Intensive Short-Term Dynamic Psychotherapy:
The following information on ISTDP is meant for educational purposes only. I tend to use elements of ISTDP theory in my therapeutic approach if I suspect it could be helpful and if a client is in agreement. I do not think of myself as an ISTDP therapist. I believe strict adherence to any therapeutic framework is seldom helpful. The main elements of ISTDP that I use in my practice is a focus on being present with the client, identifying what they think the problem is, and working on finding a solution to the problem. This often includes helping clients experience unresolved feelings and helping them process these emotions in a healthy way. These elements of ISTDP are common to many forms of therapy.
The primary goal of ISTDP is to help clients experience true feelings about the present as well as feelings from the past that might have been previously avoided. The technique is called intensive because it aims to help the client experience feelings that they might not have been aware of, to the maximum degree possible; it is short-term in that it tries to achieve this experience as quickly as possible; it is dynamic because it involves examining how past relationships influence current relationships (Malan & Coughlin Della Selva, 2006).
Most of us will seek therapy because of specific symptoms, such as anxiety or depression, or due to interpersonal difficulties. ISTDP is based on the notion that these symptoms or difficulties are present because emotions are being avoided. These emotions may be avoided, due to their having been threatening or unsafe to experience or express at some point in our lives. For example, we may learn at an early age that certain feelings are not acceptable by others or we may believe our feelings may even hurt others. Avoiding our true emotions causes conflict within us and may prevent a person from being close with others (Malan & Coughlin Della Selva, 2006).
ISTDP was developed during the 1960s to 1990s by Dr. Habib Davanloo, a psychiatrist from Montreal, who grew frustrated with other forms of psychotherapy, especially when it came to how long these therapies took before significant improvement was seen. Davanloo video-recorded his therapy sessions and watched them to determine which interventions were most effective in helping his clients experience meaningful change (Davanloo, 2000).
Origins of ISTDP
Joseph Breuer and Sigmund Freud (1895) reported that their clients showed symptom reduction and an overall improvement in functioning if they freely discussed emotionally difficult aspects of their lives in therapy. Experiencing these emotions, which had been previously outside of their awareness, seemed to help them improve (Freud & Breuer J., 1957). Freud also tried to help his clients experience their true feelings by using hypnosis, free association, and dream interpretation, however, this caused therapy to become a longer process (Gay, 2006).
David Malan theorised that because avoided feelings are outside of our conscious awareness, we feel anxiety when these feelings are close to entering our conscious awareness. According to Malan, feelings that are outside of our conscious awareness originated in our past and these emotions are triggered in current relationships. Patterns of interpersonal behaviour could be the result of early childhood experiences (Malan & Coughlin Della Selva, 2006). Bowlby's attachment theory supported this idea. |
Bowlby and Attachment Trauma
In the 1960s, John Bowlby explained attachment as a system of innate behaviours exhibited by infants which have the goal of physical and emotional proximity to the mother. For instance, a child taken out of its mother's arms cries loudly in protest, and it is only quieted by being restored to its mother's arms. Bowlby conducted numerous studies and noted strong correlations between the lack of a consistent and nurturing relationship with a mother and numerous difficulties in adulthood, including persistent depression or anxiety, increased psychiatric symptoms, poor relationship function, and decreased life satisfaction (Bowlby, 1969).
Davanloo's Discovery of the Consequences of Attachment Trauma
While Bowlby was observing children directly, Davanloo was video-recording his therapy sessions and noted that predictable themes would emerge with his clients. Davanloo discovered that when clients experienced previously avoided feelings in therapy, they showed significant improvement in both specific symptoms and interpersonal relationships (Davanloo, 1995).
Bowlby J. Separation. Vol II in Attachment and Loss. 1969. Pimlico.
Davanloo, H. (1995). Intensive short-term psychotherapy with highly resistant patients. I. Handling resistance. In H. Davanloo, Unlocking the unconscious: Selected papers of Habib Davanloo, MD. New York: Wiley. (pp. 1-27).
Davanloo, H. (2000). Intensive short-term dynamic psychotherapy: Spectrum of psychoneurotic disorders. In H. Davanloo: Intensive short-term dynamic psychotherapy: Selected papers of Habib Davanloo, MD.
Freud, S. & Breuer, J. (1957). Studies on Hysteria. In J. Strachey & A. Strachey (Eds. & Trans). New York: Basic Books, Inc. (Original work published 1895)
Gay, P. (2006). Freud: A life for our time. USA: W. W. Norton & Company, Ltd. Pages 49-50, 71-73, 107.
Malan, D. & Coughlin Della Selva, P. (2006). Lives transformed: A revolutionary method of dynamic psychotherapy (Rev. ed.). London: Karnac Books.