29 Oct Intensive Short-Term Dynamic Psychotherapy: What to Expect in Treatment

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Have you ever felt stuck in therapy, making slow progress, or none at all? You’re not alone. Many people find traditional long-term therapy frustrating or ineffective.

That’s where intensive short-term dynamic psychotherapy (ISTDP) comes in. This innovative approach aims to speed up the therapeutic process and produce lasting change in a shorter time frame.

In this article, we’ll explore what intensive short-term dynamic psychotherapy is, how it works, and what you can expect if you decide to try this treatment. We’ll cover the basics, dive into the theory behind it, and give you a clear picture of what an ISTDP session might look like.

What is Intensive Short-Term Dynamic Psychotherapy?

Intensive short-term dynamic psychotherapy, often abbreviated as ISTDP, is a form of psychotherapy developed by Dr. Habib Davanloo in the 1960s. It’s designed to help people quickly identify and resolve emotional issues that may be causing psychological distress or interfering with their daily lives.

Key Features of ISTDP

1. Short-term focus: Unlike traditional psychotherapy, which can last for years, ISTDP typically aims to achieve significant results within 10 to 40 sessions.
2. Intensity: Sessions are often longer and more frequent than in traditional therapy, sometimes lasting up to 3 hours.
3. Active therapist role: The therapist takes a more direct and confrontational approach, challenging the patient’s defenses.
4. Emphasis on the unconscious: ISTDP focuses on bringing unconscious emotions and conflicts to the surface.
5. Video recording: Sessions are often recorded for review and training purposes.

The Theory Behind ISTDP

Understanding what to expect in intensive short-term dynamic psychotherapy helps one to know a bit about the theory behind it. ISTDP is based on the idea that many psychological problems stem from repressed emotions and unresolved conflicts. These issues often start in childhood but continue to affect us as adults.

The Triangle of Conflict

A central concept in ISTDP is the “triangle of conflict.” Picture an upside-down triangle with these three elements:

1. Hidden feelings (usually anger, grief, or love)
2. Anxiety
3. Defenses

The theory suggests that when hidden feelings arise, they trigger anxiety. To manage this anxiety, we develop defense mechanisms. These defenses, while initially protective, can become problematic over time.

For example, let’s say you had a parent who was often critical. As a child, you might have developed a defense of perfectionism to avoid criticism. While this might have helped you cope as a child, as an adult, it could lead to stress, burnout, and difficulty in relationships.

The Triangle of Person

Another key concept is the “triangle of person.” This explores how patterns of behavior and emotion play out across different relationships:

1. Current relationships
2. Past relationships
3. The relationship with the therapist

By examining these patterns, you and your therapist can identify recurring issues and work to resolve them.

What Happens in an ISTDP Session?

Now that we’ve covered the basics let’s walk through what you might experience in an intensive short-term dynamic psychotherapy session.

Initial Assessment

Your first ISTDP session will likely be longer than subsequent ones, often lasting 2-3 hours. During this time, your therapist will:

1. Ask about your current problems and life history
2. Assess your psychological defenses and capacity for emotional experiencing
3. Determine if ISTDP is a good fit for you

This initial session can be intense. Your therapist might push you to confront difficult emotions right from the start. While this can feel uncomfortable, it’s designed to give both you and the therapist a clear picture of how you handle emotional stress.

Regular Sessions

If you and your therapist decide to proceed with ISTDP, you’ll begin regular sessions. These are usually scheduled weekly and last 45-60 minutes, although some therapists may use longer sessions.

Therapeutic Techniques

During ISTDP sessions, your therapist will use several techniques:

1. Pressure

Your therapist will encourage you to focus on your feelings and bodily sensations, especially when discussing difficult topics. They might ask questions like, “What are you feeling right now?” or “Where do you feel that in your body?”

2. Challenge

When your therapist notices you using defense mechanisms, they’ll point them out and question them. For example, if you change the subject when talking about a painful memory, your therapist might say, “I notice you’ve moved away from that topic. What feelings came up for you just now?”

3. Head-on Collision

This technique involves directly confronting resistance to change. It can feel uncomfortable but is designed to break through stubborn defenses. Your therapist might say something like, “I can see you’re working hard to avoid these feelings. But by doing so, you’re keeping yourself stuck. Are you willing to face these feelings now?”

4. Unlocking the Unconscious

Through these techniques, the goal is to bring unconscious feelings and conflicts into conscious awareness. This can lead to powerful emotional breakthroughs.

Physical Responses

It’s common to experience physical sensations during ISTDP sessions. You might notice:

• Muscle tension
• Changes in your breathing
• Sweating
• Trembling

These physical responses are seen as signs that you’re connecting with deep emotions. Your therapist will likely encourage you to pay attention to these sensations and explore what they might mean.

Emotional Breakthroughs

As treatment progresses, you may experience intense emotional breakthroughs. These can be cathartic moments where previously repressed feelings are fully experienced and expressed.

For example, you might finally allow yourself to feel anger towards a parent who wasn’t there for you or grief over a loss you never fully processed. While these experiences can be intense, many people find them deeply relieving and transformative.

Between-Session Work

Your therapist may assign homework between sessions. This might include:

• Journaling about your feelings
• Practicing mindfulness techniques
• Applying insights from therapy to real-life situations

This work helps to reinforce and extend the progress made in sessions.

Is ISTDP Right for You?

While intensive short-term dynamic psychotherapy can be highly effective, it’s not suitable for everyone. It may be a good fit if:

1. You’re motivated to make changes in your life
2. You’re willing to experience intense emotions
3. You’re able to commit to regular sessions
4. You’re interested in understanding the root causes of your problems

However, ISTDP might not be appropriate if:

1. You’re in acute crisis or have severe mental health issues
2. You have difficulty tolerating intense emotions
3. You prefer a more supportive, less confrontational approach

The Effectiveness of ISTDP

Research has shown that intensive short-term dynamic psychotherapy can be effective for a wide range of psychological issues, including:

• Depression
• Anxiety disorders
• Personality disorders
• Somatic symptom disorders
• Relationship problems

A meta-analysis published in the journal “Psychotherapy” in 2017 found that ISTDP showed large effect sizes for general psychopathology, depression, and anxiety, with effects maintained at follow-up.

However, it’s important to note that every individual is different, and what works for one person may not work for another. The effectiveness of any therapy depends on various factors, including the specific issues being addressed, the skill of the therapist, and the commitment of the patient.

Preparing for ISTDP

If you’re considering trying intensive short-term dynamic psychotherapy, here are some steps you can take to prepare:

1. Research ISTDP: Learn more about the approach to ensure it aligns with your goals and preferences.
2. Find a qualified therapist: Look for a therapist who has specific training in ISTDP. Don’t be afraid to ask about their experience and approach.
3. Set clear goals: Think about what you want to achieve through therapy. While these goals may evolve as you progress, having a starting point can be helpful.
4. Be open and honest: Prepare to share difficult feelings and experiences with your therapist. The more open you can be, the more effective the therapy is likely to be.
5. Commit to the process: ISTDP requires active participation and willingness to face challenges. Be prepared to put in the work, both during sessions and between them.
6. Take care of yourself: ISTDP can be emotionally demanding. Make sure you have good self-care practices in place, such as getting enough sleep, eating well, and exercising regularly.

Conclusion

Intensive short-term dynamic psychotherapy offers a unique approach to mental health treatment. Focusing on unconscious conflicts and emotions aims to achieve significant results in a relatively short time frame.

While it can be challenging, many people find ISTDP to be a transformative experience that leads to lasting psychological change.

If you’re struggling with emotional issues or patterns of behavior that you can’t seem to change, ISTDP might be worth considering.

However, as with any form of therapy, it’s important to consult with a qualified mental health professional to determine the best treatment approach for your individual needs.

 

More information:

1. https://istdpinstitute.com/resources/intensive-short-term-dynamic-psychotherapy-an-introduction/

If you or someone you know is struggling or in crisis, help is available. Call or text 988 or chat at org. To learn how to get support for mental health, drug or alcohol conditions, visit FindSupport.gov. If you are ready to locate a treatment facility or provider, you can go directly to FindTreatment.govor call 800-662-HELP (4357).

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Last Updated on October 29, 2024 by Marie Benz MD FAAD