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

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

Among these currents, still encompassed within the psychoanalytic approach, is focal psychodynamic therapy , characterized by being a brief therapeutic alternative and focusing on the patient’s priority problems.

Although it has a clear relationship with the rest of psychodynamic therapies, it also has nuances that differentiate it from the more classic psychoanalysis, giving it some advantages and limitations. Next we will see what this peculiar therapy is all 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 an objective, called a focus, is visualized, and the rest of the sessions that make up the therapy 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, use is made of techniques such as selective forgetfulness and selective attention regarding the interpretation of the patient’s problem.

In this way, and according to the authors, it is possible to make the patient have greater insight about the real cause of his suffering. Thus, once the patient understands the origin of his 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 ‘who covers a lot, does not squeeze’, that is, prefers to focus on a single issue and make sure that he resolves it before trying to change the whole internal world of the person .

Within this therapy, which is included within the psychoanalytic current, a specific problem is understood as a focus , on which the efforts and attention of both the patient and the therapist will be focused during the sessions. This focus must be specific, nothing ambiguous and clearly defined. The brief therapies are not aimed at reshaping the broad personality of the patient, but the resolution of 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 causes the patient discomfort must necessarily be long. In addition, the changes will occur slowly , which can cause the patient not to have a real perception of improvement and end up abandoning therapy, frustrated by not seeing the desired changes.

Along the same lines as the authors previously mentioned, there are many others who point out the convenience of focusing or focusing the 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 is the focus that 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 therapeutic goal originally set.

Duration and application

As its name suggests, the 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 the ideal would be that they were a total of 14 sessions in which the therapy will be carried out. The first session would consist of the interview with the patient, being 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 functioning correctly both socially and labor / academic and in life in general. It serves to make the person see what has led him to have a series of symptoms and relate them to his emotionality.

Thus, this therapy can not 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 disorders, since they can become chronic and require very deep and extensive changes in the person

Although, there are several studies that have applied this therapy in eating disorders, such as anorexia nervosa. By using this therapy, you can solve problems concerning your relationship with food, especially aspects related to calorie control.

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

Requirements to work with her

In order to be able to carry out focal psychodynamic therapy 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 to refer to another professional , such as a psychiatrist or family doctor when I give up.

Within the characteristics and requirements that the patient should meet in order to be able to apply a focal psychodynamic therapy, it is necessary that he have a good awareness of psychopathology, or suffering from a problem. He must 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 their 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 overwhelm your behavior or mental health. In case your anxiety is too high, it is recommended to apply a longer therapy, and that several aspects of the person, whether experiences or personality traits, be taken as the center.

Finally, within the most convenient characteristics that the patient must present in order to carry out this therapy, there is an adequate intellectual level , as well as non-pathological symbolization and abstraction capabilities. It is also desirable that you have a self-esteem neither too diminished nor excessive.

Of 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 to undergo this type of therapy. In addition to suffering from disorders that produce a high degree of discomfort, they must be addressed together with psychopharmacology.

On the other hand, so that the therapy can be carried out in the most appropriate way, it is necessary, of course, that the therapist has a series of requirements that allow him to carry out this therapy. Among them, is having been 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 discomfort and that of the patients, and providing a good management of the countertransference.

Although the profile of the most suitable patient for this therapy is that of 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 preliminary basis to apply the short version of these. It is recommended that, at the beginning, you are supervised by another professional with more experience.

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

Differences between classical psychoanalysis and focal psychodynamic therapy

Although within the psychoanalytic current, focal psychodynamic therapy differs from the more classic 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 personality and degree of well-being of the person. On the other hand, in focal psychodynamic therapy, whose duration is short, is limited to changes in modifiable aspects in the short term, which may lead to an improvement in the well-being of the person and that the person can see them shortly after the treatment begins.

Also, both types of therapies differ in the amount 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 prudential distance with the patient’s family, to avoid possible interruptions throughout the therapy. On the other hand, in the focal psychodynamic therapy, we try to have maximum contact with the patient’s social world, as long as it is convenient and facilitates an improvement in the well-being of the person.

by Abdullah Sam
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