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Making a Case for Quick, Confrontational Therapy

November 25, 1988|CATHERINE M. SPEARNAK

For example, a woman may be depressed because her father abused her when she was a child. However, the memory is so upsetting that she cannot bear to relive it. Instead, she turns the anger on herself, resulting in depression. Her unconscious protects her from feeling the pain, but it also stops her from feeling joy and happiness. She is miserable.

During therapy with such a patient, Trunnell systematically breaks down his client's defenses by hammering away at every smoke screen thrown up to hide the real issue: her father's abuse. Once the woman feels the pain associated with his treatment, her depression can lift.

Anger and sadness are the primary emotions most patients try to avoid, Trunnell said, and anger often doubles as a defense to feeling. Once their rage is drained away, clients experience an intense need for the tenderness and warmth they usually missed out on as children.

During therapy, patients unconsciously employ a variety of defensive techniques to stop the therapist's attempts to reveal the repressed feeling, Trunnell said. These include passivity, regression, denial, purported loss of memory, rationalization, attempts to shift attention to the therapist's behavior during a session and converting anxiety into physical symptoms. Most patients use all of them.

Whenever the patient unconsciously attempts to ignore or evade the issue, Trunnell said, he brings him back to it. The goal is to get the patient to feel the pain causing his distress rather than simply talk about it. Only then can the patient desensitize the event causing the misery and rid himself of his disorder, he said.

Trunnell practiced traditional psychotherapy for years, until the day he decided it didn't work. It was too intellectual; clients could dodge their feelings too easily, he said.

Disgruntled with the slow progress of psychotherapeutic techniques, he searched for an alternative. He found it in the short-term dynamic psychotherapy developed by Dr. Habib Davanloo, professor of psychiatry at McGill University in Montreal.

Davanloo began toying with the idea of short-term therapy during the early 1960s when he, like Trunnell, began to despair about the length of therapy and the long list of patients who couldn't get into psychiatric clinics. Over the next 10 years, Davanloo developed his short-term, confrontational technique using video cameras to review techniques he used during sessions. The tapes are now used to train others in short-term psychotherapy.

Trunnell spent several years attending Davanloo's seminars to learn more about the short-term technique, which he then began using in his San Diego practice. He said he's seen remarkable breakthroughs in patients, many of whom found little success with other types of therapy.

Whether short-term therapy catches on may have less to do with whether it works than with the fact that it saves time and is cost-effective. That alone may prompt patients to resolve their problems in six months rather than six years.

Still, Trunnell believes the strength of short-term therapy centers around its confrontational style, a style he maintains produces more effective results, and he is confident the coming years will bear out his prediction.

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