Mikkel Reher-Langberg: “We all use the same words as Davanloo, but the music is different”

In this interview with Mikkel Reher-Langberg, we discuss his upcoming book on Davanloo and ISTDP and much more. Mikkel is a psychologist and president of the Danish ISTDP Society. In 2018, he published a book on Freud’s concept of the self, Faces of the Freudian ‘I’: The Structure of the Ego in Psychoanalysis. Together with some colleagues, he has been running the private clinic Emotion center in Copenhagen for a few years now.

Dansk version. Svensk version.

What’s on your mind right now?
As you know, I work full-time at a private ISTDP clinic in Copenhagen, and I’m still very busy learning how to work with ISTDP. Alongside the clinical work, I am in the process of writing the book we are going to talk about here. In addition, I have been busy with meditation for the past few years, which I hope to be able to do more of when the book is finished.

You are finishing work on this two-volume book on ISTDP. From hearing you talk about it, I get the impression that you want to contribute to some kind of “back to the roots” process: back to Davanloo’s foundations. What is the background to the book?
The background is that I have been studying with John Rathauser for the past few years. He works in a style that is very close to Davanloo’s technique around 1990. I saw John’s work at the IEDTA congress in Amsterdam in 2016 and was completely sold on his style. I learned the basics of ISTDP through Jon Frederickson’s and Allan Abbass’ formats and styles, and since I started working with John I’ve tried to understand what is unique about his style. Over time, our collaboration has become closer and more of a friendship, and I think after a while John could see that I often understood and articulated his work in a way that he could not. Despite the fact that his clinical intuition is much stronger than my own.

At one point, John suggested that we write a book together, drawing on our different strengths. That was in early 2019. I suggested we write the book as an introduction to Davanloo, which we quickly agreed on. I have mainly been concerned with the first volume of the book, which is basically an attempt at a coherent presentation of Davanloo’s theory and methodology. The second volume consists of John’s cases, for which we have written commentaries. For me personally, writing the book has been a way of integrating my understanding of John’s work through a very close reading of Davanloo.

Would you like to share some of the key findings you have made from reading Davanloo in the way you have?
It is difficult to point to individual findings. For me, returning to Davanloo has required a fundamental restructuring of what I thought I knew about ISTDP. What I have been most interested in beyond Davanloo’s conceptual apparatus has been his way of thinking about and orienting himself in his clinical work. I have tried to decode the logic of his clinical thinking by examining the contrasts between his style and later versions of ISTDP. In doing so, I may be placing too much emphasis on the differences between Davanloo and other teachers, rather than the similarities.

Having said that, I do think there is a qualitative difference between the way most of us understand ISTDP today and the way I think Davanloo understood his craft. We all use the same words as Davanloo, but the music is different, and I don’t think that’s just because Davanloo had/has a deeper clinical intuition than most of the rest of us.

One area where I think this is evident is that many people today seem to understand ISTDP as an emotion-focused or experiential therapy. For example, the Swedish ISTDP group on Facebook has a banner that says “the deeper you feel, the more you heal”. This may seem innocuous, but in practice it means that many ISTDP therapists are most interested in “getting to the feelings”, as if experiencing feelings is, in and of itself, important or relevant.

This perspective has its strengths, of course, just as other forms of therapy have their strengths, but I think it is a perspective that is qualitatively different from Davanloo’s – at least the perspective he held until the late 1990s. The emotions he is (or was) interested in are specifically those associated with his work on the resistance, and they are not an end in themselves – they are a means of gaining a deeper understanding of and working through the patient’s unconscious. In this way, Davanloo uses resistance in a different way than most ISTDP therapists do today, which has implications for what the work looks like in practice.

You almost say that this is talking about a new form of therapy developed post Davanloo. Can you go into more detail about what is so different, perhaps with a clinical example? How is Davanloo/Rathauser-ISTDP different from Frederickson/Abbass-ISTDP? 
I do think it’s worth considering if it’s the same form of therapy! One specific clinical difference is that many people today have learned to “press through” resistance, choosing what might be called the “path of least resistance”, whereas Davanloo follows the “path of greatest resistance”. But I think the biggest difference is in the deeper conception of the work itself – not in individual technical interventions.

If you change the spirit of a method, is it still the same? It’s hard to give a clinical example, but perhaps we can compare it to yoga. If you use the different postures for the purpose of gymnastics or strength training, are they still “the same” as when used for the purpose of spiritual practice? If you understand ISTDP as a form of exposure to emotional intimacy, where the therapeutic potential lies in facilitating the breakthrough of emotions or corrective emotional experiences with the therapist, as many do, it easily overshadows the part of the work that is about creating insight into the unconscious. We could say that one does not exclude the other, but in practice I still think that many people use the method as if exposure to their own feelings were an end in itself. 

There’s a lot of good in that – but I think it’s important to be conscious of where this leads the therapy model as a whole.

You have previously written a book on Freud’s concept of self and taken some interest in philosophy – things that fit well into the psychoanalytic literary tradition. Should we who do ISTDP be more interested in reading original classical texts? Or is it a positive thing that the focus of the ISTDP community is more on craft and watching video recordings?
Both yes and no – I’m not sure that the psychoanalytic literature is relevant to our technique, just as you don’t learn to run a hundred-meter race from a marathon runner. We don’t use the transference neurosis, so it’s hard to compare the methods other than in principle. If there is to be an exchange, I think there is something beautiful, serious and generous about our approach to ISTDP training that I think the psychoanalytic community could benefit from.

One area where I think it would be fruitful to include more psychoanalytic theory is in understanding the psychic levels which run deeper than manifest emotional life. The psychoanalytic tradition has a language for the drives and intersubjective dynamics that give rise to manifest emotions which we do not have at all in the ISTDP community. Incorporating this will have an impact on how we understand the therapeutic process as a whole. I think one of the next things that will be needed in the ISTDP community is for more people to engage in the conceptualization of phase 6/7 of the central dynamic sequence – i.e. working through – which unfortunately we do not have a coherent understanding of at the moment. This phase is closely related to the way in which we view the very purpose of the therapeutic process, as well as the therapeutic mechanisms behind what we are doing. Here I think it is necessary to return to the psychoanalytic tradition for help and to broaden our perspectives.

What do you see as the major challenges for the ISTDP community in the coming years?
I think there are many who started learning ISTDP around the same time when Co-Creating Change came out, who have spent a lot of time on technique, and who are now at a point in their development as therapists where they need something to help them gain a deeper understanding of the therapeutic process itself. I think we need literature and training that focuses on the wider processes so that we can begin to use technique in a more flexible way.

In addition to this, I personally have two things that I would like to see in the near future. First, that someone would develop a phenomenology of ISTDP – a description of the structures of the patient’s and therapist’s inner experiences of the process. Second, that someone wrote in more detail about the therapist’s use of defenses in the process and what they usually look like. Unfortunately, I think that as a community we tend to place more emphasis on the patient’s defenses than on our own, and I think that many of the technical pitfalls of the method, given the recent debate about its harmful effects, could be remedied by focusing more on our own neurotic use of the technique.

What would such a phenomenology describe and contain? Care to speculate?
How does it feel when the therapy process tilts to the transference? How is it experienced when the unconscious therapeutic alliance is high versus when it is low? How is it experienced when the conscious therapeutic alliance is firmly established versus when it is not? How are increases in complex transference feelings experienced before they break through? How is the shift from before to after instant repression experienced? What is the experience of having a projection deactivated? How does it feel to have one’s central resistance properly challenged, and how does it feel when the therapist just hammers away without having made clear what the purpose of it is?

I think this type of descriptions would make it easier, especially for new therapists who have not yet developed their own experience with countertransference, to understand the patient. To be able to fine tune their approach based on the experience expressed by the patient, in addition to using the more crude objective signs such as sighs.

What are you struggling to learn as an ISTDP therapist right now?
I’m mostly working on stabilizing my empathic listening skills. One side of this is that I am trying to find a way to stop using the ISTDP therapist role as a defense against emotional closeness. Another is that I am trying to learn how to have a grip on the method that is neither too tight nor too loose.

This is something that I and many of the readers will recognize – that we use the ISTDP therapist role as a defense. Do you think ISTDP is particularly vulnerable to this kind of problem, given the focus we place on the technical aspects of the work?
Yes, I think that as ISTDP therapists we are vulnerable in at least two areas. One is the high emotional intensity of the contact with the patient that is implicit in the method. The second one is that we have very clear and high quality role models to rely on from the very beginning of our work, both in terms of technical instructions and the work of specific teachers. In this way, we have very big shoes to fill, and most of us who are interested in ISTDP are very ambitious for our own sake and for the sake of our patients.

If we think about it, it’s almost a traumatic situation to put yourself in, especially as a newly trained psychologist. When we sit there and have to navigate a high level of emotional intensity that we don’t fully understand, a very high technical level that we don’t fully master, but that we have to convince ourselves that we have mastered. And which we believe we must convince the patient and our colleagues that we have mastered – then the stage is set for us to have a therapist neurosis, where our therapist personality does not facilitate our personal development, but stands in the way of it because it does not reflect us. 

ISTDP assumes that we can go all the way from inquiry to unlocking. We need to have control of the system as a whole before it really works, and so learning the method becomes like putting together a jigsaw puzzle where the motive is constantly changing. In this way, it makes sense that perhaps more than therapists from other therapy disciplines, we acquire a kind of premature therapist identity as part of our development.

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If you enjoyed this interview with Mikkel Reher-Langberg, you might be curious about our other 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”
• Ange Cooper: “I am my patient, they are me”
• Mikkel Reher-Langberg: “Vi använder Davanloos ord, men musiken är annorlunda.”
• Mikkel Reher-Langberg: “We all use the same words as Davanloo, but the music is different”
• Mikkel Reher-Langberg: “Vi bruger alle de samme ord som Davanloo, men musikken er en anden”
• Malin Ljungdahl: “ISTDP hjälper oss att inte fastna i dualismen mellan psyke och soma”