Brief
Psychodynamic
Therapy: a
Relational
Approach
Dr. Scott Friedman
Brief Therapy Relational Models
• Horowitz
• Person schemas and problematic script sequences
• Weiss and Sampson
• Pathogenic beliefs
• Strupp & Binder
• Cyclical maladaptive pattern
• Luborsky
• Core conflictual relationship theme
Common Factors in Psychodynamic Relational
Models
• Maladaptive Relationship Style and Patterns
• Residue of childhood experiences impact adult relationships
• The unconscious as motivating force
• The Transference Template with its Cognitive and Affective
Components (Luborsky, Crits-Christoph, Friedman (1991)
Common Relational Factors
• The past is present in the here and now in our relational
patterns including with the therapist
• The therapist offers a corrective emotional experience
through the relationship and interaction
• Defenses or “Security Operations” are unconsciously
activated to, among other things, preserve self-esteem
• The unconscious as a motivating factor
Who May Benefit?
• Insight: “observing ego”
• Awareness of playing/being open to playing a role in their
problems with others
• Motivation including dealing with painful thoughts and feelings
• Ability to engage with the therapist and rapidly disengage
Supportive Aspects of the Therapy
• Define boundaries and limits: all that take place are in the
service of the person’s self understanding and benefit
• Empathy: feeling understood and soothed
• Preserve self esteem by not shaming
• Acknowledge client gains
Expressive/Insight Aspects of the Therapy
• Clarification: sharpen and bring issues and affects into focus
• Interpretation: Genetic, transference (interpersonal patterns
repeated)
• Interpersonal patterns repeated, personal issues.
• Use of the Self. Harry Stack Sullivan: Participant-Observer
self esteem based on the “reflected appraisals of others”
A Seminal Book in Psychotherapy Research
• 1984, Lester Luborsky publishes: Principles of
Psychodynamic Therapy: A Manual for Supportive-Expressive
Treatment
• Recurrent Themes that Occur in the Narratives the Client
Discusses and Has Enacted with People in their Life.
Including the therapist.
The Relational Narrative (relationship episodes)
• The client talks about people from the past and interactions
with them.
• The client talks about people in their current life and
interactions with them.
• The client may talk about therapy and their interactions with
the therapist (directly, subtly, transference).
• Interpersonal Scenarios with Interaction Details.
Components of the Core Conflictual Relationship
Theme (CCRT)
• Wish, Need or Intention:
• Overt or Implied/Subtle
(To feel valued, to be understood, to not be obligated to
submit to the other person, etc.)
Components of the CCRT
• Response of the other:
• Actual or Expected: (does not value me; misunderstand me;
dominates me).
• Transference aspect/Expected response from other
• Client’s unintentional role in having needs unmet
Components of the CCRT
• Response of the self:
The Symptom expression such as depression, anxiety, anger,
self-defeating behaviors, alienating others; repeating
maladaptive relationship patterns, etc. Symptoms viewed
through relational perspective.
What is the CCRT Formulation
• Most frequent Wish, Need or Intention and related Response
of the Other (Actual or Expected) and related
• Response of the Self (symptoms, maladaptive relationship
patterns)
Factors in Which Pattern to Explore
Dr. Jeff Binder (2204) provides us with guidance:
“The narrative theme represented by the pattern provides a plausible and
meaningful explanation of the patient’s symptoms and other problems;
The components of the pattern recur frequently and with noticeable intensity
(Luborsky and Christoph, 1977);
The pattern is part of what appears to be a dysfunctional style that contributes
to interpersonal difficulties (often including the therapy relationship) and leaves
the patient feeling anxious, depressed, and unfulfilled (Book, 1998);
The interpersonal pattern represents a plausible, meaningful, heuristically useful
facet of the patients ’life story”.
Therapy Process
• Identify the CCRT: make the unconscious relational pattern
conscious. Show it occurs in many relationship, situations and
settings.
• Identify and work through the Responses of Others: how we relate
and approach having needs met
• The wish, need and intentions tend to remain stable; how others
respond to us (because of how we respond and react to them) can
change with psychotherapy.
Therapy Process
• Termination and re-activation of the childhood CCRT
anxieties around separation and abandonment; managing
loss for client and therapist
Case Example CCRT
• Wish Need or Intention:
• To be valued and recognized; to not be taken for granted
• Response of Other-- Expected and Actual (related to how she
interacts): does not value or recognize me; takes me for
granted/not seriously.
• Response of Self: Depressed, Angry, Irritable; Self-Defeating
Behavior; Distances from peers; feels not valued/not taken
seriously.
References
•
Binder, J. (2004). Key Competencies in Brief Dynamic Psychotherapy. The Guilford Press: New York and London
•
Book, H. (1998). How to Practice Brief Psychodynamic Psychotherapy: The Core Conflictual Theme Method.
Washington, D.C.: APA Books
• Luborsky, L., Crits-Christoph, P., Friedman, S., et al. (1991) Freud’s Transference Template Compared with the
Core Conflictual Relationship Theme (CCRT): Illustration by Two Specimen Cases. Chapter 7, in M. Horowitz (Ed.)
Person Schemas and Maladaptive Interpersonal Behavior. Chicago: University of Chicago Press. (1984).
•
Luborsky, L. (1984) Principles of Psychoanalytic Psychotherapy: A Manual for Supportive-Expressive Treatment.
Basic Books
• Luborsky and Christoph (1977). Understanding Transference: The Core Conflictual Relationship Theme (2 nd ed.)
Washington DC: APA Books