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Abstract

Over the last decades, brief dynamic psychotherapy has been increasingly important in the actual clinical practice. For its brevity focalization must be accomplished. The work on focus has shown to have many advantages; it consolidates the material, abbreviates psychotherapy and is considered to be a change mechanism. For this thesis the Operationalized Psychodynamic Diagnosis System (OPD-2) was used, for this system focus consists in the specific problematic areas that are significant for the patient's psychodynamics, specifically three are the areas that can became a focus; relational pattern, inner conflict and structural vulnerabilities. The study on foci and the relation between them becomes a research and clinical imperative. But also, the study of the process is of fundamental importance for advancing the science of psychotherapy, for this, change on foci must be considered. Relevant for this thesis is to consider the change in the level of foci integration as an indicator of foci change process. Few are the studies that analyze foci from a process perspective, and even fewer are the ones that study them in significant segments, called change episodes. The objectives of this thesis are to determine types of foci and its relationship, and to analyze its relation with change considered as change in subjective theories of the patient and to foci level of integration throughout the psychotherapeutic process. In order to cover the aforementioned objectives, a multiple single subject design was used, considering the analysis of change episodes of four brief dynamic psychotherapies done as treatment as usual. Raters were used for the different stages of the procedure with good reliability and a new instrument was developed to be capable to grasp the different levels of foci presence. As for the results, OPD foci were identified in all change episodes with a higher presence in the middle phase of psychotherapy. Specifically, dysfunctional relational patterns focus was more present in the initial phase, while structural vulnerabilities were higher in the final phase. On the other hand, generic change indicators related specifically with the presence of relational pattern focus and conflict focus. Also, these indicators showed a direct relation between them and foci integration level. Finally the initial phase showed that the high presence of foci associates with lower integration, but, in the middle phase, the high presence of foci associates with a higher level of integration of them.