Intensive short-term dynamic psychotherapy (ISTDP) was first developed by psychiatrist Habib Davanloo in the 1960s. He was looking for a method to overcome resistance, which he viewed as a manifestation of conscious and unconscious defenses. Frustrated by the length and unreliability of traditional psychoanalysis, he sought a brief and active intervention to access the unconscious. Through intensive study of videotaped therapy sessions, he found a method that he believed overcame resistance in the shortest amount of time.
What is ISTDP?
ISDTP is a brief psychodynamic therapy. It is a modern take on classic psychoanalysis, which can take years to administer. Davanloo theorized that emotions stuck in the unconscious lead to negative symptoms and characterological problems. These unconscious feelings are primarily the result of unprocessed attachment trauma. The chief goal of ISTDP is to help the patient combat resistance and face their underlying feelings. Freed from resistance, they can begin to recognize their psychological conflicts and work to overcome their troubles.
Concepts of ISTDP
The Inquiry or trial
The first part of ISTDP is a 2-3 hour assessment phase, where the therapist concentrates on intervention and assesses the patient’s response, focusing on the nature and degree of their resistance. The therapist can then determine directions for treatment.
Pressure is the main technique used by the therapist. It serves to push the client beyond their comfort zone. In that way, it helps clients explore areas that have been avoided. As an example, a therapist may ask his depressed client, “let’s look at what thoughts and feelings are driving your sadness”. Pressure is likely to bring up feelings of anxiety and initiate defense mechanisms. The goal of pressure is to mobilize complex transference feelings (i.e., feelings experienced towards the therapist which relate to unresolved feelings about attachment trauma). Uncovering these feelings is the key to healing.
Clarification is the way the therapist shows the client that they are using resistance and educates them about how they defend themselves. This is necessary because clients are frequently unaware that they use defense mechanisms. For example, the therapist may say: "Do you notice that whenever you are nervous you laugh? Do you think you use laughter to cover up for anxiety?”
Once the resistance is identified, it then must be challenged. A challenge attempts to get the client to throw off their defenses to get at their unconscious feelings of past attachment trauma. For example, a therapist might say. “If you don’t laugh when you are nervous, what feelings are there?”
Unlocking the unconscious
Using pressure, clarification, and challenge, the therapist attempts to help the patient get to unconscious feelings that are buried behind their defenses. When a client can shed their defenses and allow their feelings to surface, this is known as unlocking the unconscious. This is a difficult but necessary step for both the client and the therapist. The client will experience complex painful feelings and they will be directed at the therapist. These now conscious feelings can then be explored and related to their present difficulties. This process forms the crux of healing using ISTDP.
Think of recapitulation as a consolidation of the ISTDP process. An ISTDP therapist does not interpret findings until the unconscious is unlocked. But once they have broken through, they work with the client to make connections between underlying emotions, defense mechanisms and presenting problems. Recapitulation solidifies their understanding, strengthens the alliance with the therapist, and continues to weaken their resistance.
Davanloo developed his therapy by repeatedly watching audio-visual recordings of his sessions. Therapists who practice ISTDP are encouraged to do the same and a review of videotaped sessions is a crucial component of any training program and practice. An ISTDP therapist is never done honing their craft and videotaping sessions is a large part of their evolution as a therapist.
Advantages and disadvantages of ISTDP
ISTDP is a brief psychotherapy, especially compared with classic psychoanalysis. Although it does not advocate a set amount of meetings, most disorders can be treated in 20 sessions.
As with most psychodynamic therapies, ISTDP focuses on a person’s root conflicts and emotions. This may be seen as fostering a deeper and long-lasting understanding than can be accomplished with cognitive-behavioral therapy (CBT), which primarily focuses on the present.
ISDTP has been shown effective in treating psychoneuroses, which are distressing psychological problems that do not have psychotic or bizarre symptoms. Neurotic symptoms are viewed in psychodynamic theory as exaggerated defense mechanisms arising out of unconscious attempts to cope with internal conflicts and their resulting anxiety, which is exactly what ISDTP targets. Somatic disorders are seen as a prime example of psychoneuroses. ISTDP has shown merit in treating psychogenic seizures, movement disorders, and other psychosomatic problems.
Personality disorders are famously hard-to-treat but ISDTP has exhibited impressive results in small studies of clients with a variety of personality disorders. This seems especially true with cluster C personality disorders, which include avoidant, dependent, and obsessive-compulsive disorders.
Similar to behavioral exposure techniques, ISTDP forces the client to confront difficult experiences and emotions without much buffer. This process can make the therapy experience feel uncomfortable at the very least and highly distressing at worst.
Despite it being a relatively brief therapy in psychodynamic terms, it may still be longer than most CBT-related techniques. While 20 sessions may be the average amount of sessions, more resistant problems may require double that.
Training and resources
Training in ISDTP is an extensive process that may be completed over months and years, rather than days. It is not widely taught and you may have to travel to find suitable training.
It is not uncommon for core training to be conducted over a three-year period.
- The ISTDP Institute website has information on training and additional links to valuable resources, such as books and audio courses.
- The Washington School of Psychiatry offers one-year and three-year certification programs in ISDTP. The one-year course meets over 20 weeks.
- The ISTDP Australia website lists further resources, including videos, publications, and links to pertinent websites. It also offers international training.
For those who want to see what it looks like, here is a video of an ISTDP therapy session.
Intensive short-term dynamic psychotherapy aims to break through resistance to uncover unconscious feelings and promote personal healing. It exhibits success in treating anxiety, depression, personality disorders, and somatic problems. If you would like more information about ISTDP and other forms of treatment, Theraplatform is a valuable resource. Theraplatform is an all-in-one teletherapy, practice management, and electronic documentation software for clinicians. It also has a library of worksheets and articles to help therapists with their individual practices. All therapists can benefit from a reliable and secure practice management platform. Try a 30-day free trial of Theraplatform today.