What is Intensive Short-term Dynamic Psychotherapy?

Intensive Short-term Dynamic Psychotherapy or ISTDP is a form of brief psychotherapy developed by Davanloo of McGill University, taught in several international training programs including ours, and actively researched by our Centre here in Halifax.

The basic ISTDP understanding of many psychological disorders is based on attachment and the emotional effects of broken attachments. Interruptions and trauma to human attachments may cause a cascade of complex emotions which may become blocked and avoided. When later life events stir up these feelings, anxiety and defences may be activated. This basic finding was derived from a large case series by Davanloo in the 1960-70‘s. 

These anxiety and defences maybe totally unconscious to the person doing them, and the result is ruined relationships, physical symptoms and a range of psychiatric symptoms. A proportion of all patients with anxiety, depression, substance use, and interpersonal problems have this emotional blockage problem.

These processes can lead to negative health effects in every system in the body including the gastrointestinal tract, cardiovascular system, respiratory system, immune system, muscular system and skin. The anxiety and defences can lead to increased worry about the body, and negative interactions with the health care system. Additionally, these problems can lead to disability and depression secondarily.

The treatment approach ISTDP as designed by Davanloo, is first to acquaint the patient with these unconscious processes and then to help them to overcome the emotional blocking processes. This often means a focus on the feelings the patient has in the office during the moments of the interview and pointing out the ways the patient blocks off both the emotions and the connection with the therapist in treatment.

When these feelings are experienced there is an abrupt drop in tension, anxiety and other physical symptoms and defences. Thus, the patient and therapist can then see the driving emotional forces that were being defended. Thereafter a healing process may occur in which the old avoided feelings are experienced and worked through. Often one of these breakthroughs is enough to bring about major symptom improvement, while in most cases a series of these events are required to bring about major behavioral changes. If the patient has very low tolerance of anxiety, a treatment process in group or individual therapy may be required first to build this up before the emotions can be experienced.

At the end of a successful therapy, there is an absence of somatic anxiety and major defences, so health and relationships are free to develop and persist as they were meant to before the original trauma.

This treatment and variants of it have been extensively researched and shown effective with some patients with depression, anxiety, somatization, substance abuse, eating disorders and personality problems.

Last updated:  April 29, 2008