While I include feminist, existential, and client-centered thinking in my approach to the work of therapy, my focus is on the role of unconscious forces in an individual’s response to trauma. My belief is that all of us experience trauma, even if the worst thing we have experienced was simply the painful separation of birth itself. I believe that the ultimate goal of therapy is the removal of all obstacles to the processing of the emotions that are locked inside the body, whether these have arisen as an adult, perhaps due to systemic causes, or in early childhood, as a result of attachment trauma.
A vast majority of presenting problems in therapy can be traced back to - or can have some active component involving – attachment issues. Anxiety provoking emotional states are created in us as children when we experience obstacles to our innate desire to bond to a primary caregiver (Abbass, 2015). As adults we bring this early formation of expectation for other’s behaviour to our relationships; it informs how we view ourselves and also the form and expression of any psychological problems we might experience (Kernberg, 1980).
While many of the strategies and coping mechanisms we develop in response to our early attachment experiences originally function as the best available option for survival when we are young, they can become the prime source of psychological suffering as we become adults (Abbass, 2015). They can cause somatic disturbances (Abbass, 2015), anxiety, depression, personality disorders (Abbass, Town, & Driessen, 2012), and interpersonal problems (Solbakken & Abbass, 2015).
It is important to be clear that this is automatic and unconscious behaviour, not something we are actively choosing to do. Psychodynamic theory understands the unconscious as having a major role in internal conflict and pathology and maintains that a resolution can be achieved through the therapeutic encounter - through two equally meaningful presences in the room who both share a commitment to addressing the anxiety, defenses, resistance, and complex feelings that arise during the work of therapy.
ISTDP therapy (Davanloo, 1990, 2000), focused as it is on attachment and an individual’s unconscious reactions to it, can facilitate an understanding of and healing from what often remains hidden from view because of the general focus we tend to otherwise have on dealing with symptoms rather than dealing with their causes. It makes sense that getting to the roots is the only way to ensure the weeds you want removed from your garden cannot return.
Abbass, A. (2015). Reaching Through Resistance. Seven Leaves Press: Kansas City, MO.
Abbass, A., Town, J. M., & Driessen, E. (2012). Intensive short-term dynamic psychotherapy: A systematic review and meta-analysis of outcome research. Harvard Review of Psychiatry, 20 (2), 97-108. doi: 10.3109/10673229.2012.677347
Davanloo, H. (1990). Unlocking the Unconscious: Selected Papers of Habib Davanloo, MD. John Wiley & Sons: Chichester, England.
Davanloo, H. (2000). Intensive Short-Term Dynamic Psychotherapy: Selected Papers of Habib Davanloo, MD. John Wiley & Sons: Chichester, England.
Kernberg, O. (1980). Internal World and External Reality. Aronson: New York, NY.
Solbakken, O. A. & Abbass, A. (2015). Intensive short-term dynamic residential treatment program for patients with treatment-resistant disorders. Journal of Affective Disorders, 181, 67–77. doi: 10.1016/j.jad.2015.04.003
Thoughts on Therapy and Mental Health