The frontier of brief psychotherapy : an example of the convergence of research and clinical practice

When I was a psychiatric resident not long after the end of World War II, any patient with the wits to get himself to a psychiatric clinic was taken into long-term dynamically oriented psychotherapy. Regardless of his diagnosis or clinical need, he was seen once, twice, sometimes even more frequently a week in fifty-minute sessions. Face-to-face with the therapist, he was urged to free associate and to express his dreams, fantasies, and emotions to a usually passive listener in what often appeared to be a caricature of psychoanalysis. It was not psychoanaly- sis, of course (although the differences were sometimes hard to define), but the aims were the same-to resolve psychic conflicts through in- sight and to bring about an internal psychological change that would allow the individual to work more effectively and to make healthier and happier relationships. Enough patients improved with these techniques to reinforce our penchant for using them. We were somehow able to ignore the fact that because of the limitations of time many patients withered on the waiting list. And we were able to blame our frequent therapeutic f~ilures, not to mention the damaging regressions our narrowly re- stricted techniques often induced, on the patient's unwillingness to cooperate. Procrustes's couch was as inflexible as his bed. Old customs die hard, and the mindless application of long-term therapy is still found in clinical situations where it is inappropriate or contraindicated. But change is in the air.