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Mander, G. (2002). From Free Association to the Dynamic Focus: Towards A Model of Recurrent Psychotherapy. Brit. J. Psychother., 19(2):203-218.

(2002). British Journal of Psychotherapy, 19(2):203-218

Brief Therapy

From Free Association to the Dynamic Focus: Towards A Model of Recurrent Psychotherapy

Gertrud Mander

This paper sets out to describe some of the recent changes in psychotherapy in terms of the needs of new clinical populations. Written from the perspective of the brief therapist it is about new treatment approaches in various clinical contexts which are setting time-limits and advocate focusing on selected material, in order to shorten working contracts. The history of brief focal psychotherapy is charted from the first attempt set up at the Tavistock Clinic by the analysts Balint and Malan, to the theories of Mann, Sifneos, Luborsky and, most recently, Daniel Stern who advocates ‘reapplications of treatment’ as did Freud and Erikson, i.e. ‘a form of serial life-span therapy which is the continuation of a single treatment across discontinuities in a life-span’. It emphasizes the importance of careful assessment at the outset of treatment, in order to find the ‘nuclear conflict’ (French), the ‘point of maximum pain’ (Hinshelwood) or the ‘therapeutic metaphor’ (Stern) which will constitute their chosen dynamic focus, as well as to formulate a justification for the therapist's amending of the time-frame, for the adoption of an active stance and for modifications of technique to achieve the therapeutic goal. Thus the aim of ‘making a significant difference’ in the client's self-perception and functioning substitutes for the structural changes aimed for in long-term therapy. Some clinical vignettes attempt to show how this can be done. Finally, there is the plea for an acceptance of ‘recurrent psychotherapy’ which in reality is already practised widely: more and more patients are receiving successive therapy contracts in the course of their lives, returning for more therapy whenever they encounter a fresh disabling crisis.

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