Mastering Intensive Short-Term Dynamic Psychotherapy – Author's notes — Karnacology



The possibility of failure is inherent in all learning and the further one has progressed in the process of learning, the greater the risk of failure can become.  An intellectual curiosity is at the base of real deep understanding.

Part of the challenge with learning and mastering Intensive Short Term Dynamic Psychotherapy (ISTDP)  is that it requires not only a healthy curiosity on the part of the therapist, but also a longing to keep his attention sharp and alive. Learning and mastering ISTDP does not come easily and – to be honest – it is a lifelong enterprise.There must be a curiosity to uncover the Secret Life and mechanisms of the patient’s Unconscious which control the patient’s Conscious  perception of himself and of others, his problems.  Thoughts, emotions, behaviours. A curiosity to uncover some of the links between a patient’s problems and imbalances in brain circuits controlling perceptions, thoughts, emotions, behaviours. There must be a desire to help our patients to become curious about their inner processes in order to resolve their problems. A desire to help our patients to become their own psychotherapist. As this lifelong enterprise can sometimes be a lonely one,  we thought of writing this book and  may be it could be of help to our curious young colleagues.

In ISTDP – as in all other psychotherapy schools –  the presence and quality of the conscious and unconscious working alliance of therapist and patient is of crucial importance to the quality of the therapy process and the therapy results. More than in other psychotherapy schools the establishment of such a conscious and unconscious working alliance requires that the therapist is capable of assessing from moment to moment which of his patient’s variables obstruct such an establishment ( these can be considered red traffic lights) and which of the patient’s variables are functioning as forces in favour of the working alliance (green traffic lights). Amongst others it requires from the therapist to assess from moment-to-moment at what target his interventions should be aimed. It requires from the therapist to assess from moment-to-moment whether his selected technique has reached its target, and if yes, did the intervention result into a desired response or not. And if not, was the selected technique the right choice? Was it really aimed at the selected patient’s variable? And was  the timing of the technique, the duration, the dosage properly applied?

Our book hopes to support our young colleagues to establish and to maintain a conscious and unconscious working alliance with their patients in order to take the road to the patient’s unconscious, to uncover their painful impulses and feelings that are linked to past traumatic experiences, to work them through until resolution of these past traumatic experiences. Our book hopes to support our colleagues to assess – going the therapy process –  whether their working alliance with their patients is still keeping its quality. Is the working alliance still maintaining its quality, increasing its quality  or losing its quality? Do the therapist and patient still have the same view on the patient’s problems? Do they still have the same view and the same definition of its constituting elements?  Do therapist and patient still agree about (intermediate) goals of treatment? Is there still agreement about division of tasks? Is the therapist still capable of taking an empathic position to the patient’s constructive part? Or is the therapist colluding with the patient’s superego? What about the therapist’s countertransference reactions?

In ISTDP the  sessions with the patients are audiovisually recorded. This makes it possible to the therapist (and supervisor) to check why the therapy process was not as effective as was intended. Or… Why was this session such a tremendous success to both patient and therapist? Yes, indeed, we learn from our mistakes, but we need our successes  to keep on loving our energizing challenges!

We hope this book helps our young ISTDP colleagues to maintain their attitude of curiosity and challenge.

Josette ten Have-de Labije
Robert J. Neborsky



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