The psychodynamic life narrative: a psychotherapeutic intervention useful in crisis situations

The Psychodynamic Life Narrative is a psychotherapeutic maneuver used during the first few sessions of a consultation with a patient in a crisis situation. By establishing a powerful bond between physician and patient, it offers the possibility of a rapid relief of dysphoric symptoms. In some situations, it may be useful in mobilizing a recalcitrant patient to accept psychotherapy or, in the case of the physically ill, to accept diagnostic procedures and treatments previously refused. It is most effective in patients whose general adaptation has been stable and whose psychological homeostasis has been disrupted by a life event of real and symbolic significance. Though the psychodynamic life narrative was first explored as a therapeutic maneuver in the treatment of depression in the physically ill (Viederman and Perry 1980), for reasons which will be described below, it has applicability to other situations of crisis--in some cases crises that have occurred in the distant past and left residual symptoms. This maneuver is not presented as a substitute for long-term psychotherapy or psychoanalysis where this is required and possible, and has distinct disadvantages where these treatments are contemplated. However, in some situations it may lead to significant change, particularly in the area of self and object-representations.