The Working Alliance in ISTDP: Whose Intrapsychic Crisis?, edited by Josette ten Have-de Labije. Dutch Association for Short Term Dynamic Psychotherapy (VKDP), 2001.

Reviewed by Jon Frederickson

This is a book of essays based on a summer training offered by VDKP. The first article, Dynamic Assessment of Ego Functioning in Davanloo’s ISTDP by Patricia Coughlin shows how to conduct a psychodiagnosis of ego functioning using Davanloo’s central dynamic sequence: evaluation of symptom disturbances, assessment of unconscious anxiety discharge patterns, components of affective experience necessary for a breakthrough into the unconscious, defense work, affect facilitation, turning the ego against the superego, and access to the unconscious. The most succinct summary of Davanloo’s metapsychology available.

Red and Green Traffic Lights on Davanloo’s Road to the Unconscious by Josette ten Have-de Labije is the most detailed case study illustrating how to develop the ego capacities necessary for a breakthrough to the unconscious. Absence of an ego capacity equals a “red light.” Ten Have-de Labije shows how patient responses to intervention allow the therapist to assess for the following ego functions: 1) capacity to bear feeling; 2) capacity to identify anxiety, the triggering event and emotion, and the channel of discharge; and 3) capacity to see a defense, its price, and to turn against it. The article is accompanied by a diagram of the pathway to the unconscious, along with its “green” and “red” lights.

Facilitating the Development of Therapeutic Alliance by Jan Bass and A. Marjanne Rondaij-de Jong shows how Davanloo’s central dynamic sequence develops both the conscious and unconscious therapeutic alliances. In particular, they emphasize specific interventions which will mobilize the therapeutic alliance.

The Integration of Cognitive and Dynamic Approaches in the Short Term Treatment of Depression by Allen Kalpin shows how both approaches can be useful in ISTDP. Specifically, cognitive therapy can help undo projection. When a patient can recognize that his thought is a belief rather than reality, only then is it possible to begin to examine the defensive functions of that belief. An excellent case example illustrates how Kalpin undoes projection with a depressed patient in preparation for experience of the aggressive impulse.

With Davanloo under your Pillow: The ISTDP of Dr. H. Davanloo in a Residential Setting by Kees Cornelissen describes the use of ISTDP on a six month inpatient unit designed for patients with fragile character structure and low ego adaptive capacity. This article is unique, as is all of Cornelissen’s work, for its emphasis on working with severely disturbed patients, helping them relinquish their primitive defenses, and develop their ego adaptive capacity.

The book is available for $30. To order, contact www.VKDP.com.