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

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 condition psychological.

Among these currents, still encompassed within the psychoanalytic approach, is focal psychodynamic therapy, characterized by being a brief therapeutic alternative that focuses on priority problems of the patient.

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

• Related article: "Types of psychological therapies"

Focal psychodynamic therapy: what is it?

Focal psychodynamic therapy, also called brief psychodynamic therapy, is a form of treatment in which visualize an objective, called focus, and work on it the rest of the sessions that make up the therapy. By having very specific objectives, the scope of therapy is limited in their resolution.

This psychotherapy It was developed 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 terms of interpreting the patient's problem.

In this way, and according to the authors, it is possible to make the patient have a greater insight about the real cause of his suffering. Thus, once the patient understands the origin of her discomfort, it is possible to generate more lasting therapeutic changes.

Therapy, as we were already saying, focuses on addressing a single problem or conflict in the patient, trying to reach its prompt resolution. Thus, it could be said that this psychotherapy takes into account the saying "who covers a lot, squeezes little", that is, he prefers to focus on a single issue and make sure he resolves it before trying to change the entire internal world of the person.

Within this therapy, which is included within the psychoanalytic current, focus is understood to be a specific problem, on which the efforts and attention of both the patient and the therapist will be focused during the sessions. This focus must be specific, unambiguous and clearly defined. Brief therapies do not have as their objective the remodeling of the broad personality of the patient, but the resolution of one or a limited set of problems suffered by the patient, in a period of time brief.

The internal world of each patient can be very extensive, which is why trying to solve everything that is dysfunctional can be a daunting task. A treatment that aims to fix everything that causes discomfort to the patient must necessarily be long. Besides, changes will happen slowly, which can mean that the patient does not have a real perception of improvement and ends up abandoning the therapy, frustrated by not seeing the desired changes.

Along the same lines as the authors previously commented, there are many others who point out the convenience of focusing or centering therapeutic work on a certain area, symptom or problem of the patient, giving it the highest priority during treatment. That is why this type of therapy is called focal.

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

duration and application

As its own name suggests, focal or brief psychodynamic therapy has a short duration. Although there are discrepancies between professionals, the most common is that they do not exceed 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, from the second to number 13 the treatment itself and, number 14, the closing session. These sessions would be held once a week.

This therapy is highly recommended for patients who are suffering some type of discomfort, but who they are also functioning correctly both socially and at work/academic and in life in general. It serves to make the person see what has led them to have a series of symptoms and relate them to their emotionality.

So this therapy it cannot be applied to severe personality disorders or psychiatric problems. The reason for this is, basically, because the object of focal psychodynamic therapy is very limited and brief, something that is not convenient. for the treatment of this type of disorders, since they can become chronic and require very deep and extensive changes in the person.

Although, 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 his emotionality, In this brief therapy, aspects such as their feelings towards how they think others see them are worked on., childhood lived and thoughts when looking at yourself in a mirror or putting on clothes.

Requirements to work with her

In order for focal psychodynamic therapy to be carried out in the most efficient way possible, it is necessary that both the patient and the professional meet a series of requirements. In case it is not, it will be necessary to consider other types of therapeutic options or refer to another professional, such as a psychiatrist or family doctor when they come into play.

Within the characteristics and requirements that the patient should meet so that a therapy can be applied focal psychodynamics, it is necessary that he have a good awareness of psychopathology, or 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 to say, it depends on his degree of motivation and his desire to want to reach a resolution of the problem.

The patient must have adequate impulse control., expected for their age and educational level, which is neither excessive nor insufficient. You must also have an adequate tolerance for frustration, and manifest a degree of anxiety that is within levels that do not overwhelm your behavior or mental health. In case your anxiety is too high, it is recommended to apply a longer therapy, and that several aspects of the person are taken as a center, be they experiences or personality traits.

Finally, among the most convenient characteristics that the patient must present to be able to carry out this therapy, are the have an adequate intellectual level, in addition to non-pathological symbolization and abstraction capacities. It is also desirable that you have a self-esteem that is neither too low nor excessive.

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

On the other hand, so that the therapy can be carried out in the most appropriate way, It is necessary, of course, that the therapist have a series of requirements that allow you to carry out this therapy. Among them is having been a patient in a long-term psychoanalytic therapy. With this, the therapist will be able to grow as a professional, knowing how to clearly differentiate between his discomfort and that of the patients, and having a good management of the countertransference.

Although the profile of the most suitable patient for this therapy is that of someone who is not suffering from a serious mental disorder, this does not mean that it is an easy-to-apply therapy. The therapist must have a lot of clinical experience in prolonged psychodynamic treatments, which will serve as a prior basis to be able to apply the brief version of these. It is recommended that, at first, you are supervised by another professional with more experience.

Regarding more personal attitudes, the professional must have a good detailed observation, as well as being organized and knowing how to prepare a good therapy plan. Only with detailed observation of the patient's discomfort will it be possible to detect which aspect of it should become the focus of therapy. Along with this, he must have a good tolerance for frustration because, unfortunately, it is not always possible to fix the entire internal world of the patient.

Differences between classical psychoanalysis and focal psychodynamic therapy

Although within the psychoanalytic current, focal psychodynamic therapy differs from psychoanalysis more classic for several reasons. Below we see the main differences between both types of therapies.

Within classical psychoanalysis, especially in relation to long-term therapies, it is intended to make profound changes in the personality and degree of well-being of the person. In contrast, in focal psychodynamic therapy, whose duration is short, it is limited to changes in modifiable aspects in the short term. term, which may imply an improvement in the well-being of the person and who can see them shortly after the start of the treatment.

Also, both types of therapies differ in terms of the number of weekly sessions. Classical psychoanalysis requires visiting the couch three or four times a week, while focal therapy only needs to do so once.

The most classic psychoanalysis chooses to maintain a safe distance from the patient's family, to avoid possible interruptions throughout the therapy. On the other hand, in focal psychodynamic therapy an attempt is made to have maximum contact with the social world of the patient, as long as it is convenient and facilitates an improvement in the well-being of the patient. person.

Bibliographic references:

• Garcia-Arzeno, M. AND. (1997). Brief or focused psychoanalytic psychotherapy. Cuban Journal of Psychology. 14(1), 121-126.
• Sanchez-Barranco, A. and Sánchez-Barranco, P. (2001) Brief Dynamic Psychotherapy: A Clinical and Conceptual Approach. Journal of the Spanish Association of Neuropsychiatry. 21(78). 1013-1031.