Problem-Focused Psychodynamic Psychotherapy

For many years, the general rule of thumb in psychoanalysis and psychodynamic psychotherapy has been to refrain from focusing too much on specific symptoms or problems so as to not interfere with free association or the effectiveness of the psychoanalytic approach.

When Fredric Busch, M.D., and colleagues developed panic-focused psychodynamic therapy in the 1990's and subsequently psychodynamic approaches to depression, they emphasized the value of more active interventions, a focus on symptoms and associated dynamics, and occasional psychoeducation.

In this new volume, he expands the scope of that work, articulating how a focused psychodynamic psychotherapeutic approach can be adapted for patients in general. Rather than one specific aspect of patients' difficulties, Problem Focused Psychodynamic Psychotherapy (PrFPP) focuses on the set of problems (e.g., symptoms, relationship issues, behavioral difficulties) a particular patient brings into the consulting room.

Through numerous tables and a wealth of case vignettes, this guide provides novice and experienced clinicians alike with a general template for working with patients to identify and address the overlapping and unique dynamics of various problems.

It describes how to use psychodynamic exploratory techniques to make problem lists and examine the context and emotions surrounding each issue. It also discusses how to develop a psychodynamic formulation to provide a framework for identifying and addressing the dynamic contributors to the various problems.

Therapist and patient can then undertake the "working through" process to identify how specific dynamics emerge in different contexts and overlap in contributing to problems.

All of these approaches help spur patients' self-reflective capacities and the identification of their own dynamics--making it possible to more rapidly address core difficulties. The work also enables the continued use of these modes of managing problems after the treatment is completed.

And because PrFPP is suitable for short- and longer-term interventions, it is valuable for patients who either cannot commit to long-term treatment or only have access to brief interventions.

<p>Fredric N. Busch, M.D., is Clinical Professor of Psychiatry, Weill Cornell Medical College, on the faculty of the Columbia University Center for Psychoanalytic Training and Research in New York, New York.</p>