(Originally posted 16 November 2014) The Collected Writings of Josette ten Have-de Labije, PsyD and The Collected Writings of Robert J. Neborsky, MD. Del Mar, CA: Unlocking Press, 2010.
Reviewed by Arno Goudsmit, PhD
Reading this double volume of the collected writings of Josette ten Have-de Labije and Rob Nerborsky, one comes to be impressed. The books offer a wide variety of reflections on, and interpretations of, Davanloo’s teachings. They are full of wonderful ideas and, even more importantly, full of the authors’ personal interpretations and wisdom on how to bring these ideas into fruitful therapeutic praxis.
Let’s start with some critical remarks and let’s end with the good news. While reading, one inevitably comes across topics that have been covered already in a previous chapter, or that will be elaborated in more detail in a later chapter. These repetitions are unavoidable in a straightforward compilation of papers written over more than a decade. It is pointless to enumerate the second and third times one comes across passages already met elsewhere. This is a drawback of the books. They would have deserved a rewritten presentation as a twin monograph, a digraph. And they would at least have deserved more rigorous editing. For instance, on p. R- 10, we find a real Dutch “nee” left to itself, a justified correction memo apparently not elaborated, by oversight.
But there are better things to note. The project of co-publishing the two authors’ collected writings emphasizes their close collaboration and kinship. Nevertheless there are also differences of scope. Josette and Rob differ in their emphases and priorities. For Josette the major goal seems to be the elaboration of Davanloo’s work in terms of more specific criteria for recognizing behavioral cues and in terms of more specific descriptions of therapeutic technique. For Rob the major goal seems to be a theoretical reflection on issues of attachment and loss. This is not just a theoretical hobby; it is a way of founding and justifying his attachment-based approach to ISTDP.
Rob’s emphasis is upon attachment and object relations. His theoretical remarks on the Klein-Bowlby issues are of particular importance. Take the “re-united Klein-Bowlby camp” (p. R-121). It is that current events and persons on the one hand, and on the other hand the archetypical unconscious phantasies and psychological needs of the infants may meet and mix up in the etiology of neurosis. Such meeting enables real life to become a locus of truly new and truly deep experiences that affect old objects and old relationships, and, vice versa, a locus where old issues may influence current experiences and affects. If this has been Davanloo’s original idea, it is at least Rob’s focus: “[Davanloo] has unknowingly healed the split between Klein and Bowlby by integrating the role of actual relationship into the pathology of the superego” (p. R-121). These ideas help the therapist to move freely between current, past and transferential issues, link and allude to them together, and weave metaphorical relations between them. And this is what Rob is demonstrating in his vignettes and what makes up the fluidity of mind that constitutes the core of his craft.
Another important contribution Rob makes is the differentiation between shame and guilt. This text, I think, is among the best of original theorizing presented in our field of EDT. As a result of pointing out that shame originates from a developmental stage earlier than guilt, we may come to deal with a patient’s shame differently, as an anticipation of (projected) social expulsion (p. R-92), rather than as the regular superego issue.
Josette’s emphasis and scope are different from Rob’s. She presents herself as a true disciple of the Master, elucidating and expanding his ideas, whereas her own creative additions and valuable elaborations are modestly not announced explicitly as new work. But in fact that’s what they are, offering fresh emphases, combinations and insights.
Josette’s project is to offer a practical way of applying Davanloo’s concepts, to add empirical criteria, both for diagnosis and for therapeutic technique, so that the practitioner’s work may be guided by more and easier empirical tokens and by concepts that are defined more in detail. She uses the term “maintaining Davanloo’s discovery” in the title of several papers. Her major commitment is to describe executable steps for the various aspects of his technique, and to describe observation criteria (“operationalizations”) for the theoretical concepts, so that theory and technique can be practiced better and taught better. This culminates in a variety of schemas and schedules, the most famous of which is known as the “red and green traffic lights” (p. J-105), a detailed flow chart of decision criteria and feedback loops of action steps.
However, it is not always clear which purpose (practicability of the technique, concreteness of the observation criteria, or both) is being served by a particular schema. A listing of observation criteria may be in need of some inner structure. For instance, the various criteria for a patient’s full experience of emotions (e.g., p. J-182) have more interdependence than an enumeration may convey. How are these criteria interrelated and how can these interrelations be expressed with maximum parsimony? Likewise, which of the steps that a therapist has to perform (pp. J-183ff) are meant to be consecutive in time, and which steps are logical derivations? The relations between terms may be missing, as in the extensive table on verbal versus nonverbal defense mechanisms at the levels of stimulus and response (pp. J-92ff). Without a detailed elaboration this lenghty table is not maximally effective for teaching.
A pitfall of her didactic approach, I feel, is that the reader may become immersed in rules and details that make up a certain codification of the technique, whereas the practicing therapist would also have been helped by tools for simplifying things, such as to learn how Josette manages to apply her astounding clarity of mind in complex situations. Accordingly, the application of codified technique may suffer from some static qualities, so that, for those mastering the technique, what matters is to preserve one’s freedom, that is, one’s capacity to vary and to experiment with this technique and not be overrun by it.
On the other hand, her writings and teachings, her vignettes and theoretical reflections have shown her clarity of mind and the precision of her craft. She is capable of integrating so many of the details she describes, of finding creative modes for addressing a patient’s healthy and adaptive parts, and of joining with these and empowering them for a joint effort against superego pathology. Her recommendations for making sharp distinctions between ego and superego are most helpful for a therapist who finds himself lost in a labyrinth of resistances. Likewise, the idea that a benevolent superego may come to replace the punitive one is self-evident only due to her lucid clarifications, and it helps the therapist distinguish pathological from healthy superego issues.
I would have liked to see more about her personal style of intimidating the patient’s superego. Though not described in these terms, it deserves recognition and serious study in itself, as a valuable technique. The therapist may say:
“Yes, that’s what you do. Then you behave self-negligent. I ask you whether you understand my language.” (p. J- 61)
“You think so too, you agree with that, not because I say so but because you see the sense of it?” (p. J-118)
These lines do not sound very nice, but the truly reassuring effect they may have when addressed to a patient with a vindictive superego is not to be underestimated. This way of dealing with superego pathology deserves serious study and recognition. It demands from the therapist a capacity to make an exact distinction between superego and adaptive ego, so that the patient will feel supported rather than attacked. It demands an exactness of timing and strength, so that confusion is avoided. It demands courage.
In conclusion, in this twin volume these two major proponents of ISTDP allow us to enter into their workplaces and have us watch the thoughts, the tools, and the instruments as they are using them. Thank you, Josette and Rob!