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Current Psychiatry Reviews, 2018, 14, 131-140

REVIEW ARTICLE
ISSN: 1573-4005
eISSN: 1875-6441

A Brief History of Davanloo’s Intensive Short-Term Dynamic Psychotherapy

BENTHAM
SCIENCE

Alan R. Beeber*

Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC 27516, USA

Abstract: Background: Short-term dynamic psychotherapy is a well-established treatment modality.

Habib Davanloo, MD was a pioneer in bringing it to the forefront of psychotherapy.

Objective: The aim of this paper is to highlight Habib Davanloo’s unique contribution to the field of
dynamic psychiatry and psychotherapy by tracing the development of his metapsychological theory
of the unconscious, placing it in historical perspective.

Method: The origin and development of dynamic psychiatry, from the early work of Mesmer
through classical psychoanalysis and contemporary theories will be reviewed. Next, the movement
A R T I C L E H I S T O R Y
aimed at shortening the course of psychotherapy while maintaining a psychodynamic perspective
Received: March 26, 2018
will be explored. Davanloo’s unique contributions to the field will be elaborated. The development
Revised: August 02, 2018 of Davanloo’s metapsychology of the unconscious from his earliest work beginning in the 1960’s
Accepted: August 10, 2018
and further developed in his technique of “Unlocking the Unconscious” in the 1980’s will be exam-
DOI:
10.2174/1573400514666180816113754

ined. I will then turn to Davanloo’s work in the 1990’s and early 2000’s, which focused on widening
the range of patients who could be successfully treated with his technique, and on expanding his
Current Psychiatry Reviews

training programs. Davanloo’s most recent work in the 2000’s and 2010’s involving Audiovisual
Closed Circuit Training Workshops on the Mobilization of the Unconscious, Total Removal of Re-
sistance and Multidimensional Unconscious Structural Change will be reviewed.

Conclusion: Davanloo was indeed a pioneer in short-term psychotherapy. He remains at the cutting
edge, continuing to shorten the course, increasing the depth and the range of this powerful treatment
modality, and developing innovative teaching methods.
Keywords: H. Davanloo, short-term dynamic psychotherapy, ISTDP, unlocking the unconscious, mobilization of the uncon-
scious, unconscious structural change.

1. INTRODUCTION 1.1. Development of Dynamic Psychiatry

Short-term dynamic psychotherapy is widely accepted Unconscious mental processes and dynamics have been
among effective psychotherapies in the treatment of a broad recognized since antiquity and understanding of the uncon-
range of psychiatric disorders including symptom distur- scious long preceded psychoanalysis. As Kardaun points out,
bances, characterologic and interpersonal difficulties. Habib the unconscious is well evidenced in the Greek tragedies;
Davanloo has made a unique contribution to this field with and the term appears in a draft version of Goethe’s poem
his elucidation of the metapsychology of the unconscious, “An den Mond” in 1777. She further notes that the uncon-
and his revolutionary discovery of a most highly effective scious figures prominently in the philosophical works of
technique for removal of unconscious resistance, for mobili- Leibniz, Kant, Schopenhauer and Nietzsche [1]. That Shake-
zation of the innate constructive, creative and healing forces speare had a deep understanding of unconscious desires and
of the unconscious and for the process of multidimensional fears is widely known and most richly discussed by Berg-
unconscious structural change. This paper will trace the de- mann [2]. However, this understanding of the unconscious
velopment of Davanloo’s discoveries in the historical context did not extend to medicine and psychiatry until 1775. From
of the development of dynamic psychiatry, psychoanalysis the 1400’s through the 1700’s neurosis and other mental
and psychodynamic psychotherapy. disorders were generally thought to represent demonic pos-
session. The classification of these disorders was quite ex-
tensive [3] and treatment primarily consisted of exorcism or
*Address correspondence to this author at the Department of Psychiatry, death. It was really not until the Enlightenment that medicine
University of North Carolina School of Medicine, Chapel Hill, NC 27516,
USA; Tel: 7194441020; E-mail: [email protected]
began to see these disorders as something other than posses-

1875-6441/18 $58.00+.00 © 2018 Bentham Science Publishers

132 Current Psychiatry Reviews, 2018, Vol. 14, No. 3 Alan R. Beeber

sion. Ellenberger, in his extensive review of these develop- raphical models of the mind, his theory of psychosexual de-
ments in his seminal work, “The Discovery of the Uncon- velopment and his emphasis on the Oedipal Complex were
scious,” [4] describes 1775-1900 as the period of the “first revised by his followers, most notably Adler [11] and Fer-
dynamic psychiatry.” He credits Franz Anton Mesmer enczi [12], and by later psychoanalytic theorists. Prominent
(1734-1815) with being the first dynamic psychotherapist. in this group are the works of Anna Freud [13]; and of Hart-
He promulgated a technique of treatment he referred to as man, Kris, and Lowenstein [14], which constituted the
“Animal Magnetism.” He believed he had special powers school of ego psychology. Horney [15] and Sullivan [16]
that could heal neurosis and symptom disturbances via made significant contributions in adding their views on the
“magnetism” using a hands-on technique he called “rapport.” impact of cultural and interpersonal relations to psychoana-
This controversial technique was largely replaced with tech- lytic theory. The Object Relations theorists, most notably
niques of hypnosis practiced at the Nancy School, by Bern- Klein, Fairbairn, Winnicott, Balint, synthesized by Guntrip
heim (1840-1919) and Liegault; and by Charcot (1835-1893) [17] and later Kernberg [18] and Kohut [19] further ex-
at the Saltpetriere [4]. panded and elaborated psychoanalytic theory, deemphasizing
instinct and emphasizing early attachment and relatedness to
1.2. New Dynamic Psychiatry others. However, none of these developments addressed a
major problem in psychoanalysis – that is, that psychoanaly-
Ellenberger referred to 1900 as the “Great Year”, usher- sis as practiced in the US and Britain had become increas-
ing in the period of the “New Dynamic Psychiatry” [4]. It ingly long in duration, if not interminable, and was not read-
was during this period that Freud, influenced by Janet, Bern- ily accessible to a large portion of the population suffering
heim and Charcot, in collaboration with Breuer, developed from neurotic symptom disturbances and characterologic
his treatment for hysteria. Initially utilizing hypnosis and problems.
suggestion, he moved to the technique of free association,
interpretation of resistance and of dreams. It was via the
1.4. Early Attempts at Shortening the Course of Psycho-
process of free association that Freud hoped to elicit the re-
analysis
sistances in order to demolish them and cure the neurosis. He
described the phenomenon of transference, namely that feel- It is well known that many of Freud’s cases were of short
ings originating in the past in relation to one person are duration. It has been said that Gustav Mahler was treated
transferred to another person in current life. Free association successfully in a single extended session [20] and Bruno
coupled with therapist relative passivity and neutrality fostered Walter in six sessions [21]. Yet most cases were significantly
the development of transference to the therapist. Analysis of longer and in his later years, Freud expressed great pessi-
the transference phenomena was a cornerstone of psychoana- mism. He grew concerned about the number of cases that
lytic technique. In fact, Freud advocated for fostering the became interminable, either because they were not really
development of the transference to the point of development suitable for psychoanalysis, they evidenced the presence of
of a transference neurosis, i.e. a new neurosis on top of the “super-ego resistance” or they developed intractable trans-
original neurosis [5]. It was his view that the transference ference neurosis [22]. Among Freud’s closest associates,
neurosis could be worked through via the process of interpre- Ferenczi and Rank are known for their collaboration on “The
tation of the transference and that this would allow for reso- Development of Psychoanalysis” in which they focus on
lution of the original neurosis. Transference neurosis was so active technique and the experience of the transference rela-
central to the psychoanalytic method that cases of analysis of tionship [23].
transference neurosis were required for certification in psy-
choanalysis in the United States. In “Analysis Terminable 1.5. Beginnings of Short-Term Dynamic Psychotherapy
and Interminable”, Freud expressed his pessimism that neu-
rosis could be resolved in this fashion. He was especially Modern short-term dynamic psychotherapy dates its ori-
pessimistic about resolving those cases that involved what he gins to the work of Franz Alexander and Thomas French at
called the resistances of the Super-ego, or what might be the Chicago Institute for Psychoanalysis. Concerned with the
considered masochism. He clearly felt the limitations of his increasing length of psychoanalyses and with the develop-
method in these cases. The usefulness of the concept of ment of interminable cases, Alexander and French sought to
transference neurosis became a point of controversy in psy- shorten the course of treatment through modification of ana-
choanalysis. Brenner [6] and Cooper [7] both felt the term lytic technique and selection of patients [24]. They favored
lacked precise definition, and that it simply represented in- an active technique that identified a specific psychotherapeu-
tense transference phenomena. Cooper called for “retirement” tic focus, relying heavily on the interpretation of defenses
of the term. Cases of transference neurosis became harder and and on parallels of the patient’s relationship to figures in
harder for psychoanalytic candidates to find for their train- current life to figures in the past. They emphasized that the
ing. Modern psychoanalysis downplayed the importance of patient must undergo a “corrective emotional experience”
the term, and the requirement for such cases was eventually either in the transference relationship or in their current life
dropped. For a more detailed discussion of this issue see to repair the psychopathological influences of earlier life
Beeber [8]; Chessick [9]; and Beeber and Hickey [10]. [24]. They reported in several hundred cases, that the combi-
nation of high motivation, favorable response to interpreta-
tion with insight, coupled with a positive emotional envi-
1.3. Neo Freudians, Ego Psychology and Object Relations
ronment, often led to rapid improvement in the focal prob-
Psychoanalysis underwent significant change following lem. Psychoanalysts did not meet their work with widespread
Freud’s initial conceptualizations His structural and topog- acceptance. It was not until the 1960’s that several clinical
A Brief History of Davanloo’s Intensive Short-Term Dynamic Psychotherapy Current Psychiatry Reviews, 2018, Vol. 14, No. 3 133

researchers independently began developing their own tech- initial diagnostic evaluations, working through, termination
niques of short-term dynamic psychotherapy. The most no- and follow-up outcome evaluations. It was here that Davan-
table were Malan [25], Mann [26], Wolberg [27], Sifneos loo presented his early case studies of highly resistant pa-
[28] and Davanloo [29]. They had in common that each of tients and contrasted his work with that of Sifneos’ Anxiety
them was attempting to work within the psychoanalytic Provoking Psychotherapy and with the work of Malan [29].
framework and like Alexander and French, sought to dra- The Second International Symposium and Workshop on
matically shorten the course of treatment. Short-Term Dynamic Psychotherapy continued these presen-
Though each of these early clinical investigators had a tations and discussion. Davanloo published many of the
unique emphasis, they all carefully selected patients suitable clinical presentations from these two symposia in his edited
for short-term dynamic psychotherapy. The selection criteria book, “Basic Principles and Techniques in Short-Term Dy-
included high motivation for therapy, an uncomplicated namic Psychotherapy” [29]. Included in this ground-breaking
clinical picture, often with a single psychotherapeutic focus, text are presentations of some of Davanloo’s now classic
low or absent resistance, and responsiveness to interpreta- cases, including the “Teeth-Grinding Woman”, the “Angry,
tion. These patients all had relatively high capacity to toler- Childlike Woman”, the “Man with the Impulse to Murder
ate anxiety and painful affects. His Stepfather”, the “Woman with the Fear of Losing Her
Husband”, the “Cement-Mixer Man”, and the “Man Ob-
sessed with the Size of His Genitals” [29]. In this text,
1.6. Contributions of Habib Davanloo Davanloo presented the evaluation process which he called
1.6.1. 1960’s to Early 1970’s “trial therapy” and elaborated his selection criteria from a
metapsychological, (not merely phenomenological,) point of
Habib Davanloo (1929- present) trained in psychiatry in view. In contrast to the other short-term techniques in prac-
the 1950’s at Massachusetts General Hospital. He was highly tice at that time, he described what he called a “broad fo-
influenced in the psychoanalytic tradition by his supervisors cused short-term dynamic psychotherapy” which was appli-
and distinguished faculty such as Lindemann, Zetzel and cable to a wider range of patients. While most other clini-
Deutsch. Following his residency in psychiatry Davanloo cians excluded complex patients, Davanloo showed, in his
joined the faculty at McGill University in Montreal. He re- audio-visually recorded sessions with actual patients, that his
ports that in his residency experiences and later in running technique was effective in removing resistance in highly
the Montreal General Psychiatric Outpatient services he en- resistant patients. He emphasized high activity on the part of
countered long patient waiting lists. Relatively few patients the therapist, heavy focus on the transference relationship,
were accepted into dynamic psychotherapy. He observed that and on the resistance in the transference. He described two of
the majority of patients were seen in short sessions (typically his most important interventions, which he called “pressure’
one half hour in length), most often supportive in nature, and and “challenge” to the defensive structure [29]. These two
the therapy was relatively unfocused [29]. interventions form the cornerstone of Davanloo’s technique,
In 1962, quite disillusioned with the lengthening course which depends on their judicious and timely use [29, 30]. A
of psychoanalytic treatment, and with interminable therapies, more detailed discussion of their application is beyond the
Davanloo set up a short duration psychotherapy program. In scope of this paper. It is worth mentioning that at this point
addition to the clinic, he saw a few patients himself and be- in the development of his ‘new metapsychology,” Davanloo
gan conducting a weekly psychotherapy seminar for resi- still emphasized the use of interpretation, specifically inter-
dents and medical students. It was in this program that he pretation of the relationship of impulses and feelings, to
became convinced that a shorter form of psychotherapy anxiety and defense (called the triangle of conflict), and of
could be the treatment of choice for a larger number of pa- the link of the past with current life and the transference rela-
tients. He reported that from 1963-1974 he evaluated 575 tionship (called the triangle of person) [29]. One also can see
patients, 130 of whom met criteria (revised in 1965) for what may be the beginning of the use of what Davanloo calls
short-term psychoanalytic psychotherapy. One hundred fif- his most powerful intervention, the “Head on Collision” with
teen of these patients were successfully treated with an aver- the resistance in the transference, in the transcript of the case
age of 20 sessions with 2-7 years follow-up. All were audio- of the “Angry, Childlike Woman” [29].
visually recorded [29]. At the French Language International Congress on Brief
An international symposium on psychotherapy was held Analytic Therapies, in Lausanne, Switzerland in 1976,
in Oslo, Norway in 1973. It was there that Davanloo met Davanloo presented two more of his classic cases, the “Metal
Peter Sifneos. They began discussion of their mutual inter- Pipe Man” and the “German Architect”, and presented a pa-
ests, following which Davanloo invited Sifneos to collabo- per entitled “The Search for Resistance and the Technique of
rate with him in a symposium in March of 1974 in Montreal. Total Removal of Resistance.” A discussion of Davanloo’s
In March 1975, Davanloo set up the First International Sym- early clinical research as presented in these symposia, as
posium on Short-Term Dynamic Psychotherapy. This meet- well as copies of the original programs of the symposia can
ing brought together a most distinguished international panel also be found on Davanloo’s official website, “davanloo.ca”
of experts in short-term therapy including, but not limited to: [31].
Davanloo, Saul Brown, Samuel Eisenstein, Mardi Horowitz, The early phase of Davanloo’s work can be said to have
David Malan, Judd Marmor and Peter Sifneos. The confer- culminated in the Third International Symposium in Mont-
ence included numerous workshops in which audio-visually real, November 1977. Many of the presentations from this
recorded sessions with patients were presented, focusing on conference have been published in a text entitled “Short-
134 Current Psychiatry Reviews, 2018, Vol. 14, No. 3 Alan R. Beeber

Term Dynamic Psychotherapy’, edited by Davanloo in 1980 Through systematic review of his audio-visually recorded
[32]. In this text, Davanloo describes his then current method material, he refined his understanding of the unconscious
of Short-Term Dynamic Psychotherapy. Compared to his further. He concretized his observations in the form of a
colleagues he had extended the spectrum of patients treatable “new metapsychology” of the unconscious and of the thera-
with his technique to include highly resistant patients with peutic process. To set apart his technique from psychoanaly-
complex character pathology. These patients were highly sis and from other techniques of short-term therapy he called
syntonic with their difficulties and often had masochistic, it “Intensive Short-Term Dynamic Psychotherapy’ [36]. He
self-defeating trends in their character, evidencing, what noted that by making previously syntonic defenses dystonic,
Davanloo called at the time, resistances of the superego. This and by exhausting the defenses, a new force in the uncon-
group of patients is precisely the group of patients that had scious came into operation, which he called the “unconscious
been most problematic for psychoanalysis, and for the other therapeutic alliance.” This ultimately led to the direct experi-
short-term psychotherapies of the time. As described in the ence of both positive and negative transference feelings,
earlier text [29] Davanloo was still utilizing a highly active which triggered direct access to the experience of feelings in
technique with emphasis on the use of the transference. In- relation to key figures in the patient’s past. In the case of the
terventions included early and active clarification, interpreta- “Metal Pipe Man” he utilized intervention that was the fore-
tion, and active working through of the transference resis- runner to what he would later call the “Head on Collision
tances. A major goal was to avoid the development of trans- with the Resistance Against Emotional Closeness.” Con-
ference neuroses, especially those of the dependent type. He fronting the patient’s erecting a wall between himself and the
also elucidated his technique of “Trial Therapy”. Using the therapist, Davanloo brought the patient face to face with the
“Case of the Little Dutch Girl”, he demonstrated how one self-defeating nature of this resistance. The patient then be-
goes about ruling out contraindications to Short-Term Dy- comes loaded with feeling as he recognizes that he has had
namic Psychotherapy, such as a history of psychosis, serious great difficulty showing any feeling to anyone – stemming
suicide attempts or poor impulse control. He then presented from his early relationship with his father. Davanloo called
the process of rapid identification and working through
this mobilization of feeling a “first breakthrough” into the
transference resistances and evaluating the patient’s response
unconscious. He attributed the communications from the
to interpretation. His work continued in this vein into the late
patient and the change in the whole atmosphere of the trans-
70’s and was presented in numerous workshops and in an-
ference relationship as functions of the new force in the un-
nual metapsychology courses sponsored by what was then
conscious, which he called the “Unconscious Therapeutic
known as the International Institute for Short-Term Dynamic
Alliance” [37].
Psychotherapy.
As he continued to reflect on his work further he devel-
1.6.2. 1980’s
oped new insights into the operation of the unconscious
In the 1980’s Davanloo continued his endeavors in the mind and on the process of therapy. He continued his com-
areas of clinical research in the development of his metapsy- mitment to going deeper, faster. In a seminal paper entitled
chological theory, and in education and training. He was “Intensive Short-Term Psychotherapy with Highly Resistant
committed to the idea that short-term dynamic therapies, as Patients. I. Handling Resistance” Davanloo explicated his
practiced at that time, were too restrictive. Only a small frac- theory, in exquisite detail [39]. Rather than being intuitive or
tion of patients presenting for psychotherapy met the selec- speculative, his metapsychology remained firmly anchored
tion criteria of high motivation, low resistance, high capacity in his observations of actual clinical cases. He noted, in the
to tolerate anxiety and painful emotions, and responsiveness case of the “German Architect,” that by an active technique
to interpretation. He devoted his efforts to expanding the of eliciting resistance via “pressure’” to avoided feelings
spectrum of patients treatable with his technique. He contin- (and other forms of pressure), and “challenge” to the resis-
ued to audio-visually record all of his sessions with patients tance, he could rapidly turn the patient against his resistance.
and to follow the same process throughout his investigations, This led to an intensification of the transference component
namely that of systematic review of his clinical work. He of the resistance to which he applied his most powerful in-
painstakingly observed the effects of his interventions, then tervention, the “head-on collision” with the resistance. There
tested out modifications of his technique in an attempt to was then mobilization of the direct experience of the trans-
broaden the range of patients he could treat successfully, He ference feeling and the mobilization of the “unconscious
strived to shorten the time of access to the patient’s uncon- therapeutic alliance,” sufficiently, to “unlock the uncon-
scious within the patient’s capacity to tolerate anxiety and scious.” In this way, he was able to achieve direct access to
painful affects, and concomitantly to shorten the course of the patient’s unconscious core neurotic structure. In the sec-
the psychotherapy. His clinical work focused on applying his ond part of this article, Davanloo described the process after
methodology to patients suffering from major depression, the initial “breakthrough’ into the patient’s unconscious [40].
characterological depression, functional and psychosomatic This two-part article clearly shows Davanloo’s work in sharp
disorders, somatization disorders and panic disorder. He de- distinction to the other short-term and long-term therapies of
scribed the modifications of the technique necessary to ac- the time. He demonstrated and described this powerful tech-
cess the unconscious with these patients as “restructuring” of nique of Short-Term Psychotherapy, which he referred to as
the regressive defensive systems. He explicated this process “Intensive Short-Term Dynamic Psychotherapy.” He went
using actual case material form his clinical practice and re- on to say that his technique can “bring a major breakthrough
search [33-37]. Moreover, he presented these cases and into the unconscious with every patient who suffers form
methods in numerous international symposia and at his an- character neurosis and comes to the interview in a state of
nual metapsychology courses beginning 1983 [38]. high resistance.” Moreover his work “has made clear that in
A Brief History of Davanloo’s Intensive Short-Term Dynamic Psychotherapy Current Psychiatry Reviews, 2018, Vol. 14, No. 3 135

every such patient the royal road to the unconscious is based the discharge of anxiety into striated muscle. What is more,
on the technique I have discovered to handle resistance and they have impairment in their defensive structure such that
the patient’s direct experience of his transference feelings” when anxiety is mobilized they resort to primitive defenses
[39]. Anyone reading these papers, or better yet, seeing the case such as projection, projective identification, explosive dis-
(as I have had the privilege to do on numerous occasions) charge of affect, and dissociation. They often experience
would have to agree with Davanloo that it shows that “the disruption of their cognitive and perceptual processes, which
breakthrough can be achieved completely and within a short gives rise to drifting thoughts and transitory micro psychotic
time” and that his technique is applicable to the most highly symptoms. They require an extensive phase of “restructur-
resistant patients suffering from character neurosis [40]. ing” of their defenses and of building their capacity to toler-
ate anxiety, a process Davanloo later more aptly called “mul-
In this highly productive time period, he published a se-
ries of papers, based on his vast library of recorded clinical tidimensional unconscious structural change” [47]. These
patients overlap with patients on the spectrum of borderline
material, elaborating his metapsychology further. He eluci-
personality organization. In 1993 and 1994 he presented the
dated the process of “Unlocking the Unconscious” in a num-
entire course of treatment of such a fragile patient, at his
ber of different cases [41]. In the case of the “Corporate
annual audio-visual symposium, (and elsewhere many
Lawyer” he showed that the process of the initial interview
times,) whose treatment began in the late 1980’s, a case he
could be described by a series of phases he called the “cen-
tral dynamic sequence” [42]. He elaborated the “central dy- called the “Black Widow” [48].
namic sequence” further in a two-part article utilizing the 1.6.3. 1990’s
case of the “So-called Fragile Woman”, so-called because in
After retiring from McGill in the early 1990’s Davanloo
fact she did not have fragility in her character and showed
continued his clinical research on intensifying and shortening
the capacity to withstand the impact of access to her uncon-
the course of treatment. He focused on refinements of the
scious [43,44]. He also presented cases of unlocking the un-
conscious in patients requiring a “restructuring” process be- technique of Intensive Short-Term Dynamic Psychotherapy,
as well a format he called a “powerful new method of psy-
fore access to the unconscious could be achieved (cited
choanalysis” [49]. In the early 1990’s Davanloo began inves-
above). These cases included a patient suffering from de-
tigating new variations of the technique. Whereas partial and
pression, the case of the “Woman with a Machine Gun” [33,
major unlocking of the unconscious were the methods of
34] and a patient with severe migraine headaches, the case of
Intensive Short-Term Dynamic Psychotherapy, he devised
the “Woman Used as a Go-Between” [35, 36]. Many of these
papers from the 1980’s were reprinted in a book edited by what he called “extended major direct access to the uncon-
scious,” which consists of “extended major unlocking of the
Davanloo entitled “Unlocking the Unconscious: selected
unconscious,” with concomitant “extended mobilization of
papers of Habib Davanloo, MD” [45].
the unconscious therapeutic alliance;” and “extended multi-
In the area of education, Davanloo expanded his teaching ple major unlocking of the unconscious” with concomitant
efforts. While his weekly seminar for residents and students optimum mobilization of the unconscious therapeutic alli-
continued at Montreal General, he added a format of group ance. These “extended” methods of direct access form the
supervision he called “Core Training.” This consisted of basis of his new method of psychoanalysis.
clinicians bringing audio-visually recorded sessions with
Davanloo introduced “major extended mobilization of
their patients for supervision with Davanloo in a group set- the unconscious” in the mid-1990s as a method to deepen the
ting, coupled with didactic teaching and presentations of understanding of the unconscious mind [50, 51]. He reports
Davanloo’s own work as applicable to the trainees cases. using this methodology primarily with psychiatrists and
This led to the formation of Davanloo’s Montreal Core other therapists in training in Intensive Short-Term Dynamic
Training Program and to the founding of other training cen- Psychotherapy and other professionals as well. The trainees
ters under his guidance and supervision in Europe and North are predominantly in European and North American training
America. In addition, he presented full-day workshops at the programs. The format takes into account that one often has to
American Psychiatric Association Annual Meeting from travel great distance for sessions and therefore cannot be
1980 through 1997 [46]. seen in weekly sessions of one hour’s duration as is done in
In the late 1980’s he began applying his technique with Intensive Short-Term Dynamic Psychotherapy. Sessions are
patients suffering from fragility in their character structure, arranged in a block format, such as three days duration, 1-3
manifested by the extremely low capacity to tolerate anxiety months apart. Each day consist of 5-7 sessions, with breaks
and painful affects. Davanloo repeatedly pointed out that in between. There are repeated breakthroughs into the un-
patients with solid neurotic character structure (for example conscious throughout each day and there is an extensive em-
those with obsessive character types) demonstrated a high phasis on multidimensional unconscious structural change, a
capacity to tolerate anxiety, manifested primarily in the form process that leads to permanent fluidity in the character
of tension in their skeletal (or striated) muscle system. Pa- structure. Further details of this method are found in Davan-
tients with lower capacity to tolerate anxiety often experi- loo’s publications [49, 50]. Another format of extended di-
ence little striated muscle tension. Instead, they discharge rect access to the unconscious is a trial therapy conducted in
anxiety into the autonomic nervous system (smooth muscle) three parts in a single day or on consecutive days, lasting 4-5
and develop autonomic symptoms such as nausea, diarrhea, hours in duration.
or migraine headaches. Fragility in the character structure is Davanloo refined his technique of intensive short-term
associated with an extremely low capacity to tolerate anxi- dynamic psychotherapy further in the 1990s. In these arti-
ety. These patients have virtually no or very little access to cles, he described the spectrum of psychoneurotic distur-
136 Current Psychiatry Reviews, 2018, Vol. 14, No. 3 Alan R. Beeber

bances and spectrum of fragile character structure treatable 1.6.4. 2000’s

with intensive short-term dynamic psychotherapy. On the
Entering into the 2000s, Davanloo had expanded the
left side of the spectrum are the highly responsive patient,
spectrum of patients treatable with Intensive Short-Term
with low resistance and a single psychotherapeutic focus. On
Dynamic Psychotherapy, from patients with uncomplicated
the right side of the spectrum is the most extremely resistant
patient with diffuse symptom and characterologic distur- core neurotic structure to include those with multifocal diffi-
culties, depressive disorders, functional and somatic disor-
bances and high complexity to their core pathology [51]. He
ders, panic disorders, fragility in the character and high com-
contrasted the treatment of these cases using rich clinical
plexity in their unconscious. He continued in this vein into
examples; elegantly described the psychopathological dy-
the 2000s with his interest in deepening his understanding of
namic forces at the core of neurosis and character pathology
the unconscious, using the techniques of “major extended
[52, 53]; and in those patients on the right side of the spec-
trum, the constellation of psychopathological forces he mobilization of the unconscious” which he had initially de-
vised in the mid-1990s [49, 50]. His clinical research focused
called the “Perpetrator of the Unconscious” [51]. Davanloo
primarily on the “extended mobilization” methodology, both
has made a unique contribution to our understanding of the
in his clinical practice and in small group teaching formats,
concept of resistance and defenses. Most dynamic psycho-
such as closed circuit training. It was in this way that he was
therapies make use of the concepts of ego defense mecha-
able to further augment his new metapsychology of the un-
nisms and characterologic defenses. Some also utilize the
concept of super-ego defenses (those defenses most dreaded conscious. The work was predominantly with psychiatrists,
therapists, and other professionals. He noted that this group,
by Freud and which can lead to interminable treatment).
in general, was extremely resistant. Some were considered
Davanloo observed that by virtue of applying pressure by
alexithymia. He further noted that after repeated break-
focusing the interview and by focusing on avoided issues and
throughs into the pathogenic organization they frequently
feelings, transference feeling is mobilized, and concomitant
showed high complexity in their unconscious, involving
unconscious anxiety. This, in turn, mobilizes the patient’s
defensive structure, which involves a series of “tactical de- multiple psychogenetic figures, often multigenerational in
origin [50]. It is through his application of extended mobili-
fenses” that function to resist the therapist’s efforts to under-
zation methods that he came to make significant advances in
stand and get to the core of the patient’s difficulties. This has
his metapsychology.
been the topic of many of Davanloo’s presentations in Core
Training Programs and in many of his metapsychology He noted a significant issue with respect to the patho-
courses. His discussion of the range of tactical defenses that genic role of trauma in these individuals, namely, that if
patients utilize, and the interventions one employs to further trauma occurred at about age 4 or later, there was little com-
mobilize the unconscious, are essential for any practitioner plexity to the unconscious. Access to the unconscious could
who wants to master intensive short-term dynamic psycho- be achieved with the standard method of Intensive Short-
therapy [54, 55]. Lastly, he fleshed out the central dynamic Term Dynamic Psychotherapy. However, in many of these
sequence in much greater detail, devoting comprehensive cases, trauma was at age 3 or earlier, sometimes in the first
discussion to the phase of pressure [56], the phase of chal- month of life. What is more, many of these cases evidenced
lenge [57] and the head-on collision with the resistance [58], the intergenerational transmission of difficulties, often exert-
all amplified with vivid clinical examples. ing their effects from birth. The issue of intergenerational
neurotic disturbances will be elaborated later. Davanloo de-
Davanloo continued to further develop educational pro-
veloped the concept of “fusion” to describe the unconscious
grams. He presented many symposia and workshops in
structure and dynamics in these patients. In his earlier work,
Europe, Canada and the United States throughout the decade
Davanloo observed and demonstrated that in the unconscious
of the 1990s. Indeed, from 1977 to the present he presented
of resistant patients, murderous rage and sexuality were
more than 1000 such programs. Among his presentations “fused.” While the patient was able to more easily actually
were cases of direct access to the unconscious via the ex- experience murderous rage in the transference and in relation
tended major unlocking (such as the “Man with the Crushing to the figures of the past, sexual feelings were not easily ac-
Chest Pain [49, 50]) and cases consisting of the full course of cessible. It is only after sufficient structural changes to the
treatment with emphasis on the process of working through defensive system and sufficient actual experience of guilt-
[48, 59, 60] A similar program was conducted again in 2004 laden feelings in relation to the genetic figures, that sexual
[61]. He continued the Montreal Core Training Program and feeling becomes de-fused from rage and can be experienced.
introduced closed circuit training formats in North America This allows for direct access to the role of sexuality in the
and Europe. In the closed circuit programs, trainees would core neurotic structure [50, 59]. In like fashion, Davanloo
interview patients live, while being observed by Davanloo used this concept of “fusion” to apply to the constellation of
and the other trainees in real time, in another room. This rage and guilt or rage, sexuality and guilt. He noted that the
format enabled the supervisor to observe both the patient and presence of guilt in the unconscious gave rise to major resis-
the therapist. The trainee was afforded immediate, on the tance (in fact he used the terms synonymously). He further
spot supervision. Countertransference issues if present were observed that in the initial interview neither murderous rage
obvious, and could be dealt with immediately. Expansion of nor guilt could be directly experienced initially. Guilt and
his core training and closed circuit programs gave rise to the rage were defensively fused. He concluded that the fusion of
founding of new centers, including the Italian Institute for primitive murderous rage and guilt (and sexual feelings as
Davanloo’s Intensive Short-Term Dynamic Psychotherapy in well) was a “pathogenic destructive system’” in the uncon-
1997 and the German Society for Davanloo’s Intensive scious, which gives rise to symptom disturbances, characte-
Short-Term Dynamic Psychotherapy in 1998. ological problems, interpersonal difficulties, and impairment
A Brief History of Davanloo’s Intensive Short-Term Dynamic Psychotherapy Current Psychiatry Reviews, 2018, Vol. 14, No. 3 137

of the defensive system. Guilt can only be experienced, when ence neuroses and it remained a heavy emphasis in his clini-
it is de-fused from rage in the unconscious, a process that cal work and teaching throughout the remainder of the dec-
requires sufficient mobilization of the transference feeling ade [62, 63]. Further discussion of Davanloo’s unique con-
and the transference component of the resistance [62, 63]. tribution to the understanding transference neurosis has been
He underscored that “fusion of primitive rage and elaborated elsewhere [8, 10].
guilt…is a pathogenic destructive system in the unconscious, Throughout the decade of the 2000s, Davanloo continued
which we call major resistance” [64]. to develop novel teaching formats. He continued the Core
Training Supervisory Groups in Montreal and Europe. In
In cases of trauma at age 4 or later, the process of de-
addition, in early 2000, he added a supervisory group on the
fusion was relatively straightforward and occurred rapidly in
Intensive Short-Term Dynamic Psychotherapy. However, process of working through, in which trainees presented a
single treatment case, four times over the course of a year,
those with trauma at age 3 or earlier, de-fusion was more
such that each had supervision of a full course of treatment.
complicated. It required a much higher rise in the transfer-
He also continued to use closed circuit supervision. In 2007
ence component of the resistance and the transference feel-
he initiated a unique program he called the Montreal Closed-
ing to achieve de-fusion and for guilt to be actually experi-
Circuit Experiential Training Workshop, which continues to
enced. In many cases, the process required an extensive pe-
riod of multidimensional unconscious structural change in the present [62]. These workshops were designed primarily
for advanced practitioners of Intensive Short-Term Dynamic
order to defuse guilt from murderous rage in the unconscious
Psychotherapy who desired further training in the mobiliza-
[62]. This led Davanloo to look at other factors in the uncon-
tion of the unconscious. They are different than the closed-
scious of these individuals that might be playing a role in
circuit supervisory groups, which do not include the experi-
contributing to the tenacity of the major resistance-namely,
ential component [65, 66]. As this program continues to the
the possibility there might be a transference neurosis present.
If so, the presence of a transference neurosis would certainly present, more will be said about it below.
complicate access to the original neurosis [62]. From the To recapitulate, Davanloo’s major accomplishments of
start of his career as a psychotherapist, Davanloo recognized this decade included explicating the pathogenic destructive
the morbid effect of transference neurosis on the therapeutic system of fusion in the unconscious and that of transference
process. Indeed from his earliest work, he strove to avoid the neurosis in its many forms, emphasizing the importance of
development of transference neurosis, especially of the de- the process of multidimensional structural change; elaborat-
pendent kind, through active, early handling of transference ing the process of mobilization of the unconscious; and in-
reactions and resistance. In this way, one can avoid regres- troducing a highly powerful methodology for the training of
sive transference neurosis [29]. By the middle of the decade the technique of mobilization of the unconscious, namely the
of the 2000s, he heavily emphasized the role transference experiential workshops.
neurosis played in complex cases, in his supervisory and
1.6.5. 2010 to the Present
closed circuit groups [62], as well in his annual metapsy-
chology symposia [63]. In the current decade, Davanloo has actively continued
his clinical research, primarily through the closed Circuit
In addition to the formal unresolved transference neurosis
Training Workshops and to a more limited degree, his pri-
(the sequela of previous therapy), he described an intergen-
vate practice [67]. His primary focus has been the integration
erational form transference neurosis that was passed down from
of his findings into his new metapsychology of the uncon-
one's parents, grandparents and even great-grandparents, to
the patient, through each generation or bypassing a genera- scious, which he has presented at his annual metapsychology
symposia. Main topics have included:
tion. In this sense, neurosis is transferred from one person to
another. As an example, a woman has a pathological rela- 1) The discovery of the technique of total removal of resis-
tionship with her father. She marries and has a daughter. She tance [68].
then turns the daughter against her own father. The daughter
2) The technique of major mobilization of the unconscious
then has whatever original neurosis there is in her uncon- [69].
scious with her father, with its own attendant pathogenic
system of guilt, on top of which is the system of guilt for her 3) The technique of multidimensional unconscious struc-
rage towards her father that derives from her mother’s neuro- tural changes [70].
sis with her own father. This system of guilt on top of guilt is 4) The technique of total removal of resistance, fusion ear-
especially pernicious. He cited cases of transference neurosis lier or later than age 3. The technique of removal of
that occur in the course of one's work. Similar to the inter- transference neurosis [71].
generational transference neurosis or the transference neuro-
sis resulting from psychotherapy, neurotic constellations can 5) Transference neurosis -the technical, ethical and
be passed from a supervisor to the supervisee, or from pa- metapsychological conceptualization; the technique for
tients to the therapist. A particularly common form of this total removal of transference neurosis [72].
type of transference neurosis is what he called the “destruc- 6) Intergenerational transference neurosis and the destruc-
tive competitive transference neurosis.” In the extended mo- tive competitive form of transference neurosis [73,74].
bilization, after access to the unconscious, one is able to see
that someone else’s neurosis, if you will, is on top of the 7) Removal of intergenerational and destructive competitive
individual’s original neurosis. Davanloo devoted significant transference neurosis with examples from the Closed
effort to honing the technique for removal of these transfer- Circuit experiential training program [75].
138 Current Psychiatry Reviews, 2018, Vol. 14, No. 3 Alan R. Beeber

8) The technique of removal of projective anxiety [76]. ous limitation of interpretation as a therapeutic factor and
relied less on this cognitive model of change. Instead his
9) Structural impairment of the unconscious defensive or-
work focused on a more effective model of change, leading
ganization with the presence of malignant character de-
to his discovery of “unlocking the unconscious.” Mobiliza-
fenses as a result of early trauma, fusion and presence of
transference neurosis [77]. tion of the unconscious, mobilization of the transference
feeling, mobilization of the transference component of the
10) Projective anxiety, transference neurosis and malignant resistance, breakthrough into the unconscious, unlocking the
resistances [78]. unconscious, all had in common a dominance of affective
Each of these symposia consisted of a mix of didactic responses over cognitive responses on the part of the patient,
presentations by Davanloo, with rich audio visually recorded and of a dominance of the unconscious therapeutic alliance
clinical vignettes; presentations by other clinicians experi- over the forces of resistance. In the 1990s he demonstrated
enced with Davanloo’s techniques; and recorded examples that the full spectrum of neuroses, character disturbance and
from the Closed Circuit Experiential Workshops. Through- fragility of the character could be treated successfully with
out this most recent decade, Davanloo has remained steadfast his Short-Term Dynamic Psychotherapy. In the 2000s he
to his aims of expanding the patient base suitable for treat- turned his focus to the role of early trauma and early fusion
ment with his techniques and of deepening his conceptuali- in creating complexity in the unconscious, characterized by
zation of the unconscious mind. He has enriched our under- projective anxiety and malignant character defenses. He
standing of major resistance, to include the notion of fusion noted that this group of patients was highly susceptible to the
of primitive rage and guilt in the unconscious, transference development of transference neuroses in their various forms,
neurosis in its various forms, malignant character defenses, complicating their treatment even further.
and the pathogenic role of projective anxiety. What is more, Over the more than sixty years of his illustrious career,
he has demonstrated clearly, with numerous examples, the Davanloo has focused his efforts on refining the process for
technique of total removal of the major resistance, removal total removal of resistance, removal of fusion, removal of
of fusion, removal of transference neurosis, and the process transference neuroses and on the process of multidimen-
of multidimensional unconscious structural change. sional unconscious structural change. His current work con-
tinues in this arena. He continues his efforts to train thera-
CONCLUSION pists skilled in Intensive-Short-Term Dynamic Psychother-
apy with the aim of their gaining mastery of his techniques
Freud developed psychoanalysis starting in the 1890s in of mobilization of the unconscious and multidimensional
the context of the recent discovery of dynamic psychiatry. unconscious structural change as well as the treatment of
Advances in philosophy, physics, medicine, and psychology early fusion and transference neuroses. It is with a deep
heavily influenced his theory and technique. Early on he sense of gratitude to him that I say that it has been a unique
made use of suggestion and hypnosis. Many of his early privilege to have the opportunity to train and to work with
therapies were of brief duration. He later developed the con- Davanloo over the past twenty-five plus years of my career.
cepts of transference and resistance and employed the tech- A pioneer in the 1960s, Davanloo remains at the frontier of
nique of free association. As he encountered more resistant dynamic psychotherapy today.
patients, this method became problematic in the sense of the
ever-increasing length of psychoanalysis, and even intermi-
nable analysis. He pessimistically came to the position of CONSENT FOR PUBLICATION
“bowing” to the superior forces of the resistances of the “su- Not applicable.
perego.” This contributed to the movement taken up by Fer-
enczi, Rank, and later by Alexander and French in the
CONFLICT OF INTEREST
1940’s, to attempt to shorten the course of psychoanalysis.
Although they met with significant resistance from the psy- The authors declare no conflict of interest, financial or
choanalytic community, by the late sixties and early seven- otherwise.
ties many clinical researchers independently had developed
forms of short-term dynamic psychotherapy. Davanloo ACKNOWLEDGEMENTS
sought to bring these researchers together in his international
clinical symposia in the 1970’s. The author wishes to acknowledge Habib Davanloo, MD.
I base this paper on a presentation at Davanloo’s 378h Annual
Committed to the task of deepening his understanding of
International Audiovisual Symposium on the Science of the
the unconscious and of increasing the patient base treatable
Metapsychology of the Unconscious, October 25-28, 2017,
with his short-term techniques, he was a pioneer at the fron-
Montreal, Canada. None of the metapsychological concepts
tier of dynamic psychotherapy. Through his clinical research,
in this paper are my own. They all represent his discoveries,
he uncovered many groundbreaking concepts and principles
which he has so generously shared with my colleagues and
of the unconscious, which he described in his “new metapsy- me in his various training programs. It is with great gratitude
chology of the unconscious”. In the early years of his work,
to Dr. Davanloo that I dedicate this paper.
operating from a psychoanalytic base, he focused on remov-
ing resistance through his method of pressure, challenge,
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