Class 11/12: Time-Limited Psychodynamic Psychotherapy

Question 1

Time-Limited Dynamic Psychotherapy -Hanna Levenson

Answer 1

• —Circumscribed Focus: Identify, track, maintain focus
• Limited Goals
• Time Management
• Selection Criteria
• Therapist Activity: ranging from supportive to exploratory interventions
• Therapeutic Alliance: affective, common goals, quick
• Rapid assessment and intervention
• Termination: explicit throughout
• Optimism: about achieving goals
• Contract: patient agrees to timeframe

Question 2

Time-Limited Dynamic Psychotherapy

(Characteristics)

(Commonalities)

Answer 2

• Importance of childhood experiences and development
• Role of the unconscious in behavior
• Role of conflict
• Transference-countertransference
• The therapeutic alliance
• Behavior patterns

Question 3

Time-Limited Dynamic Psychotherapy

(Characteristics)

(—Differences from Traditional Theory)

Answer 3

• Does not embrace Freudian psychoanalytic concepts and techniques
• Does make use of other theoretical approaches
  
  • More integrative in interventions

Question 4

History of Short-Term Psychotherapy

Answer 4

• —Freud began with brief model
  
  • Later shifted from catharsis to free association
• 1920s: Sandor Ferenczi and Otto Rank
  
  • focused on more active role of therapist, briefer models
• 1940s: Franz Alexander and Thomas Morton French
  
  • Adjusted length and frequency of sessions, emphasized corrective emotional experience

Question 5

History of Short-Term Psychotherapy

(1970s)

Answer 5

• —David Malan (London)
  
  • “Intensive Brief Psychotherapy” (IBP): Triangle of Conflict (impulse—anxiety—defense); Triangle of Persons
• Habib Davanloo (Montreal)
  
  • Intensive Short-term Dynamic Psychotherapy (ISTDP): Confrontation
• Peter Sifneos (Boston)
  
  • Short-term Anxiety-Provoking Psychotherapy (STAPP)focused on more active role of therapist, interpretations
• James Mann (Boston)
  
  • 12 sessions, focused on separation and loss

Question 6

History of Short-Term Psychotherapy

(1980s)

Answer 6

• —Relational models
  
  • Hans Strupp and Jeffrey Binder
    
    • Time-limited Dynamic Psychotherapy (TLDP)
      
      • Focus on recurrent, maladaptive themes (expressed in the transference)
  • Lester Luborsky
    
    • Supportive-Expressive Psychotherapy
      
      • Core Conflictual Relationship Theme (CCRT)
  • Joseph Weiss and Harold Sampson
    
    • Control Mastery Theory

Question 7

Time-Limited Dynamic Psychotherapy

(TLDP)

Answer 7

• —Binder, Strupp, Levenson
• Grounded in
  
  • Object Relations
  • Attachment theory
  • Interpersonal-relational theory (interactive dynamics)
  • Experiential-affective Change

Question 8

Principles of TLDP
Hanna Levenson (2010)

(1-9)

Answer 8

1. Search for relatedness is innate
2. Maladaptive relationship patterns form early, persist
3. Patterns persist because people identify with them
4. People are “stuck,” not “sick”
5. Focus is on relationship patterns + their emotions
6. Focus is on interactive processes rather than context
7. Focuses on one (primary) problematic relationship pattern
8. Therapist is both/and participant, observer
9. Change continues after termination

Question 9

Goals of TLDP
Hanna Levenson (2010)

(Providing new experiences for the client (with the therapist and with current relationships))

Answer 9

1. Interpersonal experiences
2. Intrapersonal (i.e., internal processes)—transforming affect
   
   1. Create positive emotional state (e.g., depression to anger)
   2. Shared implicit relationship (attunement; “holding” a client)

Question 10

Goals of TLDP
Hanna Levenson (2010)

(Providing new understandings for the patient regarding emotional shifts within and relational shifts between (i.e., experiential learning))

Answer 10

1. Intrapersonal
   
   1. Through use of countertransference
2. Interpersonal
   
   1. Through reflection, interpretation, clarification, confrontation, talking about patterns within the therapeutic relationship
   2. Removes “blame” from the story, promotes compassion for all

Question 11

TLDP Formulation
Hanna Levenson (2010)

Answer 11

• “Cyclical Maladaptive Pattern” (CMP)
• Basis of dynamic focus
• Organizing framework
• A “plausible narrative”
• “describes the cycles or patterns people get into that involve inflexible, self-perpetuating behaviors, self-defeating expectations, and negative self-appraisals and that lead to dysfunctional and maladaptive interactions with others” (Levenson, 2010)

Question 12

CMP Categories

(1-5)

Answer 12

1. Acts of the self ”)
   
   • Thoughts, feelings, motives, perceptions and behaviors
   • May be conscious or unconscious
2. Expectations of Others’ Reactions
3. Acts of Others Toward the Self
4. Acts of the Self Toward the Self (Introject)
   
   • How the client views him/herself
5. Therapist’s Interactive Countertransference

Question 13

TLDP Case Formulation: Assessment

Answer 13

Therapist:

1. Lets client tell own story
2. Conducts an anchored history
3. Attends to emotional elements of story
4. Explores emotional-interpersonal context
5. Uses CMP to gather, organize, guide questions

Question 14

TLDP Case Formulation:
Conceptualization

Answer 14

Therapist

1. Listens for behaviors and emotions (in past, current, and therapeutic relationship)
2. Is aware of own behaviors and emotions (countertransference)
3. Watches of reenactments in the therapeutic relationship
4. Develops a CMP story that describes the client’s pattern

Question 15

TLDP Case Formulation:
Treatment Planning

Answer 15

Therapist

1. Uses CMP to formulate what new experiences might be therapeutic (intra- and interpersonally)
2. Uses CMP to formulate what new understandings might be therapeutic (intra- and interpersonally)
3. Continually revises and refines the CMP
4. Considers influence of cultural factors throughout

Question 16

Form for the CMP

Answer 16

Question 17

TLDP Intervention Strategies:
Maintaining the Therapeutic Relationship

Answer 17

The Therapist

1. Responds respectfully , collaboratively, nonjudgmentally
2. Demonstrates listening receptively
3. Recognizes client’s strengths, and communicates these
4. Address clients obstacles (aka “resistance”) and opportunities

Question 18

TLDP Intervention Strategies:
Accessing and Processing Emotion

Answer 18

The Therapist

1. Helps client stay emotionally regulated
2. Encourages client to experience/express affect
3. Facilitates client’s awareness of emotions, and depth of experience
4. Helps client name emotional experience and recognize it’s significance (as it pertains to the therapeutic goal)
5. Helps client access, experience, deepen attachment-related feelings andor primary emotions related to CMP

Question 19

TLDP Intervention Strategies:
Empathic Exploration + Focused Inquiry

Answer 19

The Therapist

1. Uses open-ended questions
2. Inquires into personal meanings of the client’s words
3. Responds to the client’s statements by asking for concrete detail

___________________________________________________

1.Throughout, maintains a focused line of inquiry

Question 20

TLDP Intervention Strategies:
Relationship Focus

Answer 20

The Therapist

1. Facilitates client’s expression, exploration of feelings, thoughts, and beliefs in relation to past, current, therapeutic relationship
2. Encourages client to discuss how the therapist might feel/think about the client
3. Discloses own reactions to aspects of client’s behavior generally and to CMP specifically
4. Metacommunicates about interpersonal process within the therapeutic relationship

Question 21

TLDP Intervention Strategies:
Cyclical Patterns

Answer 21

The Therapist

1. Asks about client’s introject
2. Helps client link emotions and personal meanings to patterns of interpersonal behavior
3. Deepens client’s emotional and conceptual understanding of impact of CMP on intra- and interpersonal functioning
4. Links need for disowning emotions to early experiences with caregivers
5. Helps client incorporate more adaptive feelings thoughts, and behaviors into a new narrative

Question 22

TLDP Intervention Strategies:
Promoting Change Directly

Answer 22

The Therapist

1. Provides opportunities for client to have new experiences in interactions with therapist, others (consistent with tx goals)
2. Gives process directives in session and outside of session (e.g., homework) to help client take steps toward new emotions/experiences/understandings
3. Discusses time-limited nature of therapy