How effective is ISTDP psychotherapy? How does ISTDP help?

This has been demonstrated in numerous clinical studies (see Town, Abbas, Stride, Nunes, Bernier, Berringan, 2017; Town, 2020) and others. These studies indicate not only that ISTDP is equally effective but also that it outperforms conventional psychiatric treatment in terms of the durability of symptom remission, lower healthcare costs, and the effectiveness of this form of psychotherapy in treating treatment-resistant disorders. Pharmacological treatment addresses symptoms, whereas ISTDP leads to a lasting restructuring of personality.

So how does ISTDP—Intensive Short-Term Psychodynamic Psychotherapy—eliminate symptoms?

It focuses in a very specific way on three levels of the psychological problem:

• emotional problem

• its somatic symptoms in the patient's body

• symptoms of this problem in interpersonal relationships (at work and in personal relationships)

These levels are causally linked and, taken as a whole, contribute to the intensification of suffering in life.

If a patient experiences severe feelings of resignation and depression (a mood-related issue), their body lacks energy, as if someone had “pulled the plug”; they may also experience pain, for example, in the abdominal and the neck (somatic level), and problems related to this mood arise in their professional and personal relationships—for example, people with whom the patient felt connected begin to resent their lack of commitment to family matters, or they seek fulfillment outside the relationship; they may also delegate tasks or promotions to others (interpersonal level).

It’s a vicious cycle—a patient experiencing low mood will respond to the interpersonal reactions described by becoming even more depressed.

In ISTDP psychotherapy, the patient—with the psychotherapist serving as a guiding companion— can focus their attention on the cause of this problem—the defense mechanisms that distort reality and trigger the aforementioned depressive symptoms.

These mechanisms were once necessary for the patient in his original environment to survive relatively safely, for example in his relationship with aggressive caregivers. Later, however, they became a burden in his life, which was filled with resignation and disappointment in relationships.

During a psychotherapy session, which in ISTDP lasts longer than a traditional session—that is, 75–90 minutes—the patient, while talking with the therapist, identifies in real time the defense reactions that arise and lead to depression, and tries to understand their function. Together with the therapist, the patient forms a secure alliance that helps overcome these defenses by focusing all their attention on the physical experience of feelings that were once suppressed in the patient’s relationships with their caregivers, and in their place, they learned to adopt defensive attitudes

The organic experience of these feelings—such as anger, which was not accepted in the patient’s relationships and became a “forbidden feeling”—is, however, always associated with a relational risk for the patient—one that the patient also experiences in relationship with the therapist. As attention is focused on the feeling of anger, the patient’s anxiety—which is natural in such a situation—arises. It is experienced physically in the body (e.g., through stomach pain or chest tightness), and the therapist, in an accepting atmosphere helps the patient in the complex process of regulating this anxiety and reducing the associated symptoms. Until now, in order to avoid experiencing the “forbidden emotion” of anger and the anxiety associated with it, the patient has relied on defense mechanisms. In this way, they protected themselves and their caregivers, and in adulthood, they followed the same pattern with others, most often directing their anger against themselves—blaming themselves for things for which they were not at fault, and taking on the role of caregiver for others. It was precisely this defense mechanism that had been causing his depression up to that point. Instead of experiencing his anger and drawing on its resource by expressing his expectations of others, he took on the role of caring for others.

However, when —thanks to the therapeutic alliance—the patient realizes that his previously unconscious self-blame for crimes he did not commit leads him to resignation, causing them to lose their sense of self-satisfaction in relationships with others—all that remains is for them to confront the physical (somatic) experience of their feelings toward the people with whom they were connected.

The patient’s own acceptance of experiencing a variety of mixed feelings (including those that are forbidden) in a relationship with another person is a deeply moving experience, in which they can regain not only a sense of their own agency and vitality, but also rediscover a “lost part of themselves” and feel much closer to other people than has ever been possible before.