By Lawson Sachter, with Sunya Kjolhede
Many have attempted to define ISTDP but this is no easy task. Even if we focus only on Dr. Habib Davanloo’s work itself, it would be difficult to pin down too many specifics, since his teachings evolved over many decades on so many different levels. Not only did he expand his approach to encompass a much broader range of clients, but he also shifted his focus from what was originally more of a pressure and challenge-based approach, to one that incorporated the more nuanced range evident in the various forms of the “head-on-collision.” Later in his career he also incorporated a more collective and collaborative way of working with the intent of helping to train clinicians more thoroughly in the ways of the unconscious.
So while it’s true that the format used by Davanloo in the early days was designed to be short-term perhaps 10 to 20 sessions and sometimes even less many of the tapes he regularly presented in Montreal involved excerpts taken from the case of a woman he saw for over 80 sessions. Obviously not short-term. What’s also revealing is that many therapists continued working with him over the course of many decades, and this work evolved on both personal and professional levels. These days what further complicates the idea of “defining” ISTDP is the fact that many other therapists have created their own variations, ones that may remain more or less faithful to Davanloo’s work itself.
Though originally trained in traditional psychoanalysis, Davanloo’s frustration with many aspects of that model and his subsequent explorations led him to a series of remarkable insights. These insights rested on Erich Lindemann’s work with survivors of the 1942 Cocoanut Grove Fire, work which revealed how fluid and undefended the psyche can become in times of crisis. In terms of these formative years, Davanloo wrote, "One of the very early discoveries that I made had to do with the direct management of the resistance and the direct access to the unconscious, and the interrelation between major resistance and what I call the ‘unconscious therapeutic alliance.’"
By “the direct management of the resistance” Davanloo was referring to a series, or family of interventions that were intended to address resistances immediately and directly as they arose. He also wrote, “As the therapist's major task is to mobilize the unconscious therapeutic alliance against the resistance, he must at all costs avoid getting into the position of implying that the purpose of the interview is for him to change the patient, rather than for the patient to change himself. The therapist's task is to avoid getting into the position of being omnipotent and a figure of the past.” (italics added)
There are, however, some constants in Davanloo's method. We can say that throughout all of his work, a core element rests on the notion that unconscious guilt functions as “the perpetrator of the unconscious.” Most if not all the tapes I saw dealt with patients whose difficulties included the repression of feelings, and most prominently the repression of anger. Davanloo taught that it was largely the fusion of repressed anger and guilt that fuels the self-punitive dynamics that plague so many. Unconscious guilt, of course, is not the only driving force working against our freedom, but it is pervasive. Because of this understanding one of the primary goals of Davanloo’s ISTDP was “to drain the pathogenic zone” of this particular kind of unconscious guilt.
This intrapsychic focus wasn’t new: in 1914 Freud wrote that “removal of the resistance” was the primary task of the therapist. He also asserted that, "The ‘unconscious sense of guilt’ represents the superego’s resistance. It is the most powerful factor and the one most dreaded by us." And in 1940 he went on to write, "For the moment we must bow to the superiority of the forces against which we see our efforts come to nothing."
Davanloo discovered a radically new approach for dealing with resistance, and in the process found he was able to gain access to what he called “the locked zone” of the unconscious. This locked zone holds the most toxic, and so most heavily repressed, feelings and impulses, as well as the memories and historical links that help make sense of the entire repressive system.
Many psychotherapeutic approaches focus on accessing deeper levels of the psyche to foster significant change in the patient, with the intent, as Carl Jung put it, “to make the unconscious conscious.” What sets Davanloo’s work apart was his singular ability to bring about deep levels of change in such a relatively short period of time. He accomplished this through the dynamic ways he applied pressure on the defensive structures without creating a misalliance. He was able to convey to the patient that he was on their side in taking a stand against the crippling forces of the punitive unconscious. This is one of the most subtle, enigmatic, and yet crucial elements of the ISTDP therapeutic process.
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It seems to me there were several key components contributing to Davanloo’s ability to work so effectively. First was his remarkable gift to see into what in the earlier days he would refer to as the “central column of defense.” Rather than chasing after the defenses, he could single out the ones that were most fundamental often addressing them as key elements within a head-on collision. Such characterological defenses are the ones the patient identifies with most thoroughly, and being syntonic in nature they are delicate to address. This syntonicity is part of the reason Davanloo felt so strongly about working in the transference, especially during the initial stages of the ISTDP process. This point is highlighted in his “Central Dynamic Sequence” where he outlines the process of first “tilting” and then “crystalizing” the work into the transference.
Davanloo also seemed to have a remarkable ability to gauge the degree of pressure that would be effective in the moment. This intuitive sense was most evident in what he called the “Graded Format,” where he would use his ability to raise and lower the intensity of what he referred to as the “complex transference feelings,” and then later as the “transference component of the resistance,” to strengthen the patient’s capacity to tolerate increasing levels of unconscious anxiety, as well as further depths of feeling and impulse.
In thinking back over the years, though, I believe the most remarkable thing about Davanloo’s work, and also the most mysterious, had to do with the way he could generate such incredible pressure within a session and not create a misalliance. Again, he had an amazing ability to convey to the patient his unwavering support for something deeply authentic and alive within them to tap into and join with the patient’s own, often buried, wish to live a life of greater freedom and connection.
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When reading about Davanloo’s cases, and even when watching tapes of his actual therapy sessions, it’s easy to focus on the seemingly aggressive tactics and the patient’s rising anger, and to imagine a misalliance is in the works. What’s sometimes overlooked, however, is the recognition of the deeper dynamics that are also present. As Davanloo wrote, “The central ingredient of the technique consists of systematic pressure and challenge to the resistance, but this needs to be considered in the context of the whole process of dynamic interaction between patient and therapist.” My own sense is when referring to “the whole process of dynamic interaction,” he’s speaking most directly about the far less visible role of the unconscious therapeutic alliance.
As an example: I remember a particular session Davanloo showed in which he was applying pressure in such a way that the patient, clearly angry, finally exclaimed something like, “Up until the time that you keep asking me about this… (some issue), I’m not going to talk to you!” I recall thinking that Davanloo had blown it, that for some reason he was showing us a failed therapy. Instead, he stopped the tape at that point, looked around the room, and said, “So you can see that the therapy is going very well.” I recall wondering, what the heck is he talking about, and what is he seeing that I’m not? The tape went on from that point with Davanloo continuing to apply still further pressure until a beautiful unlocking occurred. In a follow-up session the patient expressed his deep gratitude for Davanloo’s persistence, and as I recall he went on to say that without that on-going pressure, no breakthrough would have occurred. This tape marked a significant turning point in my own understanding and therapeutic approach, and has helped me to more fully appreciate what is meant by “the therapist’s stance.”
It's clear to me now that the transformative power of Davanloo’s work lay not only in the remarkable techniques he discovered, but even more in his intuitive gift to help bring about a powerful unconscious therapeutic alliance, making it possible to apply an extraordinary level of pressure against the person’s defenses. Without this alliance, the work easily remains on more cognitive levels, moves into defensive compliance, or else falls into the danger zone of misalliance. The degree of pressure on the defenses, and their centrality to a person’s identity, can only exist in proportion to the strength of the UTA. The types of interventions that involve clarification, pressure, challenge, and head-on collisions only become possible within a field of unified effort grounded in genuine, though sometimes unconscious trust.
As a side-note here: All the tapes Davanloo presented over the years— and there were many— showed successful processes and outcomes. It’s hard to imagine that everything always went smoothly, though, and that there weren’t misalliances that occurred along the way.
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Davanloo was without doubt a brilliant and complex person. I’ve often wondered if his ability to read the unconscious of others wasn’t due, at least in part, to the fact that he was raised in a different time and culture—that as an Iranian he was able to see, or sense, things that we as Westerners are too close to easily recognize in ourselves. Similarly, it seems possible that we as Westerners might be sensitive to aspects of Davanloo’s personality that for him were more personally, or culturally syntonic.
Davanloo often talked about the significance of “communications from the unconscious”—those revelations that affirmed the alliance, or brought forth a new and perhaps unexpected area of inquiry. As the years go on, I find myself believing more and more that communications at this level move in both directions—and that in the course of this work, unseen therapeutic forces can become increasingly prominent. Jung wrote about the power of “knowing by the unconscious,” and Freud stated, “The unconscious of one human being can react upon that of another without passing through the conscious.” And I believe it was David Malan who first suggested that many of Davanloo’s “discoveries” actually arose out of some intuitively-based interventions, ones that even he wasn’t fully conscious of formulating.
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Circling back now, we can see that an essential goal of Davanloo’s ISTDP is to free the patient from the corrosive effects of guilt, in other words to “drain the pathogenic zone.” But lying still closer to the heart of this therapeutic process is the recognition that, as Davanloo stated, “The therapist's major task is to mobilize the unconscious therapeutic alliance against the resistance.” If we view Davanloo’s work as his attempt simply to hammer on the defenses until they give way, or to generate feelings, particularly anger, within the patient, we will understand it in one way. On the other hand, if we see ISTDP as a process of forcefully awakening and mobilizing the unconscious therapeutic alliance against the destructive forces of the patient’s own unconscious, then we see and experience it on an entirely different level.
Standing up to the defenses and activation of the unconscious therapeutic alliance are all of one piece. His words, spoken with a deep conviction towards the end of a conference I attended in the early 90's, still resonate powerfully for me: “The therapist simply cannot let the patient’s life go to waste!”
After an unlocking Davanloo also emphasized the importance of continuing the work with both an “analysis of the transference,” as well as what he called the “working-through phase.” These later stages of the ISTDP process may involve a further release which often includes waves of grief, forgiveness, and love—the wish to feel cared for, loved, and believed in and, in the same breath, to experience and express our own love toward those we were so dependent upon throughout the earliest years of our life.
I have no doubt that Davanloo’s tapes contained implicit teachings that are lost when transcribed onto the printed page—communications that cannot be articulated, or taught as techniques. But what seems so vital here is that the intuitive understanding he brought to his work is something lying potential within each of us, which we can continue to cultivate, as many do, through our ongoing inner work.
I also believe that what Davanloo was able to touch into is in some ways just a beginning. Unlockings and other sorts of breakthroughs help create openings, or passageways, to a still deeper understanding of the boundlessm nature of Mind, and our own intrinsic freedom and compassion. It seems to me we are on the threshold of a more expansive understanding of the human potential, and that the spirit lying at the heart of ISTDP is opening up in new and promising directions.
In truth, none of this is new. Years ago James Hillman wrote of the potential for psychotherapy to include “an exploration of the mysteries of human nature." And as William James put it more than a century ago, "Our normal waking consciousness, rational consciousness as we call it, is but one special type of consciousness, whilst all about it, parted from it by the flimsiest of screens, there lie potential forms of consciousness entirely different.”
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