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Time-limited dynamic therapy is organized around a "focus"—an affectively charged maladaptive interpersonal pattern that pervades a broad range of the patient's interpersonal relationships, including the therapeutic encounter. Identification and systematic examination of this interpersonal focus as enacted within the therapeutic relationship constitutes the primary work of the treatment. As this vignette illustrates, countertransference reactions can provide invaluable clues for identifying the nature of the therapeutic focus. The therapist's countertransference responses reflect his limited participation in the maladaptive focal pattern; the countertransference appears as a reciprocal response, "evoked" by the patient's transference enactments. In the case presented, the therapist felt intensely scrutinized by the patient, as though he was being tested, and he felt a reciprocal urge to be very careful in what he said and how he acted. These personal reactions prompted his initial hypothesis that the patient expected to be coerced and criticized, and therefore needed to remain vigilantly stand-offish while giving only the appearance of cooperation.
Subsequent to this initial formulation, the focus provided a conceptual framework within which the therapist systematically organized his impressions—including countertransference reactions—along a track that kept the therapeutic work circumscribed. Thus, in the latter part of the vignette case, the therapist's realization that he had devalued the patient's expression of affectionate interest alerted him to the continued operation of the initial focal pattern regarding the patient's chronic expectation that her feelings would be discounted and criticized.