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I THINK THE RICH, DIVERSE PERSPECTIVES offered in this conference help focus the real difficulties one encounters when trying to treat
serious pathology in a short term context. The therapist has to make choices as to what will be most effective and what to sacrifice. Obviously all of the points of view offered illuminate the broad range of possibilities which can be included and the tradeoffs implied by choosing any one perspective.
What I would like to do now is to relate to the stimulating comments that have been made, and to Balint's case material, from the perspective of a technical approach which I have been using and have found to be valuable when working with very disturbed people in long or short term treatment.
Although I can understand Dr. Myerson's caution that Balint's work should be responded to in terms of whether Balint has fulfilled his stated goals, I would suggest that the limitations of the focal approach are to a large degree the limitations of the goals themselves. Rather than accept the framework offered of simply shoring up defenses and not engaging deep pathology, I would like to open for discussion the question of whether it is possible to engage and work through underlying vulnerabilities and deep pathology even in a time limited treatment, and if so, to what degree and how.
My own view is that although the gains possible in short term treatment are obviously limited by the constraints of time, the most far reaching benefit comes from addressing and engaging the core pathology. I believe that working through a small s