ISTDP: A Brief Introduction to Intensive Short-Term Dynamic Psychotherapy
By Catherine Lockwood, MA, LMFT, and Reiko Ikemoto Joseph, MA, LMFT
As the name suggests, Intensive Short-Term Dynamic Psychotherapy (or ISTDP) is a powerful, accelerated form of psychotherapy designed to rapidly uncover and resolve deep emotional and psychological difficulties. ISTDP is evidence-based, and research has shown it to be a uniquely effective treatment for people suffering from depression, anxiety, and a broad spectrum of personality disorders and self-defeating behaviors. One of the things that makes ISTDP so effective is its intense focus on the unconscious barriers that work against successful treatment. In ISTDP, we refer to these barriers as “defense mechanisms” or simply “defenses.”
What Are Defenses and Why Do We Have Them?
All of us use psychological defenses to cope with emotional discomfort and pain. For example, we might use denial when faced with a difficult truth, or we might rationalize our actions to avoid the sting of guilt. Many of us learn to laugh over sadness or use sarcasm to conceal our hurt. Some of us convert our anger into depression, or use projection to shift unwanted feelings onto someone else. In emotionally overwhelming or traumatic situations, defenses can help us escape the experience through mechanisms such as dissociation and can bury painful memories.
Defenses serve as useful allies, especially in childhood, by shielding us from intense feelings or trauma. But they can also cripple us later in life when applied rigidly and automatically over time. We may find ourselves inexplicably cut off from certain feelings, depressed, anxious, tense, irritable, short-tempered or plagued by recurring relationship problems. The old saying “let sleeping dogs lie” is anathema to mental health because the feelings and memories we have learned to automatically push out of awareness do not lie quietly, but constantly press for expression. Our defenses function as invisible counter-pressure, keeping these painful experiences from coming to our attention. This internal conflict very often leads to debilitating psychological and physical symptoms including anxiety, depression, self-defeating behaviors, frequent headaches, digestive problems or chronic health issues.
What Does the ISTDP Experience Look and Feel Like?
Treatment usually begins with a detailed inquiry into the precise nature of your problem. Based on what is uncovered, your therapist works with you to set your therapeutic goals. Each session is a focused collaboration in which you examine specific conflicts or problematic events in your life while observing your responses to them. Your therapist will draw attention to your internal experience throughout the session, including your automatic defenses, anxiety symptoms, and emotions (both physiological sensations and impulses). Therapeutic interventions focus on what’s taking place moment to moment with the intention of replacing automatic defenses and anxiety with healthy emotional regulation. This is really the heart of the work. When clients are able to reduce their anxiety and relinquish automatic defenses, their unconscious longings, feelings and memories rapidly rise to the surface and are available for deep processing with the support of the therapist. Many clients describe this part of the therapy as extremely powerful and liberating. We find it’s not uncommon for clients to express astonishment over what they’ve learned, and to report feeling “relieved,” “free” and “at peace” at the end of an ISTDP session.
How is ISTDP Different from Other Therapies?
Things you’ll notice right away: ISTDP is not your typical “talk therapy.” In this unique model, therapist and client establish a specific set of therapeutic goals at the onset of treatment and work together in a structured, purposeful way. Initially, this may seem strange or even challenging for people accustomed to using their therapy hour to discuss whatever they wish in an open-ended or free-flowing manner. In the beginning, the ISTDP therapist takes a more active and directive role, and sessions can feel quite intense. At the same time, therapist and client work cooperatively in an atmosphere of mutual respect, trust, and honesty to monitor for excess anxiety or discomfort with an eye toward keeping it at a tolerable level.
One other thing that sets ISTDP apart from other therapies is the use of videotape. The highly complex nature of the work means that a great deal of verbal and non-verbal material surfaces during treatment. It is often difficult for an ISTDP clinician to see it all at once. With their client’s permission, most ISTDP clinicians use videotape to later review what has occurred. It is always left up to the client to decide whether or not to allow videotaping of their sessions.
How Does ISTDP Achieve Such Rapid Results?
ISTDP often succeeds where other therapies stall because of its intense focus on unconscious defenses, especially defenses that interfere with the therapeutic process. ISTDP is based on the principle that an intellectual grasp of one’s problems is not enough to cure them. ISTDP is designed to work on a deeply experiential level, and transformative change often occurs in a relatively short period of time. In fact, ISTDP is frequently used to treat people whose persistent symptoms have not resolved in the course of other therapies or with medication.
How long are ISTDP Sessions?
Because of the complex nature of ISTDP treatment, we typically recommend 90-minute sessions instead of the traditional 50-minute therapy hour, although we can work within the 50-minute session length. Some patients prefer two- or three-hour sessions. An initial longer “Trial Session” can be very helpful to get off to a strong start.
Research Support for the Efficacy of ISTDP
A large and growing body of empirical research supports the effectiveness of Intensive Short-Term Dynamic Psychotherapy, including research on significant medical cost-savings related to treating common and/or chronic medical problems with ISTDP. For more information on ISTDP, you can visit the following websites:
© 2013 “A Brief Introduction to Intensive Short-Term Dynamic Psychotherapy, Catherine Lockwood Psychotherapy, Couples and Family Counseling, Inc., and Reiko Ikemoto Joseph
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Catherine
Catherine Lockwood LMFT License #38789
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- Intensive Short-Term Dynamic Psychotherapy (ISTDP)
- American Association of Couples and Sex Therapists (AAMFT) Accredited Couples and Family Therapist
- (AACAST) Accredited Couples and Sex Therapist
- Sensorimotor treatment of trauma
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Catherine Lockwood
