Dr Sharon Lewis, DClinPsyc
Practitioners in the UK are increasingly seeking to find cost-effective, long-lasting psychotherapy techniques to treat commonly presenting difficulties such as depression, anxiety or medically unexplained symptoms.
Intensive Short-Term Dynamic Psychotherapy (ISTDP) is a brief-term, emotion-focused therapy which draws on principles of psychodynamic and attachment theory. The clinical and cost-effectiveness of ISTDP has been extensively researched and the approach has been shown to be effective for a broad spectrum of disorders, including depression, anxiety and somatisation. More than forty published research studies, including RCTs, show ISTDP to be effective for the majority of psychiatric patients with benefits enduring in long-term follow-up (Abbass, 2016)
ISTDP incorporates key common ingredients of interest in psychotherapy today, including:
- the use of video for quality improvement and research,
- systematic assessment and evaluation for treatment,
- active therapist involvement & use of the therapeutic relationship and alliance,
- cognitive restructuring,
- a high degree of emotional engagement (Kenny, Arthey & Abbass, 2014)
This approach also incorporates additional distinctive and highly effective interventions:
- monitoring unconscious anxiety signals in the body;
- techniques to interrupt the use of maladaptive defences; and
- techniques to intensify the somatic experience of emotions.
The common psychotherapy factors, together with these advanced techniques, enable clinicians to promote long-lasting change and to work with a broad range of clients within a shorter time-frame than traditional dynamic psychotherapies (Abbass, 2016).
Background and Theory
ISTDP was developed during the 1960s and 1970s by Habib Davanloo, a psychiatrist and psychoanalyst from Montreal who grew frustrated with the length and relatively limited efficacy of psychoanalysis. Davanloo developed a technique called the central dynamic sequence, in order to remove the major resistances to change, and to lead to symptom relief in as short a time-frame as possible. David Malan of the Tavistock Clinic in London reported that Davanloo’s findings were a new frontier of psychodynamic therapy referring to his discoveries as the “most important development since the discovery of the unconscious” (Davanloo, 1980).
ISTDP is based on psychodynamic and psychoanalytic principles but in practice it differs significantly from these approaches. The ISTDP therapist uses active techniques to regulate anxiety and to discourage the use of unhealthy defences in order to facilitate the direct experience of feelings in the ‘here and now’. This process builds the patient’s capacity to tolerate and integrate previously defended against, unconscious emotions.
ISTDP as it is practiced today, builds on Davanloo’s clinical insights and techniques, while incorporating insights from current research into maximimising therapeutic effectiveness, attachment theory and neuroscience.
The basic ISTDP understanding of many psychological difficulties is rooted in attachment theory, ie the emotional effects of broken attachments. The focus is on unconscious mental processes as the cause of symptomatic distress. When caregivers are not adequately attuned to their children, or significant emotional bonds are ruptured through traumatic events, intense, mixed feelings are generated, including deep pain and grief, as well as rage toward the loved one who is causing this pain.
ISTDP therapists work with the patient to uncover repressed emotions or “complex feelings” about the past attachment failures. Presenting problems and symptoms are seen as the result of the patient’s reliance on maladaptive defenses against anxiety laden feelings, longings and impulses (Coughlin & Katzman, 2013).
Learning outcomes
For those clinicians interested in practising ISTDP, or adding ISTDP techniques to their existing practice, the training programmes focus on:
- Establishing a therapeutic focus
- Identifying unconscious pathways of anxiety and the impact on the body
- Identifying when anxiety regulation is indicated, and techniques for anxiety regulation
- Identifying defences which can impede therapeutic progress and learning to intervene effectively to encourage the patient to turn against these
- Techniques to deepen emotional experiencing in the here and now
Courses are suitable for clinicians in the fields of medicine, psychotherapy, clinical and counselling psychology, psychiatry and allied fields, at all stages of their careers. No prior knowledge of ISTDP or dynamic psychotherapy is required.
Dr Sharon Lewis is a chartered clinical psychologist registered with the British Psychological Society and the Health and Care Professions Council. She runs a private practice and also works in an NHS Rheumatology service focussing on auto-immune disorders, chronic pain and functional neurological symptoms. She is a director of ISTDP-UK (http://www.istdp.org.uk ) and an IEDTA accredited trainer (http://www.iedta.net) and provides individual supervision in ISTDP as well as running ISTDP training groups at both advanced and introductory level.
References:
Abbass, A. (2016) Reaching Through Resistance: Advanced Psychotherapy Techniques. Seven Leaves Press.
Barlow, D.H., Farchone, T.J., Fairholme, C.P. et al. (2011). Unified Protocol for Transdiagnostic Treatment of Emotional Disorders. New York, NY: Oxford University Press.
Coughlin, P. & Katzman, J.W. (2013). Intensive Short-Term Dynamic Psychotherapy. Psychiatric Annals, 43(11), 486-489.
Coughlin Della Selva, P. (2009) Facilitating emotional health and wellbeing. In: D.A. Monti & B.D. Beitman (Eds.) Integrative Psychiatry. New York, NY: Oxford University Press.
Davanloo, H. (1980) Short-term dynamic psychotherapy. New York: Jason Aronson.
Freud, S. (1990) Inhibitions, Symptoms, and Anxiety: The Standard Edition. New York, NY: W.W. Norton & Company
Kenny, D.T., Arthey, S. & Abbass, A. (2014) Intensive Short-Term Dynamic Psychotherapy for Severe Music Performance Anxiety. Science & Medicine, 3-7.
