, and to take various aspects of the person 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 having an adequate intellectual level , as well as non-pathological symbolization and abstraction capabilities. It is also desirable that you have a self-esteem that is neither too low nor excessive.

From all the characteristics that the patient must 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 them a high degree of discomfort, these must be addressed together 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 have a series of requirements that allow him to carry out this therapy. Among them is having been a patient in long-term psychoanalytic therapy. With this, the therapist will be able to grow as a professional, knowing how to clearly differentiate between his discomfort from that of the patients, and arranging a 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 easily applied therapy. The therapist must have a lot of clinical experience in prolonged psychodynamic treatments, which will serve as a prior basis for applying the brief version of these. It is recommended that, at first, you be supervised by another professional with more experience.

As for more personal attitudes, the professional must have a good detailed observation , at the same time being organized and knowing how to prepare good therapy planning. Only with the detailed observation of the patient’s discomfort will it be possible to detect what is the aspect of it that should become the focus of therapy. Along with this, you must have a good tolerance for frustration because, unfortunately, the entire internal world of the patient cannot always be fixed.

Differences between classical psychoanalysis and focal psychodynamic therapy

Although within the psychoanalytic stream, 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, it is intended to make profound changes in the person’s personality and degree of well-being. On the other hand, in focal psychodynamic therapy, which lasts for a short time, it is limited to changes in short-term modifiable aspects that may lead to an improvement in the person’s well-being and that the person can see them shortly after starting treatment.

Also, both types of therapies differ in terms of 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 it once.

The most classic psychoanalysis chooses to maintain a prudent distance with the patient’s family, to avoid possible interruptions throughout the therapy. In contrast, focal psychodynamic therapy attempts to have maximum contact with the patient’s social world, as long as it is convenient and facilitates an improvement in the person’s well-being.


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