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EXPERIENTIAL SHORT-TERM DYNAMIC PSYCHOTHERAPY: A MANUAL

Ferruccio Osimo

 FormatISBN Price  
This Book is Available Paperback (6x9)9781410737878 $ 19.50  
This Book is Available Dust Jacket Hardcover (6x9)9781410737885 $ 28.50  
About the Book

Take your feelings and fly! This is the spirit of the present E-STDP manual. Psychotherapists are shown how the visceral experience of hitherto unconscious feelings can be brought about in the here and now of the session and used therapeutically. Special emphasis is given to the techniques, i.e. how to operate and when to use which type of therapeutic activity, according to the moment-to-moment feedback coming from the patient.

The book is meant for psychotherapists and other mental health professionals, wishing to upgrade their skills in the experiential and relational techniques, capable of accelerating the process of dynamic change. The detailed description of two cases, from initial evaluation to 2-year follow-up, will arouse the interest of all those who are fascinated by human life-stories.

About the Author

Ferruccio Osimo, M.D. is the President of IESA, the International Experiential STDP Association www.stdp.net . He is Adjunct Professor at Università Statale di Milano - Italy, and a Member of: OPIFER, the Italian Psychoanalytic Organization and Roster; the American Academy of Psychoanalysis and Dynamic Psychiatry; the Tavistock Society of Psychotherapists. His studies on the quality of therapeutic results are described in Psychodynamics, Training, and Outcome in Brief Psychotherapy (1992) co-authored with D.H. Malan. He recently published a chapter in the Comprehensive Handbook of Psychotherapy (Wiley, 2002). Dr. Osimo trains other professionals in E-STDP. For information on advanced courses: stdp.net@tin.it  (Italian Core Training) and  dfosha@aol.com (NYC Core Training).

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Introduction to the Dynamic Activities

As mentioned in chapter I, research data support the view that, in order to start a therapeutic process bringing about psychodynamic change, the patient needs to be enabled to experience his/her conflicting feelings with a sufficient intensity. For this reason, the sooner this emotional experience takes place with sufficient intensity and the dynamic process gets started, the briefer psychotherapy will be. Activation amounts to bringing about a sufficient increase of the intensity with which the conflicting feelings are being experienced by the patient.

Since what we need is to activate the conflicting feelings, represented as X in the Triangle of Self, and since these are kept unconscious by the defenses D and by anxiety A, we need to alter the complex balance existing among the three forces. It is certainly reasonable to act on the D corner, so as to weaken defenses, and on the A corner, thus regulating the anxiety loading the conflicting feelings. If, however, it were possible to act even on the X corner with a direct facilitation of emotional experiencing, we would actually be able to act on all the three forces involved in the maintenance of the conflict.

On the basis of these considerations, we will describe three main dynamic activities a therapist can engage in: Defense Restructuring, and Anxiety Regulation –respectively addressing defenses and anxiety- and the activity addressing the conflicting feelings, which we call Emotional Maieutics. A first general description of the three dynamic activities and of the corresponding attitudes and contributions of the therapist concludes this chapter and will be the theme of the next three.

Defense Restructuring (DA)

The purpose of this dynamic activity is to weaken the patient’s defenses, which are making a direct experience of the conflicting feelings impossible or insufficiently intense. The therapist:

(1)   concentrates on identifying all the defenses, so as to be able to mirror them to the patient;

(2)   follows the pathways enabling the patient to drop or put aside his/her usual defenses.

While restructuring the defenses, a therapist needs to be attentive and systematic, so as not to omit to address every single defense which is being employed. A sense of strategy and an ability to sustain confrontation may turn out useful for this activity.

Emotional Maieutics (XA)

The Oxford English dictionary defines “maieutic” as “pertaining to intellectual midwifery, i.e. to the Socratic process of helping a person to bring into full consciousness conceptions previously latent in his mind.” When applied to maieutics as used in the context of E-STDP, however, this definition can be paraphrased as follows: “pertaining to emotional midwifery, the process of helping a person to fully experience emotions present in him/herself.” What a midwife (= maia, in Ancient Greek) does is to help the mother to give birth, and to withstand the pain of delivery. The parallel with what a therapist can do is not just metaphorical. Emotions are in fact felt through the body and moving them out (in Latin e-movere means “move out” or “move from”) can indeed be painful. Our culture is sometimes forgetful of this aspect of emotions and I am grateful to Leigh McCullough for reminding me of this with her videorecorded cases. The therapist:

(1)   makes him/herself as much emotionally available to the patient as s/he can, giving him/her a sense of  being connected;

(2)   concentrates on the emotion that is being experienced, mirroring what s/he perceives and helping its bodily and verbal expression.         

The emphasis here is, for the therapist, on lending his/her physical and emotional perceptive capacity and on being close to the patient. Being at ease with one’s body and emotions, and having access to one’s instinctive, animal nature, are important qualities for a therapist willing to act maieutically.

Anxiety Regulation (AA)

Either autonomously on the patient’s part, or following on DA and XA, anxiety can become so intense as to act as a cloud, covering up all the other emotions. Consequently, in E-STDP, the main purpose of AA is to regulate the level of anxiety, making it compatible with emotional experiencing. The therapist:

(1)   explores, with the patient’s help, his/her ways of discharging/trying to control anxiety through his/her body, posture, expression, speech etc., and mirrors them to the patient;

(2)   acknowledges the patient’s anxiety as a normal manifestation within a relational situation charged with feelings.

From the foreword by David H. Malan

“Dr. Osimo explains the principles of his technique with great clarity. His special contribution consists of his detailed description of the various kinds of intervention available for dealing with each of the three corners of the Triangle of Conflict - defense, anxiety, and hidden feeling. In particular he introduces the concept of “maieutic” interventions for facilitating the full experience and open expression of deep feeling (the word is derived from the ancient Greek for “midwife”). Interventions of this kind have been used by many good therapists, but Dr. Osimo is the first to spell them out...”; “An especially favourable feature of the book is the exceptionally high proportion of illustrative case material, together with follow-up, from which the reader can gain an excellent idea of how the technique can be applied and the truly remarkable therapeutic results that it is able to achieve.”

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