On closing the frame: An existential argument for setting a time-limit in intensive short-term dynamic psychotherapy.
DOI:
https://doi.org/10.70839/0c5a1z89Keywords:
mortality and psychotherapy, therapeutic frame, separation anxiety, existential–phenomenological theory, analysis interminable, transference and dependency, defenses against endings, termination, death anxiety, time-limited psychotherapy, Intensive Short-Term Dynamic PsychotherapyAbstract
This paper provides a theoretical argument for setting a time-limit in Intensive Short-Term Dynamic Psychotherapy (ISTDP) as one way to circumvent protracted treatments with diminishing clinical benefits. The author draws from prior literature in the psychoanalytic and short-term dynamic psychotherapy movements, as well as existential-phenomenological theory, to suggest that the open-endedness of most psychodynamic psychotherapies provides fertile ground for defenses against termination to take root and that such defenses are often due to both the therapist’s and patient’s unconscious anxiety about their mortality. The author suggests that implicit assumptions in ISTDP about the achievable outcomes of psychotherapy, specifically the possibility that therapists can completely resolve neurotic derivatives of source trauma, do not account for the impact of our universal terror and defenses against death, which are future-oriented and therefore always at least somewhat unresolvable. The author suggests that setting a time limit at the outset of therapy, or 'closing the frame,' facilitates early recognition of unconscious defenses against death and separation. This approach helps bring underlying mixed emotions about separation, loss, and the limitations of psychotherapy to the surface before these defenses become more entrenched. Phenomenological research data and brief vignettes of time-limited ISTDP treatment from the author’s clinical practice are provided to support these ideas with examples. The author also discusses challenges and limitations of a time-limited approach to short-term psychodynamic psychotherapy.
References
Abbass, A. (2015). Reaching through resistance: Advanced psychotherapy techniques. Seven leaves press.
Becker, E. (1997). The denial of death. The Free Press.
Bowie, D. & Eno, B. (1977). Heroes. [Song]. On Heroes. RCA.
Davanloo, H. (1990). Unlocking the unconscious: Selected papers of Habib Davanloo. John Wiley & Sons.
Davanloo, H. (2005). Intensive short-term dynamic psychotherapy. In: Kaplan and Sadock’s comprehensive textbook of psychiatry. (8th edition, pp. 2628-2652) Lippincot Williams & Wilkins.
de Saussure, F., (1966). Course in general linguistics. (C. Bally & A. Sechehaye, Eds, W. Baskin, Trans.) New York, Toronto, London: McGraw-Hill Book Company.
Dylan, B. (1964). It ain’t me you’re looking for babe. [Song]. On Another side of Bob Dylan. Columbia Records.
Firestone, R. W., & Firestone, T., & Catlett, J. (Collaborators). (2022). Challenging the fantasy bond: A search for personal identity and freedom. American Psychological Association. https://doi.org/10.1037/0000268-000
Firestone, R.W. (1985). The fantasy bond: Structure of psychological defenses. The Glendon Association.
Ferenczi, S., & Rank, O. (1925). The development of psychoanalysis. (Newton, trans.) Nervous and Mental Disease Publishing Company.
Ferraro, F. Garella, A., & Zinn, D.L. (2009). Endings : on termination in psychoanalysis. Rodopi. February 29 2024
Fitzgerald, E. (1859/2009). Rubaiyat of Omar Khayyam. OUP Oxford.
Freud, S. (1937). Analysis Terminable and Interminable. In J. Strachey (Ed. & Trans.), The Standard Edition of the Complete Psychological Works of Sigmund Freud (Vol. 23, pp. 216-253). London: Hogarth Press.
Freud, S. (1915). The Unconscious. In J. Strachey (Ed. & Trans.), The Standard Edition of the Complete Psychological Works of Sigmund Freud (Vol. 14, pp. 159-190). London: Hogarth Press.
Gregory, R.J. (2022). Manual of Dynamic Deconstructive Psychotherapy. Retrieved online: https://www.upstate.edu/psych/pdf/manual-2-14-23.pdf
Heidegger, M. (1996). Being and Time: A Translation of Sein Und Zeit. (J. Stambaugh, Trans.). State University of New York Press. (Original work published 1953).
Howard, K. I., Kopta, S. M., Krause, M. S., & Orlinsky, D. E. (1986). The dose–effect relationship in psychotherapy. American psychologist, 41(2), 159.
Kalpin, A. (1993). The use of time in intensive short-term dynamic psychotherapy. International Journal of Short-Term Psychotherapy, 8(2), 75-91.
Kenney, J. (2008, January 21). The Last Session. The New Yorker, 83(44).
Kopta, S. M., Howard, K. I., Lowry, J. L., & Beutler, L. E. (1994). Patterns of symptomatic recovery in psychotherapy. Journal of consulting and clinical psychology, 62(5), 1009. https://doi.org/10.1037/0022-006X.62.5.1009
Kopta, S. M. (2003). The dose—effect relationship in psychotherapy: A defining achievement for Dr. Kenneth Howard. Journal of clinical psychology, 59(7), 727-733. https://doi.org/10.1002/jclp.10167
Lacan, J. (2007). Écrits (B. Fink, Trans.). WW Norton.
Langs, R. (1997). Death anxiety and clinical practice. Karnac Books.
Levenson, H. (1995). Time-limited dynamic psychotherapy: A guide To clinical practice. Basic Books.
Mann, J. (1973). Time-limited psychotherapy. Harvard University Press.
Malan, D.H. (1986). Beyond interpretation: Initial evaluation and technique in Short-Term Dynamic Psychotherapy. Part I. International Journal of Intensive Short-Term Dynamic Psychotherapy, 1(2), 59-82.
Malan, D.H. (1992). The most important development since the discovery of the unconscious. In Davanloo (Ed.), Short-term dynamic psychotherapy. (1st softcover ed., pp. 3-12). Jason Aronson, Inc.
Marmor, J. (1992). Historical roots. In Davanloo (Ed.), Short-term dynamic psychotherapy. (1st softcover ed., pp. 3-12). Jason Aronson, Inc.
May, R. (1983). The discovery of being. New York, NY: W. W. Norton.
Molnos, A. (1995). A question of time : essentials of brief dynamic psychotherapy. Karnac Books.
Pollack, D.L. (2024). An interpretive phenomenological analysis of patients’ experiences of unlocking the unconscious in intensive short-term dynamic psychotherapy. [ongoing, unpublished study]
Rank, O. (1941). Beyond psychology. Dover Publications, Inc.
Solms, M. (2021). The hidden spring: a journey to the source of consciousness. First edition. New York, W.W. Norton & Company
Solomon, S., Greenberg, J., & Pyszczynski, T.A. (2015). The worm at the core : on the role of death in life (First). Random House.
Strupp, H.H., & Binder, J.L. (1984). Psychotherapy in a new key: A guide to time-limited dynamic psychotherapy. Basic Books.
Wenders, W. (1991). Until the end of the world. [Film]. Warner Bros.
