Short-Term Therapy for Long-Term Change, by Marion F. Solomon, Robert J. Neborsky, Leigh McCullough, Michael Alpert, Francine Shapiro, and David Malan. W. W. Norton & Company, 2001.
Reviewed by Donn Warshow, PhD
In Short Term Therapy for Long Term Change, six master therapists discuss their diverse, dynamic techniques to uncover core affect. Their work aims focuses on buried and blocked emotions that lay beneath anxiety and defense, to free patients to experience secure and loving attachments, the outgrowth of emotional intimacy and collaborative communication.
Robert Neborsky. M.D., begins by summarizing Dr. Habib Davanloo’s method of Intensive, Short-Term Dynamic Psychotherapy. He illustrates the approach with a transcript from an18 hour treatment with a patient with PTSD, chronic depression, substance abuse and character pathology. He describes Davanloo’s Central Dynamic Sequence, a series of interventions using carefully applied pressure and challenge to overcome the self-sabotaging defenses. The defenses are superego-driven: the patient self-attacks with guilt/shame, anxiety and self-punishment to spare the love object from the force of her rage and complex emotions. This is a succinct and clear introduction to IST-DP.
Leigh McCullough illustrates how she desensitizes patients to anxiety-provoking affects (“affect phobias”) in order to free up emotional responding. She views these “affect phobias” as the driving force behind neurosis. She finds evidence that lowering defenses against affective expression improves outcome. Restructuring defenses, affects and relationships by regulating anxiety or conflicted affects will have the greatest staying power in promoting positive change.
Michael Alpert’s Accelerated Empathic Therapy helps patients to feel deeply understood in a way that many have never experienced in their lifetimes. The cornerstone of his work is a shared affective, deeply intimate emotional experience with open communication between therapist and patient. Alpert helps the patient to see and feel when the therapist is genuinely moved and truly cares, thus providing a corrective emotional experience. Dr. Alpert concludes that defenses are more readily transcended by increasing more overt expressions of compassion and caring and by minimizing pressure and challenge, i.e. by creating the safest possible relational environment.
Francine Shapiro, the creator of EMDR (Eye Movement Desensitization Reprocessing), elucidates her discoveries that anxiety associated with large- T and small- T traumas can be reduced through the use of eye movements, tapping or tones, which are applied as the patient holds in mind the most disturbing parts of the traumas. Thus, the images, cognitions, affects and body sensations associated with trauma and stored in the memory network can be reprocessed, seen in a new light, and therefore become manageable. Shapiro has stated that all of us have an internal, physiological mechanism that activates emotional healing when appropriately accessed and directed.
In the next chapter, “Breaking the Deadlock of Marital Collusion,” Marion Solomon describes how treatment helps patients become aware of childhood traumas which lead to anxiety and defense, perpetuating emotional distance in the relationship. She “uses empathic resonance to enhance each partner’s contact with the unconscious system at play in the dyad.” Dr. Solomon emphasizes the importance of integrity and the willingness for partners to explore their own projections, self-sabotaging behaviors and underlying feelings in order for a secure attachment to be achieved.
In Chapter 7, “Attachment Bonds and Intimacy,” Neborsky and Solomon offer an overview of attachment theory and research, primitive aggressive self-organization (the PASO), the spectrum of trauma (Small-t to Big-T), and defenses as neurobiology promulgating psychopathology. Short-term therapy with three insecure attachment styles is explored, with case discussions illustrating how the PASO is overcome. This refers to complex core feelings that have been repressed in the service of attachment longings and have changed into self-punishment. The therapist models secure attachment for the patient, in which the full spectrum of emotions underlying the defenses are encouraged and invited into the relationship. Thus, the defensive system can be released so that love can be experienced.
David Malan, one of the great pioneers and contributors to the development of Short-Term Dynamic Therapy, offers an overview of how it developed. He reveals how therapists can adapt the basic principles of STDP to their personal styles while maintaining efficacy. For him, research reveals three pivotal principles: addressing the resistance; illuminating the unfolding transference; and effectively facilitating the experiencing of the patient’s buried feelings. Malan describes positive outcome as “inhibition or compulsiveness replaced by emotional freedom, intensity or depth.” Malan also states that the best results “possess qualities that are specific to dynamic therapy and are superior to those of other methods.” However, this is underreported because these individual results do not show up in the statistical averages of large group outcome studies.