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Jon Frederickson is a psychodynamic psychotherapist and co-chair of the Intensive Short-Term Dynamic Psychotherapy (ISTDP) training program of the Washington School of Psychiatry. International supervisor and teacher, he has been practicing this form of psychodynamic treatment for decades. He originally trained with the developer of ISTDP, Habib Davanloo, an Iranian psychoanalyst concerned with researching the efficacy of psychoanalytic treatments. Given Frederickson's experience in working in psychiatric services, it is not surprising that he has condensend his knowledge and expertise in a book that outlines treatment principles for patients with a fragile ego. To illustrate the key elements of ISTDP treatment for fragile patients, he has combined a thorough knowledge of psychoanalytic theory, drawing from Freud, Bion, Klein, Jung, Lacan, Winnicott, Bowlby and Ferenczi among others, with extensive case transcripts. These case transcripts are retrieved from video recordings of real psychotherapy sessions.
In Co-Creating Safety: Healing The Fragile Patient, Frederickson starts by using attachment theory as his central proposition to conceptualize how ego fragility emerges as a result of trauma and insecure attachment experiences. He understands ego fragility as the difficulty that patients experience to bear internal experiences as part of ‘me’ and thus develop charactereological and automatic tendencies to split
off such experiences as ‘not me’. This creates severe symptomatology and suffering as well as a tendency towards the repetition of failed attachments. In understanding how to treat such patients, he begins by outlining the metapsychology of ISTDP in a very simplified and easily accessible fashion. He proposes that fragile patients suffer because they are unable to tolerate the feelings that external circumstances trigger. As a result of historical trauma, fragile patients become flooded with anxiety when feelings are aroused and thus use primitive defences