Short-term dynamic therapy as a unique container.

Abstract

SHORT-TERM DYNAMIC PSYCHOTHERAPY: A CONTENTS-FRAMEWORK DIALOGUE There are unique characteristics to short-term psychotherapy that influence not only the course of the therapeutic process but also the ability to intensify it. The body of professional literature dealing with short-term psychotherapy hardly ever discusses the relation between its characteristics and the therapeutic process (1-9). Mann (10, 11) is the only theoretician who discusses this point, maintaining that a framework limited in time dictates the therapeutic process. All short-term psychotherapies, he writes, bring about a present-time revival of the universal conflict between the infantile experience of time, i.e., time as being unlimited, immortality and omnipotent phantasies and the adult experience of time, i.e., personal time as limited, finite, bounded and related to boundaries, limitations, and death. It is my suggestion that the unique quality of short-term psychotherapy influences patients' and therapists' inner worlds far beyond the mere experience of time. Short-term psychotherapy is unique in three major respects. The first is the setting: therapy is intended to be short, and in some cases the termination date may also be precisely predefined. The two other aspects have to do with the therapeutic stance: therapeutic focus and the therapist's activity in maintaining that focus. These characteristics, which I refer to, generally, as structure, influence the therapeutic process, as will be described below. The analytic setting according to Etchegoyen (12), may be compared to a Rorschach card in which the patient sees things that are reflective of him or her. Etchegoyen emphasizes that the archaic part of the personality, which parallels the preverbal phase of the first months in life and is related to psychotic aspects of the personality, is expressed through nonverbal communication channels, and particularly through the patient's relation to the setting. Etchegoyen distinguishes the setting's function from its meaning. The setting has a clearly defined function but it must be mute to allow the process to be voiced (13); Etchegoyen also reminds us that thinking that the setting may truly remain mute means thinking it cannot be endowed with meaning. The setting is created because it facilitates for the best conditions for analytic functioning. Strangely enough, a large part of the analytic function is the attempt to decipher the setting's meaning for the patient, that is, what theories the patient construes about the setting. Paraphrasing Etchegoyen, we could say that the therapeutic structure is the Rorschach card onto which the patient projects his or her inner world, and that just as different Rorschach cards elicit different reactions, different therapeutic structures, (analysis, long-term psychotherapy, short-term psychotherapy) will also invite different processes. Quinodoz (14) maintains that the analytic setting is the expression of the containing function. She sees it as an vessel that both influences and is influenced by the therapeutic contents. By using the concept of active containing, Quinodoz draws our attention to the difference between a container as an inert object, that is not in any interaction with its contents, and an container that dynamically interacts with its contents, so that each is vital to the other's existence. The example brought by Quinodoz is that of a jug of milk and a breast. A jug, unlike the breast, is a container- as -thing, which can contain milk without acting on it and without being modified by it; by contrast, the is a container essential to the production of the milk which it contains, and the contained milk exerts an action on the breast (p.629). An container is essential, submits Quinodoz, to the analyst for the creation of his interpretative function and for setting in motion his 'capacity for reverie' (14, 15). …