Sunday, September 30, 2012

C.G. Jung on Archetypes and Adaptation

"Archetypes are systems of readiness for action, and at the same time images and emotions. They are inherited with the brain structure - indeed they are its psychic aspect. They represent, on the one hand, a very strong instinctive conservatism, while on the other hand they are the most effective means conceivable of instinctive adaptation. They are thus, essentially, the cthonic portion of the psyche...that portion through which the psyche is attached to nature."

C.G. Jung (1921) Psychological Types, The Collected Works of C.G. Jung, Vol. 6, par. 684, Princeton, NJ: Bollingen - Princeton University Press

Saturday, September 22, 2012

Jonathan Shedler - Distinquishing Characteristics of Psychodynamic Psychotherapies

Excerpted from Jonathan Shedler (2010) The Efficacy of Psychodynamic Psychotherapy, American Psychologist, Vol. 65, No. 2, pp. 98–109

Seven features reliably distinguished psychodynamic therapy from other therapies, as determined by empirical examination of actual session recordings and transcripts (note that the features listed below concern process and technique only, not underlying principles that inform these techniques; for a discussion of concepts and principles, see Gabbard, 2004; McWilliams, 2004; Shedler, 2006a):

1. Focus on affect and expression of emotion. Psychodynamic therapy encourages exploration and discussion of the full range of a patient’s emotions. The therapist helps the patient describe and put words to feelings, including contradictory feelings, feelings that are troubling or threatening, and feelings that the patient may not initially be able to recognize or acknowledge (this stands in contrast to a cognitive focus, where the greater emphasis is on thoughts and beliefs; Blagys & Hilsenroth, 2002; Burum & Goldfried, 2007). There is also a recognition that intellectual insight is not the same as emotional insight, which resonates at a deep level and leads to change (this is one reason why many intelligent and psychologically minded people can explain the reasons for their difficulties, yet their understanding does not help them overcome those difficulties). 

2. Exploration of attempts to avoid distressing thoughts and feelings.
People do a great many things, knowingly and unknowingly, to avoid aspects of experience that are troubling. This avoidance (in theoretical terms, defense and resistance) may take coarse forms, such as missing sessions, arriving late, or being evasive. It may take subtle forms that are difficult to recognize in ordinary social discourse, such as subtle shifts of topic when certain ideas arise, focusing on incidental aspects of an experience rather than on what is psychologically meaningful, attending to facts and events to the exclusion of affect, focusing on external circumstances rather than one’s own role in shaping events, and so on.  Psychodynamic therapists actively focus on and explore avoidances.

3. Identification of recurring themes and patterns. Psychodynamic therapists work to identify and explore recurring themes and patterns in patients’ thoughts, feelings, self-concept, relationships, and life experiences.  In some cases, a patient may be acutely aware of recurring patterns that are painful or self-defeating but feel unable to escape them (e.g., a man who repeatedly finds himself drawn to romantic partners who are emotionally unavailable; a woman who regularly sabotages herself when success is at hand). In other cases, the patient may be unaware of the patterns until the therapist helps him or her recognize and understand them.

4. Discussion of past experience (developmental focus). Related to the identification of recurring themes and patterns is the recognition that past experience, especially early experiences of attachment figures, affects our relation to, and experience of, the present. Psychodynamic therapists explore early experiences, the relation between past and present, and the ways in which the past tends to “live on” in the present. The focus is not on the past for its own sake, but rather on how the past sheds light on current psychological difficulties. The goal is to help patients free themselves from the bonds of past experience in order to live more fully in the present.

5. Focus on interpersonal relations. Psychodynamic therapy places heavy emphasis on patients’ relationships and interpersonal experience (in theoretical terms, object relations and attachment). Both adaptive and nonadaptive aspects of personality and self-concept are forged in the context of attachment relationships, and psychological difficulties often arise when problematic interpersonal patterns interfere with a person’s ability to meet emotional needs.

6. Focus on the therapy relationship. The relationship between therapist and patient is itself an important interpersonal relationship, one that can become deeply meaningful and emotionally charged. To the extent that there are repetitive themes in a person’s relationships and manner of interacting, these themes tend to emerge in some form in the therapy relationship. For example, a person prone to distrust others may view the therapist with suspicion; a person who fears disapproval, rejection, or abandonment may fear rejection by the therapist, whether knowingly or unknowingly; a person who struggles with anger and hostility may struggle with anger toward the therapist; and so on (these are relatively crude examples; the repetition of interpersonal themes in the therapy relationshipis often more complex and subtle than these examples suggest). The recurrence of interpersonal themes in the therapy relationship (in theoretical terms, transference and countertransference) provides a unique opportunity to explore and rework them in vivo. The goal is greater flexibility in interpersonal relationships and an enhanced capacity to meet interpersonal needs.

7. Exploration of fantasy life. In contrast to other therapies in which the therapist may actively structure sessions or follow a predetermined agenda, psychodynamic therapy encourages patients to speak freely about whatever is on their minds. When patients do this (and most patients require considerable help from the therapist before they can truly speak freely), their thoughts naturally range over many areas of mental life, including desires, fears, fantasies, dreams, and daydreams (which in many cases the patient has not previously attempted to put into words). All of this material is a rich source of information about how the person views self and others, interprets and makes sense of experience, avoids aspects of experience, or interferes with a potential capacity to find greater enjoyment and meaning in life.

The last sentence hints at a larger goal that is implicit in all of the others: The goals of psychodynamic therapy include, but extend beyond, symptom remission. Successful treatment should not only relieve symptoms (i.e., get rid of something) but also foster the positive presence of  psychological capacities and resources. Depending on the person and the circumstances, these might include the capacity to have more fulfilling relationships, make more effective use of one’s talents and abilities, maintain a realistically based sense of self-esteem, tolerate a wider range of affect, have more satisfying sexual experiences, understand self and others in more nuanced and sophisticated ways, and face life’s challenges with greater freedom and flexibility. Such ends are pursued through a process of self-reflection, self-exploration, and self-discovery that takes place in the context of a safe and deeply authentic relationship between therapist and patient.

Thursday, September 20, 2012

Jonathan Shedler - Robust Empirical Support for Psychodynamic Treatment

Abstract: "Empirical evidence supports the efficacy of psychodynamic therapy. Effect sizes for psychodynamic therapy are as large as those reported for other therapies that have been actively promoted as "empirically supported" and "evidence based." In addition, patients who receive psychodynamic therapy maintain therapeutic gains and appear to continue to improve after treatment ends. Finally, nonpsychodynamic therapies may be effective in part because the more skilled practitioners utilize techniques that have long been central to psychodynamic theory and practice. The perception that psychodynamic approaches lack empirical support does not accord with available scientific evidence and may reflect selective dissemination of research findings." (p. 98)

Discussion: "One intent of this article was to provide an overview of some basic principles of psychodynamic therapy for readers who have not been exposed to them or who have not heard them presented by a contemporary practitioner who takes them seriously and uses them clinically. Another was to show that psychodynamic treatments have considerable empirical support. The empirical literature on psychodynamic treatments does, however, have important limitations. First, the number of randomized controlled trials for other forms of psychotherapy, notably CBT, is considerably larger than that for psychodynamic therapy, perhaps by an order of magnitude. Many of these trials—specifically, the newer and better-designed trials—are more methodologically rigorous (although some of the newest psychodynamic randomized controlled trials, e.g., that of Clarkin et al., 2007, also meet the highest standards of methodological rigor). In too many cases, characteristics of patient samples have been too loosely specified, treatment methods have been inadequately specified and monitored, and control conditions have not been optimal (e.g., using wait-list controls or "treatment as usual" rather than active alternative treatments—a limitation that applies to research on empirically supported therapies more generally). These and other limitations of the psychodynamic research literature must be addressed by future research. My intent is not to compare treatments or literatures but to review the existing empirical evidence supporting psychodynamic treatments and therapy processes, which is often underappreciated.

In writing this article, I could not help being struck by a number of ironies. One is that academicians who dismiss psychodynamic approaches, sometimes in vehement tones, often do so in the name of science. Some advocate a science of psychology grounded exclusively in the experimental method. Yet the same experimental method yields findings that support both psychodynamic concepts (e.g., Westen, 1998) and treatments. In light of the accumulation of empirical findings, blanket assertions that psychodynamic approaches lack scientific support (e.g., Barlow & Durand, 2005; Crews, 1996; Kihlstrom, 1999) are no longer defensible. Presentations that equate psychoanalysis with dated concepts that last held currency in the psychoanalytic community in the early 20th century are similarly misleading; they are at best uninformed and at worst disingenuous.

A second irony is that relatively few clinical practitioners, including psychodynamic practitioners, are familiar with the research reviewed in this article. Many psychodynamic clinicians and educators seem ill-prepared to respond to challenges from evidence-oriented colleagues, students, utilization reviewers, or policymakers, despite the accumulation of high-quality empirical evidence supporting psychodynamic concepts and treatments. Just as antipsychoanalytic sentiment may have impeded dissemination of this research in academic circles, distrust of academic research methods may have impeded dissemination in psychoanalytic circles (see Bornstein, 2001). Such attitudes are changing, but they cannot change quickly enough. Researchers also share responsibility for this state of affairs (Shedler, 2006b). Many investigators take for granted that clinical practitioners are the intended consumers of clinical research (e.g., Task Force on Promotion
and Dissemination of Psychological Procedures, 1995), but many of the psychotherapy outcome studies and meta-analyses reviewed for this article are clearly not written for practitioners. On the contrary, they are densely complex and technical and often seem written primarily for other psychotherapy researchers—a case of one hand writing for the other. As an experienced research methodologist and psychometrician, I must admit that deciphering some of these articles required hours of study and more than a few consultations with colleagues who conduct and publish outcome research. I am unsure how the average knowledgeable clinical practitioner could navigate the thicket of specialized statistical methods, clinically unrepresentative samples, investigator allegiance effects, inconsistent methods of reporting results, and inconsistent findings across multiple outcome variables of uncertain clinical relevance. If clinical practitioners are indeed the intended "consumers" of psychotherapy research, then psychotherapy research needs to be more consumer relevant (Westen, Novotny, & Thompson-Brenner, 2005).

With the caveats noted above, the available evidence indicates that effect sizes for psychodynamic therapies are as large as those reported for other treatments that have been actively promoted as "empirically supported" and "evidence based." It indicates that the (often unacknowledged) "active ingredients" of other therapies include techniques and processes that have long been core, centrally defining features of psychodynamic treatment. Finally, the evidence indicates that the benefits of psychodynamic treatment are lasting and not just transitory and appear to extend well beyond symptom remission. For many people, psychodynamic therapy may foster inner resources and capacities that allow richer, freer, and more fulfilling lives."
 (pp. 106-107)

Jonathan Shedler (2010) The Efficacy of Psychodynamic Psychotherapy, American Psychologist, Vol. 65, No. 2, pp. 98–109

Tuesday, September 18, 2012

Donnel Stern - Dissociation and Understanding

"All understanding is context dependent, and one of the most significant contexts for clinical purposes is the self-state. How we understand the other, and ourselves, depends on the state(s) we occupy. Dissociations between an analyst's self-states can, therefore, limit or impede understanding of the analysand by depriving the analyst of a fitting context within which to grasp what the analysand says and does. Clinical understanding may require the breach of such dissociations...The claim that all experience is continously constructed does not contradict our everyday recognition that some meanings are remarkably enduring. It is entirely consistent with the idea that we continuously create our experience anew to suggest that in some cases we construct the same meaning, or the same pattern in experience, over and over again. To put the point in conventional psychoanalytic language: unformulated experience can be highly structured—though never so structured that multiple interpretations are excluded. Even those structured meanings, though, remain processes. Even the most highly organized unformulated meanings are therefore not static objects or ruts worn in the brain, and never absolute, but predispositions toward certain kinds of meaning-making and away from others...." (p. 844)

"But no matter whether it is the analyst or the analysand who resolves the dissociation first, the story does not end here. Understanding is more mysterious than the mere absence of dissociation; it does not necessarily fall into place as soon as our unconscious reasons to avoid it vanish. The view that comes to us from Heidegger, Gadamer, Merleau-Ponty, and others is that there is no way to codify the process by which understanding is reached. No one can say exactly why understanding comes about when it does, why horizons fuse now and not five minutes ago or yesterday, why language becomes able in one moment to contain experience that the moment before it could not. Even after dissociation has been resolved, the most we can do is allow history, or tradition, or the speech and conduct of the other, to act freely within us. We cannot decide to understand, even under the best of circumstances; we can only strive to put ourselves in the best position for understanding to occur. And so, while the resolution of the analyst's dissociation is crucial, it guarantees nothing: it merely means that the circular movement that may result in the expansion and flowering of meaning can occur with less obstruction by unconsciously held motivation. New understanding may follow immediately—or it may not. Resolving dissociations gives language its head, but what language will do then is beyond our capacity to know." (p. 871)

Donnel B. Stern (2003). The Fusion of Horizons: Dissociation, Enactment, and Understanding. Psychoanalytic Dialogues, Vol. 13, pp. 843-873

Sunday, September 16, 2012

The Psychoanalytic Muse Reaches 10,000 Views

The Psychoanalytic Muse came into being on March 10, 2010.  This weekend, in just 2.5 years, it reached a cumulative total of 10,000 views from 90 countries around the world.  Such a tremendous response underscores the vibrancy that the ideas and practices developed by Freud, Jung, Adler, Ferenczi, Klein, Winnicott, Fordham, Hillman, Fairbairn, Kohut and others continue to have in our contemporary situation.  Out of 146 posts, the most frequently read posting, by a margin of two to one, is the passage from Glen Gabbard and Thomas Ogden's On Becoming a Psychoanalyst.  Freud's Remembering, Repeating and Working Through followed closely by Philip Bromberg's A Relational View of Resistence were the next two most frequently read postings.  The most frequently accessed post by a Jungian author was the one titled Don Kalsched on the Defenses of Trauma.  Thank you for your continued interest in analytic literature and this blog.

Thursday, September 13, 2012

Ferro and Basile - Types of Countertransference Experience in the Analytic Field

"The field concept, originally formulated by Willy and Madeleine Baranger (Baranger & Baranger, 1961-62) has gradually assumed increasing complexity (M. Baranger, 1992; Eizirik 2005; Ferro 1996, 2002a, b;). Initially regarded as a situation whereby the products of the patient-analyst encounter are seen in terms of crossed resistances, and hence of the formation of bulwarks that are subsequently broken down by interpretations resulting from the analyst's ‘second-look’ capability, the field has increasingly become the locus of the multiple potentialities of analyst and patient alike and of all the possible worlds that may be opened up by their encounter. As we see it, it is not only a spatial but also a temporal field, inhabited by the present and the history, which constantly affords vistas onto the future. It is a field in a state of perennial transformation, a characteristic of which nothing can ever remain outside it after the ‘big bang’ of the possible worlds generated by the patient-analyst encounter within the setting. Places in the field are the present analyst-patient relationship, as well as their histories, transferences, and so on.

The field has a breath of its own, whose inhalation phase signals the arrival (or unfreezing) within it of lumps of unthinkability, while its exhalation is the collapse that follows every saturated interpretation, which reduces it to a point so as to prepare it for future expansion. This is of course an incessant movement. Another feature of the field is that sooner or later it must, however slightly, be infected by the patient's illness, and indeed itself contract that illness, in order to become the locus of the treatment and hence of transformations.

Thus, the field has an oscillatory character, swinging between the constant opening up of meaning (negative capability) on the one hand, and the unavoidable closure of meaning when it forgoes all possible stories in favour of the one pressing most strongly to be told (the selected fact).....

This suggests to me that, on the basis of a Bion-inspired view of the field enriched with concepts extrapolated from narratology, a whole series of progressively higher countertransference levels can be distinguished:

Countertransference level 0: When the field itself becomes the narrator and metabolizer of what happens in it, it digests, transforms and alphabetizes the primitive emotions aroused in it, and the signals of its functioning are picked up by the analyst, who is thus enabled to modulate them continuously. This is merely an ideal situation, because caesuras of various kinds will inevitably mobilize the events of the field. The characters of the session themselves assume the task of describing what is happening, thus allowing the analyst's interpretations to modulate the movements of the field. The analyst presides over a process co-generated by himself.

Countertransference level 1: The field is no longer able to absorb and modulate its own tensions, which instead impinge on the particular locus of the field that is the analyst's mind, thereby arousing in him an active, conscious reverie which he perceives and uses.

Countertransference level 2: When the field's tensions are so high that they overflow its central part, they overwhelm the analyst's capacity for reverie and activate particular experiences on his part, on which he must work inside himself in order, on the one hand, to digest and metabolize them and, on the other, to use them for understanding the patient and where appropriate for giving interpretations.

Countertransference level 3: The overflowing is so severe that the analyst as it were takes the problem home with him at night. Something remains encysted and needs to be worked through, for example by the precious tool of countertransference dreams.

Countertransference level 4: The overflowing is so bad that the analyst's very analytic function is overwhelmed, resulting in breaches of the setting ranging from a physical illness in the analyst to unrecognized enactments or dramatic manifestations that preclude continuation of the analysis. A field of this kind is imbued with the violations of the setting so well described by Gabbard & Lester (1995), in which it has not been possible to dissolve the countertransference and to manage it on the level of thought, so that it becomes a ‘thing’ or ‘fact’. At this point, given that one of the components of analysis — the setting — is lacking, what takes place can simply no longer be called analysis."
(pp. 4-5)

Antonio Ferro and Roberto Basile (2008). Countertransference and the characters of the psychoanalytic session. Scandinavian Psychoanalytic Review, Vol. 31, pp. 3-10

Thursday, September 6, 2012

Elizabeth Urban: Jungian and Kleinian Notions of the Inner World

"A major, if not the major, difference between Freud and Jung lay in their views about the inner world. Freud's main emphasis was on the way contents of the mind are derived from personal experience, whereas Jung's studies viewed the mind as innately endowed with a priori configurations that encompass far more than personal contents. Klein too departed from Freud on this point, and the Controversial Discussions of the British Psycho-Analytical Society revolved around this issue (Hinshelwood 1989). Both Jung and Klein thought that the primary contents of the mind are inextricably bound up with the instincts, that, in fact, they are the mental representations of instincts.

According to Jung, the primary content of the psyche is the archetype. In contrast to instincts, the archetypes are ‘inborn forms of "intuition" ‘(Jung 1919, p. 133), analogous to instinct, with the difference that whereas instinct is a purposive impulse to carry out some highly complicated action, intuition is the unconscious, purposive apprehension of a highly complicated situation. (ibid. p. 132)

Jung also notes the similarities between archetypes and instincts. The archetypes make up the collective unconscious, which is universal and impersonal; that is, it is the same for all individuals. Instincts, according to Jung, are also impersonal and universal, and are, also like the archetypes, hereditary factors of a dynamic or motivating character. Thus, instincts ‘form very close analogues to the archetypes, so close, in fact, that there is good reason for supposing that the archetypes are the unconscious images of the instincts themselves’ (Jung 1936, pp. 43-4). Elsewhere he writes that the archetype ‘might suitably be described as the instinct's perception of itself, or as the self-portrait of the instinct’ (Jung 1919, p. 136).

Archetypes described in this way are virtually the same as Klein's unconscious phantasies. She writes, ‘I believe that phantasies operate from the outset, as do the instincts, and are the mental expression of the activity of both the life and death instincts’ (Klein 1952, p. 58). Isaacs presents a fuller exposition of the relationship between phantasies and instincts than does Klein. Isaacs states that ‘phantasies are the primary content of unconscious mental processes’ (Isaacs 1952, p. 82). ‘This "mental expression" of instinct is unconscious phantasy. Phantasy is (in the first instance) the mental corollary, the psychic representative, of instinct’ (ibid., p. 83).

Although for the most part Klein and Isaacs describe phantasies in terms of ‘stories’, for example, ‘I want to eat her all up’, these stories are based upon images:
'What, then, does the infant hallucinate? We may assume, since it is the oral impulse which is at work, first, the nipple, then the breast, and later his mother as a whole person; and he hallucinates the nipple or the breast in order to enjoy it. As we can see from his behaviour (sucking movements, sucking his own lip or a little later his fingers, and so on), hallucination does not stop at the mere picture, but carries him on to what he is, in detail, going to do with the desired object which he imagines (phantasies) he has obtained.' (ibid., p. 86)

The ‘picture’ of the breast that is an image of the instinct makes Isaacs's description of unconscious phantasies virtually identical to Jung's description of the archetype as the ‘self-portrait of the instinct’. When she writes ‘such knowledge [of the breast] is inherent … in the aim of instinct’ (ibid., p. 94), she can be understood to be talking about the same thing that Jung is describing when he states that the yucca moth has an image of the yucca flower and its structure, so that, when present externally, the flower sets off instinctual behaviour (Jung 1919). Both Jung and Isaacs are stating that there is an image of the aim of the instinct—the object that fulfils the instinctual urge—that exists within the psyche, enabling the instinct ‘to know what it is looking for’.

Important differences do, however, exist between Jung and Klein. Klein was a psychoanalyst who extended Freud's concepts of libidinal and destructive instincts to pre-Oedipal development, focusing on how infancy lies at the core of the personality. On the other hand, although Jung drew attention to the inherent richness of the mind before Klein began writing, his interest in childhood and infancy is limited. Although he refers to the individuality of the infant (Jung 1911, 1921), for the most part he thinks that the infant is in primary identity with the mother (Jung 1927). The issue of primary identity raises a number of questions which have since been addressed by Fordham." (pp. 412-413)

Elizabeth Urban (1992). The Primary Self and Related Concepts in Jung, Klein, and Isaacs. Journal of Analytical Psychology, Vol. 37, pp. 411-432

Sunday, September 2, 2012

Sandor Ferenczi's Impact on the Practice of Modern Short-Term Therapy

"Ferenczi's work was far ahead of its time. Certain techniques constituting the therapist's heightened activity level are now established as brief therapy principles and are evident throughout all phases of treatment, from assessment to termination. Davanloo (1978, 1980) and Sifneos (1987), in particular, focus their activity on the persistent challenging of defenses and on anxiety-provoking conflicts respectively. Their models require highly confrontational techniques aimed at stimulating emotions. Together with Malan (1963, 1976, 1979), these authors maintain an active transference approach and seek to bring together the affective and cognitive elements of treatment. The interactive process between patient and analyst is reciprocal and emotionally charged. Mann (1973) adheres to the active analytic position, but he also revives Ferenczi and Rank's concept of enforced termination. He believes that the setting of limits forces a patient to face reality and to give up unrealistic transference expectations.

As practiced by these major proponents of modem short-term therapy, the active transference approach involves increased verbal interaction between the patient and therapist. As Bauer and Kobos (1987) observe, a verbally active therapist is not compatible with a free-associating patient. In psychoanalysis, the therapist maintains a stance of evenly hovering attention and there are few interruptions into the patient's associations. In short-term therapy, the patient's associations are often directed by the therapist to explore specific material relevant to the focus and goals of treatment. For example, if a patient became more defensive when discussing a certain topic, Davanloo would forcefully challenge the patient's resistance. His approach often raises strong affect in the patient, particularly anger. By contrast, a practitioner of long-term psychoanalytic psychotherapy or psychoanalysis would tend to observe the pattern and development of resistance before confronting the patient.

Short-term therapists adhere to a focus on the core conflict and do not permit the patient to digress defensively from this central concern. As a result, the therapist is often confronting, clarifying, and interpreting defenses, thereby increasing the emotional intensity of the session. Since the treatment focus tends to involve issues which are expressed and explored in the therapeutic dyad, the level of emotional involvement is high for the therapist as well.

With the prevailing trend from one-person to two-person psychology, practitioners of short-term therapy generally acknowledge the interpersonal nature of therapy. The therapist is not viewed as a "blank screen" but rather as a coparticipant whose behavior shapes the transference. This approach is consistent with Ferenczi's insights on countertransference as a way to understand the patient's experience. Countertransference themes in short-term treatment often involve guilt and problems tolerating separation and loss. Shafer (1986) notes that brief treatment thwarts the therapists' re-parative need to completely heal the patient, as well as the need to be omniscient and omnipotent. Unlike long-term therapy, Mann (1986) observes that in short-term psychotherapy, therapists do not receive narcissistic gratification in having patients depend on them.

Brief Focal Psychotherapy, established by Malan, emphasizes another aspect of Ferenczi's work, namely concentrating the therapist's effort on analyzing the point at which trauma occurred. Malan, like Ferenczi, did not feel it was necessary to analyze every feature of the patient's mental life. Dealing with selective aspects of the patient's conflict is described in the other models as well. In his practice of Time-Limited Psychotherapy, for instance, Mann focuses on the central issue of the patient's chronically endured pain. Malan and Davanloo focus on the triangle of conflict (wish, anxiety, and defense) and the triangle of. insight (therapist, current relationship, and parent or past figure). Lastly, Sifneos' Short-Term Anxiety Provoking Psychotherapy concentrates on the patient's "circumscribed chief complaint."

The careful selection of patients is also common to the majority of short-term practice models. Given the high level of emotional intensity, patients must be able to benefit from this experience. It is therefore not surprising that these practitioners choose patients who are highly motivated, capable of insight, and able to establish a collaborative relationship with the therapist. These ego resources are necessary to help the patient throughout the arduous and painful treatment process.

Modem short-term therapy is characterized by a high level of commitment on the part of both the patient and therapist. This can also be seen in much of Ferenczi's work. Short-term therapists have had to continually defend their techniques as having been founded on core psychoanalytic principles. They have worked hard to dispel the myth that short-term therapy is superficial and dictated solely by factors extraneous to the patient's interest. Patients often turn to brief treatment as a last resort after other therapies have failed, as did Ferenczi's patients who came from all parts of the world with the hope of being cured.Conclusion

Sandor Ferenczi, a psychoanalytic pioneer and practitioner, suggested changes in psychoanalytic technique which would shorten the length of psychoanalysis. His introduction of "active therapy" involved increased activity from both the patient and analyst as a means to facilitate the exploration of unconscious material. The psychoanalyst prescribed the performance or cessation of certain behaviors, thus instituting active measures which made the patient a full participant in the psychoanalytic process. Interpretation, Ferenczi contended, was an active intervention which interrupted the patient's psychic activity, leading to the uncovering of repressed thoughts and ideas. In collaboration with Rank, Ferenczi underscored the importance of here-and-now transference interpretations and emphasized the emotional experiences of the patient in the transference, rather than the sole intellectual recovery of memories. Ferenczi noted that intellectual discovery without affect can serve as resistance.

Ferenczi's central ideas on active psychoanalytic treatment and interpretation are the cornerstone of modem dynamic short-term treatment. His ideas have been lauded and incorporated into the works of modern short-term therapists, such as Davanloo, Mann, and Sifneos. Ferenczi's emphasis on the importance of present life events in psychoanalytic treatment is currently receiving much attention in the psychotherapeutic community. This can be seen in the emphasis on the treatment of Axis I disorders and symptomatology, as well as the process of maintaining a process in most models of short-term treatment.

Sandor Ferenczi's incessant drive to improve psychoanalytic methodology has provided inspiration to modem short-term therapists. While Davanloo and others have had the benefit of years of development in research, theory, and technique, it was Ferenczi who pioneered these efforts and who served as a role model. His courage and experimental spirit embody the essence of psychoanalytic inquiry, and have, in my estimation, earned him the title of 'Forerunner of Modem Short-Term Psychotherapy'."
(pp. 36-39)

Carol Tosone (1997). Sándor Ferenczi: Forerunner of Modern Short-Term Psychotherapy. Psychoanalytic Social Work, Vol. 4, pp. 23-41