1. Experiencing Love and Guilt about Rage: the central change agent in Davanloo's ISTDP
Allan Abbass MD, FRCPC
Professor and Director of Education,
Director, Centre for Emotions and Health
Dalhousie University, Halifax, Canada
(c) Dr Allan Abbass

2. Overview Davanloo’s “new metapsychology of the unconscious”
Clarifications of major technical interventions
Case example: The Angry Scientist
(c) Dr Allan Abbass

3. “The ISTDP therapist must have the utmost respect for the patient while at the same time no respect for the resistances that have paralyzed his or her functioning”
(c) Dr Allan Abbass

4. “The ISTDP therapist must have the utmost respect for the patient while at the same time no respect for the resistances that have paralyzed his or her functioning”
These 2 processes should happen simultaneously: otherwise the process is splitting and can have negative effects
(c) Dr Allan Abbass

5. ISTDP Papers Since 1995 Specific diagnosable patient categories
Central focus on the T
Specific interventions and timing
Specific responses relates to specific therapy events
How to identify and use specific unconscious signals
Specific techniques for fragile, somatizing and other patients
The somatic pathways of rage, guilt and grief
The need for continuous positive regard
Central role of love and forgiveness
(c) Dr Allan Abbass

6. The evolving Davanloo: 2012 +
He still teaches
Others teach for him
He cites published research
Acknowledges, including by letter, contributions of others
Is much clearer about technique, how it works and how to teach it.
Is clearer about the central role of love, attachment and forgiveness
(c) Dr Allan Abbass

7. Metapsychology of ISTDP Genesis of Psychoneurotic Disorders
BOND
Trauma
PAIN
RAGE, GUILT
about the Rage
Character problems
Symptoms
(c) Dr Allan Abbass

8. Spectrum of Psychoneurotic Disorders
Spectrum of Patients with
Fragile Character Structure
Severe/ Borderline
Low R
Moderate R
High R
Mild
Moderate
These are diagnosable and have different treatment pathways
(c) Dr Allan Abbass
Davanloo, 1995, Abbass 2002

9. Metapsychology of ISTDP
Triangle of Conflict
Unconscious
Defence
Isolation
Repression
Projection
Superego
Unconscious Anxiety
Striated Muscle
Smooth Muscle
Cognitive-perceptual
Unconscious Feelings
Pain, Rage, Guilt, Grief
(c) Dr Allan Abbass

10. Psychodiagnosis  Roadmap
Clamp Resistance
Unconscious
Anxiety
Unconscious
Defenses
Monitor
Response
Unconscious
Feelings
Pressure
(c) Dr Allan Abbass

11. 3 Categories of major resistance
Isolation of Affect
Talk about it without somatic experience
Repression
Shut down emotions unconsciously into the body or depression etc
Projection and Projective Identification
(c) Dr Allan Abbass

12. Resistance of the Punitive Superego Davanloo 1988 a and b
Manifestations: Repeated/chronic self defeat and self sabotage.
Origins: Violent and murderous rage toward loved ones and guilt about this rage.
Countless modes of presenting to psychology, medical, social and legal systems
IT is protective of others AND self-constrictive and self-punitive
(c) Dr Allan Abbass

13. Complex Transference Feelings (CTF) I
Includes positive feelings and irritation toward the therapist which link to past feelings about the bond, trauma, pain, rage and guilt
Mobilizing CTF is the engine to the Unconscious Therapeutic Alliance.
The essential element of ISTDP is rise in CTF  UTA
Mobilized by having an increasing lack of respect for the resistance in the service of assisting the patient to overcome these behaviors.
(c) Dr Allan Abbass

14. The central task of the ISTDP Therapist is to reach through the Resistance to the person stuck underneath (Pressure)
If the patient is too weak to reach back then build capacity (Graded work and other elements)
If they involuntarily resist in the transference help them see and overcome that barrier (Clarify, challenge and Head on collide)
(c) Dr Allan Abbass

15. This can only happen with continuous positive regard for the patient
Coupled with this is a continuous negative regard for the resistances that are destroying the patient and his relationships
(c) Dr Allan Abbass

16. Interventions in 30 ISTDP Trial Therapies (Abbass, Joffres & Ogrodniczuk, 2009)
Rate per hour
Percent of all
Pressure 97
59%
Recapitulation 29
19%
Clarification/challenge 23
14%
Inquiry 9 5%
Dynamic Exploration 6 3%
(c) Dr Allan Abbass

17. Pressure Davanloo 1999 The mainstay intervention of ISTDP
Encouraging the patient to connect to his true feelings and be open with the therapist about these feelings.
= Reaching through resistance to the person underneath
Psychodiagnosis and Road map
Pressure increases CTF, UTA and Resistance
(c) Dr Allan Abbass

18. Technique of Unlocking the Unconscious Davanloo 1988-2001
UTA R
CTF R
UTA
“Unlocked”
Pressure
(c) Dr Allan Abbass

19. Challenge Davanloo 1999
This is done only when the resistances are crystallizing in the therapeutic relationship (transference), when they are an obstruction to the therapeutic bond and task
First, clarify the defences with the Patient
Then pressure: encourage the patient to overcome the resistances with you
Finally, challenge the defences in concert with the patient.
(c) Dr Allan Abbass

20. Technique of Unlocking the Unconscious Davanloo 1988-2001
UTA R
Resistance is in T
Clarify
and Challenge
Keep up Pressure
CTF R
UTA
“Unlocked”
(c) Dr Allan Abbass

21. Head on Collision Davanloo 1999
With the resistances crystallized in the transference this most powerful intervention highlights the reality of
the limits of the therapist,
effects of resistance
potential of the alliance
And encourages the patient to do his or her best
Again, seldom used with low capacity patients.
(c) Dr Allan Abbass

22. Technique of Unlocking the Unconscious Davanloo 1988-2001
UTA R
Resistance in T
Head on Collision
Pressure
Challenge
CTF R
UTA
“Unlocked”
(c) Dr Allan Abbass

23. Unlocking of the Unconscious
CTF are experienced: anxiety and defence are removed or reduced
UTA is greater than resistance
Partial versus major versus extended unlocking
Partial: Link to past
Major: Image changes to the past person
Extended: During breakthrough of rage the image is the past person
(c) Dr Allan Abbass

24. Central Dynamic Sequence
Systematic Analysis of the Transference
Extensive Cognitive Recap of findings
Collaborative and repetitive
Extremely important in patients with panic,
somatization, depressive disorders and fragile character structure
(c) Dr Allan Abbass

25. Resistance goes into the T
Inquiry
Experience
Feelings
Low
Resistance
Resistance goes up
Pressure
Experience
Feelings
Moderate
Resistance
Resistance goes into the T
Experience
Feelings
High
Resistance
Clarify and Challenge
Depression,
Somatization,
Fragile
Graded
Format
to build
Capacity
Go flat at any point
(c) Dr Allan Abbass

26. Eg. threshold to cognitive disruption Anxiety Graded Format:
1. Pressure to feelings or to defences
2. Rise in complex feelings and anxiety
3. Intellectual recap to bring down anxiety
Eg. threshold to
cognitive disruption 1
Anxiety 2
(c) Dr Allan Abbass

27. Summary
ISTDP takes place via continuous positive regard for the patient
Out of that positive regard there is a continuous pressure on or disrespect for the resistances that paralyze his or her functioning.
This complex stance brings the UTA
Specific diagnostic system and treatment system
Specific interventions, timed and dictated by the format of unc anxiety, resistance, state of complex feelings and UTA
Pressure vs Challenge vs Head on Collision
(c) Dr Allan Abbass

28. Immersion Training
Halifax Canada September 24-27: Focus on detecting mobilzation of the Unconscious. Plus 6 quest speakers
Stockholm: October 18-21, 2012: Overview and psychodiagnosis across spectrum
Norway June 10-13, 2013: The Highly Resistant Patient
Contact Jennifer at
(c) Dr Allan Abbass