Theory and Practice of Experiential Dynamic Psychotherapy

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The book opens with an introduction to and history of the experiential dynamic therapies (EDT) including the groundbreaking Intensive Short-Term Dynamic Psychotherapy (ISTDP) of Habib Davanloo and its subsequent development. The centrality of relationship in therapy is emphasised and the current state of the art and science described. Material from interviews with David Malan is presented, sharing some of his experiences, thoughts and insights over decades of clinical practice, research into and promotion of short-term dynamic therapies. The essential ingredients of experiential dynamic therapies are described, and the reader is orientated to the practice of EDT. Key characteristics of taking care of the real relationship, mirroring, history taking, and putting into perspective are also presented. In addition, high technical content, experiential-dynamic interventions, including defence re-structuring, emotional maieutics, anxiety regulation, dealing with the Super-ego, connecting corners of the Triangle of Others, and Self- and Other- Re-structuring are introduced and discussed. A coding system used throughout the clinical chapters to clarify the nature, and application, of therapist interventions is described. The conceptualization of 'character hologram' is explained in detail, and illustrated with clinical material. Throughout the book, annotated extracts from real therapy sessions are presented to illustrate characteristics of EDTs in clinical practice and, wherever possible, follow-up is presented. The clinical chapters describe the application of experiential dynamic individual and group approaches within the UK National Health Service and Counselling Services, primarily, but also in other Countries having similar public health services (Holland, Israel and Italy). The relevance of experiential dynamic approaches in providing case management and supervision, and in treating the more complex presentations of common mental health problems is discussed. A research chapter provides an overview of EDT-related research to date. It is argued that EDTs represent a promising integration of a number of therapeutic principles, and their place within current mental health policy in the National Health Service in the UK is outlined.

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CHAPTER ONE. A historical overview of experiential dynamic psychotherapies

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Ferruccio Osimo

Experiential dynamic therapies descend from the line of thinking and research historically initiated by Alexander and French (1946), who were the first to declare their aim of making psychoanalytic therapy “briefer and more effective”. Before Alexander and French, some of the theoretical contributions by Sandor Ferenczi, Otto Rank, and Wilhelm Reich have been particularly relevant to the development of EDT and, more recently and specifically, David Malan and Habib Davanloo are the most prominent proponents of experiential dynamic therapy. For an account of these contributions the reader is also referred to Amanda Baker’s chapter (Chapter Two), that includes an interview with David H. Malan.

Charles Darwin, in a pre-psychoanalytic era, had already understood the links between emotion, defence (“force of habit”), body muscles, and conscious and unconscious mental mechanisms.

Certain complex actions are of direct or indirect service under certain states of the mind, in order to relieve or gratify certain sensations, desires, etc.; and whenever the same state of mind is induced, however feebly, there is a tendency through the force of habit and association for the same movements to be performed, though they may not then be of the least use. Some actions ordinarily associated through habit with certain states of the mind may be partially repressed through the will, and in such cases the muscles which are least under the separate control of the will are the most liable still to act, causing movements which we recognize as expressive. (Darwin, 1872, p. 34)

 

CHAPTER TWO. David Malan and the genesis of experiential dynamic psychotherapy in the UK

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Amanda Baker

This chapter has been formed around David Malan’s own recent reflections, and presents verbatim comments (shown in extracted text) from two interviews with David and his wife Jennie, which took place in June 2009 and February 2010. Malan’s pioneering career as a psychiatrist, psychotherapist, teacher, researcher, and writer provides us with a remarkable case study of the journey from psychoanalysis to evidence-based brief psychotherapy. Throughout his professional life he has focused on the psychodynamic underpinnings of therapeutic change, but this psychodynamic conviction was accompanied from the start by deep reservations about 1950s psychoanalysis as the mainstay of the UK’s National Health Service psychotherapy at the time he was setting out on his career. This conflict drove his search for the radical developments that eventually catalysed his contribution to Experiential Dynamic Therapy (EDT). Malan was ahead of his time in worrying about things like evidence base, brevity, and accurate follow-up. Motivations such as these, which have permeated his life’s work, are becoming crucially pertinent to the experience of therapists today who want to work psychodynamically within the public sector. It is hoped that, by presenting here some of what David Malan said as he looked back over the development of EDT, this chapter will be interesting to readers who are practitioners in the current UK climate, where there is a growing appetite among public sector psychotherapists for therapies which are relational, experiential, and dynamic while also matching the requirements of public sector commissioning. A new generation of psychotherapists, counsellors, and psychologists is welcoming EDT as a psychodynamic framework which prioritises brevity and demonstrable effectiveness, and is applicable to work with a wide range of people in a wide range of settings.

 

CHAPTER THREE. The essence of experiential dynamic psychotherapies

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Ferruccio Osimo

The present chapter outlines the essential ingredients of experiential dynamic psychotherapies, orientating the reader to the practice of Intensive Experiential-Dynamic Psychotherapy (IE-DP). Key characteristics of taking care of the real relationship, mirroring, history taking, and putting into perspective are described. In addition, high technical content, experiential-dynamic interventions, including defence restructuring, emotional maieutics, anxiety regulation, dealing with the Superego, connecting corners of the Triangle of Others, and Self- and Other-restructuring are introduced and discussed theoretically. Annotated extracts from real therapy sessions are presented to illustrate characteristics of experiential dynamic psy-chotherapies in clinical practice. The reader is also introduced to a coding system used throughout the clinical chapters to clarify the nature, and application, of therapist interventions.

As was illustrated in the first two chapters, over the last three decades we have witnessed the birth and development of experiential dynamic therapies. A customary feature of EDT is that clinical work is video recorded enabling us to view real therapy sessions and provide accurate annotated transcripts. Witnessing audiovisual recordings of real therapies can have a strong impact, especially when it includes intense emotional experiencing as well as the opportunity to directly observe character change. Video technology also gives us an opportunity to play back the process of change and its outcome in a vivid and real way. Habib Davanloo was the first to apply video technology to psychotherapy on a large scale for his research studies and scientific presentations, which proved stimulating to many. His former trainees identify with his psychotherapeutic method to a greater or lesser extent, each emphasising certain aspects and introducing new ones, or even budding new approaches, attuned to and enriched by their own personalities. Generally, these EDT approaches are more powerful than previous forms of short-term intervention, since they can be effective in a relatively short time with people presenting with complex problems, severe symptoms, and a strong resistance to change. Some illustrative clinical examples are presented herein, but interested readers are strongly advised to take advantage of any opportunity to attend seminars where they can see and hear the therapeutic process in operation with their own eyes and ears.

 

CHAPTER FOUR. Intensive Experiential-Dynamic Psychotherapy and application of the character hologram

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Ferruccio Osimo

Intensive Experiential-Dynamic Psychotherapy (IE-DP) is one of the experiential dynamic therapies (EDTs) stemming from Davanloo’s Intensive Short-Term Dynamic Psychotherapy (ISTDP). All the EDT approaches emphasise accessing the patient’s unconscious in order to bring about the conscious experiencing and working through of their painful feelings. These models involve the creation of a genuine and compassionate relationship between therapist and patient, within which deep feelings and impulses can be freely experienced, intimate thoughts are shared, and new revealing insights are achieved. IE-DP holds the personal relationship between therapist and patient and the physical experience of conflicting emotions as the basis of therapeutic change. A few crucial aspects of IE-DP are described in an earlier chapter (see pp. 44–45), and herein, one of them, the character hologram, is introduced and specifically addressed in greater detail.1 For a more thorough theoretical and clinical description of IE-DP, the reader is referred to Osimo (2002, 2003).

 

CHAPTER FIVE. Experiential dynamic psychotherapies in primary care mental health services

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Jessica Bolton

In the present chapter, the provision of primary care mental health services (PCMHS) in the UK, and the characteristics of a typical primary care mental health service will be described. The nature of the presenting problems of patients referred to PCMHS, recommended treatments, and the relevance of experiential dynamic therapies (EDT) will be outlined. In particular, the relevance of experiential dynamic approaches in treating the more complex presentations of common mental health problems will be discussed. The process involved in developing EDT formulations and the contribution of supervision will be emphasised. The chapter will include a case which was less suitable for the other therapies provided within PCMHS, for example, Cognitive Behaviour Therapy (CBT) and Person-Centred Counselling (PCC), but was amenable to EDT formulation. Pre- and post-therapy data will be presented, indicating clinical improvement as well as significant improvement in quality of life. The patient described herein completed therapy within six sessions (including Trial Therapy and one-month follow-up) after which they felt ready for the therapy to end.

 

CHAPTER SIX. Experiential dynamic psychotherapies in the psychological treatment of a patient attending oncology services

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Mark J. Stein

In the present chapter, psychological aspects of cancer will be outlined and the presenting problems of patients attending treatment for cancer-related difficulties will be described. Reference will be made to a range of psychological interventions for the psychological treatment of patients with cancer, and links will be made between presenting problems of cancer patients and specific therapeutic activities of experiential dynamic psychotherapies. The transcript of an initial interview with a woman presenting to psychology services following therapeutic mastectomy will be presented to illustrate how an Intensive Short-Term Dynamic Psychotherapy (ISTDP) perspective informed the clinical work undertaken. Patient-reported changes at short-term follow-up will be described.

The UK estimated prevalence of cancer in 1992 was 2 per cent, hence 1.2 million people in the UK were living with a diagnosis of cancer (Forman et al., 2003) and, each year, more than a quarter of a million people are newly diagnosed with cancer (Office for National Statistics, 2007). Specific challenges associated with the disease include diagnostic and treatment procedures, and reactions such as fear, uncertainty, pain, treatment-induced nausea, and vomiting. Additional challenges include adjustment reactions to diagnosis, surgery (e.g., mastectomy), and disease recurrence following remission, impact of disease and its treatment on quality of life, complications, and disease progression. Patients may also be required to undergo extensive psychological assessment prior to risk-reducing surgical procedures. Survival may be problematic for some patients with cancer, for example, if, previously, a loved one was lost to the disease. Understandably, psychological distress is a significant issue for patients with a diagnosis of cancer, and their relatives (Brennan, Cull, Harvey & Parkinson, 1997; Derogatis, 1986; Rodin, 2003; Zabora, BrintzenhofeSzoc, Curbow, Hooker & Piantadosi, 2001).

 

CHAPTER SEVEN. Experiential dynamic psychotherapies in the treatment of psycho-physical trauma

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Margarita Lobeck

This chapter will highlight the importance of an integrated approach when treating patients who have experienced a physical injury, incorporating physical, psychological, and social aspects of the trauma. It will show how Experiential Dynamic Therapy (EDT) can facilitate healing, helping to move a person from a position of being split off from their injured part towards a position of integration. “EDT” is here used as an umbrella term being influenced by concepts, theories, and techniques from various teachers in the field including Davanloo (Intensive Short-Term Dynamic Psychotherapy), Osimo (Intensive Experiential-Dynamic Psychotherapy), Fosha (Accelerated Experiential Dynamic Psychotherapy), and McCul-lough (Affect Focused Dynamic Psychotherapy). However, the main principles of working in an experiential and dynamic way, using Malan’s Two Triangles and the central dynamic sequence of working through defences and regulating anxiety to reach deep affect, are at the centre of all the work described herein.

 

CHAPTER EIGHT. Intensive Short-Term Dynamic Psychotherapy and the treatment of poly-symptomatic somatic patients

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Richard Aubrey

In the present chapter poly-symptomatic conditions for which psychological therapy is recommended will be identified and criticisms of Cognitive Behaviour Therapy (CBT) will be discussed. Experiential dynamic psychotherapies with their consideration of affective factors are suggested as a possible treatment alternative. In particular, Intensive Short-Term Dynamic Psychotherapy (ISTDP) treatment of a patient with treatment-resistant poly-symptomatic somatic problems is presented to illustrate the responsive and flexible stance of the therapist and how he helps the patient to build ego adaptive capacity. The transcript will illustrate comprehensive assessment of the patient’s anxiety manifestations, interventions to help the patient turn against automatic, habitual, and self-defeating defences, including ignoring and self-neglect, unmasking of Superego pathology, and exploration of deep feelings towards current and past attachment figures. There will be an exposition of the process of somatisation as it pertains to the patient. The author will also highlight important differences between assessment from EDT and CBT perspectives. Last, there will be discussion of the possible mutative factors in the therapy and the limitations of the ISTDP approach.

 

CHAPTER NINE. Intensive Experiential-Dynamic Psychotherapy in the treatment of long-standing depression

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Ferruccio Osimo

This chapter highlights the unique way in which Intensive Experiential-Dynamic Psychotherapy (IE-DP) can undo the triggering and maintenance of depressive mechanisms. Severe depressive symptoms inhibit and disguise the expression of the Self, depriving the individual of their individuality and making them depleted, neutral, and lacking vital energy, similar to a physically ill person. For this reason, depression is often mistaken for a purely medical condition to be treated only with drugs. The aetiology of long-standing depression is more complex than this and three levels need to be considered: (i) brain function and genetics (e.g., Panksepp, 1998; Rosenthal, 1971), socio-cultural milieu (e.g., Stevens & Price, 1996), and psycho-emotional processes (Arieti, 1978; Freud, 1917e). When we practise experiential dynamic therapy we are in a real human relationship and use techniques, interacting mostly at the psycho-emotional level (intrapsychic), and with the way individuals interact with their socio-cultural milieu and significant Others (interpersonal). Consistent with a holistic view and with findings of affective neuroscience, in so doing we may, to some extent, also affect brain function in a favourable way. By promoting emotional experience in mind and body, EDT sets in motion a benign circle of being oneself, feeling in touch with emotion, and having a sense of being oneself and capable of feeling. As a patient is starting to access emotion and comes back to feeling alive, they realise what they have been missing and this has a powerful motivating effect, enhancing the conscious and unconscious therapeutic alliance. The therapist will then be in a position to confront the patient as to whether they want to stay open to their emotions and become the owners of their inner life, or shut down again and stay depressed. Without the specific fuel of an adequate emotional experience, the healing engine cannot be started. The case study of long-standing depression presented in this chapter highlights a few salient dynamics, often characterising depressive patients, and their treatment with Intensive Experiential-Dynamic Psychotherapy (Osimo, 2003). Among the therapeutic ingredients, we will especially focus on some aspects of the patient-therapist relationship (RE), handling of the Superego (SE) and character defences with the help of the character hologram (DA), and restructuring the relationship with Self and Other (SO).

 

CHAPTER TEN. Using Intensive Experiential-Dynamic Psychotherapy to treat an underachieving gifted adolescent

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Ronete Cohen

In this chapter, the reader is introduced to the problem of underachievement in gifted adolescents. Issues relevant to psychological therapy with underachieving gifted students will be described and links will be made between the presenting problems and specific therapeutic activities of experiential dynamic therapies (EDT). Transcripts from a psychological therapy with a young gifted adolescent will be presented to illustrate how an Intensive Experiential-Dynamic Psychotherapy (IE-DP) perspective informed the clinical work undertaken, in particular, anxiety work, and separating healthy Ego from harshly critical Superego. Patient- and therapist-reported changes at termination of therapy will be outlined.

A significant proportion of my caseload consists of gifted children and adolescents who are seriously underachieving in that their school results fall far short of what would be expected from someone with their ability. Since there is no question of a lack of ability, the causes must lie elsewhere. Extensive and diverse research on the subject has consistently identified both internal and external factors. For example, Baum, Renzulli, and Hébert (1995) identify emotional problems as a major contributor to underachievement. Clemons (2008) finds that social and cognitive factors may also influence a student’s level of achievement. For example, she determined that the motivation to achieve is strongly influenced by self-perception that, in turn, is influenced by the child’s attributional style, that is, beliefs about whether success or failure is controlled by internal or external factors. This attitude (also known as “locus of control”) affects motivation, self-esteem, behaviour, and the level of risk one is prepared to take. The more an individual believes their own actions and behaviours influence events, the more positive their perception of their ability. In contrast, a belief that events are determined by others, or by fate or chance, has a negative influence on self-perception of ability.Neihart, Reis, Robinson, and Moon (2002) found that positive self-concept was associated with challenge-seeking and the willingness to take risks.

 

CHAPTER ELEVEN. Experiential dynamic therapy in a university counselling service

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Amanda Baker

In this chapter the context of university counselling will be described and the needs of students as counselling clients will be outlined. A rationale will be given for the inclusion of experiential dynamic therapy-informed work among the range of therapeutic responses offered by a university counselling service. Links will be made between the issues facing university students, developmental issues relevant to therapy with university students, and specific therapeutic activities of experiential dynamic therapy. Transcripts of excerpts from a therapy with a student presenting to a university counselling service in a post-1992 English university will be presented to illustrate how some experiential and dynamic interventions were applied within the counselling work undertaken. There is an emphasis on taking care of the real relationship (Osimo, 2012), restructuring the client’s sense of self and others, and facilitating use of fantasy, to explore hidden impulses and desensitise the client to the experience and expression of anxiety-provoking and painful feelings, especially anger. Short-term follow-up will be presented.

 

CHAPTER TWELVE. A client’s perspective

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Derek

Ialways felt that I experienced depression in a cyclical fashion and that I could feel my mood slipping over a long period of time before it “bottomed out” and started coming back up again. Sometimes, the transition was very fast, but on reflection I think that this is just the final stage of the mood drop and that the background change was still probably over a longish period—a bit like the funnel shape of going into a black hole—the last bit is the steepest. I also used to have what were probably manic episodes, especially when I was younger—I used to quite enjoy these periods of intense energy and drive, apart from the fact that you knew there would be the negative payback at some point. I’m sure I was probably hard to live with at those times too!

The most recent depressive episode was brought to a head when I was subject to fairly relentless bullying from my line manager and I felt that I had nowhere to go for support and that the backlash from taking formal proceedings would have made the process pointless. While this period was the trigger point, it was, I am sure, not the whole reason for the episode—I had been aware of feelings of despair or hopelessness for some time, the difficulty being that I was so familiar with this that I tended not to do anything about it and treated it as just the general default position of my life. Being depressed was a state of being and I managed it through sheer determination. I never took time off work, even when I felt utterly dreadful and continued to hold a responsible job. The main effects were a sort of nihilist attitude to life, devoid of colour, interest, and excitement and a deep, deep tiredness that permeated everything I did. I read a lot, as I always have, mainly as an alternative to living and getting out there and doing. It became a safe way of opting out. I didn’t make plans, think about going on holiday, or making friends. My main focus was to maintain my job and to be organised and in control.

 

CHAPTER THIRTEEN. Receiving the invitation to open up

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Arno L. Goudsmit

In this contribution, theoretical insights from object relations theory that underlie my therapeutic approach will be introduced. These can be seen to fit in well with an experiential dynamic therapy approach. In particular, I will discuss and illustrate the development of an interpersonal transitional space (cf. Winnicott, 1971) in which corrective emotional experiences can take place, that is, the therapist becoming an object to the patient thereby offering the patient a relationship working model that was missing or lost in childhood. In particular, the therapy can offer a new interpersonal space, from which the patient can develop a new or an enhanced Ego position. That is to say, the deep affects cannot be conceived just to “exist” somewhere inside the patient, if the subject who is to experience them has not yet arrived, or has sought shelter elsewhere. (The “subject” is the epistemic carrier of the affects, where the “individual” is the physical person.)

The core of object relations theory, as I understand it, entails quite a revolutionary shift, or inversion, of emphasis from the primacy of the individual to the primacy of the relation. If we take relatedness as primary, and prior to individuality, then this inversion has some implications for the idea of a subject, for then relatedness is conceived to be the substrate of individual subjectivity, rather than the subject being conceived as the primordial carrier of relationships. The latter view is the more traditional way of conceiving, but it may be useful not to stick to it in all circumstances.

 

CHAPTER FOURTEEN. Group Intensive Experiential-Dynamic Psychotherapy in a public mental health service

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Silvia Landra

This chapter describes how EDT, specifically Intensive Experiential-Dynamic Psychotherapy (IE-DP), was applied in a group setting within the Servizio Sanitario Nazionale (Italian national health service), specifically the School of Psychiatry of Milan University, by two co-therapists, Silvia Landra and Ferruccio Osimo. The origins and some relevant aspects of group analysis will be introduced. The rationale for the group approach and several relevant aspects of the group IE-DP treatment, including selection of patients, information about their presenting problems, and outcomes at one-month follow-up will be described. Nine learning points that emerged from review of video recordings of the group therapy sessions will be summarised and illustrated with transcript from the group psychotherapy. It will be noted that, in comparison with individual therapy, the sense of the co-therapists was that, within the group setting, there was an acceleration of the process in which patients learn to recognise anxiety manifestations and defences, and focus on emotional experience. The importance of a trial relationship prior to group treatment will be highlighted, and indications and contraindications for a group treatment approach will be outlined. The author concludes that the group IE-DP approach yielded encouraging results for resistant patients with Superego pathology, and that the group setting lends itself to Self- and Other-restructuring.

 

CHAPTER FIFTEEN. Privileging relationships within our places of work: what can the principles of experiential dynamic therapy bring to public services?

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Naomi Wilson

The aim of this chapter, using the metaphor of maieutics, is to give birth to a new dialogue about how the experiential and relational expertise of professionals needs to be privileged, rather than ignored, within the NHS. There is accumulating evidence of the cen-trality of the therapeutic relationship, attunement, and a highly affective focus as prerequisites to psychological healing (Schore, 2009). Moreover, this aspect of the work can be motivating for caregivers, and emotional connection is personally and professionally sustaining—what works for patients works for us too, which can only be good for service provision. In this way, the emotionally intimate relationship between therapist and patient in experiential dynamic therapy (EDT) constitutes the core of humane and effective interventions. Although humane and effective treatment is a goal of public services, the culture of our care systems in Western Europe in the twenty-first century is one where quality indicators of care are objective and almost exclusively derived from scientific or economic epistemologies. I will argue that these are divorced from people who provide care and render the relational dimension of professional knowledge invisible (Reinders, 2010). This puts professionals at risk of not being able to work as empathi-cally as is needed, which is not just an ethical concern but one that threatens our most effective tool of change, the real relationship. Recent work within neuroscience about the unhelpful predominance of “left hemisphere” understandings of the world also illuminates this over-reliance on reductive and potentially dehumanising processes of accountability within public services (McGilchrist, 2009). Theoretical frameworks from EDT can help us formulate how the political and professional contexts of our workplaces often act as barriers to emotionally effective care, and may become solidified into emotionally defensive practices. Finally, I will discuss how the relationship and relational techniques privileged by EDT can be applied to systemic problems by those working in mental health services.

 

CHAPTER SIXTEEN. Experiential short-term psychodynamic therapy from the perspective of a cognitive-behaviour therapist: a personal account

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Joop Meijers

In the mind of many, psychodynamic and cognitive-behaviour therapies are two worlds apart. A huge gulf separates them. In this chapter, I hope to show that the gulf need not be seen as a separating barrier but may, instead, be seen as a connecting stream. In the first part of this chapter I will focus on differences and similarities between the two therapeutic approaches, arguing for the possibility and desirability of a more integrative approach. I will then illustrate some of the ideas presented in the first part of the chapter with a transcript from my work with one patient whom I treated with experiential dynamic therapy.

In a world where labels and boxes count, I “am” or at least “am known as” a cognitive behaviour therapist. Since my clinical internship during, and after, my MA studies in the Netherlands in the Seventies (of the last century) I have learned, trained in, and practised Cognitive Behaviour Therapy (CBT). I was lucky in having as my clinical teachers and supervisors the founders of CBT, like Aaron Beck, Albert Ellis, and Donald Meichenbaum. In Holland, I was supervised by the late Ron Ramsay, the pioneer of CBT-based Grief Therapy (Ramsay & Happee, 1977). For my post-doctoral studies I went to Canada where Donald Meichenbaum taught me the basics of Cognitive-Behaviour Modification with children. In the Eighties and Nineties, I trained in New York at the Rational Emotive Behavior Therapy (REBT) Institute with the late Albert Ellis and his staff. Later, I visited Philadelphia, where I trained with Judy Beck who taught me Cognitive Therapy as developed by her father, Aaron Beck. Over the years, as teacher and therapist, I have integrated the different approaches and applied my own “blend” of CBT in my work with my patients (adults and children).

 

CHAPTER SEVENTEEN. EDT in the context of psychotherapy research and mental health policy in the UK

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James Macdonald

Anyone versed in psychotherapy research will wonder why we need another brand of therapy? Over thirty years of meta-analysis and comparative trials have pointed to equivalent outcomes for different models of therapy (Lambert & Ogles, 2004; Wampold, 2001). The Dodo bird’s verdict from the Caucus race in Alice in Wonderland (Carroll, 1865)—that “Everyone has won and all must have prizes”—has long been declared in the context of the equivalent effectiveness of different therapy models (Luborsky, Singer & Luborsky, 1975; Rosenzweig, 1936; Wampold, 2001). True to the Dodo bird’s pronouncement, the only comparative trial comparing an experiential dynamic therapy (EDT) with another non-psychodynamic model of therapy found equivalent outcomes between EDT and cognitive therapy (Svartberg, Stiles & Seltzer, 2004). In spite of recurrent evidence of the equivalent effectiveness of different psychotherapy models, there has been a prolific expansion of different brands of therapy, with in excess of 400 models of therapy in existence (Garfield & Bergin, 1994). This trend towards proliferation can be seen within the field of experiential dynamic therapies, where currently it is possible to distinguish derivatives of Davanloo’s (1990) and Malan’s (2001; Malan & Coughlin Della Selva, 2006) work, including Intensive Short-Term Dynamic Psychotherapy (ISTDP) (e.g., Coughlin Della Selva, 1996), Accelerated Experiential-Dynamic Psychotherapy (AEDP) (Fosha, 2000), Intensive Experiential-Dynamic Psychotherapy (IE-DP) (Osimo, 2009), and Short-Term Affect-Regulating Therapy (START) (McCullough Vaillant, 1997; McCullough et al., 2003).

 

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