Over two decades on two continents Robert J. Neborsky MD and Josette ten Have-de Labije PsyD have struggled to define and perfect the psychotherapeutic methods of Habib Davanloo MD. Both in individual practice and partnered study they have worked carefully to master the theory and application of the clinician's revolutionary approach.
These companion volumes represent their best attempts to translate Davanloo's clinical genius into language that students and researchers can use to help psychoneurotic patients who suffer from what the authors describe as "attachment trauma." As David Malan MD advised "This technique needs to be modified and softened if it is to be accepted by the majority of therapists."
Readers will discover that Neborsky and ten Have-de Labije have greatly advanced the science and teaching of Intensive Short-Term Dynamic Psychotherapy in these collections which also serve as an introduction to their forthcoming textbook Roadmap to the Unconscious (Karnac 2010).
Josette ten Have-de Labije psychologist-psychotherapist and clinical psychologist started her professional career in 1972 at the department for Neuro and Psychophysiology of the Free University of Brussels. She has since worked in the Netherlands at a public mental health center for ambulant (non-residential) patients as coordinator of the Behavior Therapy Department and member of the Diagnostic Staff. Since 1990 ten Have-de Labije who is Dutch by birth has worked in private practice.
She has given training and supervisions to ISTDP core groups and advanced core groups and led workshops and seminars all over the world. She has supervised and and taught post-graduate courses in behavior therapy at the Universities of Utrecht and Amsterdam and several post-doctorate courses and workshops. As supervisor and trainer of the Netherlands Foundation for Short-Term Dynamic Psychotherapy and of the South California Institute for AB-STDP she has led several post-doctorate courses and workshops. She has organized several national and international conferences on Behavior Therapy cancer treatment and mental health and on ISTDP. She is editor-in-chief of the Ad Hoc Bulletin of Short-Term Dynamic Psychotherapy. She published the book Mastering Intensive Short-Term Dynamic Psychotherapy: A Roadmap to the Unconscious with Robert J. Neborsky M.D. in 2012.
Review of "Precious Twins " the Collected Works of Josette ten Have-de Labije and Robert Neborsky
1 February 2016 By IEDTA Website
(Originally posted 16 November 2014) The Collected Writings of Josette ten Have-de Labije PsyDand The Collected Writings of Robert J. Neborsky MD. Del Mar CA: Unlocking Press 2010.
Reviewed by Arno Goudsmit PhD
Reading this double volume of the collected writings of Josette ten Have-de Labije and Rob Nerborsky one comes to be impressed. The books offer a wide variety of reflections on and interpretations of Davanloo's teachings. They are full of wonderful ideas and even more importantly full of the authors' personal interpretations and wisdom on how to bring these ideas into fruitful therapeutic praxis.
Let's start with some critical remarks and let's end with the good news. While reading one inevitably comes across topics that have been covered already in a previous chapter or that will be elaborated in more detail in a later chapter. These repetitions are unavoidable in a straightforward compilation of papers written over more than a decade. It is pointless to enumerate the second and third times one comes across passages already met elsewhere. This is a drawback of the books. They would have deserved a rewritten presentation as a twin monograph a digraph. And they would at least have deserved more rigorous editing. For instance on p. R- 10 we find a real Dutch "nee" left to itself a justified correction memo apparently not elaborated by oversight.
But there are better things to note. The project of co-publishing the two authors' collected writings emphasizes their close collaboration and kinship. Nevertheless there are also differences of scope. Josette and Rob differ in their emphases and priorities. For Josette the major goal seems to be the elaboration of Davanloo's work in terms of more specific criteria for recognizing behavioral cues and in terms of more specific descriptions of therapeutic technique. For Rob the major goal seems to be a theoretical reflection on issues of attachment and loss. This is not just a theoretical hobby it is a way of founding and justifying his attachment-based approach to ISTDP.
Rob's emphasis is upon attachment and object relations. His theoretical remarks on the Klein-Bowlby issues are of particular importance. Take the "re-united Klein-Bowlby camp" (p. R-121). It is that current events and persons on the one hand and on the other hand the archetypical unconscious phantasies and psychological needs of the infants may meet and mix up in the etiology of neurosis. Such meeting enables real life to become a locus of truly new and truly deep experiences that affect old objects and old relationships and vice versa a locus where old issues may influence current experiences and affects. If this has been Davanloo's original idea it is at least Rob's focus: "[Davanloo] has unknowingly healed the split between Klein and Bowlby by integrating the role of actual relationship into the pathology of the superego" (p. R-121). These ideas help the therapist to move freely between current past and transferential issues link and allude to them together and weave metaphorical relations between them. And this is what Rob is demonstrating in his vignettes and what makes up the fluidity of mind that constitutes the core of his craft.
Another important contribution Rob makes is the differentiation between shame and guilt. This text I think is among the best of original theorizing presented in our field of EDT. As a result of pointing out that shame originates from a developmental stage earlier than guilt we may come to deal with a patient's shame differently as an anticipation of (projected) social expulsion (p. R-92) rather than as the regular superego issue.
Josette's emphasis and scope are different from Rob's. She presents herself as a true disciple of the Master elucidating and expanding his ideas whereas her own creative additions and valuable elaborations are modestly not announced explicitly as new work. But in fact that's what they are offering fresh emphases combinations and insights.
Josette's project is to offer a practical way of applying Davanloo's concepts to add empirical criteria both for diagnosis and for therapeutic technique so that the practitioner's work may be guided by more and easier empirical tokens and by concepts that are defined more in detail. She uses the term "maintaining Davanloo's discovery" in the title of several papers. Her major commitment is to describe executable steps for the various aspects of his technique and to describe observation criteria ("operationalizations") for the theoretical concepts so that theory and technique can be practiced better and taught better. This culminates in a variety of schemas and schedules the most famous of which is known as the "red and green traffic lights" (p. J-105) a detailed flow chart of decision criteria and feedback loops of action steps.
However it is not always clear which purpose (practicability of the technique concreteness of the observation criteria or both) is being served by a particular schema. A listing of observation criteria may be in need of some inner structure. For instance the various criteria for a patient's full experience of emotions (e.g. p. J-182) have more interdependence than an enumeration may convey. How are these criteria interrelated and how can these interrelations be expressed with maximum parsimony? Likewise which of the steps that a therapist has to perform (pp. J-183ff) are meant to be consecutive in time and which steps are logical derivations? The relations between terms may be missing as in the extensive table on verbal versus nonverbal defense mechanisms at the levels of stimulus and response (pp. J-92ff). Without a detailed elaboration this lenghty table is not maximally effective for teaching.
A pitfall of her didactic approach I feel is that the reader may become immersed in rules and details that make up a certain codification of the technique whereas the practicing therapist would also have been helped by tools for simplifying things such as to learn how Josette manages to apply her astounding clarity of mind in complex situations. Accordingly the application of codified technique may suffer from some static qualities so that for those mastering the technique what matters is to preserve one's freedom that is one's capacity to vary and to experiment with this technique and not be overrun by it.
On the other hand her writings and teachings her vignettes and theoretical reflections have shown her clarity of mind and the precision of her craft. She is capable of integrating so many of the details she describes of finding creative modes for addressing a patient's healthy and adaptive parts and of joining with these and empowering them for a joint effort against superego pathology. Her recommendations for making sharp distinctions between ego and superego are most helpful for a therapist who finds himself lost in a labyrinth of resistances. Likewise the idea that a benevolent superego may come to replace the punitive one is self-evident only due to her lucid clarifications and it helps the therapist distinguish pathological from healthy superego issues.
I would have liked to see more about her personal style of intimidating the patient's superego. Though not described in these terms it deserves recognition and serious study in itself as a valuable technique. The therapist may say:
"Yes that's what you do. Then you behave self-negligent. I ask you whether you understand my language." (p. J- 61)
"You think so too you agree with that not because I say so but because you see the sense of it?" (p. J-118)
These lines do not sound very nice but the truly reassuring effect they may have when addressed to a patient with a vindictive superego is not to be underestimated. This way of dealing with superego pathology deserves serious study and recognition. It demands from the therapist a capacity to make an exact distinction between superego and adaptive ego so that the patient will feel supported rather than attacked. It demands an exactness of timing and strength so that confusion is avoided. It demands courage.
In conclusion in this twin volume these two major proponents of ISTDP allow us to enter into their workplaces and have us watch the thoughts the tools and the instruments as they are using them. Thank you Josette and Rob!