EXPERIENTIAL SHORT-TERM DYNAMIC PSYCHOTHERAPY

Introduction to the Dynamic Activities

As mentioned in chapter I, research data support the view that, in order to start a therapeutic process bringing about psychodynamic change, the patient needs to be enabled to experience his/her conflicting feelings with a sufficient intensity. For this reason, the sooner this emotional experience takes place with sufficient intensity and the dynamic process gets started, the briefer psychotherapy will be. Activation amounts to bringing about a sufficient increase of the intensity with which the conflicting feelings are being experienced by the patient.

Since what we need is to activate the conflicting feelings, represented as X in the Triangle of Self, and since these are kept unconscious by the defenses D and by anxiety A, we need to alter the complex balance existing among the three forces. It is certainly reasonable to act on the D corner, so as to weaken defenses, and on the A corner, thus regulating the anxiety loading the conflicting feelings. If, however, it were possible to act even on the X corner with a direct facilitation of emotional experiencing, we would actually be able to act on all the three forces involved in the maintenance of the conflict.

On the basis of these considerations, we will describe three main dynamic activities a therapist can engage in: Defense Restructuring, and Anxiety Regulation –respectively addressing defenses and anxiety- and the activity addressing the conflicting feelings, which we call Emotional Maieutics. A first general description of the three dynamic activities and of the corresponding attitudes and contributions of the therapist concludes this chapter and will be the theme of the next three.

Defense Restructuring (DA)

The purpose of this dynamic activity is to weaken the patient’s defenses, which are making a direct experience of the conflicting feelings impossible or insufficiently intense. The therapist:

(1)   concentrates on identifying all the defenses, so as to be able to mirror them to the patient;

(2)   follows the pathways enabling the patient to drop or put aside his/her usual defenses.

While restructuring the defenses, a therapist needs to be attentive and systematic, so as not to omit to address every single defense which is being employed. A sense of strategy and an ability to sustain confrontation may turn out useful for this activity.

Emotional Maieutics (XA)

The Oxford English dictionary defines “maieutic” as “pertaining to intellectual midwifery, i.e. to the Socratic process of helping a person to bring into full consciousness conceptions previously latent in his mind.” When applied to maieutics as used in the context of E-STDP, however, this definition can be paraphrased as follows: “pertaining to emotional midwifery, the process of helping a person to fully experience emotions present in him/herself.” What a midwife (= maia, in Ancient Greek) does is to help the mother to give birth, and to withstand the pain of delivery. The parallel with what a therapist can do is not just metaphorical. Emotions are in fact felt through the body and moving them out (in Latin e-movere means “move out” or “move from”) can indeed be painful. Our culture is sometimes forgetful of this aspect of emotions and I am grateful to Leigh McCullough for reminding me of this with her videorecorded cases. The therapist:

(1)   makes him/herself as much emotionally available to the patient as s/he can, giving him/her a sense of  being connected;

(2)   concentrates on the emotion that is being experienced, mirroring