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

A summary of the characteristics of this type of psychotherapy.

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

Among these currents, still encompassed within the psychoanalytic approach, we find focal psychodynamic therapycharacterized by being a brief therapeutic alternative that focuses on the patient's priority problems.

Although it is clearly related to the rest of psychodynamic therapies, it also presents some nuances that differentiate it from the more classical psychoanalysis, giving it some advantages and limitations. Next we will see what this so peculiar therapy is about.

Focal psychodynamic therapy: what is it?

Focal psychodynamic therapy, also called brief psychodynamic therapy, is a form of treatment in which a target, called a focus, is visualized and worked on. a target, called focus, is visualized and worked on during the rest of the the rest of the sessions that make up the therapy. By having very specific objectives, the scope of the therapy is limited to the resolution of these objectives.

This psychotherapy was elaborated by the group of Michael Balint, Paul H. Orstein and Enid Balint.. In it, techniques such as selective forgetting and selective attention are used in the interpretation of the patient's problems.

In this way, and according to the authors, the patient is able to gain greater insight into the real cause of his or her suffering. Thus, once the patient understands the origin of his or her 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 early resolution. Thus, it could be said that this psychotherapy takes into account the saying 'he who grasps much, grasps little', that is, it prefers to focus on a single issue and ensure that it resolves it before trying to change the whole inner world of the person.

Within this therapy, which is included within the psychoanalytic current, the focus is understood as a concrete problemThe focus is the one on which the efforts and attention of both the patient and the therapist will be centered during the sessions. This focus must be specific, unambiguous and clearly delimited. Brief therapies do not aim at remodeling the patient's broad personality, but at resolving one or a delimited set of 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 generates discomfort to the patient has to be, necessarily, long. In addition, the changes will be slow in comingThis can lead to the patient not having a real perception of improvement and ending up abandoning therapy, frustrated at not seeing the desired changes.

Along the same lines as the authors mentioned above, many others point out the convenience of focusing or centering the therapy on the patient's needs. the convenience of focusing or centering the therapeutic work in a certain area, symptom or problem of the patient, giving it a higher priority. of the patient, giving it the highest priority during the treatment. This is why this type of therapy is called focal therapy.

The psychotherapist, at the beginning of the therapy, has the great responsibility to decide which focus requires the highest priority, so that it can be properly addressed throughout the treatment. However, it is the job of the patient-therapist tandem to accept and elaborate a therapeutic plan that can achieve the therapeutic goal originally proposed.

Duration and application

As its name suggests, focal or brief psychodynamic therapy has a short duration. Although there are discrepancies among professionals, the most common is that it does not exceed 25 sessions, although ideally it should be a maximum of 25 sessions.Although the ideal would be a total of 14 sessions in which the therapy will be carried out. The first session would consist of the interview with the patient, the second to the 13th session would be the treatment itself, and the 14th session would be the closing session. These sessions would be held once a week.

This therapy is highly recommended for patients who are suffering from some kind of discomfort, but who are still functioning well both socially, at work/academically and in life in general. It serves to make the person see what has led him/her to have a series of symptoms and relate them to his/her emotionality.

Thus, this therapy cannot 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, which is not suitable for the treatment of this type of disorders, since they can become chronic and require very deep and extensive changes in the person.

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

Also, and especially related to their emotionality, in this brief therapy we work on aspects such as their feelings about how they think others see them, their childhood, and their thoughts about the way they feel about themselves.The therapy also deals with their feelings about how they think others see them, their childhood and their thoughts when they look at themselves in a mirror or when they put on clothes.

Requirements to work with her

In order 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.such as a psychiatrist or general practitioner when appropriate.

Among 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/she has a good awareness of psychopathology, or of 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 his degree of motivation and desire to reach the resolution of the problem.

The patient must have an adequate control of impulsesThe patient must have adequate impulse control, expected for his or her age and educational level, which is neither too much nor too little. They must also have an adequate tolerance to frustration, and show a degree of anxiety that is within levels that do not overwhelm their behavior or mental health. In case the anxiety is too high, it is recommended to apply a longer therapy, and to focus on several aspects of the person, whether they are experiences or personality traits.

Finally, among the most convenient characteristics that the patient should present in order to be able to carry out this therapy are the following have an adequate intellectual level, as well as symbolicand non-pathological capacities of symbolization and abstraction. It is also desirable that the patient's self-esteem is neither too low nor too high.

Of all the characteristics that the patient should present, it can be understood that this type of therapy is recommended for patients with moderate discomfort. For example, a patient with such a severe disorder as schizophrenia or bipolar disorder would not be a suitable candidate for this type of therapy. In addition to suffering from disorders that cause them a high degree of discomfort, these must be addressed together with psychopharmacology.

On the other hand, in order for the therapy to be carried out in the most appropriate way, it is necessary, of course, that the therapist has a series of requirements that allow him/her to carry out this therapy. that allow him/her to carry out this therapy. Among them, it is necessary to have been a patient in a psychoanalytic therapy of long duration. With this, the therapist will be able to grow as a professional, knowing how to differentiate clearly between his or her own discomfort and that of the patients, and having a good command of countertransference.

Although the most suitable patient profile for this therapy is someone who is not suffering from a serious mental disorder, this does not mean that it is an easy therapy to apply. The therapist should have a lot of clinical experience in prolonged psychodynamic treatments, which will serve as a previous base to be able to apply the brief version of these treatments. It is advisable that, at the beginning, he/she is supervised by another professional with more experience.

As for more personal attitudes, the professional must have a good observation of details and be organized and organized.The professional must also be organized and know how to plan the therapy well. Only with the detailed observation of the patient's discomfort will he/she be able to detect which aspect of it should become the focus of the therapy. Along with this, he must have a good tolerance for frustration because, unfortunately, it is not always possible to fix the patient's entire inner world.

Differences between classical psychoanalysis and focal psychodynamic therapy

Although within the psychoanalytic current, focal psychodynamic therapy differs from more classical psychoanalysis for several reasons. The following are the main differences between the two types of therapy.

Within classical psychoanalysis, especially in relation to long-term therapies, the aim is 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, it is limited to changes in aspects that can be modified in the short term, which can lead to an improvement in the person's well-being and that the person can see them shortly after starting the treatment.

Also, both types of therapies differ in terms of the number of weekly sessions.. Classical psychoanalysis requires a visit to the couch three or four times a week, while in the case of focal therapy it is only necessary to do it once.

The more classical psychoanalysis chooses to maintain a prudential distance with the patient's family, to avoid possible interruptions throughout the therapy. On the other hand, in focal psychodynamic therapy we try to have the maximum contact with the patient's social world, as long as it is convenient and facilitates an improvement in the patient's well-being.

Bibliographical references:

• García-Arzeno, M. E. (1997). Brief or focused psychoanalytic psychotherapy. Cuban Journal of Psychology. 14(1), 121-126.
• Sánchez-Barranco, A. and Sánchez-Barranco, P. (2001) Brief dynamic psychotherapy: Clinical and conceptual approach. Journal of the Spanish Association of Neuropsychiatry. 21(78). 1013-1031.