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What is ISTDP?

ISTDP (Intensive Short-term Dynamic Psychotherapy) is a research based, scientifically validated form of psychotherapy. It has been shown to be highly effective in resolving a variety of emotional problems including depression, anxiety, post-traumatic stress, psychosomatic illness, and personality disorders. ISTDP can relieve many self-defeating behaviors, which most often have their roots in unstable or troubled early relationships. This is done not by merely alleviating superficial symptoms, but also getting to the bottom of the origin of the problem, which usually lies in early attachments and related feelings which have been pushed down. The ISTDP therapist helps the patient to “unlock” and experience these emotions in a supportive, caring environment. Alleviating the self-defeating behaviors that have persisted for years, and resolving the root of the problems can open the door for patients to live their lives to the fullest, in satisfying work, loving relationships, creativity, and enjoying the full spectrum of their emotions.

The intensity of ISTDP involves the therapist’s very active engagement with the patient in several areas, and in turn the patient’s focused attention on the process. The ISTDP therapist is attentive to the patient’s body language, levels of anxiety, and the many self-defeating defenses against true feeling which have become unconscious and automatic. The therapist brings all this to the patient’s conscious awareness, while simultaneously tracking the relationship between the therapist and the patient, as well as links both to the patient’s past attachments and current relationships, which are also brought to the patient’s attention over the course of the therapy. Thus the ISTDP practitioner must juggle many therapeutic balls in the air, and indeed the main criticism of ISTDP is that it is very difficult to learn, requiring three years of intensive post-graduate training. Dr. Lubell has completed this training and is the only certified ISTDP therapist in the Sacramento Valley and Placer County area.

While the ISTDP therapist is highly active, rather than a neutral observer, the patient must also be fully engaged in the process, taking responsibility for his or her own life and the outcome of the therapy. The therapist provides continual feedback to the patient in order to help them overcome resistances to experiencing their feelings in a healthy, healing manner.

One of the many benefits of ISTDP is that it has been demonstrated to be shorter in duration than other psychodynamic therapies. ISTDP sessions are generally 90 minutes, and while the longer sessions might appear more costly than other therapies, the potential for faster results and greater effectiveness actually makes ISTDP more cost effective than many other therapies. Many patients experience improvement in weeks and months, rather than years and years. (Some patients who are more fragile or suffer from addictions may require a gentler, less intense approach, and thus may require more time for effective treatment.)

Habib Davanloo, M.D., the originator of ISTDP, sought to speed up the process of therapy, which in traditional psychoanalysis may take many years. He viewed videotapes of his sessions and noted which interventions were most effective, particularly in helping patients to overcome their self-punishing, self-defeating resistance to change. (Today, ISTDP therapists often video record their sessions in order to maintain the quality of their work. Videotapes are kept strictly confidential, viewed only by the therapist and occasionally by peer or senior clinicians, for the benefit of the patient.) ISTDP was further refined and developed by several of Davanloo’s students, including Robert Neborsky, M.D., Josette ten-Have de Labije, Psy.D., and Patricia Coughlin Della Selva, Ph.D. Dr. Lubell obtained her ISTDP training directly from these three present day master ISTDP practitioners and researchers.

ISTDP departs from psychoanalysis in requiring a more active stance from the therapist, who values the patient’s time and uses a structured approach based on interventions which research has shown to be effective. ISTDP maintains its psychodynamic roots in its emphasis on lifting repression and uncovering unconscious complex feelings about past attachment failures, as well as using the “transference” of the patient’s feelings onto the therapist as a vehicle for understanding and change. The experience of core emotion from the past, in the context of the therapeutic relationship, is transformative. To achieve this goal, the therapist continually encourages the patient to feel, challenges him to take responsibility for changing, and confronts the defenses that attempt to maintain the status quo (which is self-defeating and self-punishing).

ISTDP also has some similarities to cognitive behavioral therapies, in that the therapist offers the patient feedback about the physiological signs of anxiety and the somatic experience of feelings in one’s body. In this sense, ISTDP involves a desensitization of painful affect (feelings), similar to the behavioral treatment for phobias. Another similarity to cognitive behavioral treatments involves helping the patient to give up self-defeating defenses against feeling (which were learned early in life to avoid pain) and over time became conditioned, automatic responses and which currently interfere with the patient’s full enjoyment of life. ISTDP also provides the patient with affective-cognitive (feeling-thinking) restructuring, so that the patient not only experiences long buried feelings, but also gains a useful intellectual understanding of the way his or her mind works. ISTDP departs from cognitive behavioral treatments in its emphasis on attachments and relationships: with the therapist, with people in the patient’s current life, and with those in the past. ISTDP further differs in its emphasis on “unlocking” the unconscious and experiencing buried emotion.

Indeed, ISTDP may be considered a holistic treatment in that its focus encompasses the whole person: both mind and body working together; the present understood and experienced in the context of the past; and the ambitious goal of a healthy, satisfying, future lived to one’s fullest potential.