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ISTDP
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ISTDP

(Intensive Short-Term Dynamic Psychotherapy)

What Will I Cover in This Blog Post?

In this blog post, I will tell you about ISTDP, or Intensive Short-Term Dynamic Psychotherapy. It is a therapeutic approach I use extensively in my practice, especially with clients experiencing stress. This post will cover what ISTDP can help with, important aspects of the therapy, and its focus on anxiety and psychological defences. I will also present both the Triangle of Person and the Triangle of Conflict, which effectively illustrate key areas of focus in ISTDP. My hope is that after reading this, you will feel well-prepared to engage in self-exploration through this exciting form of therapy. If you feel a little nervous, that’s often a good sign!

What is Intensive Short-Term Dynamic Psychotherapy?

ISTDP stands for Intensive Short-Term Dynamic Psychotherapy. This therapeutic approach was developed by Habib Davanloo starting in the late 1960s. In ISTDP, it is believed that many of the difficulties we experience stem from unconscious emotions that we struggle to access. Therefore, a core part of the therapy involves uncovering these feelings and identifying what prevents us from experiencing them.

This therapy emerged from psychoanalysis and attachment theory. However, ISTDP is often shorter in duration compared to more traditional psychodynamic therapies. In ISTDP, the focus is on getting to the root of the symptoms you seek help for. The idea is that if the underlying cause of symptoms is not addressed, and therapy only focuses on symptom reduction, these symptoms will typically reappear after a while or manifest in a new form. A helpful metaphor is that we aim to find the mole, rather than just focusing on the molehills. In ISTDP, the therapist uses specific techniques to work collaboratively with the client, effectively uncovering the root causes of the issues they are experiencing.

What Can ISTDP Help With?

ISTDP is an evidence-based therapy suitable for treating anxiety, depression, psychosomatic problems (i.e., physical issues for which no medical explanation can be found), relational difficulties, and personality disorders.


Personally, I also use this therapeutic approach with almost all clients experiencing stress, as I find it meaningful to explore the underlying causes of stress symptoms.


I find ISTDP to be a highly effective therapy if you feel you are not yourself, for instance, if you have become stuck in a particular role. It can be beneficial if you often feel you are putting on a façade, and therefore not fully in touch with yourself or the important people in your life. If you notice yourself repeatedly encountering the same difficulties, ISTDP may help you discover what is happening and why.

What is the Experience of ISTDP Like?

Experiential Focus

ISTDP is an experiential therapy. This means that a significant part of what makes the therapy effective is that clients have direct experiences during sessions. For example, they might experience long-suppressed emotions, or become aware of how they treat themselves, leading to a profound emotional understanding. In ISTDP, it is believed that intellectual understanding alone is not enough; one must *feel* it for true change to occur.

In ISTDP, we speak of breakthroughs. This phenomenon occurs when you come into contact with something that has previously been unconscious. This could involve experiencing long-buried emotions, or realising a tendency to keep others at arm's length, which can also evoke a strong emotional reaction.

When I've asked my clients about their experience of the therapy, some typical responses have been: "You scratch beneath the surface more," "it's not just superficial talk," and "it's intense but meaningful, and I'm tired afterwards." In ISTDP, we don't spend a lot of time simply talking *about* things; instead, we work collaboratively to uncover what lies beneath. I often say that it's good to feel a little tired after a psychology session.

Here-and-Now Focus


In ISTDP, there is a strong emphasis on the 'here-and-now.' This means we constantly pay attention to what you are experiencing in your body and your other reactions in the moment. We often start by discussing a situation where you experienced the difficulties you seek help with. However, as we talk about that situation, we simultaneously observe what is happening right now, in the present moment. This ensures we detect if the same difficulties arise during the session itself. This approach can help us understand why you experience these challenges and allows you to become more aware of the internal mechanisms that may be perpetuating them.

 


For example, if you experience anxiety symptoms in specific situations, I will ask you to describe an instance of this. During our conversation, we will together monitor if you experience any of those same anxiety symptoms. This allows us to work directly with the anxiety, or any other difficulties you may be experiencing, as they arise.


Working with Transference


In ISTDP, we focus on situations where your difficulties arise, most often in interactions with other people. This is because other people naturally activate our emotions.

In relationships with others, old patterns can emerge, which are linked to our attachment system.


Our attachment system develops in childhood through our interactions with primary caregivers and sets the tone for how we later perceive and interact with others. If, as children, our needs were not met in an optimal way, we develop strategies to navigate these situations. This is a natural adaptation; we find ways to adjust to our environment.


The problem arises if these strategies are not updated but remain deeply ingrained, continuing into adulthood even when we are no longer dependent on our parents in the same way.

In ISTDP, we use this knowledge of the attachment system to understand why we behave the way we do in relationships with others. We also utilise the fact that the therapy situation itself is a relationship with another person (the therapist).


For example, if you generally tend to withdraw or hide in relationships with others, you will likely do the same in the relationship with your therapist.

For instance, you might find it difficult to express your needs and take yourself seriously. Instead, you might tend to dismiss your experiences, thinking, 'Oh well, what I'm feeling probably isn't that important.' If this is the case, it often emerges within the therapy itself. For example, if I ask, 'What would you like my help with?' and you respond, 'Hmm, it's probably silly, but I often get heart palpitations when I disagree with others,' then we can discuss *that* here and now – the fact that you are currently dismissing your own experience as 'silly'.


It is beneficial when these difficulties manifest within the therapy session itself, as it allows us to work directly with them.

The Triangle of Person in ISTDP

Persontrekanten i ISTDP. I de øverste to hjørner står terapeut og nutidig relation. I nederste er primær tilknytningsrelation

In ISTDP, we use a model called the 'Triangle of Person.' This model illustrates how relational patterns learned in our primary attachment relationships (typically with parents) will reappear in our current relationships (with partners, friends, colleagues). These patterns will also typically emerge in the relationship with your therapist, as the therapist is another person with whom you can develop a close connection.'


For example, as a child, you might have learned to suppress your needs and take on excessive responsibility because it was necessary. Perhaps your parents were not adept at helping you assert yourself or express what you needed. Consequently, you might exhibit the same tendencies in your current relationships. This could manifest as not telling your partner that you need them to do their share of household chores, or not telling a friend that they should be better at taking initiative. The same pattern can also emerge in therapy. For instance, you might not communicate what you need help with, instead focusing on what you think the therapist wants.

I ISTDP ser man, at mange mennesker har svært ved at mærke deres følelser, men i stedet oplever angstsymptomer. Dette skyldes, at følelserne af en eller anden grund er blevet "forbudte", og man i stedet mærker angst. Et klassisk eksempel er, at man ikke mærker, at man bliver vred, men i stedet bliver nervøs, anspændt eller ked af det. Grunden til, at nogle følelser på denne måde bliver undertrykt eller "omdannet" til angst, er ofte at finde i de tidligere relationer. Det kan være, ens forældre ikke har kunnet håndtere den vrede, man havde som barn, eller hvis man har set en forælder blive hidsig og råbe, når de var vrede. Det kan medføre, at vreden ubevidst bliver holdt nede, og man i stedet oplever anspændthed.

Anxiety in ISTDP

In ISTDP, we observe how anxiety manifests in the body. This is crucial because it indicates whether we are on the right track – for instance, if we are getting closer to an underlying pattern or to emotions beneath the anxiety. Anxiety also signals whether we can press ahead, slow down, or if we need to completely pause and reduce the anxiety before proceeding. It's much like a traffic light: we have green, amber, and red anxiety. To determine where we are in this 'traffic light' (go, slow down, or stop), we must examine how the anxiety is experienced in the body, here and now, during therapy.

Experienced as, for example:

  • Dry mouth
  • Sweating
  • Cold hands
  • Heart palpitations
  • Trembling/chills
  • Tension
  • Tension headaches
  • Voice cracking
  • Rapid breathing

Green anxiety

Amber Anxiety

Experienced as, for example:

  • Migraines
  • Upset stomach
  • Nausea
  • Vomiting
  • Urgent need to use the toilet
  • Decreased breathing and blood pressure

Red Anxiety

Experienced as, for example:

  • Ringing in the ears
  • Blurred vision
  • Tunnel vision
  • Foggy thinking
  • Dissociation
  • Hallucinations

The Triangle of Conflict in ISTDP

As described above, it is common to experience anxiety symptoms instead of feeling emotions directly. Since anxiety is uncomfortable, many people begin to develop various types of defences. These are unconscious strategies used to keep emotions suppressed, thereby avoiding both the feelings themselves and any potential anxiety symptoms. This dynamic can be illustrated by the Triangle of Conflict.


Because these processes often occur unconsciously, you are not necessarily aware of what you are doing. Therefore, help from another person is often needed to become conscious of your defences, allowing you to address them.

Konflikttrekanten i iSTDP. Øverst står forsvar og angst. Nederst er følelse.

Some of the most common defences include: shutting off from emotions, thinking instead of feeling, rationalising (coming up with explanations), talking around issues, blaming others, and distancing oneself.

We all use defences sometimes, and most of us are not conscious of doing so. If these defences become problematic – for example, by preventing you from connecting with your feelings, understanding your desires, or if you feel distant in your relationships – it can be very painful. ISTDP offers a way to work through these unconscious and often self-defeating strategies.

Is ISTDP Right for Me?

I hope that after reading a little about ISTDP, you feel curious to learn more about yourself, your anxiety patterns, and your psychological defences. If you wish to read more about ISTDP, I recommend visiting the Danish Society for Dynamic Short-Term Psychotherapy and the ISTDP Institute.


If you are unsure whether ISTDP is the right approach for your particular challenges, please feel free to contact me.

If you are ready to get to know yourself and your unconscious, you are welcome to book an appointment now.

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