Mastering Intensive Short-Term Dynamic Psychotherapy: A Roadmap to the Unconscious, by Josette ten Have-de Labije and Robert J. Neborsky. London: Karnac, 2012.

Reviewed by Robert Tarzwell, MD, FRCPC

This is the newest entry in the very small group of textbooks of brief psychodynamic psychotherapies, and it is welcome. With careful editing, it could become great book, showing potential to be recommendable as the mandatory text for the field.

Its 13 chapters review Davanloo’s discoveries, attachment theory, developmental psychopathology, the neurobiology of anxiety and affect, and their regulation via defences, framing the chapters on clinical application. MISTDP’s worthwhile ambition appears to be greater than simply imparting technique. Intellectual rigour is sustained through the book, with frequent discussions invoking psychology, neurophysiology, receptor pharmacology, comprehensive use of DSM and ICD nosology–and frequent reference to situations where ISTDP may, crucially, not be the treatment of choice–a refreshing scientific humility. The clinical techniques are rich and clear. Transcripts appear carefully selected as paradigmatic examples of specific clinical phenomena. As ISTDP apprentices soon learn, and journeymen regularly attest, the beguiling simplicity of Davanloo’s Central Dynamic Sequence frequently feels much more like attempting to lasso and ride a scared horse in a thunderstorm. Transcripts of this clarity are a crucial foundation to trainees regarding how therapy can proceed with a strong alliance, and I freely admit to having already incorporated many of the authors’ phrasings and techniques, with good effect.

The book is not perfect. Its innovative “Red and green traffic lights on Davanloo’s road to the unconscious,” found on the colour plate, is poorly introduced and wielded. To the good, it guides ISTDP interventions from patient responses, a unique addition to the pedagogy. However, it is not adequately explained within the text, and I had to brute-force my way through it and its uses in the clinical application chapters. This useful device risks being ignored by many students. The diagram needs to be right at the start of the technique chapters, interwoven with the CDS, and thoroughly explained. This would make the cryptic traffic-light figures accompanying each transcript much clearer. This single investment, though it demands a significant reworking of the text, would make this good book a great book.

ISTDP deserves a textbook as great as MISTDP could be. The traffic-light caveat aside, I recommend this text. I hope its example of rigour becomes an implied challenge to other authors in brief dynamic therapy to avoid shortcuts and fully embrace the rich complexity this field deserves. This is precisely the kind of intellectual calibre which has the potential to move our field out of the psychotherapeutic shadows and into the full light of day.