Restructuring Regressive Defenses

As has already been demonstrated in Chapter 3 , many of Davanloo’s techniques are employed pre-interpretively, to prepare the patient to withstand and then effectively utilize material from the unconscious. Intensive Short-Term Dynamic Psychotherapy (ISTDP) is quite demanding on both cognitive and affective levels and can only be successful if both patient and therapist are deeply involved in the process. In rare cases, patients come for the initial evaluation with the motivation and ability to become freely involved and make use of this focused and intensive approach. More often than not, however, patients arrive in a state of ambivalence—wanting help but resisting the process of opening up and experiencing anxiety-provoking and guilt-laden feelings. This resistance prevents the kind of emotional involvement necessary for a successful outcome. Davanloo (1980) has developed a standard technique for handling highly resistant patients, in which “pressure and challenge to the resistance are steadily increased and are not relaxed until the patient directly experiences the complex transference feelings” ( Davanloo, 1987a , p. 77). Following this experience, there is an outpouring of unconscious material that not only provides a deep understanding of the genesis of the patient’s difficulties but dramatically increases the unconscious therapeutic alliance. This process was illustrated in the case of the Detached Observer (see Chapter 3 ). The patient’s resistance was massive and prevented any meaningful contact between patient and therapist, as he was keeping the innermost part of himself sealed off from view. Because all the initial interventions indicated a strong ego, the standard technique of applying unremitting pressure and challenge to the defenses was employed. The outpouring of memories and associations following the breakthrough of complex transference feelings confirmed this assessment.