Balancing Spontaneity and Focus: The Role of Treatment Goals in Effective Psychotherapy

While therapists often prioritize open exploration in sessions, aligning treatment goals with patient motivations can be crucial for long-term treatment success.

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A new article published in Psychodynamic Psychiatry explores the role of treatment goals in psychodynamic therapy. Author Otto Kernberg, emeritus professor at the Weill Cornell Medical College and psychoanalyst at the Columbia University Psychoanalytic Center, argues that analysts should attend to service user’s initial motivation and treatment goals throughout the therapeutic process.

In many courses of psychotherapy, the early sessions often focus on discussing what brings a service user to treatment and what they hope therapy can do for them. This initial collaboration between service user and therapist called the working alliance, is one of the strongest predictors of successful treatment. It involves agreeing on treatment goals, defining the tasks for therapy, and building a strong bond. However, these initial goals can sometimes get lost as other issues emerge and dominate sessions, which can distract both service users and therapists.

Kernberg acknowledges that a treatmentā€™s focus can change over time. However, he argued that maintaining some connection to the original treatment goals is necessary for successful treatment. In the context of long-term psychotherapy such as psychoanalysis, the author offered the following clinical example:

ā€œA leading psychoanalyst, with demonstrated high level of knowledge and technical skills, started psychoanalytic treatment with a woman who consulted because of her significant sexual inhibition. The patient experienced very limited capacity to get excited during sexual intercourse, and great difficulty in reaching orgasm. A general review of the treatment of this case revealed that, during 3 years of a five-sessions-weekly psychoanalytic treatment, the patientā€™s sexual difficulties did not emerge in the patientā€™s productions and was ignored by the analyst. This omission was noticed with surprise by a group studying long-term effects of treatment of patients in psychoanalysis. When asked why the sexual inhibition had not been explored, the analyst responded that it had not emerged significantly in the free associations of the patient.ā€

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3 COMMENTS

  1. Balancing spontaniety and focus? Is this a real life activity, or an intellectual abstraction? If the latter, then you are imposing on reality an intellectual abstraction, which can only confuse, distort, pervert and destroy this reality. Spontaniety implies freedom, focus restriction – this is an undeniable fact. So they are mutually exclusive activities. Spontaniety implies the absance of control – focus IS control, the control of attention to a specific target. The pursuit of treatment goals is also an example of such control, and it is socially conditioned intellectual control of real life actuality, hence the enslavement and perversion and destruction of the actual through the dead, ossified and ossifying social and intellectual process, these being two sides of one thing called DEATH. And it’s how life dies in the human world – not materially but emotionally, as the instincts and feelings petrify in a conditioned, mechanical life process. SO what are you talking about? Oh yeah, treatment goals for improving our wellbeing. What a dangerous and pathological illusion you live in, one that has conditioned all your life activity rendering it similarly pathological and dangerous. And don’t airbrush what I say with your delusional positive thinking. Oh isn’t life glorious. Oh how we laughed as the world burnt down. Perhaps a huricaine or two will blow the cobwebs of human memory away and it being the end of human history and memory, we can pretend we never happened. After all, birds can’t speak. No-body will know (except the whole Universal consciousness).

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  2. The author cites the glaring oversight of a “leading psychoanalyst with a high level of knowledge and technical skills.” This fact immediately raises a number of questions in my mind. What could be the source of the therapist’s professional expertise for which he or she is presumably charging a hefty fee? Surely it’s not his or her reliance on the scientifically invalid DSM? And who or what qualified him or her to gain a reputation as a leading practitioner? Are there universally recognized, verifiable criteria for making such a judgment? Unless and until credible criteria exist, how can anyone engaged in the mental health legitimately and objectively claim that a particular diagnosis is more accurate or that a treatment is more efficacious?

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