Time Limited Dynamic Psychotherapy

New Understanding

Strupp's Findings

• identification and comprehension of his or her dysfunctional patterns.

• therapist can point out repetitive patterns that have originated in experiences with past significant others, with present significant others, and in the here-and-now with the therapist.

• therapists' disclosing their own reactions to the patients' behaviors can also be beneficial.

• found that therapists' interventions reflected their personal (positive or negative) attitude toward the patients.

• revealed that patients who were hostile, negativistic, inflexible, mistrusting, or otherwise highly resistant, uniformly had poor outcomes.

Step 1

Step 3

In the initial sessions, the therapist lets the patient tell his or her own story (learn about interpersonal style)

Develop CMP: using the four categories of the and his or her own reactions

Hanna Levenson

Step 2

• The therapist identifies what he or she could say or do (within the therapeutic role) that would most likely subvert the patient's maladaptive interactive style.

• A tension is created when the familiar (though detrimental) responses to the patient's presentation are not provided.

• Out of this tension new learning takes place.

Step 4

New Experience

Explore interpersonal context of symptoms

.Looking for commonalities in the patient's transactional patterns over person, time and place

Steps 5 & 6

• Therapist will be pulled into recreating a dysfunctional dance with the patient.

• Using the Expectations of Others' Reactions and the Behavior of Others components of the CMP, therapist becomes aware of his or her countertransferential reenactments

• "New" is meant in the sense of being different and more functional (i.e., healthier) than the customary, maladaptive pattern

• "experience" emphasizes the affective-action component of change--behaving differently and emotionally appreciating behaving differently.

But How???

Step 7

therapist can then help patients explore their reactions to the relationship which is forming with the therapist

Step 8

By incorporating all the historical and present interactive thematic information, the therapist can develop a narrative description of the patient's idiosyncratic primary CMP

Goals of TLDP

History of TLDP

Step 11

providing a new understanding via examination of the here-and-now interactions

Step 12

depathologize the patient's current behavior and symptoms by helping him or her to understand their historical development.

Step 13

Step 9

in the formulation process involves the continuous refinement of the CMP throughout the therapy

From this formulation, the therapist then discerns the goals for treatment

Step 10

First Goal = New Experience

• New Experience

• New understanding

"The blueprint that Hans Strupp and I displayed in our 1984 book has been translated by Hanna Levenson into a more elaborated and precise conceptual structure, richly detailed with clinical illustrations."

Jeffrey L. Binder, Ph.D.,

Steps to Formulation & Intervention

• Originally devised by Hans Strupp and Jeffery Binder in 1984

• Strupp considered a pioneer in psychotherapy research
• First to insist on using audio and video from actual therapy sessions

Principles of TLDP

Acts of the self

thoughts, feelings, motives, perceptions, and

behaviors of the patient of an interpersonal nature

"I am afraid to take the

promotion"

1. People are innately motivated to search for and maintain human relatedness

2. Maladaptive relationship patterns acquired early in life,

schematized, and underlie many presenting problems

3. Relational pattern maintained in the present

4. Stuck not sick

5. In vivo reenactment in therapy

6. Focuses on one chief problematic relationship pattern

7. Change process continues post termination

Time Limited Dynamic Psychotherapy

(TLDP)

CMP

Expectations of others' reactions

how the patient imagines others will react to him or her in response to some

interpersonal behavior

"If I go to

the dance, no one will ask me to dance."

1. Acts of the self

2. Expectations of others' reactions

3. Acts of others toward the self.

4. Acts of the self toward the self

Cyclical Maladaptive Pattern

Acts of Others

Toward the Self

the actual behaviors of other people, as observed (or assumed) and interpreted by the patient

"When I tried to make dinner, my father told me it tasted horrible "

outlines the idiosyncratic "vicious cycle" of maladaptive interactions a particular patient gets into when relating to others

Acts of the self toward the self

patient's behaviors or

attitudes toward oneself

"When I made the mistake, I berated myself so much I had

difficulty sleeping that night."

By Emily Rischall

Exclusion Criteria

Inclusion Criteria

• patient is not able to attend to the process of a verbal give-and-take with the therapist (e.g., delirium, dementia, psychosis, or diminished intellectual status).

• Patient's problems can be treated more effectively by other means (e.g., specific phobia).

• Patient cannot tolerate the interpretative, interactive therapy process, which often heightens anxiety (e.g., patient has impulse control problems, abuses alcohol and/or substances, or has a history of repeated suicide attempts).

• emotional discomfort
• engage or at least talk
• willing to consider how their relationships have contributed to their distress
• willing to examine feelings
• capable of having meaningful relationship, potential must exist

Building Blocks of TLDP

While the framework of TLDP is psychodynamic it incorporates current developments

• in interpersonal
• object-relations
• self psychology
• as well as cognitive-behavioral

and system approaches.

Time Limited Dynamic Psychotherapy