Symptom-Focused Dynamic Psychotherapy

Book Preface

MY EARLY BEHAVIORAL TRAINING EMPHASIZED that psychotherapy was something to “do.” I learned a variety of active intervention strategies, implemented them, and assessed the outcome. My psychoanalytic training led me to think that perhaps therapy was more about how to be with someone rather than what to do (which was a relief, as I had little idea what I was supposed to do, and how and when to do it!) Yet I liked the idea of being as effective as possible with the various problems that people brought to treatment, and it seemed that knowing some specific things to do at times might facilitate my ability to help. Gradually I began to develop a psychotherapeutic style that incorporated symptomfocused interventions into a dynamic treatment, and I found that such integration seemed coherent as I employed it with my patients.

However, that is not what I was taught. When I began my graduate program in psychology in 1977, the available theoretical paradigms were very different from current versions. The perspectives with which I became most familia —psychoanalytic and behavioral—were more distant from people’s actual experience than is the case today as well as more at absolute odds with one another. The dominant psychoanalytic paradigm was drive theory, and the behavioral theory that I was taught focused primarily on classical and operant conditioning. I began seeing my first patients when I was a young graduate student, and they displayed some complex difficulties, including sexual fetishes, paranoid delusions, and desperate relationship seeking. I found the theories I knew to be disappointing in furthering my understanding of my patients. Try as I might to apply those theories, I had to conclude that response schedules and oedipal issues were of limited explanatory value with my cases. I sought a psychoanalytically oriented internship, for I believed that a theory based on what might be going on inside a person had more potential to illuminate clinical phenomena than a strictly behavioral approach that declared one’s inner workings to be irrelevant. I learned about self psychology, some of which strongly resonated with me; for the first time, here was a theory that made sense to me in terms of my own experience. I continued to immerse myself in psychoanalytic theory and found much that was helpful. But I remained unsatisfied concerning what might constitute the most useful explanations and treatment techniques for the range of problems my patients were presenting.

Preface and Acknowledgments ix
Chapter 1 Rationale for a Symptom-Focused 1
Dynamic Treatment
Chapter 2 Active Techniques in a Context of
Integrative Possibility 24
Chapter 3 The Decision to Use Active Techniques 69
Chapter 4 Cognitive Interventions 95
Chapter 5 Behavioral Techniques 116
Chapter 6 Suggestions for Intervention with
Specific Symptoms 150
Chapter 7 A Patient with Compulsive Behaviors 178
Chapter 8 A Patient with Generalized Anxiety 202
Chapter 9 A Patient with Binge Eating and
Depression 218
Chapter 10 A Patient with a Relational Dilemma 240
References 265
Index 281