A model of time-limited treatment for the older patient.
In conclusion, brief treatment can be offered to a majority of patients when focused around current difficulties in the life structure, as opposed to past unconscious dynamic conflicts relived in the transference. Some aspects of the life structure, of course, are also unconscious, namely, those having to do with attempted solutions to core personality conflicts and those reflecting modes of ego functioning. We have utilized Loevinger's model of stages of ego development to understand the latter aspect. Personality and cognitive operations are the portals through which life-cycle tasks are experienced and interpreted. In order to formulate the problems of the life structure and of accomplishment of life tasks, the clinician must understand the major dynamic issues as they present themselves within the particular stage of ego development. In our example, Mr. S.'s sense of defect and injury was processed within a fairly "high level" of development which enabled him to undertake the therapeutic task with considerable autonomy and initiative, compatible with his view of himself and optimal interaction with others. Presentation of a therapeutic task or focus which fits the dynamic issues and the developmental stage in a manner which is readily comprehensible and relevant to the patient is the major task of the therapist in brief treatment. In this model, the patient uses the therapy to work on a life task and life structure in a goal-oriented manner jointly constructed with the therapist. This reality orientation and focus on aspects of the person closest to awareness make the model applicable to a broad spectrum of patients and to a time-limited setting in which the work can be done in different phases over time.
Kirshner
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Harvard Community Health Plan, Wellesley, Massachusetts.
D000223:Adaptation, Psychological; D000368:Aged; D000786:Anger; D004532:Ego; D006801:Humans; D008297:Male; D010554:Personality Disorders / Q000523:psychology / Q000628:therapy*; D011575:Psychoanalytic Therapy / Q000379:methods*; D011614:Psychotherapy, Brief / Q000379:methods*; D012803:Sick Role