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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.

Somatization, anxiety, depression and personality disorders are common features of many patients with chronic headaches. Intensive short-term dynamic psycho- therapy (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.

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.

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 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.