What is ISTDP?

Intensive short-term dynamic psychotherapy (ISTDP) is a scientifically validated method of treatment that accelerates the process of change, often producing deep and lasting change in a relatively short time. Adapted from traditional psychoanalytic theory, ISTDP is a collaborative process in which the therapist is active and involved, providing moment-by-moment feedback to the patient. While long-term therapies tend to focus on history collecting and talking about past experiences, ISTDP primarily focuses on patterns of relatedness that occur in the here-and-now in current relationships, including the relationship with the therapist.

In ISTDP psychological disorders are thought to result from the emotional effects of ruptures to attachment. These attachment ruptures can cause a cascade of complex feelings that become blocked or avoided, so that the person cannot feel them deeply. This inability to experience deep emotions is thought to be at the core of many symptoms and relationship difficulties. Just as we can develop phobias about external things (for example, bridges or elevators), we can learn to fear, ignore, or minimize the experience of certain feelings. In ISTDP the therapist helps patients experience as much of these warded-off feelings as they can bear at any point in the therapy. Exposure to these core feelings allows patients to get in touch with aspects of themselves that may have been buried or lost, thus unlocking their true capacities.

A Brief History of ISTDP

ISTDP was first developed in the 1960s and 1970s as a response to frustrations with the growing length and limited efficacy of psychoanalysis. Theoreticians such as David Malan and Habib Davanloo began video recording patient sessions and analyzing moment-by-moment patient/therapist interactions to determine what interventions were most effective. In the 1980s psychotherapy researchers such as Leigh McCullough began conducting programmatic process and outcome studies on ISTDP1.

Research over the past 50 years provides ample evidence that ISTDP is an effective treatment for a very broad range of clinical presentations, including depression, anxiety, somatic disorders (sleep issues), and relationship difficulties such as emotional closeness and intimacy2. Unlike most therapies in which the goal is short-term symptom reduction, the goals in ISTDP are to achieve deep and lasting change of longstanding emotional and personality difficulties. Relapse rates are high for therapies, such as cognitive behavioral therapy (CBT) that access conscious cognitions alone without changes in emotional processing3. In contrast, patients who have completed ISTDP tend to continue to improve even after the therapy has ended4. Moreover, many patients who complete this therapy experience changes that go way beyond the reasons that brought them to treatment, reporting increases in creativity, productivity, and leadership, as well as a greater ability to experience joy and closeness.

Neuroscience and ISTDP

ISTDP’s focus on the emotional effects of attachment ruptures is consistent with some of the newer findings in the emerging fields of affective and social neuroscience. Neuroscientist Jaak Panksepp asserts that we are experiencing a paradigm shift away from the radical neurobehaviorism of the 1970s and 1980s, which intentionally sought to deemphasize and bypass emotional processes5. One outgrowth of this period was the predominance of rational, left brain psychotherapies such as CBT that focused almost exclusively on language-based left brain processes such as changing maladaptive, conscious cognitions. ISTDP, on the other hand, focuses more on the implicit, nonconscious functions of the right brain. According to neuroscientist, Alan Shore, “the highest human functions – stress regulation, intersubjectivity, humor, empathy, compassion, morality, and creativity, are right brain functions6. Therefore, the focus of therapeutic change must move from the left to the right brain, from the mind to the body, and from the central to the autonomic nervous system.

Works on ISTDP cited above:

1 McCullough Vaillant, L. (1997). Changing Character. New York: Basic Books.

2 Abbass, A., Kisely, S.R., Town, J.M., Leichsenring, F., Drissen, E., De Maat, S., Gerber, A., Dekker, J., Rabung S. Russalovska, S., Crowe, E. (2014). Short-term psychodynamic psychotherapies for common mental disorders (Review). The Cochrane Collaboration. New York: John Wiley & Sons.

3 Grawe, K. (2007). Neuropsychotherapy: How the neurosciences inform effective psychotherapy. New York: Psychology Press.

4 Abbass, A., et al. (2014). Short-term psychodynamic psychotherapies for common mental disorders (Review). The Cochrane Collaboration. New York: John Wiley & Sons.

5 Panksepp, J. (2008). The power of the word may reside in the power of affect. Integrative Psychological and Behavioral Science, 42, 47-55.

6 Shore, A. (2012). The art and science of psychotherapy. New York: W.W. Norton & Company.

For more information about ISTDP, visit the ISTDP Institute: http://istdpinstitute.com


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