Character Change in Less Frequent Therapies: Psychodynamic and Transference Implications.

An approach to a once-weekly, or bimonthly (every second week), ongoing psychodynamic psychotherapy is described. The detailed description of individual sessions is intended to show the process of the uncovering of unconscious phenomena using this approach, though the therapies described are not complete. Important changes that have already occurred are described. The approach is characterized by a direct method of discovery of early painful situations that underlie specific problematic experiences in the present. The therapeutic stance is designed to establish a collaborative relationship with the patient that becomes the substrate of the relationship and often leads to an identification with the therapist who becomes an ongoing presence in the patient's life.

Recognition: A Key for Understanding a Necessary Role of the Psychotherapist for the Successful Outcome of Psychotherapy.

The purpose of this paper is to focus on an aspect of psychodynamic psychotherapy that includes psychoanalysis to illustrate the important element in the psychotherapeutic relationship called recognition. This involves an emotional sharing with the patient of the importance of particular life experiences that he has had and as such this not only cements the relationship but becomes the substrate of change and an internalization of the therapist that persists after the end of treatment. This interaction parallels the experience with a responsive mother able to echo the infant's experience. The experience of recognition is illustrated with 10 case presentations that demonstrate the power of this factor in a variety of patients ranging from brief consultations to psychoanalysis.

The Internalization of a Representation of the Therapist as an Element in Psychotherapeutic Gain.

This paper illustrates the beneficial effect of a positive benevolent transference in the development of an internalized representation of the therapist/analyst in a variety of patients in psychodynamic treatments ranging from consultation to psychoanalysis itself. This is described in patient presentations. In those who have had substantial early nurturant life experience and now find themselves in a dysphoric state due to crisis, the effect lies in the transference reactivation of these positive object relations that relieve their distress. In those who have been deprived of such early experience, the positive transference may emerge during the intensive work of psychoanalysis and may lead to the internalization of a new positive object representation of the analyst generated in the transference that persists after termination of treatment. In both of these situations, the patient discovers a sense of greater harmony with self and the world. The special conditions that permit and facilitate this process are described since this does not occur in all psychodynamic interventions.

Psychodynamic Intervention in Crisis.

This paper presents a framework for brief, intensive psychotherapeutic intervention for acute distress, manifested by feelings of depression, anxiety or anger, isolation and loneliness, that arise when crises provoke unconscious conflict. This therapy uses a technique to develop a "benevolent transference" for symptom relief and as a groundwork for gaining insight. Interventions to facilitate this process will be illustrated with case illustrations.

The induction of noninterpreted benevolent transference as a vehicle for change.

It has become widely accepted that nontransference interpretation can have power (Blum, 1983). My intent in this paper is to describe an active, intentionally evoked, but uninterpreted, positive transference that is designed to effect change in the patient in an otherwise psychoanalytically oriented therapy. The changes may range from symptom relief to more significant change, as reflected in modifications in the patient's self-perception, perception of others (self-object constellations), and experience in the world. Apart from interpretation of conflict revealed in the patient's experience of the world, the uninterpreted positive transference offers a new object relationship devoid of significant conflict that may closely approximate an ideal of the good parent (the internalization of a good object). In this respect, it contributes strongly to a change in the representational world. The positive transference is not only the substrate of the ongoing process of therapy, but also a useful product of the process. To implement this change the therapist develops a therapeutic stance through specific actions and an attitude that offers the patient a new and benevolent object.

A model for interpretative supportive dynamic psychotherapy.

A psychodynamic model of supportive therapy is described. The therapist by communicating his awareness of the experience of the patient shares it in a limited way and becomes a presence in the patient's life, thereby muting the experience of loneliness associated with internal conflict or crisis. In this respect, the aim is to "be with the patient" rather than to "act on the patient." Techniques to accomplish this engagement are outlined. The positive transference that develops under these circumstances does not obviate the possibility of the use of interpretation that may lead to substantive change. The model is illustrated by case examples.

The therapeutic consultation: finding the patient.

The psychiatric consultation has not been adequately exploited as a therapeutic device. Although, the original abstinent model for psychodynamic psychotherapy has become more flexible, passive listening with interventions to elicit diagnostic "data" remains the prevailing mode in psychiatric consultation. In this paper I develop the idea of the consultation as an active process (Viederman, M., 2002) that engages the patient emotionally for therapeutic effect.

Active engagement in the consultation process.

This paper presents a case for the active, dynamic engagement of patients during consultations. Observations and hypotheses about the patient's predominant conflicts are used to formulate interventions early in the consultation process that are designed to convey meanings that make the patient's experience comprehensible to him. This includes attention to his personality and his world view. The activity of the consultant in appropriately communicating aspects of these formulations to the patient is designed to facilitate the process of self-revelation and to permit a co-construction with the patient of a perspective on aspects of his life experience and his current problems. Active, dynamic engagement leads to the development of a bond between consultant and patient that facilitates the implementation of a treatment plan. Numerous case descriptions are included to illustrate this active approach as applied in different contexts.