Many of Freud’s early treatments were quite brief, but psychoanalysis soon became a very long form of treatment. As a result, some of Freud’s followers, notably Ferenczi and Rank, became interested in shortening treatment. Ferenczi recognized that often a patient will not experience positive connection with the therapist until anger is first experienced. He also introduced more active techniques into the therapy. Rank said that the patient’s will must be mobilized and is the primary force which must do battle with unconscious destructive forces. He also believed that for therapeutic change to take place, therapy must include aspects of emotional experience, rather than simply intellectualization. These ideas of Ferenczi and Rank are central to EDT.
Adler was the first analyst who gave up the couch, choosing to sit face to face with his patients. He also accelerated treatment by discouraging patients from taking a dependent position in therapy. Reich’s work on analyzing character defenses foreshadowed aspects of Davanloo’s later work in ISTDP.
Starting in the 1940’s a series of psychoanalytically informed theorists began to develop models of what is now called Short-Term Dynamic Psychotherapy (STDP, an umbrella term which includes the EDTs).
In 1946, Alexander and French were the first writers who explicitly aimed to make psychoanalysis “briefer and more effective.” Their model of short-term therapy was based on work with high functioning neurotic patients; the principal technique was the interpretation of transference. According to Alexander and French, the “corrective emotional experience,” i.e. re-experiencing of the conflicting emotions in the actual relationship with an emotionally responsive therapist, is pivotal in bringing about therapeutic change. If such re-experiencing can be brought about rapidly, dynamic change can also be rapid. In other words, the process of “working through” depends not on adequate time, but on adequate emotional experience. For these reasons, the research by Alexander, French, and colleagues could be called the dawning of Experiential Dynamic Therapy and of process acceleration.
Michael Balint founded the Brief Psychotherapy Workshop at the Tavistock Clinic, which consisted of a group of gifted clinicians; David Malan was one member of the group. Their original idea was to shorten therapy by selecting a specific and appropriate focus for therapeutic attention. In the mid-1960s, Malan took over the Brief Psychotherapy Workshop. His Tavistock research established that the results of short-term therapy were as good or better than those of psychoanalysis, and that short-term therapy could work with a broad range of patients. Thus he was able to debunk the “hypothesis of superficiality” which suggested that brief psychotherapy is a superficial treatment, applicable to superficially ill patients, and bringing about superficial results.
Malan stated, “The aim of every moment of every session is to put the patient in touch with as much of his true feelings as he can bear,” and to that end he organized psychodynamic therapy around what he called the triangle of conflict and the triangle of person. The triangle of conflict illustrates the relationship between anxiety, defenses, and the underlying impulses and feelings. The triangle of persons shows the connections between relationships with the therapist, other current people, and the people of the formative past. Malan’s “two triangles” became central to Davanloo’s work, and to all subsequent EDTs.
Malan was extremely generous in lending his extraordinary understanding of psychodynamics to others who were contributing to the development of brief psychotherapy, including Davanloo, McCullough, Osimo, and Couglin. Malan’s approach was originally based on interpretation, but after encountering and evaluating the work of Habib Davanloo, Malan shifted his emphasis to a much more affect-oriented, experiential approach.
Since the 1970s, short-term psychotherapy has made remarkable progress, especially thanks to the technical improvements introduced by Davanloo, whose original training was in psychoanalysis. Disappointed with the results of an approach relying primarily on interpretation, he began a systematic study of therapies, first using film and then videotape. He came to believe that the key to rapid therapeutic change lies in experiencing one’s true feelings at a very high level of intensity; this is a central goal of his therapeutic method, which he called Intensive Short-Term Dynamic Psychotherapy (ISTDP). Davanloo developed groundbreaking strategies for breaking through the defensive barrier of highly resistant patients so that they could experience their true feelings. His work, as demonstrated on video, was startling. When Malan encountered Davanloo’s work, he devoted himself to its theoretical explication and clinical investigation. In the early 1980s, Davanloo was able to demonstrate that his highly active, dynamic approach was capable of dealing with even severe character problems in less than forty sessions. He has continued to refine and extend his techniques in the decades since.
Davanloo has trained many therapists over the years, including the founders of the IEDTA, who have all continued to develop since working with him.