Englische Artikel and Dokumente

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.

Background. Intensive Short-Term Dynamic Psychotherapy (ISTDP), as developed by Habib Davanloo, is an intensive emotion-focused psychodynamic therapy with an explicit focus on handling resistance in treatment. A core assumption in ISTDP is that psychotherapeutic effects are dependent on in-session emotional processing in the form of rise in complex transference feelings that occurs when treatment resistance is challenged. Recent research indicates that an unlocking of the unconscious, a powerful emotional breakthrough achieved at a high rise in complex transference feelings, can potentially enhance ISTDP’s effectiveness. While ISTDP has a growing evidence base, most of the research conducted has used small samples and has tested therapy delivered by expert therapists. The aims of this study were to evaluate the overall effectiveness of ISTDP when delivered in a tertiary psychotherapy service, and to investigate if having an unlocking of the unconscious during therapy predicted enhanced treatment effectiveness.

Background: Somatic symptom disorders are common, dis- abling and costly. Individually provided short-term psy- chodynamic psychotherapies (STPP) have shown promising results. However, the effectiveness of STPP for somatic symp- tom disorders has not been reviewed. Methods: We under- took a systematic review of randomized controlled trials and controlled before and after studies. The outcomes included psychological symptoms, physical symptoms, social-occupational function, healthcare utilization and treatment continuation. Results: A total of 23 studies met the inclusion criteria and covered a broad range of somatic disorders. Thirteen were RCTs and 10 were case series with pre-post outcome assessment. Of the included studies, 21/23 (91.3%), 11/12 (91.6%), 16/19 (76.2%) and 7/9 (77.8%) reported significant or possible effects on physical symptoms, psychological symptoms, social-occupational function and healthcare utilization respectively. Meta-analysis was possible for 14 studies and revealed significant effects on physical symp- toms, psychiatric symptoms and social adjustment which were maintained in long-term follow-up. Random-effect modeling attenuated some of these relationships. There was a 54% greater treatment retention in the STPP group versus controls. Conclusion: STPP may be effective for a range of medical and physical conditions underscoring the role of pa- tients’ emotional adjustment in overall health. Future research should include high-quality randomized and clinical effectiveness studies with attention to healthcare use and costs

Davanloo has discovered and operationalized a means of direct assessment of character structure, including both discharge pathways of unconscious anxiety and specific manifestations of defenses. This psychodiagnostic process provides a roadmap to the unconscious buried feelings which generate the anxiety and defenses. This roadmap tells the therapist how much of which interventions are required to bring sufficient structural changes in unconscious anxiety and defenses to enable smooth, direct access to the unconscious. In following the map, changes in character structure begin to take place and are thereafter cemented by repeated unlocking of the unconscious and working through the underlying feelings. In this article, this process of psychodiagnostic evaluation, and the graded format of bringing structural changes will be overviewed and illustrated by vignettes from a course of treatment.

Practice recommendations
- Obvious anxiety in a patient with physical complaints should prompt an evaluation for somatization.
- Become familiar with the 4 patterns of somatization and their manifestations.
- Learn how to conduct an emotion-focused interview, which, when applied appropriately, will help rule somatization in or out.