Pressure: From conceptual precision to technical precision

Pressure: From conceptual precision to technical precision

Pressure is one of Davanloo’s most original and important technical contributions—but it remains surprisingly ill-defined. The literature offers hundreds of examples, yet nowhere are its conceptual boundaries clearly articulated. Where does pressure end and challenge begin?

This workshop centers on conceptual clarification, but not as a mere intellectual exercise: defining the boundaries of pressure as distinct from challenge carries real clinical stakes. Many alliance ruptures and treatment impasses begin with a single misstep: a premature challenge where pressure would have sufficed. Without a clear, boundaried conception of pressure, we may unintentionally introduce elements of challenge into our pressures—risking compliance, defiance, and a variety of iatrogenic regressions. Our capacity to prevent such errors depends, in part, on conceptual clarity.

When we have a clear understanding of pressure—what it is and what it is not—we can work with resistance in ways that protect and promote alliance. Just as importantly, clear conceptual boundaries give us a framework that supports creativity. They offer a structure within which therapists can move beyond scripts and tailor interventions to the moment and the patient. This creativity is a necessity for effective intervening in the moment with patients, but will also be necessary for the future development of ISTDP itself.

Through didactic teaching, group discussion, and video-recorded case material, participants will:

• Clarify what constitutes pressure: how to distinguish it from challenge
• Reflect on how misunderstanding this boundary can lead to premature challenges that undermine the alliance
• Review a wide range of examples of pressure, exploring how conceptual clarity supports flexible and creative use
• Discuss clinical contexts in which pure pressure, without any elements of challenge, is required to facilitate rise in the transference and study video examples of this
• Explore the underemphasized role of “pressures against”: interventions that interfere with defenses without slipping into confrontation
• See how pressure facilitates rise in the transference, preparing the ground for more challenging interventions to be introduced
• Use clinical material to identify and reflect on countertransference pressures—the therapist’s own sense of urgency, frustration, or compulsive need to help—that may fuel premature challenges. Conceptual clarification alone is not enough unless paired with emotional awareness!

This workshop is for ISTDP clinicians who want to make their work more precise and creative, and to work with resistance in a way that preserves alliance. Together, we'll build a strong conceptual framework to serve as a springboard for your clinical creativity!

Confidentiality Agreement

By clicking the button to register for this event, you agree to the following:Safeguarding the confidentiality of clinical material presented at seminars like this is of the utmost importance. Your attendance is contingent on an agreement to adhere to the following guidelines:• Participants must not share this link and must create a secure viewing environment that is utilized solely by the registered participant and protected from intrusion by, or exposure to, unauthorized persons.• Clinical material must not be discussed outside of the session in which it is presented and must not be recorded, conveyed, or disseminated in written or electronic form.• Participants must create a secure viewing environment that is utilized solely by the registered participant and protected from intrusion by, or exposure to, unauthorized persons.• If at any time a participant suspects s/he/they may recognize the identity of a patient in a case presentation, the participant agrees to leave the session immediately.• Failure to observe these guidelines constitutes a breach of the ethical principles of all psychotherapy guilds, is a HIPAA violation, and may be cause for disciplinary or legal action or both.