Theory and Practice of Experiential Dynamic Psychotherapy

Ferruccio Osimo, Mark J. Stein, Ferruccio Osimo, Mark J. Stein

• Publisher: Routledge
• Year: 2018
• Print ISBN: 9781780490632
• eBook ISBN: 9780429922848
• Topic: Psicología
• Subtopic: Historia y teoría en psicología

This book provides an introduction to and history of the experiential dynamic therapies (EDT) including the ground-breaking Intensive Short-Term Dynamic Psychotherapy (ISTDP) of Habib Davanloo and its subsequent development. It also describes the essential ingredients of EDT.

Part I
Experiential Dynamic Therapy from History to Theory and Clinics

Chapter One

A historical overview of experiential dynamic psychotherapies

Ferruccio Osimo

Experiential dynamic therapies descend from the line of thinking and research historically initiated by Alexander and French (1946), who were the first to declare their aim of making psychoanalytic therapy “briefer and more effective”. Before Alexander and French, some of the theoretical contributions by Sandor Ferenczi, Otto Rank, and Wilhelm Reich have been particularly relevant to the development of EDT and, more recently and specifically, David Malan and Habib Davanloo are the most prominent proponents of experiential dynamic therapy. For an account of these contributions the reader is also referred to Amanda Baker’s chapter (Chapter Two), that includes an interview with David H. Malan.

A precursor

Charles Darwin, in a pre-psychoanalytic era, had already understood the links between emotion, defence (“force of habit”), body muscles, and conscious and unconscious mental mechanisms.

Certain complex actions are of direct or indirect service under certain states of the mind, in order to relieve or gratify certain sensations, desires, etc.; and whenever the same state of mind is induced, however feebly, there is a tendency through the force of habit and association for the same movements to be performed, though they may not then be of the least use. Some actions ordinarily associated through habit with certain states of the mind may be partially repressed through the will, and in such cases the muscles which are least under the separate control of the will are the most liable still to act, causing movements which we recognize as expressive. (Darwin, 1872, p. 34)

Thirteen years after publishing his great work on the origin of species by means of natural selection, the great scientist published The Expression of the Emotions in Man and Animals. Ekman (1996) commented on the importance to Darwin of universality and emotional expression:

Universality mattered to Darwin because it provided support for his theory of evolution. Universality would make more plausible his claim that emotional expressions are not unique to humans but are shared with other primates. (p. 366)

As elaborated by Ekman in his book, currently such universality is substantially demonstrated for the facial expressions of happiness, disgust, surprise, sadness, anger, and fear.

Origins of experiential dynamic therapy

Experiential dynamic therapy (EDT) historically originates from short-term psychotherapies, especially Malan’s brief psychotherapy (1963, 1976a, b, 1979). EDT is a comprehensive approach, aiming to take care of all the significant aspects of an individual at a deep level, but more quickly than in previous dynamic therapy models. This is achieved by means of an acceleration of the therapeutic process. The idea of accelerating the therapeutic process is not new in the field of psychodynamic therapy and, perhaps surprisingly, even in psychoanalysis. Ferenczi (1920), in the first lines of his essay, The Further Development of an Active Therapy in Psychoanalysis, wrote: “Psycho-analysis, as we employ it today, is a procedure whose most prominent characteristic is passivity” (p. 199).

Ferenczi deeply sensed the need to introduce more active techniques and this played a major role in the more conflictual aspects of his relationship with the founder of psychoanalysis. A few pages further he goes on:

In seeming contradiction with the fundamental rule of psycho-analysis I had in a few cases to decide to encourage or discourage patients directly towards or against the production of thoughts and fantasies. I have in this way induced patients to carry out this plan who threatened to deceive me, for instance, to feign dreams. But when I became aware of the “misuse of freedom of association” by means of misleading, futile, and sidetracking ideas or fantasies, I did not hesitate to show the patient that by this he was only trying to escape the more difficult task, and to bid him resume the interrupted train of thought. These were just cases in which patients wished to avoid what touched them closely … (1920, p. 207)

When the new science he founded was dawning, even Freud carried out a number of treatments we would define as short-term. Osimo (2003a, chapter 11) describes a case of short-term psychoanalysis reported by Breuer and Freud (1895), seen through the theoretical lens of contemporary short-term psychotherapy. However, it is important to say that an abbreviation of psychoanalysis was never the intention of its founder who, moreover, regarded with suspicion all attempts in this direction. Rather, he took utmost care to let the fundamental discovery of the unconscious world unfold its potential in all possible directions and always opposed alternative approaches aiming at accelerating the process, like those by Ferenczi (1908–1933), Rank (1924), Ferenczi & Rank (1925), Adler (1928–1937), and Reich (1933). His recommendation for a passive attitude, where the analyst behaves as a sounding board to the analysand’s free associations, and keeps attention “free-floating”, promoted a progressive lengthening of psychoanalytic treatments.

It was certainly no coincidence that Freud put an end to the relationship with his brilliant disciple Otto Rank, when the latter published The Trauma of Birth in 1924. Rank’s theory of the birth trauma as prototypical of all subsequent traumas led him to propose that the re-experiencing of it and of the related fears in the analytic transference would prevent the “unconscious reproduction of the same in the severance from the analyst” (p. 214). A somewhat cruel irony is that the painful “severance” between Freud and Rank occurred precisely because of the publication of this theoretical viewpoint. Rank’s enormous insistence regarding the birth trauma and his idea of setting a time limit to treatment certainly triggered Freud’s fierce opposition but, nevertheless, Rank’s theoretical position is relevant to the development of short-term psychotherapies. Indeed, Rank was deeply concerned with the healing side of psychoanalysis, thus with emotional experience, rather than simply theoretical aspects: “… therapeutic possibilities do not conform, in any expected degree, to the increase of our knowledge, and […] even simple therapeutic action can be arrested by too much knowledge and too much [cognitive] insight” (1924, p. 202).

Adler’s theoretical focus on the complexes of inferiority and superiority, thus also on the power aspects inherent in the analyst/analysand relationship, and his consequent modifications of technique and setting are certainly relevant to the shortening of therapy. Indeed, Adler was the first analyst who gave up the couch and, choosing to sit face to face with his patients, emphasised that: “… the psychological development of a person can reach a normal condition only when he can achieve the necessary degree of ability to co-operate” (1928–1937, p. 199).

Adler also addressed the problem of “over-gratification” as a by-product of therapy, leading to a patient’s dependence on the therapist, and consequent difficulty in terminating treatment. He called this the “psychopathology of the pampered child”, or “a view of life in which the individual assumes that the other person is there for him” (p. 195). In calling for a countering of the patient’s strivings to get the therapist to take on the pampering role at a very early stage, Adler’s approach can be regarded as a contribution to the acceleration of the therapeutic process.

The analytical psychology of Carl G. Jung included the concept of archetypes (1912, 1934–1954) as primordial images deriving from the collective unconscious. Archetypes are elements of a matrix that is common to all peoples, a virtual image that is genetically transmitted. As such, archetypes would not seem to help shorten treatment, rather to make things more complicated by populating the unconscious with an endless crowd of mythological characters. In clarifying what he meant by “archetypal images” Jung (1964) stated:

… some contents of modern man’s unconscious resemble products of the mind of ancient man … the archetype is a tendency to form such representations of a motif—representations that can vary a great deal in detail without losing their basic pattern … [rather than an] “inherited representation” … [they are] an instinctive trend … Instincts are physiological urges, and are perceived by the senses. But at the same time, they also manifest themselves in fantasies and often reveal their presence only by symbolic images. These manifestations are what I call the archetypes. (pp. 66–69)

In Psychological Types, Jung (1921) paid tribute to a clinical application of archetypes when he focused on the way the effect of archetypes is manifest in each individual, and articulates the concept of co-existence of two opposites: (i) the persona or the social mask, and (ii) the shadow, representing its repressed negative. Seen through the lens of EDT, this concept becomes clinically incisive inasmuch as, by focusing on the overall mode of presentation of an individual, it can be used to address the character defence. As such, Jung’s (1964) conceptualisation of dream and archetypal images has particular relevance to the conceptualisation of the character hologram articulated by Osimo (2009) (see also pp. 107–132):

They form a bridge between the ways in which we consciously express our thoughts and a more primitive, more colourful and pictorial form of expression. It is this form, as well, that appeals directly to feeling and emotion. These “historical” associations are the link between the rational world of consciousness and the world of instinct. (Jung, 1964, pp. 47–49)

Furthermore, Jung was interested in the therapeutic power of images as messages from the unconscious because he believed that modern life had led to a stripping away of the emotional energy from ideas, but that symbolic images retained their potency, thereby having the potential to make an impact on the perceiver: “… its symbolism has so much psychic energy that we are forced to pay attention to it” (1964, p. 49).

Again, referring to the energy attached to these images:

We can perceive the specific energy of archetypes when we experience the peculiar fascination that accompanies them. They seem to hold a special spell … They [archetypes] are, at the same time, both images and emotions. One can speak of an archetype only when these two aspects are simultaneous. When there is merely the image, then there is simply a word-picture of little consequence. But by being charged with emotion, the image gains numinosity (or psychic energy); it becomes dynamic, and consequences of some kind must flow from it … they are pieces of life itself—images that are integrally connected to the living individual by the bridge of the emotions … it must be explained in the manner indicated by the whole life-situation of the particular individual to whom it relates … archetypes come to life only when one patiently tries to discover why and in what fashion they are meaningful to a living individual … they gain life and meaning only when you try to take into account their numinosity—i.e., their relationship to the living individual. (1964, pp. 79, 96–97, italics added)

In 1933, Reich published Character Analysis, in which he outlined a totally new dynamic approach to personality disorders. Reich was a radical critic of Freud’s “basic rule” of free association and held a different position as regards the approach to analytic patients. Instead of privileging verbal communication, that is, speech and language, Reich started to look to the body as a major source of interpersonal communication, and information about the individual’s unconscious mechanisms and conflicts. Davanloo’s confrontation of character pathology would seem related to Reich’s view of character, which is also relevant to the concept of character hologram (Osimo, 2009) (see also pp. 107–132). It is therefore worth quoting from Reich’s (1933) book that the character of an individual

is usually expressed in a specific attitude or mode of existence … [that] represents an expression of the person’s entire past … The way the patient speaks, looks and greets the analyst, lies on the couch, the inflection of the voice, the degree of conventional politeness which is maintained, etc., are valuable cues in assessing the secret resistances with which the patient counters the basic rule. (pp. 48–49, italics in original)

In other words, when we are faced with a character problem, we are faced with defences that have been incorporated into the patient’s behaviour, or “character armour” (p. 48) which the patient perceives as the way they naturally are, that is as a part of their ego. Consequently, Reich’s technical recommendation is to focus consistently on the patient’s “ego defence” (p. 70), because “unless the ego defence has been systematically and thoroughly worked through ...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• CONTENTS
• ABOUT THE EDITORS AND CONTRIBUTORS
• FOREWORD
• INTRODUCTION
• PART I: EXPERIENTIAL DYNAMIC THERAPY FROM HISTORY TO THEORY AND CLINICS
• PART II: CLINICAL APPLICATIONS OF EXPERIENTIAL DYNAMIC THERAPY
• PART III: TRAINING AND RESEARCH
• INDEX