Intensive Short Term Dynamic Psychotherapy

Intensive Short-Term Dynamic Psychotherapy (ISTDP) is a form of short-term psychotherapy developed through empirical, video-recorded research by Habib Davanloo, MD. It is of particular interest to TMS/PPD practitioners because it is recommended by Dr. Arlene Feinblatt, about whom Dr. Sarno wrote, "In particular I am grateful to Arlene Feinblatt, the chief psychologist of our group, for her contribution to the understanding of the psychological basis for TMS."

Dr. Feinblatt has written the following short introduction to ISTDP for the wiki:

Practitioner Arlene Feinblatt Intensive Short Term Dynamic Psychotherapy by Dr. Arlene Feinblatt, Ph.D. ISTDP is a technique based on psychoanalytic theory. A major difference regarding this technique is the handling of resistance. With psychoanalytic work a passive neutrality and indirect focus including free association and dream interpretation are utilized. The hallmark of ISTDP is the unlocking of the unconscious and maintenance of the therapeutic alliance through focus on resistence and defenses as well as undoing of the idea of therapist as omnipotent. Training in ISTDP involves videotaping of both therapist and patient during sessions. Evaluation of the patient is performed in an open-ended intake - that is, the patient is told to be prepared for a two hour, three hour or even longer session. This enables the therapist to examine how the patient tolerates the process. The major efforts of the therapist are to help the patient clarify their triangle of feelings. This includes their impulses or feelings, their anxiety and their defenses. A second triangle with which ISTDP therapists work involves using the feelings generated in the session to connect to significant people in the patient's past, current conflicts with people, and their reaction to the therapist or transference. The ego adaptive capacity of the patient determines the rapidity with uncovering can be done. Working with ISTDP takes a great deal of training. Uncovering of defenses is sensitive work. Once an unconscious therapeutic alliance is established, then, and only then, can interpretations be made. To make such interpretations earlier is to encourage intellectual rumination. I would encourage anyone interested in learning this technique to read the books published by Dr. Habib Davanloo. Books Recommended by Dr. Feinblatt: Davanloo, Habib. Basic Principles and Techniques in Short-term Dynamic Psychotherapy. Jason Aronson Publishing. 1978 Davanloo, Habib. Short-term Dynamic Psychotherapy. Jason Aronson Publishing. 1980 About Dr. Feinblatt: Dr. Arlene Feinblatt was the first psychotherapist to work with Dr. John Sarno, and she played a pivotal role in developing his TMS treatment protocol. In addition to working with Dr. Sarno for over 30 years, Feinblatt has trained several leading TMS/PPD psychologists. She also served as a Supervisor at the Clinical Health Psychology at NYU School of Medicine and was a member of the Faculty of the New York Center for Short-Term Dynamic Psychotherapy'. In addition to these roles, Dr. Feinblatt has been a Clinical Assistant Professor at New York University School of Medicine since 1993.

The underlying theory of the ISTDP approach is quite similar to that of the PPD approach. The fundamental understanding of ISTDP is that when individuals experience emotional disturbances or trauma the event may result in wide array of emotions that the individual may not be able to adequately handle. This results in these unwanted emotions becoming repressed and avoided. Davanloo discovered that through time, certain events may rekindle these repressed emotions resulting in anxiety and defenses. The exacerbation of this anxiety and repressed emotions can create a variety of physical symptoms such as gastrointestinal problems, skin disorders, and chronic pain.

Using the ISTDP approach in therapy first requires the therapist to explain the psychological process to the patient followed by working with the patient to overcome the process. The therapist should begin to examine the patient as soon as they enter the office and attempt to notice any signs of repressed emotions such as tense muscles or hand clinching. During the interview the therapist should point out noticeable ways the patient represses their emotions.

The goal of the approach is to have the patient realize that they are repressing emotions, so they can stop the process and experience their feelings. When this happens anxiety and physical symptoms drop suddenly. This also allows the therapist and patient an opportunity to begin to work through the once repressed feelings and emotions. In some cases just one breakthrough is needed to bring about major symptom improvement, however in most instances several of these events are needed before the symptoms recede. [Source]

According to the Washington School of Psychiatry:

“Intensive Short Term Dynamic Psychotherapy is designed to achieve long term structural character change in briefer periods than with traditional psychodynamic therapy. Based on psychodynamic theory, it uses active techniques designed to focus, clarify, and intensify the therapeutic process. This model of treatment was first developed by Habib Davanloo. Davanloo recognized that rapid character change could take place through helping the patient relinquish defenses against emotional experience. He accomplished this through a method of handling resistance and transference which mobilizes the patient's unconscious therapeutic alliance. As a result, the patient reveals the core emotions and conflicts which have been responsible for character problems. This model of treatment has shown excellent results with a broad range of patients in numerous psychotherapy studies over the past 35 years.”

According to Health Care Economics:

“The brief dynamic psychotherapy that Abbass and his team have found can both pack a clinical punch and save money is called intensive short-term dynamic psychotherapy. It was founded some 20 years ago by Habib Davanloo, M.D., a professor emeritus at McGill University in Montreal. It helps a person address, experience, and deal with blocked emotions and unconscious processes that lead to a wide range of symptom and character problems. Currently there are training programs for it in Halifax, Montreal, Toronto, Vancouver, California, and New York.”

Bibliography

• Davanloo, Habib. Intensive Short-Term Dynamic Psychotherapy: Selected Papers of Habib Davanloo, M.D. This is much more up to date then the older Davanloo texts and takes into consideration the advances made in psychotherapy since the early 80s.
• Davanloo, Habib. Unlocking the Unconcious. 1995. John Wiley Publishing.
• Robert Neborsky; Marion Soloman. "The Challenge of Short-term Psychotherapy", chapter 1 of the book Short-term Therapy for Long-term Change. 2001: This excerpt begins with the introduction and continues with a large portion of the first chapter, which gives an introductory overview of ISTDP, beginning by defining what the term means and the different emerging schools of thought within the discipline. The authors also address some of the confusions that have arisen in regard to the term "short-term" and "dynamic."
• Michael Laikin, Arnold Winston, Leigh McCullough "Intensive Short-Term Psychodynamic Therapy," Chapter 4 in Handbook of Short-term Dynamic Therapy. 1991: In this chapter the authors discuss several pertinent issues regarding how to treat patients. This includes an overview of how to select patients for this approach, the change of emotions in the course of an interview, and finishing with an introductory explanation of the technique and evaluation of the approach.
• Wikipedia article on Intensive Short-Term Dynamic Psychotherapy: This article begins with an overview of the origins and theoretical foundation's of ISTDP beginning with Bowlby and attachment trauma and continuing on with Davanloo's discovery of the unconscious consequences of attachment trauma. It goes on to discuss the therapeutic interventions of the approach, as well as the evidence behind it. The article ends with a comparison to Cognitive Behavioral Therapy.
• Abbass A. "Intensive Short-term Dynamic Psychotherapy in a Private Psychiatric Office: Clinical and Cost Effectiveness." American Journal of Psychotherapy - 56(2): 225-232, 2002: This 2002 study examined how effective ISTDP therapy was in conjuncture with the costs of each session. In the end the study found that ISTDP is not only cost effective, but also clinical effective. Short-Term Dynamic Therapy Gets Boost in New Efficacy Study is an article written by Psychiatric News discussing the implications of this study.
• Abbass A; Campbell S; et al. "Intensive short-term dynamic psychotherapy to reduce rates of emergency department return visits for patients with medically unexplained symptoms: preliminary evidence from a pre-post intervention study." CJEM 2009;11(6):529-534: This study found that ISTDP therapy reduced the symptoms of people with medically unexplained symptoms and somatization, along with significantly reducing their visits to emergency departments.
• Davanloo Habib. "Intensive Short-Term Dynamic Psychotherapy-Central Dynamic Sequence: Phase of Challenge." International Journal of Intensive Short-Term Dynamic Psychotherapy. 1999; 13: 237-262.
• Davanloo, Habib. "Intensive Short-Term Dynamic Psychotherapy Extended Major Direct Access to the Unconscious." European Psychotherapy. 2001; 2(1): 25-70.
• Davanloo, Habib. "Intensive Short-Term Dynamic Psychotherapy-Central Dynamic Sequence: Head-On Collision with Resistance." International Journal of Intensive Short-Term Dynamic Psychotherapy. 1999, 13: 263-282.
• Davanloo, Habib. "Intensive Short-Term Dynamic Psychotherapy-Central Dynamic Sequence: Phase of Pressure." International Journal of Intensive Short-Term Dynamic Psychotherapy. 1999; 13: 211-236

ISTDP Resources

• The Center for Emotions and Health
• The Southern California Society for ISTDP
• German Centre for STDP
• Dutch Association for STDP
• Lifespan Learning Institute
• Swiss Association for Intensive Short-Term Dynamic Psychotherapy

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