I appreciate the sophisticated reporting on short-term dynamic psychotherapy (STDP) (“Making a Case for Quick, Confrontational Therapy,” Nov. 25). Psychiatrists Haig Koshkarian’s and Jay Shaffer’s critiques of psychiatrist Tom Trunnell’s case for STDP are typical of therapists’ misunderstanding of STDP.
Koshkarian is concerned that STDP is not being “fit to the patients and their needs.” Shaffer speaks of “one-size-fits-all therapy.” They need not be concerned. I have observed psychiatrist Habib Davanloo, creator of STDP, (during four seminars) and Trunnell (during two courses) working with patients. They carefully screen them for suitability for STDP. Then, they fit STDP--which involves more than confrontational techniques--to their patients’ problems.
Shaffer believes that patients who benefit most from short-term therapy typically have problems related to a single event or issue rather than longstanding problems. This is true for some schools of short-term therapy, but Davanloo’s emphasizes multiple-issue and longstanding problems. STDP is particularly helpful for ingrained traits like passivity, emotional detachment and intellectualization.
I, too, misunderstood STDP. After viewing my first Davanloo videotape in 1984, I was stunned. I could not believe what I was seeing! He was abusing his patient--not respecting the patient’s feelings and privacy! His concepts and techniques clashed with my education and years of practicing traditional dynamic psychotherapy.
By the end of that seminar, I realized that Davanloo was not being abusive but a “relentless healer.” His patients appreciated his showing them they could quickly break through their walls of fear so as to confront their pain, sadness, rage and wasted potential, and then quickly begin to master their problems.
My knowledge of STDP has helped more of my patients rid themselves of problems permanently and in less time. With unsuitable or long-term patients, I modified Davanloo’s methods and accomplished in, say, 80 weekly sessions what typically would have required 120 sessions.
Lastly, some words on Trunnell’s provocative statement about the potential influence of STDP: “Traditional (dynamic) psychotherapy is going to die like a brontosaurus.” Some specifics of what I believe are going to die are:
* Emphasis on passive methods of coping with the core problem of dynamic psychotherapy--resistances and defenses against psychological pain.
* The limited technique repertoire for helping patients with the basic emotions of anxiety, sadness, rage and lust.
* Viewing patients as being more fragile than they really are.
* The belief that longstanding problems require long-term therapy.
LAWRENCE J. BOOKBINDER