Question and Answer Session with Dr Leo Russell
How did you first become aware of or interested in ISTDP?
It was whilst on a placement as part of my Clinical Psychology Training. My desire to know what to do in therapy to bring about maximum change had drawn me towards Cognitive Behavioral Therapy, which has done some great research into how to make change happen. However, I sensed that whilst my patients were often experiencing symptomatic relief they were not experiencing the deep emotional change that many of them hoped for.
I’d sought out a psychodynamic supervisor and was fortunate to find Desiree Hansson, a Psychologist based in South Devon. She introduced me to ISTDP ideas and helped me be more attuned in the room to the patient’s emotions. She recommended I read Patricia Coughlin and David Malan’s “Lives Transformed: A Revolutionary Method of Dynamic Psychotherapy”. I read it and was immediately struck by how ISTDP combined a very clear theory of how mental health problems are caused with an equally precise theory of how to bring about change through moment-to-moment decisions in therapy. It really did transform my life and I believe the life of many of the service-users I have had the privilege to work with since this time.
Could you describe your training in ISTDP?
My first exposure to ISTDP training was at a wonderful Summer School in Italy, where I had the opportunity to see work presented by Josette ten-Have de Labije, Patricia Coughlin and Jon Fredrickson, as well as to meet an extraordinarily welcoming, energetic, and reflective community of ISTDP practitioners. I then attended a number of great ISTDP-UK evening seminars before jumping at the first opportunity to undertake their three-year core-training programme.
The core training was an incredible experience for me, characterised by excellent and precise teaching, an atmosphere of mutual support, and the reassuringly containing structure and experience of ISTDP-UK.
Learning ISTDP is challenging because it naturally brought me up against my own emotional barriers to connection and learning. At the same time, it felt safe because the teachers were boundless in their expertise and tailored the training for each of us to our level of skill and understanding. My training group loved it so much we elected to do a fourth year!
Have there been any ISTDP clinicians who have been a particular influence on your work?
My core-training teachers Robert Neborsky and Josette ten Have-de Labije have had the most profound influence on my work. The attachment framework they use alongside their remarkable attention to detail regarding the process of therapy, their tireless enthusiasm for optimal outcomes, and the deep humanity they bring to their work, is something I always aspire to strive towards in my own clinical practice. In some cases literally – On the wall of my office I have an A3 printed copy of their diagram “Red and Green Traffic Lights on Davanloo’s Road to the Unconscious”. It is my compass whenever I find myself feeling lost in the therapy room!
I consider my practice also to be influenced by the presentations and publications of Patricia Coughlin who was very supportive to me, particularly when I was trying to find my feet in learning ISTDP. More recently, the work of Allan Abbass and his colleagues in Canada has been especially important to me, and is the touchstone for my forays into working with medically unexplained symptoms. His wealth of research into the efficacy of ISTDP across the spectrum of psychiatric diagnoses is incredible and a huge asset the ISTDP community.
What all these clinicians have in common is an absolute love of learning and a complete dedication to their patients. I’ve found this same drive and exuberance amongst ISTDP colleagues in the UK. It is infectious and energising.
In your presentation you are going to talk about attachment trauma and physical symptoms, as well as the application of AB-ISTDP for treating somatisation – could you explain briefly what this all means?
As clinicians we have long had a sense that how we deal with our emotions can have an impact on our physical selves. We now live in a time when we are truly beginning to understand how sub-optimal attachment experiences literally shape the brain and make us vulnerable to physical health symptoms.
When we converge our understanding from affective neuroscience, attachment theory, neuroplasticity, and the physiological threat response systems in the body, this has profound and powerful implications for how we can treat these physical health problems that are psychological in origin. This is something Robert Neborsky really helped us to understand in my core-training.
These insights combine to create a theory of cause that sits perfectly alongside the theory of change offered through ISTDP. I have found that service-users find this immensely helpful, and despite my being very familiar with Abbass’ research that demonstrates this point, even I have been surprised by the rapidity at which symptoms can be alleviated using this approach!
Could you tell us about your involvement with ISTDP-UK?
I first joined ISTDP-UK as a representative of my core-group in the third year of training. I then spent time as membership coordinator, before stepping into the role of vice-chair over the past year. It’s been about four years in total, which has really flown by!
I was apprehensive when I first joined because you hear of membership organisations where there is a lot of politics and power-play. What I found though was friendly, kind, and supportive colleagues who really cared about giving people opportunities to have access to good quality, reliable and cost-effective training and conferences on ISTDP.
It’s been an amazing journey for the committee over the past four years. The number of ISTDP-UK members has doubled and we have had the opportunity to host a number of conferences, seminars, and core-trainings.
I would strongly recommend anyone who has an interest in becoming involved to put their name forwards. We have an AGM coming up and a number of roles that we’re looking to fill.
Your work is within the NHS, could you tell us about the service you work in?
I work for Devon Partnership NHS Trust where I am part of a Neuropsychology Service in Exeter. My role is within a specialist clinic for Functional Neurological Symptoms. It’s an innovative and progressive service, which recruited me specifically due to my training in ISTDP.
I also work in Adult Mental Health for Somerset Partnership NHS Foundation Trust. They too have been supportive of my ISTDP training and clinical work. Most importantly it has given me a tool for helping people who have struggled to benefit from other therapies. It’s important to me to feel like I have the potential to offer added value, and ISTDP has really helped me to do this.
In your experience, is ISTDP becoming more widely acknowledged or available within the NHS?
It’s been a time of crisis for the NHS and this has badly affected posts available for all psychological therapies. However, with crisis comes the capacity for change (As Davanloo taught us!). Commissioners want services to deliver robust outcomes in less time, and ISTDP offers one of the solutions for this.
There are a good number of ISTDP-UK members doing brilliant work in the NHS across primary and secondary care mental health services, and in physical health services. Susan Hajkowski’s recent evening seminar for instance, gave a fantastic example of how to deliver ISTDP within an NHS framework.
If you could have dinner with any psychotherapist/psychiatrist/psychologist, living or dead, who would you choose?
Do I have to choose only one? I can sneak a few extra on the table right?
How about Norman Doidge, Jaak Panksepp, David Eagleman, Mary Ainsworth, David Deutsch (though technically a physicist) and some chap called Freud. As long as I don’t have to get the food bill.
Details and booking instructions for Leo’s seminar can be found here: http://www.istdp.org.uk/event/evening-seminar-with-Leo-Russell/