Intensive Short Term Dynamic Psychotherapy - ISTDP

A challenging and highly effective bodymind collaborative approach

The first time I read about ISTDP I thought it was too rough and confrontational and did not pay much attention to it. Years later, attending a general training on Experiential Dynamic approaches, I started hearing more about the rationale for such "roughness" and eventually I got hooked.

Research data shows its impressive effectiveness in treating even the patients with most complex and long standing problems - from severe depression to anxiety, from relationship problems and emotional dysregulation to even certain medical conditions such as chronic pain and non-epileptic seizures - to name a few. From the 1980's, the psychoanalyst and physician Habib Davanloo at Mcgill University in Montreal, during decades of minutiously studying thousands of hours of video tape of his own therapy sessions with his clients, was able to develop a model of therapy that goes straight to the point. Davanloo was frustrated with the slowness of the psychoanalytic method.

Because it is designed to be highly effective - out of the urge to free people from their suffering as soon as possible- ISTDP can feel intense and challenging. It is not necessarily a therapy to help you stay within your window of tolerance, but more so a therapy to help you increase your window of tolerance so that you can increase your capacity to deal with life.

As in AEDP, this model of therapy also looks at the unconscious dynamics between feelings (emotions), anxiety (as a body based experience) and defenses (coping strategies) - which generally keep us stuck in our problems.

In an ISTDP session the therapist and patient team up to notice what is going on in the body which will help map out what is going on in psychodynamic terms. We weave together the sensorial reactions in the body as we talk about things that are important to you. Sensations in your muscles, changes in temperature, stomach or breathing reactions, all of it is precious wisdom to guide our path - to notice whether the mind is shielding itself from being seen and what are the strategies that the unconscious uses to do so. Of course, if those coping strategies are happening, there is a very good reason for it - they may have been very helpful in the past, sometimes even vital. But as the patient inadvertently maintains those outdated responses, they might contribute to his/hers/their problems. Gaining awareness of these uncounscious coping strategies, helps bring the patient at choice, so that they feel more in control of their responses to the challenges of life.

Within the session the idea is that you will always have a voice. And we also diligently collaborate toward giving voice to parts of your experience that may have been silenced along the way.

One of the most remarkable contributions of ISTDP for me is the understanding of three pathways of anxiety (or more specifically speaking "signal anxiety"- anxiety that signals that conflicting avoided feelings are at bay). I'm going to write another post about it soon, but basically they are voluntary muscle anxiety, smooth muscle anxiety and cognitive perceptual disruption.