ISTDP and Its Contribution to the Understanding and Treatment of Psychotic Disorders

In this article, we review Davanloo's metapsychology of the unconscious and how it can contribute to the current psychodynamic understanding and treatment of psychosis. In this framework, current attachment and emotions become connected with unconscious conflict-laden feelings about early attachment trauma at the core of the unconscious conflict. These conflict-laden feelings mobilize unconscious anxiety and defenses, which are alongside or, in and of themselves, constitute the entire picture of psychosis. Those patients with low emotional capacities are provided specific therapeutic techniques to bolster anxiety tolerance while those more defended patients are offered means to begin to accept and experience the feelings they have about present and past adverse experiences including those caused by psychosis itself. Case and case series research have shown this model to be clinically effective and cost effective as an adjunct to care. Case vignettes will describe the assessment of capacities and treatment frame for patients with a history of psychosis. Davanloo's metapsychology of the unconscious offers an important contribution to the current psychodynamic understanding of psychosis by considering the role of attachment, emotions and unconscious conflict and addressing these through specific psychodynamic interventions.