Intensive Short-Term Dynamic Psychotherapy

What is ISTDP?

Intensive Short-Term Dynamic Psychotherapy (ISTDP) is a form of brief psychodynamic, experiential, and emotion focused psychotherapy. ISTDP addresses the underlying internal conflicts related to unresolved emotions from past attachment hurt or traumas. When we experience present day triggers to past wounds, unconscious emotions related to these wounds trigger anxiety. We avoid these anxiety-provoking emotions with unconscious patterns that were once useful but have become out-of-date and unhelpful. Because these emotions are avoided, they are often out of our awareness which makes it hard for us to know that there might be an emotionally related underlying cause to our problems. 

Through active collaboration between the client and therapist, the client can become more aware of their unconscious patterns, and how they contribute to their current life problems. With this awareness, the client gains the opportunity and choice to address the unresolved emotions to reduce anxiety and the need for the maladaptive avoidant patterns.

The origins of ISTDP

ISTDP was developed in Canada by Dr. Habib Davanloo, a trained psychoanalyst, in the 1960s and 1970s and has been refined over decades of research up to current day. Dr. Davanloo was dissatisfied with the long term approach of traditional psychoanalytic therapy and discovered an approach to treatment that could result in greater client change in a shorter period of time. While most psychotherapies were developed by starting with a theory of mental health, applying that theory in sessions, and testing for positive results, Dr. Davanloo created ISTDP by reviewing thousands of hours of videotaped psychotherapy sessions to learn what worked for his patients. ISTDP was developed from these videotaped sessions in which the patients showed Dr. Davanloo what worked. ISTDP was not created by fitting patients into a pre-existing theory, but by watching and listening to what helped patients heal, and and developing a theory from positive outcomes. ISTDP has continued to evolve and improve over time in the hands of more recent psychotherapist researchers like Dr. Allan Abbass, Dr. Joel Town, Jon Frederickson, and Dr. Patricia Coughlin, among others. 

What does “intensive”, “short-term” and “dynamic” mean?

ISTDP is “intensive” in that it involves active collaboration and constant moment-by-moment attention of here-and-now responses of the client throughout each session. This active focus on client responses can help clients more quickly see, understand, and change habitual patterns of responding that may cause their symptoms. In this way, ISTDP is “short-term” in comparison to its psychoanalytic roots. “Dynamic” refers to the way in which  psychodynamic therapies focus on addressing  underlying core conflicts at the root of the client’s distress or suffering to help them engage in deep and lasting change. 

How does ISTDP differ from other therapies?

There is a lot of overlap in different modalities of therapy. Depending on their psychological makeup, people can benefit from many different kinds of therapy ranging from cognitive behavioural therapies to emotion-focused or experiential therapies. The uniqueness of ISTDP lies in its comprehensive metapsychology (understanding of human psychological functioning) that bases intervention on moment-by-moment assessment of the client’s internal responses. The ISTDP therapist constantly assesses the client’s anxiety levels, ability to tolerate emotions, learned ways of responding to anxiety provoking emotions, and emotional states while always keeping in mind the client’s treatment goals. ISTDP is a truly person-centred treatment that constantly tailors interventions to the needs of the individual. 

The ISTDP metapsychology also offers a way to understand and treat somatic symptoms and disorders (e.g. chronic pain, fibromyalgia, gastrointestinal problems, migraines, chronic headaches, conversion disorders, pseudoseizures). How our anxiety manifests in the body and how we avoid the anxiety-provoking emotions can generate different kinds of somatic symptoms. Through careful investigation of client responses to anxiety and emotions, treatment can be tailored to improve emotional tolerance and reduce anxiety to improve somatic symptoms. ISTDP offers an alternative to treatment approaches that focus on symptom management and acceptance. By focusing on the emotional contributors to somatic symptoms, ISTDP can help reduce or resolve physical symptoms that have an emotional cause. 

While ISTDP is highly effective, it is a lot more complex and requires more years of intensive training to master than some other modalities. It is advisable for individuals who are interested in seeking this form of treatment to inquire the clinician about their training and whether they have on-going consultation.

What does the research say about ISTDP?

ISTDP is an evidence-based transdiagnostic psychotherapy and continues to show effectiveness for a wide range of psychological conditions with long lasting outcome. Research has shown ISTDP to be effective for conditions that have traditionally been seen as difficult to resolve, including  personality disorders, treatment resistant disorders, and somatic, functional, or medically unexplained symptoms.