ABSTRACT
The formulation has been discussed and a contract has been made to undertake a certain number of sessions, after which time the patient and therapist make a combined effort to concentrate on the focus of therapy and work towards the specified goals. In this chapter I discuss the aims of the “middle phase”, the unconscious use of coping styles and their effect on affective expression. I provide an introduction to anxiety, as anxiety is the reason for the development of coping styles and dampening of feelings. I present brief case vignettes to illustrate the therapeutic approach to identifying and exploring coping styles and help the patient understand that they were once adaptive but are no longer so, giving way to troubling symptoms. I help link the manner in which coping styles, such as those of isolation, displacement or avoidance come into play in order to maintain relationships; how these unconscious coping styles may have once helped to maintain the relationship with caregivers; but are, in present circumstances ineffective.
