ISSN (Print): 1573-4005
ISSN (Online): 1875-6441
Volume 14, 4 Issues, 2018
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ISSN (Print): 1573-4005
ISSN (Online): 1875-6441
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Editor-in-Chief:Yong-Ku KimDepartment of Psychiatry, College of MedicineKorea University, Ansan HospitalDanwon-gu, AnsanRepublic of Korea
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Special Issue Submission
"I had the great pleasure to browse through the articles in the first issue of Current Psychiatry Reviews that I received. The number, quality, diversity of the topics covered is unmatched. The same is true for the authors. The papers they authored will be treasured by the academic, scholarly, clinical and educational world."
Hagop S. Akiskal
Univ. of California, USA
Davanloo’s major mobilization of the unconscious and intensive short-term dynamic psychotherapy
Guest Editor(s): Catherine Hickey
3 Abstract Ahead of Print are available electronically
2 Articles Ahead of Print are available electronically
After 5 decades of active practice, Dr. Habib Davanloo continues to refine his understanding of the human unconscious.
While many are familiar with the empirical evidence for the use of short-term dynamic psychotherapies, fewer are aware of the
ongoing educational program Davanloo operates in Montreal. This Montreal Closed Circuit Training Program provides extensive
competency-based, peer reviewed training to a group of international therapists.
The purpose of this special thematic issue is to update readers on Davanloo’s latest metapsychological understanding of the
unconscious and his most advanced therapeutic techniques-which have been taught exclusively in the Montreal Closed Circuit
Training Program and in Davanloo’s Annual Metapsychology of the Unconscious symposium.
In the first paper , Dr. Alan Beeber, Professor Emeritus, presents a detailed history of Davanloo’s discoveries from the
development of Intensive Short-term Dynamic Psychotherapy to the more recent Major Mobilization of the Unconscious. Beeber
presents this historical account not only as an experienced therapist and educator, but also as a participant in the training he
has had with Dr. Davanloo-- which has spanned decades. Few have had this depth and breadth of exposure and training. Beeber
captures the evolution of Davanloo’s theories and techniques in clear and comprehensive prose that conveys the formidable rate
at which Davanloo’s methods have evolved. This paper is essential reading for novice and experienced therapists alike.
Following this, Schmitt et al.  recap the historical concepts known to many in the field including bond and attachment,
unconscious anxiety, the neurobiological pathway, and the central dynamic sequence. They move on to more recent theoretical
advances include the mobilization of the transference component of the resistance and the importance of head on collision in
achieving this. This discussion is of great importance given the difficulty many therapists have in applying a well formed head
on collision and achieving a high transference component of the resistance-which are essential in the technique of major mobilization
of the unconscious. Schmitt et al. then move on to the newest concepts in the field including transference neurosis,
intergenerational transference neurosis and impairment in the unconscious defensive organization. Readers will benefit from an
updated discussion on these topics as they are new and only covered in a few other publications [3, 4].
In the third paper , these important concepts are made more tangible by applying them to a case. This case was not from
the Montreal Closed Circuit Training Program but from the private practice of one of the authors. It was shown and discussed
during the 38th Annual Metapsychology Meeting held in Montreal, Canada in 2017. It demonstrates that through dedicated
training and supervision with Dr. Davanloo, a therapist can indeed apply these rich and powerful techniques in the real world
with actual patients. In this particular case, a young woman with anorexia nervosa and a complex unconscious makes marked
therapeutic gains and is able to move forward with her life. This is the first such documented case of a therapist applying
Davanloo’s techniques in the case of a patient with an eating disorder.
It is hoped that readers of this issue will appreciate the rapid evolution of the field. More importantly, it is hoped that readers
will appreciate that Dr. Davanloo remains the sole inventor of these advanced, cutting edge techniques.
Over the past two decades, three antipsychotic medications, olanzapine (1996) quetiapine (1997) and aripirazole (2002 and
2015) are listed in the medication blockbuster list, or the list of the highest selling medications of the year. It is unclear if this
reflects an increase in the diagnosis of psychosis, a broadening of the indications for antipsychotic medications or growing prescription
rate for second generation antipsychotic medications as opposed to first generation. However, what is clear is that the
long-term risks and benefits of many psychotropic medications are unknown and that psychiatry needs an active systematic
intervention for the parsimonious use of these medication .
The first paper by Cahill et al , describes the concept of deprescribing, originally applied in geriatric and palliative care
medicine, as a systematic intervention targeted at reducing the use of potentially inappropriate medications taking medical and
functional status and preferences into consideration (Scott, Hilmer et al. 2015). The paper builds an argument for the critical
need for a similar intervention in psychiatry and outlines strategies for the implementation of deprescribing in psychiatry. It
weighs the pros and cons of applying deprescribing to psychiatry and finally, proposes a roadmap for the further validation and
development of the approach.
The second paper  by Miller et al., describes the use of collaborative strategies such as shared decision-making during
the process of deprescribing. It also details how recovery-oriented practices such as peer support, social support, personal
medicine and recovery action plans can support the individual during the deprescribing process and provides suggestions on
how to implement deprescribing collaboratively at every step.
The third paper by Mintz et al. , is a psychodynamically informed perspective on deprescribing. The paper utilizes the
authors’ experience with treating complex ‘treatment resistant’ patients and highlights the interpersonal meaning of medication
prescribing and deprescribing. The psychodynamic aspect of deprescribing including the formation of an overall diagnosis, a
focus on the therapeutic alliance and an interpersonal approach to deprescribing are elucidated using case examples.
The fourth and final paper  applies the concept of deprescribing specifically to the use of antipsychotic medications. The
paper begins with a critical examination of the evidence of the benefits of long-term antipsychotic use in chronic psychosis and
briefly reviews medication discontinuation studies. It then discusses other important reasons for considering deprescribing such
as antipsychotic polypharmacy and off-label use. In further exploring on the deprescribing process for antipsychotic medication,
the paper discusses the use of non-pharmacological interventions such as family therapy, cognitive behavioral therapy,
substance use treatments and the use of recovery tools such as well recovery action plan and personal medicine.
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