Intensive Short Term Dynamic Psychotherapy (ISTDP)

Posted on: January 21, 2016

News & Insights From Santa Monica Psychiatrist Katherine Watkins, M.D.

Several years ago I became interested in a new type of psychotherapy, called Intensive Short Term Dynamic Psychotherapy, or ISTDP for short. Developed by Habib Davanloo M.D., a clinical researcher at McGill University and Montreal General Hospital, ISTDP is an evidence-based psychotherapy which has been shown to be uniquely effective for people with symptoms such as depression or anxiety, problems with relationships and intimacy, or physical symptoms without a medically identifiable cause, such as headache, shortness of breath, diarrhea, or sudden weakness. The ISTDP model attributes these symptoms to the occurrence of distressing situations where painful or forbidden emotions are triggered but are outside of awareness.

ISTDP posits that we suffer when we avoid complex and painful feelings; thus the therapy’s primary goal is to help the patient overcome internal resistance to experiencing true feelings about the present and past, which in turn leads to a deeper level of growth, healing and connection. The technique is intensive in that it aims to help the patient experience these warded-off feelings to the maximum degree possible; it is short-term in that it tries to achieve this experience as quickly as possible; and it is dynamic because it involves working with unconscious forces and transference feelings.^[2]^[3] In ISTDP, the experience of core emotion from the past is seen as the transformative vehicle for fundamental change. Unlike classical psychodynamic psychotherapy which relies on interpretation, in ISTDP, the therapist takes an active role encouraging the patient to feel and helps the patient confront their unconscious resistance to change.

Videotaped Psychotherapy Sessions

One of the things that is different about ISTDP is that the sessions are usually videotaped and, with the patient’s permission, used for supervision. The first time I saw some of these videotapes, I was amazed at the compelling nature of the work. However, because of my work at RAND in mental health and public policy, it was important for me to make sure that ISTDP was grounded in evidence. 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.

A useful book by Ronald Frederick, Ph.D. titled Living Like You Mean It (2009) can help the layperson understand many of the principles underlying ISTDP. It is a self-help book that provides valuable exercises useful to anyone interested in learning more about the relationship between feelings, anxiety, and defense mechanisms.