The unconscious Therapeutic Alliance 7th Norwegian Immersion in ISTDP

The unconscious Therapeutic Alliance 7th Norwegian Immersion in ISTDP
Allan Abbass MD, FRCPC Dalhousie University, Canada

The loving actions of an honest, caring other person activates, and in some cases, creates, the UTA

Overall plan for the course
Overview of ISTDP model The UTA UTA across the Rise, across treatment phases, and by spectrum Emphasis on early UTA across series of cases in spectrum ----- Meeting Notes ( :03) ----- hopeless/SI cpd stays

BOND With Parents

BOND With Parents BOND With Others

BOND With Parents

BOND With Parents Trauma PAIN FEAR

BOND With Parents Trauma PAIN FEAR Rage, Guilt about the Rage

BOND Trauma With Parents PAIN FEAR Rage, Guilt about the Rage
Avoid closeness Depression Character Disorder Somatic Symptoms Intergenerational Transmission of Trauma

Transference (Therapist/ Doctor) Current person New 1.2 Past person

Unconscious Defense Unconscious Anxiety Unconscious
2.1 Unconscious Impulses & Feelings

Complex Transference Feelings (CTF)
Feelings mobilized by trying to therapeutically attach to patient = appreciation plus irritation toward the therapist Linked to the past bond, trauma, pain, rage and guilt about rage.

Unconscious Therapeutic Alliance
Davanloo’s major discovery The unconscious healing force Mobilized by activating the complex transference feelings Works to oppose the resistance Brings mental images of past relational trauma and clear linkages to trauma

Memory and Emotion Systems
Mid rise in CTF High rise in CTF Partial unlocking Major unlocking R >> UTA Whispers from the alliance: concise understanding of dynamics R > UTA Negation, slips of the tongue R < UTA Rage, grief: clear linkages R << UTA Rage and Guilt: image transfer 4.1 R= Resistance UTA= Unconscious Therapeutic Alliance

Spectrum of Psychoneurotic Disorders (NON FRAGILE)
Spectrum of Patients with Fragile Character Structure Low Resistant Moderate Resistant Highly Resistant Severe/ Borderline Mild Moderate Striated Muscle + Isolation of affect 3.1 Smooth Muscle/Conversion + Repression Cognitive-Perceptual Disruption + Primitive Defenses

Tactical defenses Loss: grief Attachment 12.1 No Rage and Guilt

Therapeutic Alliance Inquiry Pressure Resistance Grief is felt P R Th
12.2 P R Th

Moderate Resistance Major resistance: isolation of affect Guilt
Murderous rage Trauma: Pain New 13.1 Attachment

Major unlocking: IMAGES Ongoing functions of UTA
Partial unlocking: LINKS High rise in CTF: NEGATIONS Mid rise in CTF: WHISPERS Low R Moderate R High R Repression Fragile Initial Phase Capacity Building Repeated Unlocking Working Through Termination

Mid rise in CTF: WHISPERS
Low R Initial Phase

Partial unlocking: LINKS High rise in CTF: NEGATIONS Mid rise in CTF: WHISPERS Moderate R Initial Phase Repeated Unlocking Termination

Partial unlocking: LINKS High rise in CTF: NEGATIONS Mid rise in CTF: WHISPERS High Resistance Initial Phase Repeated Unlocking Working Through Termination

Partial unlocking: LINKS High rise in CTF: NEGATIONS Mid rise in CTF: WHISPERS Repression Initial Phase Capacity Building Repeated Unlocking Working Through Termination

Partial unlocking: LINKS High rise in CTF: NEGATIONS Mid rise in CTF: WHISPERS Fragile Initial Phase Capacity Building Repeated Unlocking Working Through Termination

UTA Across Time Initial Phase Capacity Building Phase
Repeated unlocking Working through Termination

UTA over Treatment Phases
Power of UTA versus Forces of Resistance UTA: Memories, Vivid Images, Losses due to neurosis, Grief >> Rage UTA: Losses, Goodbye Therapist. Poetry Grief Partial and Major unlocking: Links and Images High rise in CTF: Negation Mid rise in CTF: Whispers Initial Phase Capacity Building Repeated Unlocking Working Through Termination

Ongoing Functions of the UTA
Keep eye on the defenses Share insights with therapist Keep remembering Keep images in mind until guilt passes Flashes of the unconscious Dreams that are memories or breakthroughs A voice or presence in the mind guiding healthy activity

ISTDP: Steps to Mobilize the UTA!!
1. Handle barriers to engagement 2. Assess the Front of the System 3. Psychodiagnosis 4. Monitor and work with parameters These will determine next interventions, pace and expected processes

STEP 1: Barriers to engagement
Barriers to collaborative engagement must be undone to see anxiety and defense manifestations

STEP 2: Find the Front of the System
1. Activated and avoided complex feelings 2. Active defenses at the front 3. Active Unconscious Anxiety 4. No activation

STEP 3: Psychodiagnosis
2. Monitor Anxiety & Defense responses Unconscious Defense Unconscious Anxiety 1. Pressure on Feelings or Defenses NEW 6.1 Unconscious Impulses & Feelings

Major Resistance: 4 Types
Isolation of affect: see with voluntary muscle anxiety Repression: see with smooth muscle anxiety and conversion Primitive Defense: See with cognitive-perceptual disruption Resistance of Guilt: Punitive Superego: need to defeat and sabotage

Unconscious Anxiety Striated Muscle: Voluntary muscle tension
See with isolation of affect/ self reflection of affect Smooth Muscle: Body organs See with repression Cognitive –perceptual Disruption See with primitive defenses

Striated muscle anxiety plus feel complex transference feelings
Complete treatment in 1 or 2 sessions Breakthrough of grief about loss Low Resistance Inquiry Resistance Rises Striated muscle anxiety plus feel complex transference feelings Moderate Resistance Pressure Repeated unlocking, working through, termination Resistance crystallizes in the transference Striated muscle anxiety plus feel complex transference feelings Clarify, Challenge, Head on Collision High Resistance 6.2 Depression, smooth muscle anxiety or motor conversion High Resistance with Repression Capacity Building Formats GO FLAT: No striated muscle anxiety Cognitive-perceptual disruption or primitive defenses Fragile Character Structure

Spectrum of Psychoneurotic Disorders
Spectrum of Patients with Fragile Character Structure Low Resistant Moderate Resistant Highly Resistant Severe/ Borderline Mild Moderate Striated Muscle + Isolation of affect 3.1 Smooth Muscle/Conversion + Repression Cognitive-Perceptual Disruption + Primitive Defenses

STEP 4: Monitor and Work with 5 Parameters
Unconscious anxiety pathways Active major defense Degree to which resistances are syntonic versus dystonic Degree of rise in the transference/ UTA Presence of thresholds and how high thresholds are

Resistance crystallizing in
Moderate Resistance Resistance Mid rise: Resistance crystallizing in transference Clarify + Challenge Complex Transference feelings Unconscious therapeutic alliance “Unlocked” Low rise: Inquiry and Pressure New 13.2 P P R R Th

Pressure: Encourage good actions
All efforts encouraging the patient to do something healthy Cementing the Bond Reaching to the person stuck under the resistances Pressure should target front of the system

Resistance crystallizing in
Mid Rise Resistance Mid rise: Resistance crystallizing in transference. Clarify and Challenge, Maintain pressure “Unlocked” Complex Transference feelings Unconscious therapeutic alliance 8.1

Clarification: Question unhealthy behaviors
Examples: Pointing out Questioning Exploring impact of defense Keep up pressure

Challenge: help patient to stop destructive actions
Interrupting and Blocking Defenses If you don’t detach, if you dont shut down Challenge is always done in concert with the patient and the growing UTA Challenge is always done while maintaining Pressure

HELP EXPERIENCE THE FEELINGS
Partial Unlocking Resistance HELP EXPERIENCE THE FEELINGS “Unlocked”: Emotion and Memory Function Greater than inhibitory functions Complex Transference feelings Unconscious therapeutic alliance 8.1

Striated Muscle Anxiety Goes Down Body Neurobiological Pathway of
Rage: goes up same system displacing anxiety AMA Atlas online

Unlocking Partial Unlocking: somatic pathway of love, rage, guilt and grief are experienced to small degree: UTA  vivid link to past person. Major Unlocking: UTA Image of current person or therapist changes to past person with passage of guilt. Extended unlocking: Rage starts with the therapist then via UTA  becomes the past person with major passage of guilt

Locked Zone Violent rage Guilt Murderous Rage Grief Primitive Murderous Rage

Resistance Complex Transference feelings First breakthrough
High rise: Resistance crystallized in transference. Head on collision Resistance Complex Transference feelings Mid rise: Resistance crystallizing in transference. Clarify and challenge First breakthrough Unconscious therapeutic alliance 8.1 Low rise: inquiry and pressure

Partial Unlocking of the Unconscious
CTF are mobilized and all aspects are partly experienced Rage and guilt partly experienced Anxiety and defences drop in proportion UTA give clear link or image of person from the past

Locked Zone Violent rage Guilt Murderous Rage Grief

Resistance Complex Partial Transference Unlocking feelings Unconscious
High rise: Resistance crystallized in transference. Head on collision Complex Transference feelings Partial Unlocking Mid rise: Resistance crystallizing in transference. Clarify and challenge Unconscious therapeutic alliance 8.1 Low rise: inquiry and pressure

Major Unlocking: major Dominance of UTA over R
Murderous rage passes in the transference Images transfers to past person Guilt passes for several minutes UTA is dominant Powerful effects: resistance is put down markedly

Resistance Major Unconscious Unlocking therapeutic alliance Complex
High rise: Resistance crystallized in transference. Head on collision Complex Transference feelings Mid rise: Resistance crystallizing in transference. Clarify and challenge Major Unlocking Unconscious therapeutic alliance 8.1 Low rise: inquiry and pressure

Head on Collision Therapists most powerful intervention
Confronts patient with reality Puts responsibility for change where it belongs – with the patient Mobilizes patient to become involved in therapeutic task and increases CTF Addressed to UTA to go into battle against the R Inter-locking chain of Clarification and Challenge to major defense Followed by Pressure to do something about the Defense

Head on Collision II Head on Collide with the Resistance in the Transference Point out the destructiveness of the R Point out the benefits of giving up the R Verify the patient’s will to overcome the R Underline the partnership Deactivate any defiance Get out of “the shoes of parent”: deactivate the transference Undo notion of therapist omnipotence Pressure: encourage them to give it their best effort Result: Complex feelings are experienced: the triggering mechanism for direct access to unconscious feelings

Head on Collision III Short Range HOC: for low to Mid Rise
Interlocking Chain: For Syntonic High Resistant cases Comprehensive: For unlocking at High Rise

Goals of ISTDP Remove destructive forces of the guilt
Free space in the person to Love, Work and Play High rates of return to work, Symptom relief and interpersonal gains with short course

Threshold to Repression
Conscious Feelings Threshold to experiencing impulse/feelings Threshold to Repression Striated Muscle Anxiety Isolation of Affect 15.1 Unconscious Anxiety Severe Repression Moderate Repression Mild Repression

Threshold to Repression
Conscious Feelings Threshold to Repression 3 2 1 3 Striated Muscle Anxiety Isolation of Affect 2 Unconscious Anxiety 1 15.2 1. Pressure or Bracing 2. Rise in complex transference feelings and anxiety 3. Recap to bring isolation of affect

Conscious Feelings 3 1 Threshold Unconscious Anxiety 2 15.3

Reflection: Recap Pressure BRACING Use when below thresholds
Evoke feelings Activate somatic pathway of rage Develop images Fire limbic areas including amygdala Use to optimize rise without being over threshold Combine both self-reflection and pressure Train brain to fire both functional regions together Use when above thresholds Self-reflect Link phenomena Observe the body Observe thoughts Fire brain self- reflective centers 15.4 Abbass, Reaching Through Resistance, 2015

CPD primitive defenses
Conscious feelings CPD primitive defenses or repression RECAP and ANXIETY REDUCING TECHNIQUES BRACING PRESSURE Unconscious anxiety and defense Isolation of affect Striated muscle FIGURE16.3 Severe fragile, borderline Moderate fragile Mild fragile

How to recap and/or reduce anxiety
Link Phenomena Link triangles past-current-therapist Link feelings-anxiety-defenses Focus on body cues Move to different situation T or C

Portraying Portraying rage can build capacity to isolate affect
Needs be done with some contact with impulse (mid rise at least) Use 3rd or 4th parties to make it easier to feel and see the rage Focus on guilt about the rage to build capacity

UTA in Repression Cases
Capacity Building: Whispers negation Dreams Links Early rises in UTA are swamped by repression and symptoms Repeated unlocking: Images and feelings felt Working through: Grief and putting all together Termination: past losses, grief and moving forward

UTA as Thresholds Rise Threshold Conscious feelings Unconscious
R << UTA Rage and Guilt: image transfer R >> UTA Whispers from the alliance: concise understanding of dynamics R > UTA Negation, slips of the tongue R < UTA Rage, grief: clear linkages Threshold Conscious feelings Guilt Rage Unconscious anxiety and defense FIGURE16.3 Grief

First Breakthroughs: Bracing
Session 4: Links but limited capacity to feel guilt Press to guilt to build capacity and raise thresholds

Striated Muscle Anxiety
Immersive Approach to Building Capacity Conscious Feelings 3 2 Threshold 1 3 2 Striated Muscle Anxiety Isolation of Affect 1 Unconscious Anxiety 15.2 1. Pressure to experience rage 2. Rise to above threshold 3. Press to feel Guilt and regulate down anxiety as needed 4. Extensive Recapping

Somatic pathways of feeling: rage, guilt, grief
Love: rising warmth, urge to smile and embrace Rage: rising heat up chest to head then down arms: tension and anxiety stop Guilt about rage: Hard waves, pain in upper chest. Feel as if have just murdered loved one. Grief: tears, painful feeling in chest. Waves not as hard and distinct as guilt. Not as loud or painful.

Fragile Character Structure Patients
Early neglect, abuse, invalidation Absence of parental figure with anxiety tolerance: usually fragile parents project on child Cognitive-perceptual disruption at some level of rise in anxiety Projection, splitting, projective identification Need capacity building Anxiety to striated/voluntary muscle Defense to self reflection on feelings/isolation of affect

Self-destruct Symptoms WEAK Trauma BOND PAIN Rage, Guilt
about the Rage Self-destruct Symptoms

Economy of Suffering: Fragile Patients
Anxiety Deception Masochism Paranoia Sadism: abuse power Somatization/ Paralysis Dependence/ Addiction Social Isolation No work or $$$ Dissociation Depression

Splitting, Projective Identification
Mild Fragility Cognitive Perceptual Disruption Splitting, Projective Identification Projection Repression Smooth Muscle Isolation of affect Striated Muscle 16.2 Severe Fragile Borderline Moderate Fragile Mild Fragile

Threshold to CPD or primitive defenses
Conscious feelings Pressure Rise in CTF Recap Threshold to CPD or primitive defenses 3 3 2 1 2 Unconscious anxiety and defense 1 Isolation of affect Striated muscle Therapeutic window FIGURE16.3 Severe fragile, borderline Moderate fragile Mild fragile

UTA RISES WITH CTF CTF UTA Conscious Feelings Unconscious Anxiety
Threshold CTF UTA Unconscious Anxiety 15.3

Rapid rotation of the front
Often within seconds the defenses shift from Projection Repression Self Attack CPD This is a hallmark of fragile character structure patients

Rapidly Rotating Fronts
Cognitive Perceptual Disruption Self attack or seek punishment Projection: Afraid Repression: Flat, weak, depressed

Treatment Phases in FCS
Capacity Building Repeated Unlocking Working Through Termination

Capacity building Phase
Psychic integration Graded format Anxiety tolerance Voluntary muscle anxiety and reflective capacity Start to mobilize the UTA Maybe few sessions to 25 sessions or more depending on level of fragility

CTF/ UTA in Mild Fragility
When CTF rise, UTA may be seen with whispers, negation or even links This tends to cause cognitive disruption with drifting May cause rotating fronts to fire Easy to deal with by recap Press to guilt to bring capacity May project the guilt on you: see you as punitive until they feel the guilt

Results of Capacity Building Phase
Anxiety in striated muscle Ability to self reflect Ability to reduce own anxiety Understanding of the trauma Reduction of paranoia/projection and grief about it Emerging empathy for family Start to have Repeated Unlocking

Projective Identification
Cognitive Perceptual Disruption Projective Identification Projection Repression Smooth Muscle Isolation of affect Striated Muscle 16.2 Severe Fragile Borderline Moderate Fragile Mild Fragile

Moderate to severe fragility
Transgender woman Was stuck in hospital for months with multiple somatic symptoms: wheel chair bound Self injury Pseudoseizures Diagnosed Dissociative Identity Disorder, severe abuse history Beginning of trial: projective processes and severe anxiety

Rapidly Rotating Fronts
Cognitive Perceptual Disruption Self attack or seek punishment Projection: Afraid Repression: Flat, weak, depressed

Projective Identification
Psychic Integration Cognitive Perceptual Disruption Projective Identification Projection Repression Smooth Muscle Isolation of affect Striated Muscle 16.2 Severe Fragile Borderline Moderate Fragile Mild Fragile

Conscious feelings Pressure Rise in CTF Recap Threshold to Cognitive perceptual disruption or primitive defenses or Repression 3 3 2 1 2 Unconscious anxiety and defense 1 Isolation of affect Striated muscle Therapeutic window FIGURE16.3 Severe fragile, borderline Moderate fragile Mild fragile

Reflection: Recap Pressure BRACING Use when below thresholds
Evoke feelings Activate somatic pathway of rage Develop images Fire limbic areas including amygdala Use to optimize rise without being over threshold Combine both self-reflection and pressure Train brain to fire both functional regions together Use when above thresholds Self-reflect Link phenomena Observe the body Observe thoughts Fire brain self- reflective centers 15.4 Abbass, Reaching Through Resistance, 2015

CPD primitive defenses
Conscious feelings CPD primitive defenses or repression RECAP and ANXIETY REDUCING TECHNIQUES BRACING PRESSURE Unconscious anxiety and defense Isolation of affect Striated muscle FIGURE16.3 Severe fragile, borderline Moderate fragile Mild fragile

Moderate to severe fragility
Transgender woman Was stuck in hospital for months with multiple somatic symptoms: wheel chair bound Self injury Pseudoseizures Diagnosed MPD, severe abuse history Beginning of trial: projective processes

Feelings/UTA in Moderate Fragility
Flash of Complex transference feelings and or grief  UTA tries to link Expect rotating fronts to try swamp the UTA You can add pressure or recap out of this Easier to handle than with severe fragile patient Expect this and handle it

Moderate to Severe Fragility
Cognitive Perceptual Disruption Splitting, Projective Identification Projection Repression Smooth Muscle Isolation of affect Striated Muscle 16.2 Severe Fragile Borderline Moderate Fragile Mild Fragile

Feelings and UTA in severe fragility
Small spike of complex feelings, grief or positive feelings  fires up massive guilt  fires the rotating gun of Projection, Repression, cognitive disruption and self attack This small spike may be seen with UTA whispers or negation which are swamped out by guilt  anxiety and rotating fronts Be prepared for this when they like you, or feel empathy for self

Psychic Integration With severe fragility
Linking things together so things fire and function together Both triangles Between triangles Between parts of self Between superego, healthy self To have a single anxious person to work with

Conscious feelings Threshold Unconscious anxiety and defense
Pressure Rise in CTF Recap Threshold 3 3 2 1 2 Unconscious anxiety and defense 1 Isolation of affect Striated muscle Therapeutic window FIGURE16.3 Severe fragile, borderline Moderate fragile Mild fragile

UTA RISES WITH CTF CTF UTA Conscious Feelings Unconscious Anxiety
Threshold CTF UTA Unconscious Anxiety 15.3

Striated Muscle Anxiety
Immersive Approach to Building Capacity Conscious Feelings 3 2 Threshold 1 3 2 Striated Muscle Anxiety Isolation of Affect 1 Unconscious Anxiety 15.2 1. Pressure to rage 2. Rise to above threshold 3. Press to Guilt and regulate down anxiety as needed 4. Extensive Recapping

Resistant Repression or Fragile Low Rise Mid Rise High rise
Little anxiety or defense: some tension and isolation of affect Tension and isolation of affect Mid Rise Defenses going into the T, Tense, UTA Whisper Start to oppose repression or fragility, anxiety varies, UTA: Whisper High rise Defenses in the T, Tense, UTA: negation Dislike the repression or fragility, anxiety varies, one part of mind fighting the other: UTA Negation Partial Unlocking Feel grief rage and some guilt. Link or image of past Major Unlocking Feel rage, guilt and grief. Image transfers with passage of guilt

Why bring rise in CTF Reduces conscious anxiety Increases hope
Makes them confident in themselves Desensitizes to mixed feelings Makes it easier for them to express anger with you in treatment The CTF CREATES the UTA

Results of Capacity Building Phase
Anxiety in striated muscle Ability to self reflect Ability to reduce own anxiety Understanding of the trauma Reduction of paranoia/projection and grief about it Emerging empathy for family

Repeated Unlocking Phase
In longer cases, phase is a year or more long Repeated partial then major unlocking of the unconscious Draining the pathogenic reservoir of rage and guilt Mobilizing positive feelings which mobilizes more rage and guilt In longer term case maybe unlockings session

Unlockings in previously fragile cases
Break through the defense of repression, not through character defenses Cleaner process in some ways Repeated extended unlockings: long passage of rage and guilt/grief Rage at times has torturous impulse with huge guilt Emergence of empathy for victim and love

Somatic pathways of feeling: rage, guilt, grief
Love: rising warmth, urge to smile and embrace Rage: rising heat up chest to head then down arms: tension and anxiety stop Guilt about rage: Hard waves, pain in upper chest. Feel as if have just murdered loved one. Grief: tears, painful feeling in chest. Waves not as hard and distinct as guilt. Not as loud or painful.

Projective Identification and Symptom Formation: Sympathy symptoms
Patient experiences what the rage wanted to do to others Choking: rage to strangle Eye pain: rage to damage eyes Head pain: rage to damage head Strange sensations: rage to cause same sensations: e.g. electricity through body Symptom is removed by experience of the guilt about the rage Very common phenomenon in fragile patients

Ongoing UTA in Repeated Unlocking
Spontaneous unlockings in week Imagery pops in head Dead bodies Sensations in body Dreams that are breakthroughs Vivid content allow strong guilt to be felt Sense of Presence: UTA Session 70 mov

Trends in unlockings Get less to more intense
Go from later in development to earlier to infancy Go from primitive to more torturous rage Early rage is more jaw (baby) With each breakthrough of rage and guilt there is more capacity for compassion and love.

Pseudohallucinations = UTA
In phase of repeated unlocking patient may have very vivid sensory experiences that are actually memories E.g. for a week smells the dog from childhood: first bond E.g smells perfume of woman who comforted him Don’t medicate: Don’t get alarmed: it’s the UTA! Patient is functioning and doing better by this point in treatment: it’s not psychosis!

Results of repeated unlocking phase
Next to no signs of fragility Emotions are separated: de-fused Compassion for self Empathy and love for others: survivor guilt Grief about psychopathology Functional gains Growing mastery of psychodynamics Altruism: wish to give to others

Working Through Phase Mobilization of grief and self compassion as guilt is removed De fusion of punitive superego from self Drives for attachment Healthy activity in life Return to function Pockets of rage and guilt still emerge Grief is dominant Empathy/love for family members Session 140 march

UTA in Working Through Links Everything: Fluidity in the unconscious
Imagery and Memories Philosophy Presence: self caring and compassion for self and others Education for the Therapist

Course of Intensive “Long-term” DP
Capacity Building Repeated Unlocking Working Through Termination Start End

Course of Time Limited ISTDP
Capacity Building Partial Unlocking Termination Start 20 sessions End

Termination Phase In longer term cases phase is several months long
Looking ahead in life Functioning or on the way Looking to intimate relationships Empathy and guilt about leaving family behind Grief about loss of therapist Grief about past losses Maybe few pockets of rage and guilt but mostly grief UTA: Grief, links, compassion, few breakthroughs of CTF

When made Return to work
Anxiety, fear etc Drifting Primitive murderous rage passed: very long Heavy guilt Resolution

Growth Cycles Healthy Behavior Change More early intense Reduced self
Feelings come up Reduced self destructiveness

Resistant Repression or Fragile Low Rise Mid Rise High rise
Little anxiety or defense: some tension and isolation of affect Tension and isolation of affect Mid Rise Defenses going into the T, Tense, UTA Whisper Start to oppose repression or fragility, anxiety varies, UTA: Whisper High rise Defenses in the T, Tense, UTA: negation Dislike the repression or fragility, anxiety varies, one part of mind fighting the other: UTA Negation Partial Unlocking Feel grief rage and some guilt. Link or image of past Major Unlocking Feel rage, guilt and grief. Image transfers with passage of guilt

The unconscious Therapeutic Alliance 7th Norwegian Immersion in ISTDP

Similar presentations

Presentation on theme: "The unconscious Therapeutic Alliance 7th Norwegian Immersion in ISTDP"— Presentation transcript:

Similar presentations

About project

Feedback

Log in

Auth with social network:

The unconscious Therapeutic Alliance 7th Norwegian Immersion in ISTDP

Similar presentations

Presentation on theme: "The unconscious Therapeutic Alliance 7th Norwegian Immersion in ISTDP"— Presentation transcript:

Similar presentations

About project

Feedback