Intensive Short-Term Dynamic Psychotherapy (ISTDP)
Habib Davanloo developed ISTDP (Intensive Short-Term Dynamic Psychotherapy) after systematic research. It requires at least three years to master the skills and is therefore not easily found. I have had the three years and extra supervision. I have found it to be very effective, even when other therapies have failed. Through ISTDP, long-standing personality issues that have made the person miserable can be changed. If your patterns of interacting with others have kept you stuck, ISTDP could be a way out of these patterns. If you have been depressed or anxious, ISTDP can work relatively quickly to give you relief. If you generally keep people at a distance, ISTDP can help you develop the internal safety you need to make connections. With ISTDP, the therapist works with your goals for yourself and with your motivation.
ISTDP is a powerful accelerated form of experiential psychodynamic therapy. Its goal is to bring rapid resolution to psychological problems and self-defeating patterns. It helps a person overcome resistances and defenses which have enabled the person to avoid core issues due to their intensity or their pain. ISTDP can free you from self-defeating relational patterns and distressing symptoms including depression and anxiety. It helps people (such as sex addicts) who have barriers to intimacy. ISTDP is only successful when the therapist and client work together in a therapeutic alliance in fighting long-standing defenses and in uncovering blocks to the true self.
Generally, after a high rise of mixed feelings with the therapist, manifested as signals of intense anxiety there is often be a breakthrough of rage, and then an immediate drop in anxiety. Once patients get in touch with their rage, they are able to describe detailed fantasies of what the rage would do if it were to take on a life of its own.
Why the rage? It is a product of thwarted efforts to attach from the past, effort to experience love. If the patient is able to experience the rageful impulse, she can get tremendous relief, but this relief is brief because of guilt about the rage. The rage was directed towards an historical figure who was loved, and therefore there is guilt. The guilt is the key to difficulties in relationships and in development of symptoms. Guilt has often led patients to ward off intimacy and closeness. The guilt often turns the rage onto the patient. There are also painful feelings about thwarted efforts at emotional closeness . There are deep yearnings for closeness, attachment and love.
The ISTDP therapist attempts to rapidly help the patient overcome resistance and then experience the waves of mixed feelings which are triggered by the intense therapeutic process. As these feelings are traced back to their origins in childhood, the patient and therapist collaborate in understanding how the patient came to be driven by the unconscious. The patient sees things more clearly and is less defensive. The ISTDP therapist uses the interventions of pressure, challenge, and head-on collision. Pressure is asking the patient to be clear about the problem, to look at feelings, to get to the root of the problems, and to commit to the work of therapy. Pressure is an encouragement to renounce defenses and to look at issues along with the therapist, issues which have been avoided. When the therapist uses challenge, he is clarifying defenses as obstacles to therapy. Some patients erect walls of resistance in therapy, and these are walls that are used in other relationships, too. The Head-On Collision is an intervention aimed at the entire defensive structure, with an appeal to the patient to try to overcome the resistance
ISTDP is an evidence-based psychotherapy. There are over 25 published outcome studies of ISTDP; twenty-one of these were recently reviewed by Dr Allan Abbass and published in Harvard Review of Psychiatry, 2012. These include randomized controlled trials, case series and 2 non-randomized controlled trials. There has been research on ISTDP for:
treatment resistant and complex depression,
functional movement disorders,
medically unexplained symptoms (Somatization)
clinical and cost effectiveness in a private practice setting
Some research articles listed on the ISTDP Institute on ISTDP:
A Selected Body of Research Studies on ISTDP. Abbass, A. (2002) Office based research in Intensive Short-Term Dynamic Psychotherapy (ISTDP): Data from the first 6 years of practice. Ad Hoc Bulletin of Short-term Dynamic Psychotherapy, 6(2):5-14.
Abbass, A. (2002) Intensive Short-Term Dynamic Psychotherapy in a private psychiatric office: clinical and cost effectiveness. Am. J. Psychotherapy 56(2): 252-232.
Abbass, A. (2002) Modified Short-Term Dynamic Psychotherapy in patients with bipolar disorder. Preliminary report of a case series. Canadian Child Psychiatry Review 11(1): 19-22.
Abbass, A. (2003) The cost effectiveness of Short-Term Dynamic psychotherapy. Journal of Pharmacoeconomics and Outcome Research 3:535-539.
Abbass, A. (2004) Small-group videotape training for psychotherapy skill development. Acad. Psychiatry28(20): 151-155.
Abbass, A. (2006) Intensive Short-Term Dynamic Psychotherapy of treatment-resistant depression: a pilot study. Depress. Anxiety 23: 449-452.
Abbass, A., Hancock, J., Henderson, J., Kiseley, S. (2007) Short-Term Dynamic Psychotherapies for Common Mental Disorders (A Review). The Cochrane Library, Issue 2. New York: Wiley Press.
Abbass, A., Joffres, M., Ogrodniczuk, J. (2008) A naturalistic study of Intensive Short-Term Dynamic Psychotherapy trial therapy. Brief Treatment Crisis Intervention 8(2): 164-170.
Abbass, A., Sheldon, A., Gyra, A., Kalpin, A. (2008) Intensive Short-Term Dynamic Psychotherapy for DSM-IV personality disorders. J. Nerv. Ment. Dis. 196(3): 211-216.
Abbass, A., Lovas, D. Purdy, A. (2008) Direct diagnosis and management of emotional factors in chronic headache patients. Cephalagia 28: 1305-1314.
Abbass, A. Joffres, M., Ogrodniczuk, J. (2009) Intensive Short-Term Dynamic Psychotherapy trials of therapy; qualitative description and comparison to standard intake assessment. Ad Hoc Bulletin of Short-Term Dynamic Psychotherapy 13(1).
Abbass, A., Campbell, S., Magee, K., Tarzwell, R. (2009) Intensive Short-Term Dynamic psychotherapy to reduce rates of emergency department return visits for patients with medically unexplained symptoms: premliminary evidence from a pre-post intervention study. CJEM 11(6): 529-534.
Abbass, A., Campbell, S., Magee, K., Lenzer, I., Hann, G., Tarzwell, R. (2010) Cost Savings of Treatment of Medically Unexplained Symptoms using Intensive Short Term Dynamic Psychotherapy (ISTDP) by a hospital Emergency Department. Arch. Med. Psychol. 2(1): 34-44.
Abbass, A., Town, J., Driessen, E. (2011) The efficacy of short-term dynamic psychotherapy for depressive disorders with comorbid personality disorder. Psychiatry 74(1): 58-71.
Callahan, P. (2002) Indexing resistance in Short-Term Dynamic psychotherapy (STDP): Change in breaks in eye contact during anxiety (BECAS). Psychotherapy Research 10(1): 87-99.
Cornelissen, K., Verheul, R. (2002) Treatment outcome of residential treatment with ISTDP. Ad Hoc Bull. Short Term Dynamic Psychotherapy 6:14-23.
Cornelissen, K., Smeets, D., Willemsen, S., Busschbach, J.Verhel, R. Long-term follow-up of a residential form of Intensive Short-Term Dynamic Psychotherapy in personality disorders. In preparation.
Hawkins, J. (2003) The role of emotional repression in chronic back pain: a study of chronic back pain patients undergoing psychodynamically oriented group psychotherapy as treatment for their pain. New York: New York University.
Hellerstein, D., Rosenthal, R., Pinsker, H, Wallner Samstag, L, Muran, J., Winston, A. (1998) /a randomized prospective study comparing supportive and dynamic therapies. Outcome and alliance. J. PsychotherapyResearch and Practice 7:261-271.
Wiborg, Il, Dahl, A. (1996) Does brief dynamic psychotherapy reduce relapse rate of panic disorder? Arch. Gen. Psychiatry 53: 689-694.
Winston, A., Pollack, J., McCullough, L, Flegenheiimer, W., kerstenbaum, R, Trujillo, M. (1991) Brief psychotherapy of personality disorders. J. Nerv. Ment. Dis 179: 188-193.
Winston, A., Laikin, M., Pollack, J., Wallner Samstag, L, McCullough, L, Muran, J. (1994) Short-Term Psychotherapy of personality disorders. America J. Psychiatry 151(2): 190-194.