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CHAPTER TWELVE. Steps on the roadmap to the unconscious in a patient with transference resistance

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

As described in the traffic lights/roadmap diagram, patients present with either anxiety on the forefront or defences. Those patients which present with defence either use verbal and non-verbal defences in the realm of character or of transference resistance. The defences originated in order to protect the ego from some sort of dysregulation when the ego was immature. This dysregulation either represented a cumulative insecurity in the attachment relationship or an acute overwhelming threat (trauma). The ego defends itself when there is no available attachment figure to co-metabolize the trauma. Hence defences are recruited to regulate both emotion and anxiety. The unconscious is a repository of these unprocessed emotions which exist in a space where there is no time and they “sleep” under the veil of the series of defences that make up for the resistance. The art of ISTDP is to help the patient identify these defences and see them as not helpful to the self and for building an alliance with the therapist in order to not utilize them. This, of course, will provoke significant anxiety and the patient must learn to self-regulate the anxiety so it doesn’t compromise the cognitive-perceptual apparatus and thus compromise self-observation. Patients who are less capable to regulate their anxiety are referred to as patients with a low ego-adaptive capacity. Mostly, they do not discriminate between the three poles of the triangle of conflict, they externalize, and they have some regressive defences in their repertoire.

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CHAPTER THIRTEEN. Exiting the roadmap to the unconscious in the phase of termination

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

The end phase of therapy is determined by the beginning. The therapy began as a problem-solving relationship wherein all the treatment goals are agreed upon in the initial interview. Once the ego starts to separate itself from the superego and the resistance is defeated, the unconscious part of the working alliance starts to develop (Davanloo, 1990). The therapist has activated the patient’s attachment longings and they have driven the patient to accept the therapist’s help to explore and revisit the trauma based feelings from the past. The patient has hopefully unmasked the eyes of his internal aggressor(s), understood his/their commands, the ways he submitted to these commands, and declared his freedom from the conditions which were imposed upon the self by his pathological superego. Through internalization of the constructive superego that was modelled by the therapist, the patient gained access to his complex of transference feelings which were associated with past traumatic experiences. In cooperation with the therapist, he has worked these feeling through. The process, as described by Davanloo (1978, 1980, 1984, 1990, 2000), itself, when administered correctly, ignites the termination phase of therapy.

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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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APPENDIX. Assessment forms

Neborsky, Robert J.; ten Have-de Labije, Josette Karnac Books ePub
Medium 9781855758216

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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