This latter point continues to be debated in the literature. He described it as developing out of the ego and becoming a full-fledged structure in its own right as part of the child's oedipal resolution. To explain these phenomena, he offered the concept of the superego as the internalization of the parents’ values and prohibitions. Prior to giving up the topographic model, Freud struggled to understand the phenomenon of unconscious guilt and its clinical manifestations, particularly the negative therapeutic reaction and issues pertaining to masochism. In large part it is this structure and the clinical phenomena that it elucidates that caused Freud to develop his structural model in the first place. The superego was the third structure of the mind in Freud's structural theory.
Malan's later work converges toward that of Davanloo's, 15,21,22 so that his and Malan's approaches are conceptually similar.Īlan Sugarman, in Encyclopedia of Psychotherapy, 2002 V. In other words, the therapist will call attention to behavior toward the therapist, but rather than asking what affect is being warded off, Malan wants to know more about the original object in the nuclear conflict who set up the transference in the first place. Like Sifneos, he sees interpretation as curative, but he aims less at defenses than at the objects they relate to. Malan's work is reminiscent of the British object-relations school. A fixed date (rather than the customary set number of sessions) avoids the chore of keeping track if acting-out causes missed sessions or scheduling errors. (In the initial trial, if the therapist has in mind the correct focus, there will be a deepening of affect and an increase in associations as the therapist tests it.) A unique feature of this treatment is that Malan sets a date to stop once the goal is in sight and the patient demonstrates the capacity to work on his or her own. Malan's method 19,20 is similar, but the therapist discerns and holds the focus without explicitly defining it for the patient. (In psychoanalysis, transference emerges, but in short-term therapy it sometimes is elicited.) Anxiety-provoking psychotherapy is longer, less crisis-oriented, and aimed at the production of anxiety-which then is used as a lever to get to transference material. One limiting feature is that it serves only 2%–10% of the population, the subgroup able to tolerate its unremitting anxiety without acting-out.Īn illustrative contrast, Sifneos's anxiety- suppressive therapy, serves less healthy patients who are able to hold a job and to recognize the psychological nature of their illness, but who are unable to tolerate the anxiety of deeper levels of psychotherapy. One can think of this method as a classical oedipal-level defense analysis with all of the lull periods removed. The therapist serves as a detached, didactic figure who holds to the focus and who challenges the patient to relinquish both dependency and intellectualization, while confronting anxiety-producing conflicts.
This treatment runs 12 to 20 sessions and focuses narrowly on issues (such as the failure to grieve, fear of success, or “triangular,” futile love relationships). Sifneos's anxiety-provoking therapy (1972, 1992) is an ideal example of a brief psychodynamic psychotherapy.
Psychoanalytic interpretation of defenses and appearance of unconscious conflicts in the transference appear in other short-term therapies (and are often downplayed), but only in these methods are interpretation and insight the leading edge of the method and, as in psychoanalysis, the main “curative” agents. The “interpretive” short-term therapies all feature brevity, a narrow focus, and careful patient selection, but the common feature is the nature of the therapist's activity. Stern MD, in Massachusetts General Hospital Comprehensive Clinical Psychiatry, 2016 Psychodynamic Short-term Therapies
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