“The Shaking Grandmother”: Assessing and Addressing Multiple Pathways to Somatic Symptom Formation in ISTDP
DOI:
https://doi.org/10.70839/6ghgmv51Keywords:
ISTDP, graded format, medically unexplained symptoms, functional neurological symptoms, conversion, somatization, unconscious therapeutic allianceAbstract
Intensive Short-Term Dynamic Psychotherapy (ISTDP) can be an effective treatment for complex cases presenting with fragility, repression, character problems and multiple medically unexplained somatic symptoms. However, in such cases, the treatment is not always “short-term,” and the therapist needs to engage in the complicated task of assessing and addressing the specific mechanism involved in the formation of diverse somatic symptoms as they emerge in sessions. This case report describes the application of graded ISTDP with a patient presenting with long-standing difficulties with depression, masochistic character traits, and multiple medically unexplained somatic symptoms. Session transcripts from early, mid and late treatment phases will illustrate the assessment and therapeutic work with anxiety thresholds, as well as detecting and restructuring somatization. Further, I will illustrate how the emergence of the unconscious therapeutic alliance (UTA) in later stages of treatment can elicit high levels of anxiety in the therapist and discuss the critical role of having supervision when working with primitive unconscious phenomena in fragile patients. Outcome at termination and one-year follow-up will be presented.
References
Abbass, A. A. (2015). Reaching Through Resistance. Advanced Psychotherapy Techniques. Seven Leaves Press.
Abbass, A. A. (2017). Building capacity: Theory and application of the Graded format of ISTDP. 6th Sweden Immersion in ISTDP. Three-day presentation at Ersta Sköndal Bräcke Högskola, Stockholm, Sweden.
Abbass, A. A., Town, J. M., & Kisely, S. (2022). Intensive Short-term Dynamic Psychotherapy for Pain. Journal of Anesthesiology and Pain Therapy, 3(2), 4–7.
Abbass, A. A., & Schubiner, H. (2018). Hidden from View: A Clinician’s Guide to Physiologic Disorders (1st ed.). Mind Body Publishing.
Choudhury, T. K., John, K. C., Garrett, R. K., & Stagner, B. H. (2020). Considering psychodynamic therapy for older adults. Psychodynamic Psychiatry, 48(2), 152–162. https://doi.org/10.1521/PDPS.2020.48.2.152
Coughlin Della Selva, P. (1996). Intensive Short-Term Dynamic Psychotherapy. Karnac Books.
Davanloo, H. (2005). Intensive Short-Term Dynamic Psychotherapy, in: B. J. Sadock & V. A. Sadock. [Eds.]. Kaplan and Sadock’s Comprehensive Textbook of Psychiatry, pp. 2628-2652.
Farzadkia, M., Farhangi, A., & Abolghasemi, S. (2023). Comparison of Effectiveness of Intensive Short-Term Dynamic Psychotherapy and Mindfulness-Based Stress Reduction in Depression and Severity of Symptoms in Women with Fibromyalgia. Jundishapur Journal of Chronic Disease Care, 12(3). https://doi.org/10.5812/jjcdc-133803
Frederickson, J. (2013). Co-Creating Change: Effective dynamic therapy techniques. Seven Leaves Press.
Frederickson, J. (2020). Co-Creating Safety: Healing the Fragile Patient. Seven Leaves Press.
Freud, S. (1963). Introductory lectures on psychoanalysis: Part III. In J. Strachey (Ed. & Trans.), The standard edition of the complete psychological works of Sigmund Freud (Vol. 16, pp. 243–463). Hogarth Press. (Original work published 1917)
Kuhn, N. (2014). Intensive Short-Term Dynamic Psychotherapy. A Reference. North Charleston: Experient Publications.
Malda-Castillo, J., Howell, B., Russell, L., Town, J., Abbass, A., Perez-Algorta, G., & Valavanis, S. (2023). Intensive Short-Term Dynamic Psychotherapy (ISTDP) associated with healthcare reductions in patients with functional seizures. Epilepsy & Behavior. 141:109147. https://doi.org/10.1016/j.yebeh.2023.109147
Russell, L. A., Abbass, A. A., Allder, S. J., Kisely, S., Pohlmann-Eden, B., & Town, J. M. (2016). A pilot study of reduction in healthcare costs following the application of intensive short-term dynamic psychotherapy for psychogenic nonepileptic seizures. Epilepsy & Behavior, 63, 17–19. https://doi.org/10.1016/j.yebeh.2016.07.017
Russell, L., Abbass, A., & Allder, S. (2022). A review of the treatment of functional neurological disorder with intensive short-term dynamic psychotherapy. Epilepsy & Behavior, 130, 108657. https://doi.org/10.1016/j.yebeh.2022.108657
Shafiei, F., Dehghani, M., Lavasani, F. F., Manouchehri, M., & Mokhtare, M. (2024). Intensive short-term dynamic psychotherapy for irritable bowel syndrome: a randomized controlled trial examining improvements in emotion regulation, defense mechanisms, quality of life, and IBS symptoms. Frontiers in Psychology, 15(March), 1–12. https://doi.org/10.3389/fpsyg.2024.1293150
Shahverdi, Z. A., Dehghani, M., Ashouri, A., Manouchehri, M., & Mohebi, N. (2024). Effectiveness of intensive short-term dynamic psychotherapy for Tension-Type Headache (TTH): A randomized controlled trial of effects on emotion regulation, anger, anxiety, and TTH symptom severity. Acta Psychologica, 244(January), 104176. https://doi.org/10.1016/j.actpsy.2024.104176
Town, J. M., Abbass, A., & Campbell, S. (2024). Halifax somatic symptom disorder trial: A pilot randomized controlled trial of intensive short-term dynamic psychotherapy in the emergency department. Journal of Psychosomatic Research. https://doi.org/10.1016/j.jpsychores.2024.111889
Zhang, L., Mersky, J. P., Gruber, A. M. H., & Kim, J. Y. (2023). Intergenerational Transmission of Parental Adverse Childhood Experiences and Children’s Outcomes: A Scoping Review. Trauma, Violence, and Abuse, 24(5), 3251–3264. https://doi.org/10.1177/15248380221126186
