With so many therapuetic modalities available for practitioners to seek training and expertise in, it is worth reflecting on what makes ISTDP unique. Read on to hear from our experienced ISTDP practitioners on the main techniques in ISTDP that differentiate it from other therapies and contribute to its effectiveness.
Focus on emotional experience
ISTDP encourages patients to experience and express their emotions in the present moment and within the therapeutic relationship, rather than just talking about them. Research suggests that emotional acceptance is an important part of the change process in any therapy1. One of the main goals in an ISTDP therapy is to facilitate the clients awareness of, access to, expression of, and acceptance of their own emotional experiences that have been avoided. This avoidance typically occurs habitually, or “unconsciously”. Avoided feelings can include (not limited to) anger, sadness, love, guilt, joy. The focus on emotions can include encouraging the patient to play out the actions (within a visualisation) of the emotion – whether it be actions associated with anger, love, caring, and/or forgiveness in order to fully experience the emotion.
ISTDP offers a model that helps clients build up their emotion tolerance over time so that clients can feel more empowered to approach and process the avoided emotions. This process can also lead to the emergence of important attachment-related memories and feelings – referred to in ISTDP as an “unlocking of the unconscious”.
Defence restructuring
As people are encouraged to feel their emotions in the present, it tends to evoke what literature refers to as “maladaptive emotional avoidance” mechanisms or as referred to in ISTDP; psychological “defences”. ISTDP aims to encourage people to notice the defences that prevent or block emotional experience, processing, and acceptance as they occur in the room. The aim of this process is to empower clients to relinquish unhelpful defences that contribute to their difficulties. The presence and severity of unhelpful defences contributes to pathology.
ISTDP does have some overlap with other therapeutic modalities for addressing defences such as functional analytic psychotherapy (FAP) and cognitive behaviour therapy (CBT). ISTDP however, offers an elaborate set of techniques designed to address deeply ingrained emotional avoidance1. For example, ISTDP offers structured ways to help address different kinds of defences, such as those that block therapeutic progress/gains, lead to therapy failing, and/or defences that are more likely to with clients have faced complex trauma experiences. These types of unhelpful defences tend to contribute to relapse risk, so having techniques to address these helps reduce the risk of relapse.
Brief and intensive
The “Intensive, Short-term” components of the ISTDP acronym refer to the relative brevity of this therapeutic modality in comparison to more traditional psychoanalysis and dynamic psychotherapies that can take many years. The intensive component refers to the focus of the therapy with focus on emotions and focus on helping clients identify and overcome their defences in line with client goals. These factors help contribute to meaningful change within weeks, months, or years for clients (depending on the nature of difficulties), rather than therapy taking multiples of years (e.g., in the case of more traditional analytic therapy).
Active and engaged therapeutic role
In ISTDP therapy, the therapist takes on a more active role than in other therapies in terms of actively monitoring what is happening with the client in the room. Examples include looking for changes in bodily anxiety and looking for cues for when to help the client regulate anxiety to help provide a more pleasant experience. The therapist also keeps an eye out for maladaptive emotional avoidance strategies or defences to then help bring the clients attention to them in a way that helps empower the client to overcome what defeats them.
Emphasis on patient responsibility, will, and emphasis on therapeutic relationship.
One of the cores of ISTDP is an emphasis on client will and autonomy. Their will to engage in therapy, their conscious will to health (desire to become healthy), and the unconscious therapeutic alliance (UTA; the clients unconscious desire to be healthy). The ISTDP therapist strives to align themselves with the will of the client, wherever the client is at, and with an attitude of acceptance to help build the UTA. However, there is also an emphasis on helping the client to realise and utilise what is within their responsibilities and power for overcoming their defences with aims to empower the client to defeat what has been defeating them. ISTDP is as much a will-based therapy as it is an emotion focused therapy.
Focus on the here and now.
As mentioned in the above sections, ISTDP seeks to help clients experience their emotions in the here and now and navigate the defence mechanisms so they can have these experiences in a more empowering and less self-defeating way. As such, ISTDP tends to focus on the present more so than with a focus on exploring the past. Often this form of exploration comes later as it is made relevant by the client.
As we focus on feeling in the present, and encourage focus on this experiencing, the process can activate unprocessed feelings from the past, in part because current emotional experience typically shares a similar neural pathway as emotion experienced in the past2 (e.g., anger experienced now uses a similar brain map as anger experienced in the past).
This process also makes any past exploration more specific and targeted towards what is relevant, as it emerges in session rather than exploring a person’s whole timeline which can be exhausting for the client and/or take up valuable therapeutic time.
References
1 Thoma, N. C., & Abbass, A. (2022). Intensive short-term dynamic psychotherapy (ISTDP) offers unique procedures for acceptance of emotion and may contribute to the process-based therapy movement. Journal of Contextual Behavioral Science, 25, 106-114. https://doi.org/10.1016/j.jcbs.2022.07.003
2 Weinberger , J., & Stoycheva, V. (2019). The unconscious: Theory, research, and clinical implications. Guilford Publications.
3 Frederickson, J. (2013). Co-creating change. Seven leaves press.
