Changing Character: Short-Term Anxiety-Regulating Psychotherapy for Restructuring Defenses, Affects, and Attachment

Changing Character: Short-Term Anxiety-Regulating Psychotherapy for Restructuring Defenses, Affects, and Attachment

Changing Character: Short-Term Anxiety-Regulating Psychotherapy for Restructuring Defenses, Affects, and Attachment

Changing Character: Short-Term Anxiety-Regulating Psychotherapy for Restructuring Defenses, Affects, and Attachment

Synopsis

Leigh McCullough Vaillant, a nationally recognized expert on short-term dynamic psychotherapy, shows therapists how to identify and remove obstacles in one's character (ego defenses) that block emotional experience. She then illustrates how the therapist can delve into that experience and harness the tremendous adaptive power provided by emotions. The result? She shows us how to have emotions without emotions "having" their way with us. Vaillant's integrative psychodynamic model holds that the source of psychopathology is the impairment of human emotional experience and expression, which includes impairment in drives and beliefs but is seen fundamentally as the impairment of affects. In this short-term approach, psychotherapists are shown how to combine behavioral, cognitive, and relational theories to make psychodynamic treatment briefer and more effective. Vaillant illustrates how affect bridges the gap between intrapsychic and interpersonal approaches to psychotherapy. Affect, she argues, has the power to make or break relational bonds. Through the regulation of anxieties associated with affects in relation to self and others, therapists can help their patients undergo meaningful character change. A holistic focus on affects and attachment has not been adequately addressed in either traditional psychodynamic theory or cognitive theory. Clearly and masterfully, Vaillant shows therapists how to integrate the powers of cognition and emotion within a dynamic short-term therapy approach.

Excerpt

A key factor in the technique of all dynamic short-term psychotherapy is the ability to break free from the passivity of classical psychoanalysis and transfer control into the hands of the therapist. In our investigations at the Tavistock Clinic we developed the principle of planning therapy from the beginning in terms of a focus, that is, a basic theme for interpretations, and actively trying to maintain this focus throughout each therapeutic session. As we later realized, however, the ability to maintain a focus depended on selecting patients who were well-motivated and responsive to interpretation. In the absence of these essential qualities, our purely interpretive technique was powerless.

It was Habib Davanloo who took activity on the part of the therapist to the limit, abandoning interpretation in the initial stages and exercising control by the relentless confrontation of defenses until a breakthrough was achieved. By this means he managed to bring into the sphere of short-term therapy many highly resistant patients suffering from severe personality disorders, who often lacked the motivation to give up their lifelong maladaptive patterns.

In 1982, a team at the Beth Israel Medical Center in New York of which Leigh McCullough Vaillant was research director began to investigate the effectiveness of short-term psychotherapy in a controlled study using as patients entirely those suffering from personality disorders. Among their results was the observation that confrontation of defenses, even when prolonged, did not in itself correlate with improvement.

This entirely ran counter to predictions based on the extreme effectiveness of Davanloo's work as seen on videotape; but the apparent contradiction can be simply resolved by the supposition that, in the hands of anyone but those most comfortable with a confrontational technique, confrontation in itself is ineffective and indeed may actually do harm. Put another way, if you are going to use persistent confrontation then you must resolve the situation in that session by breaking through into the hidden feeling that will give the patient relief. If you fail, you leave the patient merely antagonized or traumatized (4 out of the 64 in the aforementioned study described this phenomenon exactly, and 2 dropped out and refused further treatment of any kind).

One may ask, Did this lead to an impasse? The answer is no, since a . . .

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