Assessment in Brief Psychotherapy: An Application of Epigenetic Hierarchical Models

The psychotherapeutic encounter requires a reiterative assessment of a patient's functioning within some organizing model of motivation, development, and pathology. For psychotherapists who recognize and value the complexity of human experience, this demanding task involves capturing some essential element of a patient's emotional life as it is expressed in the patient's present, in his or her past, and in the transference. For therapists working within time limits, the demands are even greater. People are complex, yet the briefer encounters emphasize rapid recognition of a meaningful focus (Ornstein and Ornstein, 1972).

The epigenetic hierarchical perspective provides a rich conceptual base for locating a meaningful focus for intervention in a complex personality. The purpose of this chapter is to illustrate a method for selecting a focus in brief psychotherapy. Using vantage points from four epigenetic hierarchical models in psychoanalysis, a guide is offered for capturing essential elements of a person's function and emotional experience that informs a variety of intervention decisions. This chapter closely follows Basch's (1980, 1988, 1992, 1995) contributions to a developmental approach to psychotherapies. In his work on brief psychotherapy, Basch (1995) provided a strategy for continuously orienting the therapist to the patient's efforts to function adaptively through attention to structural and subjective aspects of the patient's self. Furthermore, Basch demonstrated how this strategy for identifying the patient's function guides the rational choice of interventions. My current effort may be considered a modest extension of his work.1 The perspectives I add to