A Study of Brief Psychotherapy by D. H. Malan (auth.)

By D. H. Malan (auth.)

The unique target of the current paintings, which was once initiated via Dr. Michael Balint, was once to discover short Psychotherapy conducted by way of psycho-analysts who're really expert and skilled. To this has been additional an try to reconcile the 'clinical' and 'objective' ways to psychodynamic fabric, via treating medical decisions precisely as carefully as is acceptable, not more and no much less. A overview of past paintings ends up in little certain end. an entire spectrum of perspectives are available, from the main 'conservative' (e.g. short psychotherapy is just potent within the mildest and newest health problems; the approach used could be superficial-any try to pass 'deeper' will bring about long term remedy; and the implications are just palliative) to the main 'radical' (seriously unwell sufferers will be commonly helped by means of a strategy containing many of the crucial components of long term tools comparable to psycho-analysis). the current paintings is predicated primarily at the remedies of 19 sufferers, handled by way of a staff of therapists below the chief­ send of Dr. Balint. The examine is essentially retrospective, however it is designed to fill a few of the very important gaps to be present in the literature: 1. precise case histories are given of all sufferers taken care of; 2. specific awareness is paid to lengthy follow-up; three. a style of assessing healing effects has been built that is considered as psychodynamically legitimate and relies on released facts; four. The relation is tested among end result and (a) the features of sufferers, (b) the features of technique.

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At what point is 'brief' therapy regarded as a failure because it has now become 'long-term'? The policy is adopted here of defining 'brief' therapy in terms of the length envisaged in the original plan or decided during therapy, allowing a good deal of latitude for difficulties over termination or the later continuation of a loose therapeutic relation. Thus, for the 48 The assessment of therapeutic results Hypertensive Housewife, 'brief' therapy is taken to have ended at the first attempt at termination, after nineteen sessions, and the continuation of regular sessions (20-39) is regarded as 'longterm'; while, on the other hand, the forty sessions of the Falling Social Worker, who was set a time limit of three months at three times a week from the beginning, are all regarded as 'brief'.

There is no need to be more exact, because the assessment criteria automatically require that the symptoms and the disturbances in human relations shall both be substantially reduced. Nevertheless, the majority of patients show only partial changes, and the result may then be much more difficult to assess. The principles adopted here are as follows: I. Partial resolution (a) Substantial improvement in the human relations without improvement in, but without exacerbation of, the symptom. (b) Limited improvement in both the human relations and the symptom.

The one exception (the Transvestist) is a patient who was in fact formally taken on, but who was quite clearly unsuitable for psychotherapy of any kind, with whom the therapist could make no contact whatsoever, and who finally drifted away from therapy without apparent improvement after a total of about five sessions. This patient made so little impact on the members of the team that he was simply ignored or forgotten-he was never included in our interim reports and no attempt was made to follow him up.

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