Every practitioner of EDT eventually develops a unique style of treatment. Some clinicians have formalized their ways of working into distinct systems of psychotherapy that have been described in books or articles. Some of these are described below.
APT
Affect Phobia Therapy (APT) is based on the premise that internal conflicts about feelings underlie most psychologically based disorders. The affect phobia therapist views these conflicts as “Affect Phobias,” a phobia about feelings. Similar to external phobias, a patient with an affect phobia avoids the experience and expression of certainly feelings like anger and grief in a same way a person with a phobia about bridges would avoid bridges. These patients adopt avoidant feelings, thoughts and behaviors to an extent that they are unaware that there is an underlying feeling that are avoiding.
The APT therapist helps his/her patient recognize the avoided feelings as well as their method of avoidance. They use Malan’s Triangle of Conflict and Triangle of Person to see the affect phobia, understand its’ origin and impact on present day relationships.
The APT therapist uses a variety of techniques in order to help the patient expose oneself to the avoided feeling in a step-by-step process using anxiety regulation and gentle confrontation of defenses.
AET continues to be an evolving psychotherapy. It focuses on the experience of body sensations. It utilizes empathic interaction to explore sensations and diminish the fears of patients regarding the experience of body sensations.
AET differs from IS-TDP in significant ways. It neither emphasizes impulses, rage, or super-ego guilt nor relies on challenge or pressure.
The stance of the AET psychotherapist is that of a knowledgeable, caring helper who shares his experience in the moment to facilitate the experience of new or feared sensations. These sensations are often somatic or visceral and frequently are linked to pain, anxiety, anger, and love.
In practice, AET is a nine-step process consisting of:
Inquiry regarding present symptoms and complaints, past symptoms and treatment, and family history.
Observation of interactive style and defenses as well as response to interventions.
Education on body sensations and the importance of emotions.
Evaluation of the capacity to recognize sensations and emotions.
Enhancement of the experience of sensations and emotions as needed.
Education on the use of “empathic interaction” and the experience of closeness.
The experience of “empathic interaction”, sharing, and closeness.
Education on the experience of sensations associated with the dyads of pleasure/pain, calm/anxiety-fear, happiness/sadness, fullness/emptiness, love/hate, yearning/repulsion, caring/attacking-raging, and joy/suffering.
Exploration of the experience of the sensory dyads as they relate to self and others.
As the capacity to experience sensations, and associated emotions, increases, defenses (and hence symptoms) decrease. Once patients learn the value of sensations, they treasure rather than fear them. The benefit that accrues from experiencing them in the moment extends beyond symptom removal. The ensuing sense of compassion and peace leads to joy.
AET was founded by Michael Alpert, MD, MPH. Michael Alpert practices Accelerated Empathic Therapy in New York City and Denville, New Jersey. He teaches and supervises through the New York/New Jersey STDP Institute www.stdp.org and is Vice President of the IEDTA. He can be contacted at
or
Intensive IE-DP
Ferruccio Osimo developed the IE-DP model on the basis of a clinical study carried out at the Tavistock Clinic, London on the quality of results obtainable by STDP (Malan and Osimo,1992). His approach of Intensive Experiential-Dynamic Psychotherapy has a unique emphasis on explicit exploration of the therapeutic relationship as a basis on which therapeutic techniques can build. The encounter of two people creates a unique interpersonal current, flowing in largely unconscious and mysterious ways. This represents a fundamental part of the actual relationship as well as of the transformational process, and learning how to tune in to these very personal aspects of the therapist-patient relationship will significantly empower a therapist's technical kit. Central to this model is the use of the three experiential-dynamic activities : Emotional Maieutics, Defense Restructuring, and Anxiety Regulation, theoretically and operationally described in Experiential Short-Term Dynamic Psychotherapy, a Manual (2003). In particular, Osimo introduces the character hologram (Osimo, 2009) a comprehensive approach to character pathology, capable of activating unconscious emotion, and maieutic interventions , paving the way to the good-enough experience and expression of deep feeling (Maya = midwife in Ancient Greek). Working with this model, each therapist will find a harmonious interplay between real relationship developing with each patient and using techniques according to the Triangle of Experiential-Dynamic Activities (Osimo, 2001)
Ferruccio Osimo, MD can be contacted at:
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A Unified Model of Personality-Guided Relational Therapy
Jeffrey J. Magnavita is a theorist/clinician who has developed various models of psychotherapy which have included Short-Term Restructuring Psychotherapy (STRP). This model primarily concerned with intrapsychic and dyadic process was based on the pioneering work of Habib Davanloo, David Malan, Wilhelm Reich, and many other pioneering figures of the Short-Term Dynamic Psychotherapy movement, as well as self-psychological and objects relations theory and methods. Later, he developed a model termed Integrative Relational Psychotherapy (IRP), which added an additional triangular configuration based on the work of Ludwig von Bertalanffy, Murray Bowen, Nathan Ackerman, and Salvadore Minuchin, and other pioneering figures of family therapy.
Most recently, Dr. Magnavita has developed an evolving model of emotional dynamic psychotherapy, personality theory and psychopathology based on an examination of processes and structures at four levels of the personality system. These are embedded subsystems which move from the microscopic to the macroscopic level of organization. There are four matrices which include: (1) biological-intrapsychic, (2) interpersonal-dyadic, (3) relational-triadic, and (4) sociocultural-familial which can be addressed using a unified approach. Dysfunctional personality adaptations are caused by traumata, developmental insults, and multigenerational transmission processes which are nonmetabolized and create multi-systemic problems in adaptation. One of the primary connections among the subsystems is the affective processes that occur at the intrapsychic, dyadic, triadic, familial and societal levels. Methods of restructuring these dysfunctioning subsystems are selected from an array of techniques based upon the level of differentiation and integration among the various component subsystems (i.e., defensive-affective-cognitive, attachment system, neurobiological system, relational system). Modalities of therapy are selected and combined, when indicated, to enhance the potency of the treatment by intervening at the various fulcrum points within a system. Thus, a tipping point can be achieved whereby the system reorganizes at a new level of function and process which is more adaptive.
Jeffrey J. Magnavita. Ph.D., ABPP can be contacted at:
Attachment-Based ISTDP
Attachment-Based Intensive Short-Term Dynamic Psychotherapy applies the clinical insights and techniques of Davanloo's ISTDP with the recent empirical research on right hemisphere processes of emotional regulation.
Disrupted secure attachment bonds at critical phases of a child's development are seen as the cause of adult psychoneurosis and some aspects of character pathology. The therapist leading the patient's awareness of the moment-to-moment experience of his emotions promotes change. Using the non-interpretive tools of moment-to-moment tracking of emotional experiencing along with pressure to feel, challenge of defenses, and choice between feeling or defense, this therapy is able to help people recover from acute and latent trauma and repair their damaged internal working models of attachment.
The cornerstone of this therapy is The Reparative Dynamic Sequence. The phases of the Reparative Dynamic Sequence are: Inquiry, Psycho-diagnosis (Meta-cognitive Monitoring), Identification of Therapeutic Task and Resistance, Overcoming Therapeutic Task Resistance, Creating An Intra-psychic Crisis, Linking The Past and Present, Working Through of Core Emotions (Achieving Core State), and Termination (Debriefing and stage setting for the next session and/or life tasks).
The central curative factors are seen as the de-conditioning of anxiety over trauma-based emotional experiences. Afflicted individuals avoid, preoccupy, or disorganize around the experience of their genuine emotions in the presence of any caregiver. Instead of receiving comfort, they self-regulate through the self-administration of the same painful affects they received as a child from their original caregiver, or they use the same rigid habitual defenses that comforted them as a child. Awareness (attention to the moments of feeling) of this process and the activation of latent capacities for secure attachment are mobilized against this painful form and constricting form of self-regulation. Finally, emotional experiencing, visualization, and verbalization of feeling to visually imagined traumatizing figures and to the formerly traumatized self are used to consolidate therapeutic state changes to long lasting trait (symptom and character) changes. Thus, movements from insecure states of mind to earned secure states are facilitated by the empathic attunement of the therapist to the discrete psychic structures.
Attachment Based ISTDP systematically incorporates and operationalizes insights from interpersonal neurobiology and affective neurosciences.
There are two active training centers supported by the faculty of the Southern California Society for ISTDP for learning Attachment Based ISTDP. One is located at Del Mar and the other in West Los Angeles. Core training consists of three years of audio-visual supervision for four weekends per year. More information can be found at www.istdp.com or contact
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ISTDP as Developed by Habib Davanloo, and as Practiced and Taught by Josette ten Have-de Labije and her group in the Netherlands
At the theoretical level Davanloo’s ISTDP is based on the psychoanalytical reference realm. However, the methods and techniques used to handle resistance and transference differ and transference neurosis is avoided. Davanloo’s methods and techniques can be applied to the complete spectrum of structural neurosis. In a systematic way patients are made familiar with their own specific pattern of defense mechanisms. By having these defense mechanisms clarified and challenged step by step, patients are motivated to relinquish their defenses in order to consciously experience their feelings and impulses according to their ego adaptive capacity. When this process is repeated, the defended feelings and impulses will be experienced more intensely and the ego adaptive capacity will increase. In this way it is possible to get access to core-neurotic conflicts and to work them through.
In the education and training programs as given in the Netherlands emphasis is given to the interacting neural and endocrine system, underlying the regulation of feelings, impulses and anxiety when assessing, exploring and evaluating a) the acuity of a patient’s cognitive / perceptive system, b) feelings, impulses, anxiety and c) nature / degree of a patient’s ego adaptive capacity.
Types of EDT
