Academic journal article American Journal of Psychotherapy

Effectiveness and Cost Effectiveness of Davanloo's Intensive Short-Term Dynamic Psychotherapy: Does Unlocking the Unconscious Make a Difference?

Academic journal article American Journal of Psychotherapy

Effectiveness and Cost Effectiveness of Davanloo's Intensive Short-Term Dynamic Psychotherapy: Does Unlocking the Unconscious Make a Difference?

Article excerpt

More than 20 years ago Habib Davanloo coined the term unlocking of the unconscious to describe how the psychodynamic concept of the human unconscious can become accessible using the technique of Intensive Short-Term Dynamic Psychotherapy (ISTDP). According to Davanloo, the possibility that unconscious material will be revealed is greatly increased when therapeutic efforts promote dominance of the unconscious therapeutic alliance over unconscious resistance. When these ingredients are present there is a psychic shift that allows unacceptable painful feelings to come to the surface. Toward adding further empirical support for the concept, in this article we compare outcomes between patients who experienced one or more major unlocking of the unconscious (N=57) to those who did not experience major unlocking (N=32) during ISTDP treatment. Significant and widespread differences were seen between these two groups, those with major unlocking had greater symptom reduction, interpersonal gains, and cost reduction for treatment. The relevance of this to clinical practice and healthcare utilization will be discussed.

KEYWORDS: Davanloo; psychodynamic therapy; unconscious; emotions

BACKGROUND

Westen (1998b), in support of psychodynamic treatments, cited a plethora of experimental research from the field of cognitive neuroscience, demonstrating that much of mental life is unconscious and supporting the basic analytic premise that people actively try to forget unwanted past experiences. The literature on the effectiveness of psychotherapy reveals an expanding evidence base for psychodynamic therapies (Shedler, 2010; Town, Diener, Abbass, Leichsenring, Driessen & Rabung, 2012). Psycho- therapy change-process research (Greenberg, 1986) may be a "necessary complement" (Elliott, 2010, p. 123) to this field to inform the nature of change. Garfield (1990) has pointed out that we study process primarily to increase effectiveness therefore the two are not divorced. The importance of recent research efforts targeting the question of with whom dynamic techniques work, for what, and how (Blatt & Sharar, 2004) may also facilitate a shift away from pejorative debates about the relative merits of dynamic theory past and present, to instead studying what happens in dynamic psychotherapy that is associated with positive change.

EVALUATING CAUSAL EFFECTIVENESS

There are many riddles that underlie the reasons and motivators for human behaviour: the same can be said for deducing outcomes of psycho- therapy. In recent decades, research has amassed evidence that points towards a common factors model for understanding the mechanisms by which psychotherapy works (Wampold, 2001). However, alongside pro- cess predictors common to many therapies, such as the therapeutic alliance (Horvath, Del Re, Fluckiger & Symmonds., 2011; Orlinsky, Ronnestad & Willutzki, 2004), all psychotherapy treatments are informed by theories that explain how change occurs. The empirical study of theoretical as- sumptions, fundamental to the architecture of how specific treatment approaches are delivered, is less common. In respect to psychodynamic schools of therapy, to a more or lesser extent, contemporary approaches are informed by the principle of facilitating awareness of "unconscious processes" (Westen, 1998a) to understand how internal networks and associations exert an influence over the mind. An important task, then, must be to operationalize the mechanisms by which changes in uncon- scious mental processes are facilitated and how therapeutic benefit may subsequently be achieved.

A range of factors in dynamically informed therapies have been high- lighted and studied including specific sequences in patient-therapist inter- action within treatment (e.g., The Referential Process- Bucci, 1984; and The Therapeutic Cycles Model- McCarthy, Mergenthaler, Schneider & Grenyer, 2011), the role of emotion mobilization (Diener, Hilsenroth & Weinberger, 2007) and cognitive-emotional integration through mental- ization (Fonagy, Gerely, Jurist & Target, 2002). …

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