Focal psychotherapy--terminable and interminable

Despite evidence that many patients use psychotherapy intermittently at times of need, most treatment is structured as though it had a clear beginning, middle, and end. The aim is to treat an identified area of psychopathology. This article presents an alternative model, in which the patient is seen as evolving, receptive to and needing different interventions at different times. Treatment consists of episodes of focal therapy within the framework of an enduring helping relationship, akin to the practice of primary medical care. Since he can call upon the therapist repeatedly if necessary, it is the patient who determines, empirically, the ultimate pattern of care. The person of the therapist serves to bridge the discontinuous contacts, allowing some patients who require the presence of a therapist in their lives over an extended period of time (a transitional phase or longer) to assure this advantage without incurring the risks or costs of uninterrupted extended treatment.