ISTDP: Not Just Any Form of Psychotherapy.
An Approach for Real Change.
by Diane Byster, LMFT, NCC, RYT
and Jon Frederickson, MSW
Do you ever find yourself thinking that your life could be better than it is now? Do you wish you had a more satisfying job, or a better relationship with a loved one? Do you have a plan in mind, but lack the self-confidence or motivation to pursue it? Perhaps you have tried psychotherapy or coaching but did not experience the change you had hoped for. Consider whether Intensive Short-Term Dynamic Psychotherapy might be a solution for you.
Intensive Short-Term Dynamic Psychotherapy (ISTDP) is designed to help people change in a shorter period of time than standard therapies. Rather than being led by your therapist or simply showing up and saying what comes to mind, in ISTDP you are asked to actively join your therapist and: 1) identify your most-cherished goals; 2) Identify the difficulties you are having in reaching your goals; 3) observe yourself closely and accurately; 4) learn what you do that keeps you from accomplishing your goals; and 5) let go of those blocks, so you can achieve what you want.
Of course, all therapists try to pay attention to you. However, in ISTDP we offer a unique kind of listening and intervention, where your therapist pays very close attention to everything you say and do moment-by-moment in the session. To understand that kind of listening, we need to also understand what causes the problems that lead people to seek psychotherapy in the first place.
In life we all experience the pain of illness, everyday disappointments, serious loss, and death. We want things from our loved ones. And they can do only one of three things: deliver, delay, or disappoint. Even when they want to give us what we want, they aren’t always able to. And, as best we can, we face these losses and deal with them, adaptively.
However, when unable to cope with everyday disappointments and more-serious losses and the emotional pain that ensues, we may inadvertently avoid or distort reality and the feelings it triggers. When someone we care about ignores, disappoints, or hurts us, we have feelings about it. Those feelings often trigger anxiety in the body. Ideally, we pay attention to our feelings and channel them into effective action. But sometimes, our feelings make us uncomfortable, so we reflexively ignore our feelings and anxiety by using habits of mind. For instance, a woman whose boss put her down at a meeting might use the habit of denial: “He didn’t mean it.” Or she might use the habit of rationalization: “He just had a bad day.” We see this all the time.
But the next step is where things get interesting. Those habits she uses? They can create her physical complaints and problems, such as chronic neck and shoulder tension, or being uninspired at work.
Of course, we don’t use these habits on purpose. When we avoid our feelings, we do it automatically. Ninety-five percent of the time we have no idea we are even doing that. That’s why we need people who can listen to us more attentively and help us notice patterns in ourselves that we haven’t seen. In ISTDP, your therapist will listen very carefully to help you see the automatic thoughts and behaviors that cause your physical complaints and problems and that interfere with your goals.
Your ISTDP therapist will be very active with you. If your therapist senses you are saying something that could add to your discomfort or create your problem, she (or he) will interrupt what you are saying. Why? She doesn’t want you to hurt yourself. She will show her compassion for you in lots of ways, but one of the most important ones is this: She will interrupt any statement or behavior that could be harmful to you.
Your therapist realizes that you can’t do anything about a habit of mind you don’t see. She will try to help you see those habits as they unfold in the moment, so you can make the choice turn away from the habits and face the feelings, now, that you avoided in the past. Rest assured that your therapist won’t be trying to criticize you. Rather, she will just be trying to observe you very carefully and help you see automatic behaviors that are hurting you, such as a harmful train of thought, an unhelpful point of view, or a damaging course of action that you tend to take and may not have noticed before. Your therapist will also offer you healthy alternatives to these automatic habits, which may be unfamiliar to you.
Once your therapist helps you see a reflexive habit that hurts you and wards off feelings, she will invite you to let go of that self-harming behavior and do one more thing: face the feelings that you have previously sent away. We know from evolution that feelings are our internal guidance system, like a G.P.S. Feelings tell us what is important to pay attention to, helping us become aware of our desires and what we want most in life. They give us the energy and motivation to pursue what we want. Your therapist will help you see — and invite you to let go of — destructive avoidance habits, so you can notice your inner life and desires, be more in touch with yourself, and be clearer about what you want in life. The clarity and energy your feelings provide will enable you to pursue your goals more effectively.
Why do we automatically move away from our feelings? We usually do so because revealing feelings to others in the past has triggered rejection or pain. If we have learned that emotional closeness leads to pain, we will tend to hide our feelings from ourselves and from others to preserve relationships with important people in our lives. Unfortunately, when we send our feelings away, we lose touch with our “internal G.P.S.,” and our relationships become more distant, even flat. Your therapist understands that something has happened to you to make you afraid of sharing your feelings. She will pay close attention to the ways you handle your feelings and to the idiosyncratic, automatic habits you use to manage your anxiety, so you can create more satisfying relationships.
The working relationship you develop with your therapist becomes a template for helping you create the satisfying relationships you want to have with others. That's why it’s important not to overlook any feelings that might get activated inside you — even feelings towards your therapist.
Since the therapy relationship encourages closeness, it is natural that different kinds of feelings will emerge towards your therapist. For instance, it is very common that having your therapist observe your habits of mind as they happen in the moment triggers mixed emotions — such as momentary gratitude about being seen and then anger that she sees you, sometimes before you see yourself. Your therapist is not trying to make you experience feelings towards her; this is happening naturally. It is very beneficial to attend to and navigate those feelings with your therapist; this will then allow you to express yourself more effectively in your relationships with others outside the consulting room.
Naturally, all change involves facing something new that makes us anxious. Ideally, we pay attention to our feelings and channel them into effective action. But because our feelings sometimes make us uncomfortable, we may automatically turn away from them, and avoid anxiety, by using old habits of mind. Your therapist will intervene anytime your anxiety gets too high. She will teach you new ways of responding to yourself so you can manage your anxiety more effectively.
Once your anxiety is regulated, some questions your therapist will ask overtly or implicitly are: How much anxiety or discomfort are you willing to tolerate for the sake of your own growth? Are you worth that kind of investment in yourself? Your therapist will ask whether you are willing to face what you usually move away from so you can accomplish your goals. In ISTDP therapy, we are always striving, every moment of each session, to balance helping you reach your goals with making sure your anxiety is at a manageable level.
The key thing to remember is that you will be asked to commit 100% of yourself on behalf of your own growth and development. Consider whether you would you be willing to do this. Only you can know for sure whether you are worth this kind of effort and investment. This therapy is a true collaboration. Your therapist will need your hard work and effort so that the two of you can co-create a relationship for real change.
What does making a 100% effort mean in practical terms?
Your therapist will invite you to be an active participant, to let her know what your specific difficulties are and what you want to accomplish in therapy, to observe yourself closely moment-by-moment, and to let her know if there is anything she says or does that make you uncomfortable.
You want to get well and lead a satisfying life. Your therapist will listen to you with that in mind. She will maintain a focus that will be effective in leading to the change you want.
In many other forms of psychotherapy, we chat, topics shift one to another, and the purpose is feeling empathy from the therapist, experiencing temporary relief from symptoms, or achieving understanding. While those are all positive benefits, they don’t necessarily lead to change. In ISTDP, our task is to help you overcome your specific difficulties and achieve your goals as quickly as possible.
After all, if your therapist sits silently and passively while you are doing something harmful, your problems will continue and you may not get better. That would perpetuate the very problem you are trying to solve! In ISTDP we actively intervene any time we see a behavior or level of anxiety we think is hurting you.
What kinds of concerns are suitable for ISTDP therapy? The following is a list of common issues that may respond well to ISTDP treatment:
You may be wondering how long this kind of therapy will take. That depends on several variables, including what you want from therapy, how hard you are willing to work for yourself, and the frequency of meetings, among others. Time is the most valuable resource we have, and it is very limited. We must take care not to waste it, especially when the purpose of therapy is to help you achieve what you want.
One thing is certain: A passive patient and an active therapist will produce a limited result. With both parties fully engaged, the changes you want to experience are truly possible in a shorter amount of time than with most therapies.
The bottom line is simply this: If you are stuck cycling the same difficulties over and over, or if your current therapy is not helping you experience a genuine shift in your thinking, feeling, behaviors, and attitude towards yourself, consider whether ISTDP therapy might offer an effective way of meeting your goals and improving your life quality.
Allan Abbass, MD, published an article in the Harvard Journal of Psychiatry that presents a meta-analysis of research on the efficacy of ISTDP. This article appears on the resource page of the ISTDP Institute Web site. More than 60 research studies have been conducted on ISTDP, making it the best-researched and -validated model of short-term therapy today. It has been found to be effective with a wide range of disorders, including depression, anxiety, panic disorders, and personality disorders.
and Jon Frederickson, MSW
Do you ever find yourself thinking that your life could be better than it is now? Do you wish you had a more satisfying job, or a better relationship with a loved one? Do you have a plan in mind, but lack the self-confidence or motivation to pursue it? Perhaps you have tried psychotherapy or coaching but did not experience the change you had hoped for. Consider whether Intensive Short-Term Dynamic Psychotherapy might be a solution for you.
Intensive Short-Term Dynamic Psychotherapy (ISTDP) is designed to help people change in a shorter period of time than standard therapies. Rather than being led by your therapist or simply showing up and saying what comes to mind, in ISTDP you are asked to actively join your therapist and: 1) identify your most-cherished goals; 2) Identify the difficulties you are having in reaching your goals; 3) observe yourself closely and accurately; 4) learn what you do that keeps you from accomplishing your goals; and 5) let go of those blocks, so you can achieve what you want.
Of course, all therapists try to pay attention to you. However, in ISTDP we offer a unique kind of listening and intervention, where your therapist pays very close attention to everything you say and do moment-by-moment in the session. To understand that kind of listening, we need to also understand what causes the problems that lead people to seek psychotherapy in the first place.
In life we all experience the pain of illness, everyday disappointments, serious loss, and death. We want things from our loved ones. And they can do only one of three things: deliver, delay, or disappoint. Even when they want to give us what we want, they aren’t always able to. And, as best we can, we face these losses and deal with them, adaptively.
However, when unable to cope with everyday disappointments and more-serious losses and the emotional pain that ensues, we may inadvertently avoid or distort reality and the feelings it triggers. When someone we care about ignores, disappoints, or hurts us, we have feelings about it. Those feelings often trigger anxiety in the body. Ideally, we pay attention to our feelings and channel them into effective action. But sometimes, our feelings make us uncomfortable, so we reflexively ignore our feelings and anxiety by using habits of mind. For instance, a woman whose boss put her down at a meeting might use the habit of denial: “He didn’t mean it.” Or she might use the habit of rationalization: “He just had a bad day.” We see this all the time.
But the next step is where things get interesting. Those habits she uses? They can create her physical complaints and problems, such as chronic neck and shoulder tension, or being uninspired at work.
Of course, we don’t use these habits on purpose. When we avoid our feelings, we do it automatically. Ninety-five percent of the time we have no idea we are even doing that. That’s why we need people who can listen to us more attentively and help us notice patterns in ourselves that we haven’t seen. In ISTDP, your therapist will listen very carefully to help you see the automatic thoughts and behaviors that cause your physical complaints and problems and that interfere with your goals.
Your ISTDP therapist will be very active with you. If your therapist senses you are saying something that could add to your discomfort or create your problem, she (or he) will interrupt what you are saying. Why? She doesn’t want you to hurt yourself. She will show her compassion for you in lots of ways, but one of the most important ones is this: She will interrupt any statement or behavior that could be harmful to you.
Your therapist realizes that you can’t do anything about a habit of mind you don’t see. She will try to help you see those habits as they unfold in the moment, so you can make the choice turn away from the habits and face the feelings, now, that you avoided in the past. Rest assured that your therapist won’t be trying to criticize you. Rather, she will just be trying to observe you very carefully and help you see automatic behaviors that are hurting you, such as a harmful train of thought, an unhelpful point of view, or a damaging course of action that you tend to take and may not have noticed before. Your therapist will also offer you healthy alternatives to these automatic habits, which may be unfamiliar to you.
Once your therapist helps you see a reflexive habit that hurts you and wards off feelings, she will invite you to let go of that self-harming behavior and do one more thing: face the feelings that you have previously sent away. We know from evolution that feelings are our internal guidance system, like a G.P.S. Feelings tell us what is important to pay attention to, helping us become aware of our desires and what we want most in life. They give us the energy and motivation to pursue what we want. Your therapist will help you see — and invite you to let go of — destructive avoidance habits, so you can notice your inner life and desires, be more in touch with yourself, and be clearer about what you want in life. The clarity and energy your feelings provide will enable you to pursue your goals more effectively.
Why do we automatically move away from our feelings? We usually do so because revealing feelings to others in the past has triggered rejection or pain. If we have learned that emotional closeness leads to pain, we will tend to hide our feelings from ourselves and from others to preserve relationships with important people in our lives. Unfortunately, when we send our feelings away, we lose touch with our “internal G.P.S.,” and our relationships become more distant, even flat. Your therapist understands that something has happened to you to make you afraid of sharing your feelings. She will pay close attention to the ways you handle your feelings and to the idiosyncratic, automatic habits you use to manage your anxiety, so you can create more satisfying relationships.
The working relationship you develop with your therapist becomes a template for helping you create the satisfying relationships you want to have with others. That's why it’s important not to overlook any feelings that might get activated inside you — even feelings towards your therapist.
Since the therapy relationship encourages closeness, it is natural that different kinds of feelings will emerge towards your therapist. For instance, it is very common that having your therapist observe your habits of mind as they happen in the moment triggers mixed emotions — such as momentary gratitude about being seen and then anger that she sees you, sometimes before you see yourself. Your therapist is not trying to make you experience feelings towards her; this is happening naturally. It is very beneficial to attend to and navigate those feelings with your therapist; this will then allow you to express yourself more effectively in your relationships with others outside the consulting room.
Naturally, all change involves facing something new that makes us anxious. Ideally, we pay attention to our feelings and channel them into effective action. But because our feelings sometimes make us uncomfortable, we may automatically turn away from them, and avoid anxiety, by using old habits of mind. Your therapist will intervene anytime your anxiety gets too high. She will teach you new ways of responding to yourself so you can manage your anxiety more effectively.
Once your anxiety is regulated, some questions your therapist will ask overtly or implicitly are: How much anxiety or discomfort are you willing to tolerate for the sake of your own growth? Are you worth that kind of investment in yourself? Your therapist will ask whether you are willing to face what you usually move away from so you can accomplish your goals. In ISTDP therapy, we are always striving, every moment of each session, to balance helping you reach your goals with making sure your anxiety is at a manageable level.
The key thing to remember is that you will be asked to commit 100% of yourself on behalf of your own growth and development. Consider whether you would you be willing to do this. Only you can know for sure whether you are worth this kind of effort and investment. This therapy is a true collaboration. Your therapist will need your hard work and effort so that the two of you can co-create a relationship for real change.
What does making a 100% effort mean in practical terms?
Your therapist will invite you to be an active participant, to let her know what your specific difficulties are and what you want to accomplish in therapy, to observe yourself closely moment-by-moment, and to let her know if there is anything she says or does that make you uncomfortable.
You want to get well and lead a satisfying life. Your therapist will listen to you with that in mind. She will maintain a focus that will be effective in leading to the change you want.
In many other forms of psychotherapy, we chat, topics shift one to another, and the purpose is feeling empathy from the therapist, experiencing temporary relief from symptoms, or achieving understanding. While those are all positive benefits, they don’t necessarily lead to change. In ISTDP, our task is to help you overcome your specific difficulties and achieve your goals as quickly as possible.
After all, if your therapist sits silently and passively while you are doing something harmful, your problems will continue and you may not get better. That would perpetuate the very problem you are trying to solve! In ISTDP we actively intervene any time we see a behavior or level of anxiety we think is hurting you.
What kinds of concerns are suitable for ISTDP therapy? The following is a list of common issues that may respond well to ISTDP treatment:
- Developing assertiveness skills
- Being too quick to react
- Getting along with co-workers, friends, and family members
- Igniting motivation
- Overcoming procrastination
- Sorting out what you want to do professionally and personally
- Interrupting the cycle of depression
- Managing anxiety effectively
- Increasing self-confidence and self-esteem
- Increasing productivity in the workplace
- Facing losses such as death and divorce
- Discovering how to generate and benefit from unplanned events
You may be wondering how long this kind of therapy will take. That depends on several variables, including what you want from therapy, how hard you are willing to work for yourself, and the frequency of meetings, among others. Time is the most valuable resource we have, and it is very limited. We must take care not to waste it, especially when the purpose of therapy is to help you achieve what you want.
One thing is certain: A passive patient and an active therapist will produce a limited result. With both parties fully engaged, the changes you want to experience are truly possible in a shorter amount of time than with most therapies.
The bottom line is simply this: If you are stuck cycling the same difficulties over and over, or if your current therapy is not helping you experience a genuine shift in your thinking, feeling, behaviors, and attitude towards yourself, consider whether ISTDP therapy might offer an effective way of meeting your goals and improving your life quality.
Allan Abbass, MD, published an article in the Harvard Journal of Psychiatry that presents a meta-analysis of research on the efficacy of ISTDP. This article appears on the resource page of the ISTDP Institute Web site. More than 60 research studies have been conducted on ISTDP, making it the best-researched and -validated model of short-term therapy today. It has been found to be effective with a wide range of disorders, including depression, anxiety, panic disorders, and personality disorders.
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