Short-term anxiety-provoking psychotherapy

Domain I · Psychodynamic & depth psychology · Peter E. Sifneos · 1965 · Boston

What it is

STAPP is a focal, insight-oriented psychodynamic therapy for relatively healthy people with one circumscribed emotional problem. Its main features are brevity, emotional re-education, problem solving and limited goals. The core idea of change: once a positive therapeutic alliance has formed, the…

Format

• Format. Face-to-face individual sessions, usually weekly, at standard psychotherapy length. No fixed number of sessions is set in advance. The therapist ends treatment when tangible evidence of change appears. Reported length varies:
• About 9–15 sessions on average in the Norwegian adaptation.

Who practises it, and how they are trained or regulated

• Phase 0: Evaluation (1–2 interviews before treatment).
• Goals: hear and prioritise the complaints; take a developmental history; reformulate the complaint psychodynamically; rate the selection criteria; agree on a focus.
• The five selection criteria (1972 version): A circumscribed chief complaint, meaning the patient can choose one problem to work on.

Evidence status, as the guide reports it

• Format. Face-to-face individual sessions, usually weekly, at standard psychotherapy length. No fixed number of sessions is set in advance. The therapist ends treatment when tangible evidence of change appears. Reported length varies:

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• If the material keeps returning and dominates, the selection may have been wrong (see 5.7).
• Ask yourself whether you are avoiding anxiety-provoking questions out of your own discomfort.
• Disagreement about the focus that persists. Better to resolve it now, or re-refer, than to drift.
• Patients who generalise as a defence. When clarification works, it produces detailed scenes with feeling.
• Several independent examples across settings. One example, or only symptom relief, is not enough evidence.

Problems the guide addresses

• Stuck client: no new material, sessions circling
• Resistance: evasion, intellectualisation, forgetting, lateness
• Overwhelm: anxiety disorganises rather than mobilises
• Non-adherence: missed sessions, wanting to stop early
• Ruptures: anger at the therapist, feeling attacked by confrontation
• Growing dependence or wish to prolong therapy
• Off-focus material dominates (characterological, pregenital, early loss)
• Erotised or seductive transference (STAPP-specific)
• Therapist-side problems
• Patient produces insight without behavioural change

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.