What is ISTDP?
Intensive Short-Term Dynamic Psychotherapy (ISTDP) is an emotionally-focused, highly experiential, psychodynamic / psychoanalytic psychotherapy. It is considered intensive as it is highly focused or concentrated and is an active therapy; simultaneously, it is experiential in nature, in that, one is in touch with various emotions during therapy sessions in an in-vivo manner. ISTDP is an accelerated and fast-acting treatment model, which is where the short-term component of the name comes from; at the time this treatment model was developed, most other therapies were long-term in nature. The aim in ISTDP is to engender change as rapidly as possible. Results are typically seen much more quickly than in traditional models of therapy. It is dynamic in nature in that forces in the unconscious, that are typically outside of awareness, are activated so that these inner conflicts can be seen, experienced, and addressed; as with other psychodynamic / psychoanalytic models of therapy, the focus is on overcoming internal resistance to facing conflicting and painful emotional material. Psychotherapy is focused on getting to the driving forces behind symptoms and behavioral patterns so that one can have true freedom, rather than simply focusing only on external stressors; this helps one truly heal and change.
ISTDP was developed by Habib Davanloo, M.D. at McGill University and has been presented at taught at multiple international conferences and training programs. It has been highly researched with a wealth of empirical validation for its effectiveness.
Other names for this therapy have included: Short-Term Dynamic Psychotherapy (STDP); “short-term psychoanalysis”; and, the “new form of psychoanalysis”. Similar therapies that developed out of and were inspired by ISTDP have been developed and covered under the umbrella term Experiential Dynamic Therapy (EDT).
The Importance of Attachment
Attachment, defined as an affectional bond (this concept was initially defined and researched by Bowlby), plays a central role in ISTDP, both in how the development of difficulties are understood and in their resolution. Interruptions to the attachment bond between parent / caregiver and child (whether it be large or subtle) give rise to complex and conflicting feelings; when these feelings are avoided and pushed away they are seen as the driving force that gives rise to suffering in the form of symptoms and harmful behavioral patterns. In ISTDP, our goal is to fully and honestly face these painful feelings and in so doing, the process of healing begins. With this growth, one becomes able to truly forgive both oneself and others allowing for true and meaningful connection in which one feels empowered. This becomes possible by facing all of the feelings related to the attachment difficulties, such as anger, sadness, love, closeness, and remorse / guilt. Without facing all these feelings many people have suffered by trying to force a merely cognitive forgiveness that is superficial and therefore does not feel genuine. The goal in ISTDP is to have a deeper level of growth, healing, and connection.
Relationship with the Therapist -- The Transference
In ISTDP, we make heavy use of the relationship with the therapist -- in technical terms, it is referred to as using the transference. We can explore your feelings and other reactions you have in real time towards me, your therapist. This acts to greatly increase the amount of data to which we have access. Using the transference provides a unique opportunity to face feelings in a relationship that are frequently avoided, minimized, or softened because of social convention. We can examine what happens as a microcosm or example of what happens in other relationships. Again, now we have an opportunity to face your feelings honestly in support of your freedom.
ISTDP is an emotionally-focused technique in which you actively experience various feelings during the session; it has been referred to as a neurobiological technique. To be clear, the goal is to become aware of the internal physical experience of all of your emotions. For example, anger would be experienced as a physical sensation within yourself. The goal is not to act out or discharge (e.g., yelling, hitting) which is what is frequently referred to in common parlance as anger. In ISTDP such destructive behaviors are not considered anger but rather barriers to being deeply in touch with the healthy physical experience of anger.
As you become able to calmly face your whole range of emotions, such as anger, sadness, remorse / guilt, forgiveness, and love, you become able to use these feelings in a productive manner to enhance closeness with people in your life. A sense of freedom and well-being comes with the capacity to face your feelings rather than the all too common situation of ignoring and avoiding feelings.
Together, in session, we will monitor your physiological responses to the material that come up. You become well acquainted to listening to your body. Thus a sense of balance is felt; for example you can use both your emotions and thoughts as guides in your life.
Anxiety that you experience will be a useful guide during our sessions together. Anxiety is typically related to something external that is seen as a threat or is worrisome (e.g., a test or public speaking). Anxiety can also be activated by internal stressors; specifically, for our work it will be used as a way to detect when difficult to face feelings are being activated. Together, we can monitor both when as well as how your anxiety is being manifested. This becomes a useful barometer in your sessions. In ISTDP we categorize how this (unconscious) anxiety is being manifested; namely:
1. In the striated / voluntary muscles (this is experienced as tension)
2. In the smooth muscles or autonomic nervous system (e.g., gastrointestinal upset)
3. In the cognitive and perceptual system (e.g., blurry vision, loss of concentration)
The interventions that are employed depend on how the anxiety is being manifested at any given moment. We, acting as a team, will monitor this together. This simple act helps to increase the capacity to regulate and tolerate anxiety; it acts to provide a sense of calm and strength in facing life’s challenges. Additionally, it helps identify where the emotional conflicts are so that we can target and face them. What typically occurs over the course of therapy is both a significant decrease in anxiety as well as an improved capacity to face anxiety when it arises.
Defense mechanisms have been described and categorized in a variety of ways. For our purposes in ISTDP we view them as behaviors that are impeding or blocking the progress in therapy. So with a major task of ISTDP therapy being one of emotional honesty, defenses can be seen as mechanisms that are used to block experiencing feelings of other difficult to face material. As such, defenses act to both block getting to this material and also put up a wall or barrier between the patient and therapist. In short, defenses interfere with your life and with the therapy. Our goal is to overcome this internal resistance to facing your feelings and to closeness. These defenses or resistance typically occur outside one’s awareness. So, first, we will act to identify them. Once we can see the clearly, we will work together, as a team, to block these crippling inhibitory forces. For example, many people are highly self-critical or ruminate but this behavior happens so frequently that unfortunately these destructive behaviors seem as though it is just who they are. In ISTDP, with the supreme effort on both your and my part and with the help of each other, we will turn against these destructive forces and towards your health, growth, and freedom.