Travels to the unconscious: Working alliance with our patients

Travels to the unconscious: The working alliance with our patients and traffic lights on the road to the patient's unconscious

A 2-day immersive training in ISTDP with Josette ten Have-de Labije, PsyD

This workshop welcomes ISTDP therapists who have completed or are in the process of completing core training. It also welcomes colleagues from different therapeutic orientations who would like to obtain a first understanding of Davanloo´s Central Dynamic Sequence and establish a conscious/unconscious working alliance with their patients.

Next to a theoretical and technical introduction of Davaanloo´s concept of the working alliance and steps to the patient´s Unconscious, there will be role plays. All participants are expected to participate actively by role-playing patient and therapist.

A clinical video of establishing and maintaining a working alliance with a patient will be shown.

If an attendee wishes to, he/she can bring a video recording of a case for this to be supervised. A full form and transcript of the case will be emailed to the facilitators a week prior to the workshop.

Workshop content

According to Davanloo, neurotic disturbances arise because of a variety of possible traumatic experiences, involving damage to or disruption of the affectionate bond between the child and caretakers. The child unconsciously reacts to this damage/disruption with a sadistic, murderous rage. It is this sadistic, murderous rage and the consequent loss (of the beloved murderous person(s), which leads to guilt and grief as well as to punitive, sadistic reactions of the superego towards the child´s ego.

The traumatic experience(s), murderous rage and its result(s), guilt and grief are repressed into the unconscious. Various symptom patterns and character pathology develop as the ego of the developing child attempts to keep functioning under the mandate of the punitive/sadistic superego in such a way that it will not be overwhelmed by the impulses and feelings themselves, by anxiety, nor by the defences.

Davanloo´s therapeutical interventions and techniques are aimed at helping the patient take the shortest possible road to unlock his unconscious and to get direct access to his core neurotic conflicts to work them through and to (ideally) resolve them.

Of course, this road to the unconscious is within the patient and the obstacles on this road are determined by the nature and degree of the patient´s problems and character pathology (the patient variables). No psychotherapy can be successful without a conscious/unconscious working alliance with the patient.

Very often, the restricted success (or even absence of success) of psychotherapy is due to a failure to establish and/or maintain a working alliance with our patients. Failure to establish and/or maintain a working alliance is often because the therapist underestimates the nature and degree of the patient´s superego pathology and overestimates the nature and degree of the patient´s ego adaptive capacity.

Many of our patients enter therapy with a profound sense of inadequacy, an inability to experience themselves as an active, lovable, capable person. They have lost their future, their hope their longings. To many of our patients the process of the joy of comprehending, the disappointment of failure, the joy of looking and looking again, of finally grasping and understanding new concepts has not been part of their interaction with former caretakers.

Therapy may offer these patients the conditions of hope. But this hope will only be satisfied based on the therapist being able to help the patient to have faith again in his own capacity to love, and to understand his own unmet longings. To have faith in being capable of bearing their rage, guilt, grief, and damaged love that was consequent on abuse, frustration/humiliation when hope and longing to be loved, to be understood, to be accepted was not fulfilled

To establish a conscious working alliance, the therapist needs the patient´s observing ego as a partner. To establish a conscious and unconscious working alliance, the therapist needs not only the patient´s attentive ego as an ally but the patient also must be strong enough to quit the self-defeating processes he puts into operation and to bear and contain impulses and feelings.

It is all about what happens when there is that fusion of the patient´s and therapist´s hard labour. It is about knowing they can count on one another while purposedly taking the ISTDP road to the unconscious, which will lead the one to experience pain, for the other one to witness and sometimes to remember while resonating. It is all about what happens when 2 minds, 2 hearts, 4 shoulders and 4 hands meet. It is all about what happens when the patient and therapist join forces to understand healthy and unhealthy processes with love, care, precision and scientific honesty.

Literature

ten Have-de Labije, J. & Neborsky, R. (2012). Mastering Intensive Short-Term Dynamic Psychotherapy: A Roadmap to the Unconscious

ten Have-de Labije, J. (2020). Stumble, fall and get up again on the road to the Unconscious. Practical Exercises for the ISTDP therapist.

Speakers

Josette ten Have-de Labije, PsyD -psychotherapist and clinical psychologist, studied at the universities of Groningen and Amsterdam (the Netherlands Institute for Brain Research). She started her professional career in 1972 at the department for Neuro and Psychophysiology of the Free University of Brussels (Belgium). Thereafter she worked in the Netherlands at a public mental health centre for ambulant (non-residential) patients as coordinator of the Behavior Therapy Department and member of the Diagnostic Staff. Since 1990 she has been working in private practice.

As a qualified psychotherapist and clinical psychologist, she was trained as a cognitive-behaviour therapist (individual and group setting), Couples therapist, therapist for psychodynamic individual and group psychotherapy, and therapist for intensive short-term dynamic psychotherapy From 1989 - 1992 she was a member of the Dutch ISTDP core-group, which was trained and supervised by Professor Dr H. Davanloo.

As supervisor and trainer of the Dutch Association for cognitive and behaviour therapy, she has given supervision and post-graduate courses in behaviour therapy at the Universities of Utrecht and Amsterdam and several post-doctorate courses and workshops.

As supervisor and trainer of ISTDP she has given supervision, several post-doctorate courses and workshops in The Netherlands. Next to that, she has given/given workshops, training and supervision on ISTDP in the USA, Canada, South Africa, China, England, Denmark, Norway, Poland, and Italy.

She has organized several national and international conferences on Behavior Therapy, cancer treatment and mental health, and ISTDP.

She has been a board member of the international experiential dynamic psychotherapy Association (IEDTA). She is editor-in-chief of the Ad Hoc Bulletin for STDP: Practice and theory. She has published several books and articles.