Intensive short-term dynamic psychotherapy (ISTDP) Flashcards
Learn the key aspects of ISTDP
What are the roots of ISTDP?
Experiencing a forbidden emotion (Freud’s Catharsis & abreaction)
shortening the course of therapy without sacrificing therapeutic effectiveness (Sándor Ferenczi,Franz Alexander, Peter Sifneos,David Malan, and Habib Davanloo).
The Triangle of Conflict (Henry Ezriel)
Attachment theory (John Bowlby)
Who is the main person ?
Habib Davanloo(born October 10, 1927) is an Iranianpsychoanalystand psychiatric researcher and working inMontreal, Quebec, Canada, who developedIntensive short-term dynamic psychotherapy(ISTDP). He was Professor of Psychiatry (now Emeritus) atMcGill University[1][2]and founding editor of theInternational Journal of Intensive Short-term Dynamic Psychotherapy.[3]
What is the main premise of ISTDP?
In the 1960s, while Bowlby was observing children directly, Davanloo was beginning his work with symptomatic and character-disturbed adults. As he began his video-recording work and became progressively successful against higher levels of resistance, he noted that particular themes reappeared with striking consistency in patient after patient
First, the therapist’s efforts to get to know the patient’s true feelings often aroused a simultaneousmixed feeling in the patient, composed of deep appreciation for the therapist’s relentless efforts to get to know the patient deeply, combined with equally deep irritation at the therapist for challenging the patient to abandon long-held resistances which could thwart the therapeutic effort.
Davanloo noted, in concert with Malan’s Triangle of Conflict, that patients would unconsciously resist the therapist’s efforts to get to the root of their difficulties. He also observed, from his videotaped sessions, that patients would simultaneously send off signals of theirunconsciousanxiety. Davanloo carefully monitored these signals of anxiety and saw that they represented the rise of complex mixed feelings with the therapist. The mix represented that part of the patient seeking relief from painful symptoms but also an active desire to avoid painful, repressed feelings.
As Davanloo became more skilled at unlocking the patient’s true unconscious feelings, he noted an often very predictable sequence of feelings. The sequence was by no means invariable, but it occurred frequently enough to allow the therapist to hypothesise its existence in a majority of cases.
First, after a high rise of mixed feeling with the therapist, manifested as signals of intense anxiety (tension in skeletal muscle, often manifested as wringing of the hands, accompanied with deep, sighing respirations), there would often be a breakthrough of rage, accompanied by an immediate drop in anxiety. This rage, Davanloo discovered, is intensely felt. It often has a violent impulse associated with it, sometimes even a murderous impulse. Once patients feel this rage, they are able to describe vividly detailed fantasies of what the rage would do if it were to take on a life of its own.
The rage is a product of thwarted efforts to attach from the past. Those thwarted efforts to love and be loved yield pain, in the form of what Bowlby described as protest. The pain yields a reactive rage at the loved person who thwarted attachment efforts.
Complete experiencing of the rageful impulse is typically accompanied by a tremendous relief at finally getting something out which has yearned for release. However, the relief is typically short lived.
Next, Davanloo almost invariably noted that patients then experience a tremendous wave ofguilt about the rage. The guilt is a product of the fact that the old rageful feelings were with a person who was also loved. It is this guilt, Davanloo discovered, which is the key ingredient in symptom formation and character difficulties. Symptoms and interpersonal difficulties (usually unconscious efforts to ward off intimacy and closeness) are the product of guilt, which turns the rage back on the self. For instance, the rage of a two-year-old toward a mother who dies may be experienced in the present as suicidal feelings (self-directed murderous rage).
Beneath the guilty feelings from the past, Davanloo almost invariably noted painful feelings about thwarted efforts at emotional closeness to parents and others in childhood. Finally, at the deepest layer of feelings are the still powerful yearnings for closeness, attachment, and love.
The goal of the ISTDP therapist is, as rapidly as possible, to help the patient overcome resistance, and then experience all the waves of mixed, genuine feeling, previously unconscious, triggered by the intense therapeutic process. Those feelings are traced back to their origins in the past, and then both therapist and patient come to understand how the patient came to be the “consciously confused, unconsciously driven” person in the present. Old pockets of emotion are drained, the patient has a clearer self-narrative, and self-destructive symptoms and defences are renounced. The understanding gained is not just cognitive, but goes to the fundamental, emotional core. The influence of Freud’s early trauma theory is evident.
When was this therapy developed?
The therapy itself was developed during the 1960s to 1990s
