Short-term psychotherapy and Freud

Sigmund Freud’s first cases analyzed through the psychoanalytic method were short-term treatments, sometimes very short (E. Gilliéron, 1997): Emmy V.N. (7 weeks), Lucy R. (9 weeks), the famous Dora’s case (3 months). For this reason we can state that Freud was the ‘unconscious’ founder of what we call now short-term dynamic psychotherapy.

Sigmund Freud

At the beginning, ‘time’ was not a fundamental criterion of Freud’s technique: later, timelessness has been encouraged by Freud because it started to be considered as the organizing principle of the unconscious psychic dimension. What’s the best way to face the unconscious world of patients, if not using its very principle (timelessness) during psychotherapeutic treatment? Therefore, psychoanalysis transformed it into a no-limit treatment.

As we know, the father of psychoanalysis devoted himself to theoretical issues, rather than technical ones. Freud’s students and successors had a different opinion about it. As they were driven by emergency situations (as world wars), they founded short-term psychotherapy.

This kind of technique, as we’ll see, gave patients the possibility to change psychologically in a short time compared with the standard duration of psychoanalysis proper.

Among those psychoanalysts who broke out of classical Freudian theory and aroused short-term psychotherapy, we should mention Sandor Ferenczi, who gave the analyst an active role (psychotherapist should give directions to the patient, for example stimulating him/her to cope with his/her fears directly and to give up neurotic satisfactions). Psychoanalyst analyzed the interconnection between the early emotional relationships (past family ties) and the current relationships (included the one with the analyst): he also determined the end of the treatment. Repeating traumatic experiences in the psychoanalytic relationship, old past events, would have provided patients with the possibility of experiencing, elaborating and exceeding them.

Sandor Ferenczi

The vision of psychotherapy as a ‘corrective’ tool of psychic experience is part of Alexander’s technique (1946), Ferenczi’s alumnus and one of the most orthodox psychoanalysts, at the beginning. Psychoanalysts should stimulate a “corrective emotional experience” so that patients can remember, relive and record again old traumatic experiences in the current psychological relationship. This procedure determines the interruption of the compulsion to repeat (Sigmund Freud) and brings about, in the patient, the change that enables him/her to get out of the neurotic circle.

Moreover, Alexander started to modify the frequency of interviews in accordance with the kind of case he was treating. Furthermore, he gave the patient instructions about daily life and prepared him to the end of the therapy (e.g. with some interruptions just before the end of the treatment).

In 1941, the first congress on short-term psychotherapy took place in Chicago. In 1968, Bellak and Small, created the six-interviews technique (only for patients in severe conditions).

During those years, Balint, one of Ferenczi’s alumni, identified the factors that bring to a positive prognosis with regard to short psychoanalytical treatment, for example a strong desire to change by means of a better knowledge of oneself and the focusing on treatment.

Michael Balint

Balint’s technique is characterized by:

Face to face position (the Freudian sofa is no more used, patient and therapist are set face to face)
immediate decision to determine the end of the treatment
final formulation of a short fundamental psychodynamic hypothesis
active interpretation technique, by which it would be possible to select the elements relevant for the initial psychodynamic analysis and leave out the unnecessary ones.

Basically, short-term psychotherapy based on psychoanalytic approach is different from strict psychoanalysis for the following reasons:

Short-term treatment: it is decided at the beginning of the psychological relationship. Hence, interviews will be less numerous if compared with psychoanalysis;

Face-to-face setting: patients are no more set on a sofa, nor psychotherapists are set behind them;

Focus on current conflicts: current conflicts are always related to the old children’s conflicts.

Sifneos devised two different kinds of short-term psychoanalytical psychotherapy: the anxiety-provoking psychotherapy and the STAPP treatment. With the first one, Sifneos wanted to reduce anxiety level of patients; the second one, instead, was aimed at provoking anxiety to patients, making them aware of their own problems in order to finally solve them. These two kinds of short-term psychotherapy were sometimes tailored to specific patients: those who had a ‘genital’ neurosis (less severe condition), patients who had a good intellective level, ability to get in touch with therapists, patients with strong motivation to change themselves, and whose children’s experience was spangled with meaningful relationship with caregivers.
The end of treatment seems to break out the classical approach (with no end).

Davanloo, founder and pioneer of Short-Term Dynamic Psychotherapy, believed that, after the first interview, psychotherapist should be able to make a clinical diagnosis on clinical, dynamic and genetic levels. In his opinion, severely disturbed patients are those who respond positively to the short-term psychotherapy. This is why it is better not to fix a term to the treatment (which lasts 15-20 interviews). Criteria for patients’ selection are two: the motivation of patients and the focus on a primary conflict area.

Finally, I have to remind Gilliéron (1994, 1997), creator of a ‘meta-model’ in which psychotherapist-patient mutual influences, early diagnosis, precise and unchanging setting, and psychic change are fundamental. Psychic development and its three level (biological, psychological and social/cultural) represent the basis on which any kind of intervention should start.

According to Gilliéron, during the first four interviews, the psychotherapist should formulate a psychodiagnostic hypothesis that will lead (at the end of the fourth interview) to an initial diagnostic orientation about the patient’s personality and the consequent decision -in accordance with the necessities of the patient- as to the interruption or the continuation of the sessions, so that a short-term psychotherapy proper (inspired by the founder of psychoanalysis) might actually be started.