Exploring Intensive Short-Term Dynamic Psychotherapy (ISTDP)

Developed by Dr. Habib Davanloo in the 1960s, Intensive Short-Term Dynamic Psychotherapy (ISTDP) is a dynamic and intensive psychotherapeutic technique that focuses on addressing deep-seated emotional issues in a relatively short period. This blog post delves into the principles, techniques, and applications of ISTDP, as well as looking at the ways in which ISTDP can help people reconnect to forgotten emotions that might lie buried underneath symptoms of anxiety and depression. By re-connecting to these emotions, the restrictive and damaging symptoms of anxiety and depression (and other mental health and relationship challenges) can be resolved.

What is ISTDP anyway?

ISTDP is grounded in psychodynamic theory, which means that it considers the role of unresolved or unprocessed conflicts and emotions that have been pushed to one side, but which still contribute to psychological distress and symptoms of anxiety, depression, and even chronic pain and physical symptoms. ISTDP seeks to bring these underlying emotions and conflicts to the surface and process them with a therapist, to promote emotional healing and growth, and ultimately to minimise the symptoms that have brought you to therapy in the first place. It is also influenced by, and related to, attachment-informed therapy, mindfulness-informed approaches, affective neuroscience, Rogerian approaches, and acceptance-based models of care.

One of the fundamental premises of ISTDP is that anxiety (and sometimes other symptoms) serve as a defence mechanism against experiencing these forgotten emotions. By identifying and addressing these defences, you can access and work through the deeper emotions which sit buried underneath, thereby reducing anxiety and other debilitating side-effects of these defences.

Key Principles:

To get a sense of what ISTDP is all about, and how it might feel in the room with a therapist, here are some principles that underpin ISTDP and which will guide how the therapy process unfolds:

  1. Emotional Awareness: ISTDP focuses on fostering emotional awareness, encouraging individuals to recognise and connect with their emotions in real-time. This process helps unveil the unconscious emotional conflicts that contribute to their distress.
  2. Defence Recognition: ISTDP places a strong emphasis on identifying defence mechanisms such as repression, denial, and avoidance. These defences are seen as barriers to emotional exploration and processing.
  3. Emotional Experience: The therapy aims to facilitate a full emotional experience, allowing individuals to feel and express their emotions without resorting to defensive behaviours.
  4. Relational Focus: The therapeutic relationship between the client and therapist plays a pivotal role in ISTDP. The therapist provides a safe and supportive environment that enables the client to explore their emotions and defences openly.

Techniques Used in ISTDP:

  1. The “Triangle of Conflict”: This technique involves understanding the interplay between the client’s feelings, behaviours, and bodily sensations. By tracing these connections, the therapist helps the client uncover underlying emotions and defences.
  2. Somatic Focus: ISTDP acknowledges the connection between emotions and bodily sensations. Clients are encouraged to notice physical sensations associated with their emotions, helping to bridge the gap between cognitive and emotional experiences.
  3. Vignettes and Role-plays: The therapist may use hypothetical scenarios or role-plays to simulate emotional situations. This approach allows the client to engage with their emotions in a controlled setting, aiding in the exploration of defences and assisting the client to look more openly and honestly at difficult emotional experiences.
  4. Direct Confrontation: Therapists practicing ISTDP may use direct and empathetic confrontation to challenge the client’s defences and avoidance behaviours, encouraging emotional exploration in the service of breaking through the barriers to emotional connection, autonomy, and closeness. This is always done carefully though, with attention to anxiety and the preferences of the client in mind. It is not the same thing as forcing someone to look at something they do not want to look at.

Applications of ISTDP

ISTDP has shown promise in treating a range of mental health concerns, including:

  • Anxiety Disorders
  • Depression
  • Personality Disorders
  • Somatisation Disorders
  • Chronic Pain
  • Chronic relationship issues
  • Chronic loneliness

How does ISTDP bring forgotten emotions to the surface?

ISTDP is an approach that focuses on helping individuals become aware of and work through their unconscious emotions and defenses to reduce symptoms and distress. Although the approach is not linear, the general way in which an ISTDP therapist will assist a client to become more aware of forgotten emotions that are masked by anxiety, depression, or other mental health symptoms, goes as follows:

1. Identification and Exploration of Defenses:

  • ISTDP therapists actively work with clients to identify and understand their defense mechanisms, which are unconscious strategies people use to avoid or suppress painful emotions (and situations that might activate these emotions)

2. Creating Emotional Awareness:

  • Through a strong therapeutic relationship and techniques such as focused attention and exploration, ISTDP therapists encourage clients to become more aware of their emotions and emotional conflicts.

3. Pressure and Challenge:

  • ISTDP therapists use a dynamic and confrontational approach, which involves gently challenging the client’s defenses and resistance.
  • By applying appropriate pressure, therapists help clients confront their defenses and bring unconscious material into conscious awareness.

4. Mobilisation of Unconscious Feelings:

  • As the client’s defenses are gradually weakened and their emotional awareness increases, previously unconscious or forgotten emotions and memories return to mind.
  • This process is essential for addressing the underlying issues that are causing emotional distress.

5. Working Through Unconscious Material:

  • The therapist and client work together to process and understand these emotions, memories, and conflicts.
  • This can involve exploring the root causes of emotional pain, past experiences, and ongoing patterns of relating to others.

6. Integration and Resolution:

  • Through this process, clients can integrate new understandings that arise from re-connecting to forgotten emotions and experiences into their current awareness, allowing for resolution of chronic anxiety and disconnection.
  • Clients gain insight into their emotional difficulties and are better equipped to make healthier choices and respond to life’s challenges in more adaptive ways.

Intensive Short-Term Dynamic Psychotherapy (ISTDP) can offer a powerful approach to psychotherapy by delving into the depths of unconscious or ’forgotten’ emotions and relational conflicts. With its emphasis on emotional awareness, defense recognition, and the therapeutic relationship, ISTDP provides a structured framework for individuals to confront their most private emotional challenges and experience liberation from chronic anxiety and disconnection.

If you’re ready to face your challenges head-on and free yourself from lifelong struggles with anxiety, depression, or loneliness, get in touch today to book a session with one of our psychologists trained in ISTDP, or to discuss other options that might best suit your therapy goals.