Method

What is ISTDP according to H. Davanloo?

ISTDP is a psychoanalytically oriented method for the treatment of a wide range of psychiatric disturbances, which intensively deals

• with the unconscious anxiety
• feelings
• defense mechanisms
• and the transference relationship to the therapist.

Transference relationship means that processes in the relationship between patient and therapist are made transparent and questioned where necessary.

ISTDP is suitable for the treatment of symptom and character disorders (neuroses) and - with modifications - for the treatment of so-called early disorders, such as borderline personality disorder (BPD).

The aim of the treatment is to help those affected to resolve their symptoms and to improve their conflict resolution strategies in everyday life. The impaired ability to relate in these disorders can be reversed by reducing anxiety and correcting projective distorted perceptions of self and others. Maladaptive self-sabotage patterns should be replaced with goal-directed strategies that serve to maintain long-term mental health.

This goal can be achieved, among other things, through a layered inner reconciliation with those individuals with whom the sufferer has remained disconnected and enmeshed through unconscious anger/unconscious hatred and the associated feelings of guilt. It should be emphasized here that inner forgiveness and reconciliation is a highly emotional process that cannot be accomplished with cognitive processes alone.

For more information on H. Davanloo’s Technique of Total Removal of Resistance and Major Mobilization of the Unconscious, see the following section.

Historical Overview

Habib Davanloo was born in Iran and, after studying medicine there, trained in neurosurgery at Harvard University in the United States before switching to psychiatry.

He underwent training analysis with Helen Deutsch, attended courses with Anna Freud in London, and practiced classical psychoanalysis himself for many years.

In the early 1960s he was appointed to McGill University in Montreal, where he became a professor of psychiatry.

During the same period he began to research the technique of psychoanalysis. The starting point of his research activity was the examination of resistance phenomena in the transference relationship with the therapist. One of the fundamental problems of the classical psychoanalytic technique lies in overcoming superego resistance. The therapist usually reacts to increasing resistance on the part of the patient with increasing passivity. This leads to interminable, unproductive, or difficult-to-terminate analyses. Freud wrote in 1937 in “the finite and the infinite analysis” “in warding off this resistance ‘to healing’ we must confine ourselves to making it conscious and to attempting the slow dismantling of the hostile superego.”

Davanloo subsequently developed more active interventions in working with the patient’s defenses to overcome superego resistance in his research work, meticulously evaluating verbal and non-verbal responses on the video-recordings with his patients.

The correlations between types of interventions, reactions, the duration of the therapies and their effectiveness were astonishing to him and initially led to the development of his system of “Intensive Short-Term Dynamic Psychotherapy” [so-called standard technique].

After proving the effectiveness of this form of therapy, he began publishing his method in the 1970s and presenting it to professionals at congresses in North America and Canada. In 1985 the 1st European audiovisual congress was held in Bad Ragaz, Switzerland (panel: Dr. Davanloo, Dr. David Malan and Dr. A. Benz, Zurich). Regular congresses followed in Europe, mainly in Switzerland, Germany and Italy.

Davanloo initially limited himself to working with predominantly compulsively structured patients, i.e., patients with a relatively healthy unconscious defense structure who have a relatively high ability to withstand inner conflict tension and to keep contents from the unconscious away from the conscious mind. Gradually he extended his work to patients with regressive defense structures up to patients with fragile defense mechanisms who suffer relatively quickly from anxiety overload as is common in “early disorders”.

According to his research over the last 15-20 years, he has come to believe that early disorders are based on the intergenerational transmission of neuroses (transference neuroses), in which the way of feeling and behaving is transferred from the main caregivers, usually the parents to their offspring. The percentage of this type of neuroses in his collective is about 50% in relation to the so-called original neuroses, in which the effective traumatization occurs only after the 4th/5th year of life or later.

Working with and on the unconscious of the patients mobilizes the unconscious of the therapist as well. Unresolved conflicts in the therapist’s unconscious may result in an inability to apply the treatment technique correctly. In working with the unconscious of physicians, Davanloo has concluded that this professional group is itself frequently affected by transference neuroses.

Transference neuroses cannot be adequately treated with the standard technique, which usually consists of a trial therapy session of up to 3 hours followed by weekly sessions, because the defense mechanisms re-form after a breakthrough and the unconscious cannot be sufficiently mobilized in this way.

In order to be able to help patients suffering from this form of neurosis, he developed a technique back in the 1990s, which he then called Block Therapy or Extended Trial Therapy.

Since 2007/2008 he has been offering an “Experiental Closed-Circuit Training Workshop” for professionals, where participants meet with him as a supervisor and teacher about 4-5 times a year for 5-6 days for the purpose of mobilizing the unconscious.

Usually the unconscious of the participants is mobilized by watching and analyzing video recordings from the work with the participants or with patients from his professional practice during 1-2 days, which facilitates the subsequent work on the unconscious in the following days. Colleague A interviews Colleague B with subsequent discussion and analysis of the pre-recorded interview or, depending on the mobilization in the group, several interviews take place in succession before subsequent analysis. In complex situations, Dr. Davanloo himself can intervene.

Through immediate discussion after the sessions, a restructuring is achieved that counteracts immediate renewed displacement.

He calls this technique “H.Davanloo’s Technique of Total Removal of Resistance and Major Mobilization of the Unconscious”.