Background
The study investigated the effectiveness of an Intensive Short-Term Dynamic (ISTDP) r... more Background
The study investigated the effectiveness of an Intensive Short-Term Dynamic (ISTDP) residential treatment program for patients with treatment resistant anxiety- and/or depressive disorders, with and without comorbid personality disorders.
Method
A non-randomized controlled trial examined the effects of an eight week intensive residential treatment program based on principles from ISTDP. Patients (N=60), who had repeated prior treatment failure for current mental disorder, sufficient dysfunction to warrant hospitalization, and evidencing capacity to take an intrapsychic perspective on own problems, were included. Outcome variables included measures of target complaints (depression/anxiety, social role dysfunction, and interpersonal distress), general symptom distress, and interpersonal functioning. Measures were administered throughout and after treatment. Change was assessed by multilevel growth curve modeling. Changes during and after treatment were compared to those reported by a sub-sample of wait-list controls taking treatment as usual (N=30).
Results
The treatment group evidenced significant improvements on all measures. By contrast, receiving treatment as usual while on the wait-list did not yield significant changes. Effect sizes in the treatment group were consistently large at both termination and follow-up. Fourteen months after treatment 50.0% of patients had recovered in terms of target complaints. Approximately 53.3% and 48.3%, respectively, had recovered in terms of general symptom distress and interpersonal functioning.
Limitations
Limitations included a relatively small sample size, inability to discern the effectiveness of separate components of the treatment program, and lack of randomization of patients to wait-list and treatment.
Conclusion
ISTDP-based residential treatment with an eight-week time-limit appears to be effective for alleviating common and severe, treatment resistant mental disorders. The treatment program was superior to receiving treatment as usual while on the wait-list. Participation in the program quickly reduced target complaints, symptoms and interpersonal problems for patients who, based on previous treatment experiences, were expected to fare poorly in treatment. Gains were consistently maintained or improved further at follow-up. Results are promising for patients with chronic debilitating problems who often do not profit from traditional psychiatric treatment.
The objective is to study the effectiveness of Intensive Short-Term Dynamic Psychotherapy (ISTDP)... more The objective is to study the effectiveness of Intensive Short-Term Dynamic Psychotherapy (ISTDP) trial therapies. In a tertiary psychotherapy service, Brief Symptom Inventory (BSI), Inventory of Interpersonal Problems (IIP) medication use, and need for further treatment were evaluated before versus 1-month post trial therapy in a sequential series of 30 clients. Trial therapies were interviews with active focus on emotions and how they are experienced. The interviews resulted in statistically significant improvements on all BSI subscales and one of the IIP subscales. One-third of clients required no further treatment, seven stopped medications, and two returned to work following trial therapy. The ISTDP trial therapy appeared to be clinically effective and cost effective. Future research directions are discussed. [Brief Treatment and Crisis Intervention 8:164-170 (2008)]
Psychotherapy supervision and training are now widely available online. However, many supervisors... more Psychotherapy supervision and training are now widely available online. However, many supervisors still may be unclear on how online supervision actually works, or what it actually looks like in practice. In this article, three case examples of online videoconference-based supervision programs will be described. Partial transcripts from two online supervision sessions are provided. The benefits and limitations of online supervision are discussed, including discussion of supervision process, ethics, privacy, and security.
Journal of the American Psychoanalytic Association, 2014
We are writing regarding Paolo Migone's "What Does 'Brief' Mean?" (JAPA 62/4), in which he discus... more We are writing regarding Paolo Migone's "What Does 'Brief' Mean?" (JAPA 62/4), in which he discusses various issues related to brief therapy from the perspective of psychoanalysis. We found the paper interesting and concur with many of his views. Our own clinical and research focus is in the area of Habib Davanloo's model, intensive short-term dynamic psychotherapy (ISTDP). From this perspective and with an up-todate understanding of ISTDP, we are writing to clarify certain aspects of the model. (2012). A meta-analysis of psychodynamic psychotherapy outcomes: Evaluating the effects of research-specific procedures. Psychotherapy 49:276-290.
There is growing evidence from RCTs supporting the efficacy of both short-term (STPP) and long-te... more There is growing evidence from RCTs supporting the efficacy of both short-term (STPP) and long-term psychodynamic psychotherapy (LTPP) for specific mental disorders. In a first series of meta-analyses, LTPP was shown to be superior to shorter forms of psychotherapy, especially in complex mental disorders. However, the evidence for LTPP has not gone unchallenged. After several responses have addressed the raised concerns, a recent meta-analysis by Smit and colleagues (2012) again challenges the efficacy of LTPP. From a methodological perspective, a critical analysis of the Smit et al. meta-analysis was performed. Furthermore, we conducted two new metaanalyses adding studies not included in previous meta-analyses. The purpose was to examine whether the results of the previous meta-analyses are stable. Due to differing inclusion criteria, the meta-analysis by Smit et al. actually compared LTPP to other forms of long-term psychotherapy. Thus, they essentially showed that LTPP was as eff...
More than 20 years ago Habib Davanloo coined the term unlocking of the unconscious to describe ho... more More than 20 years ago Habib Davanloo coined the term unlocking of the unconscious to describe how the psychodynamic concept of the human unconscious can become accessible using the technique of Intensive Short-Term Dynamic Psychotherapy (ISTDP). According to Davanloo, the possibility that unconscious material will be revealed is greatly increased when therapeutic efforts promote dominance of the unconscious therapeutic alliance over unconscious resistance. When these ingredients are present there is a psychic shift that allows unacceptable painful feelings to come to the surface. Toward adding further empirical support for the concept, in this article we compare outcomes between patients who experienced one or more major unlocking of the unconscious (N = 57) to those who did not experience major unlocking (N = 32) during ISTDP treatment. Significant and widespread differences were seen between these two groups, those with major unlocking had greater symptom reduction, interpersonal...
After participating in this educational activity, the reader should be better able to evaluate th... more After participating in this educational activity, the reader should be better able to evaluate the empirical evidence for pre/post changes in psychoanalysis patients with complex mental disorders, and assess the limitations of the meta-analysis. The effectiveness of psychoanalysis is still a controversial issue, despite increasing research efforts. To investigate the empirical evidence for psychoanalysis by means of a systematic review of the literature and a meta-analysis of the research data. A systematic literature search was undertaken to find studies regarding the effectiveness of psychoanalysis, published between 1970 and 2011. A meta-analysis was performed. Fourteen studies (total n = 603) were included in the meta-analysis. All but one were pre/post cohort studies. At treatment termination, the mean pre/post effect size across all outcome measures was 1.27 (95% confidence interval [CI], 1.03-1.50; p < .01). The mean pre/post effect size for symptom improvement was 1.52 (9...
Clinical supervision and training are now widely available online. In this article, three of the ... more Clinical supervision and training are now widely available online. In this article, three of the most accessible and widely adopted new developments in clinical supervision and training technology are described: Videoconference supervision, cloud-based file sharing software, and clinical outcome tracking software. Partial transcripts from two online supervision sessions are provided as examples of videoconferencebased supervision. The benefits and limitations of technology in supervision and training are discussed, with an emphasis on supervision process, ethics, privacy, and security. Recommendations for supervision practice are made, including methods to enhance experiential learning, the supervisory working alliance, and online security. C Psychotherapy supervision and training are rapidly moving online. A Google search reveals psychotherapy training via Internet-based videoconference in virtually all major psychotherapeutic modalities, including acceptance and commitment therapy (ACT), cognitive-behavioral therapy (CBT), dialectical-behavioral therapy (DBT), emotion-focused therapy (EFT), eyemovement desensitization and reprocessing (EMDR), intensive short-term dynamic psychotherapy (ISTDP), and psychoanalysis, among others. Clinical supervisors are quickly integrating numerous new technologies into their practice, including webcams, tablet computers (e.g., the iPad), the Internet "cloud," web-based software for tracking clinical outcomes, and smartphone applications, or "apps" (e.g., www.isupelive.com).
The way that healthcare providers feel, both within themselves and towards their patients, may in... more The way that healthcare providers feel, both within themselves and towards their patients, may influence their clinical performance and impact patient safety, yet this aspect of provider behavior has received relatively little attention. How providers feel--their emotional state --may be influenced by a variety of factors including characteristics of the patient, ambient conditions in the healthcare setting, diurnal, circadian, infradian and seasonal variables, as well as endogenous disorders of the individual provider. Analogous to cognitive errors, the provider's emotional state may also contribute to errors, which can be referred to as 'emotional errors'. Clinical reasoning and judgment may be particularly susceptible to emotional influence, especially those processes that rely on intuitive judgments. However, emotional influences on decision making and patient safety have attracted little attention to date. To reduce emotional errors, the level of awareness of these factors should be raised. Emotional skills training should be incorporated into undergraduate and postgraduate education. Specifically, clinical teaching should promote more openness and discussion about provider's feelings towards patients. Strategies should be developed to help providers identify and de-bias themselves against untoward emotional influences that may impact care, particularly in the emotionally evocative patient. Psychiatric conditions within the provider that may compromise patient safety need to be promptly detected, diagnosed and managed.
Background
The study investigated the effectiveness of an Intensive Short-Term Dynamic (ISTDP) r... more Background
The study investigated the effectiveness of an Intensive Short-Term Dynamic (ISTDP) residential treatment program for patients with treatment resistant anxiety- and/or depressive disorders, with and without comorbid personality disorders.
Method
A non-randomized controlled trial examined the effects of an eight week intensive residential treatment program based on principles from ISTDP. Patients (N=60), who had repeated prior treatment failure for current mental disorder, sufficient dysfunction to warrant hospitalization, and evidencing capacity to take an intrapsychic perspective on own problems, were included. Outcome variables included measures of target complaints (depression/anxiety, social role dysfunction, and interpersonal distress), general symptom distress, and interpersonal functioning. Measures were administered throughout and after treatment. Change was assessed by multilevel growth curve modeling. Changes during and after treatment were compared to those reported by a sub-sample of wait-list controls taking treatment as usual (N=30).
Results
The treatment group evidenced significant improvements on all measures. By contrast, receiving treatment as usual while on the wait-list did not yield significant changes. Effect sizes in the treatment group were consistently large at both termination and follow-up. Fourteen months after treatment 50.0% of patients had recovered in terms of target complaints. Approximately 53.3% and 48.3%, respectively, had recovered in terms of general symptom distress and interpersonal functioning.
Limitations
Limitations included a relatively small sample size, inability to discern the effectiveness of separate components of the treatment program, and lack of randomization of patients to wait-list and treatment.
Conclusion
ISTDP-based residential treatment with an eight-week time-limit appears to be effective for alleviating common and severe, treatment resistant mental disorders. The treatment program was superior to receiving treatment as usual while on the wait-list. Participation in the program quickly reduced target complaints, symptoms and interpersonal problems for patients who, based on previous treatment experiences, were expected to fare poorly in treatment. Gains were consistently maintained or improved further at follow-up. Results are promising for patients with chronic debilitating problems who often do not profit from traditional psychiatric treatment.
The objective is to study the effectiveness of Intensive Short-Term Dynamic Psychotherapy (ISTDP)... more The objective is to study the effectiveness of Intensive Short-Term Dynamic Psychotherapy (ISTDP) trial therapies. In a tertiary psychotherapy service, Brief Symptom Inventory (BSI), Inventory of Interpersonal Problems (IIP) medication use, and need for further treatment were evaluated before versus 1-month post trial therapy in a sequential series of 30 clients. Trial therapies were interviews with active focus on emotions and how they are experienced. The interviews resulted in statistically significant improvements on all BSI subscales and one of the IIP subscales. One-third of clients required no further treatment, seven stopped medications, and two returned to work following trial therapy. The ISTDP trial therapy appeared to be clinically effective and cost effective. Future research directions are discussed. [Brief Treatment and Crisis Intervention 8:164-170 (2008)]
Psychotherapy supervision and training are now widely available online. However, many supervisors... more Psychotherapy supervision and training are now widely available online. However, many supervisors still may be unclear on how online supervision actually works, or what it actually looks like in practice. In this article, three case examples of online videoconference-based supervision programs will be described. Partial transcripts from two online supervision sessions are provided. The benefits and limitations of online supervision are discussed, including discussion of supervision process, ethics, privacy, and security.
Journal of the American Psychoanalytic Association, 2014
We are writing regarding Paolo Migone's "What Does 'Brief' Mean?" (JAPA 62/4), in which he discus... more We are writing regarding Paolo Migone's "What Does 'Brief' Mean?" (JAPA 62/4), in which he discusses various issues related to brief therapy from the perspective of psychoanalysis. We found the paper interesting and concur with many of his views. Our own clinical and research focus is in the area of Habib Davanloo's model, intensive short-term dynamic psychotherapy (ISTDP). From this perspective and with an up-todate understanding of ISTDP, we are writing to clarify certain aspects of the model. (2012). A meta-analysis of psychodynamic psychotherapy outcomes: Evaluating the effects of research-specific procedures. Psychotherapy 49:276-290.
There is growing evidence from RCTs supporting the efficacy of both short-term (STPP) and long-te... more There is growing evidence from RCTs supporting the efficacy of both short-term (STPP) and long-term psychodynamic psychotherapy (LTPP) for specific mental disorders. In a first series of meta-analyses, LTPP was shown to be superior to shorter forms of psychotherapy, especially in complex mental disorders. However, the evidence for LTPP has not gone unchallenged. After several responses have addressed the raised concerns, a recent meta-analysis by Smit and colleagues (2012) again challenges the efficacy of LTPP. From a methodological perspective, a critical analysis of the Smit et al. meta-analysis was performed. Furthermore, we conducted two new metaanalyses adding studies not included in previous meta-analyses. The purpose was to examine whether the results of the previous meta-analyses are stable. Due to differing inclusion criteria, the meta-analysis by Smit et al. actually compared LTPP to other forms of long-term psychotherapy. Thus, they essentially showed that LTPP was as eff...
More than 20 years ago Habib Davanloo coined the term unlocking of the unconscious to describe ho... more More than 20 years ago Habib Davanloo coined the term unlocking of the unconscious to describe how the psychodynamic concept of the human unconscious can become accessible using the technique of Intensive Short-Term Dynamic Psychotherapy (ISTDP). According to Davanloo, the possibility that unconscious material will be revealed is greatly increased when therapeutic efforts promote dominance of the unconscious therapeutic alliance over unconscious resistance. When these ingredients are present there is a psychic shift that allows unacceptable painful feelings to come to the surface. Toward adding further empirical support for the concept, in this article we compare outcomes between patients who experienced one or more major unlocking of the unconscious (N = 57) to those who did not experience major unlocking (N = 32) during ISTDP treatment. Significant and widespread differences were seen between these two groups, those with major unlocking had greater symptom reduction, interpersonal...
After participating in this educational activity, the reader should be better able to evaluate th... more After participating in this educational activity, the reader should be better able to evaluate the empirical evidence for pre/post changes in psychoanalysis patients with complex mental disorders, and assess the limitations of the meta-analysis. The effectiveness of psychoanalysis is still a controversial issue, despite increasing research efforts. To investigate the empirical evidence for psychoanalysis by means of a systematic review of the literature and a meta-analysis of the research data. A systematic literature search was undertaken to find studies regarding the effectiveness of psychoanalysis, published between 1970 and 2011. A meta-analysis was performed. Fourteen studies (total n = 603) were included in the meta-analysis. All but one were pre/post cohort studies. At treatment termination, the mean pre/post effect size across all outcome measures was 1.27 (95% confidence interval [CI], 1.03-1.50; p < .01). The mean pre/post effect size for symptom improvement was 1.52 (9...
Clinical supervision and training are now widely available online. In this article, three of the ... more Clinical supervision and training are now widely available online. In this article, three of the most accessible and widely adopted new developments in clinical supervision and training technology are described: Videoconference supervision, cloud-based file sharing software, and clinical outcome tracking software. Partial transcripts from two online supervision sessions are provided as examples of videoconferencebased supervision. The benefits and limitations of technology in supervision and training are discussed, with an emphasis on supervision process, ethics, privacy, and security. Recommendations for supervision practice are made, including methods to enhance experiential learning, the supervisory working alliance, and online security. C Psychotherapy supervision and training are rapidly moving online. A Google search reveals psychotherapy training via Internet-based videoconference in virtually all major psychotherapeutic modalities, including acceptance and commitment therapy (ACT), cognitive-behavioral therapy (CBT), dialectical-behavioral therapy (DBT), emotion-focused therapy (EFT), eyemovement desensitization and reprocessing (EMDR), intensive short-term dynamic psychotherapy (ISTDP), and psychoanalysis, among others. Clinical supervisors are quickly integrating numerous new technologies into their practice, including webcams, tablet computers (e.g., the iPad), the Internet "cloud," web-based software for tracking clinical outcomes, and smartphone applications, or "apps" (e.g., www.isupelive.com).
The way that healthcare providers feel, both within themselves and towards their patients, may in... more The way that healthcare providers feel, both within themselves and towards their patients, may influence their clinical performance and impact patient safety, yet this aspect of provider behavior has received relatively little attention. How providers feel--their emotional state --may be influenced by a variety of factors including characteristics of the patient, ambient conditions in the healthcare setting, diurnal, circadian, infradian and seasonal variables, as well as endogenous disorders of the individual provider. Analogous to cognitive errors, the provider's emotional state may also contribute to errors, which can be referred to as 'emotional errors'. Clinical reasoning and judgment may be particularly susceptible to emotional influence, especially those processes that rely on intuitive judgments. However, emotional influences on decision making and patient safety have attracted little attention to date. To reduce emotional errors, the level of awareness of these factors should be raised. Emotional skills training should be incorporated into undergraduate and postgraduate education. Specifically, clinical teaching should promote more openness and discussion about provider's feelings towards patients. Strategies should be developed to help providers identify and de-bias themselves against untoward emotional influences that may impact care, particularly in the emotionally evocative patient. Psychiatric conditions within the provider that may compromise patient safety need to be promptly detected, diagnosed and managed.
Uploads
Papers by Allan Abbass
The study investigated the effectiveness of an Intensive Short-Term Dynamic (ISTDP) residential treatment program for patients with treatment resistant anxiety- and/or depressive disorders, with and without comorbid personality disorders.
Method
A non-randomized controlled trial examined the effects of an eight week intensive residential treatment program based on principles from ISTDP. Patients (N=60), who had repeated prior treatment failure for current mental disorder, sufficient dysfunction to warrant hospitalization, and evidencing capacity to take an intrapsychic perspective on own problems, were included. Outcome variables included measures of target complaints (depression/anxiety, social role dysfunction, and interpersonal distress), general symptom distress, and interpersonal functioning. Measures were administered throughout and after treatment. Change was assessed by multilevel growth curve modeling. Changes during and after treatment were compared to those reported by a sub-sample of wait-list controls taking treatment as usual (N=30).
Results
The treatment group evidenced significant improvements on all measures. By contrast, receiving treatment as usual while on the wait-list did not yield significant changes. Effect sizes in the treatment group were consistently large at both termination and follow-up. Fourteen months after treatment 50.0% of patients had recovered in terms of target complaints. Approximately 53.3% and 48.3%, respectively, had recovered in terms of general symptom distress and interpersonal functioning.
Limitations
Limitations included a relatively small sample size, inability to discern the effectiveness of separate components of the treatment program, and lack of randomization of patients to wait-list and treatment.
Conclusion
ISTDP-based residential treatment with an eight-week time-limit appears to be effective for alleviating common and severe, treatment resistant mental disorders. The treatment program was superior to receiving treatment as usual while on the wait-list. Participation in the program quickly reduced target complaints, symptoms and interpersonal problems for patients who, based on previous treatment experiences, were expected to fare poorly in treatment. Gains were consistently maintained or improved further at follow-up. Results are promising for patients with chronic debilitating problems who often do not profit from traditional psychiatric treatment.
The study investigated the effectiveness of an Intensive Short-Term Dynamic (ISTDP) residential treatment program for patients with treatment resistant anxiety- and/or depressive disorders, with and without comorbid personality disorders.
Method
A non-randomized controlled trial examined the effects of an eight week intensive residential treatment program based on principles from ISTDP. Patients (N=60), who had repeated prior treatment failure for current mental disorder, sufficient dysfunction to warrant hospitalization, and evidencing capacity to take an intrapsychic perspective on own problems, were included. Outcome variables included measures of target complaints (depression/anxiety, social role dysfunction, and interpersonal distress), general symptom distress, and interpersonal functioning. Measures were administered throughout and after treatment. Change was assessed by multilevel growth curve modeling. Changes during and after treatment were compared to those reported by a sub-sample of wait-list controls taking treatment as usual (N=30).
Results
The treatment group evidenced significant improvements on all measures. By contrast, receiving treatment as usual while on the wait-list did not yield significant changes. Effect sizes in the treatment group were consistently large at both termination and follow-up. Fourteen months after treatment 50.0% of patients had recovered in terms of target complaints. Approximately 53.3% and 48.3%, respectively, had recovered in terms of general symptom distress and interpersonal functioning.
Limitations
Limitations included a relatively small sample size, inability to discern the effectiveness of separate components of the treatment program, and lack of randomization of patients to wait-list and treatment.
Conclusion
ISTDP-based residential treatment with an eight-week time-limit appears to be effective for alleviating common and severe, treatment resistant mental disorders. The treatment program was superior to receiving treatment as usual while on the wait-list. Participation in the program quickly reduced target complaints, symptoms and interpersonal problems for patients who, based on previous treatment experiences, were expected to fare poorly in treatment. Gains were consistently maintained or improved further at follow-up. Results are promising for patients with chronic debilitating problems who often do not profit from traditional psychiatric treatment.