Short-term anxiety-provoking psychotherapy

1. Introduction

Version followed: Peter E. Sifneos's Short-Term Anxiety-Provoking Psychotherapy (STAPP) as set out in Short-Term Dynamic Psychotherapy: Evaluation and Technique (1979; 2nd ed. 1987), with selection criteria from Short-Term Psychotherapy and Emotional Crisis (1972) and the later Short-Term Anxiety-Provoking Psychotherapy: A Treatment Manual (1992). Other models (Malan, Davanloo's ISTDP, Mann) are not followed here.

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 [source: Barth & Nielsen chapter page; Google Books description of the 1992 manual]. The core idea of change: once a positive therapeutic alliance has formed, the therapist acts as an objective teacher. They ask questions and make confrontations the patient would not ask themselves. These deliberately raise anxiety, so the patient has to look at the unresolved conflict (classically oedipal) behind the presenting complaint, see how it repeats in current relationships and with the therapist, and learn more mature solutions. The 2nd edition names problem solving, self-understanding and new learning as the active therapeutic factors [source: 2nd-ed. preface excerpt, Bokus page]. Anxiety is a lever. It is kept at a level that drives work without overwhelming the patient [source: Eppel 2021, pp. v–ix].

2. Framework

Format. Face-to-face individual sessions, usually weekly, at standard psychotherapy length [uncertain: exact length not confirmed in the sources]. No fixed number of sessions is set in advance. The therapist ends treatment when tangible evidence of change appears [source: Sifneos 1979/1987, phase structure; Barth & Nielsen summary]. Reported length varies:

About 9–15 sessions on average in the Norwegian adaptation [source: Tijdschrift voor Psychiatrie report].
"Several months", rarely over a year, per the manual's publisher description [source: Google Books].
The commonly cited 12–20 sessions [uncertain: not confirmed in the sources].

Sessions are videotaped for supervision and outcome review where possible [source: Tijdschrift report; Sifneos, Routledge chapter on termination, outcome and videotaping].

Phase 0: Evaluation (1–2 interviews before treatment). [source: Sifneos 1979, Part 1 chapter titles: common complaints; history taking and reformulation of the presenting complaints; criteria for selection; evaluation process]

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):
1. A circumscribed chief complaint, meaning the patient can choose one problem to work on.
2. At least one meaningful, give-and-take relationship in early life.
3. Flexible interaction with the evaluator, with expression of feeling.
4. Above-average psychological sophistication or intelligence.
5. Motivation for change, not only for symptom relief.
Motivation is rated on seven sub-criteria: the patient
- recognises that the symptoms are psychological;
- is introspective and honest about difficulties;
- is willing to take an active part in treatment;
- is curious about themselves;
- is willing to change, explore and experiment;
- has realistic expectations;
- will make reasonable sacrifices of time and money.
Scoring: all 7 = excellent, 6 = good, 5 = fair, 4 = questionable, 3 or fewer = unmotivated. [source: Laaksonen 2014, summarising Sifneos 1965/1968/1972]
The earlier 'emotional crisis' criterion was dropped in 1972 [source: Laaksonen 2014].
In some programmes, two evaluators assess independently, a group decides from the video, and doubtful cases get a second interview [source: Tijdschrift report; this describes the Norwegian programme and may not be Sifneos's own Boston procedure, so marked uncertain].
Exclusions: a focus that is mainly pregenital or characterological, such as dependency, passivity, acting out, or a central abandonment problem [source: Tijdschrift report].
Moving on: the patient meets the criteria and agrees to work on a stated focus. In Sifneos's research form this was an unresolved oedipal conflict.

Phase 1: Patient-therapist encounter (opening, about sessions 1–3). [source: Sifneos 1979, ch. 'The Opening Phase of STAPP']

Goals: build a working alliance quickly; restate the agreed focus; note and openly use the early positive transference.
Moving on: the patient is engaged with the focus and reports positive feelings toward the therapist, or these can be named. [synthesis: specific markers inferred]

Phase 2: Early treatment. [source: Sifneos 1979, ch. 'Early Therapeutic Considerations']

Goals: use the positive transference as a working tool; clarify the oedipal focus with concrete material; start linking past figures, current relationships and the therapist; steer away from side issues.
Moving on: the patient produces focal material on their own, and the first anxiety-provoking confrontations are tolerated without regression.

Phase 3: Height of the treatment. [source: Sifneos 1979, chs. 'The Height of STAPP' and its case example; chapter abstract notes treatment reaches the height rapidly after the opening phase]

Goals: sustained, anxiety-provoking confrontation and clarification of the oedipal conflict. Repeated past–present and transference–parent links. Confronting defences and resistance. Working through the painful feelings, such as guilt, rivalry, anger at a parent, or longing. Shifting toward problem solving.
Moving on: the patient makes the links themselves, uses insight outside sessions, and begins to bring examples of changed behaviour.

Phase 4: Evidence of change and termination. [source: Sifneos 1979, chs. 'The Last Phase of STAPP' and 'The Terminal Phase'; Tijdschrift report]

Goals: gather tangible evidence of change in behaviour and in relationships, check symptom change, and end.
Termination is often raised by the patient. Sifneos reported it was rarely a problem.
After the end: follow-up interviews to judge outcome [source: Sifneos 1975 'Criteria for psychotherapeutic outcome', title only; Routledge chapter].

3. Guiding principles

Sources for this section: Sifneos 1972/1979/1987 as summarised in the pages cited, plus the Google Books, Tijdschrift and psychology.town pages. Items marked [synthesis] are derived.

Selection decides the treatment. Only offer STAPP to patients who meet the criteria. Offer others a different therapy rather than adapting STAPP.
Motivation for change outranks symptom relief. Probe whether the patient wants to change how they live, not just to feel better.
One focus, agreed explicitly. Name the focus in the contract and refer back to it every session.
Active therapist, not a neutral listener. You talk, ask, confront and steer. Long silences are not part of the method.
Anxiety is deliberately provoked. Ask the question that makes the patient uncomfortable, as long as the discomfort produces work rather than collapse.
Therapist as objective teacher. Your questions lead the patient to discover the conflict, rather than being handed conclusions. This is the Socratic stance [source: Google Books manual description; 'Socratic' wording uncertain].
Use the positive transference early. Name the patient's positive feelings toward you and use them as alliance and evidence. Don't wait for them to deepen.
Prevent a transference neurosis. Interpret transference feelings promptly so dependence and regression don't build up [source: psychology.town].
Stay on the oedipal focus. Avoid pregenital and characterological issues. When dependency, passivity or acting-out material appears, treat it as resistance and redirect. Don't explore it [source: Tijdschrift report].
Link past, present and transference. Repeatedly connect the parental relationship, current relationships and the therapy relationship.
Problem solving and new learning are the goals. The patient should leave able to apply the method to future problems [source: 2nd-ed. preface; psychology.town].
Limited goals. Success means resolving the focal conflict, not reorganising the whole personality.
Termination on evidence. End when concrete behavioural examples of change appear. Don't extend therapy to pursue new problems.
Record and supervise. Videotape sessions and review them, especially for countertransference [source: Tijdschrift; Routledge chapter].
Monitor countertransference. Oedipal material and an active style can pull you toward seductiveness, rivalry or interrogation. Check your own reactions in supervision [synthesis; 'countertransference' is a key term in the manual per Google Books].

4. Intervention inventory

The items below are the technical elements named in the sources (chapter titles of Sifneos 1979/1987, the publisher descriptions, and secondary summaries). The full texts of Sifneos's books are not drawn on, so step-by-step detail is reconstructed from those descriptions and marked [synthesis] where gaps are filled. All example language is illustrative, not Sifneos's own words.

4.1 Evaluation interview and developmental history

Purpose / when: Before treatment, to understand the complaints, trace their development and collect the data needed to rate the criteria [source: Sifneos 1979, Part 1 chapters; 1992 manual contents 'Evaluation', 'The Presenting Problems', 'Taking a Developmental History'].
Steps:
1. Ask the patient to list every complaint.
2. Ask which one they most want resolved.
3. Take a chronological history: earliest memories, the relationship with each parent and siblings, school, adolescence, sexual development, and close relationships up to now.
4. Look for at least one give-and-take relationship.
5. Note how flexibly the patient interacts with you and whether they show feeling.
6. Look for the repeating triangular (oedipal) pattern linking past and present complaints.
Example language (illustrative): "You've mentioned three difficulties. If we could only work on one, which would you choose?" "What is your earliest memory of your father? And of your mother?"
Watch for: Whether the patient can prioritise. Vague, diffuse complaints, or a history dominated by early loss, deprivation or chronic dependency, point away from STAPP. A working candidate gives specific, emotionally alive accounts.

4.2 Psychodynamic reformulation of the presenting complaint (trial interpretation)

Purpose / when: At the end of evaluation, to restate the complaint as a conflict and test whether the patient can use a dynamic idea [source: Sifneos 1979, ch. 'History Taking and Reformulation of the Presenting Complaints'; the 'trial' framing is synthesis].
Steps:
1. Pick two or three history episodes that share a pattern.
2. Put them side by side for the patient.
3. Offer a tentative link to the complaint.
4. Watch the response: elaboration, new memories, or a show of feeling all suggest psychological sophistication.
Example language (illustrative): "You lose interest in men once they become available, and as a girl you felt you had to compete with your mother for your father. Could these be connected?"
Watch for: Intellectual agreement with no feeling, or flat rejection, means sophistication or motivation is questionable. Real curiosity is a good sign.

4.3 Assessment of motivation for change

Purpose / when: During evaluation. This is the criterion Sifneos weighted most heavily [source: Laaksonen 2014 summarising Sifneos 1968].
Steps:
1. Probe each of the seven sub-criteria directly.
2. Score 0–7.
3. Accept for STAPP only at 'good' (6) or 'excellent' (7). The cut-off is my inference from the scoring bands [synthesis].
Example language (illustrative): "Suppose the symptom went away but nothing else changed. Would that be enough?" "What are you prepared to give up to come every week?" "What do you expect therapy to do, and what do you expect to do yourself?"
Watch for: Wanting only symptom relief, or magical expectations. A factor analysis of the STAPP evaluation form found that 'motivation for therapy' and 'desire to change' are separate dimensions, so rate both [source: Karger abstract, Psychother Psychosom vol. 49; year not verified].

4.4 Focus agreement and therapeutic contract

Purpose / when: At the end of evaluation or in session 1, to give the therapy a single, shared target [source: Sifneos 1979; Laaksonen notes that from 1972 the focus could be agreed after selection].
Steps:
1. State the focal conflict in plain language.
2. Get the patient's explicit agreement.
3. Agree weekly meetings, no fixed end date, and an ending when change is evident. Explain that you will be active and will sometimes ask uncomfortable questions.
4. Obtain consent to videotaping where it is used.
Example language (illustrative): "We've agreed to look at what happens in your relationships when there are three people involved, and how that goes back to your family. I'll be active. I'll ask questions that may make you anxious, because that's how we'll get to it."
Watch for: Disagreement about the focus that persists. Better to resolve it now, or re-refer, than to drift.

4.5 Building the alliance through the early positive transference

Purpose / when: Phase 1 and early Phase 2. Sifneos used positive transference as the main driver of early work [source: psychology.town; Sifneos 1979 opening-phase chapter].
Steps:
1. Listen for signs of positive feeling toward you: compliments, eagerness, idealisation, comparisons.
2. Name them early, in a matter-of-fact way.
3. Connect them to the alliance and, where relevant, to the focal parent.
Example language (illustrative): "You've said twice today that you look forward to coming. You seem to have warm feelings toward me already. Let's keep an eye on that, because it may tell us something about the focus."
Watch for: The alliance holding when you name the feelings. Growing dependence or idealisation that blocks work means you need to interpret promptly (4.9).

4.6 Clarification

Purpose / when: Throughout, especially early. Use it to make vague material specific and to collect focal evidence [source: brief's version hint; Tijdschrift report lists confrontation and interpretation].
Steps:
1. Pick a vague statement.
2. Ask for a specific instance: who, when, what was said, what was felt.
3. Summarise the clarified sequence back to the patient.
Example language (illustrative): "You said 'things got tense'. Tell me exactly what happened. Who said what, and what did you feel at that moment?"
Watch for: Patients who generalise as a defence. When clarification works, it produces detailed scenes with feeling.

4.7 Anxiety-provoking (Socratic) questioning

Purpose / when: The method's signature intervention, from Phase 2 onward and most intense at the height. It leads the patient to look at what they avoid [source: Google Books manual description of the therapist as an objective teacher raising unconsidered questions].
Steps:
1. Spot the point the patient skips over: a feeling, a motive, a parallel with a parent.
2. Ask a short, direct question aimed at it.
3. Don't answer it yourself. Let the anxiety rise.
4. If the patient evades, repeat or sharpen the question.
5. When the patient arrives at the answer, have them put it in their own words.
Example language (illustrative): "Why do you suppose you chose the one man who was already engaged?" "What did you feel when your father praised your sister?" "What's the risk in winning?"
Watch for: Productive anxiety (flushing, pauses, new memories) versus disorganising anxiety. If the patient becomes overwhelmed, step back to clarification (see 5.3).

4.8 Confrontation

Purpose / when: Phase 2 onward. Use it to put in front of the patient a contradiction, an evasion or a defence they are using, so they can't keep sidestepping the focus [source: Tijdschrift report, active confronting therapist; brief's version hint].
Steps:
1. Name the observable behaviour: changing the subject, laughing at a painful point, saying "I don't know", intellectualising.
2. Name the contradiction (said versus felt, said versus done).
3. Link it to the focus.
4. Wait for the response. Don't soften or retract.
Example language (illustrative): "Each time we come to your mother's reaction, you start talking about work. What happens to you right at that point?" "You say you didn't care, but your voice changed."
Watch for: Defensiveness that eases into fresh material is the aim. Hostility that hardens calls for an alliance check (5.5). Sifneos's model assumes a patient sturdy enough to take this, which selection is meant to guarantee.

4.9 Transference interpretation (the parent–transference link)

Purpose / when: Early and throughout. Address feelings toward the therapist straight away, use them as evidence of the focal conflict, and prevent a transference neurosis from forming [source: psychology.town, early head-on transference interpretation; Tijdschrift, early use of transference].
Steps:
1. Note the feeling toward you: wish to please, rivalry, disappointment, flirtation, fear of your judgement.
2. Ask about it directly.
3. Link it to the feeling toward the focal parent.
4. Link both to the current relationship in the complaint.
Example language (illustrative): "You apologised for disagreeing with me. Is that like how you handled disagreeing with your father?" "You wondered if I'd be disappointed in you, the way you described waiting for your mother's verdict."
Watch for: Interpret before dependence builds. If the patient increasingly brings material to please you, or wants more sessions, interpret that wish rather than gratify it [synthesis].

4.10 Past–present linking (triangle of insight)

Purpose / when: At the height of treatment, to show the patient how the oedipal pattern repeats across parents, current figures and the therapist [source: Tijdschrift report, citing the triangle of insight: past–present, transference–present, transference–past].
Steps:
1. Collect a vivid current episode.
2. Ask for a parallel memory.
3. Ask for any parallel with you.
4. Have the patient state the common pattern.
5. Return to it each time new material shows it again.
Example language (illustrative): "With your boss, your father and, last week, with me, you held back from saying what you wanted. What's the common thread?"
Watch for: A link the patient states unprompted is a strong sign. If links only ever come from you, the patient may be complying without insight.

4.11 Keeping to the focus and redirecting characterological or pregenital material

Purpose / when: Whenever dependency, passivity, acting-out, early deprivation or other off-focus material comes up. In STAPP this is treated as a regressive pull away from the oedipal focus [source: Tijdschrift report: characterological material is left alone except to interpret it as resistance].
Steps:
1. Acknowledge the material briefly.
2. Point out that it moves away from the agreed focus.
3. Interpret the move as possible avoidance.
4. Bring the patient back to the focal theme.
Example language (illustrative): "We've drifted to how much you need people to take care of you. That's real, but it isn't what we agreed to work on, and I notice it came up just as we were getting to your rivalry with your sister. Let's go back there."
Watch for: If the material keeps returning and dominates, the selection may have been wrong (see 5.7).

4.12 Confronting resistance and defences

Purpose / when: At the height of treatment, when the patient's anxiety leads to evasions, intellectualisation, lateness, forgetting or 'nothing to talk about' [source: Tijdschrift, interpreting resistance; Google Books lists 'resistance' as a key term in the manual].
Steps:
1. Describe the resistance behaviour.
2. Link it to the anxiety the last session raised.
3. Ask what the patient is protecting themselves from.
4. Return to the content that was avoided.
Example language (illustrative): "You forgot last week's appointment the week after we talked about your feelings for your brother-in-law. What do you make of that?"
Watch for: Resistance that gives way after it's named. Repeated acting out, or resistance that turns into absences, may mean the anxiety is too high (5.3).

4.13 Problem solving and new learning

Purpose / when: Height and late phase. Help the patient find more mature solutions to the conflict than the old neurotic pattern, and turn insight into a reusable way of thinking [source: 2nd-ed. preface on problem solving, self-understanding and new learning; Sifneos 1985 paper titled 'Problem solving: a technical requirement' (German, title only); Tijdschrift report].
Steps:
1. Once the pattern is clear, ask how the patient might handle the next similar situation differently.
2. Look together at the options and their consequences.
3. Have the patient try one between sessions.
4. Review it next session using the same questioning approach.
Example language (illustrative): "Now that you can see what you do when there's a rival, what could you do differently at the dinner on Saturday?" "How did you work that out for yourself this time?"
Watch for: The patient starting to use the method on their own ('I asked myself why...'). This is the stated long-term aim.

4.14 Eliciting tangible evidence of change

Purpose / when: Late phase. Confirm change with concrete examples rather than reports of feeling better [source: Tijdschrift report, 'evidence for change'; Sifneos 1979 last-phase chapter].
Steps:
1. Ask for specific recent situations in which the patient acted differently in the focal area.
2. Check that the change is in behaviour and relationships, not just symptoms.
3. Ask the patient to state what they now understand.
Example language (illustrative): "Give me a recent example where you would have backed off before, and what you did this time."
Watch for: Several independent examples across settings. One example, or only symptom relief, is not enough evidence.

4.15 Termination

Purpose / when: Once tangible evidence of change is in place (4.14). Sifneos reported that termination is often proposed by the patient and is rarely a problem [source: Tijdschrift report; Sifneos 1979 'The Terminal Phase'].
Steps:
1. When the evidence is in, raise ending yourself if the patient hasn't.
2. Review the focus, what was understood and what changed.
3. Briefly address feelings about ending, such as sadness, gratitude or wanting to continue, and link them to the focus where relevant.
4. End within one to a few sessions.
5. Don't open new problems.
Example language (illustrative): "You've given me several examples of handling things differently. I think we've done what we set out to do. How do you feel about stopping?"
Watch for: New complaints appearing just as ending comes up. Treat them as a reaction to termination unless they are serious [synthesis].

4.16 Follow-up outcome interview

Purpose / when: Months after ending, to evaluate outcome against the original focus [source: Sifneos 1975 papers 'Criteria for psychotherapeutic outcome' and 'Evaluating the results of STAPP' (titles only); Routledge chapter on termination and outcome].
Steps:
1. Re-interview the patient.
2. Compare their current functioning in the focal area, their symptoms, their self-understanding, and their use of problem solving with the baseline.
3. Ideally a different evaluator does this [uncertain].
Example language (illustrative): "Looking back at what brought you here, what's different now, and how did it come about?"
Watch for: The patient describing new learning and applying it to new situations. This is the outcome Sifneos sought.

4.17 Videotaping and supervised review (therapist-side)

Purpose / when: Throughout, for training, supervision and catching countertransference [source: Tijdschrift report; Routledge chapter; Sifneos 1979 'Instruction in STAPP'].
Steps:
1. Get consent.
2. Record the sessions.
3. Review key segments in supervision.
4. Check three things: whether you stayed on focus, whether your confrontations were followed through or dropped, and whether you got drawn off-focus.
Watch for: Ask yourself whether you are avoiding anxiety-provoking questions out of your own discomfort.

Not found in the sources

Sifneos's method relies on interview technique. The sources contain no structured exercises, homework sheets or worksheets. Problem-solving 'experiments' between sessions (4.13) are my own operationalisation [synthesis].

5. Handling problems

Where these responses rest on sources, they are tagged. Most of the operational detail is synthesis, because the full texts weren't available.

5.1 Stuck client: no new material, sessions circling

Check that the focus is still the agreed one. Restate it explicitly [synthesis].
Sharpen the anxiety-provoking questions. Stuckness often means questions have become too comfortable [synthesis, consistent with the method's rationale].
Look for an unaddressed transference feeling, such as wanting your approval, and interpret it (4.9).
If the patient still can't produce focal material after re-contracting, reconsider the focus formulation, or the selection itself [synthesis].

5.2 Resistance: evasion, intellectualisation, forgetting, lateness

Treat it as resistance against the focus and confront it, linking it to the anxiety from the previous session (4.12) [source: Tijdschrift report, resistance interpreted].
Don't let resistance turn into a new topic. Name it, then go back to the content it was avoiding [synthesis].

5.3 Overwhelm: anxiety disorganises rather than mobilises

Signs: confusion, dissociation, panic, sharp regression, acting out between sessions, or a crisis.
Response: lower the intensity. Switch from confrontation to clarification and support. Slow down, then return to the focus once the patient has stabilised [synthesis]. Sifneos's principle is that anxiety should stay at a level that serves learning [source: Eppel 2021 on optimal anxiety].
If decompensation persists, the patient probably doesn't meet the criteria. Shift to a supportive or anxiety-suppressive approach. Sifneos contrasted anxiety-provoking with anxiety-suppressive therapy for patients with fewer resources [uncertain: based on his 1967 distinction].
If suicidal ideation or another risk appears, pause the method and carry out a standard risk assessment. Follow usual safety-planning and escalation procedures. STAPP is not designed for patients at acute risk.

5.4 Non-adherence: missed sessions, wanting to stop early

Explore what was being discussed just before the missed session, and interpret the avoidance (4.12).
Revisit the motivation agreed in the contract: "You said you wanted to change X. What's happened to that?" (illustrative) [synthesis].
If the patient has already shown real change, an early wish to stop may be legitimate. Test it with evidence (4.14) rather than assuming it's resistance [synthesis].

5.5 Ruptures: anger at the therapist, feeling attacked by confrontation

Acknowledge the patient's experience of being pushed. Ask directly about the anger and examine it as transference, such as anger at the rival or at a critical parent (4.9) [synthesis].
Separate a technical error from transference. If you were harsh or got the timing wrong, say so plainly, then go back to the focus [synthesis].
Negative transference that persists and dominates is not typical of a well-selected STAPP patient. It may mean characterological pathology the evaluation missed [synthesis, consistent with the selection logic].

5.6 Growing dependence or wish to prolong therapy

Interpret the wish to be looked after as a move away from the oedipal focus and toward pregenital needs, and redirect (4.11) [source: Tijdschrift report, dependency excluded].
Don't add sessions or extra contact. Use the wish as material [synthesis].

5.7 Off-focus material dominates (characterological, pregenital, early loss)

First, redirect (4.11).
If the material keeps taking over, it's likely a selection error. Discuss this openly with the patient. Refer to a different treatment (longer-term dynamic therapy, or a model designed for character pathology) rather than stretching STAPP [synthesis]. Sifneos's own series found failures clustered in patients with abandonment or characterological problems [source: Tijdschrift report].

5.8 Erotised or seductive transference (STAPP-specific)

Oedipal work invites romantic or sexual feelings toward the therapist. Name them early and matter-of-factly, then link them to the focal parent and the current relationship (4.9) [synthesis grounded in the oedipal focus].
Keep strict professional boundaries. Never gratify or play along. Take the material to supervision. If it erodes the frame, consult and consider referral [synthesis; standard ethics].

5.9 Therapist-side problems

Losing nerve: the therapist avoids anxiety-provoking questions out of their own discomfort. Video review helps (4.17).
Interrogation: confrontation becomes hostile cross-examination. Check the tone. The stance is that of a teacher, not a prosecutor [synthesis].
Chasing new problems: extending treatment to pursue issues beyond the focus. Stick to limited goals [source: Barth & Nielsen page].

5.10 Patient produces insight without behavioural change

Move to problem solving (4.13). Ask for a concrete attempt in the next relevant situation and review it in detail. Don't end until tangible evidence of change appears [synthesis based on 4.13–4.14 sources].

5.11 Focus other than oedipal

The 2nd edition widened STAPP's applications to elderly patients and patients with physical symptoms [source: 2nd-ed. preface]. Some summaries mention grief or loss foci [uncertain].
When the focus isn't oedipal, keep the same structure: one agreed focus, active questioning, past–present–transference links. Be stricter about selection [synthesis].

Sources

Sources:

Books and papers cited (full text not drawn on):

Sifneos, P. E. (1972). Short-Term Psychotherapy and Emotional Crisis. Harvard University Press.
Sifneos, P. E. (1979). Short-Term Dynamic Psychotherapy: Evaluation and Technique. Plenum.
Sifneos, P. E. (1987). Short-Term Dynamic Psychotherapy: Evaluation and Technique (2nd ed.). Plenum.
Sifneos, P. E. (1992). Short-Term Anxiety-Provoking Psychotherapy: A Treatment Manual. Basic Books.
Sifneos, P. E. (1975). Criteria for psychotherapeutic outcome; Evaluating the results of short-term anxiety-provoking psychotherapy. Psychotherapy and Psychosomatics (titles only).
Sifneos, P. E. (1985). Problem solving: a technical requirement for anxiety-provoking short-term psychotherapy (German). Psychother Psychosom Med Psychol (title only).

The full texts of the 1987 book and the 1992 manual are not drawn on directly. Step-level detail in section 4 is therefore partly [synthesis].

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