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Problem-Focused Psychodynamic Psychotherapy

Fredric N. Busch, M.D.

  • ISBN 978-1-61537-385-7
  • Item #37385

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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.

This volume articulates 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.


  • Introduction
  • Chapter 1. Developing a Problem List
  • Chapter 2. Use of Psychodynamic Techniques
  • Chapter 3. Examining the Context, Emotions, and Developmental History Contributing to Problems
  • Chapter 4. Developing A Psychodynamic Formulation
  • Chapter 5. Addressing Problems: A Framework
  • Chapter 6. Addressing the Role of Adverse and Traumatic Experiences in Problems
  • Chapter 7. Understanding Personality Disorders
  • Chapter 8. Integrating Dissociated Aspects of Self and Other Representations
  • Chapter 9. Working Through
  • Chapter 10. Managing Termination
  • Index

About the Authors

Fredric N. Busch, M.D., is Clinical Professor of Psychiatry, Weill Cornell Medical College, on the faculty of the Columbia University Center for Psychoanalytic Training and Research in New York, New York.

Psychodynamic psychotherapy is one of the basic treatments of psychiatry. Often formulated as directed to character or personality, Fred Busch here expands our understanding to consider therapy directed to the problems defined by the patient.Busch, an expert on psychoanalytic theory and a master in constructing manuals for therapists, has created a book that is richly supplied with detailed clinical vignettes and belongs in the collection of anyone who studies, practices, or teaches these treatments.—Robert Michels, M.D., Walsh McDermott University Professor of Medicine and Psychiatry, Weill Cornell Medicine; Former Joint Editor-in-Chief, The International Journal of Psychoanalysis

Into the plethora of books on psychotherapy, with their manualized prescriptive approach, so difficult to apply in a real life clinical settings where each patient is unique and often comes with a mixture of illnesses and problems, now comes
Fred N Bush, MD with his book on how clinicians actually do the work with real patients! He concentrates on the psychodynamic approach because all approaches to psychotherapy that engage the emotions are ipso facto doing psychodynamic work. This book is a must read for beginners and a pleasure for us more experienced. I learned from it. I recommend it most highly!—Eric R. Marcus, M.D., Professor of Clinical Psychiatry, Columbia University College of Physicians and Surgeons; Supervising and Training Analyst, Columbia University Center for Psychoanalytic Training and Research

Fred Busch has done an incredible thing! He has shortened psychodynamic therapy by focusing on symptoms. (He will also improve outcome studies, because most outcome studies are symptom-based.) Busch offers a succinct way of making a symptom list and doing a psychodynamic formulation, including past and present history and issues related to trauma ( an undertheorized subject in our field, in my view). He offers a primer on how to use psychoanalytic techniques, including how to work with transference, free association, and interpretation, to mention only a few. He has a whole chapter on the concept of working through. He covers personality disorders. He explains how to work with concepts from general psychiatry, including the therapeutic alliance and termination. Busch does this all (and illustrates these concepts with case examples) in less than 170 pages. This book should be part of the education of every psychiatrist, young and old!—Elizabeth L. Auchincloss, M.D., Aaron Stern, M.D., Ph.D. Professor of Psychodynamic Psychiatry and Vice Chair for Education, Department of Psychiatry, Weill Cornell Medicine

This concise, clearly written guide to psychodynamic psychotherapy is all about accessibility and practicality.Busch writes with the experience of a senior clinician who has worked with so many people and seen so many problems that he gets to the point quickly and knows how to help people change what they can.The book organizes the theory and practice of dynamic therapy around the daily interventions of the psychodynamic therapist – addressing denial and resistance, conveying the value of insight and understanding, focusing on transforming understanding into change.It's a must for those who want to enhance the effectiveness of their work with patients as well as those new to the field.—Richard F. Summers, M.D., Clinical Professor of Psychiatry and Senior Residency Advisor, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania

Fred Busch is providing us with the right book at the right time. Like any scientific field, psychoanalytic/psychodynamic thinking can benefit from research and development. Busch's experience with a team that produced impressive research has prepared him for this excellent book that provides a distillation of what is effective in psychodynamic therapy. This book shows how targeted use of psychoanalytic concepts and techniques moves that model of therapy beyond a stereotyped vagueness to an approach to psychiatric conditions that is focused in its application and broad in its impact. This highly readable book brings the person, in contrast to the symptom, to the center of the therapist's work; it enhances the therapist's ability to bring about life change. As a writer, Busch combines conciseness, clarity, and precision, skillfully illustrating each point he makes with a relevant clinical example. This book will help therapists provide their patients with the kind of comprehensive approach to their problems that is essential if we are to maintain psychiatry's commitment to attend to the needs of the whole person.—Frank Yeomans, M.D., Ph.D., Clinical Associate Professor of Psychiatry and Director of Training, Personality Disorders Institute, Weill Cornell Medical College; Adjunct Associate Clinical Professor of Psychiatry Department of Psychiatry Columbia University Vagelos College of Physicians & Surgeons; President, International Society for Transference-Focused Psychotherapy

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