Chartered Clinical Psychologist and ISTDP Trainer and Supervisor

Q. How did you first become interested in ISTDP?

A. In 2006, browsing through the magazine of the Division of Clinical Psychology British Psychological Society, I came across an advert placed by Jennie Malan about an ISTDP conference to be held in Oxford. I remember she promised “revolutionary” therapy techniques and I remember thinking something along the lines of: ‘Well that seems like a bit of overblown advertising but then David Malan is highly respected, so…I’ll go along anyway.”

I was proved wrong. The techniques were revolutionary, and I I had no idea how embarking on this training would change my life, both personally and professionally.

Q. Could you tell us a bit about your early background as a psychologist – how did you start out?

A. I started my career as a researcher in the early 1990s, at the Centre for the Study of Violence & Reonciliation (CSVR) in Johannesburg, South Africa. This was a not-for-profit organization affiliated to the University of the Witwatersrand. After my training as a clinical psychologist, I went back to work at the Trauma Clinic of the CSVR, which provided treatment to survivors of criminal and political violence. I developed a specialisation in treatment of Traumatic Stress and went on to become the clinical supervisor of the clinic.

By uncanny coincidence (if you believe in coincidence, that is), years later I discovered that in developing ISTDP techniques Davanloo had been strongly influenced by his work with survivors of a nightclub fire. He realised that in trauma victims, unconscious conflicts and buried emotions were readily accessibly and available for reworking. ISTDP techniques focus on creating an internal crisis in patients in the consulting room in order to ‘unlock’ the unconscious.

There are similarities between the brief-term model developed in South Africa to treat trauma survivors, and some of the tenets of ISTDP. Both approaches stress that developing a sense of mastery is key to the person’s recovery; that a cognitive understanding of one’s own mental processes is important; and that it is critical to access the retaliatory rage as a result of victimisation, as well as any associated (survivor) guilt and grief over losses.

Q. Could you describe your training in ISTDP?

A. Following the Oxford Conference in 2006, I joined the first UK Core Group Training taught by international trainers Patricia Coughlin, Rob Neborsky and Jon Frederickson. I was hooked. When I’d finished my first three years of core training I did a further year of advanced training and I was then privileged to ‘shadow’ Robert Neborsky through two more Core Training groups before I started teaching and supervising myself.

Q. Have there been any ISTDP clinicians who have been a particular influence on your work?

A. I am privileged to have been exposed to the work of several of the leading clinicians in ISTDP. In addition to the trainers mentioned above, I am strongly influenced by the work of Josette ten Have de Labije and Allan Abbass. I have been lucky enough to attend trainings and conferences worldwide so I’m sure my own style is a hybrid of everything I have absorbed.

Dr Robert Neborsky has worked closely with ISTDP-UK since its inception. He travels frequently to the UK to deliver training and supervision and to work with us in developing ISTDP training programmes and conferences. The influence of his Attachment-Based ISTDP on my own work is profound.

Over the past ten years I have also worked alongside a group of colleagues in ISTDP-UK as we all grapple with the agony and ecstasy of mastering ISTDP techniques. I am constantly learning from all of these talented therapists.

Q. In your presentation you are going to talk about the application of ISTDP for treating medically unexplained symptoms. Could you tell us a bit about this?

A. ISTDP has been tremendously helpful in understanding the psychological processes that can underlie physical symptoms. I believe this approach has a critically important contribution to make in the understanding and treatment of individuals who present with ‘medically unexplained’ or functional neurological symptoms.

In my presentation I will emphasise how important it is to correctly diagnose pathways of unconscious anxiety. That is, the physical manifestations of anxiety in the session that arise in response to feelings being triggered (as opposed to thoughts or worries about external events). These signs of anxiety are often ignored and neglected by the patients themselves, and as a result, they impact on physical health and – in combination with early attachment trauma and unprocessed emotions – this results in physical symptoms.
I will demonstrate how assessment and regulation of physical pathways of anxiety is key to treatment planning and the first step that needs to be taken before emotional processing can be successfully attempted by clinician and client.

This is a diverse and clinically complex client group and I think it’s important to have appropriate expectations, as opposed to touting ISTDP as a “miracle cure.” But in some cases, it has been possible to help people to relieve their symptoms in quite dramatic ways which would not have been possible if I had not had ISTDP techniques to draw on. I’m a passionate advocate of the ISTDP approach, as I believe that armed with the right knowledge, clinicians have the potential to intervene in the frustrating cycle where patients embark on multiple, expensive and invasive medical consultations and procedures, which then inflict more emotional trauma and potentially cause further physical problems.

Details and booking instructions for the ISTDP-UK Symposium at the Freud Museum can be found here: