ISTDP (Intensive Short-Term Dynamic Psychotherapy)

Intensive Short-Term Dynamic Psychotherapy (ISTDP) is an evidence-based form of psychodynamic psychotherapy developed by Dr. Habib Davanloo. ISTDP is designed to help people access and experience their true feelings, particularly those that have been avoided or suppressed, in order to resolve emotional conflicts and symptoms. The therapy is characterised by its active, focused approach that aims to break through psychological defences quickly and efficiently. ISTDP has been shown to be effective for a wide range of mental health conditions and can often achieve significant results in fewer sessions than traditional psychodynamic therapy.

Table of Contents

• Definition
• Understanding ISTDP
• How ISTDP Works
• Conditions Treated with ISTDP
• The ISTDP Assessment
• Benefits of ISTDP
• The ISTDP Process
• Research and Evidence
• Training and Competency
• Challenges and Considerations
• Finding an ISTDP Therapist
• What to Expect in ISTDP
• Integration and Maintenance
• Remember
• References

Understanding ISTDP

• Unconscious feelings - accessing emotions that have been pushed out of awareness
• Defence mechanisms - identifying and working through psychological defences
• Triangle of conflict - understanding the relationship between anxiety, defences, and feelings
• Triangle of person - exploring patterns in current relationships, past relationships, and the therapeutic relationship
• Corrective emotional experience - experiencing avoided emotions in a safe therapeutic context

Theoretical Foundation:

• Psychodynamic theory - based on understanding unconscious processes
• Attachment theory - recognising the impact of early relationships
• Affect theory - understanding the role of emotions in psychological health
• Defence theory - identifying how people protect themselves from painful emotions
• Neurobiological understanding - incorporating brain science into treatment

Key Concepts:

• True self vs. false self - distinguishing authentic feelings from defensive presentations
• Emotional breakthrough - moments when genuine feelings emerge
• Character defences - ingrained patterns of avoiding emotions
• Somatic experiencing - paying attention to physical sensations and emotions
• Therapeutic alliance - building a strong, honest relationship with the therapist

How ISTDP Works

1. Assessment - evaluating the person's capacity for ISTDP
2. Challenge defences - actively confronting avoidance patterns
3. Access feelings - helping the person experience avoided emotions
4. Link patterns - connecting current problems to past experiences
5. Integration - incorporating new emotional awareness into daily life

Therapeutic Techniques:

• Defence analysis - identifying and challenging defensive behaviours
• Pressure and support - applying therapeutic pressure while providing safety
• Clarification - helping people see their patterns clearly
• Confrontation - directly addressing avoidance and defences
• Interpretation - explaining the meaning and connections of behaviours and feelings

The Triangle of Conflict:

• Anxiety - the uncomfortable feelings that arise when approaching difficult emotions
• Defences - the ways people protect themselves from anxiety and painful feelings
• Impulses/Feelings - the true emotions that are being avoided

The Triangle of Person:

• Current relationships - how patterns show up in present-day relationships
• Past relationships - understanding the origins of emotional patterns
• Therapeutic relationship - how patterns emerge in therapy itself

Conditions Treated with ISTDP

• Generalised anxiety disorder - chronic worry and tension
• Panic disorder - panic attacks and anticipatory anxiety
• Social anxiety - fear of social situations and judgment
• Specific phobias - intense fears of particular objects or situations
• Agoraphobia - fear of being in situations where escape might be difficult

Mood Disorders:

• Depression - major depressive episodes and chronic depression
• Dysthymia - persistent low-level depression
• Bipolar disorder - mood swings and emotional instability
• Seasonal affective disorder - depression related to seasonal changes
• Adjustment disorders - difficulty coping with life changes

Trauma-Related Conditions:

• Post-traumatic stress disorder (PTSD) - trauma-related symptoms
• Complex trauma - trauma from prolonged, repeated experiences
• Childhood trauma - addressing early life traumatic experiences
• Attachment trauma - trauma related to early caregiver relationships
• Developmental trauma - trauma that occurred during critical developmental periods

Personality and Relationship Issues:

• Personality disorders - particularly those involving emotional dysregulation
• Relationship problems - difficulties in intimate and social relationships
• Attachment issues - problems forming and maintaining close relationships
• Emotional regulation difficulties - trouble managing and expressing emotions
• Self-esteem issues - negative self-concept and self-worth problems

The ISTDP Assessment

• Evaluating readiness - determining if someone is suitable for ISTDP
• Testing defences - seeing how the person responds to therapeutic pressure
• Assessing ego strength - evaluating the person's capacity to handle intense emotions
• Motivation assessment - determining the person's commitment to change
• Contraindications - identifying factors that might make ISTDP inappropriate

Assessment Criteria:

• Psychological mindedness - ability to think about emotions and motivations
• Capacity for insight - willingness to look at oneself honestly
• Emotional tolerance - ability to experience difficult emotions without becoming overwhelmed
• Motivation for change - genuine desire to work on problems
• Absence of severe pathology - no active psychosis or severe personality disorders

Contraindications:

• Active psychosis - current delusions or hallucinations
• Severe substance abuse - active addiction that would interfere with therapy
• Severe personality disorders - particularly those with poor reality testing
• High suicide risk - immediate danger to self
• Severe medical conditions - physical health issues that would be exacerbated by intense emotions

Benefits of ISTDP

• Shorter duration - often achieves results in fewer sessions than traditional therapy
• Focused approach - directly targets core emotional conflicts
• Rapid access - quickly gets to underlying issues
• Cost-effective - fewer sessions means lower overall cost
• Time-limited - clear structure and timeline

Effectiveness:

• Evidence-based - supported by numerous research studies
• Lasting results - changes often persist long after therapy ends
• Symptom reduction - significant improvement in presenting problems
• Emotional growth - increased emotional awareness and regulation
• Relationship improvement - better capacity for intimate relationships

Emotional Benefits:

• Authentic self - greater connection to true feelings and desires
• Emotional freedom - less constrained by defensive patterns
• Increased vitality - more energy when not suppressing emotions
• Better relationships - improved capacity for intimacy and connection
• Self-compassion - greater understanding and acceptance of oneself

The ISTDP Process

• Building alliance - establishing trust and safety
• Assessment - evaluating suitability for ISTDP
• Education - explaining how emotions and defences work
• Goal setting - identifying what the person wants to change
• Contract - agreeing on the therapeutic approach

Working Phase:

• Defence analysis - identifying and challenging defensive patterns
• Emotional breakthrough - accessing previously avoided feelings
• Pattern recognition - seeing how past experiences affect current life
• Working through - repeatedly experiencing and integrating emotions
• Relationship exploration - understanding patterns in relationships

Integration Phase:

• Consolidating gains - strengthening new emotional awareness
• Applying insights - using new understanding in daily life
• Relapse prevention - preparing for future challenges
• Termination planning - preparing for the end of therapy
• Follow-up - checking in after therapy ends

Research and Evidence

• Randomised controlled trials - multiple studies showing effectiveness
• Meta-analyses - systematic reviews demonstrating positive outcomes
• Long-term follow-up - sustained benefits months and years after treatment
• Comparative studies - often as effective as or more effective than other therapies
• Neurobiological research - brain imaging studies showing changes after ISTDP

Effectiveness Data:

• Symptom reduction - significant improvement in anxiety, depression, and other symptoms
• Functional improvement - better work, social, and relationship functioning
• Quality of life - overall improvement in life satisfaction
• Cost-effectiveness - fewer sessions needed compared to other long-term therapies
• Durability - benefits maintained over time

Research Findings:

• Rapid improvement - many people show significant improvement within 10-20 sessions
• Broad applicability - effective for many different mental health conditions
• Mechanism of action - works by increasing emotional awareness and reducing defences
• Predictor studies - identifying who is most likely to benefit from ISTDP
• Training research - studies on how to effectively train ISTDP therapists

Training and Competency

• Basic training - foundational courses in ISTDP theory and technique
• Supervised practice - extensive supervision with experienced ISTDP therapists
• Video review - detailed analysis of therapy sessions
• Ongoing education - continuing education and advanced training
• Certification - formal certification programs available

Core Competencies:

• Theoretical knowledge - understanding of psychodynamic and ISTDP principles
• Technical skills - ability to identify and challenge defences effectively
• Emotional regulation - therapist's own emotional awareness and stability
• Assessment skills - ability to evaluate suitability for ISTDP
• Relationship skills - capacity to build strong therapeutic alliances

Training Process:

• Didactic learning - classroom instruction in theory and technique
• Experiential learning - personal therapy or self-exploration
• Supervised practice - working with clients under supervision
• Video review - detailed analysis of therapeutic interactions
• Peer consultation - ongoing discussion with other ISTDP therapists

Challenges and Considerations

• Emotional intensity - therapy can be emotionally challenging
• Rapid pace - faster than many people are used to in therapy
• Confrontational style - more direct than some other therapeutic approaches
• Anxiety-provoking - deliberately brings up difficult emotions
• Requires commitment - demands active participation and honesty

Suitability:

• Not for everyone - requires specific psychological capacities
• Assessment crucial - careful evaluation needed to determine appropriateness
• Contraindications - some conditions make ISTDP inappropriate
• Timing considerations - may not be right at certain life stages
• Cultural factors - may need adaptation for different cultural backgrounds

Therapist Requirements:

• Extensive training - requires specialised training and supervision
• Personal work - therapists need their own emotional awareness
• Ongoing supervision - continued supervision and consultation needed
• Emotional demands - can be emotionally demanding for therapists
• Skill development - requires ongoing skill refinement

Finding an ISTDP Therapist

• ISTDP training - formal training in ISTDP methods
• Supervision experience - adequate supervised practice
• Ongoing education - commitment to continuing ISTDP education
• Professional credentials - appropriate mental health licensing
• Experience - sufficient experience with ISTDP methods

Questions to Ask:

• What training have you had in ISTDP?
• How much supervision have you received?
• How many ISTDP cases have you treated?
• Do you participate in ongoing ISTDP consultation?
• How do you determine if someone is suitable for ISTDP?

Finding Resources:

• ISTDP Institute - training and referral resources
• Professional organisations - psychodynamic therapy associations
• Training programs - universities and institutes offering ISTDP training
• Referral networks - other mental health professionals who know ISTDP therapists
• Online directories - websites listing ISTDP-trained therapists

What to Expect in ISTDP

• Assessment process - evaluation of suitability for ISTDP
• Education - learning about emotions, defences, and how therapy works
• Goal setting - identifying what you want to change
• Building alliance - developing trust and safety with the therapist
• Beginning work - starting to explore emotions and patterns

During Therapy:

• Active participation - therapy requires your active engagement
• Emotional intensity - expect to experience strong emotions
• Pattern recognition - learning to see your defensive patterns
• Breakthrough moments - times when you access previously avoided emotions
• Integration work - applying insights to your daily life

Potential Challenges:

• Initial anxiety - therapy may feel uncomfortable at first
• Resistance - natural tendency to avoid difficult emotions
• Emotional overwhelm - sometimes emotions may feel very intense
• Relationship patterns - old patterns may emerge in the therapeutic relationship
• Change anxiety - anxiety about changing familiar patterns

Integration and Maintenance

• Emotional awareness - continuing to notice and honour your emotions
• Pattern recognition - identifying defensive patterns in daily life
• Relationship skills - applying new understanding to relationships
• Self-compassion - treating yourself with kindness and understanding
• Ongoing growth - continuing to develop emotional awareness

Maintaining Progress:

• Regular self-reflection - continuing to examine your emotions and patterns
• Relationship practice - applying new skills in relationships
• Stress management - using emotional awareness to manage stress
• Support systems - maintaining connections with supportive people
• Professional support - occasional check-ins with therapist if needed

Remember

References

Schröder, T., Cooper, A., & Naidoo, R. (2015). Intensive short-term dynamic psychotherapy (ISTDP). Retrieved from https://www.researchgate.net/publication/295548086_Intensive_short-term_dynamic_psychotherapy_ISTDP

Town, J. M., Diener, M. J., Abbass, A., Leichsenring, F., Driessen, E., & Rabung, S. (2012). A meta‑analysis of psychodynamic psychotherapy outcomes: Evaluating the effects of research‑specific procedures. Psychotherapy, 49(3), 276–290. https://pubmed.ncbi.nlm.nih.gov/22962969/

Abbass, A. (2015). Reaching through resistance: Advanced psychotherapy techniques. Seven Leaves Press. https://www.amazon.com/Reaching-through-Resistance-Psychotherapy-Techniques-ebook/dp/B00WLEEQOY

Johansson, R., Andersson, G., & Hedman-Lagerlöf, E. (2013). Internet-based affect-focused psychodynamic therapy for social anxiety disorder: A randomised controlled trial with 2-year follow-up. Psychotherapy, 50(2), 180–189. https://pubmed.ncbi.nlm.nih.gov/29251954/