Can deep trauma or life-long angst heal quickly, in just a few psychotherapy sessions, or even one session? Yes, according to Patricia Coughlin, Ph.D., a proponent of Intensive Short-Term Dynamic Psychotherapy (ISTDP), and co-author, with David Malan, of Lives Transformed: A Revolutionary Method of Dynamic Psychotherapy (Karnac, 2007).

Dr. Coughlin spoke in Albuquerque, at the University of New Mexico IDEAS in Psychiatry Program, on Nov. 11, 2011.

Most brief psychotherapies aim to reduce symptoms such as anxiety or depression. ISTDP, however, delivers the deep insights and healing traditionally sought via years of daily psychoanalysis on the couch. Like psychoanalysis, ISTDP derives from the work of Sigmund Freud and attachment theorists. Yet ISTDP delivers results in just a few sessions. According to research, even one session can bring lasting results, such a getting off medications, or a reduction of panic attacks.

Dr. Coughlin explains, "The patient is in need of an experience, not an explanation." To enable this, the ISTDP therapist assumes a trance-like voice, helps the patient get in touch with childhood emotions and rage, and then adopt new ways of coping with these feelings. "We go to hell, and then come back with the patient," she said.

As an example, she showed a video of a star athlete who lost his drive to apply to college. He was a muscular, blond man who reportedly never shed a tear, even after his mother died. Under Dr. Coughlin's guidance, the man spoke about how angry he was throughout his childhood, at his mother's uncaring attitude toward him. He beat his dog regularly, simply because the pet's self-absorption reminded him of his mother. To Dr. Coughlin, he revealed that as a child, he wanted to choke his mother, to behead her, and to watch her blood spatter. After extensive descriptions of his violence-laden fantasies, he revealed that his rage was because he always needed her love. He envisioned her coffin floating on a river, and he as a small boy clinging atop it, not wanting to leave her. In touch with his anger, the patient resolved his grief, became engaged with the world, and applied to college-within eight sessions.

"My own feeling is that the DSM is not helpful," Dr. Coughlin said of the Diagnostic and Statistical Manual of Psychiatric Disorders. She explained, "It is descriptive, but tells us nothing about the cause."

Regarding anger management, she said, "Rage is reactive. We weren't born that way." The key is to get to the root of the conflict, and to resolve it, she said. By resolving anger and guilt, a patient can let go of destructive and sabotaging behaviors. The patient can stop acting out.

Even insurance companies have taken interest in the cost-savings ISTDP can bring. In study of emergency room patients with severe but unexplained symptoms, an average of 3.8 ISTDP sessions were given to 77 patients. Psychotherapy focused on the link between suppressed emotion and the physical symptoms. The patients had an 80 percent reduction in panic attacks and a 69 percent reduction in repeat visits to the hospital. In another study by Allan Abbass, ISTDP was administered to 89 patients who were considered highly impaired. One-third had been hospitalized or suicidal, one-fourth were unemployed and disabled, 46 percent took multiple medications, and 83 percent were considered treatment resistant, having failed three or more therapies. After an average of fifteen sessions, 71 percent had stopped all their medications. Eighteen of 22 returned to work. A savings of $402,523 yearly for three years resulted, in terms of prescriptions, disability payments, and physician and hospital costs.

A single ISTDP session was given to 30 patients in another study. Of the ten patients who took psychiatric medications, seven stopped the drugs. Two returned to work. One-third of the patients required no further treatment.

About the Author

Dora Calott Wang, M.D.

Dora Wang, M.D., is the author of The Kitchen Shrink: A Psychiatrist's Reflections on Healing in a Changing World. She is a psychiatrist based at the University of New Mexico.

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