One conflict instead of a hundred problems: What focal therapy teaches about change

Your boss is getting on your nerves, your relationship is struggling, your mother calls too often, you sleep badly, and you have been meaning to exercise more for ages. Faced with a list like that, it is easy to feel overwhelmed. Where do you even start? For more than sixty years, short-term psychodynamic therapy has given a surprising answer: not everywhere, but in one single place.

What the theory is called: focal therapy

The idea of working on one central conflict within a limited time, instead of on everything at once, is called focal therapy. The concept comes from the Hungarian-British psychoanalyst Michael Balint. Together with Enid Balint and the US psychiatrist Paul Ornstein, he described it in 1972 in the book “Focal Psychotherapy”, which grew out of a London workshop on focal therapy¹. As early as 1963, David Malan had examined in “A Study of Brief Psychotherapy” which patients benefit from a short treatment and how technique and outcome are related².

In Germany, the psychoanalyst Rolf Klüwer, among others, developed focal therapy further. He describes it as a treatment with limited goals, a limited field of work and a limited number of sessions, usually 10 to 30. The focus gives it its name³.

What a focus is

A focus is more than a topic. It condenses the understanding of a conflict into a phrase, often a single sentence. Klüwer describes how this sentence brings together the different signals a person sends: their complaints, the way they shape relationships, earlier attempts at solutions that did not work, and the direction in which a solution might lie³. One example from his book reads (translated): “You must not take an exam, or the priest in you will die.”³

Importantly, the focus is a working hypothesis. Everything that comes up later is understood in its light, and at the same time it is checked whether it holds true³.

Focal and nuclear conflict

As early as 1958, the US psychoanalyst Thomas French distinguished two levels. The nuclear conflict is the deep, biographical core conflict. The focal conflict is its current form, usually closely tied to the present life situation. French stressed that orienting towards the focal conflict helps you not to get lost among the many possible interpretations⁴.

Why one conflict can lie behind many problems

That many outer problems can be traced back to a few inner patterns is well researched. The US psychologist Lester Luborsky developed the Core Conflictual Relationship Theme (CCRT) for this purpose. It describes a wish, the expected response of others and one’s own response to it. Research shows a unique and pervasive pattern for each person, a kind of template that repeats across different relationships⁵. You can read more in Why we keep ending up in the same patterns.

The Operationalized Psychodynamic Diagnosis (OPD), developed in Germany, takes up the same idea. Its manual contains tools for determining the main focuses of treatment and deriving a strategy from them⁶. The OPD conflict model describes inner core conflicts, for example between closeness and independence. An introduction can be found in Inner conflicts: where the idea comes from.

What research on short-term therapy shows

The German psychotherapy researchers Falk Leichsenring, Sven Rabung and Eric Leibing analysed 17 randomised trials of short-term psychodynamic therapy. Typical features were 16 to 30 sessions, an active therapist and work on specific conflicts or themes identified early in treatment. Maintaining the focus and setting achievable goals were explicitly part of it⁷.

The results: large improvements in target problems, general complaints and social functioning. The effects remained stable at follow-up and in some cases even increased. Compared with other psychotherapies, including cognitive behavioural therapy, there were no significant differences⁷.

A Cochrane review by an international team led by the Canadian psychiatrist Allan Abbass, which also included Leichsenring and Rabung, summarised 33 studies with around 2,200 participants⁸⁹. Short-term therapy was more effective than the comparison conditions in the short and medium term; in the long term, the data were too thin for firm conclusions. The authors describe a promising approach with modest to large gains, but urge caution because the studies differ widely in method and quality⁹.

In 2010, the US psychologist Jonathan Shedler summarised several meta-analyses in the journal American Psychologist. His conclusion: the benefits of psychodynamic therapy are at least as large as those of other psychotherapies, and they last. In one of the meta-analyses he summarised, the effect size for overall symptom improvement rose from 0.97 at the end of treatment to 1.51 when people were reassessed nine months or more later¹⁰.

Does sticking to the focus really help?

A German study led by Peter Götze and Jochen Eckert looked at exactly this question. Therapists with better outcomes addressed the focus significantly more often during treatment. They also described it in a more complex and more relationship-oriented way than colleagues with weaker outcomes¹¹.

Why the first weeks count

A classic study by Kenneth Howard and David Orlinsky shows why short-term work makes sense at all: for many people, change begins early. A paper co-authored by the German psychotherapy researcher Wolfgang Lutz summarises the figures like this¹²:

Early does not mean overnight, though. Why real change still takes patience is explained in Change takes time.

What you can take from this for yourself

Focal therapy is a treatment provided by professionals. But the basic idea can also be used for your own self-reflection. A simple path in five steps:

1. Write down your problem areas.

   Everything that is grinding right now: work, love, family, friendships, yourself.

2. Look for what they share.

   Where do you experience similar situations? What do you wish for each time, what do you fear, and how do you react?

3. Put it into one sentence.

   For example: “I would rather say nothing so that nobody is disappointed, and then I feel overlooked.”

4. Test it in daily life.

   Does the sentence fit for a week? If not, change it. It is a hypothesis, not a verdict.

5. Try one small step.

   One situation a week in which you do things differently. Then watch what starts moving in the other areas.

It helps to treat yourself kindly, especially when the sentence hurts. More on this in Self-compassion. And sometimes a pattern also has a hidden benefit that keeps it alive. That is the topic of The hidden benefits of old patterns.

How MindMotion takes up the idea

MindMotion does not provide psychotherapy. The app is a tool for psychological self-reflection and is closer to coaching. Research on focal therapy is an inspiration for us, not a treatment programme. What we adopt is the attitude: not a hundred problems at once, but first finding the pattern that connects them.

How it works in detail is shown in How MindMotion works. Why an app does not replace therapy is explained in Therapy app or coaching app?

Frequently asked questions

Find your focus

MindMotion is still in development and free to use without sign-up. Start the Mind-Check, see which pattern might lie behind your problem areas, and tell us whether it helps you.