We did an interview with Jon Frederickson ahead of his first ISTDP workshop on Finnish soil at the end of March. In the interview he discusses the relationship between psychoanalysis and ISTDP, as well as his own discovery of ISTDP and other themes.
How do you feel about going to Finland to present for the first time?
I’m very excited of course to teach a new group of therapists. But, honestly, what has me really excited is to be in the homeland of Sibelius. Such a giant in classical music! If only I had a little more time, I would visit his home in the woods and absorb the mood of the forest of which his music spoke.
For people who don’t know you, how did you end up becoming a therapist and later on specializing in ISTDP?
I was initially inspired to become a therapist through the writings of Erich Fromm. Such an inspirational writer, a psychoanalyst, a sociologist, an atheistic mystic. How could I not be fascinated by such a brilliant and heartful role model! I became psychoanalytically trained and some years later had a chance to see videotape of ISTDP. It was like seeing psychoanalysis live and active in a way I had never dared to imagine.
In the nineties you had quite a lot of training with Patricia Coughlin, and later on you met Davanloo and trained with him. How did you find training with Patricia and Davanloo?
Supervision with Patricia revolutionized my work as a therapist, making my therapy far more focused and effective. With Davanloo, it was a bit startling. I was chair of a psychoanalytic psychotherapy training program and yet with Davanloo I was for the first time understanding many concepts on far deeper levels than I ever had before. Sadly, he dismissed psychoanalysis at that point in his career. Yet his training only deepened my appreciation and understanding of its depths.
Speaking of psychoanalysis, what’s your perspective on the relationship between psychoanalysis and ISTDP?
Freud said that any therapy is psychoanalysis if it operates with a concept of the unconscious and the transference. ISTDP meets those criteria. ISTDP is obviously more active an approach than a classical analysis done on the couch. However, its work is entirely based on the exploration of unconscious feelings, addressing unconscious anxiety, and the careful work with unconscious defenses and resistance in the transference relationship. And in line with Bion’s statement about psychoanalysis, our work is based on faith that the patient will become healed by becoming at one with the emotional truth of this moment.
In Helsinki you’re doing a workshop on trauma. Does ISTDP offer a unique take on trauma, or is this a standard psychoanalytic perspective?
I don’t know how to answer that because psychoanalysis is such a pluralistic community now that it would be reductionistic to claim that there is “one” way psychoanalysts work with trauma. Unlike some other communities, ISTDP therapists and analysts understand that the effects of trauma depend on multiple factors such as the child’s age when the trauma occurred, nature of the trauma, genetics, temperament, and the parental response to trauma.
We also recognize that dealing with the trauma involves not just the mind but the body. And we also recognize that issues of symbolization and mentalization must be carefully attended to. And we also note whether it was a one-time trauma or a case of cumulative trauma. All these factors lead to a complexity in treatment which any psychoanalytically informed clinician must take into account.
ISTDP is in many ways still a “new form of therapy”, given that so few people have been trained in it. What are some of the aspects of ISTDP that still are in need of development?
ISTDP, while quite effective in research studies, has yet to develop research specifically into the treatment of narcissistic personality disorder and perversions. Our recent research with drug addicts is showing a surprising amount of effectiveness with patients suffering from psychotic symptoms. So I think we need to do more research into what differentiates the near-psychotic group of patients who respond to work on splitting and projection, and the psychotic level of character structure that does not respond. Given the successes we are having, I am hoping we can build on Marcus’ work on near-psychosis in our future work.
A common reaction to reading about ISTDP or watching a presentation is that the method is confrontational and even violent. Should ISTDP be less confrontational?
ISTDP isn’t violent, defenses are. That’s we try to block and identify defenses which do violence to the patient. Let us not forget that defenses cause the patient’s problems and presenting problems. They are a form of internalized violence. And the most compassionate thing we can do is block unconscious forms of violence that hurt the patient, and to help them see these previously invisible mechanisms so that he they have a chance to do something different.
Likewise, we don’t interrupt the patient. We interrupt the defenses that interrupt the patient. We never interrupt the heart speaking from its depths, we interrupt the defenses that keep the patient from speaking from her heart. Also, the idea of confrontation makes no sense about 99% of the time. After all, if the poor patient can’t see a defense, is not using it intentionally, and is unaware of it, he just needs some compassionate help to see his defenses. Otherwise, how could he do anything different in the moment?
Think of self-attack. It’s a form of violent communication to oneself. A child who grew up with a critic becomes a critic to himself. The nicest thing we can do is interrupt this form of self-cruelty and help the patient look under that defense to see what the feelings are being warded off.
Coming back to you, in what ways have your way of doing therapy changed over the past five or ten years, and why?
Hahaha! Throughout my career, as I look back, I can see that I have increasingly surrendered my resistance to being here, now, with the patient I have. I am increasingly able to accept the patient unconditionally, without needing him to change in any way. This may sound easy or trivial to readers who believe you already do this. And, if you do, good for you! But I find that this is a universal journey we take as therapists as we give up even the tiniest resistances to reality: meaning the patient as he is. My work has become very attuned to the tiniest cues of the unconscious will-to-health. And that shift may be the most important technical shift in my work recently.
What are you struggling to learn as a teacher and therapist right now?
I’m in the midst of several projects with the aim of developing new forms of training and supervision. The research shows that graduate training does not improve therapist effectiveness. And after graduation, research shows that therapists do not improve. Research also shows that 93% of psychotherapy supervision is ineffective and 35% actually harmful. So in this part of my career I am most interested in researching what helps therapists become more effective. That is why I am focusing on skill building exercises and DVDs. I have a skill building book coming out next year. And I’ve begun a three-year study where we will study learning processes in a training group. That research will be the basis of a book I will write on the teaching and learning of experiential therapy.
You have two new books in the making. Can you tell us something about them?
My next book, Co-Creating Safety: treating the fragile patient, is designed for therapists who want to learn how to treat the most disturbed patients in their caseloads, ranging from patients who just had a psychotic break to patients in the borderline spectrum of character structure. After that, my next book will be, Healing Through Relating, a skill building book with skill building exercises training therapists in the fifty most important skills in developing a therapeutic alliance. I was trained as a professional musician. So I’m trying to develop some “étude” books now for therapists.
Would you like to say something directly to the Finnish audience about the event?
I look forward very much to showing you a three-hour session which will allow us to learn concepts, see them put into action, and see how a patient begins to recognize the unconscious enactments that have driven her suffering. There is something about seeing a real therapy that is helping the patient moment by moment that is unlike any other kind of learning experience. I look forward to seeing you there!
If you liked this Jon Frederickson interview, you might be interested in our other interviews. Among them, there’s another Jon Frederickson interview from last year. There’s also a recent interview with Kristy Lamb on ISTDP for addictions that might be of interest. Here are the five most recent interviews:
- Niklas Rasmussen: “Det är så lätt att tappa bort sig själv i ISTDP”
- Maury Joseph: “How much does our theory shape the patient’s experience?”
- Ola Berge: “ISTDP erbjuder ett perspektiv som saknas i psykiatrin”
- Johannes Kieding: “ISTDP is uniquely vulnerable to misalliances”
- Jonathan Entis: “Defiance is the single most important defense”
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