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Traditionally, psychoanalytically oriented clinicians have eschewed a direct focus on symptoms, viewing it as superficial turning away from underlying psychopathology. But this assumption is an artifact of a dated classical approach; it should be reexamined in the light of contemporary relational thinking. So argues Mary Connors in Symptom-Focused Dynamic Psychotherapy, an integrative project that describes cognitive-behavioral techniques that have been demonstrated to be empirically effective and may be productively assimilated into dynamic psychotherapy.What is the warrant for symptom-focused interventions in psychodynamic treatment? Connors argues that the deleterious impact of symptoms on the patient's physical and emotional well being often impedes psychodynamic engagement. Symptoms associated with addictive disorders, eating disorders, OCD, and posttraumatic stress receive special attention. With patients suffering from these and other symptoms, Connors finds, specific cognitive-behavior techniques may relieve symptomatic distress and facilitate a psychodynamic treatment process, with its attentiveness to the therapeutic relationship and the analysis of transference-countertransference. Connors' model of integrative psychotherapy, which makes cognitive-behavioral techniques responsive to a comprehensive understanding of symptom etiology, offers a balanced perspective that attends to the relational embeddedness of symptoms without skirting the therapeutic obligation to alleviate symptomatic distress. In fact, Connors shows, active techniques of symptom management are frequently facilitative of treatment goals formulated in terms of relational psychoanalysis, self psychology, intersubjectivity theory, and attachment research. A discerning effort to enrich psychodynamic treatment without subverting its conceptual ground, Symptom-Focused Dynamic Psychotherapy is a bracing antidote to the timeworn mindset that makes a virtue of symptomatic suffering.
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SYMPTOM-FOCUSED DYNAMIC PSYCHOTHERAPY Copyrighted Material Copyrighted Material SYMPTOM-FOCUSE DYNAMIC PSYCHOTHERAPY MARY E. CONNORS THE ANALYTIC PRESS 2006 Mahwah, New Jersey Copyrighted Material London © 2 0 0 6 by The Analytic Press, Inc., Publishers All rights reserved. N o part of this book may be reproduced in any form—by photostat, microform, retrieval system, or any other means—without the prior written permission of the p u b lisher. Published by The Analytic Press, Inc., Publishers Editorial Offices: 10 Industrial Avenue Mahwah, NJ 0 7 4 3 0 www.analyticpress.com Designed and typeset by CompuDesign, Charlottesville, VA Library of Congress Cataloging-in-Publication Data Connors, Mary E., 1953— Symptom-focused dynamic psychotherapy / Mary E. Connors. p. cm. Includes bibliographical references and index. ISBN 0-88163-444-1 1. Psychodynamic psychotherapy. I. Title. [DNLM: Behavior Therapy. 2. Behavioral Symptoms—therapy. WM 425 C752S 2006] RC489.4.P72C66 2006 616.89'4—dc22 2005054550 Printed in the United States of America 10 9 8 7 6 5 4 3 2 1 Copyrighted Material FOR MY BROTHER, ROBERT J. CONNORS I951-20OO Copyrighted Material Copyrighted Material CONTENTS Preface and Acknowledgments ix Chapter 1 1 Rationale for a Symptom-Focused Dynamic Treatment Chapter 2 Active Techniques in a Context of Integrative Possibility 24 Chapter 3 The Decision to Use Active Techniques 69 Chapter 4 Cognitive Interventions 95 Chapter 5 Behavioral Techniques 116 Chapter 6 Suggestions for Interventio