Seminar 9: Introduction To Davanloo's Intensive Short-Term Dynamic Psychotherapy With Highly Resistant Patients

Introduction to Davanloos Intensive
Short-Term Dynamic Psychotherapy

With Highly Resistant Patients
Directors:
Date:
Time:
Location:
Alan Beeber, M.D.

Gary Gala, M.D.
Monday, May 5, 2014
8 AM - 12 noon
New York Hilton Midtown
Bryant Suite
Seminar 9
American Psychiatric Association New York, NY, May 3 - 7, 2014 167th Annual Meeting
Seminar9
EducationalObjectives:
Attheconclusionofthissession,theparticipantshouldbeableto:1)Identifythe
psychodynamicforcesunderlyinghumanpsychopathologyinabroadrangeof
patients;2)IdentifyanddiagnosethemanifestationsofMajorResistanceinthe
psychotherapeuticprocess;3)Identifyanddescribethemainelementsof
Davanloo'stechnique;and4)Acquireanunderstandingofthecrucialelementsof
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Seminar9
COURSEFACULTY
Director:
AlanBeeber,M.D.
Faculty:
GaryGala,M.D.
Agenda
The materials contained in this packet were submitted
and reviewed by the course /seminar director(s) and
were correct at the time of print. Any changes to the
material that were made after the review deadline
are the responsibility of the course/seminar director(s).
Introduction to Davanloos Intensive ShortTerm

Dynamic Psychotherapy in Highly Resistant Patients

Schedule of Presentations
1:00
1:10
1:30
2:30

2:45

3:30

4:30
4:55

Introduction and Announcements

Overview, and History

Davanloos Metapsychology
Break
10 min. Dr. Beeber

20 min. Dr. Gala
1 hr. Dr. Beeber
Audiovisual presentation I
45 min. Dr. Beeber
This presentation will focus on the early phase of an initial interview with a highly resistant
patient with mixed symptom disturbance and syntonic character pathology. The emphasis
will be on the psychodiagnostic process. The technique of application of the phases of
inquiry, pressure and crystallization of the character defenses in the dimension of the
transference will be demonstrated.

Time will be divided as follows:
10 min.
introduction of the case and central concepts
25 min.
video vignette
10 min.
discussion by Dr. Gala and questions from participants

Audiovisual presentation II

1 hr. Dr. Beeber
This presentation will focus on the later phases of the initial interview with the same patient.
The emphasis will be on the technique of mobilization of the transference component of the
resistance, head on collision with the resistance and removal of the major resistance.
Mobilization of the direct experience of the transference feeling will be demonstrated which
leads to direct access to the unconscious pychopathological nuclear structure.

Time will be divided as follows:
10 min.
introduction of the case and central concepts
30 min.
video vignette
20 min.
discussion by Dr. Gala and questions from participants

Group discussion by Faculty and Participants 25 min.

Feedback and Adjourn
Outline


Outline of presentations

Introduction and Announcements

Dr. Beeber

Overview, and History

Dr. Gala
History of the development of shortterm dynamic psychotherapies
Development of Davanloos technique based on clinical research
Development of Davanloos metapsychology, the problem of resistance
Davanloos Metapsychology

Dr. Beeber
Spectrum of psychopathology treatable with Davanloos Intensive ShortTerm
Dynamic Psychotherapy (DISTDP)
Psychopathological dynamic forces. The role of Fusion.
Central Dynamic Sequence
Adverse phenomena avoided by DISTDP
Contraindications to DISTDP

Audiovisual presentation I

Dr. Beeber

Video vignettes of the early phase of an initial interview with a highly resistant
patient with mixed symptom disturbance and syntonic character pathology. Focus
will be on the psychodiagnostic process.
Technique of application of the Central Dynamic Sequence, phases of Inquiry and
Pressure will be demonstrated. Rapidly identification of the discharge pattern of
unconscious anxiety and the patients capacity to tolerate anxiety.
Nature of the defensive structure including tactical and characterological defenses
will be illustrated.
Pathway to direct access to the Unconscious will be elucidated. Further application
of the phase of Pressure to crystallize the patients characterological defenses in the
dimension of the Transference. Preparation for turning the patient against his
destructive defenses (making syntonic defenses dystonic).

Audiovisual presentation II

Dr. Beeber
Video vignettes of the later phases of the initial interview with the same patient.
Technique of mobilization of the Complex Transference Feeling (CTF), the
Transference Component of the Resistance (TCR), Head on Collision with the
destructiveness of the resistance and removal of the Major Resistance.
Mobilization of the direct experience of the CTF, which leads to dominance of the
Unconscious Therapeutic Alliance over the forces of the Major Resistance
Mobilization of the Neurobiological Pathways (NBP) of Murderous Rage, the NBP of
Guiltladen and Griefladen unconscious feeling.
Direct access to the unconscious with the first view of the unconscious
pychopathological nuclear structure. Recap and Consolidation.

Group discussion by Faculty and Participants

Slides
INTRODUCTION TO DAVANLOOS
INTENSIVE SHORT-TERM DYNAMIC
PSYCHOTHERAPY WITH HIGHLY
RESISTANT PATIENTS
Course Director: Alan R. Beeber, MD.

Professor Emeritus of Psychiatry
Faculty:
Gary J. Gala, MD.

Associate Professor of Psychiatry
UNC School of Medicine
Chapel Hill, NC
Disclosure: Alan Beeber, MD

No significant financial or affiliation interest with
goods/organizations regulated by Food and Drug

Administration that may have a direct or indirect interest in
the subject matter of this program.
Disclosure: Gary Gala, MD


Acknowledgments
Habib Davanloo, MD
Professor Emeritus, McGill University
DAVANLOOS INTENSIVE SHORT-TERM

DYNAMIC PSYCHOTHERAPY :
OVERVIEW AND HISTORY
Gary J. Gala, MD.

Associate Professor of Psychiatry
Associate Chair for Education
Chapel Hill, NC
Disclosure: Gary Gala, MD


Overview
History of the development of short-term dynamic
psychotherapies
Development of Davanloos technique based on clinical
research
Development of Davanloos Metapsychology, the problem
of Resistance
History of STDP: Contributions of Habib

Davanloo
Psychoanalytic background
Influenced by Zetzel, Deutsch, Alexander
Disillusioned with the increasing length of analysis
Disillusioned with intractable Transference Neurosis/analysis
interminable
Developed Short Term Dynamic Psychotherapy
Initial focus on highly responsive patients
Emphasis in early work was on interpretation of T-C-P link
Expanded the spectrum of patients who could be treated
with Intensive STDP
Davanloo, H. , (2001) Intensive Short-Term Dynamic Psychotherapy: Selected Papers of Habib Davanloo, M.D.
The Problem of Resistance

Resistance was central to Freuds theory of
Psychoanalysis and of the Unconscious

Secondary and primary gains from neurotic disturbances
derived from resisting giving up the neurotic illness
The Problem of Resistance II

"It may thus be said that the theory of psycho-analysis is
an attempt to account for two observed facts that strike

one conspicuously and unexpectedly whenever an
attempt is made to trace the symptoms of a neurotic back
to their source in his past life: the facts of transference
and resistance. Any line of investigation, no matter what
its direction, which recognizes these two facts and takes
them as the starting-point of its work may call itself
psychoanalysis, though it arrives at results other than my
own
Freud, S. (1959). "Inhibitions, symptoms, and anxiety". In J. Strachey (Ed. & Trans.) The standard edition of
the complete psychological works of Sigmund Freud (Vol. 20, pp. 75175). London: Hogarth Press.
(Original work published in 1926.)
Resistance of Repression
Freud wrote optimistically in 1914,
the doctor uncovers the resistances which

are unknown to the patient; when these have
been got the better of, the patient often relates
the forgotten situations and connections without
any difficulty.
Freud S. Remembering, Repeating and Working-through. In: Standard Edition of the Complete Psychological
Works of Sigmund Freud. Vol 12. London: Hogarth Press; 1996:145156.
Resistance of the Superego I
In 1926 Freud wrote pessimistically,
The unconscious sense of guilt represents

the superego's resistance. It is the most
powerful factor, and the one most dreaded by
us.
Freud S. The Question of Lay Analysis. In: Standard Edition of the Complete Psychological Works of
Sigmund Freud. Vol 20. London: Hogarth Press; 1996:177250.
Resistance of the Superego II

In Analysis Terminable and Interminable, 1937 Freud wrote much more
pessimistically,
For the moment we must bow to the

superiority of the forces against which we see
our effort come to nothing
Freud S: Analysis Terminable and Interminable. In: Standard Edition of the Complete Psychological Works
of Sigmund Freud. Vol 23. London: Hogarth Press; 1996:209254.
Davanloos contributions:
Developed technique of Mobilization of the Unconscious
Developed technique of Total Removal of the Resistance
Developed the techniques of ISTDP and Block Therapy,
as well as a method of psychoanalytic investigation and

Multidimensional Unconscious Structural Change
DAVANLOOS METAPSYCHOLOGY
Alan R. Beeber, MD.

Chapel Hill, NC
Davanloos contribution III:

Developed technique of Mobilization of the Unconscious
Rapid mobilization of tactical and characterological defenses
Rapid activation of transference feeling
Crystallization of the Resistance in the Transference
De- fusion of primitive murderous rage, sexualized feeling and guilt
Direct access to the psychopathological dynamic forces (Davanloo,
1988)
Mobilization of the Unconscious

Depends heavily on the development of the Twin
Factors of:
Transference Component of the Resistance
Complex Transference Feelings
Davanloo, H. (2010). Annual Audiovisual Immersion Course: the technique of the Removal of
Resistance. Montreal, Que. , October 2010.

Affective responses predominate over Cognitive
responses
Unconscious Therapeutic Alliance predominates over
the forces of the Resistance
Davanloo, H. (1995). Intensive Short-Term Dynamic Psychotherapy: Spectrum of Psychoneurotic

Disorders. International Journal of Short-Term Psychotherapy, 10(3,4), 121-155

Major mobilization of the Transference Component of
the Resistance
Major mobilization of the Neurobiological Pathway of
Primitive Murderous Rage in the Transference
Guilt

Creates fluidity in the Unconscious
Provides a vivid portrait of the Pathogenic
Organization of the Unconscious

Brings about intrapsychic reorganization of the
defensive system; and increases capacity to tolerate
anxiety and painful affects.
Spectrum of Psychopathology
Highly responsive; single

focus; low resistance
High resistance; complex

symptom and character
pathology

Low Resistance
Highly Responsive
Circumscribed Problem
Single Psychotherapeutic Focus

Moderate Resistance
Diffuse Psychoneurotic Disturbances

Presence of Character Pathology
Multi-foci Core Neurotic Structure

High Resistance
Character Neurosis
Diffuse Symptoms and Character Disturbances
Highly complicated Core Pathology

Extreme Resistance
Diffuse Symptoms and Major Character Disturbances

Extremely Complex Core Pathology

Psychopathologic Dynamic Forces 1
Bond, Attachment
Davanloo, H. (1995). Intensive Short-Term Dynamic Psychotherapy Major Unlocking of the
Unconscious-Part II. The Course of the Trial Therapy After Partial Unlocking. International Journal
of Short-Term Psychotherapy, 10(3,4), 183-240
Pain of Trauma to Bond

Bond, Attachment
Primitive Murderous Rage

Bond, Attachment
Sexual
Primitive Murderous
Rage
Bond, Attachment
Guilt
Sexual
Bond, Attachment
Grief
Guilt
Sexual
Bond, Attachment

Character Resistance
Grief
Guilt
Sexual
Bond, Attachment

Resistance Against
Emotional Closeness
Grief
Guilt
Sexual
Bond, Attachment
Triangle of Persons
Transference
Current
Past
Triangle of Conflict
Defense
Anxiety
Impulse/Feeling
Unconscious Discharge Patterns of

Anxiety
Striated muscle tension

Smooth muscle e.g. irritable bowel or migraine
headaches
Cognitive and Perceptual system e.g. drifting of
thoughts or hallucinations
Benefit
Anxiety
Physiological Concomitants of Feelings

Rage
Fireball in abdomen, moves upward to chest, arms, hands; jaw,
biting.
Guilt
Deeply painful, high amplitude waves, chest, upper
bronchi/pharynx, gasping, +/- nausea
Grief
Lower amplitude, lower in chest, sobbing

Major mobilization of the Transference Component of
the Resistance
Primitive Murderous Rage in the Transference
Guilt
Resistance and the Unconscious

Therapeutic Alliance
R
R - Resistance
UTA - Unconscious
UTA
Resistance, Transference and

Unconscious Therapeutic Alliance
Intensity
Resistance
Complex
Transference
Feelings
Unconscious
Therapeutic
Alliance
Time
Davanloo
unpublished used with
H. Davanloo unpublished usedH.
with
permission
permission


pathology

Spectrum of Capacity to
Tolerate Anxiety
CAPACITY:
high
moderate
low
DISCHARGE PATHWAY :
striated muscle
tension
autonomic
cognitive and
perceptual
Adapted fromDavanloo, H. (1995). Intensive Short-Term DJournal of Short-Term Psychotherapy, 10(3,4),

121-155 ynamic Psychotherapy: Spectrum of Psychoneurotic Disorders. International
Spectrum of Psychopathology II
PROBLEMS:
focal
diffuse symptoms
RESISTANCE:
low
mild
moderate
high
syntonic
diffuse and
primitive
CHARACTER PATHOLOGY:
absent
or mild
dystonic
Adapted from: Davanloo, H. (1995). Intensive Short-Term Dynamic Psychotherapy: Spectrum of Psychoneurotic Disorders.
International Journal of Short-Term Psychotherapy, 10(3,4), 121-155
Spectrum of Psychopathology III
TRAUMA:
mild
moderate
severe
very serve - early

and/or repetitive
RAGE:
absent
murderous
absent
or mild
moderate
primitive
murderous
primitive
torturous mr
GUILT:
heavy
extremely heavy guilt

laden unc. feeling
Fusion
Fusion of Guilt and Primitive Murderous Rage :
a pathogenic destructive dynamic system in the unconscious.
A major task of the therapist is the rapid removal of this destructive
system
Age at the time of Trauma:
The earlier and more intense the trauma:
The more tenacious the fusion and the more resistant the feelings are
to mobilization
The more intense and primitive the unconscious rage
The more complexity in and hence the longer the duration of therapy
Davanloo, H. (2010, 2011), 31st and 32nd Annual A/V Immersion Courses on the Metapsychology of the Unconscious

Resistance Against
Emotional Closeness
Grief
Guilt
Sexual
Bond, Attachment
Fusion
Fusion of
Murderous Rage,
Sexual Feeling and
Guilt
Trauma to Bond
H. Davanloo unpublished used with permission
Bond, Attachment

(overview)
Phase 1 Inquiry
Phase 2 Pressure
Phase 3 Challenge
Phase 4 Transference Resistance
Phase 5 Direct Access to the Unconscious
Davanloo, H. (1995). Intensive Short-Term Dynamic Psychotherapy: Technique of Partial and

Major Unlocking of the Unconscious with a Highly Resistant Patient---Part I. Partial Unlocking of
the Unconscious. International Journal of Short-Term Psychotherapy, 10(3,4), 157-181

(overview contd)
Phase 6 Systematic analysis of the
transference
Phase 7 Dynamic exploration of the
unconscious
Phase 8 Consolidation/psychotherapeutic
planning

Conscious
Preconscious
Discharge
Pathway of
UCS Anxiety
Character
Defenses
Unconscious
Pathogenic
Organization
Conscious
Discharge
Pathway of
UCS Anxiety
Preconscious
Character
Defenses
Unconscious
Pathogenic
Organization
( fused rage/guilt)

Partial Mobilization
UTA
R - Resistance
UTA - Unconscious

Major Mobilization
UTA
R - Resistance
UTA - Unconscious
AUDIOVISUAL PRESENTATION I
THE DIAGNOSTIC PROCESS
Alan R. Beeber, MD.

Chapel Hill, NC
Phase 1 Inquiry.
Phase 2 Pressure

Central Dynamic Sequence 1

Phase 1,
Inquiry:
Exploring the patients difficulties: initial ability to
respond.
Psychodiagnostic in function
Davanloo, H: "Intensive Short-Term Dynamic Psychotherapy", in: Kaplan H., and Sadock B. (eds),
Comprehensive Textbook of Psychiatry, 8th ed, Vol 2, Chapter 30.9, 2628-2652, Lippincot
Williams & Wilkins, Philadelphia, 2005

Phase 2,
Pressure:
The aim of the pressure phase is to mobilize
resistance until resistance is tangibly crystallized

between the therapist and the patient.

Intensity
Resistance
Complex
Transference
Feelings
Unconscious
Therapeutic
Alliance
Time
Davanloo
with
permission
permission
Conscious
Preconscious
Discharge
Pathway of
UCS Anxiety
Character
Defenses
Unconscious
Pathogenic
Organization
Conscious
Discharge
Pathway of
UCS Anxiety
Preconscious
Character
Defenses
Unconscious
Pathogenic
Organization
( fused rage/guilt)
Case Presentation
23 year old man referred for ISTDP by a resident
Past history of polysubstance abuse (amphetamines,
cocaine, hallucinogens) with mood symptoms and

paranoid ideation. Abstinent for 11 mos.
Depression, paranoid ideation, generalized and social
anxiety, remote history of panic attacks
Case Presentation II
Difficulties in IPRs. Few friends, anxiety in intimate
relationships, strained relationship with Grandfather

Difficulties with anger. Temper tantrums, revenge
fantasies.
Treatment: Sertraline, quetiapine, atomoxitene. Referred
for psychotherapy, then for ISTDP.
Case Presentation III

Past personal history
Born/raised in NC
One brother 6 yrs. His junior.
Father was closest friend. Suicided when patient 8 years old.
Distinct memories of events. Mother looked like a corpse.
Strained relationship with Grandfather.
Graduated #2 in high school class, accepted to an Ivy but couldnt
go for financial reasons.
Video Vignette


pathology

Tolerate Anxiety
CAPACITY:
high
moderate
low
DISCHARGE PATHWAY :
striated muscle
tension
autonomic
cognitive and
perceptual

PROBLEMS:
focal
diffuse symptoms
RESISTANCE:
low
mild
moderate
high
syntonic
diffuse and
primitive
absent
or mild
dystonic
TRAUMA:
mild
moderate
severe
very serve - early

and/or repetitive
RAGE:
absent
murderous
absent
or mild
moderate
primitive
murderous
primitive
torturous mr
GUILT:
heavy

laden unc. feeling
AUDIOVISUAL PRESENTATION II
MOBILIZATION, REMOVAL OF
RESISTANCE , DIRECT ACCESS TO UCS
Alan R. Beeber, MD.

Chapel Hill, NC

(overview)
Phase 1 Inquiry
Phase 2 Pressure
Phase 3 Challenge
Phase 4 Transference Resistance
Phase 5 Direct Access to the Unconscious


(overview contd)
Phase 6 Systematic analysis of the
transference
Phase 7 Dynamic exploration of the
unconscious
Phase 8 Consolidation/psychotherapeutic
planning


Phase 3, Challenge:
Resistance needs to be crystallized to the point at
which it can be systematically challenged meaningfully

and effectively.

Phase 4, Transference
Resistance:
Intensification of the resistance and its transference
component, transference resistance

Mounting the challenge to the transference resistance

Phase 4, Transference Resistance
(cont.):
Head-on collision with the transference resistance to
bring the patient face to face with the selfdestructiveness of his or her resistance

Phase 4, Transference Resistance
(cont.):
Mobilization of the unconscious therapeutic alliance
against the resistance, which leads to the state of

intrapsychic crisis, or tension between the resistance
and unconscious therapeutic alliance

Intensity
Resistance
Complex
Transference
Feelings
Unconscious
Thrapeutic Alliance
Time
H. Davanloo unpublished used with
permission

Phase 5, Direct Access to the
Unconscious, Major Direct Access to
the Unconscious:
Mobilization of the neurobiological pathway of the
primitive murderous rage and its passage in the

transference. This is immediately followed by

the Unconscious:
The emergence of sadness, a further affective
response indicating that the intense guilt feelings are

mobilized but have not yet been experienced
consciously.

the Unconscious:
The patient attentively looks at the visual imagery of
the murdered damaged body of the therapist, and then

the Unconscious:
The visual imagery of the murdered body of the
therapist is transferred to the visual imagery of the

murdered body of the biological figure of the early life
orbit of the patientmother, father, sibling,
grandparent, and so on.

the Unconscious:
It is important to note that, in this mental imagery, the
visual imagery of the murdered body of the therapist

appears exactly as does the visual imagery of the
murdered body of the mother, father, or siblingin
terms of the color of the hair, eyes, and so forth.

the Unconscious:
This visual imagery is extremely intensefor example,
the patient sees the visual imagery of the dead body of

the mother with blond hair and blue eyes, and the
visual imagery of the dead body of the therapist is no
longer present.

the Unconscious:
The actual experience of intense guilt-laden
unconscious feeling, which is an intense affective

responsea very painful experience that involves the
neck and the upper part of the chest.

the Unconscious:
The duration of the passage of the guilt averages 8 to
12 minutes in the first major unlocking. This is followed

by
The emergence of intense positive feeling toward the
people of the past and the actual experience of the
grief-laden unconscious feeling

the Unconscious:
Now, both the patient and the therapist have a first
direct view of the psychopathological dynamic forces

responsible for the patient's symptom and character
disturbances.

Phase 6, Systematic Analysis of the
Transference:
This is extremely important, particularly in patients with
panic, somatization, functional, and depressive

disorders.

Phase 7, Dynamic exploration into the
unconscious:
With the breakdown of the major resistance and major
mobilization of the unconscious therapeutic alliance,

the unconscious introduces the pain of trauma and
vivid incidences of traumatic events of the past, with
repeated breakthrough of the guilt and painful feelings.

Phase 7, Phase of Consolidation:
Extensive recapitulation and analysis of the whole
process
Exploring the patient's response and setting up
psychotherapeutic planning
Video Vignette II
AUDIOVISUAL PRESENTATION III

GRADED TECHNIQUE: PATIENT WITH
LOW CAPACITY TO TOLERATE ANXIETY
Alan R. Beeber, MD.

Chapel Hill, NC


pathology

Tolerate Anxiety
CAPACITY:
high
moderate
low
DISCHARGE PATHWAY :
striated muscle
tension
autonomic
cognitive and
perceptual

PROBLEMS:
focal
diffuse symptoms
RESISTANCE:
low
mild
moderate
high
syntonic
diffuse and
primitive
absent
or mild
dystonic
TRAUMA:
mild
moderate
severe
very serve - early

and/or repetitive
RAGE:
absent
murderous
absent
or mild
moderate
primitive
murderous
primitive
torturous mr
GUILT:
heavy

laden unc. feeling
AUDIOVISUAL PRESENTATION IV
PROCESS OF WORKING THROUGH
Alan R. Beeber, MD.

Chapel Hill, NC

Resistance Against
Emotional Closeness
Grief
Guilt
Sexual
Bond, Attachment
Fusion
Fusion of
Murderous Rage,
Sexual Feeling and
Guilt
Trauma to Bond
H. Davanloo unpublished used with permission
Bond, Attachment
Conscious
Discharge
Pathway of
UCS Anxiety
Preconscious
Character
Defenses
Unconscious
Pathogenic
Organization
( fused rage/guilt)

Intensity
Resistance
Complex
Transference
Feelings
Unconscious
Therapeutic
Alliance
Time
Davanloo
with
permission
permission
DAVANLOOSMETAPSYCHOLOGY:
PERSPECTIVESFROMANONISTDP
THERAPIST
GaryJ.Gala,MD.
AssociateProfessorofPsychiatry
AssociateChairforEducation
UNCSchoolofMedicine
ChapelHill,NC
Perspectives
SettingsinwhichtoapplyISTDPotherthanoutpatient:
strategiesandrationale
Durabilityoftheeffect:Whatistheevidence?
Howfarawayistheunconsciousanyway?ISTDPasamore
directapproach.
Whatdowemeanwhenwetalkaboutpartsoftheself?Is
theperpetratorahomunculus?
CochraneReviewofSTPP
Abbasetal:Shorttermpsychodynamic
psychotherapiesforcommonmental
disorders:CochraneDatabase:2006Issue4,
Art.No.CD004687
EfficacyofSTPPvs.minimalornontreatment
23studies/1431pts.InRCTs
Measuredgeneralsx,anxiety,depressionand
socialadjustment
CochraneReviewofSTPPII
Results
Significantlygreaterimprovementintreatmentgroupvs.
controls
Maintainedinmedium/longtermfollowup
Modesttomoderateoftensustainedgainsforavarietyof
patients
Limiteddataandheterogeneitybetweenstudies.
Abbass AA,HancockJT,HendersonJ,Kisely SR.Shorttermpsychodynamicpsychotherapiesforcommonmentaldisorders.CochraneDatabaseof

SystematicReviews 2006,Issue4.Art.No.:CD004687.DOI:10.1002/14651858.CD004687.pub3.
STDPEmpiricalBasis
Targetsunconsciousemotionalprocesses
>60CTs.>40RCTs
Efficaciouswithanxiety,depression,personality
disorder,andsomaticsymptomdisorders.Gainsare
heldinlongtermfollowup
(AndersonandLambert,1995,Leischering2004,Abbass,Kisely,Henderson
andHancock,Cochranereview,2006)
Equalothertherapiesforsymptomreduction
Superiortowaitlistandminimaltreatments
Superiortomedicationalone
EvidenceforpersistentCostEffectiveness(Abbass,
2002,2003)
SystematicReviewSTDPforSymptom
Disorders
23studies:13RCT,10CaseSeries
Conditions:IBS,ChronicPain,UrethralSyndrome,Chronicdyspepsia,
Ulcer,IschemicHeartDisease,COPD,CrohnsD.,RheumatoidD.,
Dermatitis,FunctionalMovementDisorders
91.3%hadsigsymptomreduction
91.6%hadsigsocialoccupationalgains
76.2%hadsigpsychologicalimprovement
77.8%hadreducedHealthcareUtilization:lesssurgeryinCrohns
andUlcerdisease.LesshospitaldaysinCrohns
SystematicReviewII
Metaanalysis:
SigeffectsforSomaticSymptoms,anxiety,depression
inSTandLT
SignificantlyfewerdropoutsinSTDPpatients.
Heterogeneitymeansinterpretresultswithcaution.
ShortTermPsychodynamicPsychotherapyforSomaticDisordersAbbass A.Kisely S.Kroenke K.

Psychother Psychosom 2009;78:265274(DOI:10.1159/000228247)
OverviewofISTDPOutcomeStudies
N=7RCTs
N=109patients,mostlywithPDs
Allbut1mainmeasurestatisticallysiggains
Robusteffectsizes
Superiortowaitlist/minimalcontactcontrols
Equaltoothersimilarmodels
EffectsmaintainedinMean1.5yearfollowup
N=1CT
N=166,Robusteffectsversuswaitlistcontrol
N=9CaseSeries
N=578
Robusteffectsizes.
Broadlyeffectiveintherealworld
Evidenceofpersistentcosteffectiveness
Mean2.5yearfollowupshowsgainsmaintained
ISTDPtechniqueappearsmorepowerfulthanolderSTDPs
DavanloosISTDPEmpiricalBasis
EfficaciouswithPD: Winston,1991,1994,Hellerstein,1998,Abbass in
press
BetterthanMedsaloneforpanic: Wiborg,1996
Effectivewithtreatmentresistantdepression,(Abbass,2006)
functionalmovementdisorders(Hinson,2005),Headaches
(Abbass,Lovas,PurdyinpressCephalalgia).
Efficaciouswithpelvicpain,urethralsyndrome(Baldoni 1995)
andchronicbackpain(Hawkins,2003).
86%ofpsychiatricofficereferralswerecandidates.Abbass 2002a
Outcomeproportionaltodegreeofemotionalexperience.
Abbass 2002a
ClinicallyEffectiveandcosteffectiveinrealworld Abbass 2002a

Datashowitislearnable Abbass,2004
SingleSessionbringssymptomreductionAbbass etalinpress
Background
Materials
References

References
Beeber A: The Perpetrator of the Unconscious in Davanloos new metapsychology,

Part I: Review of classic psychoanalytic concepts. Intl J Intensive ShortTerm Dyn
Psychother 1999; 13(3): 151157.

Beeber AR.: The Perpetrator of the Unconscious in Davanloos new metapsychology,
Part II: Comparison of the Perpetrator to classic psychoanalytic concepts. . Intl J
Intensive ShortTerm Dyn Psychother 1999; 13(3): 159176.

Beeber A.: The Perpetrator of the Unconscious in Davanloos new metapsychology,
Part III: Specifics of Davanloos Technique. . Intl J Intensive ShortTerm Dyn
Psychother 1999; (3): 177189.

Davanloo H: Basic Principles and Techniques in ShortTerm Dynamic
Psychotherapy. New York: Spectrum, 1978

Davanloo H: ShortTerm Dynamic Psychotherapy. New York: Jason Aronson, 1980

Davanloo, H. Unlocking the Unconscious: Selected papers of Habib Davanloo, MD.
Chichester, England. John Wiley and Sons, 1990

Davanloo H: Intensive ShortTerm Dynamic Psychotherapy: selected papers of
Habib Davanloo, MD. Chichester, England. John Wiley and Sons, 2000

Davanloo H: Intensive ShortTerm Dynamic Psychotherapy: Extended Major Direct
Access to the Unconscious. Euro Psychother 2001, 2(1): 2570.

Davanloo H: Intensive ShortTerm Dynamic Psychotherapy, in: Comprehensive
Textbook of Psychiatry, 8th ed, Vol 2, Chapter 30.9, Edited by Kaplan H and Sadock B.
Philadelphia, Lippincott Williams & Wilkins, 2005, pp26282652.

Self-Assessment


SelfAssessment Questions

1.
2.
3.
4.
5.
6.
Which of the following disorders can be treated with Davanloos Intensive

ShortTerm Dynamic Psychotherapy (DISTDP)?
a. schizophrenic disorders
b. antisocial personality disorder
c. anxiety disorders with somatic symptoms
d. ulcerative colitis
e. advanced Alzheimers Dementia
Which of the following represents a contraindication to DISTDP?
a. highly resistant patients with functional disorders
b. highly resistant depressed patients
c. highly resistant manic patients
d. highly resistant patients with lifelong characterologic difficulties
e. patients suffering from somatization disorders
Which of the following is a phase in the Central Dynamic Sequence?
a. interpretation
b. bypassing character resistance
c. mirroring transference responses
d. direct access to the unconscious
e. avoidance of feelings
The Central Dynamic Sequence is applied:
a. in strict order
b. randomly to keep the patient off guard
c. with a Head on Collision at the beginning of the interview to boost the
transference feeling
d. with a Head on Collision at the end of the interview so that the patient
leaves the interview with a heightened level of transference feeling
e. in a fluid, spiral fashion determined by the patients responses
A major aim of the phase of Pressure is to:
a. tilt the character defenses in the dimension of the Transference
b. mobilize and intensify erotic transference feelings
c. lower the Complex Transference Feeling
d. activate regressive defenses
e. reassure the patient
The phase of Pressure:
a. mobilizes the tactical organization of resistance
b. mobilizes character defenses
c. allows the therapist to determine the discharge pattern of anxiety
d. all of the above
7.
8.
9.
10.
11.
12.
e. none of the above

The phase of systematic Challenge should begin:
a. before the phase of Pressure
b. when resistance is clearly crystallized in the transference
c. only after the unlocking of the unconscious
d. during telephone contact prior to the initial interview to boost the
transference feeling
e. immediately following the phase of Inquiry
A major aim of the Head on Collision is to:
a. develop a transference neurosis
b. promote compliance with the therapist
c. challenge the patients sense of self
d. mobilize the Unconscious Therapeutic Alliance against the Major
Resistance
e. create a state of tension between the therapist and the patient
The Head on Collision:
a. is the most powerful intervention in DISTDP
b. is a total blockade of all the forces of the Major Resistance
c. undoes defiance and compliance
d. all of the above
The Head on Collision:
a. is used only with patients with low capacity to tolerate anxiety
b. should be done piecemeal to allow the defenses to recover
c. consists of 17 interventions which must all be applied
d. all of the above
A major component of the Head on Collision with the resistance is:
a. emphasizing the destructive nature of the resistance
b. challenge to the libido
c. interpretation of the resistance
d. interpretation f the transference
e. pressure for compliance
Head on Collision with Resistance Against Emotional Closeness (RAEC):
a. reverberates with the early feelings of attachment, bond, love and
trauma.
b. mobilizes transference feeling
c. can mobilize griefladen unconscious feeling
d. all of the above


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c.
c.
d.
e.
a.
d.
b.
d.
d.
e.
a.
d.
SelfAssessment Answers

Certificate
Directions on how to obtain your
Course Certificate of Attendance.

Seminar 9: Introduction To Davanloo's Intensive Short-Term Dynamic Psychotherapy With Highly Resistant Patients

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Introduction to Davanloos Intensive

Short-Term Dynamic Psychotherapy

Alan Beeber, M.D.

Introduction to Davanloos Intensive ShortTerm

Introduction and Announcements

10 min. Dr. Beeber

45 min. Dr. Beeber

Group discussion by Faculty and Participants 25 min.

Introduction to Davanloos Intensive ShortTerm

Course Director: Alan R. Beeber, MD.

Gary J. Gala, MD.

Disclosure: Alan Beeber, MD

goods/organizations regulated by Food and Drug

Disclosure: Gary Gala, MD

goods/organizations regulated by Food and Drug

DAVANLOOS INTENSIVE SHORT-TERM

Gary J. Gala, MD.

Disclosure: Gary Gala, MD

goods/organizations regulated by Food and Drug

History of STDP: Contributions of Habib

with Intensive STDP

The Problem of Resistance

Psychoanalysis and of the Unconscious

The Problem of Resistance II

an attempt to account for two observed facts that strike

the doctor uncovers the resistances which

Resistance of the Superego I

In 1926 Freud wrote pessimistically,

The unconscious sense of guilt represents

Resistance of the Superego II

For the moment we must bow to the

as well as a method of psychoanalytic investigation and

Alan R. Beeber, MD.

Davanloos contribution III:

Mobilization of the Unconscious

Mobilization of the Unconscious

Davanloo, H. (1995). Intensive Short-Term Dynamic Psychotherapy: Spectrum of Psychoneurotic

Mobilization of the Unconscious

Mobilization of the Unconscious

Organization of the Unconscious

Highly responsive; single

High resistance; complex

Davanloo, H. (1995). Intensive Short-Term Dynamic Psychotherapy: Spectrum of Psychoneurotic

Davanloo, H. (1995). Intensive Short-Term Dynamic Psychotherapy: Spectrum of Psychoneurotic

Diffuse Psychoneurotic Disturbances

Davanloo, H. (1995). Intensive Short-Term Dynamic Psychotherapy: Spectrum of Psychoneurotic

Davanloo, H. (1995). Intensive Short-Term Dynamic Psychotherapy: Spectrum of Psychoneurotic

Diffuse Symptoms and Major Character Disturbances

Davanloo, H. (1995). Intensive Short-Term Dynamic Psychotherapy: Spectrum of Psychoneurotic

Psychopathologic Dynamic Forces 1

Psychopathologic Dynamic Forces 2

Pain of Trauma to Bond

Psychopathologic Dynamic Forces 3

Primitive Murderous Rage

Psychopathologic Dynamic Forces 4

Psychopathologic Dynamic Forces 5

Psychopathologic Dynamic Forces 6

Psychopathologic Dynamic Forces 7

Psychopathologic Dynamic Forces 8

Unconscious Discharge Patterns of

Striated muscle tension

Physiological Concomitants of Feelings