ISTDP was developed by Habib Davanloo, MD, working at McGill University in Montreal, starting in the 1960s and continuing in the following decades.
In his early work with highly resistant patients, Davanloo showed that transformative and lasting therapeutic change can be achieved when patients
- are able to fully experience their unconscious complex feelings toward early attachment figures; and
- have sufficient insight into the defenses that they have habitually used to avoid these feelings, and avoid emotional closeness with others.
Davanloo describes two competing forces within each patient, which he calls the resistance and the unconscious therapeutic alliance (UTA). When patients enter therapy, resistance is dominant; the task of therapy is to mobilize the UTA to the point where it is able to dominate the resistance and support a new, healthy adaptation to the patient’s life. One of Davanloo’s central insights is that this can be achieved by rapid mobilization of both the resistance and “complex transference feelings”: that is, the mixed feelings that arise toward therapists as a result of their persistent efforts to relate directly to the patient rather than the patient’s destructive defenses.
Davanloo discovered that when patients experience these complex feelings, the resulting state of low unconscious anxiety results in an “unlocking” of the unconscious, allowing patients and therapists to understand the origins of patients’ problems, and also to achieve lasting therapeutic change. Davanloo’s method for achieving this unlocked state and exploiting its therapeutic potential are summarized in his “central dynamic sequence.”
After achieving these insights with highly resistant patients, Davanloo went on to modify his technique so that it is safe and effective for patients with depression, somatoform disorders, and fragility, based on his understanding of “discharge pathways of unconscious anxiety.”
In the years since Davanloo developed ISTDP, an impressive body of research has shown that it can lead to rapid, lasting change for patients with a very broad range of clinical conditions.
A number of figures in the IEDTA are active in teaching and promoting ISTDP: