Habib Davanloo, M.D., was a pioneer in the field of dynamic psychiatry. In the early 1960s, he observed that very few patients were being accepted into dynamic psychotherapy and that, in general, therapy was unfocused. He and other therapists were also becoming disillusioned with the ever-lengthening course of psychoanalysis. These factors led to his interest in short-term dynamic psychotherapy (STDP). He set up a short-term psychotherapy program in his clinic and saw patients himself, in addition to supervising residents and students. In 1973 at a conference in Oslo, he encountered Peter Sifneos, whom he first met in Boston during their time at Massachusetts General.

They began corresponding. Two years later, in March 1975, Davanloo organized the First International Symposium on Short-Term Dynamic Psychotherapy. In this and subsequent symposia, he brought together many psychotherapists who, like him, were working in short-term techniques.

This group included Sifneos, Saul Brown, Judd Marmor, David Malan, Mardi Horowitz, Samuel Eisenstein, and James Mann, among others. Davanloo was also a pioneer in psychotherapy in another sense: he was among the first to video record his sessions with patients. Indeed, he would present his video-recorded cases of initial interviews, full courses of treatment, and outcome evaluations at these early symposia, which, in turn, formed the basis of two books (1, 2). Davanloo’s clinical research consisted of a process of video recording sessions with patients, then conducting a painstaking review of each recording, analyzing and refining each therapeutic intervention.

Using this technique, he was able to concretize the process into what he called the “central dynamic sequence.” Another of Davanloo’s unique observations was that of the discharge pattern of unconscious anxiety, which he described as manifesting in voluntary muscle tension, in autonomic discharge, and in the cognitive and perceptual sphere.

This observation had important implications for how rapidly and in what way one could access the unconscious. Moreover, he discovered that by focusing on emotions, on resistance, and on the transference relationship, he could rapidly mobilize the patient’s unconscious (by which he meant “dominance of the unconscious therapeutic alliance over the destructive forces of the resistance” [3]) and move directly to the dynamic engine at the core of the patient’s difficulties.

He called this process “unlocking the unconscious.” Through repeated “unlockings” in a process of working through, Davanloo was able to help patients experience the intense feelings that they had so far avoided—the pain of trauma, rage, guilt, grief, love, and forgiveness—as well as achieve peace in relation to the conflict or trauma, usually concerning the people closest to them in early life. In his view, the experience of unconscious guilt was the most important factor in this process (3).

Existing modalities of short-term therapy were highly selective of patients. Patients were chosen for high motivation and low resistance; frequently, a single, uncomplicated psychotherapeutic focus was implemented; and treatment goals were often limited. To broaden access to treatment, Davanloo focused his efforts on developing a therapy for a wide range of patients, including patients highly resistant to treatment, that was effective not only for symptom reduction and resolution but also for complex interpersonal and syntonic characterological difficulties.

He called this new technique intensive short-term dynamic psychotherapy (ISTDP), in contrast to STDP, and the theory underlying the technique the “new metapsychology of the unconscious.” In the 1980s and 1990s, he worked to further expand the range of patients who could be treated with ISTDP.

According to Davanloo, conditions treatable with ISTDP across the “psychodiagnostic spectrum” include somatic symptom disorder, clinical depression, and “fragile” character structure (characterized by an extremely low capacity to tolerate anxiety and feelings), as well as masochistic, self-defeating, or self-damaging character traits. He further refined modifications to the standard technique, such as “graded format,” “restructuring,” and “multidimensional unconscious structural change,” to facilitate the treatment of these patients.

He published his cases extensively (4–6) and presented them at scores of conferences, symposia, and metapsychology courses throughout the 1980s and 1990s and into the 2000s. Davanloo remained at the cutting edge of dynamic therapy into the 2000s and later, further elucidating the metapsychology of the unconscious via his clinical research. Two concepts continued to influence his metapsychological understanding of the core neurotic structure:

traumatization of the attachment to early figures and the concomitant pain of the trauma leading to the development of unconscious reactive feelings of murderous rage and guilt. He made an important observation, namely, that patients who experienced trauma at age 4 or later typically did not have a pernicious form of unconscious guilt and could be treated with the standard technique of ISTDP.

However, for those who were traumatized at age 3 or earlier, unconscious guilt and murderous rage remained what he called “fused” in the unconscious, and the unconscious guilt could not be directly experienced. He emphasized that the fusion of primitive rage and guilt “is a pathogenic destructive force in the unconscious which we call ‘major resistance’” (3). These patients needed to undergo a process of “multidimensional unconscious structural changes” and a defusion of guilt and rage before they could experience the guilt, which was the main pathogenic force in the unconscious.

Defusing these elements required an exceptionally high degree of mobilization of the “transference component of the resistance.” Moreover, Davanloo found that mobilizing patients’ experience of what he called the “neurobiological somatic pathway” of primitive murderous rage and guilt-laden unconscious feelings was essential to bring about resolution of the pathogenic core of the unconscious. If these feelings, especially guilt, were not directly experienced, the feelings could develop into an unresolved transference neurosis in addition to the original neurosis. These technical and metapsychological advances build on the foundation he laid with his standard technique of ISTDP.

To highlight these advances, he called his method Davanloo’s intensive short-term dynamic psychotherapy, or DISTDP. Patients who have been treated with ISTDP, and thus have experienced the unlocking of intense feelings, describe the process as leaving behind a heavy load, feeling free (of the pain of trauma, guilt, etc.), and being at peace with their early attachment figures (3).

Davanloo continued to focus his efforts on deepening his understanding of the unconscious by developing techniques of “major extended mobilization of the unconscious” and block therapy formats. In contrast to the standard technique of ISTDP, which consisted of once-weekly hour-long sessions, he created an extremely intensive format involving blocks of therapy lasting several hours a day, for 3–4 days in duration, with an extensive emphasis on multidimensional unconscious structural changes.

These blocks, often 1 or 2 months apart, required that the therapist be able to achieve and maintain a high degree of mobilization of the transference component of the resistance and a strong unconscious therapeutic alliance in order to sustain the gains between sessions. In the 2010s, Davanloo focused his therapeutic and teaching efforts on refining these techniques. He observed that therapists who had a high degree of mobilization of their unconscious could work more successfully with these techniques.

In the late 2010s, his teaching centered on mobilization of the unconscious of experienced therapists to help them to better deliver his intensive treatment. He developed small-group experiential training workshops in the Montreal Program in Mobilization of the Unconscious.

The onset of the COVID-19 pandemic disrupted his workshops given the limitations of international travel. However, as the pandemic abated, he became ever more vigorous in his teaching efforts and resumed offering workshops into the 2020s. In November 2023, Davanloo passed away at home after a brief illness.

Through his many years of training hundreds of professionals worldwide, his pioneering case-based work has been independently validated and his treatment has been shown to be both efficacious and cost-effective for a broad range of patients

Author and Article Information Department of Psychiatry, School of Medicine, University of North Carolina, Chapel Hill (Beeber); German Society for Davanloo’s ISTDP, Nuremberg, Germany (Gottwik); Italian Institute for Davanloo’s ISTDP, Florence, Italy (Rosseti). Send correspondence to Dr. Beeber (abeeber@med.unc.edu). The authors report no financial relationships with commercial interests.