Narrowing down the therapeutic task in ISTDP

Abstract

Effective use of the therapeutic alliance is key to successful therapy across different treatment modalities. In this article we argue that one of the distinctive features of ISTDP is how the therapist manages the therapeutic alliance by narrowing down the therapeutic task again and again throughout the treatment. ISTDP therapists need to strive for absolute clarity about different emotional and defensive responses, in order to keep the therapeutic alliance firmly directed towards emotional experiencing and resistance relinquishing. What is more, the patient must also share this understanding of the task at hand and bring full willingness to join with the therapist to accomplish it. This process is illustrated by pieces of transcript from a successful treatment course, where we show how the therapeutic task is developing along the different stages of the therapeutic process. Maintaining a narrowly defined task is the central means to keep treatment intensity up, and a sine qua non of facilitating major unlockings of the unconscious.