No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Intensive short-term dynamic psychotherapy: A review of the treatment method and empirical basis
Abstract
Based on over forty years of videotaped case-based research, Habib Davanloo of McGill University, Canada, discovered some of the core ingredients that can enable direct and rapid access to the unconscious in resistant3 patients, patients with functional disorders, and patients with fragile character structure. We will describe here some of the main research findings that culminated in his description of a central therapeutic process involved in the intensive short-term dynamic psychotherapy (ISTDP) model. We will also describe the evolution of the technique over the past thirty years and summarize the empirical base for Davanloo's ISTDP. © 2013 Italian Area Group of the Society for Psychotherapy Research.
... After the pioneering work of Davanloo (1980Davanloo ( , 1990) the ISTDP treatment model, in addition to the traditional way of learning psychotherapy founded on the oral or written transmission of the knowledge (Freud, 1905(Freud, , 1909a(Freud, , 1909b, uses a more technological training modality. Through the use of video technology in didactic teaching, case practice and supervision, it is possible not only to listen and read the therapy reports, but also to see and listen to the psychotherapy live through video review (Abbass, 2004;Abbass et al., 2013b). The advantages of this learning method are clear: the psychotherapy setting is open and other therapists can directly learn a way of doing psychotherapy live. ...
... This objective offers an implicit evaluation of the degree to which the ISTDP approach is transmissible while maintaining the effectiveness already recognized in the literature (Abbass et al., 2012;Abbass et al., 2013b;Rhamani et al., 2020b). ...
... All these data show that beneficial effects of ISTDP when provided by experienced clinicians are also achievable by novice psychotherapists during training. This appears true not only for changes at level of symptom remission (Rahmani, et al., 2020a;2020b), but also at the level of structural/personality change (Abbass et al., 2012;Abbass et al., 2013b;Lilliengren et al., 2020). Our findings provide information about role of limited clinical experience on clinical effectiveness and suggest that factors beyond clinical experience may contribute to outcomes. ...
This study examines the effectiveness of psychotherapy provided by novice therapists, in an attempt to clarify the controversial relationship between treatment effectiveness and therapist experience. To achieve this, we examined the short- and long-term effec�tiveness of intensive short-term dynamic psychotherapy (ISTDP) in the treatment of patients with the Diagnostic and Statistical Manual of Mental Disorder, IV edition - Text Revision anxiety disorders, as provided by novice psychology trainees. Twenty-two
patients with anxiety disorders were provided ISTDP. Patients improved significantly on all outcome indices, including the global assessment of functioning, the symptom checklist and the inventory of interpersonal problems, at the end of the treatment and at 6 and 12 month follow-up. In addition to these results, there was marked structural personality
change as evidenced by ratings on the Shedler Westen assessment procedure (SWAP-200), at the same assessment moments; the SWAP-200 psychological health index
score showed a meaningful increase in adaptive psychological resources and capacities, while the mean number of personality di�agnoses decreased from the beginning to the end of therapy, and all patients maintaining their gains in 6-12 month follow-up. We
conclude that ISTDP provided by novice psychotherapists is efficacious in bringing broad and in-depth change to pathology that can perpetuate anxiety disorders and other psychiatric conditions.
... Davanloo conceptualised the Central Dynamic Sequence (discussed further below) as a systematic method for how, in an idealised therapeutic scenario, the therapist can help the patient overcome their defensive processes in order to contact their hidden attachment emotions (Tab. 7.3, adapted from Abbass, Town, & Driessen, 2013;Davanloo, 1990Davanloo, , 2001Davanloo, , 2005). Davanloo, 2001) 1 Inquiry ...
... The empirical base for ISTDP is still developing. Abbass, Town, and Driessen's (2013) review found 21 outcome studies pertaining to personality disorders, somatic disorders, depression and anxiety disorders, and mixed samples that reference Davanloo's method in their description of treatment. Of these studies, 13 (including 5 RCTs), met criteria for meta-analysis and used common outcome measurements. ...
... Spectra of Psychoneurosis and Fragility (Adapted fromAbbass, Town, & Driessen, 2013) ...
... Thus, in addition to the traditional way of learning psychotherapy founded on the oral or written transmission of the knowledge started with Freud (1905Freud ( , 1909aFreud ( , 1909b, these trainees experience a new and more technological modality starting with the pioneering work of Davanloo. Through this method, it is possible not only to listen and read the therapy reports, but also to see and listen to the psychotherapy live (Abbass, 2004;Abbass., Town, & Driessen, 2013). The advantages of this learning methodology are clear: the psychotherapy setting is open and the other therapists can learn a way of doing psychotherapy "live". ...
... A second objective following on the first is to verify whether ISTDP is effective even when applied by young clinicians, who obtained the title of psychotherapist less than two years previously. Therefore there will also be an implicit evaluation of the degree to which the ISTDP approach is transmissible while maintaining the efficacy already recognized in the literature (Abbass, Town, & Driessen, 2012, 2013. Finally, our last goal is to evaluate whether the obtained changes are limited to symptom remission or if there is also a significant change in personality structure in order to say that some degree of intrapsychic change has occurred. ...
... The flexibility of the approach, the rapid diagnosis conducted through the identification of both the anxiety discharge pathways and the major defenses utilized by the patient, together with the changes in technique of recent years, allow the application of ISTDP to almost 86% of psychotherapy patients (Abbass, 2002). Recent studies on ISTDP show that it is effective with depressive disorder, panic disorder (including obsessive compulsive disorder and phobia) as well as personality disorders (Abbass, Town, & Driessen, 2012, 2013. The metapsychological basis of ISTDP derived from detailed case study, links to both psychoanalytic psychotherapy and Bowlby's attachment model (1982). ...
In the following paper we report on systematic outcomes of Davanloo’s Intensive Short-term Dynamic Psychotherapy
as provided by psychology trainees. Eight patients with anxiety disorders were provided ISTDP. Broad
ranging results found that both clinician and patient symptom ratings were improved significantly. Beyond this
self-reported interpersonal problems were markedly reduced and there was evidence of marked structural personality
change as evidenced by ratings on the SWAP-200 instrument. We conclude that ISTDP therapy provided
by trainees is efficacious bringing broad and in depth change to pathology that can perpetuate anxiety disorders
and other psychiatric conditions
... Patients on the spectrum of fragile character structures have experienced severe, early trauma (Abbass, Town, & Driessen, 2013) with research data demonstrating the presence of a very high degree of primitive murderous rage and guilt within the unconscious (Davanloo, 2000). As they have little capacity to isolate affect or intellectualize about feelings and become tense in the voluntary (striated) muscle, they instead use projection, projective identification, depression, and experience cognitive disruption (Abbass, 2001(Abbass, , 2015. ...
... Regarding the symptoms of hallucinations and delusions in psychosis combined with a loss of reality testing, the propositions are as follows. As projective defenses and splitting prevent the experience of contradicting emotional states, there may be no unconscious anxiety at all (Abbass, Town, & Driessen, 2013). If there is a strong stimulus that triggers mixed emotions and overwhelms these primitive defenses, unconscious anxiety in fragile psychotic people is manifested as cognitive perceptual disruption. ...
In this article, we review Davanloo's metapsychology of the unconscious and how it can contribute to the current psychodynamic understanding and treatment of psychosis. In this framework, current attachment and emotions become connected with unconscious conflict-laden feelings about early attachment trauma at the core of the unconscious conflict. These conflict-laden feelings mobilize unconscious anxiety and defenses, which are alongside or, in and of themselves, constitute the entire picture of psychosis. Those patients with low emotional capacities are provided specific therapeutic techniques to bolster anxiety tolerance while those more defended patients are offered means to begin to accept and experience the feelings they have about present and past adverse experiences including those caused by psychosis itself. Case and case series research have shown this model to be clinically effective and cost effective as an adjunct to care. Case vignettes will describe the assessment of capacities and treatment frame for patients with a history of psychosis. Davanloo's metapsychology of the unconscious offers an important contribution to the current psychodynamic understanding of psychosis by considering the role of attachment, emotions and unconscious conflict and addressing these through specific psychodynamic interventions.
... Davanloo conceptualised the Central Dynamic Sequence (discussed further below) as a systematic method for how, in an idealised therapeutic scenario, the therapist can help the patient overcome their defensive processes in order to contact their hidden attachment emotions (Tab. 7.3, adapted from Abbass, Town, & Driessen, 2013;Davanloo, 1990Davanloo, , 2001Davanloo, , 2005). ...
... Spectra of Psychoneurosis and Fragility (Adapted fromAbbass, Town, & Driessen, 2013) ...
When people seek psychological support, formulation is the theory-driven methodology used by many practitioners to guide identification of the processes, mechanisms, and patterns of behaviour that appear to be contributing to the presenting difficulties. However, the process of formulating – or applying psychological theory to practice – can often seem unclear.
In this volume, we present multiple demonstrations of formulation in action – written by applied psychologists embedded in clinical training, research, and practice.
The volume covers a range of contemporary approaches to formulation and therapy that have not been considered in extant works, and includes unique sections offering critical counter-perspectives and commentaries on each approach (and its application) by authors working from alternative theoretical positions.
... 11 The interested reader can find a description of these studies in recently published reviews. 11,20 Several key points can be distilled from this literature: First, the RCTs, which were of adequate quality 3 to use as the basis for evidence-based recommendations, demonstrated efficacy of ISTDP for personality disorders. ISTDP was efficacious when compared to control, 22,22 and no significant differences were found compared to other formal psychotherapy treatment. ...
... These studies are thoroughly described in two recently published articles. 11,20 Several findings were evident across the literature. First, patients treated with IST-DP had significant improvements in target symptom ratings post-treatment, including measures of chronic back pain, psychogenic movement disorder, general somatic symptomology, and urinary symptoms or pelvic pain. ...
CME EducationaL Objectives 1. Review the outcome evidence of prior meta-analytic reviews of intensive short-term dynamic psychotherapy (ISTDP). 2. Provide an additional meta-analysis of ISTDP for the treatment of personality and somatic disorders. 3. Suggest areas for future study in the use of psychodynamic psychotherapy for personality and somatic disorders. The literature reviewing studies of psychodynamic psychotherapy clearly demonstrates evidence for the efficacy of both short-term and long-term models. Meta-analytic reviews synthesizing effects across different psychodynamic psychotherapy formats have been conducted for common mental disorders, depression, depression in the setting of personality disorder, personality disorders, and somatic disorders. Psychodynamic psychotherapy demonstrates superiority to control condition, and no significant difference to other formal psychotherapies, including cognitive behavioral therapies. Building upon a recently published systematic review and meta-analysis,11 the aim of this article is to further examine the evidence for a contemporary psychodynamic psychotherapy treatment protocol, intensive short-term dynamic psychotherapy (ISTDP), in the treatment of personality and somatic disorders.
... 5 Although psychiatry residency training programs continue to underscore the importance of psychodynamic psychotherapy as a paradigm, faculty members are often unaware of the outcome data to support this. 6 ISTDP, in particular, is accumulating increased empirical support for the treatment of a wide array of diagnoses. 7,8 We are not aware of any studies in the literature that assess outcome measures and cost-effectiveness of psychodynamic psychotherapy delivered exclusively by psychiatry residents. ...
... This mirrors other studies in this field. 7,8,18 In our clinic, we serve a region spanning 8 hours by car, so it is great work for many patients to come to receive care. Thus, many treatment courses are brief with an average of approximately seven sessions. ...
CME Educational Objectives 1. Understand the role of training in psychodynamic psychotherapy in psychiatry residency training programs. 2. Learn a potential model for training residents in a short-term model of psychodynamic psychotherapy. 3. Review the efficacy and cost-savings data in a study training residents in this model. Whereas psychiatry grows as a field through contributions from neuroscience, genetics, psychopharmacology, and diagnostic specificity, psychiatrists continue to value the importance of psychodynamic assessment and intervention. This is reflected in the current Royal College of Physicians and Surgeons of Canada and American College of Graduate Medical Education (ACGME) guidelines in psychiatry, requiring the demonstration of competency in psychodynamic psychotherapy. This has been further underscored through the roll out of the Next Accreditation System, requiring faculty in psychiatry training programs to delineate the achievement of resident milestones in the area of psychodynamic psychotherapy.
... Intensive short-term dynamic psychotherapy (ISTDP), delivered as a brief intervention, is effective across a broad range of psychiatric conditions [1]. Treatment starts with a comprehensive clinical interview called a trial therapy. ...
Received: January 23, 2018
Accepted: February 11, 2018
Published online: April 10, 2018
Issue release date: August 2018
... A defining feature of PDT models is that symptoms and defenses are based on underlying internal conflicts (Leichsenring & Salzer, 2014). The assumed nature of the conflict may vary somewhat across models-for instance, between activating and inhibitory emotions in affect-phobia therapy (McCullough & Andrews, 2001) and between attachment wishes and rage over their frustration in short-term dynamic therapy (Abbass, Town, & Driessen, 2013). Anyhow, the symptoms are explained in terms of latent variables, leading to an inability to define the presumed cause independent of outcome and to represent within-person relationships. ...
The purpose of this study was to examine the conceptualization of mental problems and disorders inherent in the therapeutic theories used in psychodynamic (PDT) and cognitive-behavioral therapy (CBT). Supportive-expressive (SET) and cognitive (CT) therapy for social anxiety disorder (SAD) were used as representative examples. Based on the typology proposed by Kendler, Zachar, and Craver, we found that PDT models accord with an essentialist model of mental disorders, while CBT models align with a mechanistic property cluster (MPC) model. Because the PDT explanatory concepts represent definitions of symptoms rather than causal explanations of them, PDT models cannot be examined with regard to mechanisms of change. Moreover, because these concepts are treated as latent constructs, they are not able to represent within-person causal/mechanistic relationships between observable phenomena. PDT models cannot while CBT models can lead to testable predictions and knowledge accumulation.
... Among the brief therapy methods, intensive short-term dynamic psychotherapy (ISTDP) (Abbass, 2015;Davanloo, 2000) is a broadly applied treatment of mixed psychiatric disorders with growing empirical support. This treatment model has been studied with case series research and randomized controlled trials and found to show large treatment effects for psychosomatic, depressed, anxious, personalitydisordered, and mixed populations, which are maintained in follow-up (Abbass et al., 2012Town and Driessen, 2013). ...
This study examined the effects of trial therapy interviews using intensive short-term dynamic psychotherapy with 500 mixed sample, tertiary center patients. Furthermore, we investigated whether the effect of trial therapy was larger for patients who had a major unlocking of the unconscious during the interview compared with those who did not. Outcome measures were the Brief Symptom Inventory (BSI) and the Inventory of Interpersonal Problems (IIP), measured at baseline and at 1-month follow-up. Significant outcome effects were observed for both the BSI and the IIP with small to moderate preeffect/posteffect sizes, Cohen's d = 0.52 and 0.23, respectively. Treatment effects were greater in patients who had a major unlocking of the unconscious compared with those who did not. The trial therapy interview appears to be beneficial, and its effects may relate to certain therapeutic processes. Further controlled research is warranted.
... We are both concordant with the basic finding that psychodynamic therapy can be "uniquely effective" in these complex populations (Davanloo, 1990). Several of the aspects of this research have been corroborated by various groups of process researchers over the past 20 years (Abbass, Town, & Driessen, 2013). ...
Intensive short-term dynamic psychotherapy (ISTDP) was developed out of the need for relatively short psychodynamic psychotherapeutic treatment approaches to complex and resistant patient populations so common in public health systems. Based on extensive study of video recordings, Habib Davanloo discovered, and other researchers have validated, some important clinical ingredients that align the therapist with healthy aspects of the patient striving for resolution of chronic neurotic disorders and fragile character structure. In the case of character neurotic highly resistant patients, these approaches including "pressure," "clarification," "challenge to defenses," and "head on collision" can be used in a tailored and properly timed way to help the chronically suffering patient to overcome his or her own resistance and access core drivers of these pathologies. In this article the meta-psychological basis of ISTDP is reviewed and illustrated with an extended case vignette.
COVID-19 has not only killed and infected millions of people worldwide but has also resulted in unprecedented psychosocial stressors that continue to have profound mental health consequences for many people, exacerbating pre-existing psychological suffering and contributing to the onset of new stress related conditions. It has also resulted in a major revolution in the delivery of mental health treatment abruptly shifting psychotherapeutic practice to online technology. Psychotherapists need to be prepared for how their clinical work may change. This qualitative research study has been phenomenological in nature, attempting to capture and contribute to the literature on the lived experience of psychotherapists in navigating the transition through a global pandemic and exploring how the accompanying shift to telehealth has impacted clinical practice and the therapeutic relationship, if at all. A single-session, semi-structured interview lasting approximately one hour was conducted over Zoom with 15 mental health clinicians certified in an integrative psychotherapeutic attachment-based treatment model Accelerated Experiential Dynamic Psychotherapy (AEDP). Research findings and data were analyzed using a thematic coding process and principles of grounded theory. Significant findings of this study included the identification of factors that might negatively impact the online therapeutic relationship and the recognition of ways to strengthen and enhance telehealth effectiveness with an attachment-based and relational lens. Advantages and disadvantages of telehealth practice were identified and explored in addition to the effects of shared trauma on the therapeutic relationship and the post-traumatic growth and resilience of the therapist. Implications for theory, practice and social work education are discussed. Limitations included the small size and homogeneity of the study sample.
Purpose: Short Term Psychodynamic Psychotherapy (STPP) has been demon- 10 strated as an effective treatment for several mental health difficulties. However, its implementation in secondary mental health services in the
National Health Service (NHS) is scarce. The aim of this study was to bridge
the gap between controlled trials and practice-based evidence, by exploring an
initial estimate of the therapeutic effects of this intervention as well as its 15 safety in a secondary care NHS community mental health setting. Method:
The study followed a quantitative case series design. Eight clients with com-
plex, enduring mental health difficulties, supported by a community secondary
mental health service received a course of STPP. They completed outcome measures at the start, at the end and eight-weeks following completion of 20 therapy. Results: All participants but one completed the therapy and atten-
dance rates were high (>75%). No adverse effects were reported. All partici-
pants but two reported improvement in the CORE-OM, BSI and the PHQ-9
and these were maintained at follow-up. Conclusions: The results suggested
that STPP was a safe and acceptable intervention, that may have contributed to 25 clinical and reliable improvement for 4 participants, non-reliable improvement
for 2 and non-reliable deterioration for one participant who finished the treatment.
In diesem Kapitel wird zunächst eine Übersicht über verschiedene Wirksamkeitsnachweise für die Intensive Psychodynamische Kurzzeittherapie nach Davanloo (IS-TDP) gegeben. Im Anschluss werden die aktuellen Forschungsaktivitäten der Deutschen Gesellschaft für IS-TDP beschrieben.
The aim of this study was to evaluate changes in long-term health care costs and symptom severity after adjunctive intensive short-term dynamic psychotherapy (ISTDP) individually tailored and administered to patients with bipolar disorder undergoing standard psychiatric care. Eleven therapists with different levels of expertise delivered an average of 4.6 one-hour sessions of ISTDP to 29 patients with bipolar disorders. Health care service costs were compiled for a one-year period prior to the start of ISTDP along with four one-year periods after termination. Two validated self-report scales, the Brief Symptom Inventory and the Inventory of Interpersonal Problems, were administered at intake and termination of ISTDP. Hospital cost reductions were significant for the one-year post-treatment period relative to baseline year, and all cost reductions were sustained for the follow-up period of four post-treatment years. Self-reported psychiatric symptoms and interpersonal problems were significantly reduced. These preliminary findings suggest that this brief adjunctive psychotherapy may be beneficial and cost-effective in select patients with bipolar disorders, and that gains may be sustained in long-term follow-up. Future research directions are discussed.
In the following review the author describes, from his experience, how behaviors including idealization, devaluation and splitting may obstruct the learning of specific psychotherapy methods such as Intensive Short-Term Dynamic Psychotherapy (ISTDP). A working definition of idealization/devaluation and the problems that occur when it becomes entrenched in trainees or in training programs is described. It is hoped that this paper will stimulate reflection and discussion among psychotherapy students and teachers.
More than 20 years ago Habib Davanloo coined the term unlocking of the unconscious to describe how the psychodynamic concept of the human unconscious can become accessible using the technique of Intensive Short-Term Dynamic Psychotherapy (ISTDP). According to Davanloo, the possibility that unconscious material will be revealed is greatly increased when therapeutic efforts promote dominance of the unconscious therapeutic alliance over unconscious resistance. When these ingredients are present there is a psychic shift that allows unacceptable painful feelings to come to the surface. Toward adding further empirical support for the concept, in this article we compare outcomes between patients who experienced one or more major unlocking of the unconscious (N = 57) to those who did not experience major unlocking (N = 32) during ISTDP treatment. Significant and widespread differences were seen between these two groups, those with major unlocking had greater symptom reduction, interpersonal gains, and cost reduction for treatment. The relevance of this to clinical practice and healthcare utilization will be discussed.
Examined therapist–patient interactions in 16 cases of brief psychotherapy. Three types of therapist intervention (patient–therapist interpretations, patient–significant other interpretations, and clarifications) were compared in terms of the frequency of patient affective or defensive behavior that occurred in the 3 min following each. Therapist-intervention and patient-response episodes were investigated to determine their relationship to outcome at termination of therapy. Results indicate that patient–therapist interpretations followed by patient affect bear a significant relationship to improvement at termination, whereas an intervention followed by defensiveness correlates negatively with outcome. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Urethral syndrome (urinary symptoms and pain without organic lesions) is a frequent female pathology but its aetiology is obscure and its treatment undetermined. A number of studies have highlighted emotional disturbances in these patients. To assess the efficacy of psychotherapy in the treatment of this syndrome, the authors studied 36 patients diagnosed with urethral syndrome. Of these, 13 were randomly selected for short-term dynamic psychotherapy. The remaining 23 patients were treated with traditional urological therapies and used as the control group. After the medical diagnosis and during follow-up at 6 months and 4 years, one psychological questionnaire (SQ) was administered together with a specially prepared clinical questionnaire. The urinary symptomatology and pain disappeared completely in over 70 per cent of the patients who had completed the psychotherapy. For the remaining patients, at the termination of the treatment the symptomatology had improved to the point that it was no longer a problem. These results proved stable in time and were associated with a general improvement in psychic status, particularly for the depression, anxiety and hostility levels. In the controls, on the other hand, no significant improvement was noted in the parameters examined.
The aim of this research was to examine the relationship between therapist interventions and patient affect responses in Short-Term Dynamic Psychotherapy (STDP). The Affect Experiencing subscale from the Achievement of Therapeutic Objectives Scale (ATOS) was adapted to measure individual immediate affect experiencing (I-AES) responses in relation to therapist interventions coded within the preceding speaking turn, using the Psychotherapy Interaction Coding (PIC) system. A hierarchical linear modelling procedure was used to assess the change in affect experiencing and the relationship between affect experiencing and therapist interventions within and across segments of therapy. Process data was taken from six STDP cases; in total 24 hours of video-taped sessions were examined. Therapist interventions were found to account for a statistically significant amount of variance in immediate affect experiencing. Higher levels of immediate affect experiencing followed the therapist's use of Confrontation, Clarification and Support compared to Questions, Self-disclosure and Information interventions. Therapist Confrontation interventions that attempted to direct pressure towards either the visceral experience of affect or a patient's defences against feelings led to the highest levels of immediate affect experiencing. The type of therapist intervention accounts for a small but significant amount of the variation observed in a patient's immediate emotional arousal. Empirical findings support clinical theory in STDP that suggests strategic verbal responses promote the achievement of this specific therapeutic objective.
Short-term dynamic psychotherapy is a group of well-researched brief treatments with over 50 published controlled trials testing its effectiveness against a range of treatment and nontreatment controls. Studied samples are often high users of medical services, hospital services, mental health services and disability insurance. If short-term dynamic psychotherapy is effective, it should translate into demonstrable reductions in medical and social system costs. This review examines whether or not short-term dynamic psychotherapy is a cost-effective treatment.
The efficacy of short-term psychotherapy has become an area of increasing interest. The primary objective of this study was to assess the results of two forms of short-term psychotherapy in patients with personality disorders.
Eighty-one patients with personality disorders were randomly assigned to brief adaptive psychotherapy, short-term dynamic psychotherapy, or a waiting list for therapy. Outcome at termination of therapy for the treatment groups and at the end of the waiting period for the waiting list group was evaluated by means of ratings of target complaints and scores on the SCL-90 and the Social Adjustment Scale. In addition, for 38 of the treated patients, target complaints were reevaluated an average of 1.5 years after treatment ended.
Patients in the two therapy conditions improved significantly on all measures in comparison with the patients on the waiting list. There was no significant difference between the results in the two therapy conditions. The waiting list period averaged approximately 15 weeks; treatment averaged 40 weeks. At follow-up, after an average of 1.5 years, target complaint ratings were not significantly different from those at the termination of therapy.
These data indicate that brief adaptive psychotherapy and short-term dynamic psychotherapy are effective for patients with certain types of personality disorder and that the two therapy approaches do not differ in overall outcome.
The authors report preliminary results of Brief Supportive Psychotherapy (BSP) in the Beth Israel Brief Psychotherapy Program for a sample with primarily Cluster C Axis II disorders. This study compares 24 patients treated with BSP with 25 patients treated with Short-Term Dynamic Psychotherapy (STDP). STDP was chosen because its confrontational methods contrast dramatically to BSP, which emphasizes building self-esteem, reducing anxiety, and enhancing coping mechanisms. Videotaped therapies were based on manualized 40-session protocols. Similar degrees of improvement were seen in BSP and STDP at termination and at 6-month follow-up. A study of therapeutic alliance in BSP showed stable and high levels of alliance in good-outcome cases and more variability in poor-outcome cases. These preliminary findings are consistent with other studies and suggest supportive psychotherapy may be effective for many patients, leading to significant and lasting change.
To assess the cost and clinical effectiveness of psychiatrist-provided Intensive Short-term Dynamic Psychotherapy (ISTDP) of patients referred to a private office.
ISTDP was provided to 89 patients referred to a private psychiatric office in Vancouver, Canada. Pretherapy self-report scores, (BDI, BAI, BSI, IIP [see full names in text]) medication costs, disability costs and healthcare costs were compared with posttherapy values and normative values.
Patients' mean self-report scores went from the abnormal to normal range after an average of 14.9 hours of therapy. Returns to work, reduced healthcare utilization, and medication stopping accounted for a cost reduction of over Cdn$400,000 at one year after therapy.
ISTDP appears to be an effective and cost-effective form of intervention when provided by a psychiatrist in a private office. Randomized controlled studies are warranted to further examine the cost benefits and efficacy of ISTDP.
Psychotherapy instructors have used video technology to train residents for over 40 years. Though it has met with some controversy, many will argue that videotape review is essential for self-directed learning and accurate psychotherapy supervision.
The author describes a technique of small-group videotape training as provided in a psychiatry residency training program.
He reviews the merits and limitations of this format and suggests simple and inexpensive technical approaches to augment this training.
The author concludes that small-group videotape training is an efficient psychotherapy training format that encourages self-monitoring and the exchange of supportive peer feedback.
Anxiety in a patient with physical complaints should prompt an evaluation for somatization.
This pilot study examined the effectiveness of Intensive Short-term Dynamic Psychotherapy (ISTDP) in treatment-resistant depression (TRD). Ten patients with TRD were provided a course of ISTDP. Clinician and patient symptom and interpersonal measures were completed every 4 weeks, at termination, and in follow-up. Medication, disability, and hospital costs were compared before and after treatment. After an average of 13.6 sessions of therapy, all mean measures reached the normal range, with effect sizes ranging from 0.87 to 3.3. Gains were maintained in follow-up assessments. Treatment costs were offset by cost reductions elsewhere in the system. This open study suggests that ISTDP may be effective with this challenging patient group. A randomized, controlled trial and qualitative research are warranted to evaluate this treatment further and to examine its possible therapeutic elements.
This study evaluated the efficacy and long-term effectiveness of intensive short-term dynamic psychotherapy (ISTDP) in the treatment of patients with DSM-IV personality disorders (PD). Twenty-seven patients with PD were randomized to treatment with ISTDP or a minimal-contact, delayed-treatment control condition. ISTDP-treated patients improved significantly more than controls on all primary outcome indices, reaching the normal ranges on both the brief symptom inventory (1.51-0.51, p < 0.001) and inventory of interpersonal problems (1.56-0.67, p < 0.001). When control patients were treated, they experienced benefits similar to the initial treatment group. In long-term follow-up, the whole group maintained their gains and had an 83.3% reduction of personality disorder diagnoses. Treatment costs were thrice offset by reductions in medication and disability payments. This preliminary study of ISTDP suggests it is efficacious and cost-effective in the treatment of PD. Limitations of this study and suggestions for future research are discussed.
This study examined the effects of therapist confrontations and clarifications on patient defensive and affective responding in short-term dynamic psychotherapy. Four videotaped therapy sessions from each of 16 patients were coded on a per-minute basis for the occurrence of selected patient and therapist variables. Contrary to prediction, no significant differences were found regarding the effects of confrontation and clarification of defense on immediate patient affective responding. In addition, therapist confrontation of patient defensive behavior elicited significantly more defensive responding than did clarification. Results also indicated that, within a 3-minute frame, patients' affective and defensive responding in minute 3 is most closely related to their own behavior in minute 1 regardless of the intervening therapist activity. Future research, it is suggested, needs to focus on a longer time frame as well as on the cumulative effects of persistent confrontations on patient affective responding.
The objective is to study the effectiveness of Intensive Short-Term Dynamic Psychotherapy (ISTDP) trial therapies. In a tertiary psychotherapy service, Brief Symptom Inventory (BSI), Inventory of Interpersonal Problems (IIP) medication use, and need for further treatment were evaluated before versus 1-month post trial therapy in a sequential series of 30 clients. Trial therapies were interviews with active focus on emotions and how they are experienced. The interviews resulted in statistically significant improvements on all BSI subscales and one of the IIP subscales. One-third of clients required no further treatment, seven stopped medications, and two returned to work following trial therapy. The ISTDP trial therapy appeared tobe clinicallyeffectiveandcosteffective. Future researchdirections arediscussed. (Brief Treatment and Crisis Intervention 8:164-170 (2008))
The present study investigated change in patient resistance in the transference relationship in Davanloo's (1990) STDP by assessing change in patient BECAs, from early to late therapy. A clinical sample (n=6) significantly differed between early and late therapy on anxiety, BECAs, and GAF ratings. Change, from early to late therapy, in GAF ratings (indexing therapeutic improvement) correlated marginally significantly with change, from early to late therapy, in BECAs (indexing reduction of resistance in the transference). Results are seen as consistent with Davanloo's (1990) theory that positive therapeutic outcomes are caused by positive changes in alliance, from early to late therapy, and by related negative change in resistance, from early to late therapy. Results also are seen as consistent with Westerman et al's (1995) model of linearly increasing alliance in successful STDP, and with other research implicating reduced resistance as a factor in STDP's efficacy.
This paper describes the profile of verbal response modes utilised in the expert application of Short-Term Dynamic Psychotherapy (STDP). One hundred and fifteen randomly selected segments from six treatments of STDP were analysed. Trained raters used a verbal response mode coding system to examine the individual speaking turns of an expert therapist. Based on the profile of therapist interventions reported, it was concluded that the actual conduct of this treatment in routine practice illustrates the empirically informed modifications to STDP technique integrated alongside the common characteristics of STDP based on the therapist (i) adopting an active stance, (ii) maintaining treatment focus using frequent confrontations and the ‘Triangle of Conflict’, and (iii) tailoring treatment to participant functioning using a combination of supportive and expressive interventions. Furthermore, specific differences in therapist activity were observed across treatment phases as well as between participants.
Studied patient defensive behavior and therapist addressing defense (TAD) in short-term dynamic psychotherapy and brief adaptive psychotherapy in 28 adult patients with personality disorders. Three levels of patient defense (immature, intermediate, and mature) were coded. Only intermediate defensive behavior such as intellectualization and rationalization decreased. The greater the frequency of Ss' intermediate and immature defenses early in treatment, the better the outcome. Ss' defensive behavior was significantly correlated with the therapist addressing this behavior and with a decrease in immature and intermediate defenses. The frequency of TAD was significantly correlated with patient outcome. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This paper attempts to provide an overview of a variation of Davanloo's Intensive Short-Term Dynamic Psychotherapy known as the Graded Format. This format is the appropriate choice for therapists who wish to treat particular diagnostic groups such as depressive disorders, functional disorders, panic disorder, certain psychosomatic conditions, syntonic character pathology, patients with low capacity to tolerate anxiety and those with mild to moderate degrees of fragility. A summary of key conceptual and technical aspects of the Graded Technique is provided along with some clinical vignettes, followed by a brief overview of why some therapists fail to apply this method, the consequences of such failure and the method's overall advantages.
The current study examined changes in the ratio of patients' affective and defensive behaviors during the course of brief psychodynamic psychotherapy. Treatments of 16 patients were videotaped. For each patient, four sessions were evaluated with a minute-by-minute coding system of process variables. When patients were grouped according to outcome scores, significant differences between the high outcome and the average-to-low outcome groups emerged. During the early phase of treatment, patients in both groups showed an average of one affective response per five defensive responses. By the late phase of treatment, the high outcome patients showed a marked shift to one affective response per two defensive responses, while the low outcome patients remained the same. An incidental finding was a negative correlation between good outcome and the ratio of defensive behavior to total patient activity.
Habib Davanloo has spent his career developing and teaching methods to accelerate dynamic psychotherapy, including his technique of intensive short-term dynamic psychotherapy (ISTDP). Over the past 20 years, outcome studies using this treatment have been conducted and published. We performed a systematic review of the literature to obtain studies presenting ISTDP outcome data. We found 21 studies (10 controlled, and 11 uncontrolled) reporting the effects of ISTDP in patients with mood, anxiety, personality, and somatic disorders. Using the random-effects model, we performed meta-analyses including 13 of these studies and found pre- to post-treatment effect sizes (Cohen's d) ranging from 0.84 (interpersonal problems) to 1.51 (depression). Post-treatment to follow-up effect sizes suggested that these gains were maintained at follow-up. Based on post-treatment effect sizes, ISTDP was significantly more efficacious than control conditions (d = 1.18; general psychopathology measures). Study quality was highly variable, and there was significant heterogeneity in some analyses. Eight studies using various measures suggested ISTDP was cost-effective. Within limitations of study methodologies, this evidence supports the application of ISTDP across a broad range of populations. Further rigorous and targeted research into this method is warranted.
Somatization of emotions accounts for excess emergency department (ED) visits in the form of medically unexplained symptoms (MUS). Intensive short-term dynamic psychotherapy (ISTDP) has been used to diagnose and manage somatization. We examined the effectiveness of this procedure for ED patients with MUS.
We implemented a service that included staff education, timely access to consultation and gathering of outcome data.
Patients were assessed and treated shortly after referral. There was a mean reduction of 3.2 (69.0%) ED visits per patient (standard deviation [SD] 6.4) the year afterward (95% confidence interval [CI] 1.3-5.0, p< 0.001). In comparison revisit rates during the same time interval for 3 available ED populations (i.e., those matched by visit rates, those with matching complaints and all patients referred to the service but never seen) showed either smaller reductions or higher ED use (ranging from a 15% reduction to a 43% increase). Treatments averaged 3.8 sessions per patient (SD 5.3). Self reported symptoms improved significantly with the Brief Symptom Inventory global rating, which changed from a mean of 1.21 (SD 0.58) before assessment to 0.86 (SD 0.63) ( p< 0.01) at the end of contact with the service. The service appeared acceptable to both emergency physicians and patients.
This emotion-focused assessment and treatment method appeared to be feasible and may be effective in reducing both symptoms and repeat ED use.
Typescript (photocopy). "Graduate Program in Psychology." Vita. Thesis (Ph. D.)--Rutgers University, 1988. Includes bibliographical references.
Typescript. Thesis (Ph. D.)--New York University, School of Education, 2003. Includes bibliographical references (leaves 152-172).
Thesis (Ph. D.)--Columbia University, 1987. Includes bibliographical references (leaves 115-126). Microfiche (positive).
Somatization, anxiety, depression and personality disorders are common features of many patients with chronic headaches. Intensive short-term dynamic psychotherapy (ISTDP) is a brief therapy method developed specifically to treat patients with this cluster of somatic problems, symptoms and maladaptive behaviours through focusing on how the patient handles emotional experiences. It also contains a direct method of assessing the somatic discharge pathways of both emotions and anxiety, thus allowing direct observation of somatization in the case of many chronic headache sufferers. In this review, we summarize the extant literature on emotional factors in headache, review the evidence for short-term dynamic therapies in somatic problems and describe the assessment and treatment method of ISTDP we use routinely with chronic headache sufferers.
Although panic disorder can be effectively alleviated by drug treatment, the relapse rate is high. By adding brief dynamic psychotherapy focused on the psychosocial vulnerability of patients with panic disorder to an established drug treatment regimen, we hypothesized that this would result in a lower relapse rate after pharmacotherapy.
Patients with panic disorder (defined by DSM-III-R) were randomized to treatment with either clomipramine for 9 months (n = 20), or clomipramine for 9 months combined with 15 weekly sessions of brief dynamic psychotherapy (n = 20). Measures of anxiety and depression were collected at intake and at regular intervals. The patients had blind follow-up interviews at 6, 12, and 18 months after beginning treatment.
All patients in both groups became free of panic attacks within 26 weeks of the start of treatment. On termination of pharmacotherapy, the relapse rate was significantly higher in the clomipramine-only group during the follow-up period. There were significantly lower scores for most anxiety measures in the clomipramine plus psychotherapy group at the 9-month follow-up.
The addition of brief dynamic psychotherapy to treatment with clomipramine significantly reduces the relapse rate of panic disorder compared with clomipramine treatment alone.
PMD are disabling, but lack any generally accepted treatment strategies.
Ten patients with PMD received treatment with Psychodynamic Psychotherapy. Patients were assessed with psychiatric rating scales and the movement disorder was rated by a blinded rater with the Psychogenic Movement Disorder Rating Scale (PMDRS).
Total mean PMDRS (p = 0.0195), total PMDRS function scores (p = 0.0142), Hamilton depression scores (p = 0.009), Beck anxiety scores (p = 0.002), and GAF (p = 0.0083) all improved with psychotherapeutic intervention.
Psychotherapy and appropriate use of adjunct psychiatric medication can be a successful intervention for PMD.
The authors systematically examined the relationship between therapist facilitation of patient emotional experience/expression and outcome in psychodynamic psychotherapy.
Computer and manual searches were conducted for relevant publications, and 10 independent samples of short-term dynamic psychotherapy were included in a meta-analysis. Data analysis included calculation of an overall effect size of the relationship between therapist affect focus and outcome, statistical significance, and test for homogeneity. In addition, moderator analyses were conducted to examine the potential impact of type of outcome construct used and the methodological quality of individual studies.
The overall average weighted effect size across all outcome types was statistically significant (r=0.30), and the homogeneity statistic was nonsignificant. Moderator analyses indicated a statistically significant relationship between therapist facilitation of patient emotional experience/expression and outcome when more than one outcome construct was included but not when either a single or an unclear outcome construct was used. There were no significant relationships between methodological quality and the size of the effects, although use of audio- or videotaping for supervision demonstrated a moderate effect.
These data indicate that therapist facilitation of patient affective experience/expression is associated with patient improvement over the course of psychodynamic psychotherapy. Although the size of this relationship was not significantly related to methodological quality, results suggest the importance of close supervision of actual techniques through the use of audio- or videotapes. Additionally, results highlight the importance of defining outcome in a multidimensional way to properly assess theoretically relevant effects.
Intensive short-term dynamic psychotherapy: Correlates with clinical effectiveness
- A Abbass
- M Joffres
- J Ogrodniczuk
- M Hilsenroth
Abbass, A., Joffres, M., Ogrodniczuk, J., & Hilsenroth, M.
(2008). Intensive short-term dynamic psychotherapy: Correlates with clinical effectiveness. Proceedings of Dalhousie
University, Department of Psychiatry Research Day.
An analysis of counseling response mode profile in Short-Term Dynamic Psychotherapy
- A Bernardelli
- J De Stefano
- A Stalikas
Bernardelli, A., De Stefano, J., & Stalikas, A. (2002). An analysis
of counseling response mode profile in Short-Term Dynamic Psychotherapy. The Journal of the Hellenic Psychological
Society, 9(1), 1-8.
Long-term follow-up of a residential form of intensive short-term dynamic psychotherapy in personality disorders
- K L M Cornelissen
- D Smeets
- S P Willemsen
- J J V Busschbach
- R Verheul
Cornelissen, K. L. M., Smeets, D., Willemsen, S. P., Busschbach,
J. J. V., & Verheul, R. (in prep.). Long-term follow-up of a
residential form of intensive short-term dynamic psychotherapy in personality disorders.
Clinical manifestations of superego pathology
- H Davanloo
Davanloo, H. (1987). Clinical manifestations of superego pathology. International Journal of Short-Term Psychotherapy,
2(4), 225-254.
Clinical manifestations of superego pathology. Part II. The resistance of the superego and the liberation of the paralyzed ego
- H Davanloo
Davanloo, H. (1988) Clinical manifestations of superego pathology. Part II. The resistance of the superego and the liberation of the paralyzed ego. International Journal of Short-Term Psychotherapy, 3(1), 1-24.
Unlocking the Unconscious
- H Davanloo
Davanloo H. (1990). Unlocking the Unconscious. Chichester:
Wiley.
The consequences of overcoming resistance and emotional disclosure on lymphocyte T-helper and T-supressor and psychological pathology
- N Ghorbani
- P Dadsetan
- J Ejei
- H Motiyan
Ghorbani, N., Dadsetan, P., Ejei, J., & Motiyan, H. (2000). The
consequences of overcoming resistance and emotional disclosure on lymphocyte T-helper and T-supressor and psychological pathology. Journal of Psychology (Persian), 3, 368-389.
Does patient insight into defensive functioning mediate the relationship between affect experiencing and outcome in intensive short-term dynamic psychotherapy? Unpublished doctoral dissertation
- P Paserpskytė
Paserpskytė, P. (2012). Does patient insight into defensive
functioning mediate the relationship between affect
experiencing and outcome in intensive short-term dynamic
psychotherapy? Unpublished doctoral dissertation, University
of Sheffield, Sheffield, UK.
An Investigation into the Relationship between Affect Experiencing, Degree Of Inhibition and Distress In Intensive Short-Term Dynamic Psychotherapy. Unpublished doctoral dissertation
- A Salvadori
Salvadori, A. (2010). An Investigation into the Relationship
between Affect Experiencing, Degree Of Inhibition and Distress
In Intensive Short-Term Dynamic Psychotherapy. Unpublished
doctoral dissertation, The University of Sheffield, England.
Brief psychotherapy of personality disorders Patient defense/therapist interventions
- A Winston
- J Pollack
- L Mccullough
- W Flegenheimer
- R Kestenbaum
- M Trujillo
Winston, A., Pollack, J., McCullough, L., Flegenheimer, W.,
Kestenbaum, R., & Trujillo, M. (1991). Brief psychotherapy of personality disorders. Journal of Nervous and Mental
Disease 179(4), 188–193.Winston, B., Winson, A., Wallner
Samstag, L., & Muran, C. (1994). Patient defense/therapist
interventions. Psychotherapy, 31(3), 478–491. doi:
10.1037/0033-3204.31.3.478
Office based research in intensive shortterm dynamic psychotherapy (ISTDP): data from the first 6 years of practice
- A Abbass
Abbass, A. (2002b). Office based research in intensive shortterm dynamic psychotherapy (ISTDP): data from the first 6
years of practice. Ad Hoc Bulletin of Short-term Dynamic Psychotherapy, 6(2), 5-14.
The effects of continued confrontation on patient affective and defensive response. Dissertation Abstracts International
- A Makynen
Makynen, A. (1992). The effects of continued confrontation on
patient affective and defensive response. Dissertation Abstracts International, 54, 01B.
Paving the royal road: An overview of conceptual and technical features in the graded format of Davanloo's intensive short-term dynamic psychotherapy
- J W Whittmore
Whittmore, J. W. (1996). Paving the royal road: An overview of
conceptual and technical features in the graded format of
Davanloo's intensive short-term dynamic psychotherapy. International Journal of Short-Term Psychotherapy, 11(1), 21-39. doi: 10.1002/(SICI)1522-7170(199603)11:1<21::AID-SHO114>3.0.CO;2-Q
Brief psychotherapy of personality disorders
- A Winston
- J Pollack
- L Mccullough
- W Flegenheimer
- R Kestenbaum
- M Trujillo
- B Winston
- A Winson
- L Wallner Samstag
- C Muran
Winston, A., Pollack, J., McCullough, L., Flegenheimer, W.,
Kestenbaum, R., & Trujillo, M. (1991). Brief psychotherapy of personality disorders. Journal of Nervous and Mental
Disease 179(4), 188-193.Winston, B., Winson, A., Wallner
Samstag, L., & Muran, C. (1994). Patient defense/therapist
interventions. Psychotherapy, 31(3), 478-491. doi:
10.1037/0033-3204.31.3.478