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On "Short-Term Dynamic Psychotherapy"

(SEPI Forum, Nov.-Dec. 2000)

 

 

(Editor's Note) This interesting discussion on Short-Term Dynamic Psychotherapy (STDP) begun with a conference announcement and ended with another conference announcement, both by Allen Kalpin. The first conference was "Core Factors for Effective Short-Term Dynamic Psychotherapy" (Milan, Italy, May 10-12, 2001), and the second one was "Emotional and Relational Experience in Psychotherapy: Two Models for Transforming Affects" (Toronto, Canada, February 24, 2001). Luckily, Tullio Carere-Comes was hooked by Allen's first announcement and reacted with a criticism to the "short-term" concept; Allen, in turn, was hooked by Tullio's provoc ation, thus beginning an intense debate around the identity of the STDP approach. Paolo Migone soon intervened, taking side with Tullio, and arguing that the "short-term" concept might be misleading in order to find a core distinguishing feature of this approach. According to Paolo, the "experiential factor", not the time-limit setting, is the key feature of STDP. Others agreed with him, first of all Diana Fosha, who intervened often and authoritatively on this matter (Diana featured as speaker on both the aforementioned conferences, and, as Allen reminded us, is the one who coined the term "experiential STDP"). But Paolo also suspected that some key concepts of STDP's theory and practice might not be totally new, but already well known and discussed in the history of psychoanalytic theory of technique. And we shouldn't forget that the "experiential factor", important as it may be, is a central aspect of the Gestalt therapy tradition, as well as of many experiential or humanistic psychotherapies (the "third force" of psychotherapy movement). To this regard, Bob Resnick, an experienced Gestalt therapist, made an interesting clarification. Hilde Rapp, in a very sensitive way, picked up various themes and clarified them, mediating among different views and linking various themes to conceptualizations already existing in the literature. Also Niquie Dworkin and Ang Wee Kiat Anthony made useful comments. In the overall, it was a stimulating and clarifying discussion, with a beginning characterized by a difference of opinion and a conclusion characterized by an agreement on some of the major issues, and an enrichment for all.

 

Allen Kalpin, 31 Oct 2000

I would like to announce a conference that will take place May 10-12, 2000 in Milan Italy. The conference is entitled, "Core Factors for Effective Short-Term Dynamic Psychotherapy," and will be the first conference of the newly formed International Experiential STDP Association (IESA). "Experiential STDP" is a new term which encompasses a variety of promising therapeutic approaches within the more general heading of Short-Term Dynamic Psychotherapy (STDP). This term was first used in Diana Fosha's recently published book "The Transforming Power of Affect: A Model for Accelerated Change." An essential feature which distinguishes these approaches from other forms of STDP is the emphasis on facilitating emotional experience as an essential part of the therapeutic process. The first STDP approach promoting the full experiencing of emotions has been Habib Davanloo's Intensive Short-Term Dynamic Psychotherapy (ISTDP). Various other therapeutic systems have been influenced by ISTDP and share its emphasis on emotional experiencing. Examples of such approaches are the psychotherapeutic systems which have been developed by Leigh McCullough, Jeffrey Magnavita, Michael Alpert, and Diana Fosha. There will be a variety of presentation formats, and there will be extensive use of videotaped case presentations. In this first conference the emphasis will be on examining the factors which the various Experiential STDPs have in common. There will also be research presentations. Presenters will include the founders of IESA, Michael Alpert, Patricia Coughlin Della Selva, Diana Fosha, Allen Kalpin, Jeffrey Magnavita, Leigh McCullough, Ferruccio Osimo, and Isabel Sklar. We hope you will consider attending this exciting conference. More information can be obtained at the following websites:
http://www.psycho media.it/pm-cong/2001/opifer-stdp2.htm, http://www.stdp.org/

 

Tullio Carere, 1 Nov 2000

I am sorry that I could not attend this conference, if it was on May 10 -12, 2000, but very happy to attend it if it will be on May 10-12, 2001. Not because of the "short-term", which I don't believe and am not interested in, but because of its "emphasis on facilitating emotional experience". Tullio Carere-Comes, M.D., Viale Vittorio Emanuele 90, 24121 Bergamo, Italy, tel. +(39) 035-259450, E-Mail <tucarere@TIN.IT>

 

Allen Kalpin, 2 Nov 2000

Tullio, I am glad that you are considering attending the conference, and look forward to seeing you there. I am interested in your comment about "not believing" regarding "short-term." Do you mean that you:

-don't believe that any change is possible in a short-term therapy?

-don't believe that as much change is possible as in long-term therapy?

-or some other meaning?

Allen Kalpin, Toronto, Canada, E-Mail <AKalpin@AOL.COM>

 

Tullio Carere, 5 Nov 2000

Allen, as it seems to me that I have already given a response to your question, please let me quote myself, from a message dated 9 July 2000 on this listserv:

<< I abhor short-term therapy (that is, a therapy that is scheduled to be short since the beginning), as I abhor long-term therapy (a therapy that is scheduled to be long since the beginning), as I abhor any manualized treatment (except for research aims) that prescribe what the client and I are supposed to do and for how long. In my view true therapy, as true life, cannot be forced in any predefinite scheme. The true therapist, consequently, is one who puts all his theoretical and technical convictions at stake in every session, ready to negotiate and change anything and open to whatever the process brings in the way. In this view short-term (or long-term, or whatever) treatment should not be encouraged. What is encouraged, instead, is the openness to the process, the availability to have it last few sessions or many, many years; to accept a prolonged dependence if it is needed to reach genuine independence; to focus on symptoms and problems, or psychological and spiritual growth, or both; to put in the foreground the client-therapist relation, or an outside relation, or both; to work on a remaking, or on an uncovering level, or both; and so on. And above all, the willingness to change the established agenda from session to session, and inside any session.>>

I hope you will consider it as a response to your question. Tullio

 

Paolo Migone, 7 Nov 2000

On 2 Nov 2000, Allen Kalpin wrote:

>I am interested in your comment about "not believing" regarding "short-term."

> Do you mean that you: >-don't believe that any change is possible in a short-term therapy? >-don't believe that as much change is possible as in long-term therapy? >-or some other meaning?

Like Tullio, I am critical of Short-Term Dynamic Psychotherapy (STDP), and I would like to explain why. I think the following.

If STDP has a technique that works better and faster, this technique should be used with every patient (this is also an ethical problem: nobody should keeps patients in long analyses just to take their money or whatever). At this point, this (supposedly better) technique should not be called STDP technique, but "technique" tout court, the technique of dynamic psychotherapy: our patients will improve faster, that's all, and we will not need to set an a priori limit to the number of sessions or length of therapy (are we afraid maybe that if we do not set a time-limit they will never end the therapy? No, of course, otherwise they would not be improved). It is obvious that the a priori time-limit setting is the only criterion to differentiate operationally a "short-term therapy" from a "normal therapy", otherwise we would never be able to differentiate STDP from a normal therapy where the therapist is so good that he is able to cure the patient in a short time. [If we claim that the time-l imit setting is useful to "push" patients to improve faster, this too could be OK, but this is not new, since this kind of "parameter" (Eissler, 195 3) was used for example by Freud (1914 [1918] - SE, 17) with the Wolf Man. The issue here is what we want to accomplish and why. In fact, this argument is not often used by STDP theorists.]

On the other hand, if STDP does not have a special or different technique, but if the problem is simply to do a short therapy, that's OK ("short-term therapy" in this case would be simply a descriptive term, without any theoretical interest, and we would end up with a tautology: short-term therapy is a therapy which is short): the therapist will simply do his/her best to do whatever is possible given the time-limit (and in this case it is important for the patient to know on advance that the therapy will last only a given time, otherwise we would cheat him). But this is what everyone of us does if there is an "external" reason to do a short-term therapy (e.g., research setting, insurance, lack of money on the part of the patient, etc.), and here we do not have an "internal" reason (i.e., internal to the theory, a different theory of technique). In other words, my opinion is that STDP does not have a theory of its own. The problem of shortening the therapy has always been part of the century-long classical debate on theory of technique, since Ferenczi ("active therapy"), to Alexander ("corrective emotional experience") and so on. It belongs to the discussion around psychoanalytic technique.

I want to explain better what I mean with an example. In the early '80s I started to be interested in STDP (I went to Montreal to learn from Davanloo etc.), and I soon became critical of STDP. I wrote an article on STDP, with my critical ideas (also an English version appeared: Short-term dynamic psychotherapy from a psychoanalytic viewpoint. Psychoanalytic Review, 1985, 72, 4: 615-634), and in certain circles people believed that I was an expert of STDP simply because they had seen the title of this article (without reading it or understanding it, I do not know). Be as it may, the fact was that I started to receive referrals of patients who "wanted STDP" ("I do not like Freudian therapy, it is too long, I want to improve faster" etc. - this sort of things). I simply started seeing these patients, without commenting too much on these rationalizations, i.e., taking them as manifest content: I thought they wanted simply to trust someone and to get better as soon as possible.

In the same time, I was receiving patients of course who wanted simply a "therapy" (or an "analysis", the words changed according to the different psychotherapeutic subcultures); these patients wanted openly to change, to understand better themselves, etc. I was able to observe an interesting phenomenon: those patients who had asked an "analysis" were able to terminate easily, while those who had asked a short-term therapy were not able to terminate, they became deeply or pathologically attached, they showed a lot of complex problems etc. This is my explanatory hypothesis: the manifest request of short-term therapy could be a sign of the fear of intimacy, attachment etc., while the normal request of a therapy could be the sign of the absence of such a fear, because these patients (un)consciously knew that they were able to terminate without major problems (of course we can perform STDP to those more "dependent" or "difficult" patients, if we consider them "unanalizable" - forgive me for this outdated term - but the problem is that this kind of traditional or "conservative" reasoning is just the opposite of what is said by those who believe in STDP. Also, we should not forget, as Eissler [1953] argued very well, that it is easy to treat a resistance to an obstacle by simply removing that obstacle, but this is not therapy: changing the psychic structure means to change something inside of a patient, not outside of him).

To conclude: STDP, beside being a sign of bad theorizing, could be a "symptom", both on the part of the patient and of the therapist (who may be afraid of not being able to handle long and interminable analyses, over-involvement, etc.). From the sociological point of view, STDP is a product that can be sold in the mental health market, because both individual patients and mental health providers like the idea that it is possible to cure in a shorter and less expensive way. The trademark "STDP" attracts patients, and STDP therapists may profit of it. But every experienced therapist knows how to use termination as an intervention, which is an intervention like any other intervention: it can have powerful therapeutic as well as counter-therapeutic effects, it depends on what we want to accomplish (if you are interested, I can give examples where this intervention is used in "opposite and equal" ways: interrupting a treatment could be the only way to change a given patient, and convincing him/her not to termin ate, when s/he desperately complains and wants to terminate, could be the only way to dramatically change another patient - such as in the case of "passing a test" [of love, of real care, of unconscious expectation of rejection, etc.] by the therapist). But, knowing the importance of this intervention, only if we are in an open-ended therapy we can use it (I am talking here of any kind of therapy, also of those therapies that do not aim at insight at all - systemic therapists here have made plenty of experience, and have a lot to teach us).

In order to avoid misunderstandings, I have to state clearly that I am not saying I don't like STDP and that I like long-term therapies o analyses: this kind of reasoning is exactly the same and opposite mistake (like those patients - and therapists - who perform STDP in order "not to change at all"). Also "long-term therapists" may suffer of fear of separation, may be unable to terminate, may defensively (and in collusion with the patient) do a long analysis in order not to change the patient. I have to say that very likely this is often the case. Paolo Migone, M.D., Via Palestro 14, 43100 Parma, Italy, Tel./Fax + (39) 0521-960595, E-Mail <migone@unipr.it>.

 

Allen Kalpin, 7 Nov 2000

Dear Tullio and Paolo, you both raise some very thought provoking questions about Short-Term Dynamic Psychotherapy (STDP). I will respond to some of the issues you raise, and I would be interested in how others who practice STDP might respond, as well.

I do not consider STDP some completely different entity from the rest of psychodynamic psychotherapy. Those who write about STDP often trace the roots of it to Freud's shorter cases and others who made early attempts to shorten treatment, like Ferenczi and Rank. When any dynamic therapist is making a conscious effort to put some limit on length of treatment, for any reason, this could be called Short-Term Dynamic Psychotherapy. If you are trying to get better at providing effective time-limited dynamic treatment, then it could be said that you are "developing your own system of STDP."

There is no unified theory of STDP. There are many kinds of STDP, which are very different from one another in goals, selection criteria, range of techniques, and underlying theory of change. An obvious commonality is the attempt to shorten treatment. Some approaches try to achieve this by strict patient selection criteria and careful selection and restriction of the therapeutic focus. Others have developed techniques that attempt to bring about especially rapid therapeutic change. STDP therapists can and do learn from therapists of other orientations. I think that "non-STDP" dynamic psychotherapists can learn something from those who have put particular effort into developing techniques for increasing the pace of change in treatment.

Experiential STDP is a recently evolved designation for a few different STDP approaches which attempt to increase the pace of change by the facilitation of intense in-session emotional experience. These approaches have somewhat different theoretical underpinnings among them. We are in the early stages of developing theories of change which hopefully will be capable of more unifying these various systems.

Outside of the research setting, I have not met any STDP therapists who keep to a rigid pre-determined number of sessions. In my own work I try to collaborate with the patient in determining when "enough is enough," with the shared realization that this is not a treatment that will go on forever.

Careful consideration is given to the question of whether the amount of change is sufficient and whether the person has also gained "tools" that will enable him or her to carry on the process of change after therapy stops. I realize that others may look at this otherwise, however, I feel a responsibility to balance the needs of the person I am currently working with, with the needs of the people on my two-year waiting list. Allen.

 

Paolo Migone, 8 Nov 2000

Dear Allen, thank you for your reply. I basically agree with you. My main point, as I said, is that everyone of us, not only STDP therapists, should "collaborate with the patient in determining when 'enough is enough,' with the shared realization that this is not a treatment that will go on forever": so, this seems to me not to be a difference of STDP from "normal psychotherapy". (Incidentally, if a patient - or, for that matter, a therapist - has the fantasy that "a treatment will go on forever", this could be a beautiful opportunity to analyze, and correct, this "narcissistic, omnipotent etc." - you name it - transference or countertransference defense).

You say that "an obvious commonality [of the various STDPs] is the attempt to shorten treatment", and, again, I think that nobody should prolong treatment for the sake of prolonging it. But - we may ask - let's assume that a patient "needs" a longer treatment (it is just an assumption), which theory of technique should we use? This is the point. In other words: do we have one or two psychodynamic theories?

You also say: "Outside of the research setting, I have not met any STDP therapists who keep to a rigid pre-determined number of sessions". But this is exactly what any analyst or therapist (of any orientation) does. Once again this does not constitute a demarcation of STDP as a different technique.

You say: "Experiential STDP is a recently evolved designation for a few different STDP approaches which attempt to increase the pace of change by the facilitation of intense in-session emotional experience". This sounds quite interesting to me, and possibly a good correction of the old "classical" psychoanalysis where the cognitive aspects were emphasized (the fallacious idea that interpretation was the only curative factor), and where neutrality, anonymity, abstinence, etc., were encouraged and considered techniques that had a given meaning to every patient (as Larry Friedman [Trends in psychoanalytic theory of treatment. Psychoanalytic Quarterly, 1978, 4: 524-567. Also in The Anatomy of Psychotherapy. Hillsdale, NJ: Analytic Press, 1988], among others, has shown, this emphasis on interpretation was a reaction in order to differentiate psychoanalysis from the many psychotherapies that in the '50s and '60s were beginning to threat its identity, also at the market level, not only at the level of theoretical and empirical research). But the critical discussion around these concepts has been very rich in recent psychoanalysis, to the point where nowadays it has become much more fashionable to be "intepersonalists", "intersubjective", etc., than "classical" (who now have become the "bad guys"). The problem is that many STDP techniques (especially the more radical trends, such as Davalnoo's) rely very much on interpretation. Furthermore, the issue of the "experiential" aspects of the psychoanalytic process has always been at the heart of the history of the classical debate around psychoanalytic technique. I see any discussion on this matter not as "on STDP", but as "on psychoanalysis" (or "on psychotherapy", if you prefer).

I agree with you that "there are many kinds of STDP, which are very different from one another". As Malan once said, roughly there are two trends, two "parties": the "conservative" (like me and you, I suppose), and the "radicals" (like Davalnoo, I would say - and apparently also the late Malan, if we look at his important and oft-quoted statement "Freud discovered the unconscious, Davanloo discovered how to use it therapeutically"). The radicals really believe in a different technique, that can truly shorten the treatment, and I think this is the real challenge, the interesting aspect of the entire issue. But my objections are just to this radical trend of the STDP movement.

Thank you very much for your comments, that allowed me to explain better my ideas. Paolo.

 

Allen Kalpin, 14 Nov 2000

Paolo, here are a few thoughts in response to your last email:

1. You comment that all therapists should try to find ways to shorten treatment, and you wonder how this is any different from what is done in Short-Term Dynamic Psychotherapy (STDP). The difference is that in STDP there is a PLANNED time limitation. In STDPs there is an assessment process in which, in accordance with the particular model of STDP that is being practiced, a determination is made regarding whether the patient can be successfully treated in a time-limited way. Although the time limit is usually not a rigid exact number of sessions, there is still an approximate time frame for treatment.

2. You write, "But - we may ask - let's assume that a patient "needs" a longer treatment (it is just an assumption), which theory of technique should we use? This is the point. In other words: do we have one or two psychodynamic theories?" I think that there are many psychodynamic theories and associated techniques. We can all learn from each other. I believe that the theories and techniques that have been developed by various Short-Term Dynamic Psychotherapy practitioners can be made use of by practitioners of other forms of treatment, whether psychodynamic or cognitive or any other school, to help to make treatment more efficient and effective.

3. I am happy to say that you will be able to see "the late Malan," as you refer to him, presenting at the conference in Milan in May!!!! Allen.

 

Hilde Rapp, 15 Nov 2000

Dear Allen, it sounds to me as if we are talking about a general commitment to what a colleague of mine, Jennifer Elton Wilson, has called 'time conscious therapy'. My own thumbnail sketch of what I make of this commitment is as follows:

>to be at all times aware of the therapeutic focus, and to agree what it is with the client

>to continually assess with the client how much of the focal disturbance has been dealt with

>to test whether current work has opened up a new focus of disturbance which needs working through

>to assess with the client how much more time is needed to complete the rebalancing of the client's functioning and sense of wellbeing

>to discuss and deal with issues of endings throughout the time we work together, right from the first assessment session, and to agree to a planned ending.

I do this in any therapeutic work, whether I work with a client for six sessions, or, as is also the case, for twelve years!

My sense is that such commitment is implicit in all theories of therapeutic practice, including psychodynamic or psychoanalytic ones, if for no other reason than that of wellformedness: to aim for a process with a recognizable beginning, middle and end. Regards. Hilde Rapp, E-Mail <rapp.biip@CABLEINET.CO.UK>

 

Allen Kalpin, 18 Nov 2000

Hilde, your description of "time-conscious therapy" certainly contains many of the essential elements of Short-Term Dynamic Psychotherapy. It adds to the case that Tullio and Paolo have made for the idea that to talk about STDP involves making an arbitrary distinction from the rest of dynamic psychotherapy.

When a group of us were discussing founding the organization that has now become the International Experiential STDP Association (IESA) I suggested that we leave out the "short-term" element and instead talk about Experiential Dynamic Psychotherapy. However, others believed strongly that what we do is very much within an already existing tradition of STDP, and that we should retain that distinction.

STDP cases wouldn't go on for twelve years. An essential element of STDP is treatment planning that focuses on trying to figure out what can reasonably be achieved with an individual within a circumscribed time frame, and what would be the best way to go about this. To meet the challenge of this constraint, therapeutic systems have arisen which have elements that set them apart from other systems of dynamic psychotherapy.

On the other hand, I agree that it would be inadvisable to over-emphasize the differences. There is a convergence taking place in psychotherapy. I subscribe to a wonderful email forum in which prominent cognitive-behavioral therapists discuss issues and cases. If terminological differences are set aside, what they do clinically is often not much different from what is done in dynamic therapy.

Similarly, especially within this SEPI forum, I do not think that we should get too hung up on the "short-term" issue, but rather acknowledge that there are various traditions which have different historical roots, and look for what we can learn from each of them. Allen.

 

Niquie Dworkin, 19 Nov 2000

Hi SEPI- After long months of lurking I am now going to venture to participate in the stimulating discourse I have heretofore been quietly enjoying. As an integrationist with psychoanalytic and social constuctionist leanings, here is my concern about short-term dynamic therapy: If the patient feels any sort of pressure from the therapist to "move along" or attain certain goals, might he/she "get better" or fail to raise certain vital conflicts or concerns in order to get with what she or he perceives as the therapist's program? How can we encourage growth and autonomy without interfering with the patient's own individual pace? My own tendency is to listen for indications from the patient that he/she is feeling better and is wondering about ending treatment and then to explore this, not to raise the idea myself. Couldn't some short-term models have the potential to inadvertently collude with the patient's reluctance to address deep, painful, but necessary issues?

I am very interested in hearing from experts in STDP on these matters. Niquie.

 

Allen Kalpin, 21 Nov 2000

Niquie, writers on Short-Term Dynamic Psychotherapy claim that the existence of a time frame can motivate a person to deal with issues that they might have a tendency to endlessly put off dealing with in open ended treatment. The existence of this time pressure is also thought to potentially stir up important issues that can then be dealt with, that may never be stirred up otherwise.

I certainly have found that when I have set a termination date when there previously wasn't one, the pace of change often increases dramatically. I think there are advantages and disadvantages to both open ended and time limited treatment, and that, as usual, the challenge is to be able to know which is best for which patient. Allen.

 

Paolo Migone, 20 Nov 2000

On 18 Nov 2000, Allen wrote:

>When a group of us were discussing founding the organization that has now

>become the International Experiential STDP Association (IESA) I suggested >that we leave out the "short-term" element and instead talk about >Experiential Dynamic Psychotherapy...

I agree that the term "Experiential" is a good term to describe the direction taken by this line of STDP research: to try to evoke emotions, to relive them, to work on them, etc.

Yesterday I acted as discussant of a STDP paper, and we saw also a video. The therapist (in the same way as I saw in many of Davanloo's videos) in a way was inducing the patient to "experience" some feelings he was afraid of, e.g., aggression and anger, and to work on them. For those who are familiar with Gestalt techniques, this is very similar to one of its basic techniques (think of the technique of the chair, or role-playing), and, as we know, Gestalt is one of the most well known "experiential" techniques. In several videos I saw of STDP therapists, often at the middle or the end of the session the patient cries, or tell the therapist how he hates him and so on.

Another thing that comes to mind, to this regard, is "scream therapy" or other cathartic techniques with all the complex and rich implications (for example: after the patient has been induced to act out painful or scaring feelings or ideas, he sees the therapist who is able to handle them well, and this "new experience" with the therapist is a good source of identification, reassurance, and change of pathogenic beliefs).

But the problem is always the same, faced in the history of the theory of technique all along this century: the problem of defenses and how to overcome them, in other words how to help the patient not to be overwhelmed by the "experience" induced by the "short-term" therapist. In my opinion there are not many directions we can take: one possibility is to take again roads already taken in the past (think for example of Freud when he was massaging the forehead of the patients in order to encourage them to overcome the resistances - this was a specific phase of the history of psychoanalytic technique). The theoretical and clinical implications of these (perfectly legitimate) techniques are those that should be in our focus of attention. Paolo.

 

Allen Kalpin, 21 Nov 2000

Paolo, you raise the issue of the parallels between the encouraging of emotional experience in experiential STDP and that which takes place in other approaches, like Gestalt Therapy. This is certainly an interesting issue.

There are these commonalties, but there are important differences. STDP works within a psychodynamic framework, whereas Gestalt and the "experiential psychotherapies" do not. Also, the experiential STDPs place a large emphasis on the experience of the emotions in relation to the therapist, whereas in Gestalt techniques, like the empty chair technique, the therapist acts as a guide to encourage the patient to experience feelings towards others, usually not the therapist.

At the Washington SEPI meeting I had some wonderful discussions of these similarities and differences with Les Greenberg. Out of those discussions has arisen a workshop in Toronto planned for the end of February as a post-convention workshop of the Ontario Psychological Association conference. This will feature Les Greenberg and Diana Fosha, and will be a chance to compare and contrast these approaches to emotional experiencing with case videotape and discussion.

You bring up a fundamental problem: "But the problem is always the same, faced in the history of the theory of technique all along this century: the problem of defenses and how to overcome them, in other words how to help the patient not to be overwhelmed by the "experience" induced by the "short-term" therapist." The various practitioners of STDPs have developed specific approaches to this central problem. Gestalt/experiential therapists don't use the term "defenses," but even so, in my opinion, still have developed their own methods for overcoming defenses, although they may refer to this in some other way. Similarly, the various practitioners have developed methods regarding assessment, timing, pace, and integration of the experiences, which are meant to prevent people from becoming overwhelmed. Allen.

 

Paolo Migone, 22 Nov 2000

On 21 Nov 2000, Allen Kalpin wrote:

>Writers on Short-Term Dynamic Psychotherapy claim that the existence of a

>time frame can motivate a person to deal with issues that they might have a >tendency to endlessly put off dealing with in open ended treatment. The >existence of this time pressure is also thought to potentially stir up >important issues that can then be dealt with, that may never be stirred up otherwise.

Dear Allen, my objection is the following: an ideal therapy should change the patient, not the environment. In other words, the problem is to understand why a patient has the need to procrastinate (is this is the case) and we should change this symptom, not change his procrastination by "forcing" him to go faster (by environmental pressure, i.e., setting a time-limit). In fact, what happen if in his future life he does not have anybody who forces him to do things? The symptom might return as before STDP. The goal of therapy is to change people from within, to make them (relatively) autonomous from the environment.

It is of course true that time-limit setting might work for specific goals we want to pursue. It was used also by Freud in 1914 with the Wolf Man (1918 - SE, 17). But one thing is to use it as a "parameter" (a "manipulative" intervention that later we try to analyze in order to see if the patient can do without it), another thing is to "cure" only through parameters that will be never analyzed nor eliminated (i.e., through environmental changes, where supposedly the patient remains the same and simply responds to external stimula - I am aware that I am oversimplifying, but I want to push the theoretical implications to their extreme consequences). The therapies that work through "social" or "environmental" interventions are usually called "psychosocial treatments" or "sociotherapies", not psychotherapies (think for example of the family interventions in schizophrenia, which are very effective, where it is quite difficult to change the patients from within because he is too sick, while we can reduce the number of hospital admissions simply by teaching some skills to family members). But, if we agree on this theoretical argument, STDP would not change that specific problem (it would be a legitimate technique, but in the "conservative" way, not in a "radical" way - i.e., it would work only for specific patients etc.).

In the history of psychoanalysis (and, we might say, in the history of ideas in psychotherapy) both these issues were discussed in depth by Kurt R. Eissler: in 1953 when he introduced the term "parameter", and in 1950 when he strongly criticized Alexander's concept of "corrective emotional experience" (Eissler feared that the corrective experience could be mutative simply because it could induce a reaction, while he was pursuing the "pure gold" of psychoanalysis which aims at changing the psychic structure, so that the patient becomes more steadily autonomous from the environment). Paolo.

References:

Alexander F., French T.M. et al. (1946). Psychoanalytic Therapy: Principles and Applications. New York: Ronald Press (Internet edition of chapters 2, 4, and 17 ["Corrective emotional experience"]: http://www.p sychomedia.it/pm/modther/probpsiter/alexan-2.htm) Eissler K.R. (1950). The "Chicago Institute of Psychoanalysis" and the sixth period of the development of psychoanalytic technique. Journal of General Psychology, 42: 103-157 (Internet edition: http://www.p sychomedia.it/pm/modther/probpsiter/eiss50-2.htm). Eissler K.R. (1953). The effect of the structure of the ego on psychoanalytic technique. J. Am. Psychoanal. Ass., 1: 104-143 (Internet edition: http://www.p sychomedia.it/pm/modther/probpsiter/eiss53-2.htm).

 

Allen Kalpin, 22 Nov 2000

Paolo, the idea about the potential therapeutic benefits of a time limit is not about producing merely a behavioral change out of compliance. One therapeutic pathway that typically gets activated with this and many other forms of limit setting is that feelings are stirred up by the setting of these boundaries. When these feelings are successfully brought out into the open and worked through true psychotherapeutic change can result.

James Mann (Time-Limited Psychotherapy. Cambridge, MA: Harvard Univ. Press, 1973) wrote about this with reference to his version of STDP which was very specifically limited to 12 sessions for each patient. His idea was that this provided a built in framework that stimulates issues of attachment and loss in many people, and that real change can occur by working this through. I don't know how successful his particular approach has been, and am merely using this as an example of what the idea is supposed to be about the therapeutic use of time limits.

I think that there are lots of parallels in long-term therapy. Sessions are over at a certain time. There are rules about payment for appointments or missed appointments. The therapist might end up saying "no" about many things. The reactions that a person has to these sorts of setting of limits can should be used therapeutically to work through and come to terms with what is stirred up by coming up against these boundaries. It is no different about the boundaries of a time limitation on length of treatment. Allen

 

Diana Fosha, 22 Nov 2000

Dear Niquie, I am so glad that lurking turned into a venturing out into discourse. It is good to have your thoughtful queries.

You write :

"If the patient feels any sort of pressure from the therapist to 'move along' or attain certain goals, might he/she 'get better' or fail to raise certain vital conflicts or concerns in order to get with what she or he perceives as the therapist's program? How can we encourage growth and autonomy without interfering with the patient's own individual pace? My own tendency is to listen for indications from the patient that he/she is feeling better and is wondering about ending treatment and then to explore this, not to raise the idea myself. Couldn't some short-term models have the potential to inadvertently collude with the patient's reluctance to address deep, painful, but necessary issues?"

Let me venture to share some musings. They are of two sorts:

1) I think the issue of patients reading their therapists expectations and unconsciously seeking to comply with them (among many other motives) is a general issue that applies across the board to all therapies, long-term and short-term and it well behooves all therapists to attend to it. Just as you wonder whether some short-term models have the potential to inadvertently collude with the patient's reluctance to address deep, painful, but necessary issues, one could well wonder whether some long-term models do not collude with the patients' dependency wishes and their reluctance to resolve their issues so as not to have to leave the therapeutic relationship. And so on.....

2) Unlike the STDPs that centrally use the time limit to move treatment along, the experiential STDPs in essence strive to facilitate and access deep levels of core affective experience. With access to previously feared-to-be-unbearable feelings (which when experienced together with the therapist prove not to be), the patient also gains access to what was excluded (or defended against) along with the core affects: i.e., memories, fantasies, resources, aspects of self experience, ways of relating etc. Core affect is certainly a royal roads to the unconscious. What access to core affect -- and all the unconscious phenomena that go with it--gives us is the opportunity to do the therapeutic working-through in a state where the work is not impeded by its having to be done through the distorting impact of defenses or the inhibiting impact of anxiety or shame. In the experiential STDPs the acceleration comes from accessing deep levels of experience quickly, often from the first session on. Thus, the issue of rush ing the patient along fades. An observation I have made -- am curious other colleagues agree -- is that in getting from surface to depth or from defenses to core affect, the therapist tends to lead the process. Once deep affective experience is in the picture, the patient is in the driver's seat.

Would be interested in your further venturings. Diana Fosha, New York, E-Mail <DFosha@AOL.COM>.

 

Diana Fosha, 22 Nov 2000

Dear Paolo, I found your comments intriguing and showing an erudition I very much appreciated. My question to you is as follows: if your procrastinator's procrastination disappears, thus making him no longer a procrastinator, and furthermore if he now can also deal with his aggression, or has completed his pathological mourning, or what have you, and he can reasonably well work and love (Freud) and play (Winnicott), and speak coherently about his formative emotional experiences (Mary Main, Peter Fonagy), and if the methods by which his transformation was facilitated can be repeated with others with some reasonable measure of predictability, does it matter if those methods receive a particular label or another?

Wouldn't that be confusing means with ends? "If the "pure gold" of psychoanalysis which aims at changing the psychic structure, so that the patient becomes more steadily autonomous from the environment" is achieved by active means, is the gold any less pure than if it were achieved by other means? Diana.

 

Tullio Carere, 23 Nov 2000

Diana, you wrote to Paolo:

>My question to you is as follows: if your procrastinator's procrastination

>disappears, thus making him no longer a procrastinator, and furthermore if he >now can also deal with his aggression, or has completed his pathological >mourning, or what have you, and he can reasonably well work and love (Freud) >and play (Winnicott), and speak coherently about his formative emotional >experiences (Mary Main, Peter Fonagy), and if the methods by which his >transformation was facilitated can be repeated with others with some >reasonable measure of predictability, does it matter if those methods receive >a particular label or another? >Wouldn't that be confusing means with ends? "If the "pure >gold" of psychoanalysis which aims at changing the psychic structure, so >that the patient becomes more steadily autonomous from the environment" is >achieved by active means, is the gold any less pure than if it were achieved by other means?

It is no surprise to me if these ends are achieved by active means. On the contrary, I am persuaded that these ends are *better* achieved by active means. But it would be a surprise if they were achieved in a short-term treatment (i.e., a treatment that is scheduled to be short since the beginning). Is the short-term thing included in what you say above? If so, can you indicate to me an article or a book by your group where this is demonstrated? Tullio.

 

Hilde Rapp, 23 Nov 2000

Dear Diana, regarding all your recent posts, I am very struck by your accessible structuring of the field both regarding the task and regarding the sequencing of interventions. Your observations very much reflect my own thinking and practice.

You talk about the task as having a horizontal axis which serves to build and maintain the relationship with the client, and a vertical axis which serves to organize the depth of emotional working through of core affect. You also talk about segmenting the session into three parts- the first to get there, the second to do the work, and the third to reflect on where we have been.

My own way of understanding this is that the first segment is to do with relationship building, with tuning in on one another, agreeing what needs to be done and why, and, in my case, also sounding out how much in depth work can be tolerated on that day- given the client's general life situation and external pressures. In this phase we might agree, for instance, that something needs to be done but that there will be a better window to do the work in two weeks time after some external calm has been reestablished, and in this session we will merely 'prime the field' and 'take some soundings'.

The second segment is to change direction and to work on the vertical axis and to go to what ever depth was agreed in the first segment. If a special opportunity arises to go deeper than agreed, I would normally move briefly into the horizontal plane again and agree to proceed, together with agreeing a signal that tells me " stop and take time out, this is too painful after all". If there is a very good bond between the client and myself, we might have agreed in the first segment that over the next few sessions we will take some risks and go with the pain as the opportunity arises, without on stream negotiation. This is especially valuable if there is a deep fear of pain which makes the client stiffen at the mere thought of getting in touch with it- i.e. the 'defenses' get mobilized to such an extent that therapeutic experiencing is foreclosed. My experience is that even then the client may feel emotionally 'raped', but if the alliance is strong and the task is well primed this is much less likely, and to finally overcome the block brings deep relief ( and sometimes gratitude). This is the segment which really leads to change.

The third segment is working on the cross, integrating our shared understanding of how the in depth work simultaneously serves to build greater trust, greater closeness and a wider repertoire of feeling and behaving both in the therapeutic relationship and in other significant relationships outside. Insight is greatly promoted here, and provides anchors and contexts for the change achieved in segment two.

This way of working in three segments and along two main axes has been particularly helpful with clients who suffer from narcissistic wounds and from borderline personality disturbances, including identity diffusion.

(Obviously the relational axis can be further refined, for instance, in the way that Tullio does, into maternal and paternal vertices; into a metric of closeness and distance, domination and submission, rather like John Birtchnell and Lorna Benjamin might; into affects which are directly related to the social relational dimension where we make affective bonds with significant others, and affects, which arise in one's relationship to oneself as constitutive of our personality, character, identity, self definition- the very useful distinction made all the time by Sidney Blatt and his colleagues...)

In a sense, every therapy is organized as a series of short term therapies: each session has a beginning, middle and end. Each piece of affective work has a core theme, explores a core affect as far as is possible before moving on to the next theme. (Freud actually wrote about this in his early work on hysteria- I can find you the reference if you like. Also you may know Grof's work on Core Emotional Experience [COEX] systems?)

Regarding the length of treatment: If there is only one major focal disturbance, the therapy work will be done in a relatively short time. If there are multiple core conflictual relationship patterns, as in identity diffusion and multiple personality disorder, as Kluft defines it, or a generic disturbance in the structuration of all affects (and associated cognitions) such as the 'pathological organizations Bion and the Kleinians have brought to our attention, then the work needs to proceed over a longer period.

My clients and I think of the form of therapy I do as being analogous to a book with a number of chapters. Some books are short and have short chapters, and some are long with many chapters, etc, but throughout, in each session, in each chapter, in the whole book, there is a steady rhythm of approaching each other, going deep together to explore an affective theme, and stepping back and saying good bye.(occasionally I conduct very long term treatment which feel more like a trilogy).

I wonder whether some such similar conceptions don't underlie all approaches which integrate psychoanalytic concepts with expressive techniques, and which strive to integrate the facilitation of insight with active participation change? (Gestalt therapy with its cycles comes to mind, as does CAT)? Cordially. Hilde

 

Paolo Migone, 23 Nov 2000

On 22 Nov 2000, Diana wrote to Niquie:

>...Just as you

>wonder whether some short-term models have the potential to inadvertently >collude with the patient's reluctance to address deep, painful, but necessary >issues, one could well wonder whether some long-term models do not collude >with the patients' dependency wishes and their reluctance to resolve their >issues so as not to have to leave the therapeutic relationship. And so on....

I fully agree, actually this is one of my central arguments, as I think I said. I never said that "I like long-term therapies". The concept of "long-term" is, so to speak, equal and opposite to the concept of "short-term": both imply a technical rigidity and possibly a disservice to the patient. A better term would be "open-ended". My point is that there is an advantage in being open-ended because you have the choice "to be a STDP therapist" if you decide so, i.e., you can use termination as a therapeutic (or experiential) intervention, while in STDP you do not have the choice of using termination (e.g., in case you want to prolong the treatment if you want to give this "experience"), so your repertoire is more limited. You might reply that many STDP therapists do not set an a priori time-limit to the therapy: in this case there is no difference in principle between me and you, since both of us try to do our best to help our patients, and I do not object at all experiential techniques (I might not be good at it, or less experienced than you, but this is another matter - we should not forget also that the therapist's personality is important in shaping the technique, and also we should consider the therapist-patient match - but, again, these are other matters). The problem is that if you eliminate the criterion of the time-limit setting from the definition of STDP we cannot differentiate any more a "short therapy" from a "therapy that is short because the therapist is good", and you should call your technique not "experiential STDP", but simply "experiential dynamic therapy". If you do so, I am totally in agreement with you.

But there is a second point. As Hilde said, "every therapy is organized as a series of short term therapies: each session has a beginning, middle and end", and soon or later also a long-term therapy ends (unless there is a non-analyzed denial of the end/death etc. - but this would be a beautiful opportunity to see and possibly analyze a defensive need on the part of one of the two partners of the therapeutic relationship). But I add that in long-term therapy there is the so called termination phase (few months, with an a priori stated time-limit setting) in which the patient (and the therapist) can experience all sort of things (separation anxieties etc.) experienced and worked through by STDP therapists.

On 22 Nov 2000 EST, Diana wrote in response to Paolo:

>My question to you is as follows: if your procrastinator's procrastination

>disappears, thus making him no longer a procrastinator, (...) >does it matter if those methods receive a particular label or another? >Wouldn't that be confusing means with ends? "If the "pure >gold" of psychoanalysis which aims at changing the psychic structure, so >that the patient becomes more steadily autonomous from the environment" is >achieved by active means, is the gold any less pure than if it were achieved by other means?

I couldn't care less of labels. I used these labels because I assumed they meant something. I mean that, if the argument of my mail of Nov. 22 is correct, with STDP you could not change some patients' specific problems that, on the contrary, you could change better (and of course faster) with an open ended approach (see my mail of Nov. 22 for the details of my argument).

On 23 Nov 2000, Diana wrote in response to Paolo:

>...In the current experiential STDPs, there is work along two dimensions:

>the emotional (the vertical axis of depth and emotional experience) and the >relational (the horizontal axis of connection)...

Let me take this opportunity to say how I see things. Some decades ago there were two major approaches: psychodynamic and behavioral. Soon many therapists felt themselves uncomfortable in both these parties, because they felt that both psychoanalysts and behaviorists were missing something important of psychotherapy (and maybe of human nature). They called themselves in various ways, "experiential", "humanistic" etc., and were a very complex and not unified group of people (among them, Rogerians, Gestalt therapists, etc.).

They were labeled the "third force" of the psychotherapy movement. Often they were dismissed in various ways, but my impression is that they were right in pointing out some difficulties both of psychoanalysis and behavior therapy (think, for example, of the de-emphasis on the importance of relationship in many behavior therapists, or of the "personectomy" which was typical of many classical psychoanalysts of that time - due to neutrality, anonymity, etc., which were chronic narcissistic injuries to many patients, and we needed Kohut [who repeated some ideas of Rogers] to emphasize that).

As we know, a very important characteristic of this movement was the emphasis on the "experiential" aspects of the relationship to promote change. Now, if the line of research of "experiential STDP" goes in the direction of trying to improve the theory and technique of dynamic psychotherapy by "integrating" it (now the fact that we are in the SEPI list comes to my mind) with important missing elements (such as the experiential factor), I appreciate this endeavor, and I sympathize with STDP. My only objection concerns the "short-term" part, because I strongly believe that all this is part of the debate on theory of technique of dynamic psychotherapy (or of psychoanalysis tout court). Nobody should do long-term therapies when you can shorten them, because long-term therapy is not a value in itself, it is simply a residue of an outdated psychoanalytic cliché (for example, I guess we all remember when some analysts used to say that "only with a long analysis you can really change a patient").

I thank you for your thoughtful mails, that gave my the opportunity to reply to you. Paolo.

 

Allen Kalpin, 26 Nov 2000

Paolo, I agree with what you have written. Therapists who do STDP sometimes elect to work in a "time-unlimited" way with a person. Obviously in such situations the work cannot be properly called "short-term." Maybe the right term in such cases would be "STDP-style" or "eSTDP-style'" therapy.

I say this because these short-term models have developed techniques which are distinctive and different from those used in other psychodynamic approaches, and certainly when I work with a person in a time-unlimited way the work still very clearly bears the stamp of an eSTDP approach. Allen.

 

Diana Fosha, 30 Nov 2000

Dear Hilde, thank you for your extraordinarily (though-par-for-the-course) eloquent note. I particularly liked your saying "In a sense, every therapy is organized as a series of short term therapies: each session has a beginning, middle and end. Each piece of affective work has a core theme, explores a core affect as far as is possible before moving on to the next theme."

I would love to take you up on your offer and get references both to where Freud discusses a similar idea in Cases on Hysteria, and to Grof's work on COEX systems (Core Emotional Experience), the latter being totally new to me.

As to your intriguing comment about clients who may feel "raped" by the push (so to speak) for deep experiencing: in such cases, when I have backed off, validated their reticence and suggested that it is important to wait and be patient, there is often a paradoxical effect: it is then the client who takes the lead and plunges ahead. Motivation being restored by the experience of not being helpless; instead feeling in control.

I would be interested in your experiences. Best regards, Diana.

 

Diana Fosha, 30 Nov 2000

Dear Tullio, you write:

"It is no surprise to me if these ends are achieved by active means. On the contrary, I am persuaded that these ends are *better* achieved by active means. But it would be a surprise if they were achieved in a short-term treatment (i.e., a treatment that is scheduled to be short since the beginning). Is the short-term thing included in what you say above? If so, can you indicate to me an article or a book by your group where this is demonstrated?"

At this point, most of us doing "experiential STDP" do not work with a time limit which is imposed from the beginning, but allow the termination to emerge organically from within the work. Nevertheless, I believe that the experiential focus, the activity of the therapist, and the non-abstinent, non-neutral stance of the therapist, all within a psychodynamic framework for understanding phenomena substantively contributes to the acceleration of the therapeutic process (because of the rapidity of the deepening and because of the transformational power of deep affective experiences). Some of the treatments end up being truly short-term, but not all. Here are some references:

Coughlin Della Selva P. (1996). Intensive short-term dynamic psychotherapy. New York: Wiley.

Davis D. (1988). Transformation of pathological mourning into acute grief with intensive short-term dynamic psychotherapy. International Journal of Short-Term Psychotherapy, 3: 79-97. Fosha D. (2000). The transforming power of affect: A model of accelerated change. New York: Basic Books (the patient whose initial session is micro-analyzed in chapter 9 had an eight session treatment, with follow up revealing maintenance and enhancement of the gains he had made) Fosha, D. (2000). Meta-therapeutic processes and the affects of transformation: Affirmation and the healing affects. Journal of Psychotherapy Integration, 10: 71-97. Magnavita, J. J. (1997). Restructuring personality disorders: A short-term dynamic approach. New York: Guilford. McCullough Vaillant, L. (1997). Changing character: Short-term anxiety-regulating psychotherapy for restructuring defenses, affects, and attachment. New York: Basic Books.

However, there are some remarkable results obtained also in cases where the time limit is determined from the beginning. I would urge you to take a look at the following:

Malan D. H. (1976). The frontier of brief psychotherapy. New York: Plenum Press.

Mann J. & Goldman R. (1982). A casebook in time-limited psychotherapy. New York: McGraw-Hill (particularly the case of Mrs. R, which I think is a truly extraordinary achieved in 12 sessions).

Con affetto, Diana.

 

Diana Fosha, 30 Nov 2000

Dear Paolo, this series of e-mails has really gotten to what I believe is the heart of the matter, and at least in theory, it appears that you and I and Hilde and Tullio and Allen all agree which has something to do with the deep transformations brought about by deep affective experiences and with the incorporation of the "missing element," i.e., both the experiential factor and the relational factor where neutrality and abstinence are no longer the defining features of the therapist's stance.

As Allen Kalpin wrote in an earlier e-mail, there was a discussion amongst the members of our group as to whether we should keep the term "short-term" for our approach, or whether to merely refer to it as experiential-dynamic treatment, which is what Allen Kalpin suggested, or Accelerated Experiential-Dynamic Psychotherapy (AEDP) which is the term I use to refer to my own work. the general consensus was that for reasons of acknowledging the tradition that differentially shaped all of us we would retain the term "short-term." What that tradition is distinguished by is using the very specific concern with effectiveness and efficiency without sacrificing depth and thoroughness to guide technical and stance innovations in the work (much as Ferenczi did), which of course then leads to new phenomena, which of course lead to the necessity for theoretical advances to account for the "new" data," which in turn spur on technical developments and so on....

Since the experiential STDP conference in May will be held in - relatively speaking - your backyard, I hope you join us in Milan, take a look for yourself at what the work looks like, what the nature of the changes is, what the therapeutic process actually looks like - as this will be a videotape-heavy conference - and how that all jives with where and how experiential STDP fits in with integrative treatments as well as with contemporary psychoanalytic work. but in the meantime, we'll keep e-talking.

Thank YOU for YOUR thoughtful and erudite remarks and the opportunity to find common ground, having started from divergence. Regards, Diana.

 

Hilde Rapp, 30 Nov 2000

Dear Diana, Dear Paolo, perhaps it is high time to revisit the issue of neutrality and abstinence in its own right? I believe the use of these terms signposts an important confusion in the field of psychoanalysis: Abstinence and neutrality were recommended by Freud as intrinsic to the stance of an analyst intent on making a contribution to the science of the human condition by uncovering new knowledge to the body of observations constitutive of the analytic field.

One might speculate, that were Freud alive today, he might well have been intrigued by the more contemporary notion of the scientist as 'participant observer', especially in the human sciences... However, Freud , as is clear from his case histories, other writings, and from observations by his analysands, notably, Lampl de Groot, conceived quite differently of what was required to effect a cure as a therapist.

It would seem important to link the discovery procedure(heuristic) chosen much more closely to the goals and epistemic purpose of the inquiry, and to examine carefully whether the techniques devised for implementing the chosen methodology are actually fit for the purpose of the inquiry.

Ferenczi, especially kept alive Freud's approach to active intervention in therapy (as it turned out at great cost to himself). However, within the Anglo-Saxon tradition in particular, despite Fenichel's insistence in 1946 that there are many ways to do therapy, it was Freud's approach to psychoanalytic science, rather than his actual work with clients, which was taken as the template for perfecting, I believe, mistakenly, the technical paradigm par excellence for psychoanalytic therapy.

I am writing something about this at the moment, and in the process of my researching the issue, I notice that Helmut Thomae and Horst Kaechele in Ulm have similar concerns.

Would you be interested to pursue this theme? Maybe, Diana, this would be interesting for the conference as well? Cordially, Hilde.

 

Hilde Rapp, 30 Nov 2000

Dear Diana, see my other post as well. [In reference to your mail of No. 30, 2000,] yes, I agree, I too have found- and this chimes with Ferenczi, that it is more often than not empowering for the client, if the therapist validates to the client that she has overstepped the boundary, so to speak, inadvertently, 'emotionally raped' the client. In my view any such 'admission' on part of the therapist must however be done within a coherent enough series of 'feeling complexes' such as pain or anger, in which it forms one link, and it must be linked to working through key interpersonal sequences as well.

This is what I meant when I said, some therapies are brief, because the client has only one significant focus in the distortions or deficiencies of his emotional experiencing: for example they have a very diminished repertoire of dealing with the hurt associated with anger, but otherwise their repertoire is more or less fine. The more diffuse or the more widespread the difficulty, as in early onset! (sex or other) abuse survivors, the longer the therapy, because each feeling complex needs to be worked through, balanced, and expanded into a reasonable repertoire.

You asked me to give some examples of how I work with this in practice:

I would venture to say that I have had some clients who have been repeatedly bogged down in many different previous forms of what sounded like good therapy, but where a good therapist could nonetheless not get round their defenses and their fear of their fear of their own affect. so, a number of such 'cases' to 'emotionally rape' the client was actually the only way to work with the massive resistance to working with a particular affect, or to work with ANY emotion at all. But I do warn the client that would, over the next three session ( or whatever) take them by surprise as the opportunity arose, and that we would take time out and work through what doing this brought up for them. Only twice in thirty years has this left a scar which took a lot of subsequent work to heal- but heal it, it did- except for that tell tale fine white line... Of course there is no way of telling what would have ( more likely NOT have) happened if we had not taken the risk!

I suppose I might say that my way of working with this fear of feeling is that it is akin to setting up a desensitization process with carefully staged mini episodes of flooding ( the 'emotional rape')- just to get the business of feeling going at all. The crunchpoint is however, that from the outset, the therapy is set up, always, in every session, to take place within a meta-communication framework. Also, sometimes, I don't start with the 'target' emotion, but somewhere else, less defended.

In my view, 'interpreting' either the transference or the countertransference is a meta communication par excellence. And In a sense, working with meta-communications is a way of working with affect, exactly not the target affect, but the resistance itself, but in an arena that is relatively little defended. Because we don't normally, in ordinary relationships, communicate like that- there are no real triggers for old transference patterns or normal resistances here:

"The artificial nature of the therapeutic hour and the peculiar way of working together provides unique opportunities to develop a therapeutic relationship which always works along two levels. It is like no other relationship. The special opportunity of therapy is BOTH to do what is normal, namely to react with affect( including absent, or blocked feeling - I class this as an affective response too!) to the other person, AND, and this is the weird bit of therapy, where the way we talk is and not normal( except in Woody Allen movies!) to stand back to observe our own actions and reactions, to notice patterns in them, and then to talk about what is going on in quite a detached way. There is a funny film about a girl on her first date who does this, and understandably the man runs screaming. So if you did this in a social relationship, all the spontaneity would go out of it, and you would wreck it. Our deal here is to stay with this weird process, because we know it provides a normally a safe way to help us a ccept who we are and to help us change certain aspects of our behavior".

The client and I agree: "As far as possible, we will not fully act out the feelings we provoke in one another, but we will both make a commitment to notice what is happening and to name it, however hard this may be".

I might say: "You will, without fail, do things in therapy which will hurt me, but instead of going into a sulk as I might do if I were in a social relationship with you, I will do my best to look with you at what we can learn from this, what unconscious forces are at work here, and how much influence we may be able to gain over them, so that you may have new choices..."

"... I will not always manage not to hurt you back..."

" ... I may sometimes hurt you, not deliberately, and not because you hurt me first, but because I too have my inner demons..."

"...I am trained to pay attention to such things, and I have an ethical commitment to be as honest with you about what happens here as I can..."

"... I will apologize to you, and more importantly, I will examine with you what contribution my unconscious patterns may have made to my hurting you, and if significant- I will work on that outside this, your, therapeutic space with someone I trust and who is there for me".

All this is not unlike Ferenczi - but Freud too wrote about the patients unquestioned right to protest to the physician about such boundary violations, and if need be to resist fiercely. (I think the reference for this is Imago edition: GW, XIII:97)

I might say: "Sometimes, what will happen is that I am actually responding to old patterns of expectations and behavior which are alive in you and which have set up a field between us (I explain this too in terms of child development, attachment research etc.)"

" ...In a strange way, these patterns can act like a hypnotic induction, inviting me, and probably other important people in your life to confirm your expectation that you will be hurt, and many people then actually do something hurtful to you" (I might explain something about reciprocal role relationships/core conflictual relationships/role responsiveness/Transactional Analysis [TA] games and ego states...). Or, I might, explain: "What we do is more like creative play [a la Winnicott and Vygotsy]: Like children engaged in make believe, powerful and real feelings will be enacted in the therapeutic space. At the height of the drama, both Haensel and the witch feel real fear, just as they would in the real world. But just as in the playroom the witch has not really been killed, and does not really die- so in the therapy room, I, as the therapist have not really been mortally wounded by your attack. Although I feel real pain, I can bear it because I sincerely believe that you were, 'as if acting under a spell', and that must of the bad feelings which have led you hurt me are really meant for another person, who is not in the room. So, I don't really believe, that I was meant to be your real target. And, also, I can bear the pain, because my training as a therapist has prepared me to know and recognize when someone acts as if under a spell, and I have made a commitment not to punish you when you are acting 'as if under a spell'."

I might at some point add" In TA there are some good descriptions of how this happens, and some of them are quite funny. Some people find this way of looking at things really helpful- and I am happy to take you through some of this if you like. The good thing about TA is that it can help you also to spot when you are the one who is being attacked by another person, who doesn't really mean you, but now they are the one acting as if under a spell. The good thing is that too you can learn how to protect yourself in the way that I have shown you that I protect myself." or "In CAT there some really useful ways of putting some of these patterns on paper, and some people actually carry these maps in their pocket and it really helps them to hang on in there and not to get sucked in to the old patterns...if you want we can try making a map for you sometime..."

I will always say: "Any hurt you have inflicted on me, because you are genuinely angry with the real me, Hilde, we will need to deal with separately from what we have talked about in terms of 'acting as if under a spell'... I always want to know when you feel that I have done something that deserves your righteous anger, and I will always, to the best of my ability, be straight with you about this."

I might add: "I may not always agree with you. You may feel justified in your anger towards me, but I don't see that I have really done anything to deserve it... I won't deflect your anger and make it out to be to do with 'as if under a spell'... I will hear you out, but I won't necessarily apologize... Sometimes we just have to live with the conflict, or respectfully agree to differ. But I will work hard with you to clear up as much as we can clear up, and to reach as much understanding as our shared commitment, skill, good sense, good will, and sense of humor will allow..."

Or "I am genuinely angry with you, and I think it is quite straight. I can see no evidence that you are acting 'as if under a spell'... I think that what you are doing is damaging you (or the therapy/ me/ your relationship with your lover...) and I will hold my ground... We have agreed from the outset that in these situations I will confront and challenge you, and that we will look together at what choices you have, why doing this is so important to you, what the risks and consequences of doing it are etc... Anything else would be negligent and irresponsible on my part and that goes against my ethical commitment to you as your therapist."

Obviously, I will say a sentence at a time, as and when this makes sense in terms of timing an pacing. I will also translate what I say as far as possible into the language of the client. And, of course within this frame, I'll do the real expressive work! But I will, over the first few sessions- or in a really brief therapy, in the first session, say something like this, and enough of it to make a up a reasonably comprehensive explanation of what we do in therapy, why we do it, and why I think it helps.

My feedback from clients is, that it is this kind of frank and explicit meta-communication, and my evident sincerity in pursuing the truth at all times, over time builds sufficient trust between us for them to risk themselves- and indeed, in due course, to tolerate the disappointment that we both make mistakes, to live with uncertainty, and to bear the discovery that trust has to be earned all the time, and to dare to have the hope that many mistakes can be repaired, and to live with the pain that some really can't...

Anyway- this should give you more than enough of an idea of what a Hilde video might look like- obviously plus the actual expressive work itself which takes place within the frame, howls and all! I just realized, that so often we focus on what the clients SAYS- and what the therapists THINKS or FEELS. We don't often report meta-statements of what the therapists SAYS to client about what they THINK and FEEL...

I have just looked for the reference to the bits of Freud you asked for, and I notice that my ancient file has corrupted. I think this is the one: Imago, 1895, GW: I, 292, ff. Freud describes two patterns here- the second was a real illumination for my work with identity diffusion/multiple selves/pathology in my post childhood sex abuse clients). I think Laplanche and Pontalis' dictionary (Vocabulaire de la psychanalyse. Paris: Presses Universitaires de France, 1967 - a student has my copy alas) has a concordance at the back that lets you identify the corresponding place in the Strachey edition- maybe your librarian can do it for you. The trouble is, for many of these passages, the only authoritative reading is the German original- I and I have done all my own re-translations...don't tempt me to wax lyrical about this one...

Here is the Grof reference:

Grof S. ([1975] 1979) Realms of the Human Unconscious. Observations from LSD Research. London: Souvenir Press (p. 46 specially).

Diana, I think we are tuning up to getting the special issue up and running...? Love, Hilde.

 

Paolo Migone, 4 Dec 2000

On Nov 2000 EST, Diana Fosha wrote:

>Dear Paolo, this series of e-mails has really gotten to what I believe is the heart of the matter, and at least in theory...

Dear Diana, thank you for your mail, and for reminding me of the Milan meeting of May 10-12, 2001, with David Malan, you and other experiential STDP therapists (I already knew about it, because our common friend Feruccio Osimo had given me the brochure).

You say that now we understand each other better, and I agree. I am glad that you too see the "short-term" aspect as of secondary importance, actually as maybe irrelevant. The central issue is the experiential factor in therapy (the "missing element", as I called it), which is a problem of technique. It belongs to the discussion around theory of technique of any dynamic therapy, not only of STDP.

For the sake of this pleasurable discussion, I would like to try to see if we might still have some differences.

You (and other STDP therapists) seem to imply that the "experiential" element concerns overcoming defenses, being somehow active, evoking previously repressed emotions etc., in other words not behaving like the "classical" analyst who is often silent, anonymous, neutral and so on.

According to this view, the "classical" analyst is not "experiential". But I would object that any intervention is experiential, maybe even more experiential, for that matter, are the interventions of the classical analysts: they often induce strong feelings, such as shame, (narcissistic) injuries, difficulty in opening up to the therapist, possible reinforcement of pathological transferential patterns, etc. (they may often induce the powerful feeling of being held and understood, for that matter, and may rapidly provoke therapeutic change). So, what is the difference between STDP and classical analysts? Both of them give and evoke experiences, and it could not be otherwise. I mean that the problem is not deciding between being or not being "experiential", but another one: which kind of experience we want to promote in therapy. If what we want to promote is a real and better (or faster) change, it seems that some techniques work better than other techniques. But it seems to me that the independent variable should not be the technique, but the patient, i.e., his or her cognitive pattern, diagnosis, developmental level, transference, whatever you want to call it (in the terms of psychotherapy research, these variables are called "patient variables" - incidentally, according to some data these process variables account for the greatest percentage of outcome, while the specific techniques employed account for less than 10% of outcome). It is the patient (his/her needs) who "decides" which technique the therapist will use, often independently form the awareness or wish of the therapist.

In order to give you an example of what I want to say concerning experiential technique, I still recall a video of STDP I saw some time ago of David Malan, who never spoke during an entire session: according to descriptive criteria only, he seemed a "classical" analyst, but probably (and correctly) he believed that this was the right thing to do with that particular patient in that difficult phase of that (short-term) treatment.

Maybe Malan in that session was extremely "experiential" with that patient, e.g., the patient received an important mutative experience, given the (never silent?) parents he had, the (agitated or chaotic?) experiences he had in childhood, etc. But I do not need to go on with these comments, because I assume they are clear to each one of us, and also we do not need to recall the acute observations made by the late Merton Gill (1984) concerning the analysis of transference and the meaning of the ground rules of psychoanalysis (or of any therapy, for that matter) that have different meanings for every particular patient (incidentally, Gill was very talkative and somehow experiential with his patients).

But let's go back to my original argument about the meaning of the term "experiential", that now seems to have become a key characterization of the new STDP. Again, now I want to criticize the possibility to characterize a technique with the term "experiential", because it might be imprecise or lead to misunderstandings. For example, as Hilde and others correctly said, a patient might feel "raped" by the STDP push for deep experiencing, and in theory this might make him less inclined to open up, to trust the therapist and so on (I am not saying that this is the case, I am simply making a theoretical hypothesis). Looking at some STDP videos, I did have at times the impression that the therapist was somehow "violent", and if he in effect was obviously succeeding in evoking and working through deep aggressive emotions, maybe in the same time he was moving the patient away from other important (and opposite?) emotions or problems. But I am not making here a problem of correctness of technique with a given pati ent, I am talking of a more important issue, namely, the consistency of our theory of technique.

What I want to say could be summarized as follows: if, in order to differentiate STDP from other techniques (e.g., from "classical" psychoanalytic technique), STDP therapists emphasize a descriptive aspect of the technique, such as its (descriptively) experiential component, they risk to do the same and opposite mistake of classical analysts: classical analysts believe that some attitudes could have a give meaning for every patients (anonymity, abstinence, silence, etc. - up to every aspect of classical technique, such as the couch and the four-times-a-week frequency), and now experiential STDP therapists believe that they need to be "experiential" in order to provoke change. But what kind of "experience" are we talking about? Experience does not exists "per se", it is a function of the way the patient perceives it. For example, a typical "STDP experience" could work very well with an obsessive-compulsive patient who repress aggression, but might work less well with a patient with a different diagnosis.

To conclude, I think that maybe by "experiential" we mean something else, such as, for example, paying more attention to the way the patient subjectively perceives what we do (in the same way as Gill and others spoke of in the '70s and '80s). Probably we mean also a decreased faith in verbal insight and a more faith in (corrective) experience in order to change people (in the same way as Alexander spoke of in the 40's, and now Fonagy and others rediscover and talk a lot about, when they for example mention the importance of procedural memory and so on). Thank you for your comments. Paolo.

References of Merton Gill:

Gill M.M. (1982). The Analysis of Transference. Vol. 1: Theory and Technique. New York: Int. Univ. Press. Gill M.M. (1984). Psychoanalysis and psychotherapy: a revision. Int. Rev. Psychoanal., 11: 161-179. Internet edition: http://www.publinet.it/pol/i tal/10Gil-aI.htm (debate [in Italian]: http://www.psyc homedia.it/pm-lists/debates/gill-dib-1.htm).

 

Hilde Rapp, 4 Dec 2000

Dear Paolo, dear Diana, I welcome this new turn in the debate, focusing more explicitly on what we mean by 'experiential'. Not long ago we had an animated - though somewhat frustrating to some - exchange about aspects of Bion's work. He, together with other analysts (cf. Patrick Casement) has made much of the importance of 'Learning from Experience'. I would imagine that this would be a minimal requirement for an experiential form of therapy, that therapists know how to create the facilitating conditions for the patient to learn from experience. And further that they enable the therapist to learn from the patient, what specifically it is/was, he/she did that made such new learning possible.

I am just writing a chapter in which questions such as these pre-occupy me greatly: my surmise is that so called 'experiential' approaches have risen more quickly, overall, than analysts, to Morris Eagle's challenge, made in 1984 (Recent Developments in Psychoanalysis. A Critical Evaluation. New York: McGraw-Hill; reprinted by Harvard Univ. Press, 1987), that we should find out what we as therapists can, do, and should contribute to the therapeutic work, which helps patients to change.(Les Greenberg's work comes to mind here - and so of course does a whole catalogue of others...)

Is 'experiential' work marked out from non experiential work ( if any such exists) by an explicit focus on how clients change through learning from experience? I look forward to the next installment of this conversation. Cordially, Hilde.

 

Allen Kalpin, 4 Dec 2000

Hilde and Paolo, from both of your emails it is clear that the word "experiential" can be used to describe many types of experience. The word as it is used in "experiential STDP" specifically refers to the experience of emotions. These approaches put emphasis on promoting the in-session experience of emotions, in contrast to, for example, talking about emotions. For example, rather than saying, "I am sad," the experience of sadness is encouraged and facilitated. Of course, there must be much care and discretion used in the assessment of what emotions to promote in who, when.

The idea is that this emotional experience can be therapeutic (e.g., Diana's book is entitled, "The Transforming Power of Affect: A Model for Accelerated Change"). One main conceptualization for the mechanism of change is encapsulated in the simple psychodynamic model of the "triangle of conflict," (Malan D., Individual psychotherapy and the science of psychodynamics. London: Butterworth, 1979.) which is a part of the metapsychology of the eSTDPs. This is the simple idea that fear of the experience of one or more of the basic emotions leads to anxiety when these emotions are stimulated and to defenses against the experience of the emotions. The anxiety and defenses cause problems. By sufficient experience of the feared feelings the anxiety and problematic defenses are reduced. Leigh McCullough (McCullough Vaillant L., Changing Character: Short-Term Anxiety-Regulating Psychotherapy for Restructuring Defenses, Affects, and Attachment. New York: Basic Books, 1997) has referred to this as "desensitization of affect phobias." This desensitization is usually not sufficiently achieved by talking about the feeling, just as overcoming a fear of elevators is usually not achieved by talking about elevators. The eSTDPs have developed various techniques for promoting the actual experience of emotions in order to bring about this desensitization, and, thus, to reduce anxiety and the use of pathological avoidance mechanisms. Allen.

 

Ang Wee Kiat Anthony, 5 Dec 2000

I can see the value of helping certain most patients get in touch with their emotions in therapy but wondered if there might be some for which it might be quite overwhelming (eg. in Post-traumatic Stress Disorder, bulimia associated with multiple impulsive disorders, personality disorders with dissociative states). What are some guidelines to help clinicians decide when it would appropriate to mobilize feelings and when not to? Anthony Ang.

 

Hilde Rapp, 5 Dec 2000

Dear Anthony, yes, I agree that great caution is needed not to re-traumatize patients clients) who, in the face of humiliation and terror, had to learn to shut down their feelings and sensations in order to survive with even the smallest kernel of their spirit and sense of human dignity intact. It is with these clients in mind, that I wrote earlier about the need to prepare the ground very carefully.

First we need to validate the client's strength of spirit and his wisdom in having known how to close down in the face of humiliation and torture.

Then we need to explain that the client looses much of his adaptability and flexibility, or worse still he may actually put himself at risk by depriving himself of much needed information about people, the environment and their own reactions to 'stimuli'.

We need to get agreement that the client would like to rebalance his repertoire of emotional responsiveness.  We need to test the client's readiness to learn how to go about gradually opening up to the warded off feelings.  What will be asked of her is now to have the resources to tolerate the pain and shame resulting from ordinary misunderstandings or mistakes. We are not asking her to cope with the extreme emotions of the original trauma.

In some case to revisit and cathartically abreact the original trauma may well be necessary and helpful, but often on can do everything necessary 'asymptotically'- the original trauma remains encaspsulated within the scarred area, so to speak, but as much function as possible is restored in all the surrounding tissue.

This can only be done by setting up conditions in which trust is built all the time as the practitioner takes great care to be predictable, transparent, reliable, respectful and caring in familiarizing the client with the processes uses in therapy to achieve shared goals.

Once such a frame holds, the client may well feel safe enough to trust the practitioner that they will proceed with the same tact and care when they begin working to open up a traumatically shut down feeling complex. It is like opening Pandora's box- I do it a crack at a time, a demon at a time - if at all possible.

I think that Lee Mc Collough's way of working was also developed very much with such considerations in mind- and I hope Lee, Allen, and Diana will share their thoughts on this point. Cordially, Hilde.

 

Paolo Migone, 5 Dec 2000

On Dec 2000, Allen wrote:

>The word as it is used in

>"experiential STDP" specifically refers to the experience of emotions. These >approaches put emphasis on promoting the in-session experience of emotions, >in contrast to, for example, talking about emotions. For example, rather >than saying, "I am sad," the experience of sadness is encouraged and >facilitated. Of course, there must be much care and discretion used in the >assessment of what emotions to promote in who, when.

I fully agree with you, Allen, that talking about emotion could be a defense from emotions, and that expressing emotions fully (as other techniques, such as Gestalt etc., teach us) is an important goal of therapy because it means that we have worked through specific mental contents, remembered past life episodes etc., as according to Freud's classical theory of the lifting of repression as related to change and to an increased integration of personality.

My objections simply concern the fact that this is the age-old problem of overcoming defenses, a problem that was faced in psychoanalysis already since the '30s and '40s, after the concept of defense became popular (with the diffusion of Ego Psychology and the abandonment of "Id Psychology").

Hilde has expressed very well, I think, the various ways of working with defenses. If the characterization of experiential STDP is simply to remind everybody that we should not intellectualize too much the therapeutic process, I fully agree. But I have difficulty in seeing a specific technique of experiential STDP, assuming of course that the "therapist variables" are the same for all of us (therapist's personality factors, his/her ability to face strong or painful emotions etc.). I do not see where is the technical "trick" of accelerating the therapeutic process, especially with difficult patients. It seems to me that we all face the same problems (I mean that all of us try in the same way to avoid the patient feeling of being "raped" by an experiential approach, if this is the case). Every therapist should pay attention to affect, and if this is something the therapist did not consider before we should think that it means that this therapist was practicing a wrong technique. Paolo.

 

Bob Resnick, 5 Dec 2000

On 5 Dec 2000, Paolo Migone wrote:

<< and that expressing emotions fully (as other techniques, such as Gestalt etc., teach us) is an important goal of therapy because it means that we have worked through specific mental contents, remembered past life episodes etc., as according to Freud's classical theory of the lifting of repression as related to change and to an increased integration of personality. >>

Dear Paolo, as a Gestalt Therapy trainer for almost 35 years, I want to comment that the goal of Gestalt Therapy with regard to emotional expression has to do with both discrimination as well as heat and light and is not formulaically in favor of catharsis. The ability to "stifle" oneself is sometimes also very useful and even sometimes needed for survival. To add to the mix, occasionally, the expression of emotions can also be a "defense"/deflection/avoidance - e.g. avoiding genuine contact with another.

We, as Gestalt Therapists, are interested among other things, in the person being functionally able to discriminate and choose whether, where, with whom (in short, to contextually modulate) the expression of their emotion. In addition, emotional expression based on technique and/or therapist imperatives without awareness of the relevant interruptions - gives us heat but no light. To be therapy we sometimes need heat (emotions) - we almost always need the light (awareness). Cordially, Bob Resnick, Gestalt Associates Training, Los Angeles, E-Mail <BobResnick@AOL.COM>.

 

Tullio Carere, 8 Dec 2000

I very much agree with Paolo when he says that "the independent variable should not be the technique, but the patient", because " It is the patient (his/her needs) who 'decides' which technique the therapist will use, often independently from the awareness or wish of the therapist". In a truly client- or patient- centered (not in Rogerian sense) therapy the therapist is not very much concerned with her own theory or technique, but with the crucial question: What does this person need right now? And with the corollary question: What can I do to meet his needs? If the question is genuine, there cannot exist a "short" therapy, because there is no way to know in advance what kind of experience the patient will need, and for how long. Every time we put our theory or technique in the foreground, as Mike Basseches has reminded us, we run the risk to be theoretically or technically abusive. But who decides what the patient really needs? As I do not take it for granted that the therapist is the one who knows what the patient needs, I do not take it either for granted, that the patient is the one who knows what he himself needs. But if both give up the pretence that they know anything for sure, then a dialogue can begin, and through the dialogue the logos can have the floor, that is the awareness of what is right for a given person at a given moment in a given situation. Is the position of the interlocutors in this dialogue completely symmetrical? I wouldn't say that. The patient has the right to expect that his therapist avails herself of a map of the basic needs that patients usually bring to the therapy relation, not as the tablets of the law, but as a system of reference that collects the experience of many therapists of many schools. For instance, I have appreciated the definition by Diana of a horizontal-relational, and of a vertical-explorative axis of the therapy field, as it precisely corresponds to the experience of many a therapist across different schools. But I wonder if the two axes are given equal opportunities in the therapy, in the sense that one does not decide in advance that the experience on the explorative-uncovering axis is more meaningful than the experience on the relational-remaking axis, or viceversa. In a patient such preconception would be obviously understandable and acceptable, while in a therapist it would be in my opinion less understandable and justifiable. Tullio.

 

Allen Kalpin, 12 Dec 2000

On 5 Dec 2000, Ang Wee Kiat Anthony wrote:

I can see the value of helping certain most patients get in touch with their

>emotions in therapy but wondered if there might be some for which it might be quite overwhelming (e.g. in Post-traumatic Stress Disorder, bulimia>associated with multiple impulsive disorders, personality disorders with dissociative states). What are some guidelines to help clinicians decide when it would appropriate to mobilize feelings and when not to?

Anthony, I will add a few words to Hilde's response to your question. Poor impulse control would certainly be a contraindication to emotionally focused work, as would the tendency to dissociate. However, these sorts of problems as assessed by history, unless they seem to be of quite extreme nature, are not necessarily absolute contraindications. It is important to see how the person actually responds to emotional experience in the therapy session. If there is reason for caution then this must be done in a very careful and graded way, with a lot of attention to how the person actually responds to a very low level of emotional experience. After each exposure to emotional experience there needs to be a lot of cognitive work to help the person integrate, make use of, and grow from the experience. It is not about catharsis. Allen.

 

Hilde Rapp, 13 Dec 2000

Allen, "After each exposure to emotional experience there needs to be a lot of cognitive work to help the person integrate, make use of, and grow from the experience. It is not about catharsis." I think this is very pithy important message to get over- beautifully put. Hilde.

 

Allen Kalpin, 12 Jan 2001

**** Emotional and Relational Experience in Psychotherapy: Two Models for Transforming Affects****

Les Greenberg and Diana Fosha, One-day workshop:

Saturday, February 24, 2001, Toronto Marriott Eaton Centre, Toronto, Ontario, Canada.

Presented as a post-convention workshop of the Ontario Psychological Association

I want to announce this now so that if you might consider attending you will have time to arrange it. The brochure is not quite ready, and the announcement is not yet up on the OPA website. This should be a very interesting event which will feature two SEPI members comparing and contrasting their approaches to working with emotions in psychotherapy. Les Greenberg is a psychotherapist and psychotherapy researcher here at York University in Toronto. He has done tremendous process and outcome research and has written extensively on emotions in psychotherapy. His approach to working with emotions is based on the gestalt therapy tradition.

Diana Fosha is in the forefront of the new discipline of "experiential STDP" (she coined the term). Her approach to working with emotions and to conceptualizing is grounded in the psychodynamic tradition. Through the use of didactic presentations, panel discussions, and a lot of clinical videotapes, we plan to compare and contrast these two approaches. How much of what these two clinicians are doing is really similar, but just defined by different terms? How much is really quite different? What is similar and different about the outcomes of the two approaches? Come see for yourself. If you are interested in further information you could contact the

OPA: ONTARIO PSYCHOLOGICAL ASSOCIATION

730 Yonge Street, Suite #221, Toronto, Ontario M4Y 2B7, Tel: (416) 961-5552 - FAX: (416) 961-5516 E-mail: Carla@psych.on.ca

Or just let me know and I could make sure you get the registration information as soon as it is available. By the way, both speakers will also be doing keynote addresses as part of the OPA convention itself. Allen.

Here is some more information pasted from the brochure:

Intended Audience: This workshop is designed for practicing psychotherapists of varied orientations who wish to broaden their skills in working with emotion in psychotherapy and deepen their theoretical understanding of models on which affect-centered psychotherapeutic work is founded. Videotaped case examples will be shown to illustrate a range of short-term interventions based on psychodynamic, experiential and relational principles. Program: 08:30-09:00 Registration 09:00-10:30 Two Models of Working with Emotion in Psychotherapy: Diana Fosha, Ph.D. and Les Greenberg, Ph.D. 10:30-10:45 Coffee Break 10:45-12:30 Videotape presentation and discussion 12:30-13:30 Lunch 13:30-15:00 The use of the relationship and experiential interventions in creating affective change: Diana Fosha, Ph.D. and Les Greenberg, Ph.D. 15:00-15:15 Coffee Break 15:15-16:15 Videotape presentation and discussion 16:15-16:45 Panel discussion of the two models 16:45-17:00 Wrap Up Speakers: Diana Fosha, Ph.D. is Associate Clinical Professor at The Derner Institute of Advanced Psychological Studies, Adelphi University, New York and the developer of AEDP (Accelerated Experiential-Dynamic Psychotherapy). She is the author of The Transforming Power of Affect: A Model for Accelerated Change, Basic Books, 2000) and several papers on experiential short-term dynamic psychotherapy. Her recent work has focused on integrating recent cutting-edge developments in affective neuroscience, emotion theory and developmentally-based understandings of the dyadic regulation of affect into clinical work with patients. Dr. Fosha maintains a private practice in New York City. Les Greenberg, Ph.D. is Professor of Psychology at York University in Toronto, Ontario. He is the Director of the York University Psychotherapy Research Clinic and one of the leading authorities on working with emotions in psychotherapy. He is a primary developer of emotion focused therapy. Dr. Greenberg's has co-authored major texts on emotion focused approaches to treatment including Emotion in Psychotherapy (1986), Emotionally Focused Therapy for Couples (1988), Facilitating Emotional Change (1993), and Working with Emotions in Psychotherapy (1997). Among his most recent edited books are Empathy Reconsidered: New Directions in Theory Research and Practice and Handbook of Experiential Psychotherapy (1999). Dr. Greenberg is a founding member of the Society of the Exploration of Psychotherapy Integration (SEPI) and a past President of the Society for Psychotherapy Res e arch (SPR). The Workshop: Les Greenberg will present a three-phase model of emotion focused intervention, empathy - evocation - reconstruction and reflection. Participants will be introduced to specific interventions used to evoke and process unresolved emotional experience. Process diagnosis, used to assess adaptive and maladaptive and secondary or defensive emotions, will be discussed. The goal is to learn skills of validating, evoking and restructuring emotion. Dr. Fosha' model of Experiential Dynamic Psychotherapy (AEDP) addresses four affectively-based models of change: (1) the facilitation of core affect and the release of adaptive action tendencies; (2) the dyadic regulation of affect and the achievement of coordination and affective resonance; (3) the process of somatic focusing; and (4) empathy and the emergence of 'true self' experience. The workshop will focus on each model of change, as well as on the specific interventions designed to bypass defenses, ameliorate anxiety and shame, activate the change process and harness its transformational potential. Learning Objectives: 1. Develop a conceptual understanding of the four models described above 2. Learn techniques to bypass defenses against affective experience 3. Learn techniques to ameliorate inhibiting experiences of fear and shame 4. Learn how to access and work through adaptive affective experiences to produce change. 5. Develop skills of differential diagnosis and differential intervention with emotion. 6. Learn when to regulate and when to access emotion. 7. Learn how to access adaptive emotions to produce change. 8. Learn to identify phases in emotional processing to resolve unfinished business