Intersubjectively oriented,time-limited psychotherapy with children: how does the therapist evaluate the therapeutic process and what are the therapist’s tasks?

Based on the therapist’s evaluations of three therapies, this research aims to study the therapeutic process in intersubjectively oriented, time-limited psychotherapy with children. A primary objective is to further develop the therapy method. The study comprises therapies with children 6–11 years of age, who had experienced difficult family situations. Each child received 12 therapy sessions. The number of therapy sessions with children and parents was agreed upon beforehand, and the therapeutic objectives were approved by the parents. Each of the therapy processes were evaluated by the therapist by answering three questions and filling in three forms after each therapy session. The forms were: The Feeling Word Checklist; an alliance form for the child; and a process form. The therapeutic alliance and the behaviour of the therapist during the therapy sessions are discussed on the basis of the total material. The following main tasks for the child therapist emerged: structuring the therapy sessions; following the child’s initiatives; participating and cooperating with the child; exploring the child’s expressions; and understanding and regulating emotions.     

Time‐limited therapy in a Community Mental Health Team setting

This study examines time‐limited therapy in a Community Mental Health Team (CMHT) setting. This work is a key tension for CMHTs who are under pressure to focus on clients with a serious mental illness as a priority as opposed to clients who might be deemed the ‘psychologically distressed’. The development of CMHTs in the UK is described. Limited research on time‐limited therapy in a CMHT setting is identified. Results suggest that time‐limited therapy has a positive impact on the mental health needs of clients referred to a CMHT by GPs. It is concluded that it is appropriate to justify the use of time‐limited therapy in a CMHT‐based setting. Suggestions for further research are made.     

Time and again: Intermittent Brief Dynamic Therapy

Abstract

The author notes that in many of the settings in which Brief Therapy takes place that a client may return after the ending for a further series of sessions. Time-limited therapy has placed an emphasis upon the termination phase of the therapy and linked this to the process of individuation and separation. Such an approach, as articulated by Mann (1973 Mann, J. 1973. Time-limited psychotherapy, Cambridge, MA: Harvard University Press.  [Google Scholar]), which draws conceptually from the work of Winnicott (1965 Winnicott, D. W. 1965. The maturational processes and the facilitating environment, London: Hogarth Press.  [Google Scholar]) and the notion that the infant achieves unit status from the original undifferentiated merger with the mother, is not easily compatible with Intermittent Brief Dynamic Therapy. The work of attachment theorists and Stern (1985 Stern, D. N. 1985. The interpersonal world of the infant, New York: Basic Books.  [Google Scholar]) provide an alternative basis upon which to conceive of the development of the infant. While emphasizing the importance of attending to affects at points of separation and ending, as is evidenced in the work of Della Selva (2004 Della, Selva P. C. 2004. Intensive short-term dynamic psychotherapy, London: Karnac.  [Google Scholar]), such a framework is more readily compatible with the development of Intermittent Therapy, and with the realities of the settings in which much brief work takes place. The author also comments upon the flexibility inherent in Winnicott's own practice of brief consultations, and the implications of this for the development of Intermittent Brief Dynamic Therapy. The paper includes a case study that illustrates this debate and which provides evidence for the therapeutic potency of a form of Brief Dynamic Intermittent Therapy where a dynamic focus maintains a structuring pattern to the narrative over a sequence of several periods of Brief Therapy, spread over a number of years.     

Negotiating time: the significance of timing in ending inpatient work

This paper discusses work with young people during their stay on an NHS psychiatric inpatient unit, especially focusing on the end of treatment and the appropriate timing of discharge into the community. When approaching the end of an admission, various factors are considered that seem particularly relevant to the decision of when a young person may be ready to leave and cope with the transition back to life outside the unit. Indications of medical stability, in patients where this has been an issue, is a factor of prime importance. Other important factors include family functioning; the availability of adequate ongoing local CAMHS support for the child and family; suitable school provision; and the identity of the child within a peer group. The reality of NHS resources and the demand for inpatient beds is another pressing consideration. The young person's own motivation emerges as crucial at this stage – towards the end of treatment – not only in terms of what is said, and therefore evident verbally, but also through signs of internal shifts in the child that indicate a capacity to re-engage with life outside in a lasting way. Decisions about when to stop are taken with all this in mind and when the decision does not seem straightforward, it can provoke considerable anxiety in the multi-disciplinary team. Clinical material from psychotherapy with a young adolescent boy with anorexia nervosa is used to illustrate some of the dilemmas.     

Working with the complexities of adolescent mental health problems: applying time-limited adolescent psychodynamic psychotherapy (TAPP)

This article discusses the application in a CAMHS setting of a distinctive intervention for adolescent mental health difficulties, time-limited adolescent psychodynamic psychotherapy (TAPP). TAPP has been developed specifically for working with adolescents and the characteristic developmental and psychosocial complexities they present to mental health services. It is widely recognised that supporting the developmental process in adolescence is central to therapeutic interventions and the therapeutic aim of TAPP is to enable recovery of the capacity to meet developmental challenges. The key factors of TAPP are described, including the formulation and working with a developmental focus, the therapeutic stance, working with transference and counter-transference, working with time limits, and the emphasis is placed on engagement of adolescents in therapy in TAPP. The experiences of introducing and developing TAPP in the CAMHS service are discussed with two brief and one extended case examples and this leads to a discussion of the kinds of outcomes achieved. It is concluded that TAPP is a key and relevant intervention for adolescents in complex and vulnerable situations; further work will be undertaken to continue its application in these settings and to formally assess outcomes.     

Receiving slaps,receiving words. The violence of separation in a public service time limited psychotherapy group for adolescents

The authors propose a reflection on a time-limited psychoanalytic group for children, adolescents and families, run in a public service. Some patients in the group give accounts of violent relationships and traumatic experiences. The accounts of violent, interpersonal and intrapsychic relationships influence the group’s capacity of thinking, which leads to difficulties in the processing of symbolic aspects. The fundamental question is that of whether it is possible to work in a time-limited, institutional, psychoanalytical framework, in which psychotherapists have to attempt to give meaning to experiences which take place in a repetitive present, in a space/time in which the prospect of a conclusion appears to be inconceivable. By means of a clinical example, and with particular emphasis on the first sessions and the dream brought up by a patient who has been a victim of domestic violence, the authors discuss the possibility of modifying, chiefly from within, the feeling of the immutability of early psychic material, which is itself intrinsically violent.     

Three fragments on trauma and time

How does trauma influence a client and a therapist’s experience of time in time-limited therapy? The therapist must first work to understand and remain responsive to the different registers of time now operative following the traumatic event. This paper contends that in the immediacy of trauma, hallucinatory wish-fulfilment oblivious to the structuring conditions of time and space appears to dominate. In chronic traumatic states, time appears to circle in a narrow compass, buffering between a cluster of moments surrounding and including the moment of traumatic rupture – as if struggling to re-establish a secure connection with linear time. The three clinical fragments presented attempt to describe different experiences of traumatic bereavement and the felt movement of time within them. The death of another confronts us not only with their loss but with our own mortality – the time we have lived and the time we have left. It is not surprising, therefore, that an individual's otherwise fluid transitions between different temporalities are disturbed in the aftermath of traumatic bereavement. The therapist’s capacity to regulate tempo when the client’s subjective experience of time is dysregulated offers an important means of containment. The aim of the therapist working with the traumatically bereaved client is to develop collaborative understanding to get thinking moving again and to gradually help the client unpin time, moving it beyond the confines that it occupies in trauma.     

Time-limited group psychotherapy: Has cinderella found her prince?

The time-limited group psychotherapy treatment format is in demand in a healthcare delivery system that is increasingly concerned with effective and efficient methods for treating acute mental health problems and maintaining patients in the community. The empirical literature provides strong support for the positive outcome of relatively brief treatment. A larger service delivery system ensures a flow of patients who can be managed in a variety of types of groups. This will require the group clinician to become comfortable working in conjunction with a larger system and knowledgably delivering different types of treatment while continuing to use the group itself as a major source of therapeutic power.     

Mobilizing self through short-term dynamic interpersonal psychotherapy: a preliminary report

Background: The key features of short-term dynamic interpersonal psychotherapy (STDIP) are outlined along with the background of its development. Preliminary data demonstrating functional improvement in a small case series of patients is presented.

Methods: Nineteen patients were evaluated at commencement and end of therapy in a pilot study. Instruments used were the Childhood Trauma Questionnaire (CTQ); Beck Depression Inventory (BDI); Brief Symptom Inventory (BSI); COPE (Coping Style Questionnaire); Relationship Styles Questionnaire (RSQ) and Social Adjustment Scale-Self Report (SAS-SR).

Results: This cohort had significantly elevated scores on the CTQ. They demonstrated substantial improvement on measures including the BDI, and several subscales of BSI, COPE, RSQ and SAS-SR.

Conclusions: The small numbers and naturalistic design preclude firm conclusions however the results suggest that STDIP can be used to successfully treat patients, notwithstanding a history of childhood trauma.     

The relationship between existential-phenomenological and cognitive-behaviour therapies

The tendency of GPs to cap the number of counselling sessions offered to their patients in primary care has led to an ongoing debate about the effectiveness of time-limited counselling and brief therapy models. the advantages and disadvantages of brief as opposed to open-ended models of counselling in primary care need to be considered from the point of view of the client, the counsellor and the GP. Given that outcome research shows no difference between the two methods, a cost-benefit analysis would indicate that, for the majority of cases, time-limited counselling works very well. But there is still a minority of clients who do need open-ended therapy, and their needs are not being served by the present NHS system. Counsellors should therefore not be debating for either brief or open-ended style in primary care, but should be organizing themselves into expanding the service to give GPs the choice of both approaches.