Defining the Technique of 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 Therapist and patient seek to build a working alliance, which transforms into a powerful unconscious therapeutic alliance. Then, 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, attachment theory with psychoanalytic metapsychology.

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