859291 APY Australasian PsychiatryBaée and Jeyasingam
Australasian
Invited Article
Short-term psychodynamic
psychotherapy: a brief history
James Baée   Senior Clinical Lecturer, Sydney University, Sydney, NSW, and; Staff Specialist, Northern Sydney Local Health
District, Brookvale Community Health Centre, Brookvale, NSW, Australia
Neil Jeyasingam  Sydney University, NSW, Australia, and Northern Sydney Local Health District, Brookvale Community
Health Centre, Brookvale, NSW, Australia
Abstract
Objective: To discuss the development and rationale for different models of short-term psychodynamic psychotherapy.
Conclusion: There are a variety of historical reasons for the current climate of short-term dynamic therapies that
can help inform upon their application and future directions.
Keywords:  brief psychotherapy, short-term psychodynamic psychotherapy, psychodynamic, history
“For if little psychotherapy was good, more was better, and
most was best”.1
The roots of short-term psychodynamic psychother-
apy (STPP) are in psychoanalysis, leaning on the prin-
ciples of psychoanalytic theory and technique.2 This
form of therapy is time-limited, with a clear endpoint
agreed upon before the initiation of therapy. Practical
definitions of time-length are difficult due to no clear
consensus as to what time period defines short-term
therapy.2 In addition, increased spending on mental
health in Australia and poor access to services provide
pressure to offer effective therapies for the Australian
population.3,4 This review will discuss the develop-
ment of STPP methods for contemporary populations.
The first descriptions and early
revisions: 1890s–1940s
Short-term psychodynamic psychotherapy’s first dem-
onstrations – as with psychoanalysis – are arguably
found in the works of Sigmund Freud and his collabora-
tion with Josef Breuer in 1893.5 Indeed, Freud often
employed an early form of ultra-brief therapy, with
some experiencing symptomatic improvement within a
single session.5 The notion of catharsis was cited as a
primary mechanism of the effectiveness of this
approach, releasing the unconscious repressed emo-
tions and providing relief. Despite some successes with
the cathartic method, a number of conditions proved
unresolved.6 A preferred mode of practice on long-term
Psychiatry
Australasian Psychiatry
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DOI: 10.1177/1039856219859291
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transference-based psychoanalysis was emphasised,
Freud no longer endorsing any further development of
brief interventions. The primary aim of therapy being
the exploration of the patient’s unconscious by means
of free association, rather than the clinician actively pro-
viding the psychological material for a therapy ­session.7
No articulated focus of therapy was established, with
free association the predominant technique guiding the
session.
Hungarian psychoanalyst Sándor Ferenczi hypothesised
an alternate methodology in 1920, postulating the
­correlation of the active therapist and the contraction of
treatment length.6 He and Otto Rank developed this
­further,8 in the process rupturing their academic
relationship with Freud.9 The notion of the active
­
­therapist was furthered by Franz Alexander in 1942, who
believed that the corrective emotional experience of therapy
was integral to the benefit of psychoanalysis.10 This pro-
vided a key concept of an endpoint of therapy, with a sug-
gestion of enduring psychological change after successful
emotional amendment. This challenged the belief that
short-term therapy could not produce lasting transfor-
mation. Furthermore, the novel concept of recovery
occurring outside the therapy session was highlighted
by Alexander and Thomas French, placing an emphasis
Corresponding author:
James Baée, Northern Sydney Local Health District, Brookvale
Community Health Centre, 612-624 Pittwater Rd, Brookvale,
NSW 2100, Australia.
Email: James.Baee@health.nsw.gov.au
1

on the extra-therapeutic hours of patients, rather than
the intensive psychoanalytic sessions practiced until
this time.10
A post-war reappraisal: 1950s–1970s
The post-war society in the 1950s gave rise to a further
demand of psychodynamic therapy for both military and
non-military personnel.11 This provided a need to
develop alternative therapies to the traditional long-term
psychodynamic model. Many clinicians subsequently
endeavoured to confront defences and anxieties of
patients rapidly, accelerating affective responses in ther-
apy. Clinicians focussed on patients who were able to tol-
erate this challenge.12 Prominent psychoanalysts
including Peter Sifneos developed short-term anxiety-
provoking psychotherapy in 1956,13 James Mann devel-
oping time-limited psychotherapy (TLP) in 197314 and
Habib Davanloo developing intensive short-term
dynamic psychotherapy (ISTDP).15,16 These therapies
were directed to specific patient populations and estab-
lished rigorous frameworks to treat these patient groups.
Davanloo’s ISTDP was especially novel as interviews were
videotaped for both training and therapeutic purposes,17
providing a consistency of teaching previously unknown
prior to the use of audiovisual technology. David Malan
concurrently developed a Tavistock system of STPP in
1963,6 however in later years collaborated with Davanloo
and his system of psychotherapy. The therapy popula-
tions were specifically selected by criteria with significant
contraindications, highlighting the ongoing challenge of
accessing therapy for complex patient groups.15,18
The brief dynamic strategies noted above proved a
more effective method to meet the greater volume of
patients in this period. The time-limited manner of
therapy provided an articulated focus in therapy. These
strategies focussed the therapy to contemporary prob-
lems, rather than focussing solely on historical issues
and developmental trauma. This directed clinicians
towards symptomatic relief and outcome measures for
clients, underlining the importance of the result rather
than methodology of the therapy. This required the cli-
nician to challenge clients and their resistances rather
than taking a less confrontational approach to therapy.
The cognitive revolution and the
dynamic response: 1970s to present
The development of short-term therapies focussed on
outcomes was evolving rapidly; however, the need to
train clinicians to deliver therapy in a standardised man-
ner remained unanswered. Additionally ­ high-­quality
evidence for psychodynamic therapy within the aca-
demic community was lacking. This produced the need
for development of standardised training for consist-
ency in research and clinician training environments.
The former psychoanalyst Aaron Beck produced the first
Cognitive Behavioural Therapy (CBT) manual in 197819
2
Australasian Psychiatry 00(0)
in order to provide a standardised training text for non-
psychodynamic clinicians hoping to adopt the CBT
model. Following the cognitive therapies, Lester
Luborsky subsequently described a technique for
­supportive-expressive psychotherapy in 1984,20 provid-
ing the first psychodynamic manual for clinicians. This
approach again emphasised outcome, keeping the
­client’s function intact whilst exploring their problems
and conflicts. This led to developments by other
­clinicians including Mann’s TLP21 producing standard-
ised manuals. It is therefore noted the impact of
Cognitive Therapy in not only encouraging the develop-
ment of a research basis for dynamic psychotherapy, but
the increased organisation of an intervention previously
regarded as necessarily unstructured.
The manualisation of different therapies provided oppor-
tunities for research, as standardised therapies now could
be compared in trials directly. Research supporting STPP
emerged22–25 albeit with outcomes mixed for certain
patient subsets.26 Certain patients were non-responsive
to STPP, and there remained a perception that individu-
als with personality disorders were ‘unanalysable’27,28 and
not amenable to psychodynamic treatment.29 A strategy
for this cohort was not clearly articulated in literature
until British psychiatrist Robert Hobson and Australian
psychiatrist Russell Meares established a conversational
model (CM) of STPP.30 This emphasis on the dynamics of
the dialogue between patient and clinician represented a
further direction for STPP, most notably with success in
borderline personality disorder.31 The treatment of com-
plex patients with less stringent criteria for inclusion pro-
vided greater access to therapy, with promising results of
symptomatic improvement which was maintained at
follow-up.31–33 Following these studies, two methods of
the CM were established by Joan Haliburn in Australia
and Else Guthrie in the UK.34,35 At the time of writing,
however, more evidence is needed to further validate
these approaches.
The current use of aspects of psychodynamic therapy
within psychiatry is remarkably widespread.22–24
Medications, CBT and interpersonal therapy are often
therapies of first choice, whilst psychodynamic therapy
is in decline.36 This is ironically in parallel with literature
validating STPP across a number of settings. High-quality
studies have displayed modest to large benefits for a
wide variety of patients, with STPP often comparable to
other forms of psychological intervention.23,24 If STPP is
applied in appropriate populations, this could provide
further arrows in the psychiatrist’s quiver to assist with
relief of the burden of mental illness of many patients.
Conclusion
Short-term psychodynamic psychotherapy has adapted
to the contemporary needs of patients over differing
generations and contexts. It is often characterised by
activity in a focal area combined with confrontation of
patient’s defences and anxieties in order to progress
Baée and Jeyasingam
rapidly. The utility of this treatment is disputed, but
favourable literature is present for its efficacy. Novel
methods of STPP are being established, most notably
the CM in the Australian context. The ongoing devel-
opment of the evidence base is needed to further study
its potential benefit and validity in the field of
­psychiatry. Informed by its history, further investiga-
tion of the application and future direction is critical
to understand STPP’s role within the psychiatric
­profession.
Disclosure
The authors report no conflict of interest. The authors alone are responsible for the content
and writing of the paper.
Funding
The authors received no financial support for the research, authorship, and/or publication of
this article.
ORCID iD
James Baée https://orcid.org/0000-0003-2260-6487
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