Understanding and resolving sexual conflicts with Intensive Short-Term Dynamic Psychotherapy (ISTDP)
We’re very happy to welcome Patricia Coughlin back to Malmö for this one-day conference. The focus of the talk will be on understanding conflicts around sexuality. Patricia Coughlin, a renowned expert in ISTDP, will discuss how to detect the presence of these conflicts in your patients, and present methods designed to resolve them. Authentic videotaped examples of work with patients who struggle with conflicts around sex, jealousy and rivalry will be shown.
Patricia Coughlin Della Selva, Ph.D., is a licensed Clinical Psychologist with over 35 years of clinical experience. Currently she is Clinical Faculty at the University of New Mexico School of Medicine. Over the past 20 years she has written professionally, given presentations at professional conferences and conducted workshops for mental health professionals internationally. Currently, she is conducting training groups in New York, Australia, Denmark, and Poland. Patricia last presented in Sweden in the fall of 2016.
Location: Nobel house, Act room, Per Weiiersgatan 6, 211 34 Malmö, Sweden
Date: Thursday, September 10th, 2020
Time: Registration starts at 8.30, workshop 09.00–17.00 (lunch approx. 12.00-13.00), book signing 17.00-18.30
Price: 2000 SEK for non-members, 1500 SEK for members of the Swedish society for ISTDP, 750 SEK for full-time students (regardless of membership). Lunch and coffee is included in the price. 15% discount for “early bird” registrations before April 15th! Register now – seating is limited!
Registration: E-mail your full name, work title, any food allergies or preferences and full invoice information to Victoria Paglert (firstname.lastname@example.org) for registration.
Contact: Victoria Paglert (email@example.com), Peter Lilliengren (firstname.lastname@example.org)
We’re very excited to offer ISTDP training in Finland for the first time. Following the workshop by Jon Frederickson at the end of March this year, to our knowledge this will be the second ISTDP event in Finland. The three-day course gives a complete introduction to the theoretical and practical foundations of Intensive Short-term Dynamic Psychotherapy, ISTDP. Alongside theoretical lectures, the course includes skills training, role-plays, observation of actual therapy video and group discussions. This is the main content:
an introduction to the central theoretical principles of ISTDP
practical skills to establish an effective working alliance and a consistent focus on affect
practical skills to assess and regulate anxiety manifestations during sessions
practical skills to identify and manage defenses and resistance
a critical introduction to the evidence base for ISTDP and other short-term dynamic therapies
The course is open for psychotherapists and psychologists, as well as students within these fields.
The course is led by lic. psychologist Thomas Hesslow. He runs the ISTDP-unit at the psychiatric outpatient clinic Kronan in northwestern Stockholm. He’s a certified ISTDP-therapist, trained by Jon Frederickson, Tobias Nordqvist and Peter Lilliengren. Currently he’s in Jon Frederickson’s Training of trainers program to become an ISTDP teacher and supervisor. He’s also on the board of the Swedish society for ISTDP and doing ISTDP-research part-time. Before doing ISTDP he specialized in dialectical behavior therapy, DBT.
PRE-CORE is a prerequisite for later entering ISTDP Core training, which is the three year program to become a certified ISTDP therapist. Thomas Hesslow and Liv Raissi are planning for a Core training in Helsinki starting during fall 2020. More information on this is due later this spring.
For more information about the ISTDP PRE-CORE in Helsinki and details for registration, please download the flyer in English, Finnish or Swedish.
CANCELLED. Due to the coronavirus pandemic, this event has been postponed (2020-03-12)
This is an interview with Kristy Lamb, who’s a psychiatrist and ISTDP clinician in California. For the past few years, she’s been running an outpatient clinic – BOLD Health – which treats addictions using an intensive format of ISTDP.
It’s been two years now with the BOLD clinic if I’m not mistaken. How does it feel? What have you learned? We started BOLD Health in March of 2017, so we are coming up on our 3 year anniversary already. It’s all really exciting – so much has happened over the past 3 years.
Trained as a physician in Family Medicine and Psychiatry I had no background at all in business before this. So it has been a wild ride of learning as I go, trying to balance all the different aspects of the project. Learning about running a business and being an entrepreneur with regular supervision and deliberate practice for the clinical development of my staff and myself.
For better or worse, much of the learning about the business has been trial and error. So much of what I didn’t know, I didn’t realize until some issue or crisis and it was in working through the crisis that I learned. I think it is much this way in therapy that you know what to do and how to do it until you come across something new, and then, the working through, the attunement and attention to the response to intervention, helps build your working model.
What’s the background of the clinic? How are things developing? When I first graduated from residency (after five years of training in family medicine and psychiatry after medical school), I was working in a number of different environments practicing both general medicine and psychiatry from a concierge clinic to a homeless shelter and even in the jails. I had a passion for serving underserved and marginalized populations, but wanted to expose myself to all different clinical environments to see how things worked. It was clear that the system in the US creates a great chasm between the haves and the have nots.
In the county clinics I had 15 minutes to see a patient and taking extra time to do any type of therapy was frowned upon because the system was so impacted. However, in the concierge, pay-for-service model I could spend as much time as I needed with people and as you’d expect those patients got better. So I set out to start a private practice in order to have the time and space to hone my skills in ISTDP but eventually to build space to do research so we can show the long-term cost-effectiveness of ISTDP and bring the model back to the community setting. And that’s where things are now.
Why is ISTDP a suitable treatment for addictions? Aren’t there other psychological models with more scientific backing? This is such an important question. With the number of people dying from substance use each year growing exponentially, it’s imperative that we are figuring out what treatments work and what treatments don’t work. Unfortunately, in the US over 90% of treatment programs are based in the 12-step model which has only about an 8% success rate. It has no scientific backing and was started as community support, not treatment. We are certainly not against the 12-step program and encourage our patients to engage in the community of 12-step. But we also recognize that substance dependence requires psychological treatment and often medications in the early stages if patients are to have sustained sobriety and more so, sustained success in their lives.
In regard to why ISTDP is such a great model for addiction treatment, it really comes down to the way we conceptualize addiction – as Jon Frederickson says, “We are all addicted to avoiding reality.” We all use different mechanisms to numb and avoid the reality of our lives and drugs and alcohol are just one way we do this – so some people go to TV, or work, or exercise, or compulsions.
Any of our defenses can be seen as a mechanism to avoid what we are feeling. Drugs and alcohol are no different and once someone is no longer under the influence by just abstaining from the substance, they can start to look at what was driving the numbing that, in this case, can be lethal. When the substances are seen as just another defense it is clear that ISTDP is a perfect model to treat the human disease of affect intolerance.
I think another reason why ISTDP is so important in addiction are the interventions that provides the therapist with a clear and direct way to address the common defenses in this group. Handling projection of will, projection of omnipotence, denial, helplessness and hopelessness, and anxiety regulation. All of which are imperative if treatment is to be successful.
What’s the treatment format, length of treatment, rules etc? And how did it come about? Our treatment program averages 10 weeks depending on the patient’s level of acuity. When a patient signs up for the program they undergo neuro-psychological testing, a commitment interview assessing their will for engagement in treatment and then start the program with groups 3-5 days per week, once per week individual therapy and once per week as needed medication management appointments.
Each day consists of 30 minutes of biofeedback, an hour of group psychoeducation and then an hour and a half of what we call The BOLD Seat which is structured group therapy. All the group members are given an opportunity to take the BOLD Seat in front of the group to look at a specific problem for the day with the therapist leading the group. The other patients observe and participate, helping that patient see anxiety and defenses. Also, watching your peer gives you the opportunity to see yourself objectively as you may resonate with what the person in the BOLD Seat is saying but be able to see it from a different, more compassionate, distance.
I had the good fortune of meeting Jon at a week-long training in Whidbey Island, WA, in 2016 and I was just starting to look at group therapy for addiction. We then started working on expanding the previous work that had started in Arizona and now, four years later, here we are. Jon has been an integral part of our development not only for the structure of the program but he provides weekly supervision to our team and has helped establish the ethos of the clinic – compassion, respect and integrity.
What are some of the challenges when doing ISTDP with persons who struggle with addictions? Really there is no difference in treating someone with addiction problems than any other patient if the patient is currently sober. Jon Frederickson often talks about the notion that there are specific criteria necessary to actually have a patient in the room. You can’t do therapy with someone who is actively intoxicated so monitoring for this is critical.
That being said, as we are an addiction treatment center we have to be sensitive to still welcoming people who are ambivalent about their treatment or struggling to maintain sobriety. We have to greet them with compassion and honesty: they may need a residential program or an inpatient detox or a residential program to begin with. So they can really get some time away from the drugs or alcohol, so that they later can get the most out of our program.
Accordingly, when we screen for use during the program we work to approach the patient with compassion and understanding to let them know that relapse is common. And we don’t have a right or a need to punish them, but rather use the testing as just information to let us know if their will for engagement in treatment is aligned with their actions. Knowing that that sometimes it’s not, and we just have to pull back and get clear about where they are and what they want for themselves. We work really hard not to own the will of sobriety in any of our patients.
Many patients in recovery haven’t connected to their internal motivation for treatment. They are in program because of their partner, or parents, or job, or the law are setting an ultimatum. We have to work really hard to get clear that unless the patient wants to engage, treatment won’t work.
What’s it like to do a core training with your fellow colleagues and staff? It feels like such a gift to be doing core training with our staff. When we started, part of the collaboration with Jon Frederickson was to start a new core training cohort with our staff and weekly supervision with him and Esther Rosen.
My first core training with Patricia Coughlin was personally life changing and the people I met there have become lifelong friends. But it has been a totally different experience to have all of my work colleagues now be a part of the quarterly intensive training. And for us to be able to come back to BOLD and stay motivated between core trainings with weekly skill building and supervision. So many things in place to keep focus.
It really feels like a dream to be working in a clinic based in ISTDP. Even during our lunch breaks we are chatting about defenses, portrayals and psychodynamic understandings of our patients. It creates an environment of support and collaboration like nothing I have ever experienced in any other work environment. I am incredibly grateful to Jon and our whole team for building this space.
In the swedish context there’s quite a lot of talk about deliberate practice nowadays. What are you struggling to learn right now as a therapist? I am a big fan of deliberate practice and have seen how deeply it changed my work. In 2016, I took a short course in deliberate practice and then had ongoing supervision with Tony Rousmaniere. I couldn’t agree more with Tony’s notion that the therapist’s own work is the glass ceiling between good providers and great providers. It is only when you can notice and work through your own “stuff” that comes up in sessions that you can really be present with the patient in front of you.
So the deliberate practice related to skill building is wonderful and undoubtedly makes for improved outcomes, but it is the personal work that Tony taught me that I find the most difficult and the most important. What I need to pay attention to so I can know when my anxiety comes up, where I might unconsciously avoid going with my patients, or biases I might have from my own life experiences. It is through this internally focused deliberate practice that I have been able to become more present and more available to my patients, which results in markedly more effective work. This work takes a lot of effort: making time and space for watching my own videos and – as importantly – making time for my own self-care and therapy.
If you dream a bit, where would you like ISTDP and addiction psychiatry to go within the next 5 or 10 years? Thank you for asking! I happen to be someone who sets goals that I think others often think are idealistic or impossible but at BOLD we encourage our staff to dream wildly about what can be.
I deeply believe in this model and want to see it become the standard of care for addiction treatment. We are looking to start a revolution and would love to see the BOLD Method be known across the world as the most effective treatment of addiction. Dream big! Right?
I would also love to see our clinic running as an incubator where we can continue to hone the model and build a body of research that supports what we are doing, as well as become a training facility so that we can support others to engage in this model of treatment.
If you liked this Kristy Lamb interview, maybe you’ll appreciate some of our other interviews. Below, you’ll find a list of our five most recent ones.
How did it feel to present to a swedish audience? As you know, this was actually my first time both visiting Sweden as well as teaching. I was very happy to see some old friends who I’ve met at past conferences, meet many engaging new colleagues, as well as make some new friends. It was a pleasure to be with you in Sweden and to see how your ISTDP community is growing!
You presented some thought-provoking ideas for modifying the graded format of ISTDP, managing the thresholds differently. Can you explain your perspective on this? And how is it different from the standard graded approach? With the graded format, I was trained to first think about the use of ‘pressure’ to mobilize complex feelings. Next, we look for a threshold to detect when the patient is struggling to intellectually hold in mind complex emotional states and instead become flooded with anxiety. At this point, the therapist helps to reduce anxiety using different strategies. One observation around the clinical application of this approach that I spoke about during the workshop is how easily we can teach the process as though there are explicit “go” and “stop” signs.
The concept of a threshold can be helpful when initially learning this approach in order to avoid too much anxiety being triggered. But viewing patient tolerance more as a Threshold Window can allow therapists to involve patients more in the process, and help them better learn to self-regulate. I’d describe this more as principle we can be aware of during learning, teaching and supervision that can allow therapists to begin to incorporate what Allan Abbass has called “bracing” interventions. This can be done instead of formal recapping or other anxiety regulating interventions.
You offered some modifications to the phase of inquiry that were very well received by the swedish audience. How did that come about? It’s something that I noticed over time when I was reviewing trial therapy tapes. I felt like I was missing something if I wasn’t asking patients about feelings, clarifying anxiety or defences within the first few minutes. However, there were other occasions when I was using these kinds of interventions early in sessions – but I would be left questioning why am I doing this and how helpful is was. This made me think about some of the learning challenging when teaching. And it made me rethink the timing of the transition from ‘inquiry’ to phases of structured ‘pressure’ in ISTDP.
In Gothenburg, I showed a tape in which the patient came into a trial therapy exhibiting a mixed bag of responses that we might consider examples of unconscious anxiety and defence combined. In the tape, I didn’t comment explicitly on these processes for around 10 minutes and instead stuck with a phase of inquiry. The subsequent group discussion raised some good questions about the importance of the pace and timing of therapist interventions early in sessions. The audience appeared to appreciate me saying that it isn’t always entirely clear what is happening moment-to-moment, so collecting more data from sitting with the patient can be helpful.
I think in our effort to provide and teach “intensive short-term” treatments we can easily prioritise the need to intervene. We even sometimes intervene before we understand why we are intervening. During the 2-day seminar it felt like we were able to have a very a constructive discussion about these issues. My thought is that these are likely learning and training challenges in ISTDP as much as they are about technical elements related to the phase of inquiry in treatment.
What are you struggling to learn as a clinician right now? I have begun seeing a series of patients with chronic symptoms that have an explicit behavioural component such as OCD (e.g., compulsive behaviours), Tourette’s and other tic-based presentations. There hasn’t been a lot written on this topic around the use of ISTDP and in my experience these cases present infrequently to dynamically orientated therapists. It’s been a challenge and learning curve to think about how to adapt and tailor a dynamic approach to specifically target change in symptoms that involve repetitive behavioural patterns.
For instance, in ISTDP I would aim to help a patient see harmful patterns and behaviours so that they become motivated to interrupt them independently. In contrast, a traditional CBT exposure and response prevention approach involves a more directive therapist stance in advising a patient to prevent the ‘response’. In the cases I have treated so far, I am struck by how much emphasis there has needed to be on an explicit therapist stance towards response prevention. I think it is a subtle but significant shift for the ISTDP therapist to focus on interrupting an explicit in-session behaviour like a vocal tic in contrast to purely intrapsychic defences.
What are some of the current challenges for the further development and dissemination of ISTDP globally? One of the challenges for the dissemination of any psychotherapy is having the means to effectively train others to deliver the treatment. Over time, through these dissemination efforts, if enough clinicians can be trained to become both effective therapists and trainers themselves, there reaches a critical mass at which point the treatment is readily accessible for patients. There are probably only a handful of therapies which can be said to have achieved this globally.
The manualisation of psychotherapies has been a key part of what has made this possible. However, the development of treatment manuals to treating mental health as discreet “disorders” defined by symptom clusters is problematic. I think this paradigm has contributed to the numbers of patients who fail to remit or relapse following psychotherapy generally. In contrast, I think ISTDP is best described as an approach that is fundamentally built to achieve ambitious changes in personality. While my own experience as a researcher and clinician confirm that this is possible, as with other therapies, therapist factors and patient factors contribute significantly to outcomes.
I think the ISTDP Core Training programs conducted in the last decade indicate that there are many elements to ISTDP that can be taught to a broad group of therapists. The programs teach the delivery of effective treatment that is likely comparable to the outcomes achieved in other treatments. However, my current view is that I think there are other elements of ISTDP that are very difficult to learn, particularly given the training resources typically available to most therapists (e.g., access to and frequency of supervision).
If some of the more difficult-to-learn treatment elements were emphasized less, akin to dropping the ‘intensive’ from ISTDP, I think we would have a treatment that could be more easily disseminated globally. It is arguable that in doing so, we could compromise the nature of the changes possible in treatment by de-emphasizing the elements that promote personality level changes. This is a question that would need addressing empirically.
Do you think we should drop the “intensive” then? Or what do you propose? I don’t think the field needs a new treatment with a new acronym. What I am pointing out is that there are different elements to ISTDP that require different competencies to be taught and adequately mastered by a therapist. If attempting to gain competency in multiple domains limits the transferability of the treatment, I am proposing that therapists can be trained and encouraged to utilise specific elements as they are able.
This type of learning environment might help therapists to flourish and grow rather than to become discouraged and drop-out. Perhaps within the field of psychotherapy training there is a risk that in an effort to maintain the presumed integrity of the treatment, it is very possible that the alliance between therapists and their trainers/teachers can be adversely effected. I think this is a central challenge around the dissemination of ISTDP.
Do you have any upcoming research in the pipeline? I am just preparing a manuscript describing the 12-month post treatment outcomes and a cost effectiveness analysis from the Halifax Depression Study. This a randomized controlled trial that compared the outcomes of time-limited ISTDP against the effects of secondary care community mental health team treatment for treatment resistant depression (TRD). We published the initial findings in the Journal of Affective Disorders in 2017 showing ISTDP is an efficacious treatment for TRD with 36% of patients reaching full-remission at the end of treatment. The follow-up findings are also very encouraging.
What’s your vision for the future of ISTDP? Currently there are very few academic centres around the world in which ISTDP research is being conducted. For the growth of any treatment, research is an important part of dissemination alongside offering the possibility of innovation in methods and technique. In particularly, as a clinical psychologist and researcher having both trained and conducted clinical trials in ISTDP, I think my understanding of some the teaching and learning challenges around ISTDP has been enhanced greatly by this work. Moving forward, I would hope there are increasingly more opportunities for people at all stages of learning to be involved in ISTDP training and research within academic centres of excellence.
If you enjoyed this Joel Town interview, you might find our other interviews interesting. You can find the whole list here. Below you’ll find a list of five of our most recent interviews:
In April, the polish ISTDP therapist and teacher Beata Zaloga visits Göteborg for a one-day workshop on the topic of fragile character structure. Fragile character structure refers to patients whose identity is fragmented and dependent on primitive defenses such as projection, somatization and splitting.
Fragile character structure represents one of the greatest challenges in the psychotherapeutic field. The group of patients with this profile suffer from longstanding difficulties with projection, denial and splitting, often resulting in severe psychiatric symptoms including borderline personality organization. In ISTDP, a combination of the graded format and structural integration is needed to help patients build more emotional capacity and a more stable sense of self. Over time, increases in emotional capacity allows feelings to break through into consciousness.
This case presentation will show you how to:
Help the patient to face feelings they avoided through their self-neglect
Help the patient see and let go of defences of somatization, weepiness and projection
Use the technique of bracing to build the capacity to bear feelings without using primitive defences
Help the patient process unconscious feelings so they do not need to ward them off through self-punishment.
Beata Zaloga brings a uniquely warm and delicate touch to the therapy encounter. Another reminder of how different voices around the world give us a richer perspective on how ISTDP can embody the human encounter.
For more information about this Beata Zaloga workshop and registration, see this flyer.
In October, Jon Frederickson invites you to a workshop in Göteborg on how to use ISTDP in the treatment of “character resistance”. Character resistance refers to patients who are heavily identified with self-negligent and self-destructive behaviors.
Imagine you meet a patient who has defeated every therapist he has seen for thirty years. He’s not sure he has a problem. He’s not sure anyone can help him. He has given up. He thinks his previous therapist was “bullshit.” He has come only because someone sent him. Then he asks: “What should I do here?”
How do we begin therapy if no problem is declared? Can we explore anything if it is not the patient’s will to do therapy? What’s a good way to handle projection? What do we do when the patient devalues the therapist? In this presentation of a videotaped initial session, Jon Frederickson will show how to work with treatment destructive defenses that would prevent any therapeutic alliance from forming. The case will also show how to mobilize an unconscious therapeutic alliance when there is no conscious therapeutic alliance.
In this workshop, you will learn how to:
Maintain a therapeutic focus in the face of provocation and acting out.
Mobilize the patient’s will to the task.
Turn the patient against his treatment destructive defenses
We will go through the videotape moment by moment to show how to assess and intervene on a microscopic level. The emphasis will be not just on learning theory, but on developing intervention skills.
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:
To treat depression, we must know what causes it. And by learning to assess each patient response, we can figure out what causes depression even in the therapy. Then we can address the cause and help the patient overcome her depression.
In this videotape presentation of a therapy session, we will learn how to identify what makes patients depressed so we can help them recover. The patient had suffered for years in spite of various therapies. She had a pattern of overworking, doing the work of others, and not being able to stand up for herself. Her husband was unemployed by choice, so she was the sole source of support. Due to her self-criticism, she couldn’t see her genuine capacities and strengths.
Through the moment-to-moment analysis of the session, we will learn how to support depressed patients, how to help them build the inner strength they need to face the feelings they have feared, and how to help them bear together with us what they could not bear alone.
This one-day workshop will take place at Ersta Bräcke Sköndal Högskola on the 6th of March 2020. For information and registration, download this flyer.
CANCELLED. Due to the coronavirus pandemic, this event has been cancelled (2020-03-12).
As the writer William Faulkner once said, “The past is never dead. It’s not even past.” And what better example of that can we find than in the ways patients relive their traumas from the past in their present life. Every therapist knows that what patients cannot put into words they will put into action. The question becomes: how do we help patients move from reliving their traumas in therapy to being able to work through those traumas so that they become free to live into life in a new way.
We will study a videotaped three-hour initial session with a woman who had been in therapy for over twenty years. Her therapy had helped her understand her past cognitively, but it had not changed her emotionally. She was still suffering from depression, anxiety, and a series of relationships with abusive men.
to help patients work through traumatic memories and experiences.
how to help patients bear what was once unbearable.
how to link bodily experiences in therapy with past traumas.
how to deactivate projections onto the therapist.
how to help patients move from reliving the past to living in the present.
The event will take place on the 26th of March in downtown Helsinki. For more information and registration, here´s a flyer. For information in Finnish, follow this link.
CANCELLED. Due to the coronavirus pandemic, this event has been cancelled (2020-03-12).
Here’s another interview on the topic of the recent IEDTA-conference. This time we sit down with the IEDTA Vice President and Head of education, Leone Baruh, and talk about the conference as well as the newly developed format of ISTDP for families and couples: TIF.
How do you feel about the Boston conference? The conference exceeded my expectations in many ways. I experienced the Boston meeting with pleasure and enthusiasm, enjoying the fruits of the hard work of integration, carried out over the past 5 years, between models and different people. I joined the IEDTA Board during the 2014 Washington conference. Besides me, that Board included five wonderful persons: Michael Alpert, Kees Cornelissen, Allen Kalpin, Nat Kuhn and our inexhaustible president Kristin Osborn. I will be forever grateful to Kristin for having marked the path we are following. The personal goal that I set for myself at the time can be summed up in a word shared by the entire board: inclusivity. I believe that the fifty and more Boston presentations explain and show how much the IEDTA community has matured over the years.
What did you find most surprising or exciting about the conference? The curiosity and the open-mindedness of the participants. When I heard the questions and answers at the end of the presentations I felt that openness, and not controversy, prevailed. I realized that our community is finally ready to grow up and become an adult.
Was there any specific contribution that stood out to you? I was impressed by the value of the presentations overall. With so many contributions inspired by all the different souls of IEDTA, there was a real risk that quality would be compromised. Instead I saw young colleagues so eager to share and show their intuitions, so able to amaze us with the quality of their therapies that, at the end of the first day, I decided to leave (with great sorrow, I have to admit) the great hall and focus on lesser-known topics and speakers.
Can you tell us about your contribution at the conference? The entire board worked hard for about two years to make the Boston conference a success and we’re proud of the result in terms of participation, climate and overall satisfaction. There’s no need to specify everyone’s contribution because we all did our best, but we all owe a debt of gratitude to Nat Kuhn for taken over a double role: President of the IEDTA and organizer of the conference. A personal sacrifice that only a few would have accepted in his place. Thanks Nat.
Moving on to the topic of TIF, how did you end up developing ISTDP for families and couples? The full story is a long one and I’m afraid it might bore your readers. To summarize, I can say that in the nineties as a young psychologist, during my specialization in ISTDP, I saw for the first time the videos of Davanloo and Sifneos. I also had the good fortune to know privately and collaborate professionally with Gianfranco Cecchin. Boscolo and Cecchin are worldwide known for having founded the Milanese Family Therapy Center, better known as The Milan Approach.
In the nineties in Saronno we experimented with the first form of family therapy centered on the symptoms and problems of children. The team was composed of Cecchin, two extraordinary child neuropsychiatrists and a me as a young psychologist. It was a short and intense period. Unfortunately no clinical evidence was kept – I only have anecdotal memories from that time. After twenty years of working with ISTDP I felt a growing desire to better understand that Saronno period and to check if it was possible to create cross-fertilization spaces between those two worlds: ISTDP and family therapy.
In Italy I’ve been collaborating for years with a fantastic group of experienced ISTDP therapists ready to take up and share the challenges that I launch. Thus came about the core training in Bologna, Castelfranco Veneto, Rimini and Padua. This is also how the exciting challenges related to ISTDP applied to the context of professional sport and to couples, families and children within families were born.
Can you tell us some of the things you’ve learned while developing TIF? The TIF formula (Intergenerational Family Therapy) prescribes the presence of at least two therapists who take charge of the family in a constant positive reciprocal communicative attitude. If these two therapists are inexperienced in couple dynamics, the therapists become three and the third will have the function of supervisor of the two therapists. Three therapists are provided even if the symptomatic patient is only one – the child. The last frontier of TIF – what we’re in the process of developing now – is an ISTDP-informed therapy for children and adolescents. Up until now, we’ve been using techniques from CBT when dealing with the symptomatic issues of the children.
Working with TIF, we’ve learned a lot about our own vulnerability to splitting and projections, and how easy it is for therapists to fall into the trap of thinking that the problem is not in the couple’s relationship, but in one of the two partners. Being an expert therapist has partially mitigated this attitude, but it’s hard work.
What can you tell us about the outcomes of the 40 families so far treated with TIF? I could lose myself in the amount of information we are acquiring thanks to the outcomes (and insights) on the families treated. In the coming years we’re planning to present and better teach the model in the centers that will request our help. We have contacts with different contexts in Europe and the USA and we are open to new collaborations.
If I must choose a single aspect that captures my interest in this period, I’d say that it concerns the correlation (not yet statistically evaluated) between pressure to awareness and outcome. As ISTDP clinicians, we are used to thinking of Pressure as pressure to feeling and to believe that without emotional breakthroughs it’s difficult to achieve significant and stable results. If this is true for individual therapies, it may not be so for couples. My hypothesis is that some types of couples that struggle to function correspond to patients that in ISTDP we would evaluate on the fragility spectrum. This seems to be true even when the two persons that form the couple aren’t fragile. According to this hypothesis, the pressure to awareness helps the couple become more capable of intellectualizing about their difficulties and conflicts, and it contributes to shifting the couple from the territory of fragility to the territory of neurosis.
What would you like say to people thinking about going to the next conference in Venice in 2021?We have the serious intention of making Venice 2021 a mythical event! IEDTA congresses are always a great opportunity for professional enrichment and, keeping the value of the presentations at a very high level. This time we wish to favor the relational, human and interpersonal dimension. We want this conference to be an unforgettable experience not only for the therapist, but also for the precious human being who lives it. We want it to be amore.