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Facilitating the Process of Working Through in Psychotherapy:
Mastering the Middle Game

by Patricia Coughlin


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Facilitating the Process of Working Through in Psychotherapy provides a detailed understanding and de-mystification of the concept of "working through" in dynamic psychotherapy, the most vital but neglected aspect of the therapeutic process.

Just as there are multiple factors responsible for the creation and perpetuation of symptoms and suffering, multiple interventions are frequently required to work through and resolve them. This volume spans topics such as multiple causation, repetition compulsion, and the polarities of experience, while emphasizing the importance of providing a corrective emotional experience, recognising and repairing ruptures to the alliance and facilitating a positive ending to treatment. Verbatim transcripts of the author’s therapy sessions illustrate the factors responsible for working through toward enduring change, and readers are taken through theory, research, and practice.

This book is essential reading for all psychotherapists who are committed to increasing therapeutic effectiveness while enhancing their own personal and professional development.

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Published 2022 by

Cambridge University Press.

Psychotherapy in Later Life
Edited By Rajesh R. Tampi, Brandon C. Yama, Kristina F. Zdanys, and Deena J. Tampi
Contributing Author Dr. Patricia Coughlin co-wrote the chapter entitled "Short-Term Psychodynamic Psychotherapy"


Psychotherapy in Later Life is a practical how-to-guide for psychiatrists, psychologists and mental health workers on choosing and delivering evidence-based psychological therapies to older adults. It covers all the main evidence-based psychological therapies such as cognitive behavioural therapy (CBT) and interpersonal psychotherapy (IPT), as well as specialist topics such as combining psychotherapy with pharmacological treatments, working with diverse populations and individual versus group therapy.


The World Health Organization estimates that over the next four decades, the proportion of the world's older adults will nearly double, from twelve percent to twenty-two percent, and that one in five older adults has a diagnosable mental health disorder. Given the increasing number of older adults requiring mental health treatment, incorporating talking therapies into treatment plans is key to tackling issues related to polypharmacy, medication interactions and side effects. Written by experts in geriatric mental health, this book provides the most authoritative information on the use of psychotherapy in older adults.

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Published 2020 by

Cambridge University Press.


Maximizing Effectiveness in Dynamic Psychotherapy
By Dr. Patricia Coughlin

The best therapists embody the changes they attempt to facilitate in their patients. In other words, they practice what they preach and are an authentic and engaged, as well as highly skilled, presence. Maximizing Effectiveness in Dynamic Psychotherapy demonstrates how and why therapists can and must develop the specific skills and personal qualities required to produce consistently effective results.

The six factors now associated with brain change and positive outcome in psychotherapy are front-and-center in this volume. Each is elucidated and illustrated with detailed, verbatim case transcripts. In addition, a method of treatment that incorporates all these key factors — Intensive Short-Term Dynamic Psychotherapy (ISTDP) — is introduced to the reader.


Therapists of every stripe can learn to develop and integrate the clinical skills presented in this book in order to improve their interventions, enhance effectiveness, and, ultimately, help more patients in a deeper and more-lasting fashion.


Published July 2016 by Routledge.

Integrative Psychiatry
By Daniel A. Monti, MD and Bernard D. Beitman, MD
Contributing Author Dr. Patricia Coughlin wrote the chapter entitled "Facilitating Emotional Health and Well Being"


Published by Oxford University.

Lives Transformed
By Dr. Patricia Coughlin, written in collaboration with Dr. David Malan


Published by Karnac Books.

Intensive Short-Term Dynamic Psychotherapy: Theory and Technique
By Dr. Patricia Coughlin, written in collaboration with Dr. David Malan


Published by Karnac Books.

Papers & Journal Articles

“Intensive Short-Term Dynamic Psychotherapy” (an introduction) by Patricia Coughlin and Jeff Katzman Psychiatric Annals 43:11, 2013 – View/download PDF

“Facilitating Emotional Health and Well Being” — chapter in Textbook of Integrative Psychiatry (2009) – View/download PDF

Katzman, J. & Coughlin, P. (2013). “The Role of Therapist Activity in Psychodynamic Psychotherapy.” Psychodynamic Psychiatry, 41, 73–88 – View/download PDF

Katzman, J; Abbass, A., Coughlin, P., Arora, S. (2014). “Building connections through Teletechnologies to augment resident training in Psychodynamic Psychotherapy.” Academic Psychiatry, March

Coughlin, P. & Kazman, J. (Guest Editors). “Intensive Short-Term Dynamic Psychotherapy.” Psychiatric Annals, 43:11, 486–489

Mott, L. & Coughlin Della Selva, P. (2011). Intensiv dynamik coaghing – fordele ved en folelsesfokuseret tilgang. Elmhold, C & Tanggard, L. (Ed.). Forlelser i ledelse. Aarhus: Klim

Coughlin, P. (2010). “Emotional Health and Well Being.” In D. Monti and B.D. Beitman (Eds), Textbook of Integrative Psychiatry. NY: Oxford Universities Press

Coughlin, P. (2008). “The Practice of Psychotherapy: Lost or Found?” Psychotherapy Bulletin, 43, 33–35

Coughlin Della Selva, P. (2006). “Emotional Processing in the Treatment of Psychosomatic Disorders.” Journal of Clinical Psychology, In Session, April

Coughlin Della Selva, P. (2001). “Working to Identify and Remove Tactical Defenses.” Qadermidi Psychiatria Practica, 17/18, 37–47

Coughlin Della Selva, P. (2001). “Dynamic Assessment of Ego Functioning in Davanloo’s ISTDP.” In J. ten Have-de Labija (Ed.), The Working Alliance in Intensive Short_Term Dynamic Psychotherapy. The Netherlands: The Netherlands Foundation for Intensive Short-Term Dynamic Psychotherapy

Della Selva, P. C. (1993). “The Significance of Attachment Theory for the Practice of Intensive Short-Term Dynamic Psychotherapy,” International Journal of Short-Term Psychotherapy 8, 189–206

Della Selva, P. C. (1992). “Achieving Character Change in ISTDP: How the Experience of Affect Leads to the Consolidation of the Self.” International Journal of Short-Term Psychotherapy, 7, 73–87

Della Selva, P. C. (1991). “The Emergence and Working Through of Pre-Verbal Rrauma in Short-Term Dynamic Psychotherapy.” International Journal of Short-Rerm Psychotherapy, 6, 195–216

Della Selva, P. C. (1987). “A Sleep Disorder: My Child?” In M. Weissbluth, Sleep Well. London

Affiliations & Links

Doctor Patricia Coughlin is a member of the following organizations: 


For more information on ISTDP or Dr Patricia Coughlin's specialized training please review some of our videos and interviews or contact us directly.

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