Psychotherapie dynamisch intensiv direkt: Lehrbuch zur Intensiven Dynamischen Kurzpsychotherapie, by Paul Troendle. Psychosozial Verlag, 2005. Regretably, not available in English at this time.
Reviewed by Esther Rosen, PhD
Everything you ever wanted to know about ISTDP, – “Intensive Short Term Dynamic Psychotherapy” – the” ins and outs” of this fascinating psychotherapeutic treatment approach, you find in this very comprehensive book. In this German text Troendle provides a rich foundation of philosophical thought and scientific findings from areas such as anthropology, Freud´s psychoanalysis, developmental psychology as well as Neurosciences. His rendition of theory and technique of this captivating paradigm of psychotherapy is rich, precise, and clear. Troendle´s vast and detailed knowledge of the classical as well as the contemporary psychoanalytic thinking provides a strong context in which he presents us with the ideas of Habib Davanloo, the founding theorist and clinician of ISTDP.
The goals of ISTDP are identical to the goals of the psychoanalytic treatment: The therapist aims to change the character pathology of the patient by resolving the core neurotic conflict. Cornerstone of ISTDP is a conceptualization of emotional processes based on Freud’s original understanding yet crystallized in two simple models which were formulated originally by Menninger, Malan and then Davanloo; the triangles of conflict in connection with the triangle of person. This conceptualization serves the ISTDP therapist as an understanding of the state of the patient at any moment. Is the patient engaging in defense, experiencing anxiety or is he experiencing a feeling or impulse?
In following a carefully developed sequence of interventions and techniques, the “Central Dynamic Sequence”(CDS), the ISTDP therapist is aiming for a break through to the unconscious. By way of applying several well defined techniques such as pressure to feeling as well as challenging the resistance the therapist seeks to develop an alliance with the patient that goes beyond conscious cooperation. The patient’s repressed emotions pushing toward a conscious experience the “unconscious therapeutic alliance” (UTA ) constitute an important therapeutic factor in Davenloo´s understanding of the therapeutic process. A “major unlocking” of the unconscious enables the patient to experience the whole spectrum of the complex emotions. The experience of the murderous rage, guilt, pain and grief is the precondition for real forgiveness and deeply felt exoneration. Now the channels are free for the capacity of love. The most important therapeutic element is the patient´s insight into his unconscious guilt related to his murderous rage. The psychopathology of the patient is directly linked with the patient´s tendency to punish himself as a means to deal with his unconscious guilt. The more intensely the patient is experiencing his guilt, the more the patient´s resistance will decrease.
Troendle´s presentation of the central dynamic sequence offers the student of ISTDP a rich palette of examples of interventions as well as their rationale, detailed explanations,practical suggestions and caveats about the likely mistakes of a beginner. The reader will also find a diverse array of vignettes based mostly on Troendle´s own clinical work.
While Davanloo originally saw patients with low anxiety tolerance, high fragility, and superego pathology as inappropriate candidates for ISTDP, Troendle describes modifications of the original process of therapy – the graded technique which allow a much larger patient population to benefit from ISTDP. Troendle offers lists of patient characteristics that would still lead to the exclusion of a patient from the treatment of ISTDP, which include patients with severe cognitive disruptions such as psychotic processes as well as patients with endogenous depressions, chronic alcohol and drug dependency.
Paul Troendle `s book might well assume the place of a bible within the community of ISTDP therapists. It is by far the most comprehensive textbook of ISTDP theory and technique available today. The student of ISTDP will not just read it once and then put it aside. This book will serve as a critical reference book in the understanding of theoretical concepts and their application to the therapeutic work. One can only hope that it is eventually translated into English to be available to a wider readership.