Intensiv dynamisk korttidsterapi (ISTDP) utvecklades under 1980- och 1990-talet i Kanada. Behandlingsmetoden är specifikt utvecklad för komplexa och kroniska tillstånd där andra behandlingar inte haft önskad effekt, men går även att anpassa till mildare former av psykologiska besvär. Den här kursen lär under tre intensiva dagar ut de teoretiska och praktiska grunderna i metoden.
Intensiv dynamisk korttidsterapi (ISTDP) är en modern psykodynamisk behandlingsmetod som betonar upplevelsebaserat arbete som fokuserar på känslor. Under 2010-talet har metoden etablerats i Sverige, och ISTDP har blivit ett allt vanligare inslag på landets psykolog- och psykoterapeutprogram. Vid Stockholms Universitet och Karolinska Institutet genomförs forskning på metoden som i nuläget erbjuds på ett femtiotal vårdmottagningar i Sverige.
Pre-core
OM KURSEN
Kursen omfattar tre heldagar och ger en grundläggande introduktion till ISTDP. Utöver en teoretisk bakgrund innehåller kursen videobaserad undervisning samt rollspelsövningar där du får möjlighet att utveckla specifika färdigheter i att observera patienter och intervenera utifrån ISTDP-principer. Följande moment ingår:
en introduktion till de grundläggande teoretiska principerna inom ISTDP
praktiska färdigheter för att etablera en god arbetsallians och ett emotionellt präglat fokus för behandlingen
praktiska färdigheter för att bedöma patientens ångestnivå och reglera denna
praktiska färdigheter för att identifiera och hantera försvar och motstånd
Introduktionskursen är ett behörighetskrav för att läsa den treåriga ISTDP-utbildningen Core, om du önskar göra detta senare. Flera coreutbildningar kommer att starta på olika platser i Sverige under 2024, och vi planerar för att starta minst en coreutbildning i Skåne under 2024. Mer information om utbildningar kan du hitta på www.istdpinstitutet.se eller på mci.istdpmalmö.se.
MÅLGRUPP
Kursen riktar sig till psykologer, läkare, socionomer, fysioterapeuter, psykoterapeuter och studenter inom dessa yrken, men vi välkomnar även annan vårdpersonal som kan ha nytta av ISTDP-färdigheter i sitt arbete.
TID OCH PLATS
Kursen kommer att hållas centralt i Malmö 6-8:e maj 2024. Tiderna är 09.00-16.30
LÄRARE
Thomas Hesslow
Kursen hålls av och Thomas Hesslow och Ida Welbourn. Thomas är leg. psykolog och ISTDP-terapeut/lärare/handledare, kliniskt verksam vid Malmö ISTDP-mottagning. Han är en av grundarna till det svenska ISTDP-institutet och Malmö Centrum för ISTDP. Förutom att han håller coreutbildningar så undervisar han även vid Lunds Universitet och Linnéuniversitetet. Han gick coreutbildningen för Tobias Nordqvist och Jon Frederickson, och har regelbunden handledning med Jonathan Entis och Allan Abbass. Thomas har tidigare arbetat med personlighetsproblematik inom psykiatrin, först som DBT-terapeut och senare med Sveriges första ISTDP-team vid öppenvårdsmottagningen i Sundbyberg.
Ida Welbourn
Ida Welbourn är leg psykolog, leg psykoterapeut, specialist i psykologisk behandling samt certifierad ISTDP-terapeut och medgrundare till Malmö ISTDP-mottagning. Hon gick core-utbildningen 2018- 2021 för Nina Klarin, Tobias Nordqvist och Peter Lilliengren samt härefter post-core för Thomas Hesslow. Går 2022-2025 lärar- och handledarutbildningen Training of trainers för Jon Frederickson. Ida har drygt 20 års klinisk erfarenhet, sedan 2016 som psykodynamisk psykoterapeut, parterapeut (EFT) samt familjeterapeut (ABFT) och har tidigare arbetat som psykolog med utredning och behandling inom barn- och ungdomspsykiatrin (BUP), barnhälsovård, vuxenhabilitering samt inom skola/förskola med konsultation, handledning och fortbildning.
KOSTNAD
Kursen kostar 5000 SEK exkl. moms. Heltidsstudenter betalar 3500 SEK exkl. moms. Då ingår undervisning, kursmaterial och fika under de tre dagarna.
KURSARRANGÖR
Kursen arrangeras av Malmö Centrum för ISTDP i samarbete med ISTDP-institutet, ett nätverk för ISTDP-utbildning i Sverige (www.istdpinstitutet.se).
Malmö Centrum för ISTDP erbjuder sedan hösten 2021 en postcorekurs för terapeuter som avslutat den treåriga coreutbildningen. Våren 2024 drar vi igång en ny omgång. Vi ses varannan månad för två heldagar under hela 2024, sammanlagt 10 dagar, plus en eftermiddag med Jonathan Entis. Förutom att deltagarna tar med sig inspelningar att bli handledda på till varje tillfälle så kommer kursläraren att visa film och föreläsa om olika aspekter av ISTDP.
TEMAN
Tredje generationen ISTDP. Mycket håller på att förändras inom ISTDP i och med att den tredje generationen ISTDP-lärare nu håller utbildningar och sprider ISTDP i världen. Den här kursen kommer att diskutera några aktuella trender inom den globala ISTDP-gemenskapen som hänger samman med att den tredje generationen nu kliver fram. Några av dessa teman är: psykoanalytiska perspektiv på ISTDP, för- och nackdelar med radikal self-disclosure, Davanloos renässans och psykedelisk ISTDP.
Motstånd.Patienter med högt motstånd och högre grader av syntonicitet kräver att vi som terapeuter kan intervenera med hög precision och uthållighet. Vi behöver kunna ifrågasätta motståndet och samtidigt acceptera att patienten har all rätt att hålla kvar vid det – vi behöver acceptera eller kanske till och med älska motståndet. Kursen kommer dessutom att lära ut några av grunderna i Jonathan Entis sätt att arbeta med motstånd på, vilket bland annat betonar arbete med de taktiska aspekterna av motståndet, samt ett reducerat användande av “pressure to feeling”.
Terapeuten som person. Vilka inre hinder har du som terapeut för att kontinuerligt sätta press på motståndets framsida parallellt med att du bjuder in till ett positivt samarbete?
OM LÄRARNA
Thomas Hesslow
Huvudlärare är Thomas Hesslow. Thomas är leg. psykolog och ISTDP-terapeut/lärare/handledare, kliniskt verksam vid Malmö ISTDP-mottagning. Han är en av grundarna till det svenska ISTDP-institutet och Malmö Centrum för ISTDP. Förutom att han håller coreutbildningar så undervisar han även vid Lunds Universitet och Linnéuniversitetet. Han har lärt sig ISTDP av Jon Frederickson, Tobias Nordqvist, Allan Abbass, Ange Cooper, Peter Lilliengren och Jonathan Entis. Han är chefredaktör för Journal of Contemporary ISTDP. Under 2024 ger Thomas ut en bok om ISTDP, Intensiv Dynamisk Korttidsterapi – en introduktion.
Jonathan Entis
Gästlärare är Jonathan Entis. Jonathan är legitimerad psykolog (PhD) med privat mottagning i Cambridge, Massachusetts. Han är verksam som lärare vid Harvard Medical School, där han de senaste fem åren har undervisat och handlett inom ISTDP. Jonathan leder ett antal internationella online-utbildningsgrupper inom ISTDP och håller även en postcore tillsammans med John Rathauser i Amsterdam. Han är medförfattare tillsammans med John Rathauser och Mikkel Reher-Langberg till den kommande boken “Fundamentals of Davanloo’s Intensive Short-Term Dynamic Psychotherapy, Volume I.”. Här är en intervju med Jonathan: intervju.
PRAKTISK INFORMATION
Målgrupp: Kursen riktar sig till kliniskt verksamma personer som har genomgått den treåriga ISTDP-utbildningen Core, och som är sugna på att fortsätta utvecklas i grupp. Vi kommer att ses i en grupp om 7-8 personer.
Tid och dag: Kursen består av fem tvådagarsmoduler på plats i Malmö plus en eftermiddag på Zoom. Tvådagarsmodulerna kommer att ske 9.00-17.00. Kursen sker på följande dagar:
modul 1 – 8-9:e februari
Eftermiddag med Jonathan – 15:e mars kl 14-17.
modul 2 – 4-5:e april
modul 3 – 7-8:e juni med Thomas och Jonathan (detta är ett öppet evenemang, se mer info här)
modul 4 – 5-6:e september
modul 5 – 7-8:e november
Schema: Varje handledningstimme innehåller 50 minuter handledning och 10 minuter diskussion i grupp. Schemat för modul 1,2,4 och 5 är som följer.
Dag 1 föreläsning 9-12, lunch, handledning 13-16.30, forum/grupptid 16.30-17
Dag 2 handledning 9-12, lunch, handledning 13-16.30, forum/grupptid 16.30-17
Schema för modul 3 kommer senare.
Plats: Platsen är Malmö ISTDP-mottagning, Amiralsgatan 20, Malmö. Eftermiddagen med Jonathan sker på Zoom.
Kostnad: Deltagande kostar 5000 kr per modul exkl moms, förutom modul 3 som kostar 3500 kr exkl moms. Eftermiddagen med Jonathan kostar 1500 kr exkl moms. Sammanlagt kostar kursen 25000 kr exkl moms.
Anmälan och frågor: Skicka ett mail till Thomas Hesslow (thomas.hesslow@gmail.com) där du anger namn, fakturaadress, utbildning och arbetsplats. Ange också för vem och när du läste Coreutbildningen.
We at the Malmö Center for ISTDP are thrilled to welcome Jonathan Entis back to Malmö, this time during early summer 2024. He’ll be coming here for a 2-day conference focusing on managing resistance in ISTDP.
Jonathan Entis
In the era of evidence-based medicine, despite great efforts, the health care system fails to help many depressed and anxious patients. A recurring research finding is that about two thirds of patients in psychiatric care and one third of patients in primary care get no relief from treatment, even when being offered the gold standard treatment alternatives currently available. From the perspective of Intensive Short-term Dynamic Psychotherapy (ISTDP), much of this nonresponse is caused by multiple unaddressed ways of avoiding and/or resisting emotional closeness in the therapy situation.
ISTDP was developed during the 1970s and 1980s by Habib Davanloo in Montreal, Canada. He invented a number of novel strategies aimed at reaching the most highly defended patients, the ones who at the time were considered impossible to treat. Spending a lot of time watching his own recordings of therapy sessions, he tested and refined specific strategies of helping his patients see, understand and let go of highly entrenched defenses, especially when those were linked to the patient’s identity (eg. highly syntonic).
Today, ISTDP is one of the most studied forms of psychodynamic psychotherapy, with 38 randomized controlled trials published thus far (81 if you include studies using the broader EDT term). ISTDP has empirical support for treating depressive disorders, somatic symptom disorders, personality disorders and anxiety disorders. ISTDP does well when compared to other treatments, and there is some evidence that ISTDP and similar models are more effective than comparison therapies in the treatment of functional somatic disorders (i.e. fibromyalgia, pain, IBS etc.)
In this conference, Jonathan Entis and Thomas Hesslow will showcase work on different aspects of managing resistance within the ISTDP model. Emphasis will be put on the following aspects of resistance work:
– The conscious therapeutic alliance. Keeping the work transparent and explicit. – Mapping the resistance. Getting to know the different parts of the resistance. – Exhausting the resistance. Recognizing the signs that resistance is exhausted. – Compliance and defiance dynamics. Clarifying the intertwined needs for dependence and autonomy. – Head-on colliding. Managing the tension between change and acceptance.
We think this will be two great days of learning for both newcomers to ISTDP as well as the advanced ISTDP clinician. On both days, the focus will be on watching videos from real cases and providing different perspectives on these. On Day one, Jonathan will present and Thomas will be the discussant. On Day two, Thomas will present a case in the morning, and in the afternoon Jonathan will provide supervision to three participants.
BIO
Jonathan Entis, Ph.D., is a licensed psychologist in private practice in Cambridge, Massachusetts. He is on the faculty of Harvard Medical School, where for the past five years he has taught and supervised in ISTDP. He is an IEDTA-certified teacher in ISTDP and has presented both nationally and internationally. Jonathan leads a number of international online training groups in Davanloo’s ISTDP, and is co-leading an advanced Core Training in Amsterdam with John Rathauser. He is also a co-author with John Rathauser and Mikkel Reher-Langberg on the upcoming book, Fundamentals of Davanloo’s Intensive Short-Term Dynamic Psychotherapy, Volume I. You can contact him at drjonathanentis@gmail.com. Here you can read an interview with Jonathan.
Thomas Hesslow
Thomas Hesslow is a clinical psychologist and ISTDP therapist. He’s one of the founders of the Swedish ISTDP Institute and Malmö Center for ISTDP. He provides ISTDP therapy, supervision and training in Malmö in southern Sweden. He was trained by Tobias Nordqvist, Jon Frederickson, Allan Abbass, Peter Lilliengren, Ange Cooper and others. He teaches at Lund and Linneaus Universities, and regularly offers core training in Sweden. He’s the editor-in-chief of the Journal of Contemporary ISTDP.
ATTENDANCE
The workshop is open to licensed healthcare professionals and therapists in good standing, as well as students within these fields.
DATE AND TIME
June 7-8th. Times are roughly 9.00-17.00. At the end of the first day, there will be a social event.
LOCATION
The event will take place in central Malmö in southern Sweden. You can get to Malmö conveniently by flying to Copenhagen Airport, and then taking a 20 minute train from there. The venue will be confirmed at a later point.
Please note that online attendance is not possible for this event.
Malmö
TICKETS
Early bird ticket: $375 (members get a discount) Standard ticket: $450 (members get a discount) Day 1 ticket: $250 Day 2 ticket: $250
The early bird two-day ticket is available until 2024-01-31. Members of the Swedish/Danish ISTDP Societies get a 10% discount on all prices (use the campaign code “member” when you buy the ticket). Full time students get a 20% discount (use the campaign code “fulltimestudent“).
You can buy early bird tickets by following this link. Other tickets will be released at a later stage.
MORE INFO
At the end of the first day, there will be a social event.
There are three spots for supervision on day 2. If you’re interested in being supervised, send an email to Thomas after having bought a ticket. Priority will be given to participants who are in core/post-core training.
How do problems of will show up during the opening phase of a therapy? How do will problems manifest in the transference resistance? How do they invite enactments leading to treatment impasse? In what ways might standard ISTDP interventions enact and thus reinforce the transference?
These and other questions will be addressed as we have the great pleasure to welcome none other than Jon Frederickson to the Malmö Center for ISTDP this fall. During the evening, we will look at the opening of a consultation with a person whose transference resistance had led to repeated enactments of the transference in previous therapies.
Details
Date: November 7th
Time: 18.00-20.30
Price: The cost is 600 SEK (Inc. VAT), this includes a sandwich at about 19. Student price is 400 SEK (inc. VAT).
Location: Malmö Center for ISTDP, Amiralsgatan 20, Malmö, Sweden.
Audience: This presentation is open for healthcare professionals and students in these professions. Due to confidentiality agreements, the presentation is only open to residents in the nordic countries.
Tickets: You can buy tickets here: tickets. If you’re a full time student, you can enter the promotion code “student” to get a student discount.
Niklas Rasmussen, leg. psykolog, är ISTDP-terapeut och -lärare. Till vardags arbetar han vid ISTDP-mottagningen Stockholm vid Mariatorget med terapier, handledning och undervisning. Han har tidigare arbetat många år med behandlingsrefraktära patienter och har ett stort intresse för psykiatrisk problematik. Han är en av organisatörerna bakom ISTDP-dagarna som Svenska ISTDP-föreningen arrangerar i september 2023. I den här intervjun pratar vi med Niklas bland annat om hans idéer kring arbete med terapeuters motöverföring och den bok som han håller på att skriva om detta.
Jag föreställer mig att du är mitt uppe i organiserandet av ISTDP-dagarna. Hur känns det? Det känns som att vi gör något viktigt för ISTDP-intresserade i Sverige. Ambitionen är att visa på den otroliga bredd som nu finns inom svensk ISTDP – ett helt gäng terapeuter har arbetat så pass länge med metoden att de utvecklat egna intressanta tankar om metoden.
På ISTDP-dagarna kommer vi visa att vi har expertis på hemmaplan genom att ha en stor bredd bland föreläsarna och paneldeltagarna. Dessutom föreläser två internationellt kända ISTDP-terapeuter: Monica Urru (Italien) och Dion Nowoweiski (Australien). Föreläsningarna kommer varvas med paneldiskussioner kring terapeututveckling och psykoterapiforskning.
Niklas Rasmussen
Är det någon särskild presentation som du ser fram emot extra mycket? Det blir första gången för mig att se både Monica och Dion så det ser jag mycket fram emot! Är också mycket nyfiken på vad min mottagningskollega Sandra Ringarp har att säga på temat ”Att hitta sin egen röst i ISTDP”. Den rubriken fångar in något som alla som fördjupar sig i en terapimetod behöver förhålla sig till: risken att tappa bort sig själv som terapeut och istället upptas av tankar om behandlingsprinciper och teoretiska begrepp.
Efter femton år lämnade du psykiatrin för några år sedan och öppnade sedan privatpraktik. Vad tycker du om det? Saknar du de komplexa patienterna? Jag saknar att vara där min kompetens behövs som allra mest, alltså inom offentlig vård. Jag la ner min själ i att arbeta inom psykiatrin och jag höll ut längre än många av mina kollegor. Jag kan sakna att arbeta med patienter med allvarligt sjuka patienter. Dock erbjuder de patienter jag träffar i min privata praktik i högsta grad utmaningar för mig som terapeut. Så jag har aldrig tråkigt på jobbet.
Du ska föreläsa i höst, och skriver också en bok, om hur terapeuter kan använda sina känslor som guide i mötet med patienterna. Vad är bakgrunden till att du ska göra det? I den ISTDP-handledning jag har fått själv och i den jag själv ger har terapeutens känslomässiga reaktioner alltid haft en central roll. Men vad jag vet har ingen skrivit särskilt utförligt om terapeutens känslor ur ett ISTDP-perspektiv. Det säger sig självt att en terapeut som inte förmår uppmärksamma och reglera sin ångest, eller hanterar sina känslor mot patienter med försvar som självattack eller utagerande kommer få problem att både hjälpa sina patienter och orka med sitt arbete. Det finns hur mycket som helst att skriva om på det här temat.
Handlar det här om att ISTDP behöver förändras på något sätt, eller hur tänker du? Har vi nedvärderat arbete med motöverföringen? Jag har som sagt fått mycket hjälp med min motöverföring av mina ISTDP-handledare – mer än i all annan handledning som jag fått tidigare. Samtidigt uppfattar jag att ISTDP-kulturen präglas av idealet att ISTDP-terapeuter ska ha väldigt bra koll på sina egna inre konflikter och att vi ska sträva efter att höja vår affekttolerans så mycket som möjligt. Det finns mycket positivt i det… men det kan lätt slå över i något idealistiskt och överjagsstyrt.
Med min bok vill jag bidra till en bredare förståelse av terapeuten. Vem är terapeuten? Vi terapeuter behöver till exempel värna om vår självacceptans och vår självomsorg så att vi kan bära oss själva, även i situationer då vi upplever vårt inre som ett kaos. Det är ju inte helt ovanligt att uppleva det så, till exempel i mötet med allvarligt sköra patienter. Om vi tappar vår självacceptans kommer vi ofrånkomligen fastna i vårt motstånd på ett sätt som missgynnar både oss och våra patienter.
Så tror du över tid att ISTDP kommer att förändras i sin essens som en del i detta arbetet som du och andra nu gör med att uppmärksamma terapeuten som person, terapeutens känslor och så vidare? Eller här är ett annat sätt att ställa samma fråga: behöver grundböckerna i ISTDP förändras, eller ska man snarare tänka detta som något som läggs till ovanpå det gamla? Det är ju väldigt svårt att fånga in vad ISTDP är i sin “essens”. Vi har att förhålla oss till muntliga och skriftliga källor. Och jag tycker att de grundböcker som fått störst genomslagskraft inte lyfter fram vikten av att terapeuter uppmärksammar egna reaktioner (känslor, ångest, försvar, motstånd) i relation till sina patienter. Personligen uppfattar jag detta som ett komplement, som att ”fylla i en lucka” i ISTDP-litteraturen. Men vem vet, det kanske är något som utmanar mer grundläggande principer i ISTDP. Det får framtiden utvisa.
Min erfarenhet sedan jag öppnade privat mottagning har definitivt varit att det känslomässigt är ett helt annat register som aktiveras i relation till mer högfungerande patienter, jämfört med psykiatrins mer sköra patientgrupp. Vad är din erfarenhet av ditt känsloliv sedan du bytte jobb, känns det annorlunda att sitta ner med patienterna nu? Det är utan tvekan så att personer som söker terapi privat ofta har en problematik präglad av högt motstånd. För mig innebär det att jag får möta mycket känslomässig smärta och frustration kopplat till mina egna erfarenheter av att bli avvisad och längta efter närhet – patienterna undviker ju känslomässigt kontakt genom sitt motstånd och detta blir, i symbolisk mening, ett avvisande av mig som person. Många som jag träffar i terapi kämpar med en upplevelse av plågsam känslomässig distans i sina relationer och det är sorgligt för mig att höra på ett personligt plan eftersom jag känner igen mig i det.
Överlag har jag mer utrymme att uppmärksamma mina känslomässiga reaktioner nu när jag har större kontroll över min arbetssituation. Arbetsförhållandena i psykiatrin krävde en slags funktionell känslomässig distans. Det blev ett sätt att orka.
Vad är det största som du brottas med som terapeut just nu? För något år sedan ägnade jag mig mycket åt uppmärksamma medgörlighet (compliance) hos mina patienter. Det var en tydlig blind fläck för mig och det krävdes mycket reflektion och handledning för att belysa den och kunna arbeta med denna del av motståndet.
Just nu upptas mina tankar mycket av karaktärsförsvar: att ignorera, förminska, bagatellisera och ”prata över” sina känslor och sin ångest. För patienter med hög ångest är detta nästan alltid en vidmakthållande faktor. Det finns en enorm potential i att se och arbeta med dessa försvar och jag märker att både jag och många som jag handleder tenderar att missa det, eller åtminstone underskatta hur syntona sådana karaktärsförsvar kan vara. Här finns också en spännande motöverföringskomponent: patienten ignorerar konsekvent betydelsen av sitt inre liv och terapeutens motöverföring riskerar att präglas av det. Detta kan leda till att även terapeuten omedvetet börjar ignorera patientens inre liv.
På vilket sätt kan detta ta sig uttryck med patienterna för dig? Alltså att du också ignorerar patienternas inre? Jag skulle uttrycka det som att jag som terapeut får samma ”blinda fläck” som patienten. Det handlar om att se vidden av vissa patienters bristande intresse för och omsorg om sitt eget inre liv och förstå konsekvenserna av det. Jag tycker att detta behöver vara en del av alliansbyggande i högre utsträckning: att kolla av med patienten om hen bryr sig om sitt inre, tar sitt inre på allvar och verkligen vill sig själv väl.
Allt detta är så fundamentalt för att en terapi ska bli genuint hjälpsam och det kan krävas mycket arbete att etablera genuin självomsorg hos en patient. Om det inte görs fastnar både terapeut och patient i att ”låtsas” som att patienten bryr sig som sig själv, alltså en sorts brist i alliansen. Konsekvensen blir att patientens ångest förblir oreglerad och genuin känslobearbetning uteblir.
Var skulle du vilja att ISTDP tar vägen de kommande 5-10 åren, vad är din vision? I Sverige finns det nu många med expertkunskaper inom metoden. Vi som har dessa kunskaper behöver nu röra oss mot ökad mognad och visdom: ökad öppenhet, minskad prestige, ödmjukhet inför allt vi inte vet, intresse för mångfald och komplexitet, mindre idealisering. Tänk om vi till och med skulle röra oss mot mer integrering mellan ISTDP och andra affektfokuserade terapimetoder!
Det finns en irrationell beröringsskräck mellan t ex AEDP, AFT och ISTDP. Metoderna betonar olika, viktiga aspekter av det terapeutiska arbetet och ISTDP som metod skulle må bra av att sätta värde på det. En genomtänkt och vitaliserande integrering inom det affektfokuserade fältet, det är min framtidsvision för ISTDP.
Hur tror du att man skulle kunna få till det? Vi behöver vara aktiva i vår strävan efter integrering och vara medvetna om att det är något som kommer ta lång tid. Vi får inte ge upp så fort det blir dåligt stämning. Strävan måste vara vitalisering snarare än urvattning.
Rent konkret tror jag på att dialog mellan företrädare för de olika affektfokuserade metoderna där vi tar fasta på det bästa i våra respektiva metoder. Sedan kan detta sippra ner i hur vi undervisar och handleder. Kanske kan det bli en panel på det temat på ISTDP-dagarna 2024!
Om du gillade den här intervjun så kanske du kan vara intresserad av den långa intervju vi gjorde med Ange Cooper om hennes process av att integrera ISTDP med sin personlighet. Du hittar den här. Annars så kan du hitta våra fyra senaste intervjuer här:
Senvåren 2023 startar en ny omgång av den treåriga core-utbildningen i Malmö med Hanna Radomski och Christina Aune som huvudlärare. Vi kommer även bjuda in gästlärare. Kursgruppen träffas fyra gånger om året under tre dagar för teoretisk undervisning, rollspel och handledning utifrån videoinspelade terapisessioner. Utbildningen arrangeras vid Malmö Center för ISTDP i samarbete med ISTDP-institutet.
Utbildningens innehåll
Coreutbildningen är utvecklad av Jon Frederickson vid Washington School of Psychiatry. Utbildningsgruppen träffas vid fyra tredagarsmoduler per år under tre års tid, alltså sammanlagt 36 heldagar. Varje modul har ett unikt tema och innehåller teori, teknik, videoobservation, färdighetsträning/rollspelande och handledning utifrån kursdeltagarens egna terapivideofilmer. Stor tonvikt läggs vid att skapa ett gott, medkännande samarbetsklimat inom gruppen. Gruppen kommer bestå av ca åtta deltagare.
Mellan varje tredagarsmodul förväntas varje kursdeltagare arbeta med psykoterapeutiska arbetsuppgifter och förbereda sig inför kommande modul genom att läsa kurslitteratur samt titta på sina terapifilmer från eget patientarbete. I kursen ingår även ISTDP-handledning om minst en timme mellan varje modul (face-to-face eller via zoom).
Under det första året ligger fokus i utbildningen på att etablera ett effektivt terapeutiskt samarbete med olika typer av patienter. Under det andra året är fokus att utveckla färdigheter och känslomässig kapacitet för att arbeta med det “graderade formatet” av ISTDP, dvs. de tekniker som används vid arbete med patienter med högre ångestnivå och lägre affekttolerans. Under det tredje och sista året ligger fokus på att lära sig aktivt arbete med patienter med högt motstånd i terapirummet.
Under kursen kommer du att succesivt förbättra dina terapeutiska färdigheter i att bedöma och arbeta med olika patienter utifrån deras unika sätt att relatera. Förutom att Core ger en teoretisk förståelse för ISTDP så genomsyras utbildningen av ett fokus på det praktiska psykoterapeutiska hantverket. En del av utbildningen inriktas på att öka terapeutens känslomässiga kapacitet, så att inte terapeutens eget undvikande eller blinda fläckar kommer i vägen för ett effektivt terapeutiskt fokus. Syftet med att olika gästlärare kommer för att visa sitt sätt att arbeta är också att ge dig som deltagare en bredd, att tydliggöra att ISTDP kan bedrivas på olika sätt och förhoppningsvis hjälpa dig att hitta din egen stil som ISTDP-terapeut.
Lärare
Hanna Radomski Hanna är leg. psykoterapeut och certifierad ISTDP-terapeut. Hanna läser lärar/handledarutbildning i ISTDP under ledning av Jon Frederickson. Hanna gick sin coreutbildning för Nina Klarin, Peter Lilliengren och Tobias Nordqvist och har efter avslutad utbildning maj 2021 fortsatt ha regelbunden handledning med Peter Lilliengren, Glenn Kristoffersson och Thomas Hesslow. Hanna är styrelsemedlem i den svenska föreningen för ISTDP. Hanna arbetar med patienter både i privat regi, och som ackrediterad psykoterapeut inom Region Skånes vårdval Psykoterapi, samt med handledning i ISTDP. Sedan tidigare har Hanna lång erfarenhet av arbete på späd- och småbarnspsykiatrin med föräldrar med psykisk ohälsa och anknytningssvårigheter mellan föräldrar och barn.
Christina Aune Christina Aune är legitimerad psykolog sedan 2003 och certifierad ISTDP-terapeut. Hon gick Core-utbildningen 2018-2021 med Nina Klarin, Peter Lilliengren och Tobias Nordqvist som lärare och har sedan dess haft kontinuerlig handledning med Peter Lilliengren och Thomas Hesslow. Sedan hösten 2020 har Christina gått Post-core för Thomas Hesslow. Christina arbetar privat vid Malmö ISTDP- mottagning och har sedan tidigare många års erfarenhet av arbete inom primärvården samt barn- och ungdomspsykiatri. Mellan 2022-2025 går hon Training of trainers med Jon Frederickson.
Behörighetskrav
Vårdlegitimation (psykolog, kurator, läkare eller psykoterapeut)
Genomgången introduktionsutbildning inom ISTDP (pre-core)
Möjlighet att kunna arbeta med psykoterapeutiska arbetsuppgifter under minst två dagar per vecka under utbildningens gång
Examinationskriterier
För att erhålla ISTDP-institutets certifiering som ISTDP-terapeut krävs närvaro vid samtliga moduler samt att deltagaren erhåller handledning på minst tio av sina terapisamtal under utbildningens gång.
Modul 1: Augusti/September 2023, Modul 2: November 2023
Kostnad
7800 kr per modul exkl moms. Detta inkluderar priset för modulen, samt en handledningstimme mellan varje modul (10 tillfällen). Sammanlagd kostnad för hela utbildningen är 93600 kr exkl moms.
Plats
Malmö ISTDP-mottagning, Amiralsgatan 20 i Malmö.
Anmälan
Skicka ett mail till kontakt@hannaradomski.se. Ange namn, fakturaadress, yrkestillhörighet och arbetsplats. Anmälan är bindande från och med två månader före den första kursdagen. Man binder sig till första året med ambitionen att fullfölja hela utbildningen. Inför fjärde modulen binder man sig till de resterande två åren.
Frågor
Om du har frågor kan du vända dig till kontakt@hannaradomski.se
Du kan ladda ner den här informationen som utskriftsvänlig PDF här:
We at the Malmö Center for ISTDP (MCI), together with the Swedish and Danish societies for ISTDP, are thrilled to host this 2-day workshop during spring 2023, focusing on managing resistance in ISTDP. This will be the third event in the event series Return to Davanloo that we’re organizing at the MCI.
Jonathan Entis
In the era of evidence-based medicine, despite great efforts, the health care system fails to help many depressed and anxious patients. A recurring research finding is that about two thirds of patients in psychiatric care and one third of patients in primary care get no relief from treatment, even when being offered the gold standard treatment alternatives currently available. From the perspective of Intensive Short-term Dynamic Psychotherapy (ISTDP), much of this nonresponse is caused by multiple unaddressed ways of avoiding and/or resisting emotional closeness in the therapy situation.
ISTDP was developed during the late 1970s and 1980s by Habib Davanloo in Montreal, Canada. Davanloo developed a number of novel strategies aimed at reaching the most highly defended patients, the ones who at the time were considered impossible to treat. Spending a lot of time watching his own recordings of therapy sessions, he tested and refined specific strategies of helping his patients see, understand and let go of highly entrenched defensive strategies, especially when those were linked to the patient’s identity (eg. highly syntonic).
With a growing evidence-base to support Davanloo’s findings, ISTDP has been successfully established in northern Europe in the last decade. More than 600 therapists have gone through the three-year ISTDP core training in the nordic countries alone in this brief period of time. Dr. Entis strives to revive certain parts of Davanloo’s teachings that are not emphasized in the branch of ISTDP currently taught in the nordic countries. He represents a slightly different flavour of ISTDP, with a similar but different way of approaching the resistance which includes a bigger emphasis on tactical defenses. Here you can read an interview with Jonathan that we did last year.
We think this will be two great days of learning for both newcomers to ISTDP as well as the advanced ISTDP clinician. On Day One, Jonathan will present didactic presentations with audiovisual presentations of actual therapy sessions with patients across a range of psychodiagnosis. On Day Two, live supervision will be offered to attendees who wish to have their work supervised in front of the group.
Here’s what Jonathan wants to say about the workshop:
In developing ISTDP, Davanloo created a revolutionary system for gaining access into the unconscious and resolving psychological suffering. He advocated for a therapeutic focus on turning patients against their own avoidance mechanisms, or resistance, and towards an embrace of emotional honesty.
Dr. Davanloo’s system, although highly effective, is incredibly difficult to master. No aspect of the model is more arduous to learn than the effective management of resistance, which rests on the therapist’s ability to maintain a positive alliance while relentlessly addressing the patient’s defenses.
In my view, some current iterations of ISTDP underemphasize this work on resistance, which might lead to the student of ISTDP putting premature pressure on the patient to experience feelings that are not within conscious reach. This can cause iatrogenic anger, misalliance, and all too often, impasse. In this 2-day workshop, I will showcase how to work exhaustively with resistance while maintaining a strong alliance.
I will highlight many of the technical elements necessary to help patients overcome their resistance, including confronting the tactical organization of the resistance, determination of syntonicity levels and how to adapt the approach accordingly, and the use of head-on collisions—the most challenging of all interventions to integrate.
Bio
Jonathan Entis, Ph.D., is a licensed psychologist in private practice in Cambridge, Massachusetts. He is licensed in both Massachusetts and New York. He is on the faculty of Harvard Medical School, where for the past four years he has taught and supervised in ISTDP. He is an IEDTA-certified teacher in ISTDP and has presented both nationally and internationally. He co-leads an annual seminar on working with syntonic defenses in Davanloo’s ISTDP with John Rathauser, PhD. Jonathan leads four international monthly online training groups in Davanloo’s ISTDP, and will co-lead an advanced Core Training in Amsterdam with John Rathauser beginning in early 2023. He is also a co-author with John Rathauser and Mikkel Reher-Langberg on the upcoming book, Fundamentals of Davanloo’s Intensive Short-Term Dynamic Psychotherapy, Volume I. You can contact him at drjonathanentis@gmail.com.
Attendance
The workshop is open to licensed healthcare professionals and therapists in good standing, as well as students within these fields.
The supervision hours are offered on a first come, first served basis. If you’re interested, make sure to buy a ticket as soon as possible and specify in the form that you’re interested in receiving supervision.
Date and time
April 20: presentation day
April 21: supervision day
Times are roughly 9.00-17.00. At the end of the first day, there will drinks served at the Malmö Center for ISTDP.
LOCATION
The event will take place in central Malmö in southern Sweden. You can get to Malmö conveniently by flying to Copenhagen Airport, and then taking a 15 minute train from there. The venue will be confirmed at a later point.
Please note that online attendance is not possible for this event.
Malmö
Tickets
Early bird full ticket for both days (applicable before February 2023, $350) Full ticket for both days ($400) Day 1 only ticket ($200) Day 2 only ticket ($200)
Members of the Swedish and Danish societies of ISTDP get a discount: Early bird full ticket for both days (applicable before February 2023, $300) Full ticket for both days ($350) Day 1 only ticket ($175) Day 2 only ticket ($175)
Registration
Please use this form to register: form. After filling out the form, we will contact you with information about how to proceed with the payment.
More info
At the end of the first day, there will be a reception with drinks.
Return to Davanloo is a series of seminars at the Malmö Center for ISTDP emphasizing the roots of ISTDP in different ways. The first in the series was the Mikkel Reher-Langberg seminar in may 2022 on Davanloo’s development. The second seminar was the Allan Abbass seminar on Idealization and devaluation of ISTDP in november 2022. This will be the third seminar in the series.
We say return to Davanloo not in the sense of uncovering the true Davanloo, but rather in the sense of keeping Davanloo alive in the 21st century. Reading and drawing inspiration from Davanloo with the lens of the problems that we face as therapists today. We believe that for ISTDP to grow strong it needs a strong foundation in the Davanludian roots, at the same time as it allows for branches to unfold in many different directions.
Maury Joseph is a licensed clinical psychologist and ISTDP clinician based in Pennsylvania. Before relocating his practice, he served as the faculty chair of the ISTDP program at the esteemed Washington School of Psychiatry. In recent years, Maury has been at the helm of two fascinating seminars, one focused on psychoanalytic listening and the other on interpersonal/relational psychoanalysis. In this interview, we explore the concept of a “relational turn” in ISTDP and what it could mean for the field.Please note that this is a long read.
Maury Joseph
Thomas: What are you excited about right now?
Maury: I am very excited about this chance you’ve given me to share some ideas that 11 years of study of ISTDP and psychoanalysis have impregnated my mind with. I haven’t put pen to paper on any of the ideas I’ve been working over in the past few years regarding a “relational turn in ISTDP”, so you’ve given me a great challenge and opportunity here. That said, I am also quite nervous about it.
Relational ideas are inherently critical, highlighting and interrogating our biases and preconceptions. If I look at the history of psychoanalysis as a reference, those who bring forth questions that challenge emotionally invested, mainstream ideas tend not to make many friends in the process.
So this is a challenging thing for me—on the one hand loving ISTDP, wishing to conserve and develop Davanloo’s contribution, loving my friends and teachers in this community, and, fundamentally, as a person, wanting more than anything to be liked; and on the other hand, having ideas that might press against and challenge what I conceive of as unexamined group-level assumptions, a practice that has not been known to generate only fond feelings. So I am excited to share these ideas, but also in prayer regarding their reception.
Relational psychoanalysis
For the past years, you’ve been leading a reading group focusing on relational psychoanalysis. For the reader who is not familiar with this branch of psychoanalysis, what are the central principles of relational psychoanalysis? Relational psychoanalysis is a big tent with a long history, but I’ll summarize what stands out as important to me and what I think might be useful to ISTDP readers. It will inevitably be a biased sample! I recommend some study of authors within the interpersonal/relational tradition to all your readers so they can form their own impressions and see how they compare to mine. Anyone looking for an introductory syllabus, or who might like to hop into one of my reading groups, is welcome to contact me.
For me, relationality is about recognizing and understanding how the therapist’s subjectivity, their history, unconscious biases, preconceptions, theories, neuroses etc., influence the therapeutic process; how the therapist’s mind is in concert with the patient’s mind in shaping the therapy, both the new, maturational experiences and the repetitive, stagnating ones. This is in contrast to other perspectives that see the therapist as more like an objective observer of, and non-participant in intrapsychically-mediated processes unfolding spontaneously and organically from the within patient, unimpacted by the therapist’s unique person.
Relational thinkers give special attention to unconscious enactment—how the patient’s and therapist’s minds conspire to unconsciously live out interpersonal dynamics that turn out to have meaning to both of them. They suggest this is an inevitable, necessary, and ultimately helpful aspect of therapy, part of the therapeutic action.
A relationalist would not aspire to some kind of perfect technique, but would instead value and strive for reflection and conversation about the imperfect human mess that is happening, and for fastidious observation of their participation in it. For this reason, therapeutic success in a relational conception will usually require maturation and growth for both participants; both will become more conscious of their unconscious needs and patterns. This is in contrast to the notion of the therapist as ever-sane, mature, thoroughly analyzed, and able to see the patient’s gambits for interpersonal reenatctment without accidentally (unconsciously) falling into them.
Relational theory is a field theory, in which every clinical event has conscious and, more importantly, unconscious inputs from each participant, such that we are challenged to think about the unconscious co-creation of clinical events like “resistance” or “projection”. We ask questions like, “In what ways is this therapist’s technique unconsciously contributing to the very resistance they’re seeking to reduce?” “Is it possible that the therapist’s approach to reducing this projection is unwittingly reinforcing it?” This is in contrast to an approach that see’s all the pathology and destructiveness in the relationship as coming from the patient’s neurosis, and all the therapist’s behavior as perfectly sound.
Relational thinking also challenges notions of objectivity in the therapist, suggesting that our biases and unconscious blindspots, in addition to the interpersonal pressures we encounter in the relationship, are so pervasive that we ought to approach any of our conclusions with skepticism, bearing in mind the multiple factors that shape them, and keep an open mind to alternative interpretations. This is in contrast to an approach that grants objectivity to the therapist, a capacity to “see things as they are”, without bias.
Following that, there is also a critique of our metapsychologies, our theories about the structures and constituents of the mind. Whereas a dogmatic Freudian might look at certain of Freud’s conclusions as ultimate Truths, a relationalist might look at them as plausible interpretations of data, plausible narratives constructed about the lived interpersonal experiences of one time- and culture-bound man, but not necessarily as universal, ultimate truths.
A relationalist might interrogate theoretical conclusions by thinking about the history, biases and preconceptions, and cultural surround of the theorist, and explore how the techniques he used could unintentionally shape his patient’s responses in a particular way, biasing the range of metapsychological conclusions he could reach.
That is less than the tip of the iceberg, but perhaps good enough for our purposes.
A relational critique of Istdp
What do you think the relational school can offer ISTDP?
One very difficult thing here is the issue that ISTDP is not a monolith, and that I have a deep wish not to let this devolve into a “straw dog” type conversation. Depending on who you’ve trained with, how long you’ve trained, what your training was before you came to ISTDP (including the training of being a child in your particular family), all ISTDP therapists will have different degrees of development of what you could call a “relational sensibility”.
So, I’ll say this: I think that any therapy benefits from increased willingness on the part of the therapist to interrogate their own assumptions. In fact, Jon Frederickson recently related to me a finding that metacognitive capacity in the therapist, our ability to think critically about our thinking, is a better predictor of effectiveness than their intelligence. I think relational ideas provide tools for self-critical thinking that, to me, enhance our integrity and trustworthiness as therapists.
Here are a few questions that relational thinkers might offer us if we wished to do some kind of relational inquiry into our own work as ISTDP therapists, teachers and supervisors:
Heinrich Racker
Where do we locate pathology in the therapeutic interaction?
Do we tend to see resistance as mainly a product of the patient’s pathology, history, trauma, or do we also take into consideration the ways our presence and technique might evoke, contribute to, or reinforce this thing we label “resistance”?
In a “one-person”, pre-relational psychology, we tend to locate the pathology in the ill, distorting patient, whereas the therapist is seen as sane and perceptive, unobstrusively facilitating the emergence of the patient’s inner life.
The relational perspective might be nicely summarized with some quotes by Heinrich Racker: “We are still babies and neurotics even when we are adults and analysts,” or, “The truth is that [the therapy] is an interaction between two personalities, in both of which the ego is under pressure from the id, the superego, and the external world; each personality has its internal and external dependencies, anxieties, and pathological defenses; each is also a child with his internal parents…”
“We are still babies and neurotics even when we are adults and analysts”
Heinrich Racker
Do we, in resonance with Racker, consider our neurotic contributions to therapy stalemates? Is there room in our theory for the patient’s sanity and perceptiveness, and for the possibility that the phenomena we are coding as “resistance” might plausibly represent the patient’s efforts at self-protection from some unconscious countertransference on our part?
To what extent can we use the concept of “transference” as a defensive denial of our own contribution to the patient’s perceptions of us? Can we consider that some description of us that we wish to code as “projection” might also represent a plausible description of our behavior, but one that we’ve been unconscious of?
I think, in general, we come out of ISTDP training with a highly advanced sensitivity to the ways patients show us their history through resistance and defenses. A relational critique would ask us to expand our theory and clinical thinking to include the ways the therapist’s history also unconsciously emerges in the therapy, and even to consider this a normal part of the therapy process, which can be turned to constructive use if we do not deny its presence. We might also ask how many of our misalliances are the result of such denial?
What is our theory of what triggers transference?
My understanding is that the conventional belief among early analysts was that transference was a “spontaneous”, intrapsychically-driven response to the “ideal conditions” provided by the analysis: anonymity, neutrality, frame, supine position, etc. At least that’s the straw dog retelling of it.
Ida Macalpine
Later analysts, notably Ida Macalpine and then, later, Leo Stone instead suggested that the analytic situation had very specific contours, very salient valances that would stimulate very particular memory networks. They felt that conventional analytic technique “pulled” for specific rather than nonspecific developmental schemata to be transferred into the relationship. Stone felt, for instance, that because of the inherent separateness built into the situation, separation-related conflicts and memories would be the most likely to emerge in treatment. Interesting theory.
I think that for the most part, in the ISTDP community, our theory of what triggers transference is that it is our “concern”, our “relentless efforts to attach”, our “offering of a secure relationahip”, and the way our interventions, which are both irritating and loving, “trigger mixed feelings that link to past attachments”.
Relational theorists would challenge us to think more deeply and in specific about the forms our “efforts to attach” take, so we can more consciously consider what kinds of patient responses we might prime. I think it would be useful to examine how our particular interventions might “pull” for particular types of responses from patients, prime particular developmental schema or associative and memory networks, resulting in the emergence of particular transferences from particular developmental levels or having to do with particular developmental conflicts.
Macalpine, Stone, and many others called into question the idea that must simply create the “ideal conditions” for the spontaneous unfolding of the patient’s repressed mental life, and they challenge us to carefully describe the unique conditions that we create, and to consider how those particular conditions might evoke selective rather than general aspects of the patient.
Along those lines would be questions about our metapsychology.
Insofar as any technique will prime particular associative networks, evoke particular interpersonal schema, etc., then the findings of our work are always somewhat biased or shaped by our approach to the patient. From those findings, we make extrapolations about the nature and constituents of the mind, our metapsychological claims.
In the ISTDP world there does seem to be strong consensus about the metapsychology of the unconscious, the “concentric circles” (see below), the cascade of feelings of warm bond, trauma to the bond, pain of trauma, reactive rage, guilt about the rage, and defenses against that. At conferences and presentations, our technique seems to confirm this by turning up this same pattern again and again, and I think we tend to assume that what we find through our technique represents a kind of bedrock of human psychology.
A relational critique would invite us to ask whether and to what extent our sense of the bedrock of human psychology could be an artifact of the way we approach the human subject, and whether a different approach might point to a different underlying structure of the mind, or of neurosis? We’d be invited to wonder whether our approach selectively evokes some reactions and not others, and whether this is shaping our conclusions about the nature and constituents of the mind in a biased way.
The concentric circles. Figure from Davanloo, H. (1995d). Intensive Short-Term Dynamic Psychotherapy: Technique of Partial and Major Unlocking of the Unconscious with a Highly Resistant Patient – Part II. The Course of the Trial Therapy After Partial Unlocking. International Journal of Short-Term Psychotherapy, vol. 10.
Finally, and very much following on #3, a relational critique might ask us questions about our relationship to our theory.
To what extent does our theory—our ideas of how the mind works, what makes symptoms, what a mind needs to experience in order to have less symptoms, etc.—guide our relationship to the patient?
In what ways do our theory and preconceptions lead us to pursue some lines of inquiry and not others; to make certain inferences about the deeper meaning of what they’re saying and not others? How much does our theory shape the patient’s experience in their therapy? How much and in what ways should our knowledge and preconceptions drive their therapy process? Do we guard adequately against situations of submission and compliance, in which the patient conforms to the agenda that our theory presents to them?
ISTDP is, in my opinion, unique among the dynamic therapies in that it has the best-developed system for monitoring unconscious signals from the patient and detecting error-correcting feedback; ISTDP-trained therapists are, in my opinion, usually uniquely capable of staying close to the patient’s experience, letting the patient’s productions lead, learning from the patient as they go.
However, ISTDP also has – perhaps uniquely among the dynamic therapies – a highly schematized procedure with an avowed hierarchy of optimal outcomes. This creates a kind of identity conflict for the therapist: I am uniquely well-trained to follow the patient, but I also am uniquely filled up with ideas about where the patient ought to go.
So perhaps there is a unique need for us to examine our relationship to our theory, and to pay careful attention to the vicissitudes that occur in that relationship during sessions. This would be very much in the spirit of relational inquiry.
To me, the perspective that the therapeutic reality is co-created by the analytic dyad is an attractive, sympathetic one. But there’s been quite a lot of critique that this perspective leads to relativism, and that relational psychoanalysis represents a postmodern dilution of psychoanalysis. One of the strengths of ISTDP is its assertive use of “concrete reality” when encouraging the patient to face reality and turn against defenses. Do you think a relational turn in ISTDP would risk losing some of this strength?
I think it is overreliance and inflexibility around a particular perspective, not the particular perspective itself, that can take away our strength. I can sin equally against the patient in the name of knowing or of not knowing reality.
Some therapists are more vulnerable to anxiety about knowing—do I dare have an opinion? Authority? They will characteristically have trouble asserting themselves, setting boundaries, making confrontations, and this, of course, will threaten alliances and weaken their work.
Others are more vulnerable to anxiety about not knowing, and will tend to defensively superimpose clarity on experiences that are probably still open to multiple interpretations. Perhaps they will tend to relate to the patient dogmatically, ritualistically. Therapy here will be weakened because the we will not be able to perceive and cope with the full complexity of the encounter, and patients will feel stuffed into a tiny preconception, or stretched on a bed of Procrustes.
I think what a real relational turn would ask is not a radical relativism, which has indeed been much critiqued, but instead a disciplined attention to our relationship to knowing, an intentional inquiry into how we experience vicissitudes in knowing during the clinical encounter, and an effort to make meaning out of that.
For example, I feel very sure of my perspective on reality right now—what does that mean? Could that be an artifact of forces in this relationship? Is that a position that I’m uniquely attracted to due to my own anxieties, or one that the patient uniquely longs for me to embody because of hers? Or, alternatively, Why am I so anxious about confronting this patient right now? Am I allowed to share my perspective on reality in this relationship? What about in other relationships? Does my hesitance have resonance with dynamics from the patient’s other relationships or early life? Mine?
A subjective sense of knowing or not knowing “concrete reality” can have a wide range of rich meanings, and I think attention to these meanings can only serve to strengthen our work. Without this analysis we can devolve into pseudo-omniscience, believing we know reality because we feel like we know reality, which would ultimately weaken us.
practicing ISTDP
In what ways has your own practice changed as a consequence of diving deeper into relational thought?
I’d say I listen longer before I intervene and intervene more cautiously, and importantly, I have begun to take very seriously the observation of my own participation. I pay a great deal of attention to the pressures and anxieties I feel in the sessions and try to use those feelings to make sense of what’s happening, wondering what those feelings say about the patient, about me, about possible unconscious determinants of our interaction.
I try to listen to the words that are coming to my mind or out of my own mouth, and I try to think about the ways my thoughts and interventions might reflect or represent some heretofore unconscious (now becoming conscious) participation in an enacted relationship paradigm.
I’ve also become quite a bit more forgiving of my humanness. It used to be that when I’d have some kind of enactment or misalliance, I’d run to supervision and hit the books looking for a way to perfect my technique so that I wouldn’t be in that embarrassingly normal situation ever again! I think that now I try to do my best with what does happen, learn from it, and try to make meaning out of it, rather than push myself or the patient to embody some image I have of what “should”happen.
I am striving to have fidelity to the patient’s unconscious signaling system more than anything else, even when that requires that I abandon any wish for fidelity to a particular technique or metapsychology.
What are you struggling to learn as a therapist at this moment?
I’ll take your question in a slightly different direction to what I’m struggling with as a teacher. One question I’m wrestling with a lot is how to teach ISTDP in a way that evades, to whatever degree possible, dogmatism, ritualism, and idealization. Some amount of all of this is inevitable because it depends in part on the psychology of the trainee. However, I am trying to figure out how I can teach in a way that ensures I am not feeding that tendency or am actively countering it. I’d be happy to go into more detail about that, but that’s probably another interview.
As a therapist, the task for me right now, as always, is continuing to expand affect tolerance and continue to tolerate the shattering and death of ideals and preconceptions. They go hand in hand fortunately. I think my unconscious motivations for becoming a therapist, how I thought it would go, are more or less the opposite of how it actually has gone. I went to some Jon Frederickson presentations, saw these amazing sessions, and Jon would get a round of applause at the end, and at some level that is what I thought it would be.
The hard learning thus far for me is that therapy is actually painstaking work, with only occasional gratification and many injuries and insults along the way. This has been a difficult adjustment that has required much work. So that’s the big ever-struggle, the work on me. But I am lucky to be surrounded by family, friends, and colleagues who help me.
Where do you want to see ISTDP going in the coming years?
I don’t know where ISTDP is going, but if I could have a wish granted I would love to see us have a domain-specific journal where controversies and conflicts could be hashed out. Without an ISTDP journal most new ideas are published in formats like this, or on social media platforms, where there is no peer review, no refereed platform for scholarly debate. I think that could weaken our field over time. I think there is much room for debate and controversy left in ISTDP, and many questions that we treat as settled could benefit from some reopening and interrogation. We can’t do that without a journal and editorial board.
Another wish I’d love to have granted in the coming years would be the disappearance of the phrase, “It’s interesting,” or, “Maybe it’s therapy, but it’s not ISTDP”. I have been hearing it a whole bunch lately! To me it reflects a ritual-based conception of ISTDP, where ISTDP is about using some specific vernacular rather than what I think is, in my opinion, it’s essence—careful fidelity to the signaling system of the unconscious. I think we need an examination of exactly what is ISTDP, and if we had a journal it would be fun to hash this out.
To me, ISTDP is at least 2 things—an assessment system for determining the “position of the unconscious”, and, separately, a package of interventions. Lately I have encountered, much to my dismay, numerous people holding the opinion that if you are not using the package of interventions (pressure, challenge, and head-on-collision) in a way that at least partially uses the boiler-plate language of the founder, then what you’re doing is not ISTDP. I see it differently, and would love to have my perspective considered:
My current working definition of ISTDP is any approach that works with resistance and transference and utilizes – what I think is Davanloo’s most important discovery – a signaling system of the unconscious. I aim for a kind of “optimized” (by attention to signaling) dynamic therapy.
For my purposes at this point, ISTDP is no longer defined by what I say to the patient, even if my words are occasionally modeled on words I learned from Davanloo, nor by specific events like unlocking, even if they do occur anyway, but instead by a careful attention to the manifestations of unconscious communication via the body and speech of the patient, and by a highly focused effort to make interventions that facilitate the continued emergence of such communications.
I understand that mine is a loose definition of ISTDP, but I also think it allows me a great deal of room for creativity, a creativity that I find very necessary in working through the thorny moments of clinical practice that no book or training could have prepared me for. I worry about what kinds of creativity are choked off, and what kinds of therapeutic processes and experiences are missed, when we limit our definition of ISTDP to a particular set of words and discrete processes, as opposed to an infinite set of interventions and processes that have a shared essence.
Perhaps one final thing is that I’d love to see continued critical appraisal of Davanloo’s ideas. I think a major step in this direction is represented by Mikkel Reher-Langsborg’s recent lecture on YouTube, dismantling the notion of Davanloo as a monolithic, tracing an evolution and thinking critically about that evolution. Bravo, Mikkel!
Mikkel Reher-Langberg presenting at the Malmö Center for ISTDP in May 2022 on the theme of Davanloo’s development over time.
Like early Freudians we tend not to critique Davanloo. We take his findings as a final say. I think the style in which his articles are written has contributed to this. Only his interpretation of the events is given, and are often asserted with a certaintistic verbiage. Alternative perspectives are rarely given, and if they are given at all, are dismissed or even mocked. As an author he positions himself as beyond critique, beyond alternative explanations, and I think this has fostered some of the idealization of him. His writing style plays right into the ideal-seeking tendencies of many trainees, though it surely pushes others away.
I think there is quite a lot from Davanloo that could bear some interrogation.
Psychoanalysts have had to sort out what aspects of Freud’s ideas were sociohistorical artifacts, or products of his own unconscious biases so that they can identify and conserve those aspects that show a more timeless power and relevance. We have had none of that in ISTDP, and I think that part of the conservation of Davanloo’s genius contribution will also require a critical appraisal. Right now there is none of that in the literature, so I think we tend more towards unthinking acceptance that inhibits creativity, exploration, and new discovery.
This is a terrible irony—Davanloo gave us very powerful tools for exploration and discovery, and yet we seem to only want to confirm again and again what he already found. So, I think that is, more than anything, what I’d like to see in ISTDP in the coming years—new discoveries.
Intensiv dynamisk korttidsterapi (ISTDP) utvecklades under 1980- och 1990-talet i Kanada. Behandlingsmetoden är specifikt utvecklad för komplexa och kroniska tillstånd där andra behandlingar inte haft önskad effekt, men går även att anpassa till mildare former av psykologiska besvär. Den här kursen lär under tre intensiva dagar ut de teoretiska och praktiska grunderna i metoden.
Intensiv dynamisk korttidsterapi (ISTDP) är en modern psykodynamisk behandlingsmetod som betonar upplevelsebaserat arbete som fokuserar på känslor. Under 2010-talet har metoden etablerats i Sverige, och ISTDP har blivit ett allt vanligare inslag på landets psykolog- och psykoterapeutprogram. Vid Stockholms Universitet och Karolinska Institutet genomförs forskning på metoden som i nuläget erbjuds på ett femtiotal vårdmottagningar i Sverige.
Kursen
En PRE-CORE ger grundläggande kunskaper och färdigheter för att kunna gå vidare med CORE-utbildning (tre-årig utbildning till ISTDP-terapeut) för den som så önskar. En CORE-utbildning startar i Växjö så snart som vi har tillräckligt många deltagare.
Upplägg
Den 19-21 april 2023 är du välkommen på en introduktionskurs i ISTDP i Växjö. Kursen leds av leg psykolog Christina Aune och leg psykolog Christoffer Hallberg – som båda går handledar/lärar-utbildningen i ISTDP (Training of trainers) med Jon Frederickson.
Kursen omfattar tre heldagar (kl 9-17) och kommer att innehålla både teoretiska och praktiska moment såsom undervisning, rollspel och övningar, samt filmvisning från terapisessioner. Teorin varvas med upplevelsebaserade övningar för att förbättra inlärningen.
Du kommer att lära dig:
Meta-psykologin bakom ISTDP
Att etablera medveten allians och upprätthålla ett intrapsykiskt fokus
Att fokusera på affekter
Att bedöma och reglera ångestnivå
Känna igen och arbeta med olika typer av försvar och motstånd
Att använda dina egna responser på patienter som del av bedömning
Målgrupp
Kursen riktar sig till leg psykologer, leg psykoterapeuter, psykologstudenter som påbörjat utbildningens kliniska del samt andra yrkesgrupper med grundläggande psykoterapiutbildning.
Lärare
Christina Aune
Christina Aune är legitimerad psykolog sedan 2003 och certifierad ISTDP-terapeut. Hon gick Core-utbildningen 2018-2021 med Nina Klarin, Peter Lilliengren och Tobias Nordqvist som lärare och har sedan dess haft kontinuerlig handledning med Peter Lilliengren och Thomas Hesslow. Sedan hösten 2020 har Christina gått Post-core för Thomas Hesslow. Christina arbetar privat vid Malmö ISTDP- mottagning och har sedan tidigare många års erfarenhet av arbete inom primärvården samt barn- och ungdomspsykiatri. Mellan 2022-2025 går hon Training of trainers med Jon Frederickson.
Christoffer Hallberg
Christoffer Hallberg är legitimerad psykolog och certifierad ISTDP-terapeut. Han gick Core- utbildningen 2014-2017 med Tobias Nordqvist som lärare, och har haft kontinuerlig handledning med honom sedan dess. Arbetar vid egen privat mottagning i Borås och som konsult på Mini Maria (missbruksvård för ungdomar) i Borås – och har sedan tidigare erfarenhet av ungdomsmottagning, beroendepsykiatri och vuxenpsykiatri. Går training of trainers med Jon Frederickson 2022-2025.
Anmälan: Skicka din anmälan med namn, faktureringsadress, arbetsplats och yrkeskategori till christoffer@psykologhallberg.se . Anmälan är bindande från 30 dagar innan kurstillfället.
För fjärde terminen i rad kör vi ett samarbete med vår systerförening i Danmark (Dansk Selskab for ISTDP, www.istdp-danmark.dk) med syfte att anordna digitala kvällsföreläsningar om ISTDP. En uttalad ambition är att bjuda in presentatörer från Norden och andra delar av världen samt att visa på bredd i olika tillämpningar av ISTDP. Alla presentationer sker på engelska med undertexter på filmklippen. Föreläsningarna kommer ske via Zoom och ligger kvällstid kl 17.00-19.30
Kostnaden är 1200 kr för alla fem föreläsningarna för medlemmar i Svenska Föreningen för ISTDP. Är du ännu inte medlem i föreningen kan du bli det i samband med anmälan. Medlem i föreningen blir du här: https://registreringar.istdpsweden.se. Förutom medlemsskap krävs även att du genomgått den tre dagar långa introduktionsutbildningen precore, samt att du har legitimation eller är student i slutet av din utbildning på legitimationsgrundande utbildning.
Observera att dessa presentationer kommer att visa ISTDP på avancerad nivå, utan att redogöra för grunddragen i metoden. Bakom interventioner som kan se enkla ut finns alltid komplexa bedömningar som avgör hur det är lämpligt att agera i stunden. ISTDP är en omfattande metod som tar tid att lära sig. Därför är denna seminarieserie endast öppen för dem som redan har gått en introduktionskurs (så kallad precore). Därutöver behöver du ha legitimation eller vara i slutet av din legitimationsgrundande utbildning. Är du nyfiken på ISTDP och vill lära dig mer om grunderna i metoden så kan vi varmt rekommendera att läsa mer om utbildning på vår hemsida.
Här köper du biljett till vårens föreläsningar: Klicka här
VÅRENS FÖRELÄSNINGAR
1. februari: Patricia Coughlin: “handling resistance without contributing to it”
About Patricia: Patricia Coughlin, Ph.D., is a Clinical Psychologist with over 40 years of experience. Having trained with Habib Davanloo, she developed a specialty in ISTDP and has been a prominent teacher and supervisor in the field since the 1990s. In addition, she has written many articles, and four books, on theory and practice of ISTDP.
About Patricia’s presentation: In this webinar we will focus on the topic of “handling resistance without contributing to it”. ISTDP is a method of psychotherapy based on the theory of unconscious conflicts. All too often, therapists focus exclusively on defense and resistance and, in so doing, contribute to it. Davanloo taught us to identify and then intensify the patient’s conflict in such a way that they turn on and abandon their defenses in order to face their true feelings. This procedure is designed to create an intrapsychic crisis, which, when successful, unlocks the unconscious. Engaging in an interpersonal conflict with patients can lead to misalliances and drop outs. Learning to manage the twin forces of alliance and resistance, in order to facilitate an internal crisis and opening of the unconscious, is an essential skill to master.
1:a mars: Brian Kok Ravn: “The Stuck Electrician – Working with Syntonic Character Defenses”
About Brian: I have been in the field as a clinical psychologist since 2006 and got my initial training working with outpatient psychiatry specifically focusing on personality disorders. I finished my Core Training with Ph.d. Patricia Coughlin in 2012 and went on to participate in Jon Fredericksons “Training for Trainers”. I started out teaching my first core group in 2015 and has since then started a new core group each year. I’ve been in supervision with Dr. Allan Abbass since 2015 and has twice presented cases with both fragile and high resistant patients at the Copenhagen Immersion seminar taught by Dr. Allan Abbass. Currently I work solely as a private practitioner in Psykolog Kok Ravn ApS with a broad range of topics doing both Individual ISTDP Psychotherapy, ISTDP Informed Couples Therapy, Supervision, Training and Individual and Group Dynamic Coaching for Businesspeople.
About Brian’s presentation: Highly syntonic character defenses are quite a challenge for the therapist to work with. We will look into session fourteen in the fase of treatment where the patient through previous repeated clarification slowly begins to turn on his defenses and let feelings rise in the transference. It will be demonstrated how turning the patient against his own defenses with this kind of high resistance requires both pressure, clarification, challenge and head on collision in combination.
5:e april: Jody Clarke: ” Opening the Family Tomb: A Study of the Intergenerational Transmission of Psychopathology”
About Jody: Jody Clarke is certified as a Psychospiritual Therapist with the Canadian Association of Spiritual Care (CASC), he is also a Professor of Pastoral Theology, at Atlantic School of Theology in Halifax. Through a series of wonderful incidents he was invited to his first symposium in Intensive Short Term Dynamic Psychotherapy two decades ago. From there he was invited to join Dr. Davanloo’s Supervision Group. Then from 2007 – 2020 Jody became a member of Dr. Davanloo’s Montreal Closed-Circuit Video Workshop. He has written and co-authored several papers integrating ISTDP with literature and events in history.
About Jody’s presentation: Exploring the nature of the intergenerational transmission of psychopathology is fascinating on numerous fronts. The pathogenetic figure or figures contribute directly to the to the character of the resistance. Essentially, the family tomb does not want to be open. In this presentation we will watch the application of Davanloo’s ISTDP and the subsequent breakthrough into the family crypt. Davanloo’s theories are designed to free patients from the destructive forces in their lives, but his technique also offers liberation for ancestor’s long since buried.
About Tami: I am a licensed marriage and family therapist in private practice in San Diego, CA. I originally trained as a couple’s therapist. I am a certified Emotionally Focused Couple (EFT), Supervisor and Therapist, Dually Certified in Accelerated Experiential Dynamic Psychotherapy (AEDP) for Individuals and Couples, and IEDTA Certified in Intensive Short Term Dynamic Psychotherapy (ISTDP). My background in EFT for Couples, AEDP, and ISTDP have all served me well in shaping and expanding my clinical skills and developing my efficiency and art as a psychotherapist. I am passionate about teaching and training motivated therapists in helping them become more effective at what they do. I offer both individual supervision and an ISTDP Informed Couples Monthly Training. My colleague Matt Jarvinen and I co-created the ISTDP San Diego Community offering online training with master EDT trainers to therapists globally to help spread the love and efficacy of ISTDP. I am the president of the IEDTA and have served on the IEDTA Board for the past 4 years My husband and I have been married for 33 years. We have two grown, strong daughters and two precious grandsons. To learn more, visit me at www.tamichelew.com
About Tami’s presentation: Many ISTDP and EDT therapists who work with both individuals and couples are naturally interested in learning how to effectively apply their work to couples from an ISTDP framework. Most current couples’ models do not work from a theory of unconscious anxiety, nor explicitly identify defense patterns and their costs as explicitly as ISTDP. Dr. Davanloo’s contribution to defense work and understanding the pathways of unconscious anxiety is incredibly relevant in working with couples; especially when the stimulus (often their partner) is sitting next to them in the room. Equally important is increasing a couple’s capacity towards experiencing and expressing their mixed feelings openly and honestly with one another. This builds capacity on many levels in both partners toward less defensiveness, greater anxiety regulation and affect tolerance toward emotional closeness in being less guarded and distant, and more open-hearted and connected, which is often their shared longings for couples’ treatment. The focus of this presentation is based both on theory and technique; ISTDP metapsychology and the application of ISTDP clinical skills by closely monitoring the response to intervention in each couple member. This will include monitoring each partner’s triangle of conflict and triangle of persons to better understand how each of their intrapsychic conflicts and/or low ego capacity is unconsciously contributing to their interpersonal conflicts causing their current symptoms and suffering. When each partner can better understand both their own and their partner’s dynamics, it helps build empathy between them and is a motivator for healthy change. We will view case material demonstrating how to effectively work with a couple when both partners have different ego capacities. Many couples are highly motivated and yet feel stuck in relational defeating patterns and high anxiety during times of conflict. We will look at how to work with the complexities of detachment, projective processes, repression, and cognitive-perceptual disruption in the room and we will witness the change processes as they unfold. We will be underscoring the 5 parameters in Dr. Allan Abbass’s work that comes from Dr. Davanloo’s Central Dynamic Sequence which serves as a road map for working with both individuals and couples. These include assessing the ego capacity of each partner by restructuring defense patterns of relating, moving from syntonic to dystonic defense patterns, restructuring anxiety pathways as needed, detecting any anxiety thresholds that are too high, and inviting the de-repression of feelings, to bring breakthroughs into the unconscious. Working actively on the “front of the system” activates both partner’s resistance systems, Complex Transference Feelings, along with the Conscious Therapeutic Alliance (CTA) and the Unconscious Therapeutic Alliance (UTA), which is the healing force in each couple member and therapist. This way of working offers a comprehensive psychotherapeutic couples treatment course that is effective and short-term. This presentation will show that working in this focused way, in the here-and-now, by monitoring anxiety dysregulation and building affect tolerance helps both partners to have more capacity to deal, feel and relate to one another in good times and in hard times. Also, honoring the urge of expressing loving impulses to reach out and hold hands or offer a much-needed comforting hug is welcomed. These tender, loving moments are meaningful to the couple and lead to further gains of deeper, honest communication and character change that offer corrective emotional experiences together. Learning Objectives include: 1. How to assess and psycho-diagnose the ego capacity of each couple member. 2. When and how to use Graded ISTDP interventions when detecting anxiety thresholds so that each partner can feel safe in their body and in the room with us and with each other to build more ego and relational capacity. 3. Witnessing the restructuring efforts so that resistances drop, and Alliance can grow and overcome resistance for both partners to feel more in contact with their mixed feelings and with each other. 4. How to explicitly privilege the felt emotion of love and other positive feelings to increase and deepen their emotional intimacy and attachment bond. You will witness and feel their love in the room. Reaching the couple stuck underneath their resistances by understanding and healing their unconscious wounds transforms their love through healthier ways of relating which positively impacts their children, their grandchildren, and the generations to come. To me, this is sacred legacy work. Working effectively with couples from an ISTDP framework can be a significant factor in contributing to the greater collective conscious healing in the couple and family system, society, and the world at large.
7:e juni: Niklas Rasmussen: “Undervalued functions of the head-on collision in ISTDP”
About Niklas: Niklas Rasmussen is a licensed psychologist, a certified ISTDP therapist, trainer and supervisor. He has 15 years experience of clinical work, mainly in outpatient psychiatric health care. Since 2019 he has a private practice in Stockholm offering ISTDP therapy, ISTDP-training and supervision. He also teaches ISTDP at Uppsala University and at Marie Cederschiölds högskola i Stockholm
About Niklas’ presentation: Head-on collision (HOC) is usually described as an effective intervention when the patient’s resistance is crystallized. It is defined by a therapeutic position of radical honesty about the prize of the resistance. In ISTDP-literature, the main goal with HOC is described as helping highly resistant patients towards emotional break-throughs. But the therapeutic stance associated with HOC can have multiple functions in the therapeutic process, such as: 1) assessing the patient’s suitability for ISTDP in trial therapy: 2) initiating termination of therapy when necessary. 3) establishing and reestablishing therapeutic borders in therapy. 4) a path to essential self-care for the therapist.
In his presentation, Niklas will discuss these extended, and so far undervalued, functions of HOC based on his own experience as an ISTDP therapist, supervisor and supervisee. He will also talk about how HOC can be used at different stages of a therapist´s development and common countertransference reactions associated with the use of HOC.