Short-Term Dynamic Psychotherapy: Evaluation and Technique

260 Pages·1979·4.79 MB·English

by  Peter E. Sifneos M.D. (auth.)

Short-Term
Dynamic Psychotherapy
Evaluation and Technique
TOPICS IN GENERAL PSYCHIATRY
Series Editor:
John C. Nemiah, M.D.
Psychiatrist-in-Chief, Beth Israel Hospital
and Professor of Psychiatry, Harvard Medical School
HYPNOSIS
Fred H. Frankel, M.B.Ch.B., D.P.M.
THE FRONTIER OF BRIEF PSYCHOTHERAPY
David H. Malan, D.M., F.R.C. Psych.
THE PRACTITIONER'S GUIDE TO PSYCHOACTIVE DRUGS
Ellen L. Bassuk, M.D., and Stephen C. Schoonover, M.D.
SOCIOCULTURAL ROOTS OF MENTAL ILLNESS: An Epidemiologic Survey
John J. Schwab, M.D., and Mary E. Schwab, M.D.
SHORT-TERM DYNAMIC PSYCHOTHERAPY: Evaluation and Technique
Peter E. Sifneos, M.D.
Short-Terll1
Dynamic Psychotherapy
Evaluation and Technique
Peter E. Sifneos, M.D.
Harvard Medical School
PLENUM MEDICAL BOOK COMPANY
NEW YORK AND LONDON
Library of Congress Cataloging in Publication Data
Sifneos, Peter E
Short-term dynamic psychotherapy.
(Topics in general psychiatry)
Includes bibliographical references and index.
1. Psychotherapy. I. Title. [DNLM: 1. Psychotherapy, Brief. 2. Interview,
Psychological. 3. Anxiety. WM420.3 S573s)
RC480.S45 616.8'914 78-27561
ISBN-13: 978-1-4684-3532-0 e-ISBN-13: 978-1-4684-3530-6
DOl: 10.1007/978-1-4684-3530-6
© 1979 Plenum Publishing Corporation
Softcover reprint of the hardcover 1st edition 1979
227 West 17th Street, New York, N.Y. 10011
Plenum Medical Book Company is an imprint of Plenum Publishing Corporation
All rights reserved
No part of this book may be reproduced, stored in a retrieval system, or transmitted,
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recording, or otherwise, without written permission from the Publisher
TO JEANNETTE
Understanding and warm
Tolerant and magnanimous
A tower of strength
A beloved sister
Foreword
Short-term psychotherapy, although brief, is not ephemeral. In the
decade or two of its existence, it has grown into a sturdy tree, and a
sign of its maturity is the fact that it is now the subject of an increasing
number of overview articles summarizing its literature and findings.
Yet it remains a young and vigorous discipline. Its pioneers have not
been elevated to a pantheon of venerable but mute immortals; on the
contrary, they are to be found at the forefront of the field, actively
contributing to the development of its theory and practice. This
volume is ample testimony to their continued creativity.
Dr. Sifneos has lectured and written extensively about short-term
anxiety-provoking psychotherapy (STAPP). Based on psychoanalytic
principles, STAPP aims to resolve pathological psychic conflicts and
help those suffering from them to learn new ways of being in their
most intimate relationships. It does so by actively focusing the
patients' sights on their Oedipal problems, and its effectiveness
(given a proper selection of subjects by specific criteria) has been
amply documented in controlled clinical studies.
One of the significant virtues of Dr. Sifneos's therapeutic tech
niques is that they can be systematically taught to the aspiring
psychotherapist. Dr. Sifneos has touched briefly on his procedures
here and there throughout his published writings, but detailed
information about his approach has been restricted to those fortunate
enough to have direct viva voce instruction through his didactic
lectures and clinical supervision. Now, in this volume, he devotes his
attention singly and entirely to the practical details of his method of
vii
viii Foreword
short-term psychotherapy and does so with a clarity that arises from
the demonstration of actual encounters with patients in therapeutic
interviews. Step-by-step, Dr. Sifneos takes the reader through the
evolution of the treatment process as this occurs with real individuals
undergoing therapy.
The careful study of his exposition will not in itself make one
an expert psychotherapist; that, of course, can come only from ap
plying one's knowledge in the active, repeated practice of the art.
But the reader can be assured of discovering exactly what he needs
to know and do to become proficient in the therapeutic method Dr.
Sifneos describes. That is the first and major step to effective and
lasting learning.
JOHN C. NEMIAH, M.D.
Preface
During the last few years, dynamic psychotherapies of brief dura
tion have suddenly become very popular. Although a few investiga
tors studied these kinds of treatment methods systematically over a
long period of time, and were convinced of their effectiveness, the
recent emphasis on primary care, the increased national health in
surance coverage, and the documentation which has been provided
pointing to tangible therapeutic results, even in patients with
serious neurotic difficulties, have aroused a great deal of interest in
these treatment modalities all over the world. The familiar criti
cisms from advocates of long-term psychotherapy are more sub
dued, and one hears less often the pompous pronouncement that
psychotherapy is unscientific. For all intents and purposes, there
fore, it seems that short-term psychotherapy is here to stay.
Time limitation is, of course, a crucial factor in all brief thera
pies, yet it is paradoxical that there is no consensus among the
workers in this field as to exactly what is me&.lltby this concept. It
should be emphasized from the start, however, that the primary
reason for shortening the time interval is not because of demands
that more services be made available to patients in the community
at large. Rather, the governing force behind any kind of therapeutic
intervention should be the documentation that it is a treatment well
suited to each patient's idiosyncratic needs. In this respect, certain
kinds of brief therapy are indeed indicated for a fairly large group
of well-selected patients.
Some of these issues have been dealt with in my book Short-
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x Preface
Term Psychotherapy and Emotional Crisis (Sifneos, 1972) in a more
general way. Because of a certain prevailing confusion, however,
and to avoid misunderstandings, I shall elaborate in the present
volume my ideas about short-term dynamic psychotherapy more
extensively. Furthermore, instead of writing only one chapter about
the evaluation of the patient and one on the technique, as I did in
my previous book, I shall concentrate on presenting as system
atically as possible the psychiatric evaluation of a well-selected
group of patients. In addition, I shall give a detailed description of
the technique of a specialized kind of. psychotherapy of short dura
tion, called "anxiety provoking." In order to illustrate convincingly
what I am discussing, I have used as many verbatim clinical vi
gnettes as possible so as not only to demonstrate as explicitly as I
can how short-term dynamic psychotherapy should be performed,
but also to encourage many therapists to utilize it in their everyday
practice.
Anxiety-provoking" psychotherapy utilizes the patient's anxi
II
ety as a motivating force to help him resolve his difficulties. Be
cause it is also short term in duration, it will be referred from now
on as STAPP (Short Term Anxiety-Provoking Psychotherapy).
STAPP is not the only kind of brief dynamic psychotherapy.
Malan (1976a,b,c) has described a technique of brief psychotherapy
which lasts up to 40 interviews. He has also demonstrated convinc
ingly and brilliantly that he obtains successful results even with pa
tients who have serious psychopathology and whom we would not
have considered to be good candidates for STAPP. Mann (1973),
with his 12-interview "time-limited psychotherapy," is able to deal
successfully with individuals who have problems with separation
and for whom his type of treatment is ideally suited.
Davanloo (1978) has ingeniously developed a broad-focused brief
dynamic psychotherapy for individuals with incapacitating phobias
and obsessive-compulsive symptomatology which, by creating a
therapeutic alliance and then dealing head-on with the defenses
over a period of several months, is able to help them deal with the
conflicts underlying their difficulties and to produce an impressive
psychodynamic resolution of their problems.
There are others who offer modified forms of brief dynamic
psychotherapy, such as Bellak and Small (1965), Barten (1971),
McGuire (1965a,b, 1968; McGuire & Sifneos, 1970), Notman,