Interaction Structure and Transferential Patterns in Brief Psychotherapy: A Single-case Study

Abstract

Nowadays it is sufficiently accepted that the therapeutic action of psychotherapy is expected to lie at the interface between two dimensions: identification and interpretation of the patient's dysfunctional relationship patterns arising in the relationship with the clinician. This can only happen, however, if there is a temporal space where the transference-countertransference reactions to be explored and understood can emerge (Jones, 2000). The limited number of sessions characterizing short-term psychotherapy does not seem to allow the unfolding of these dynamics, thus suggesting that the therapeutic action of this approach lies outside the patient-therapist relationship. The aim of this study is to investigate the possibility that, even within the few sessions that characterize short-term psychotherapy, the dynamics of transferencecountertransference typical of the patient's dysfunctional relationship patterns do in fact emerge. For this purpose, a study has been made of the patterns of patient-therapist interaction, measured by the Psychotherapy Process Q-set. The patterns identified are related to the change found in the Core Conflictual Relationship Theme, allowing reflection on the role played by alternating interaction patterns in the variation of the patient's intrapsychic conflicts in this psychotherapy model.

Dimensions of Activity in Countertransference and Therapist Reactions: Therapist Reactions During Sessions with Depressed Patients

“…These interaction patterns allow the clearest insight into transference-countertransference dynamics in the therapeutic relationship. De Bei & Montrosi (2013) claim, in line with Jones (2000), that the therapist's and patient's experience, recognition and understanding of these recursive interactions should be linked to therapeutic interventions and compared to the mediating effects of analytic techniques (Zimmermann et al 2014).…”

“…Building on the expected dimensions of therapists' reactions, the second question was to find an "interaction structure" (Jones 2000) nurturing the relationship between therapist and patient in initial, middle and final therapy session with depressed patients by correlating the dimensions of therapists' reactions with patients' affect parameters. The concept of "Interaction structure" evolved around the findings that patients and therapists tend to interact "through stable and repetitive patterns" (De Bei & Montrosi 2013) during treatment. These interaction patterns allow the clearest insight into transference-countertransference dynamics in the therapeutic relationship.…”

Uso do psychotherapy process Q-set para pesquisas em psicoterapias psicanalíticas: revisão sistemática da literatura

“…Em dois estudos (De Bei & Montorsi, 2013; utilizaram as avaliações do PQS ao longo do tratamento para identificar padrões de relacionamento paciente-terapeuta (estruturas de interação). Por exemplo, De Bei e Montorsi (2013) investigaram a possibilidade de que mesmo na psicoterapia de curto prazo, a dinâmica da transferência -contratransferência poderia se manifestar.…”

“…São tratamentos que demandam flexibilidade para acomodar as questões emergentes do paciente em crise. Os trabalhos nesta categoria refletem tanto o aprimoramento da análise de processo ao longo de sessões terapêuticas sob a perspectiva de uma metodologia quantitativa de investigação , quanto de uma metodologia qualitativa (De Bei & Montorsi, 2013), associada ao estudo temático das estruturas de interações, conceito relacionado a outros conceitos psicanalíticos como transferência-contratransferência e enactment (Jones, 2000). A identificação de padrões repetitivos de interação paciente-terapeuta amplia os recursos da pesquisa em psicoterapia, permitindo o desenvolvimento de evidências acerca das características do processo psicoterápico que aprofundam nossa compreensão sobre casos individuais e desse modo delimitam novas possibilidades de aproximação entre a pesquisa empírica e a prática clínica.…”

Development and Characteristics of the Therapeutic Alliance in a Short-Term Dynamic Psychotherapy: A Descriptive Case Study

“…The treatment was an STDP approach based on the work of Davanloo (1990), integrated with suggestions from Fosha (2000), in a Psychological Service in Northern Italy. In the STDP intervention model, the therapist starts to deal with the alliance problem when the patient, after many questions and clarifications, starts to show some signals of negative transference (for this point see De Bei & Montorsi, 2013). At this point the therapist makes an explicit reference to the importance of having the patient as an ally against the dysfunctional modalities emerging in the psychotherapeutic relationship.…”