Psychotherapy Integration Papers

Influential Readings on Psychotherapy Integration     CyberPsych Site Index


Applying the Visions of Reality to a Case of Brief Therapy

Stanley B. Messer

Rutgers University

Correspondence concerning this article should be send to Stanley B. Messer, Rutgers University, Graduate School of Applied and Professional Psychology, 152 Frelinghuysen Rd., Piscataway, NJ 08854-8085

Portions of this article appear in Messer and Warren (1995) and Messer and Woolfolk (1998) and were presented at the meeting of the Society for the Exploration of Psychotherapy Integration in Madrid (July 1998).

Author's affiliation: Graduate School of Applied and Professional Psychology, Rutgers University, Piscataway, NJ

Key Words: visions of reality, brief therapy, integrative therapy


The "visions of reality" refer to assumptions about the nature and content of human reality and have been used to describe different genres of literature as well as psychoanalytic, behavioral and humanistic modes of therapy. In this paper, four visions--the tragic, romantic, comic and ironic--are applied to a single case, spelling out the way in which each can direct the focus of a therapist’s attention to different aspects of a client’s problems. Each vision can also influence the process of therapy and its goals. Keeping the several visions in mind can broaden both the therapist’s and the client’s view of the client’s life situation and problems, thereby opening up possibilities for integrative work. The paper also spells out the shift in visions of reality that is necessary when conducting brief versus long-term therapy.



Applying the Visions of Reality to a Case of Brief Therapy

In a series of articles and chapters (e. g., Messer & Winokur, 1980, 1984, 1986), Winokur and I applied a narrative typology labeled "visions of reality" (Schafer, 1976) to three major schools of therapy, namely, psychoanalytic, behavioral, and humanistic. We attempted to illuminate, within the framework of these models, the way in which narrative forms provide a template for the construal of human experience and the possibilities and limitations of the therapy change process. The typology includes the romantic, tragic, ironic, and comic genres and has been elaborated upon most extensively by the literary critic Northrop Frye (1957, 1965), and by Roy Schafer (1976) in connection with psychoanalysis. The conclusion we arrived at was that the disparate visions to which these three modes of therapy adhered set limits to their integration especially given the nature of their practice in the 1970s and early 1980s. Along with sounding a cautionary note regarding integration, however, we discerned a trend on the part of proponents of these schools of therapy to incorporate elements from the other’s predominant vision, making the prospects for integration appear brighter (Messer, 1986; Messer & Winokur, 1986).

After reviewing the ways in which the visions can serve as a template to understand underlying thematic structures in different theories and techniques, this paper will try to demonstrate that it is both possible and desirable to keep in mind each of the visions in treating the same case in order to appreciate fully the client’s complexity. That is, they can be usefully brought to bear in therapy to highlight the different dimensions of an individual client’s experience, or by recognizing how each may best apply in certain clients or circumstances. This effort also has the effect of opening up possibilities for integration that therapists may not have considered previously.

Andrews (1989), in a conceptually rich, integrative paper argued that "when we structure a personal style or therapeutic outlook around a single vision, we risk becoming one-dimensional caricatures...Each style or vision is an ingredient in the full human experience, and we need them all" (p. 812). Pointing to the dangers inherent in emphasizing any one vision, he contended that we, as therapists, must recognize the predominant vision of reality held by our clients and help them identify and broaden the stylistic options they have chosen. In this connection, but now from the therapist’s side, it is interesting to note Vasco’s (1998) finding that therapists who made use of different epistemic modes (empiricism, rationalism, and metaphorism) were found to be more flexible in terms of their therapeutic styles (directive, reflective, and encouraging self-examination). The same therapeutic flexibility may very well be true for those therapists who make use of the several visions of reality.

In what follows, I will first review the visions of reality and how they apply to the current practice of psychoanalytic, cognitive behavioral, and humanistic/experiential therapies. A case will be presented, followed by how the visions might be applied to this case, highlighting how different features of the client’s problems and personality are most readily captured by one or another vision. In addition I will refer to how each vision affects the process or techniques of therapy, and the outcomes most consonant with it. Because the case was conducted as a brief psychodynamic therapy, I will also show how the visions of reality of psychoanalysis are altered in this mode of therapy.

The Visions of Reality

The Romantic Vision

From the romantic viewpoint, life is an adventure or quest in which each person is a hero who transcends the world of experience, achieves victory over it, and is liberated from it. "It is a drama of the triumph of good over evil, of virtue over vice, of light over darkness (White, 1973, p. 9). The romantic vision idealizes individuality and what is "natural." It advocates free, uninhibited, and authentic self-expression: "The fully developed individual is characterized by true spontaneity, by the richness of his subjective experience" (Strenger, 1989, p. 595).

The romantic vision is fundamental to humanistic psychotherapy (Perls, 1969; Rogers, 1961) within which life is viewed primarily as an adventuresome quest. Humanistic and experiential psychotherapists emphasize the cultivation of emotional sensitivity and expressiveness and seek to develop in their clients spontaneity, creativity, authenticity, agency, and experiential intensity (Bohart, 1995; Greenberg, Rice, & Elliott, 1993). Here is how some current practitioners of humanistic/experiential therapy (Watson, Greenberg & Lietaer, 1998) describe important subtypes of this model: "One of the central tenets of Gestalt therapy, like existential therapy, is to facilitate the individual in becoming more authentic" (p. 19); "In process-experiential therapy, an important task is to bring emotions and their associated action tendencies into awareness" (p. 20). Regarding existential therapy, "one of the primary objectives is to have clients face the givens of existence and confront the attendant anxiety so that they can learn to live more authentically and responsibly in the moment (p. 18)".

Operating within this romantic, Dionysian sensibility, humanistic psychotherapists tend to see "adjustment" to society as undesirable. Society is viewed as a straitjacket, a constrictive entity that causes us to lose touch with our feelings and our inner selves, hence limiting our capacities for self-actualization. The creative artist, rather than the businessperson, is seen as embodying the epitome of human functioning (Messer & Woolfolk, 1998).

Psychoanalytic therapy also partakes of the romantic vision, but with a different emphasis. In stressing an exploration of the unconscious, the irrational and the unknown, psychoanalysts are influenced by the romantic attitude. Psychoanalysis also is conceived of as a journey, a quest for redemption. The therapeutic process encourages a regression away from everyday reality and into the world of dreams, free associations, and fantasies. Unlike humanistic therapy, however, it envisions more obstacles en route and is much less optimistic about the possibilities of ultimate self-actualization and liberation. Nor does it value as strongly as do some humanistic therapies, acting "naturally" and, what it might term, narcissistically.

In contrast to both the psychoanalytic and humanistic therapies, cognitive behavior therapy is more reality-oriented and practical than it is romantic. Problems are defined operationally, measured objectively, and treated expediently. Therapy is conceived of as a psychotechnology (Woolfolk, 1992) that can be systematized and manualized.

The Ironic Vision

The ironic attitude is antithetical to the romantic view. It is an attitude of detachment, of keeping things in perspective, of recognizing the fundamental ambiguity of every issue that life presents to us. Each aspect of a person's behavior may represent something else, be it a dream (latent vs. manifest content), a symptom (a displaced or distorted wish), or an interpersonal interaction (hostility disguised by sugary kindness). The ironic vision has in common with the tragic vision an understanding that there are inherent difficulties in human existence, that life cannot be fully mastered, that its mysteries cannot be truly understood.

Schafer (1976) tells us that the ironic perspective in psychoanalysis "results in the analysand’s coming to see himself or herself as being less in certain emotional respects than was initially thought--less, that is, than the unconscious ideas of omnipotence and omniscience imply" (italics added, p. 52). This is in contrast to humanistic/experiential therapy where the goal is for clients to see themselves and life’s possibilities as greater or more than before therapy.

Psychoanalytic therapists adopt the ironic attitude in therapy when they take a position of relative detachment. They do so in order to detect the flip-side of the client’s utterances and behavior--the hidden meanings, contradictions, and paradoxes. By contrast, in their therapeutic demeanor cognitive behavior therapists and humanistic therapists are more apt to be friendly, self-disclosing, transparent, and affectively expressive, which may lessen the possibility of discerning irony. Cognitive behavior therapists also are more likely to take client complaints at face value and accept their stated therapeutic objectives without critical inquiry into them (Messer, 1986). Humanistic therapists tend to accept most client feelings as authentic expression. It is the essence of the ironic posture to shun credulity, to take nothing for granted, and to assume that nothing is exactly as it seems on the surface. The credibility granted to the client by both humanistic and cognitive behavior therapy is contrary to the ironic mode.

Gold and Wachtel (1993) view cyclical psychodynamic theory (Wachtel, 1997) as falling within the ironic vision, replacing Freud's tragic vision (discussed next). They emphasize the irony in patients' creating an "unwitting repetition of past maladaptive relationships and traumatic experiences in the very search for new and productive interactions" (p. 61). By avoiding anxiety, individuals close themselves off from the possibility of new experiences and new ways of interpreting inner states and interpersonal encounters. They seek out others who will not require them to change, and the ironic result is the continuation of the anxiety they have been trying to avoid--the opposite of that which was consciously intended.

The Tragic Vision

The tragic and ironic visions are linked insofar as they both include a distrust of romantic illusions and happy endings in life. Furthermore, these sensibilities favor reflection and contemplation, whereas the romantic and comic views are more action oriented. Tragedy, however, unlike irony, involves commitment. In a tragic drama, the hero has acted with purpose and in so doing has committed, at least in his or her mind, an act causing shame or guilt. He or she suffers by virtue of the conflict between passion and duty and, after considerable inner struggle, arrives at a state of greater self-knowledge. In the tragic vision the limitations of life are accepted--not all is possible, not all is redeemable, not all potentialities are realizable. The clock cannot be turned back, death cannot be avoided, human nature cannot be radically perfected.

Many aspects of traditional psychoanalysis fall within the tragic vision. The demands of the drives are seen as fundamentally at odds with the constraints imposed by society and the processes of socialization (Wolitzky, 1995). People are viewed as caught within early fixations, which themselves are subject to repression and thus lie beyond their ken. The fixations result from our sexual and aggressive nature and the intrapsychic and interpersonal conflicts such a nature gives rise to-- discord from which we never can be entirely free. For the psychoanalytic therapist, the price of self-knowledge is a degree of suffering. The outcome of psychoanalytic treatment is not unalloyed joy and happiness or all obstacles overcome, but rather the fuller recognition of what one’s struggles are about, a fuller understanding of the conditions and limitations of life within which one must work.

Both humanistic/experiential and cognitive behavior therapies contain fewer tragic elements than psychoanalysis. Humanistic psychology views people as fundamentally good, innocent, and unfallen. Its straightforward optimism about human prospects for self-actualization is diametrically opposite to the somber and complex realism of the tragic view. Traditional cognitive behavior therapy also is a fundamentally optimistic, practical technology to modify feelings and behavior rather than to understand and accept them (but see Jacobson, 1994, for a different view). Recalcitrant life situations simply require ever more powerful, scientifically validated therapy techniques. The inner reconciliation based on self-knowledge described in psychoanalysis is not featured as a therapeutic goal.

The Comic Vision

Whereas in tragedy things go from bad to worse, in comedy the direction of events is from bad to better, or even best. Although there are obstacles and struggles in a comedy, these ultimately are overcome and there is a reconciliation between hero and antagonist, between the person and his or her social world. Harmony and unity, progress and happiness prevail. For this reason, dramatic comedies often end with festive celebrations. Note that the conflicts portrayed in a comedy are ones between people and the unfortunate situations in which they find themselves, and not the kind of inner struggles or implacable oppositions encountered in dramatic tragedy.

In cognitive behavior therapy, conflict may be ascribed to external situations or internal forces that can be mastered through application of therapeutic technology (Fishman & Franks, 1997). Cognitive behavior therapists are more interested in the direct alleviation of suffering than in the exploration of internal struggles. A phobia of crossing streets, or a complaint of lack of assertiveness or anxiety is approached with a spirit of optimism and attacked head-on with empirically tested procedures and educative instruction. By contrast, struggles over separation issues symbolically expressed in difficulty crossing streets, or over fear of aggressive impulses in the unassertive client, are explored by the psychoanalytic therapist not only with the goal of their remediation (psychoanalysis does have some comic thrust), but also with the view that increased consciousness of one’s condition is itself worthwhile.

Humanistic/experiential therapies do not strive for happy endings in quite the way cognitive behavior therapists do, nor are they as basically contemplative about inevitable warring and discordant factions of the mind as is psychoanalytic therapy. But the humanistic approaches do emphasize the substantial possibilities for gratifying impulses that Kris (1937/1952) has described as an essential aspect of the comic view. For them, freer, more joyful, laughter-filled existence is attainable. The true self one comes to discover and liberate in humanistic therapy is not one fraught with struggle, nor is it one seeking reduction of tension, but rather is an authentic self, free from conditions of worth, in touch with natural organismic valuing, and satisfied with life’s enormous possibilities for self-enhancement.

I now present a case to illustrate how the visions of reality might be applied to an actual clinical situation.

The Case of Mrs. B.

Mrs. B is a 45 year old, married, Jewish woman who has been feeling poorly for some time. For the past two months, she has experienced frequent crying spells, a lack of interest in people and activities, and a wish to run away from it all. She acknowledged some suicidal ideation but has no plan of action or history of suicide attempts. She failed to meet the criteria for Major Depressive Disorder, but rather was diagnosed as Depressive Disorder, Not Otherwise Specified (311; DSM-IV)

When asked what had happened two months ago, Mrs. B. responded that she had learned from her 16 year old daughter that she had been sexually molested over a two year period by her older brother when they were younger. While her daughter acknowledges feeling depressed, she has not been willing to say more about what occurred, and has recently started seeing a therapist at her mother’s urging. Mrs. B. says she both wants to know and doesn’t want to know what happened. She feels that she can’t tell her husband about it and is reluctant to confront her son for fear that revealing this information will "destroy the family." However, she finds herself having antagonistic feelings toward her son that are beginning to "leak out". Mrs. B has tried to come to grips with the revelation about her children, but finds herself unable to do so, complaining that she was "falling fast and would soon explode". Over the past 6 months, she has taken several kinds of antidepressants which did not help her. Two weeks ago she started on a course of Prozac.

A significant background stressor, which has contributed in an important way to her feeling poorly, is her medical condition. She suffers constant, intractable pain from lupus, arthritis, and collagen vascular disorder, has high blood pressure and is fearful that her life will be shortened by these ailments ("Lupus is like a slow cancer that will eventually attack my organs"). Walking is painful for her and she is unable to climb a flight of stairs. What worries her is that she will end up in a wheelchair. In addition, she had a breast removed five years ago when it was discovered that she had cancer, and received chemotherapy for a period of time. She was told that she has a genetic marker for cancer. One of the side effects of the several medications that she takes has been a weight gain of 50 lbs. that very much distresses her. Not surprisingly, she worries about dying, wonders if there is a God, and "what comes next, after you die?"

Another ongoing stressor is that her husband lost his job a year ago and has not been able to find regular employment. He has started his own business, which is seasonal, and it is not yet financially solvent. In addition to working full time in an administrative position in a large company, Mrs. B. tries to help her husband run his business.

The client describes her husband as a quiet, decent man, much like her deceased father, who lacks self-confidence and is both self-critical and very critical of others. He is passive, not a go-getter like her, she says, and he can’t handle too much at once. He tends to minimize her medical problems which leaves her feeling that she has to face them alone. She would like him to be more affectionate to her and to be more helpful around the house, especially given her physical difficulties. She does most of the household chores herself--cooking, cleaning, handling bills--and rarely asks for help since she doesn’t want to provoke arguments and risk her marriage coming to an end. It is likely that he is depressed, she says, and he is also taking Prozac.

Mrs. B was married once before, and divorced about 15 years ago. She describes her first marriage as physically and emotionally abusive, in which she was hit and pushed around a great deal. Her two children are from that marriage. Her son is married and her daughter is in high school, but is not performing well. She commented that she feels like she is a mother to everyone but gets nothing for herself. She feels guilty if she is not making others happy, yet is frustrated because she doesn’t get to do what she wants to do. She wonders if she is trying to make up for her longstanding feeling of not being good enough.

Mrs. B.’s father died 10 years ago when he was 60 and she was 35. They had a close relationship and she still misses him. Her mother tries to be helpful to her but "babies me too much." In this vein, her mother lets her know that the proper role of a wife and mother is to cook, clean, and otherwise attend to all the physical and emotional needs of her family. When she was growing up, her mother was very strict with her, and critical of her.

Mrs. B. is well regarded at work, seems to take pleasure in the challenges there, and is striving to advance herself by taking workshops in her area of expertise. She tends to miss some days at work due to her medical condition, but is able to take work home. She is engaging to be with and, despite her many problems, conveys a degree of strength and perseverance under very adverse circumstances. She has hobbies in the artistic realm that also give her pleasure.

Visions of Reality in the Case of Mrs. B.

The Tragic Vision

Here we will try to imagine how the visions of reality might influence the angle of regard of the therapist at different points along the way in therapy. In terms of content, the tragic vision would highlight the irreversible features of Mrs. B.’s life condition. She has reared her children and can undo little of whatever damage has accrued from the sexual contact between them. She must struggle with the attendant guilt of not having noticed, or not wanting to notice, what was happening at the time, and in what way she may have been to blame. She has no easy choice facing her, whether it is to let sleeping dogs lie or to confront her children with their deeds. To do the former is to allow the wounds to fester and possibly to spoil her relationship with her son. To do the latter is to risk a permanent rupture among several members of her family. From the tragic perspective, the piper must be paid or, stated differently, there is no free lunch.

Her medical condition is chronic and is slated to worsen. One cannot wish this away, in the spirit of the romantic vision, or avoid the daily reminders of her condition evidenced in her pain and difficulty walking. Her life possibilities are no longer what they once were, that is, she may have to accept that she will not get the college degree she wanted, or rise to greater heights in her company, simply because her physical condition won’t allow it.

From the point of view of process and technique, the tragic view calls for exploration, reflection, and contemplation, which is most typical of psychoanalytic and humanistic approaches. The therapist participates in the client’s problems in a manner similar to the audience’s participation with the hero in a tragic drama. Just as the audience responds with pity and terror based on an identification with the hero’s plight, the therapist responds empathically to the client based on resonance with similar tragic themes or echoes of them in his or her own life. The therapist also recognizes the ubiquity and universal nature of the kinds of conflict, anxieties and suffering that the client faces. Both understanding and treating them within the tragic vision call for an introspective and subjective stance with a thoroughgoing internal focus.

In terms of expected outcomes, the tragic vision stresses limitation based on circumscribed human possibility. At best, one exchanges neurotic misery for everyday unhappiness (Breuer & Freud, 1895/1955). Even the successfully treated person will be subject to occasional reversals which, depending on how chance and fate play themselves out, can range from mild to severe. There may continue to be an ongoing struggle with the same issues, although hopefully at a diminished level. Both the therapist and Mrs. B. come to realize, within the tragic view, that the best she can do is come to accept her fate with a certain degree of equanimity--a calm acceptance with a modicum of despair.

The tragic view, in isolation from the leavening provided by the other visions of reality, can lead to an overly gloomy and pessimistic therapeutic stance. The danger here is in subtly encouraging the client to wallow in her angst leading to passivity which would allow opportunities for action to pass her by. Some of this leavening comes from the therapist keeping in mind the comic vision which is taken up next.

The Comic Vision

As in comic drama, one might view the content of Mrs. B’s problems as situational obstacles to be overcome through direct action. The problems can be framed as maladaptive interpersonal interactions between her and her children, and her and her husband which are potentially ameliorable. Similarly, her husband’s employment and business woes can be approached in a problem solving mode that could improve Mrs. B.’s mood and reduce her anxiety. Ways can be proposed to improve her physical condition as well. With respect to technique, within the comic vision one would approach Mrs. B. with a sense of optimism and can-do. True, she is depressed and life is not easy for her, but mental health practitioners have available tools and techniques to make things better. The client’s depression can be alleviated with the appropriate medication which will at least lift her mood, and/or she can be administered an empirically supported treatment for depression such as cognitive or interpersonal therapy (Task Force, 1995). Her distorted beliefs and maladaptive interpersonal relations may be thereby improved. Perhaps certain behavioral stress reduction techniques, appropriate diet, and an exercise regimen would also help control her condition, albeit not cure it.

Regarding the relationship to her husband, she can be taught assertiveness training to get more of her own needs met, and/or communication skills to improve their marriage. In this way a reconciliation between our "hero’" and her "antagonist" could come about. With respect to her children, perhaps the situation can be cognitively reframed as their experimenting with sex to prepare themselves for adult life (as is accepted in some cultures), thus alleviating or eliminating her guilt.

Outcomes within the comic vision are decidedly more optimistic than within the tragic. There is an increased pragmatic capacity to perform social roles more adequately, in this case Mrs. B’s role as wife, mother, and employee. Happy endings are anticipated, including improvement in coping skills, such as Mrs. B’s way of handling her illnesses, and increased social assertiveness in Mrs. B. posture toward her husband.

The limitations or danger in this approach is "in the assumption that the therapist knows best and that the client merely has to follow advice in order to lead a satisfying life" (Andrews, 1989, p. 808), which can remove too much responsibility from clients for charting their own course and destiny. The comic vision can also induce expectations for cure in the client that are unrealistic, leading to disappointment.

The Romantic Vision

Within the romantic vision, the creative, fulfilling and adventurous aspects of life are emphasized, even if there are temporary setbacks. In Mrs. B.’s case, she has artistic interests that can be capitalized on to help her live a more satisfying life. Regarding the process of therapy, Mrs. B. can be helped to strive to fulfill her potential in the work sphere and to develop her artistic talents as expressions of her true self. Her inner life of fantasies and daydreams can be explored with the view of encouraging her to see herself as a complex, striving individual who is not defined solely by her illnesses or her current life condition. She can be helped to live more in the moment than in the past. In general, the therapist, acting within the romantic tradition, holds an attitude of curiosity and openness to unexpected developments in the client, characteristic of the humanistic therapy tradition.

With respect to outcomes, Mrs. B.’s drama is one of the opposing forces of light and darkness, which, consonant with this vision, can be settled favorably. The therapist’s unconditional acceptance of her, and her enhanced agency, will help to bring her along to newfound pleasures in life and new possibilities. The danger in a one-sided emphasis on the romantic vision is of overplaying the creative possibilities and ignoring the client’s and life’s realistic limitations. Clearly, not all fantasies can be realized nor all aspirations fulfilled.

The Ironic Vision

This vision provides a corrective to the romantic vision in particular. The process or technique of therapy within the ironic vision calls for the therapist to be skeptical of all he or she sees and hears from the client. It encourages a questioning, challenging, even confronting attitude towards what the client says and does. The ironic vision also predisposes the therapist to keep the three visions in balance. Things may not be as bad as they seem for Mrs. B., but they are not infinitely malleable. One should not be too readily persuaded to side with Mrs. B.’s position or with that of her husband, her children, or her boss. What might seem at first blush like a clear case of fate conspiring against Mrs. B. may turn out to be her bringing things on herself, e. g., by doing too much for others, by not standing her ground, and even by not attending to her illnesses in an optimal way. Might she have chosen accomplices to play out her cyclical maladaptive pattern? Within the ironic vision, nothing should be taken at face value or for granted.

With respect to outcomes, an ironic goal would be to reduce the discrepancy between the ideal (e.g., complete harmony between Mrs. B. and her family; a full recovery from her illnesses; the attainment of a higher degree) and what is really possible by recognizing the exaggerated nature of the ideal and then working to modify it. (To modify one’s behavior to approximate the ideal would be a comic rather than ironic goal). That is, irony, like tragedy, is characterized by a certain degree of resignation, not action.

Another goal of irony is honest self-perception and freedom from illusion. For example, Mrs. B. came to recognize her own role in the family’s issues and dynamics despite her difficulty doing so; it led to tears but also to relief at its exposure in a safe setting. The liability of the ironic stance is that its unremitting skepticism and confrontation can verge on hostility and lead to an intensification of the client’s self-criticism (Andrews, 1989) and to accusatory interpretations (Wile, 1984).

In general, each of these angles of regard can influence the conduct of the case, allowing the therapy to assume an integrative character of the therapist’s choosing according to the mix of visions brought to bear or his or her degree of rootedness in a particular theoretical/therapeutic framework. The emphasis on different visions should also depend on the nature of the case, and how receptive the client is to working within one or another vision.

The Visions of Reality and Brief Psychodynamic Therapy

I conducted the case of Mrs. B. within a brief psychodynamic framework with integrative elements, and will offer here a general account of how the visions of reality are modified when working within such a framework. Some of the major elements of brief psychodynamic therapy (BPT) include a time limit, a focus formulated at the start of therapy, more active intervention and dialogue than in long term psychoanalytic therapy, and goal setting. Although my emphasis below is on psychodynamic therapy, some of the shift in visions required undoubtedly apply to other modes of brief therapy as well. As the practice of therapy in general becomes briefer, it is important to keep in mind what the tradeoffs may be, and one way of capturing these is through the lens of the visions of reality.

Brief psychodynamic therapy partakes of the romantic vision by stressing a tailor-made, dynamic formulation of the client’s problems: In doing so, it prizes individuality and the uniqueness of the client’s quest. It values dreams, fantasies, and spontaneity, encouraging patients to speak freely, to open up and explore the unknown. As in psychoanalysis, it expects the process to be conflict-ridden and painful at times. On the other hand, by emphasizing a rapid formulation of the client’s problems and the early setting of a focus, the open-endedness of the romantic quest is curtailed. The therapist, by selecting interventions along the line of the focus, and specifying goals in advance, deliberately narrows the quest. Similarly, the journey is shortened by virtue of the time limit, and the degree of "redemption" or change brought about is often circumscribed. Nevertheless, rapid termination-- going on to face life on one’s own--also lies in the spirit of the romantic vision.

Brief psychodynamic therapists incorporate an ironic posture insofar as they strive to discern hidden meanings, to uncover the unacceptable wish or feeling behind the defense. Like psychoanalysts, they adopt an attitude of suspicion towards the patient’s statements, taking nothing for granted. They challenge the patient’s illusions, although not in as thoroughgoing a way as in psychoanalysis. The greater activity and dialogic nature of BPT, however, may tend to obscure the recognition of irony on the therapist’s part. Also, since brief dynamic therapy is not open-ended and inherently interminable, it deliberately limits the possibility of uncovering multiple meanings and the layers of personality processes.

In this connection, Kupers (1986) has discussed the loss in BPT of protracted self-reflection. It is this quality of psychoanalytic therapy which Habermas (1971) has referred to as emancipatory. It is the ability to get beyond superficial and mystifying appearances to the deeper levels of personal or social truth. The more that brief therapy is narrowly technical, adjustive, or purely clinical, the more conformist it becomes. To the extent that BPT limits self-reflection, the possibility for unfettered exploration leading to radical criticism of self and society is compromised.

The tragic outlook is present in BPT as it is in most forms of psychoanalytic therapy. Its theoretical base is similar, as are some of its modes of intervention. Ironically, BPT is both more tragic and more comic than long-term psychoanalytic therapy. It is more tragic in that it often settles for circumscribed gain at the expense of fuller character analysis and broader structural change. It sets limits on what is possible by virtue of its brevity, focus, and goal setting. The practice of brief psychodynamic therapy recognizes the difficulty if not impossibility of transforming patients in the miraculous and thorough way they often hope for when seeking treatment. It accepts the limitations of both inner and outer resources for the task at hand.

Brief psychodynamic therapy is also more comic in outlook than traditional psychoanalytic therapy. The brief therapist approaches therapy in a hopeful and optimistic spirit. To formulate a focus is to regard client problems as comprehensible, definable, and predictable. The time limit conveys a message to clients that some problems are, after all, resolvable or ameliorable in a finite time period, thereby highlighting the potential for human change and improvement. The need for separation, however, returns the person to the tragic vision at the end of therapy. Nevertheless, even at this point the therapist conveys confidence that the client can examine separation fears, go through with termination, and cope with these fears.

The therapist’s heightened activity in BPT is also more consonant with the comic and romantic visions’ stress on problem solving and action, versus the more contemplative and reflective stance of the psychoanalytic therapist within ironic and tragic views. Insofar as brief therapies incorporate behaviorally based elements, they take on even more of the coloring of the comic vision. To the extent that specific goals are set and aimed for in brief therapy, it is more comic in thrust than tragic.

For the practitioner whose major mode of practice is long-term therapy, an adjustment in vision of reality is required to conduct BPT. There is enough similarity between long and short- term modes, however, that the shift is not a totally radical one, but it is a significant shift nevertheless. Integrative therapies each have their own mix of visions of reality as well. By remaining aware of the characteristics of each vision, one may more readily construct a therapy--short or long term, integrative or eclectic-- that contains the mix of visions one is striving to achieve.



Andrews, J. D. W. (1989). Integrating visions of reality: Interpersonal diagnosis and the existential vision. American Psychologist, 44, 803-817.

Breuer, J., & Freud, S. (1895). Studies on hysteria. Standard Edition, 2, 1-305. London: Hogarth Press, 1955.

Fishman, D. B., & Franks, C. M. (1997). The conceptual evolution of behavior therapy. In P. L. Wachtel & S. B. Messer (Eds.), Theories of psychotherapy: Origins and evolution (pp. 131-180). Washington, DC: American Psychological Association Press.

Frye, N. (1957). Anatomy of criticism. New York: Athenaeum.

Frye, N. (1965). A natural perspective: The development of Shakespearean comedy and romance. New York: Columbia University Press.

Gold, J. R., & Wachtel, P. L. (1993). Cyclical psychodynamics. In G. Stricker & J. R. Gold (Eds.), Comprehensive handbook of psychotherapy integration (pp. 59-72). New York: Plenum Press.

Greenberg, L. S., Rice, L. N., & Elliott, R. (1993). Facilitating emotional change. New York: Guilford Press

Habermas, J. (1971). Knowledge and human interests (J. J. Shapiro, Trans.). Boston: Beacon Press.

Jacobson, N. (1994). Behavior therapy and psychotherapy integration. Journal of Psychotherapy Integration, 4, 105-119.

Kris, E. (1952). Ego development and the comic. In Psychoanalytic explorations in art (pp. 204-216). New York: International Universities Press.

Kupers, T. A. (1986). The dual potential of brief psychotherapy. Free Associations, 6, 80-99.

Messer, S. B. (1986). Behavioral and psychoanalytic perspectives at therapeutic choice points. American Psychologist, 41, 1261-1272.

Messer, S. B., & Warren, C. S. (1995). Models of brief psychodynamic therapy: A comparative approach. New York: Guilford Press.

Messer, S. B., & Winokur, M. (1980). Some limits to the integration of psychoanalytic and behavior therapy. American Psychologist, 35, 818-827.

Messer, S. B., & Winokur, M. (1984). Ways of knowing and visions of reality in psychoanalytic therapy and behavior therapy. In S. B. Messer & H. Arkowitz (Eds.), Psychoanalytic therapy and behavior therapy: Is integration possible? (pp. 63-100). New York: Plenum.

Messer, S. B., & Winokur, M. (1986). Eclecticism and the shifting visions of reality in three systems of psychotherapy. International Journal of Eclectic Psychotherapy, 5, 115-124.

Messer, S. B., & Woolfolk, R. L. (1998). Philosophical issues in psychotherapy. Clinical Psychology: Science and Practice, 5, 251-263.

Perls, F. S. (1969). Gestalt therapy verbatim. Lafayette, CA: Real People Press.

Task Force on Promotion and Dissemination of Psychological Procedures (1995). Training in and dissemination of empirically validated psychological treatments. The Clinical Psychologist, 48 , 3-23.

Rogers, C. (1961). On becoming a person . Boston: Houghton Mifflin.

Schafer, R. (1976). A new language for psychoanalysis. New Haven: Yale University Press.

Strenger, C. (1989). The classic and the romantic vision in psychoanalysis. International Journal of Psychoanalysis, 70, 593-610.

Vasco, A. B. (1998, July). From encapsulation to paradigmatic complementarity: Psychotherapists' epistemic and therapeutic styles. Paper presented at the meeting of the Society for the Exploration of Psychotherapy Integration, Madrid, Spain.

Watson, J. C., Greenberg, L. S., & Lietaer, G. (1998). The experiential paradigm unfolding: Relationship and experiencing in therapy. In L. S. Greenberg, J. C. Watson, & G. Lietaer (Eds.), Handbook of experiential psychotherapy (pp. 3-27). New York: Guilford Press.

White, H. (1973). Metahistory . Baltimore, MD: Johns Hopkins University Press.

Wile, D. B. (1984). Kohut, Kernberg, and accusatory interpretations. Psychotherapy , 22, 793-802.

Wolitzky, D. L. (1995). The theory and practice of traditional psychoanalytic psychotherapy. In A. S. Gurman & S. B. Messer (Eds.), Essential psychotherapies: Theory and practice (pp. 12-54). New York: Guilford Press.

Woolfolk, R. L. (1992). Hermeneutics, social constructionism, and other items of intellectual fashion: Intimations for clinical science. Behavior Therapy, 23, 213-223.




Design and Hosting by CyberPsych