As part of their lead-up to my presentations in July 2016, ISTDP-UK asked me a series of questions. I enjoyed reflecting on and answering them, and I thought the answers might be of broader interest, so I’m posting them here.
I understand that you were the Assistant Director of the Psychotherapy Research Programme at Harvard’s Beth Israel Deaconess Medical Centre. Can you say something about the work you did in that role?
Leigh McCullough’s research group met every Wednesday afternoon for years, usually in her home. Watching video, and usually coding it, was always at the center of what we did, and it was a great way to learn how to do therapy. During the decade I was in her group, the main research focus was the ATOS (Achievement of Therapeutic Objectives Scale), and I was involved in developing it and demonstrating its reliability. The other major project that she, Stuart Andrews, and I focused on was writing “Treating Affect Phobia,” as a user-friendly companion to her book “Changing Character.”
How did you first become aware of or interested in ISTDP?
Leigh was one of the founders of the International Experiential Dynamic Therapy Association (IEDTA, www.iedta.net), along with a number of other people who had trained with Habib Davanloo and then gone in various directions. A group of us went with her to the second IEDTA meeting in Washington DC in 2003. The IEDTA is the best place to see a variety of styles of ISTDP and other therapies, and I highly recommend it. Our next conference is coming up in Amsterdam, 3-5 November 2016 and I really encourage folks in the UK (and everywhere else) to attend.
You have drawn on various different approaches in the past, why did you choose to specialize in ISTDP?
The ISTDP video that I saw from Allan Abbass and others in 2003 and at subsequent events was very compelling, and seemed to involve a deeper layer of the unconscious than any other work I had seen. At the same time, although I was billing myself as a short-term therapist, and teaching short-term therapy, many of my own cases were becoming long-term. I was helping people, but in many cases only up to a point, and then the therapy would stall. So I was very interested in anything that would make my work more effective, and by 2008 the time had arrived to make the switch in a serious way.
The topic of your masterclass is “getting from start to finish in ISTDP.” What can people expect from this day?
Well, honestly, I am not entirely certain. I think workshops of this sort need some spontaneity, and I am hoping for a lively interchange that will help direct the day. I also welcome communication beforehand about things that people are particularly interested in, and I will try to include what I can. One thing I will touch on related to the ‘start to finish’ theme is that while we see lots of individual sessions, especially initial sessions, there is very little written about the entire arc of therapy. Another aspect of ‘start to finish’ that I will try to cover at more length has to do with things that keep a therapy slow or stuck. Finally, I think many of us find the topic of Head-On Collision somewhat daunting and I will try to help with that.
I understand that you have received great feedback on your book “Intensive Short-Term Dynamic Psychotherapy: A Reference.” How did the idea for this book come about?
Interestingly, the IEDTA gets the credit again, via the EDT-List email discussion group (www.tiny.cc/edt-list). There were fairly frequent requests for definitions of terms, and a number of the same terms kept recurring. But the immediate impetus was that there were frequent misunderstandings and even some conflicts on the listserv because people would use the same word, such as “projection,” in different senses, without realizing it. I began to see that there was a lot of value in brief pieces, about the length of a listserv post, treating a particular term or subject. My goal above allwas to help the beginner, by writing the book I wish I’d had when I was starting out. A secondary goal was to try to address some of the fragmentation that has arisen from different “schools” of ISTDP putting individual stylistic and in some cases theoretical stamps on their work. I think this is inevitable, and basically healthy, as long as people can continue to communicate and cross-fertilize. So I was hoping to help folks who are experienced with one strand of ISTDP to branch out. I think I made a decent start in that direction, but because my own training has been primarily from Allan Abbass and Jon Frederickson, I’m not sure I was able to do justice to all the strands in the current ISTDP world.
As you mention, the reception has been phenomenal. So much of what we write ends up gathering dust somewhere, so it has been very gratifying to hear from people, at all levels of experience, that their copy is dog-eared, or that they keep it close at hand. The most surprising has been the number of people who have read it cover to cover and enjoyed it. Of course I read it cover to cover a couple times while writing it, but I didn’t really have a choice at that point! I’m not sure I’d recommend it, but it works for some people.
What do you think are the opportunities and challenges facing the development of ISTDP in the future?
At one point David Malan said that the main question was whether anyone but Davanloo could actually do the therapy. We now have students of Davanloo, and students of theirs who can do the therapy with a high degree of mastery. The main challenge at this point is in scaling up the training and delivery of the therapy. There will always be room for improvements in the model, but it’s already a really great therapy. What is needed, more than improvement in the model, is for each therapist to be able to see that they can grasp the essence of ISTDP, and then deliver it in a way that is genuine and authentic to them. I’m not sure we’ve figured out how to teach it that way.
In addition, for ISTDP to thrive in the world, it is essential that we create a vibrant, healthy, welcoming, and reasonably cohesive worldwide community of ISTDP practitioners and learners. I believe that the world desperately needs what ISTDP has to offer, and that it would be an enormous tragedy to have its dissemination held back by factionalism and what Davanloo is now calling “destructive competitiveness.” For a lot of reasons, starting with the fact that we are all human beings, our community falls short at times. But one thing that I frequently tell beginners: it’s easy to get discouraged about your ISTDP abilities, but creating a healthy community is a place where beginners have as much opportunity to contribute as people with more experience. It is possible to be passionate about what you are doing without devaluing people who have a different approach, and we all have a part to play in making that vision a reality.
What advice would you have for anyone interested in training to become an ISTDP clinician?
(a) Watch video. Your own video, other people’s video, beginners, experts, everything. (b) Get supervision, don’t just go to workshops. Get supervision from a number of people and find out who is helpful to you. (c) Hang in there. ISTDP is a lifetime learning curve. I jokingly say that at times the only thing that kept me going was knowing that as badly as I was doing ISTDP, it was better than what I was doing before. I say it jokingly because I don’t want people to know how true it was. (d) Do all the stuff we encourage our patients to do; in particular, be compassionate with yourself. It would be really great for you if you could be more compassionate with yourself than I was with myself (see ‘c’ above), but if you can’t it isn’t the end of the world. Allan Abbass has said that doing ISTDP is like having a one-third speed ISTDP treatment. Sadly, I discovered it was one-third of my speed, not one-third of his speed, but it is true in my experience. Aim high, but understand that you do not need to do the therapy perfectly to help people in wonderful and important ways. I have definitely failed to help a number of people, but I have also been lucky to find out that I was actually very helpful to at least a few people that I thought I had not helped at all. (e) Focus on effectiveness, more than on speed. It is much easier to make an effective therapy quicker than to make a quick therapy more effective.
If you could have dinner with any psychotherapist/psychiatrist/psychologist, from any time in history, who would you choose?
Honestly, I am not sure we make the best dinner companions. And maybe it is about getting old(er) but I am ever more skeptical of our celebrity-driven culture, even for intellectual celebrities. There are some good things about getting older; this may be one of them or maybe I am just grumpier. But OK, enough grumpiness… perhaps I am being parochial but I will say William James. If you are looking for a good read, I can highly recommend Louis Menand’s “The Metaphysical Club” about James and his 19th-century American intellectual milieu.