Time-Limited Dynamic Psychotherapy
In Time-Limited Dynamic Psychotherapy, Dr. Hanna Levenson demonstrates an attachment-based, empirically supported, brief approach that privileges experiential learning. Time-limited dynamic psychotherapy originated as an interpersonal, time-sensitive approach for clients with chronic, pervasive, dysfunctional ways of relating to others.
This therapy is very focused and requires being attuned to the client; staying aware of one's countertransference; recognizing transference–countertransference reenactments; and providing corrective, interpersonal experiences in the therapy relationship. The goal is not symptom reduction, per se, but rather to change ingrained relational patterns.
In this session, Dr. Levenson works with a woman whose relationship with her second husband seems to echo her relationship with her father. Dr. Levenson helps her to begin to understand the cycle of maladaptive relationships she has cocreated in her life, and instills hope and direction for future work.
Time-limited dynamic psychotherapy (TLDP) originated as an interpersonal, time-sensitive approach for clients with chronic, pervasive, dysfunctional ways of relating to others (Strupp & Binder, 1984). However, its premises and techniques are broadly applicable regardless of time limits. The brevity of the treatment promotes therapist pragmatism, flexibility, and accountability (Levenson, Butler, Powers, & Beitman, 2002). Furthermore, time pressures help keep the therapist attuned to circumscribed goals using an active, directive stance (Levenson, Butler, & Bein, 2002). The focus is not on the reduction of symptoms per se (although such improvements are expected to occur), but rather on changing ingrained patterns of interpersonal relatedness or personality style.
While the scaffolding of TLDP is psychodynamic, the current model is integrative, incorporating recent developments in attachment, interpersonal, experiential, cognitive–behavioral, and system approaches (Levenson, 2003). Attachment theory holds that people are innately motivated to search for and maintain human relatedness (Bowlby, 1973). Early experiences with parental figures result in mental representations of these relationships or working models of one's interpersonal world. These experiences form the building blocks of what will become organized, encoded, experiential, affective, and cognitive data (i.e., interpersonal schemas) informing the child about the nature of human relatedness.
Although one's dysfunctional interactive style is learned early in life, a TLDP perspective holds that this style must be supported in the person's present adult life for the interpersonal difficulties to continue. This focus is consistent with a systems-oriented approach that stresses the context of a situation and the circular processes surrounding it. Maladaptive patterns are maintained through their enactment in the current social system, as others (including the therapist) are invited to unwittingly replicate familiar responses from the client's troubled past.
When the therapist colludes with the patient to recreate the dysfunctional interpersonal dynamic, it is viewed as "interpersonal empathy" (Stupp & Binder, 1984) or "role responsiveness" (Sandler, 1976) rather than a therapeutic failure. The TLDP therapist uses this information to change the nature of the interaction in a positive way, thereby engaging the client in a healthier mode of relating.
In addition, the therapist can collaboratively invite the client to look at what is happening between them (i.e., metacommunicate) or in outside relationships, either highlighting the dysfunctional reenactment or solidifying new experiential learning.
The TLDP therapist seeks two overriding goals with clients: new experiences and new understandings. New experiences are actually composed of a set of focused experiences throughout the therapy in which the client gains a different appreciation of self, of therapist, and of their interaction. These new experiences emphasize the affective–action component of change and are designed to subvert or interrupt the client's maladaptive interactive style.
The therapist gives the client the opportunity to disconfirm his or her interpersonal schemas, promoting a corrective emotional–interpersonal experience (Alexander & French, 1946). This in vivo learning is a critical component in the practice of TLDP. These experiential forays into what has been frightening territory for the client can occur with the therapist or with others in the client's life. Such emotionally intense processes make for heightened affective learning and permit progress to be made more quickly.
The second goal of providing new understandings focuses more specifically on cognitive changes. The client's new understanding usually involves an identification and comprehension of his or her dysfunctional patterns. To facilitate such a new understanding, the TLDP therapist can point out repetitive patterns that have originated in experiences with past significant others, with present significant others, and in the here-and-now with the therapist. Therapists' judicious disclosing of their own reactions to clients' behaviors can also be beneficial.
TLDP was developed to help therapists deal with patients who have trouble forming working alliances due to their lifelong dysfunctional interpersonal difficulties. However, from a relational point of view, many symptoms (e.g., depression and anxiety) and problems in living (e.g., marital discord) stem from one's impaired relatedness to self and other; consequently a wide range of clinical issues and presentations could be successfully addressed using TLDP. For a formal set of selection criteria, see Levenson (1995).
TLDP would not be the treatment of choice for problems that can be treated more effectively by other means (e.g., simple phobia, bipolar disorder) or when patients cannot tolerate the interactive, interpersonal, circumscribed therapeutic process (e.g., due to impulse control problems, psychotic symptoms, or substance abuse disorders).
In order to focus the therapeutic work, the TLDP therapist identifies a client's cyclical maladaptive pattern (Binder & Strupp, 1991), which describes the idiosyncratic vicious cycle (Wachtel & McKinney, 1992) of maladaptive interactions that a particular client manifests with others. These cycles or patterns involve inflexible, self-defeating expectations and behaviors, and negative self-appraisals that lead to dysfunctional and maladaptive interactions with others (Butler, Strupp, & Binder, 1993).
A successful TLDP formulation should provide a blueprint for the therapy. It should describe the nature of the problem, lead to the delineation of goals, serve as a guide for interventions, and enable the therapist to anticipate reenactments and understand countertransferential reactions.
Implementation of TLDP does not rely on a set of techniques. Rather it depends on therapeutic strategies that are useful only to the extent that they are embedded in a larger interpersonal relationship. Since the focus is on experiential interpersonal learning, theoretically any intervention that facilitates this goal could be used.
Training and Research
For the therapist who wants more information on training in this model, Dr. Levenson recommends a multifaceted approach including reading, on-going supervision, consultation (expert and peer), and workshops with instructional videotapes (see Binder, 2004; Levenson, 1995, 2006, 2007). This is one of the few models where there are research studies on training outcomes (Henry, et al., 1993). For a summary of the empirical research on TLDP, see Levenson (2007).
- Alexander, F., & French, T. M. (1946). Psychoanalytic therapy: Principles and applications. New York: Ronald Press.
- Binder, J. L. (2004). Key competencies in brief dynamic psychotherapy: Clinical practice beyond the manual. New York: Guilford Press.
- Binder, J. L., & Strupp, H. H. (1991). The Vanderbilt approach to time-limited dynamic psychotherapy. In P. Crits-Christoph & J. P. Barber (Eds.), Handbook of short-term dynamic psychotherapy (pp. 137–165). New York: Basic Books.
- Bowlby, J. (1973). Attachment and loss: Separation, anxiety, and anger (Vol. 2). New York: Basic Books.
- Henry, W. P., Strupp, H. H., Butler, S. F., Schacht, T. E., & Binder, J. L. (1993). Effects of training in time-limited dynamic psychotherapy: Changes in therapist behavior. Journal of Counseling and Clinical Psychology, 61, 434–440.
- Levenson, H. (1995). Time-limited dynamic psychotherapy: A guide to clinical practice. New York: Basic Books.
- Levenson, H. (2003). Time-limited dynamic psychotherapy: An integrative approach. Journal of Psychotherapy Integration, 13, 300–333.
- Levenson, H. (2006). Time-limited dynamic psychotherapy. In A. B. Rochlen (Ed.), Applying counseling theories: An online, case-based approach (pp. 75–90). Upper Saddle River, NJ: Pearson.
- Levenson, H., Butler, S. F., & Bein, E. (2002). Brief dynamic individual psychotherapy. In R. E. Hales, S. C. Yudofsky & J. A. Talbott (Eds.), The American Psychiatric Press textbook of psychiatry (4th ed., pp. 1151–1176). Washington, DC: American Psychiatric Press.
- Levenson, H., Butler, S. F., & Beitman, B. (1997). Concise guide to brief dynamic psychotherapy. Washington, DC: American Psychiatric Press.
- Sandler, J. (1976). Countertransference and role-responsiveness. International Review of Psycho-Analysis, 3, 43–47.
- Strupp, H. H., & Binder, J. L. (1984). Psychotherapy in a new key. New York: Basic Books.
- Wachtel, P. L., & McKinney, M. K. (1992). Cyclical psychodynamics and integrative psychodynamic therapy. In J. C. Norcross and M. R. Goldfried (Eds.), Handbook of psychotherapy integration. New York: Basic Books.
The professional career of Hanna Levenson, PhD, reflects a 30-year dialectic between intrapsychic and relational perspectives, insight and experiential learning, and clinical practice and scientific inquiry. Originally trained in personality theory and social psychology at Claremont University in California, she later retrained in clinical psychology at the University of Florida, Coral Gables, then interned at Langley Porter Institute (University of California, San Francisco School of Medicine) in 1976.
She has been specializing in the areas of brief psychotherapy and clinical supervision for over 25 years. She is professor of psychology at the Wright Institute in Berkeley, California, and director of the brief psychotherapy program at California Medical Center in San Francisco.
For the past 20 years, she was clinical professor in the Department of Psychiatry of the University of California School of Medicine and director of the brief psychotherapy program at the San Francisco VA Medical Center.
Dr. Levenson is the author of over 75 papers and two books, the Concise Guide to Brief Dynamic and Interpersonal Psychotherapy (2002), and Time-Limited Dynamic Psychotherapy: A Guide to Clinical Practice (1995; Spanish edition, 1997), selected by the Behavioral Science Book Service as a "book-of-the-month."
In 2000, she founded the Levenson Institute for Training (LIFT), a center where mental health practitioners can receive in-depth training and certification in integrative, focused therapy. She also maintains a private practice in San Francisco and Oakland, California.
Dr. Levenson is a member of the American Psychological Association, the California Psychological Association, the Society for Psychotherapy Research, and the Society for the Exploration of Psychotherapy Integration.
- Anchin, J. C., & Kiesler, D. J. (Eds.). (1982). Handbook of interpersonal psychotherapy. New York: Pergamon Press.
- Gill, M. M. (1993). Interaction and interpretation. Psychoanalytic Dialogues, 3, 111–122.
- Greenberg, J. R., & Mitchell, S. A. (1983). Object relations in psychoanalytic theory. Cambridge, Mass.: Harvard University Press.
- Kiesler, D. J. (1988). Therapeutic metacommunication: Therapist impact disclosure as feedback in psychotherapy. Palo Alto, CA: Consulting Psychologists Press.
- Levenson, H., & Burg, J. (2000). Training psychologists in the era of managed care. In A. J. Kent & M. Hersen (Eds.), A psychologist's proactive guide to managed health care (pp. 113–140). Mahwah, NJ: Erlbaum.
- Levenson, H., & Davidovitz, D. (2000). Brief therapy prevalence and training: A national survey of psychologists. Psychotherapy, 37, 335–340.
- Levenson, H., & Evans, S. A. (2000). The current state of brief therapy training in American Psychological Association-accredited graduate and internship programs. Professional Psychology: Research and Practice, 31, 446–452.
- Levenson, H., & Strupp, H. H. (2007). Cyclical maladaptive patterns in time-limited dynamic psychotherapy. In T. D. Eells (Ed.), Handbook of psychotherapy case formulation (pp.164–197). New York: Guilford.
- Levenson, H., & Strupp, H. H. (1999). Recommendations for the future of training in brief dynamic psychotherapy. Journal of Clinical Psychology, 55, 385–391.
- Messer, S. B., & Warren, C. S. (1995). Models of brief psychodynamic therapy: A comparative approach. New York: Guilford.
- Neff, W. L., Lambert, M. J., Lunnen, K. M., Budman, S. H., & Levenson, H. (1997). Therapists' attitudes toward short-term therapy: Changes with training. Employee Assistance Quarterly, 11, 67–77.
- Safran, J. D., & Muran, J. C. (2000). Negotiating the therapeutic alliance: A relational treatment guide. New York: Guilford.
- Safran, J. D., & Segal, Z. V. (1990). Interpersonal process in cognitive therapy. New York: Basic Books.
- Siegel, D. J. (1999). The developing mind: Toward a neurobiology of interpersonal experience. New York: Guilford.
- Stern, D. (1985). The interpersonal world of the infant. New York: Basic Books.
- Strupp, H. H. (1993). The Vanderbilt psychotherapy studies: Synopsis. Journal of Consulting and Clinical Psychology, 61, 431–433.
- Sullivan, H. S. (1953). The interpersonal theory of psychiatry. New York: W. W. Norton.
- Teyber, E. (2006). Interpersonal processes in psychotherapy: A relational approach (5th ed.). Pacific Grove, CA: Brooks/Cole.
- Travis, L. A., Binder, J. L., Bliwise, N. G., & Horne-Moyer, H. L. (2001). Changes in clients' attachment styles over the course of time-limited dynamic psychotherapy. Psychotherapy, 38, 149–159.
- Weiss, J. (1993). How psychotherapy works. New York: Guilford.
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