This is Part 2 of our 3-part blog post series about Intensive Short-Term Dynamic Psychotherapy (ISTDP).
When people read the name Intensive Short-Term Dynamic Psychotherapy, the word that usually jumps out at them is Intensive. It can sound intimidating, conjuring up images of a harsh or confrontational interrogation.
In reality, the word intensive simply means we are being deeply respectful of your time, your resources, and your desire for change. It means we are not content to just sit back and chat superficially for months while you remain stuck in the same painful loops. We are going to focus deliberately on what matters most, and continue to re-focus along the way when habits and defenses try and take us off track.
Let’s walk through the kind of thing that actually happens step-by-step when you sit down for an ISTDP session.
1. Establishing a Clear, Meaningful Goal
A typical ISTDP session does not start with a vague question about how your week went. Instead, we begin by identifying a specific, concrete problem you want help with right now.
We look for real-world examples. If you say that you struggle with low self-esteem, we will ask you to recall a specific moment recently where that low self-esteem showed up and got in your way. By anchoring the therapy in concrete, real-life moments, we avoid getting lost in abstract theories and ensure every session is directly relevant to your daily life.
2. Tracking the Body in Real Time
Once we start exploring that specific situation, emotions will naturally begin to surface. You might feel a wave of sadness, irritation, or anxiety. This is where the unique nature of ISTDP becomes visible.
The therapist will frequently pause the conversation to ask what you are noticing physically. Unresolved emotions trigger physical responses in our nervous system, and your body maps out exactly how you handle that stress. We look at three main pathways of physical anxiety:
Striated Muscle Tension: You might notice your chest tightening, your shoulders climbing toward your ears, or your hands clenching. This is generally a sign that your body is holding onto the energy of the emotion, and it means we can safely keep exploring.
Smooth Muscle Response: For some people, anxiety hits the internal organs. This shows up as a sudden knot in the stomach, nausea, or a wave of bowel urgency.
Cognitive-Perceptual Disruption: If anxiety gets too high, you might suddenly feel foggy, dizzy, or lose your train of thought entirely. You might get headaches of a particular kind.
If your anxiety shifts into your stomach or makes your mind foggy, it means the emotional pressure is currently too high for your system to handle safely. In ISTDP, we do not push through this. Instead, we pause and work together to lower and regulate that anxiety until your mind is clear and your body is calmer again. This builds your physical capacity to tolerate deep feelings without getting overwhelmed.
3. Spotting the Blocks As They Show Up
As we work together, your automatic protective system (those defenses we talked about in Part 1 of this blog post series) will inevitably show up right there in the room. They might look like:
Changing the subject or telling long, detailed stories to avoid a painful feeling.
Analysing your feelings instead of actually experiencing them.
Smiling or laughing while describing something deeply sad or upsetting.
Becoming highly self-critical or blaming yourself to avoid feeling angry at someone else.
In traditional therapy, these moments are often missed or simply discussed as concepts. In ISTDP, the therapist will gently but clearly point them out the moment they happen. They might say something like, “Notice how just as we touched on that sadness, you cracked a joke and looked away? Let us pause the jokes for a second and see what is actually underneath.”
This is not done to judge or criticise you. It is done because you cannot change a habit until you see it happening in real time. By highlighting these blocks, the therapist helps you see how you inadvertently distance yourself from your own feelings and from other people.
An Active Partnership
ISTDP is very interactive. It is a highly conversational, collaborative, and focused process. The therapist and client work together like a team to confront and undo old habitual defence systems that no longer serve but which are playing out automatically.
Think of it like learning to drive a car with a specialised instructor. You are the one with your feet on the pedals, controlling where we go. The therapist is in the passenger seat, helping you spot the blind spots, pointing out when you have accidentally left the handbrake on, and ensuring you have the skills to handle the vehicle safely when the road gets rough. If needed, they can step in and take the wheel for a moment. But the goal is always to allow the client to do as much of the driving as possible. Eventually, they won’t even need the therapist anymore, and that is the goal.
By the end of a successful session, the aim is not just that you understand your problems better. It is that you have actually experienced a physical shift: taming your physical anxiety, spotting your own self-sabotaging blocks, and feeling a closer connection to your actual emotional experiences.
In our 3rd and final post of this blog series, we will help you figure out whether this specific style of therapy is the right fit for your current needs and personality.