14 Chapters
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CHAPTER FIVE. Resistance, transference, ego-adaptive capacity, and multifoci core neurotic structure

Neborsky, Robert J.; ten Have-de Labije, Josette Karnac Books ePub

Davanloo, as well as many ISTDP therapists, often speaks of transference, character resistance, transference resistance, superego resistance, and multifoci core neurotic structure. However, in psychoanalytic and in the ISTDP literature, often the terms are used in a sloppy way. To give some examples: often terms such as defence and resistance or terms such as transference reactions and transference feelings are used interchangeably. Whenever terms can be used interchangeably, this would mean that the terms are completely synonymous (and that one of them could be considered as superfluous). However, terms such as defence and resistance, or transference reactions and transference feelings, are not synonymous. They refer to different descriptive statements, specifying different things. This lack of precision leads to confusion.

Confusion of the therapist is neither of advantage to the therapist nor to the patient, and will undoubtedly influence their working alliance in a negative way. So let us do our best to come to clear definitions of the concepts of character resistance, transference resistance, superego resistance transference, countertransference, and multifoci core neurotic structure.

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CHAPTER TWO. The neurobiological regulation of emotion and anxiety

Neborsky, Robert J.; ten Have-de Labije, Josette Karnac Books ePub

Any of our functions, be it perception, or thinking, feeling, behaviour, involves the integration of an unknown number of neurons in specific brain areas and in the nervous structures outside our brain. Therefore, we think it will be helpful to the ISTDP therapist to have at least some basic knowledge of the process of neural transmission and of specific brain regions and neuronal network systems that are thought to be involved in the regulation of our feelings and anxiety. Regarding the neuro-anatomy, we base ourselves mainly on Carpenter (1972) and on Netter’s Anatomy of the Nervous System (CIBA, 1994).

The structures of the limbic system are largely interconnected with the rest of the brain, and they are believed to play an important part in the regulation of our feelings and anxiety.

First, however, we want to give you a warning, as in the literature the definitions of structures belonging to the limbic system may vary.

The term “limbic system” is used to include 1) cortical and 2) subcortical parts of the brain:

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CHAPTER THREE. Emotion regulation and the role of defences

Neborsky, Robert J.; ten Have-de Labije, Josette Karnac Books ePub

The road to the patient’s unconscious is in the patient and not in the book (not even in this one!), and establishing a conscious and unconscious working alliance is dependent on the therapist’s expertise to assess the nature and degree of the patient variables that function as red and green traffic lights on this road. Thus, we first want to elaborate on such patient variables as how healthy versus unhealthy is the regulation of the patient’s emotions, and what is the function of the patient’s defences in the patient’s particular emotional regulation process? All of our patients who come for help have a certain degree of unhealthy regulation of emotions.

The consequences of failures in a healthy regulation of emotions range from personal distress and unhappiness to socially maladaptive and self-destructive patterns of behaviour. The more our patients are located on the right side of Davanloo’s spectrum of structural neurosis, the more their emotions and anxiety are regulated in an unhealthy way, the more these patients exert self-destructive patterns of behaviour in their interactions with themselves and with important and unimportant others.

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CHAPTER EIGHT. The independent variables: ISTDP techniques to change red traffic lights into green

Neborsky, Robert J.; ten Have-de Labije, Josette Karnac Books ePub

Although Davanloo’s intensive short-term dynamic psychotherapy is theoretically based on the psychoanalytic reference realm, his techniques are derived from structured psychotherapy methods such as behaviour therapy or cognitive-behaviour therapy.

The term “structured” refers to the fact that the therapist takes an active and directive stance. It is the therapist who—at each time in the therapeutic process—determines the focus of investigation. Especially in the early phase of the therapeutic process, the therapist also may take the position of a teacher, teaching the patient how to look and to understand his problems.

At each time in the therapeutic process the timing and selection of the specific technique, the dosage of that technique, and its duration are dependent on the momentary state of the patient’s variables and the patient’s reaction to the interventions.

However, a therapist’s clinical judgement can never be fully manualized and, although the therapist’s use of the techniques is prescribed by the therapeutic method, in this case by the ISTDP method, we advise our colleagues not to forget to use their common sense and to apply their interventions with flexibility and creativity.

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CHAPTER SEVEN. The road to the patient’s unconscious and the working alliance

Neborsky, Robert J.; ten Have-de Labije, Josette Karnac Books ePub

In psychotherapy, one of the initial concerns of therapist and patient is to understand the nature of the patient’s problems in order to resolve them.

This is specifically true for Davanloo’s trial-therapy model of the initial assessment which he considers the only reliable method to determine if the patient is likely to respond to ISTDP. However, in achieving this twofold task (understanding the nature of patient’s problems and testing patient’s responses), it is at the same time the therapist’s aim to implement Davanloo’s theory to this particular patient and to relate his observations back to the particular theoretical constructs that provided Davanloo’s framework for interpreting data and generating predictions.

This means that in order to assess and understand the patient’s psychodynamics, character structure, ego-defensive organization and (last but not least) genetically structured core-neurotic conflict, the therapist has to implement Davanloo’s set of interventions, which he refers to as the central dynamic sequence (CDS). This CDS can be considered as the treatment protocol for trial therapy.

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