My work as a psychotherapist has always been strongly influenced by psychodynamic theory. In 2005, I attended a conference on Intensive Short Term Dynamic Psychotherapy (ISTDP) and was powerfully impacted by observing on videotape the work of colleagues who were using psychodynamic theory but applying it in ways that I had not previously seen. This experience motivated me to become involved in training programs to learn how to incorporate ISTDP into my own practice. I now approach the psychotherapy work I do from the vantage point of ISTDP.

Intensive short term dynamic psychotherapy (ISTDP) is an approach to psychotherapy that derives from more traditional psychoanalytic (psychodynamic) psychotherapy. It is based on the belief that most emotional suffering results from our difficulty facing complex painful feelings inside of us. These painful feelings may be triggered by a recent experience and it may appear to us that what just happened in our lives is the cause of our pain. However, upon closer examination in therapy it usually becomes clear that the recent event is so painful because there are unresolved and often unacknowledged feelings resulting from earlier painful experiences (traumas). When these underlying feelings can be understood and directly experienced in therapy, there can be very positive changes in how we feel and how we function in our lives.

Painful feelings result in anxiety when they come close to our conscious awareness. So even if we believe that we are anxious because of a specific current circumstance in our lives, the true source of anxiety will be painful feelings that are generating conflict internally. We use defense mechanisms to ward off the anxiety and the underlying painful feelings. While some defense mechanisms can work well for us and even allow us to be successful (e.g. managing anxiety and emotional pain by being very hardworking, organized, and ambitious), there is usually a cost to us emotionally as a result of relying upon these defenses. When someone seeks therapy, it is usually because habitual defense mechanisms are not effective in dealing with a current crisis or else we have become aware that our defenses are exacting a cost that is no longer acceptable (e.g. a lack of intimacy due to defenses that cause us to maintain an emotional distance from others).

Most forms of psychodynamic therapy attempt to help patients understand how their current suffering is due to painful (often unconscious) feelings; to show them how defense mechanisms are getting in the way of a healthy life; and how to link the current difficulties to past painful experiences in life. Commonly, the current difficulties can make sense when seen in the context of early painful experiences in childhood, especially those involving significant figures such as parents and siblings. This method can help patients develop good insight into how their minds work and why they struggle as adults to have healthy relationships, successful careers, and feelings of fulfillment.

Unfortunately, developing insight into oneself is valuable but often insufficient to bring about the kinds of changes that most seek when they enter therapy. Many people find that even after significant periods of time in therapy, they are still struggling with the issues that led them to seek help in the first place. Those of us who practice ISTDP have found that this approach has the potential to be more effective than other therapies. How to find out if you might be helped by this approach can only be determined by a 90-120 minute consultation which will allow you to experience how this approach differs from previous therapy experiences you may have had.

At the heart of ISTDP is the belief that it is not enough to have insight into our feelings. Rather, it is thought that the way to change the most is to have a direct experience of feelings in the therapy session itself. This means that the therapist takes a very active stance in helping patients experience deep and essential feelings. The therapist works hard to identify the defenses that are preventing a patient from having direct access to feelings. Patients are acquainted with their defenses so that they can begin to make a choice about keeping these defenses or facing their feelings honestly and fully. This process usually triggers anxiety which is understandable given that feelings are being brought closer to the surface that are associated with pain and a sense of danger. In ISTDP, anxiety is addressed throughout the session to help the patient regulate anxiety so that feelings can emerge and not be overwhelming. Patients are helped to see the various ways that feelings are being avoided even when it appears that meaningful issues are being addressed in the session. For example, talking about other people in your life may be a diversion from facing your own feelings towards them. Tendencies to speak from an intellectual and rational standpoint are identified and challenged so that underlying feelings can be revealed and faced directly. The feeling of anger is often threatening and avoided and this must be addressed since anger which is suppressed often leads to depression and self-defeating patterns of behavior.

In short, a serious collaboration takes place between therapist and patient to get to the heart of the matter and not waste time talking around the issues. Sometimes the experience may feel very challenging and intense, especially when patients are accustomed to having a wide latitude to talk about whatever comes to their minds in therapy. However, patients generally appreciate that the therapist is making a serious effort to help them get to a point of mental health that is consistent with their stated goals and which will prove to be enduring. While the approach is called short term, this does not mean that a specific number of sessions is predetermined. Instead, the therapist is committed to working with the patient to make each session be a meaningful step towards addressing the core issues that led to the decision to seek help in therapy.

For Psychotherapists interested in studying ISTDP, please go to the Supervision page.