Reiko Ikemoto-Joseph: “This is one of the aspects of ISTDP I love the most: its infinite flexibility”

At the end of January 2020, Reiko Ikemoto-Joseph, Licensed Marriage and Family Therapist, is presenting her work on the healing power of guilt at Ersta Bräcke Sköndal Högskola. We had a chat with her to find out more about what she thinks about ISTDP, couples therapy and working with creative people, among other things.

How did you find ISTDP or did ISTDP find you? 
I was very fortunate to have discovered ISTDP very early in my clinical training at a day seminar offered in Los Angeles. I watched a videotaped session of a man who was struggling with inexplicable rage toward his 4-year-old daughter. When I saw the use of pressure and challenge, my jaw hit the ground. I didn’t exactly understand what I was seeing but I knew right then that I wanted to learn how to do it. I immediately enrolled in an introductory ISTDP course and from there I was hooked. It’s been nine years since that day and I am as enthralled, obsessed and curious as ever about Davanloo’s metapsychology and the many different ways it can be understood, applied and adapted. So I supposed I found ISTDP first but it has certainly found its way into my psyche and grabbed hold. 

Can you say something about your style of ISTDP? What do you emphasize in your work and what do you appreciate most about working with ISTDP? 
During my training I have consciously and unconsciously integrated the styles and interventions of my teachers. However, over time they have become my own. I find a great deal of joy and satisfaction in re-interpreting my teachers’ interventions in my own language and creating new interventions to suit the specific needs of my patients. This is one of the aspects of ISTDP I love the most: its infinite flexibility. Once you integrate the metapsychology, it’s possible to adapt the approach to nearly every person you treat. I would say that I always emphasize the working alliance. All of my initial interventions target the specific barriers that prevent an active and involved partnership with my patient. 

All of us struggle to learn ISTDP. Starting out, after a few years and also after a number of years. Can you tell us something about what you’re learning right now and what you’re struggling with? 
Right now I’m experimenting (and struggling) with the best way to approach extreme fragility. I’ve always enjoyed working with moderately fragile patients but patients on the extreme side of the fragile spectrum are especially challenging for me because the pace of the work is so slow. ISTDP is known for its ability to effect rapid change and I find it very exciting to facilitate major unlockings early in the treatment. This is not possible with extremely fragile patients. With these patients, the bulk of the work involves meticulous and painstaking restructuring. Additionally, many patients with early and severe abuse quickly flood with anxiety, dissociate, and cannot tolerate working in the transference. So recently I’ve been experimenting with using bilateral stimulation and EMDR resourcing techniques with such patients to stabilize them at the beginning of each session. So far it has proved very useful in reducing anxiety and creating the conditions for a conscious and unconscious working alliance.

You specialize in couples therapy. I’ve heard some people do couples therapy in a format where they do individual therapy with the other partner as audience, and then you alternate during or between sessions. What kind of format do you use? Did you have to modify ISTDP in some ways to make it fit couples work? 
As you noted, this is a particular interest of mine. I love working with couples. One of the nice things about couples work is that the couple usually comes “pre-mobilized,” meaning that the partners already have complex feelings activated toward each other when they walk through the door. They also find it very easy to identify specific examples of their problems with one another. The aspects of ISTDP that are fairly easy to adapt to couples work are: (1) directing the partners’ attention to their respective triangles of conflict and triangles of persons. I help each of them see how these two triangles work together to perpetuate their difficulties. This in turn helps them see and take responsibility for their specific contribution to the problem instead of blaming each other. One innovation that I developed with my colleague, Catherine Lockwood, is redirecting rage into the transference. For example, if one partner is lashing out at the other, I’ll interrupt and help the enraged partner observe his or her anxiety, rage and discharge. Next, I’ll invite him/her to experience and regulate the rage with me instead. Often it’s possible to make a cognitive link to an earlier genetic figure or distressing memory. This is usually extremely illuminating (and a huge relief) to the observing partner. I save ample time at the end of each session to invite both partners to summarize what they experienced and observed and to link it to their presenting problem.

On your website you mention that you work with people in the creative community. Do you find that this group is different to treat than other groups of clients? 
From a metapsychological perspective, creative clients are no different than other types of clients. However, I find that as a group, creatives tend to be very identified with their punitive superegos. Their torment shows up as relentless self-criticism of their creative efforts, which they often rationalize as “good for them.” For me, creative clients are a lot of fun to work with because they resonate so strongly with metaphor and archetypical themes (e.g. exile, freedom, revenge). 

What’s your vision for the future of ISTDP? Where do you see us going as a community in say, 5 or 10 years? 
My vision for the future of ISTDP is greater recognition in the psychotherapy community at large and wider availability of clinicians. There are some states in the U.S. without a single ISTDP practitioner. Finding ISTDP clinicians to refer to is a constant struggle. I’d also like to see us create more opportunities for collaboration and cross-pollination with other emotion-focused and/or trauma-based models such as EFT or EMDR. I have some training in both of these modalities and find there is a surprising degree of overlap with ISTDP. 

Do you have anything in particular to say to the people going to or thinking about going to the event in January? 
I will be showing two cases that feature major unlockings of the unconscious, including some very surprising visual transfers. I presented the first case at the most recent Boston IEDTA conference for the session on highly complex and resistant cases. This is a unique opportunity to see examples of the twin factors (transference and resistance) activating an unusually strong unconscious therapeutic alliance. It’s also a great opportunity to see the profound healing power of guilt in Davanloo’s ISTDP.

Make sure to register for the January event soon as seating is limited. See the flyer for more information.

Below you’ll find some of our other recent interviews: