Patterns of change: tracking the therapeutic focus

ABSTRACT

INTRODUCTION: Brief dynamic psychotherapy has been increasingly important in the actual clinical practice. For its brevity, focalization must be accomplished. The work on focus consolidates the material, abbreviates psychotherapy, and is considered to be a change mechanism. Operationalized Psychodynamic Diagnosis OPD-2 proposes a concept of focus as the specific problem areas that are significant for patient's psychodynamics, in terms of relational pattern, inner conflicts, and structural vulnerabilities. The study on foci becomes a research and clinical imperative, where change on foci must be considered. AIMS & METHODS: This study aimed to (1) identify foci in change episodes and (2) establish the relationship between them during the process. A multiple single-subject design was used, considering the analysis of 13 outpatient psychotherapies done as treatment as usual (average of 18 sessions each process). OPD-2and Level of Presence of Foci were used to identify foci worked by therapist and patient during change episodes, already codified in a previous research usign the list of Generic Change Indicators. RESULTS & DISCUSSION: 208 change episodes were analysed. Conflict focus relates inversely with structural focus at the initial phase, and the latter appears to increase during the process. Some focus relates to different levels of patients change. Results are discussed in their clinical relevance. (AU)