H. Davanloo’s ISTDP
a very brief history
ISTDP Intensive Short-Term Dynamic Psychotherapy is a unique form of psychodynamic treatment facilitating the rapid resolution of a wide range of emotional disorders. ISTDP was conceived and developed in the 1960s by Dr. Habib Davanloo, Emeritus Professor of psychiatry at McGill University, for purposes of scientific research at Montreal General Hospital and McGill University.
ISTDP was developed to remedy the unacceptable length of treatments of the psyche and their relatively high rate of failure. From the beginning the sessions were audio-visually recorded thus allowing little room for the therapist’s interpretation. The audio-visual recordings allow peer review and analysis ; as importantly, they enable the therapist to witness where he, himself, encounters unconscious difficulties with the patient.
ISTDP is a unique form of treatment
ISTDP treats the dynamic pathogenic core of the human unconscious psyche.
ISTDP interventions are specifically designed to restructure the pathogenic core and subsequent self-sabotaging patterns of behaviour.
With the techniques unique to ISTDP, the patients is rendered un-able to activate his self-defeating system in the course of therapy, i.e. Resistance (Transference Neurosis being a major resistance) and its array of defenses. Resistance in neurotic disorders is the cause of treatment failure : in ISTDP treatment, the therapist methodically helps the patient gain awereness of, own and fight the self-defeating pathological elements of his Unconscious Defensive Organization that want to come into play and defeat the purpose of the therapy by keeping the therapist
at a distance and not letting the patient access his repressed feelings.
Relentlessly, therapist and patient fight together until the path is cleared for the patient to experience the repressed unconscious feelings and impulses that constitute the pathogenic core of his suffering.
Originally, pathological behaviours emerge as the child’s or infant’s coping mechanisms, unconscious adaptive responses to traumatic, insecure, difficult bonds from the significant figures in his life.
These adaptive survival responses allow the child to
maintain the life bond, the necessary nurturing portion of attachment from his significant figures. The responses are structured and fueled by Unconscious Guilt. By repressing them,the Guilt helps the child deal with the feelings of destructive rage generated by the pain and the suffering he experiences in the bond.
Pathogenic Guilt comes into existence as the only way of coping with the suffering while at the same time protecting the nurturing bond that is the source of this suffering.
Thus, the engine of the unconscious pathogenic core and subsequent suffering of the patient in adulthood is the Guilt that had helped him at some point in his distant past.
ISTDP treatment fundamentally
differs from other forms of therapy
on several essential points:
Transference and its interpretation
In ISTDP : One important initial task of the therapist in ISTDP treatment is to defeat unconscious attempts by the patient’s Resistance at reproducing the original core conflicts with the therapist – i.e. developing a Transference Neurosis – and activating the defense mechanisms used to avoid the emergence and experience of repressed feelings attached to these conflicts.
The transference of the infantile conflicts onto the relationship between patient and therapist and the subsequent emergence of a Transference Neurosis is viewed as a major self-defeating, self-sabotaging defense mechanism produced by the Unconscious Resistance of the patient to avoid the experience of destructive painful feelings : Transference Neurosis in treatment acts as a protective shield and decoy, hiding the patient’s original core neurosis from view and allowing it to remain untouched in the course of treatment. The existence of a transference neurosis in therapy results in the therapist treating the Transference Neurosis that was created in the course of therapy whereas the pathological core and the organization of the psyche around the core remain out of reach.
If the patients, as often happens, consults several therapists in the course of his life, the original neurosis becomes cemented under several successive layers of transference neuroses and all the more inaccessible.
The patient’s commitment
In ISTDP : The personal free-willed commitment to the therapy is ascertained in the first session. Then, monitoring the patient’s degree of anxiety in order to maintain it at levels that will allow the patient to keep an active will to work, the therapist helps the patient confront and fight his purpose-defeating unconscious Resistance and defense mechanisms blocking the access to the core of his suffering. Without the patient’s committment to work against the destructive part of himself, no work is possible.
The therapeutical alliance
In ISTDP : The therapist seeks to establish a Therapeutical Alliance with the patient at both conscious and unconscious levels, to enable them to work together at removing the Resistance erected by the dynamic destructive forces of the Guilt at work in the patient’s Unconscious. Therapist and patient deal with the defense mechanisms as they emerge until the patient is finally able to reach the Guilt and the feelings repressed by Guilt.
Audio-visually recorded sessions
In ISTDP : The sessions are audio-visually recorded. Psychoanalytical investigation makes sense and begins only after the Unconscious Resistance of the patient has been activated and removed within the therapeutical relationship, the defenses have been overcome, the doors to the Unconscious unlocked or partially unlocked and repressed feelings experienced.
The therapist’s interventions are based on the neurobiological responses of the patient. Between sessions the therapist views the audiovisual recordings, and by observing the type and timing of the defenses, the patient’s physiological and neurobiological responses, recalibrates and readjusts his interventions. Patient and therapist collaborate in removing the Resistance and unlocking the way to deeply repressed feelings and impulses which lie at the core of the patient’s neurotic suffering.