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What happens in an Intensive Short –Term Dynamic Psychotherapy (ISTDP) session?

what happens in an intensive short –term dynamic psychotherapy (istdp) session?

This post is by Psychology Melbourne psychologist  Aisha Seedat-Timol

I am often inspired in my work by a quote from American psychotherapist Jon Frederickson, founder of the ISTDP Institute, in one of his books, The Lies We Tell Ourselves:

"Life is hard, but psychological suffering can be unbearable. To find a way to bear it, we may seek a good therapist. But once we find such person, how do we work together to stop suffering?"

Traditionally, psychoanalytic treatment has been a lengthy process, involving long-term commitments from both patient and therapist that can include more than one session per week, extending over years. There is a substantial financial commitment too, at times without immediate, obvious return.  

Intensive Short-term Dynamic Psychotherapy (ISTDP) was developed by Canadian psychoanalyst, Dr Habib Davanloo,  at McGill University in the 1960s. As it evolved and provided patients with direct access and re-experiencing of unconscious feelings, it produced rapid, evidence-based, ground-breaking results.  

More importantly, Davanloo’s results challenged the psychoanalytic cliché of progress as a years-long struggle and demonstrated that widely applicable brief psychotherapy can achieve successful outcomes much more quickly. 

ISTDP is more active and focused than traditional psychodynamic psychotherapy. It has been shown to be effective in the treatment of anxiety, depression, character disorders (referred to as personality disorders in the Diagnostic and Statistical Manual of Mental Disorders) and somatisation.

The treatment approach is based on examining the physiology of emotions (physical manifestation), the effect on anxiety levels and the avoidant patterns that a person puts into place that lead to suffering. The work brings to the conscious the link between the physical manifestations of anxiety and emotions as well as the defence patterns and habits that a person develops against these, resulting in suffering.

If the defences work well at keeping feelings hidden, little or no anxiety is experienced. If the defences fail, anxiety rises. 

The therapist directly examines those patterns, defined by anxiety affecting the muscles (striated anxiety: tensions, butterflies in the stomach, fidgeting etc.), the smooth muscles (somatoform: headaches, chronic pain, bowel problems) and cognitive perceptual functioning (mind going blank, dizziness, dissociating, urge to discharge in an impulsive manner). 

Gentle but persistent "pressure" - more accurately encouraging the patient to be present and not to defend - is exerted, inviting the patient to acknowledge and turn against the defences that block the experience of the true feelings. In simple words, difficulties in fully accessing and feeling emotions result in physical sickness or anxiety.

Photo by Brett Jordan on Unsplash