unconscious anxiety

This chapter addresses the development of the work of Habib Davanloo, M.D. from the early 1960’s to the present. His focus has been both on shortening the length of psychoanalytic therapies and expanding the base of patients treatable with his techniques. He, like others at the time, initially worked with highly motivated patients with a single therapeutic focus. Over the decades his clinical and clinical research base expanded to include patients with the highest complexity in their unconscious structure and the highest unconscious resistance. This includes the full spectrum of neurotic and characterologic disturbances, fragile character structure and complex cases of persistent, unresolved Transference Neurosis. His current clinical work, clinical research and education of therapists have major implications for the future of dynamic psychotherapy. His metapsychology is presented with attention to the issues of unconscious feelings, manifestations of unconscious anxiety and his unique perspective on the unconscious defensive structure. His methods of Intensive Short-term Dynamic Psychotherapy (DISTDP) with “unlocking the unconscious,” Mobilization of the Unconscious, and Total Removal of Resistance are described. The evidence base for short-term dynamic and DISTDP is briefly reviewed. Lastly, the focus of Davanloo’s current work is introduced, namely his concentration on Transference Neurosis. This topic is discussed further in the next chapter.

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.