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For many years, the general rule of thumb in psychoanalysis and psychodynamic psychotherapy has been to refrain from focusing too much on specific symptoms or problems so as to not interfere with free association or the effectiveness of the psychoanalytic approach. When Fredric Busch, M.D., and colleagues developed panic-focused psychodynamic therapy in the 1990's and subsequently psychodynamic approaches to depression, they emphasized the value of more active interventions, a focus on symptoms and associated dynamics, and occasional psychoeducation. In this new volume, he expands the scope of that work, articulating how a focused psychodynamic psychotherapeutic approach can be adapted for patients in general. Rather than one specific aspect of patients' difficulties, Problem Focused Psychodynamic Psychotherapy (PrFPP) focuses on the set of problems (e.g., symptoms, relationship issues, behavioral difficulties) a particular patient brings into the consulting room. Through numerous tables and a wealth of case vignettes, this guide provides novice and experienced clinicians alike with a general template for working with patients to identify and address the overlapping and unique dynamics of various problems. It describes how to use psychodynamic exploratory techniques to make problem lists and examine the context and emotions surrounding each issue. It also discusses how to develop a psychodynamic formulation to provide a framework for identifying and addressing the dynamic contributors to the various problems. Therapist and patient can then undertake the \"working through\" process to identify how specific dynamics emerge in different contexts and overlap in contributing to problems. All of these approaches help spur patients' self-reflective capacities and the identification of their own dynamics—making it possible to more rapidly address core difficulties. The work also enables the continued use of these modes of managing problems after the treatment is completed. And because PrFPP is suitable for short- and longer-term interventions, it is valuable for patients who either cannot commit to long-term treatment or only have access to brief interventions.

Background “Mindfulness‐based” interventions show promise for stress reduction in general medical conditions, and initial evidence suggests that they are accepted in trauma‐exposed individuals. Mindfulness‐based cognitive therapy (MBCT) shows substantial efficacy for prevention of depression relapse, but it has been less studied in anxiety disorders. This study investigated the feasibility, acceptability, and clinical outcomes of an MBCT group intervention adapted for combat posttraumatic stress disorder (PTSD). Methods Consecutive patients seeking treatment for chronic PTSD at a VA outpatient clinic were enrolled in 8‐week MBCT groups, modified for PTSD (four groups, n = 20) or brief treatment‐as‐usual (TAU) comparison group interventions (three groups, n = 17). Pre and posttherapy psychological assessments with clinician administered PTSD scale (CAPS) were performed with all patients, and self‐report measures (PTSD diagnostic scale, PDS, and posttraumatic cognitions inventory, PTCI) were administered in the MBCT group. Results Intent to treat analyses showed significant improvement in PTSD (CAPS (t(19) = 4.8, P < .001)) in the MBCT condition but not the TAU conditions, and a significant Condition × Time interaction (F[1,35] = 16.4, P < .005). MBCT completers (n = 15, 75%) showed good compliance with assigned homework exercises, and significant and clinically meaningful improvement in PTSD symptom severity on posttreatment assessment in CAPS and PDS (particularly in avoidance/numbing symptoms), and reduced PTSD‐relevant cognitions in PTCI (self blame). Conclusions These data suggest group MBCT as an acceptable brief intervention/adjunctive therapy for combat PTSD, with potential for reducing avoidance symptom cluster and PTSD cognitions. Further studies are needed to examine efficacy in a randomized controlled design and to identify factors influencing acceptability and efficacy.

Attempted suicide is the main risk factor for suicide and repeated suicide attempts. However, the evidence for follow-up treatments reducing suicidal behavior in these patients is limited. The objective of the present study was to evaluate the efficacy of the Attempted Suicide Short Intervention Program (ASSIP) in reducing suicidal behavior. ASSIP is a novel brief therapy based on a patient-centered model of suicidal behavior, with an emphasis on early therapeutic alliance. Patients who had recently attempted suicide were randomly allocated to treatment as usual (n = 60) or treatment as usual plus ASSIP (n = 60). ASSIP participants received three therapy sessions followed by regular contact through personalized letters over 24 months. Participants considered to be at high risk of suicide were included, 63% were diagnosed with an affective disorder, and 50% had a history of prior suicide attempts. Clinical exclusion criteria were habitual self-harm, serious cognitive impairment, and psychotic disorder. Study participants completed a set of psychosocial and clinical questionnaires every 6 months over a 24-month follow-up period. The study represents a real-world clinical setting at an outpatient clinic of a university hospital of psychiatry. The primary outcome measure was repeat suicide attempts during the 24-month follow-up period. Secondary outcome measures were suicidal ideation, depression, and health-care utilization. Furthermore, effects of prior suicide attempts, depression at baseline, diagnosis, and therapeutic alliance on outcome were investigated. During the 24-month follow-up period, five repeat suicide attempts were recorded in the ASSIP group and 41 attempts in the control group. The rates of participants reattempting suicide at least once were 8.3% (n = 5) and 26.7% (n = 16). ASSIP was associated with an approximately 80% reduced risk of participants making at least one repeat suicide attempt (Wald χ21 = 13.1, 95% CI 12.4-13.7, p < 0.001). ASSIP participants spent 72% fewer days in the hospital during follow-up (ASSIP: 29 d; control group: 105 d; W = 94.5, p = 0.038). Higher scores of patient-rated therapeutic alliance in the ASSIP group were associated with a lower rate of repeat suicide attempts. Prior suicide attempts, depression, and a diagnosis of personality disorder at baseline did not significantly affect outcome. Participants with a diagnosis of borderline personality disorder (n = 20) had more previous suicide attempts and a higher number of reattempts. Key study limitations were missing data and dropout rates. Although both were generally low, they increased during follow-up. At 24 months, the group difference in dropout rate was significant: ASSIP, 7% (n = 4); control, 22% (n = 13). A further limitation is that we do not have detailed information of the co-active follow-up treatment apart from participant self-reports every 6 months on the setting and the duration of the co-active treatment. ASSIP, a manual-based brief therapy for patients who have recently attempted suicide, administered in addition to the usual clinical treatment, was efficacious in reducing suicidal behavior in a real-world clinical setting. ASSIP fulfills the need for an easy-to-administer low-cost intervention. Large pragmatic trials will be needed to conclusively establish the efficacy of ASSIP and replicate our findings in other clinical settings. ClinicalTrials.gov NCT02505373.

A cognitive-behavioural therapy (CBT) programme designed for post-traumatic stress disorder (PTSD) in people with severe mental illness, including breathing retraining, education and cognitive restructuring, was shown to be more effective than usual services. To evaluate the incremental benefit of adding cognitive restructuring to the breathing retraining and education components of the CBT programme (trial registration: clinicaltrials.gov identifier: NCT00494650). In all, 201 people with severe mental illness and PTSD were randomised to 12- to 16-session CBT or a 3-session brief treatment programme (breathing retraining and education). The primary outcome was PTSD symptom severity. Secondary outcomes were PTSD diagnosis, other symptoms, functioning and quality of life. There was greater improvement in PTSD symptoms and functioning in the CBT group than in the brief treatment group, with both groups improving on other outcomes and effects maintained 1-year post-treatment. Cognitive restructuring has a significant impact beyond breathing retraining and education in the CBT programme, reducing PTSD symptoms and improving functioning in people with severe mental illness.

This practical volume is an introductory text and a quick reference guide to short-term therapy, by an experienced therapist and teacher of psychodynamic short-term therapy. It is based on lectures given on the topic to experienced therapists wanting to familiarise themselves with short-term therapy.