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C-21. Educational course: Intensive short-term dynamic psychotherapy compared to classical analysis and to CBT

Published online by Cambridge University Press:  16 April 2020

Abstract

Type
Interdisciplinary
Copyright
Copyright © European Psychiatric Association 2005

Objective: The course gives a: - theoretical introduction in ISTDP - videopresentation of an initial interview - discussion of the conformities and differences between ISTDP, classical analysis and CBT

Methods: ISTDP is a psychoanalytical method, developed by G. Davanloo (McGill University, Montreal) under consequent audiovisual evaluation, with the aim of a direct access to the unconscious neurotic structure and its treatment. ISTDP uses an active technique. The defensive system is rapidly identified, the patient is made acquainted with it and its selfsabotaging consequences in his life. Thus the patient turns himself against his defences, mobilizes his own will, which becomes a decisive force in the treatment. The patient perceives the therapist with his relentless but respectful confrontations as a solid partner in the struggle to overcome the pathogenic forces, an unconscious therapeutic alliance emerges. At the same time this work at the defences mobilizes the unresolved feelings (which are repressed by the defences) in the transference, and triggers corresponding anxiety. A crucial element in ISTDP is the continuous observation of the neurobiological channels of anxiety, and the knowledge of how they indicate the patient's tolerance capacity, in order to keep the process securely within the patient's capacity. The process results in the patient's inner experience of his repressed feelings in the transference with a subsequent shift to the person in his life, towards whom the repressed feelings originally were generated. The corresponding feelings of rage, guilt, grief, but also affection, can be directly worked through, the defensive (symptom- and problem-generating) system can be overcome and the tolerance capacity gets improved. Compared to classical analysis there exists a common metapsychological base, but the technique is different. ISTDP does not use free association, interpretation and the development of a transference neurosis. Based on the patient's will it applies challenge and pressure to overcome the defences and the anxiety, and pressure to the inner experience of the repressed feelings. Through this direct experiencing and working through of the feelings, that rise up in the transference, it avoids the development of a transference neurosis, which thus contributes to the shortening of the analytical process. Compared to CBT the metapsychological foundations are mainly different, but there are several common technical elements. For instance the patient improves his anxiety tolerance by repeated exposition to anxiety. While in CBT this is achieved by exposition to external, anxiety provoking situations, this is done in ISTDP by the inner mobilisation of anxiety provoking, unconscious feelings.

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