The Therapeutic Relationship in Brief Focal Psychotherapy

When the mutative factors in dynamic psychotherapy are considered, those comprising the relationship between the patient and therapist almost invariably lead the list. The nature of this relationship and the aspects of it that induce change have received a great deal of attention in the literature. This paper will attempt to describe experience with the therapeutic relationship in the kind of short-term dynamic focused psychotherapy which has developed from the work of Mann (1969), Sifneos (1979), Malan (1976), and Davanloo (1978). Some of the most graphic technical differences between brief focal psychotherapy and more traditional longer therapies concern ways in which the therapeutic relationship is handled. These differences will be described and an attempt made to extrapolate from experience with short-term therapy to, hopefully, illuminate questions concerning the therapeutic relationship in all dynamic therapies.

The technique of brief focal psychotherapy has been described extensively (Marmor, 1979; Brodaty, 1983; Weissberg, 1984) and will be reviewed only briefly. During the evaluation, the patient's main complaint is isolated and an underlying conflict labeled as the focus. The main task of therapy is to explore the focal conflict in the context of its early origins, of its present manifestations, and of its influence on the therapeutic relationship. The focal conflict produces ramifications in the developing therapeutic relationship, and these and any other interfering resistances are pointed out in a confrontational but not adversarial manner. The therapist's confrontational and relentless insistance on the maintainance of a focus usually elicits expression of hitherto repressed affect, frequently rage, directed at the therapist, which is typically associated with relief and strengthening of the therapeutic relationship. Maintenance of attention on the focal conflict