History and Metapsyhcology

Habib Davanloo

History

❖ Psychoanalytic background

❖ Disillusioned by length of treatment

❖ Disillusioned by resistance

Freud and Resistance

❖ 1914: Removal of the resistance is the analysts primary task. (Remembering, Repeating and Working Through)

❖ 1926: The “unconscious sense of guilt” represents the superego’s resistance. It is the most powerful factor, and the most feared by us (The Question of Lay Analysis)

❖ 1937: For the moment we must bow to the superiority of the forces to which we see our efforts come to nothing (Anaysis Terminable and Interminable)

History post Freud

❖ Davanloo, Malan, Sifneos, Alexander

❖ Shortened treatment

❖ Became more active

❖ Actively confronted defenses

❖ Encouraged emotional expression

Davanloo and Resistance❖ In the classical technique resistance is a serious impediment; in

my technique it is to be welcomed as an indicator that painful conflict are not merely being approached, but can be brought to the surface and resolved. Each time resistance is penetrated there is a marked and unmistakable increase in the strength of the therapeutic alliance (Davanloo, 2000. Intensive Short-Term Dynamic Psychotherapy: Selected papers of Habib Davanloo)

Davanloo’s contribution

❖ Rapid mobilization of emotions

❖ Rapid mobilization of client’s defenses

❖ De-fusion of mixed feelings (rage, guilt, grief, sexual) from anxiety and defenses

❖ Direct access to the psychopathologic dynamic force (attachment trauma)

Bowlby and Attachment❖ Inborn need to form attachments

❖ Attachment is necessary to form one’s sense of self, regulation of affective states, and regulation of relationships

❖ Broken attachments interfere with the above

❖ Broken attachments (neglect, trauma, abuse)

Key Concepts: Metapsychology

❖ Development of Neurotic Structure ❖ Triangle of Person ❖ Triangle of Conflict ❖ Complex Transference Feelings ❖ Manifestations of Unconscious Therapeutic Alliance

Bond With Parents

Bond With Others

BOND With

Parents

BOND With

Parents

PAIN

Trauma

BOND With

Parents

PAIN

Rage, Guilt about the Rage

Trauma

BOND With

Parents

Trauma

PAIN

Rage, Guilt about the Rage

Feelings Avoided

Symptoms DevelopAbbass, 2011

Attachment Bond

Pain of trauma to Bond

Primitive Murderous Rage

Guilt

Grief

Character Resistance

Resistance Against Emotional Closeness

Still Face Experiment Video

Cause of psychopathology Review

❖ Failures in emotional environment (neglect, inadequacy, abuse, rejection, etc.)

❖ Leads to cascade of painful affects—Rage—guilt—pain—anxiety.

❖ Defenses are developed as a way to regulate painful affects

❖ Defenses lead to the development of symptoms and problems

❖ Defenses that kept a child safe at 5 are self-destructive at an adult age

Fusion❖ Age at the time of trauma

❖ The earlier and more intense the experience of trauma:

❖ The more tenacious the fusion of rage and guilt

❖ The higher the unconscious anxiety

❖ The stronger and more tenacious the defenses

❖ The more likely to have superego pathology

❖ The more complexity and longer treatment

Defenses

❖ The mind’s early adaptive response to pain

❖ Regulate affect: restore feeling safety and reduce adversive emotional experience

❖ Cognitive, interpersonal, and emotional strategies

❖ Affects can be used as defenses

❖ Defensive patterns mirror the “rules” of relationship with primary caregivers

Consequences of defense

❖ Psychopathology: The long term reliance on defense against genuine affective experience

❖ Constricts and distorts relational and affective experience

❖ Results in “symptoms” instead of feelings

Triangle of Conflict and Person

How this works in practice:

Triangle of ConflictAnxiety

--panic, worry, dread

Defense —detachment,

defiance, rumination

Impulse/Feeling --Grief, Anger, Rage, Joy, Excitement, Emotional

Closeness, Sexual feeling, Guilt

Triangle of PersonTransference

Current

Past

Mobilization of the Unconscious emotions

❖ Helps to create a fluidity in the unconscious

❖ Provides access to the pathogenic forces operating in the unconscious

❖ Brings about intrapsychic reorganization in the person’s defensive system and increases capacity to tolerate anxiety and painful affects (exposure)

Unlocking the Unconscious

UTACTF “Unlocked”

R/A

PR P R PTh

R

Low Rise Pressure

R is Crystallizing:

Clarify/ challenge

R is in the T: Head on Collide

Psychodiagnosis

❖ Observe: Any tension, sigh, confusion etc.❖ Pressure: e.g. Ask about actual feelings in a specific

incident where they got anxious, or increased physical symptoms.

❖ Ask about anger and how it affects them❖ Clarify the ways the patient avoids feelings.❖ Observe the physical response: listen with your eyes❖ Reduce the anxiety to reduce/remove symptoms by

intellectualizing about the process.

Dr Allan Abbass 2017

Therapist effort to Attach to Patient

Activates attachment Feelings anxiety and defenses

Patient will either 1. Feel the feelings,

2. Defend and detach from therapist, 3. Go flat with a repressive or fragile response

4. OR Have no reaction

Therapist will then 1. Help feel the feelings 2. Deal with the defenses 3. Build structure and capacity 4. Search for the anxiety and resistance