This paper points out: (1) The fundamental importance, during the patient’s first visit, of a shift of the objective involvement on the therapist’s person, when a significant real object fails. (2) An initial interpretation, based on understanding this mechanism, is mutational in that it transfers the mourning for relations to internal objects. (3) The patient usually takes medical advice when in a more or less open crisis situation, where his objective investment (internal and external) is shaken. (4) The nature of the crisis can be understood, by a deep investigation of the patient’s relational context following a psychoanalytical pattern. (5) Application of these concepts allows very short interventions (psychotherapeutic interventions), the therapeutic value of which is undeniable.

The author reminds first a few elements of his own conception about the focalization as well as the influence of the setting on the psychic functioning. He shows how the dynamic elements which enlighten the central conflict of the patient occur already during the first minutes of the first interview. Such a conceptualization applies not only to short psychotherapies but also to all vital experiences which may be solved with a punctual psychotherapeutic intervention (1–3 sessions).

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This article studies the motivations of patients for psychiatric consultation. A better understanding of patient-therapist interactions will be helpful in producing an initial psychotherapeutic intervention that, in turn, will lead to an immediate change in the patient's attitude, facilitating treatment by giving it a correct orientation. A clinical example illustrates the above points.

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