Key takeaways
ISTDP is an active, collaborative form of therapy that explores feelings and patterns in the moment.
The therapist and patient may notice ways of coping that are connected to distress.
Experiences and outcomes vary, and the approach may not be the right fit for everyone.
What is ISTDP?
ISTDP stands for intensive short-term dynamic psychotherapy. The model was developed to help people address emotional barriers and patterns that may be connected to distress, such as anxiety and depression, as well as relationship challenges such as distancing, withdrawing, or people pleasing. But what is it like to sit in an ISTDP session? And what is intensive about it?
Active engagement in therapy
ISTDP invites active engagement and participation from therapist and patient alike. Rather than only talking about difficulties, the patient and therapist look together at distressing patterns and what may be happening in the moment. The therapist pays attention to ways the patient may avoid feelings and helps them notice areas of conflict or emotional blockages. The process is collaborative. Exploring these areas can bring up anxiety, which the therapist and patient can notice and explore together, including what is happening in their relationship.
For illustration, a therapist might ask about a situation that makes a patient anxious, while paying attention to the patient’s desire to collaborate and capacity to tolerate anxiety. The therapist might ask whether the patient notices anxiety as they talk about the situation, rather than assuming that an observation tells the whole story. If the anxiety becomes too intense, the therapist and patient can work together to regulate it before continuing to explore difficult feelings.
The therapist’s job is never to force the patient. It is to work collaboratively with the patient’s wish to engage, their ways of avoiding difficult experiences, and their capacity to tolerate anxiety and emotions. A patient can say, “This feels too intense,” “Can we slow down?” or “I want to stop.” They do not have to wait for the therapist to notice. These requests are part of the conversation about pace, consent, and how to work together.
Highlights resistance
Resistance can be a friend in ISTDP because it may offer clues about an underlying conflict. Some patients come to therapy wanting to change while also feeling pulled to hold on to familiar ways of coping. They may not initially see these patterns or how they affect them. ISTDP invites the patient to notice and explore these patterns and the feelings behind them.
For example, a patient might come in with anxiety and feel eager to find relief. As they and the therapist explore their experience, they might notice that emotional vulnerability feels difficult, too. Recognizing both the wish for relief and the discomfort around vulnerability can open a conversation about the conflict and possible choices. Each patient’s experience is different.
Focus on emotional processing
In ISTDP, the patient and therapist pay attention to how the patient feels in the moment, whether discussing a past event, a current situation, or the relationship with the therapist. Some people find it easier to talk about emotions than to experience them. They may rely on patterns such as detachment or intellectualization. Together, the patient and therapist explore those patterns and the feelings they may be protecting.
Emotional experience may bring new understanding of past experiences and the ways a person learned to cope. It does not follow the same path for everyone.
In ISTDP, the therapist pays attention to the bodily experience of emotion as well as the words a patient uses. Within this approach, noticing sensations, impulses, and ways of holding back can help a patient explore how they experience a feeling in the moment. These observations are something to explore together, not proof that the therapist knows what a patient feels from their appearance.
For illustration, a patient might say they feel sad while noticing that they are holding back tears. The therapist could invite them to explore what they notice in their body and what it is like to let someone else be present with that sadness. The patient may agree, disagree, or describe a different experience. The aim is to understand their experience together, without requiring tears or any particular outward expression of emotion.
The opportunity to change patterns in therapy
By noticing patterns that may contribute to distress, patients can become more familiar with how those patterns show up in their lives and in therapy. The therapist invites the patient to observe what is happening and explore whether another response is possible. Facing underlying feelings can be an opportunity to understand and work toward changing patterns that feel hurtful or limiting.
ISTDP is an active process that invites participation from both patient and therapist. It asks patients to bring curiosity to their emotional lives and to work with a therapist on experiences that can feel intimate or difficult. Some patients may find this work helps them develop a greater sense of self, self-confidence, self-care, or capacity for closer relationships. The experience and outcomes vary, and the approach may not be the right fit for everyone.
A first ISTDP therapy appointment is an opportunity to explore whether the approach feels like a good fit, rather than a commitment to ongoing therapy. Initial ISTDP sessions are sometimes called “trial therapies.” The patient and therapist can discuss how the active, in-depth approach feels and whether they want to continue working together. It is important that patients have the freedom to say what they like or dislike about the approach. Because ISTDP is active and experiential, the first appointments give you a chance to experience the approach and consider how it feels for you. People often begin to get a sense of fit within one to three sessions. That is an opportunity to discuss whether to continue, not a deadline for deciding or a promise of results. This therapy appointment is distinct from Fellow Therapy’s free introductory phone consultation.
Laura Meeker Wicksall LMSW, LCSW
Owner of Fellow Therapy
Frequently asked questions
What does ISTDP stand for?
Intensive short-term dynamic psychotherapy.
What happens in an ISTDP session?
The patient and therapist work together to notice feelings and patterns, including what may be happening in their relationship.
Is ISTDP right for everyone?
Not necessarily. Experiences and outcomes vary, and the approach may not be the right fit for everyone.