What is ISTDP?

An effective and evidence-based method

Intensive Short-Term Dynamic Psychotherapy (ISTDP) was developed in the period between the 1960s and 1990s by Dr. Habib Davanloo, Professor Emeritus of Psychiatry at McGill University in Canada. ISTDP is taught all over the world, especially in North America and Europe, and the method has become very widespread in Scandinavia over the past ten years.
Since the turn of the millennium, approximately 60 controlled clinical studies and meta-analyses of the effects of ISTDP have been published in peer-reviewed journals, and the effectiveness of the method for the most common psychiatric disorders, including very complex disorders, is by now well documented. A large part of the studies has been carried out by Professor Allan Abbass and his research group at Dalhousie University in Canada,

ISTDP was developed to treat psychological problems and symptoms that have their roots in traumatic experiences during childhood and adolescence, especially in relation to caregivers, which have led to disruption of natural and normal attachment. Psychological/relational trauma lead to a number of complex emotions that are blocked and avoided in order to maintain attachment. When experiences in new relationships later in life stir up these complex and conflicted emotions, anxiety and defense mechanisms becomes activated and lead to the problems and symptoms the client seeks help for.

Davanloo’s conclusion, after studying hundreds of patient treatments in the 1960s and 70s, was, that patients usually only have a vague sense of the connection between traumatic experiences during childhood, and problems in the present, as unconscious processes in the form of anxiety and defense mechanisms gets in the way. This is the essence of psychodynamic theory, and confirmed in a series of studies by Abbass, and other researchers, who have investigated psychodynamic short-term therapy, and other forms of psychodynamic psychotherapy.

Unconscious mechanisms
Anxiety and defense mechanisms are usually completely or partially unconscious, and lead to a number of psychiatric symptoms and problems such as anxiety, depression, psychosomatic/functional disorders, personality disorders, broken relationships, poor self-esteem, and reduced quality of life. Most clients with anxiety, depression, substance abuse, and relational problems have emotional conflicts and defense mechanisms they are not aware of, but which nonetheless greatly affect their lives.

These unconscious processes can lead to adverse effects on all body systems, including the gastrointestinal tract, circulatory system, respiratory system, immune system, muscles, and skin. In addition, anxiety and defense mechanisms can lead to concerns about bodily functions, conflicts with the health care system, sick leave, depression, and problems functioning at work.

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How does ISTDP work?

The first task in ISTDP is to assess what problems and symptoms the client has and examine what unconscious processes are involved in creating and maintaining these. Then, the client and therapist can, as a collaborative team, challenge the emotional blockages and handle the anxiety that inevitably gets stirred up. The client will often experience strong feelings that gets activated towards the therapist, which in turn activates defense mechanisms to avoid these feelings and contact with the therapist. This is the case in most clients-therapist relations and gives the team a unique opportunity to work through old unfinished attachment problems that still affects the client and causes unnecessary suffering and inhibitions.

When the repressed emotions are experienced, tension in muscles and other bodily symptoms and defense mechanisms will be reduced, so that the client and therapist can see the underlying, emotional forces that drives defense mechanisms and anxiety. Then, when old, avoided feelings are experienced and worked through, the healing process can begin. Sometimes a single breakthrough to underlying emotions is enough to create a significant improvement in symptoms, but most often, repeated breakthroughs to underlying avoided emotions are necessary to create the desired changes.

ISTDP is not a fixed procedure used with all clients but adapted to the individual client’s tolerance for anxiety and conflicted emotions. In cases where the client has insufficient anxiety tolerance, we start by strengthening the anxiety tolerance and ability to observe and reflect on bodily signs of anxiety. Once the ability to tolerate own anxiety has been sufficieltly strengthened, we can move on to explore the underlying conflicted emotions, in a safe way that is not overwhelming.

After a successful treatment, the client’s anxiety and defense mechanisms will be reduced, health and well-being improved, and the development which was disrupted by the initial traumatic experiences can be resumed.

ISTDP has been thoroughly studied over the last 20-30 years, and there are currently over 50 controlled clinical studies showing that the method is effective in treating depression, anxiety disorders, psychosomatic symptoms and functional disorders, substance abuse problems, eating disorders, and personality disorders.

If you are interested in reading more about ISTDP and research results, I can recommend visiting Professor Allan Abbass’s website under ‘Publications’. You will find the link here.

You may also contact me for further information on ISTDP and literature at allan.e.larsen@gmail.com