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Mardi J. Horowitz Search for more papers by this author. Furthermore, the question of meaning in life cannot be productively answered by armchair speculation and deep introspection. Interpersonal Psychotherapy Running as a common thread throughout all of the insight-oriented approaches to treatment has been the revitalization of interpersonal psychotherapy from its original Sullivanian conception to its current intersection with models of brief therapy and the rediscovery of the saliency of the therapeutic alliance.
Sullivan , believed that psychopathology can be best characterized by the re- current patterns of interaction that the individual has with others in his or her interpersonal sphere. What evolved from this and subsequent projects was a manual-based and empirically-supported form of treatment for depression e.
Interpersonal psychotherapy is predicated upon attachment theory Bowlby, and the primacy of intimate emotional bonds. Accordingly, man develops intimate emotional bonds with specific individuals as an instinctual mechanism that serves as a protective function in survival from birth through the entire life cycle.
As a result, intense anxiety is associated with losing, or becoming separated from, an intimate other. The converse is also true: emotional security is promoted by the physical and emotional availability of protective figures in early life. Based upon this early learning, three patterns of attachment have been identified Ainsworth, a, b : First, there is the pattern of secure attachment in which the person has considerable confidence that his or her parental figure will be available and responsive in times of threat or adversity.
A person raised in such an environment generally feels able to transfer such confidence to other situations in exploring the world and the other relationships around him or her. Second, there is the pattern of anxious-resistant attachment in which the person has been raised by a parent being available and responsive on some occasions, but not on others. Such a person feels uncertain and prone to separation anxiety and is generally insecure about exploring the world and other relationships.
Object Relations Brief Therapy: The Therapeutic Relationship in Short-Term Work
In later life, such an individual attempts to be emotionally self-sufficient and to live without attachment to others in a somewhat self-absorbed or narcissistic existence. Each of these patterns of approaching others results in a certain style of interpersonal coping behaviors in the attachment history requiring the careful attention of and assessment by the interpersonal psychotherapist as he or she attempts to repair intimacy lost or gone awry Siegel, In general, those patients who have grown up with more anxious, less secure attachments are more vulnerable to emotional symptomatology.
However, even those with secure attachments may become symptomatic in response to the disruption of attachments related to normative losses that occur within the life cycle. Correspondingly, emotionally-mediated behavior becomes a key focus of attention in interpersonal psychotherapy. The focus for interpersonal psychotherapy is based upon the assumption that emotional symptoms anxiety and depression are the consequences to losses or disruption in the interpersonal support network of the patient.
The primary foci of treatment have been distilled into four thematic problem areas for the purposes of interpersonal psychotherapy e. These problem areas involve a grief, b interpersonal disputes, c role transitions, and d interpersonal skill deficits and sensitivity.
Interpersonal losses almost always involve both a grief reaction to the loss of a figure who has provided a sense of safety and security in the world e. Framo as well as discordant relationships with close friends or reference groups e. And, finally, the question of interpersonal skill deficits and sensitivity to others involves deficiencies that the patient might have in requisite social skills, such as assertiveness, or responsiveness to the affective life of others that serve to create and maintain supportive social relationships.
Herein lies the first psychotherapeutic dilemma for the interpersonal psychotherapist.
The presence of transference is ubiquitous from the outset in almost any pro- fessional helping relationship, so invariably there are exceptions to this stance regarding the therapeutic relationship. For exam- ple, when social skill deficits are identified, this element of treatment can take the form of social learning therapy, such as assertion training to enhance social con- tacts, with direct modeling by the therapist, and prescriptive instructions for and encouragement of behavioral homework. Herein lies a second psychotherapeutic dilemma for the interpersonal therapist.
The periodic directive stance taken by the interpersonal psychotherapist creates for them the same fundamental dilemma frequently experienced by cognitive-behavior therapists. First, the management of dilemmas in therapy is a dynamic process in which moment-to-moment decisions transpire with a reasonable degree of spontaneity in the course of an ongoing and constantly changing therapeutic dialogue between the patient and therapist. Secondly, dilemma management is a dialectical process in which the patient and therapist work toward an integration or synthesis of the conflict by means of a thorough examination of each arm of the dialectic.
The spe- cific resolution of the conflict, in many instances, may be less important than the fully considered exploration of alternatives that are examined by the patient. The Socratic method of learning in therapy becomes an important analogue and tool for learning in life. And, finally, the management of dilemmas in psychotherapy is also an inherently interpersonal process in which the emotional and relational life of the patient is empathically considered.
As such, the dilemmas surrounding a given focus and the therapeutic task of adhering to it are a process that defines the nature of psychotherapy. Patterns of infant-mother attachment: Antecedents and effects upon development. Bulletin of New York Academy of Medicine, 61, — Ainsworth, M. Attachments across the life-span. Alexander, F. Psychoanalytic therapy: Principles and application. New York: Ronald Press. Balint, M. Focal psychotherapy: An example of applied psychoanal- ysis.
London: Tavistock Publications. Beauchamp, T. Principles of biomedical ethics 4th ed. New York: Oxford University Press. Blos, P. The adolescent personality. New York: Appleton-Century-Crofts. Bowlby, J. The role of attachment in personality development. Bowlby, A secure base: Parent-child attachment and health human development pp. New York: Basic Books.
Budman, S. Theory and practice of brief therapy. New York: Guilford Press. Bugental, J. The third force in psychology. Journal of Humanistic Psychology, 4, 19— Carkhuff, R.
Beyond counseling and therapy. The client-centered process as viewed by other therapists. Rogers, E. Gendlin, D. Truax Eds. Cummings, N. Brief intermittent psychotherapy throughout the life cycle. Gilligan Eds. Brief intermittent therapy throughout the life cycle.
Berman Eds. The essence of psychotherapy: Reinventing the art in the new era of data. The general practice of psychology.
Professional Psychology, 10, — Davanloo, H. Basic principles and techniques in short-term dynamic psychotherapy. New York: Spectrum. Short-term dynamic psychotherapy. New York: Jason Aronson. Intensive short-term psychotherapy with highly resistant patients. Handling resistance. The central dynamic sequence in the unlocking of the unconscious and com- prehensive trial therapy. Part I. Major unlocking. Davison, G. Abnormal psychology 7th ed. New York: Wiley. Deutch, F. The clinical interview, Volume 1: Diagnosis, A method of teaching associative exploration.
New York: International Universities Press. The clinical interview, Volume 2: Therapy, A method of teaching sector psychotherapy, Vol. Ekstein, R. Psychoanalytic techniques. Abt Eds. Erikson, E. Childhood and society. New York: Norton. Framo, J. In-laws and out-laws: A marital case of kinship confusion. Framo, Explorations in marital and family therapy: Selected papers of James L.
SAGE Reference - Object Relations Therapy
New York: Springer Publishing Company. Frankl, V. New York: Washington Square Press. Implications of object-relations theory for the behavioral treatment of agoraphobia. American Journal of Psychotherapy, 39, — Greenblatt, M. The goals and responsibilities of the psychotherapist: Some problematic issues. Mahrer Ed. Gustafson, J. The dilemmas of brief psychotherapy.
New York: Plenum Press. Hall, C. Theories of personality. Hemingway, E. A moveable feast. Heidegger, M. Being and time. Horowitz, M. Regressive alterations in the self concept. American Journal of Psychiatry, 3 , — Hugo, V. Les Miserables. Very brief therapy -- Object relations brief therapy and personality-disordered patients: I -- Object relations brief therapy and personality-disordered patients: II -- Reflections on object relations brief therapy and managed care: brevity and integrity -- A brief epilogue.
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