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

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