What is ISTDP? (Intensive, Short-term Dynamic Psychotherapy)

It seems that TMSers see themselves as needing to be there for everyone, also they are also inclined to put themselves through extreme stress to achieve their goals. They are often reluctant to ask for help until symptoms hit. Then they end up being forced to ask for help, maybe give up their jobs, and go to multiple doctors and therapists in a pursuit to fix the pain problem.

What if there was a way to uncover ‘the flaw’ that put them in pursuit of perfectionism to push themselves like a machine, to get everything done? A little known therapy called Intensive Short-Term Dynamic Psychotherapy (ISTDP) has been developed since the 1960’s. The model was developed by Dr. Habit Davenloo from McGill University in Montreal.

 

When a patient presents with symptoms in the body like pain, the therapist looks at what is behind the pain. Why is this person suffering so deeply? By searching out the cause of the pain and gently releasing it, the patient is healed.

The mechanism for causing the suffering is an internal belief perception that they must be flawed in some way, or ‘broken’  to persistently have pain or autoimmune illnesses.

The patient's Core Experiential State, this is the most common state in the first 7 years of life is how patients perceive themselves. If they have endured criticism or neglect, a parent's illness or death, divorce or their own hospitalization, they will see their core experiential state as being deficient, so to compensate they blame themselves for the problems and fear they have endured. As if they had a personal flaw. This notion is based on the evolutionary idea that interpersonal problems must be their fault rather than the fault of the caregiver in their lives. They do this to keep themselves safe within their family system. 

 

Patients come into the meeting either with the anxiety of defenses. The therapist helps the patient to see the internal transactional patterns that are causing the pain/stress or defenses. 

 

The Intensive Short-Term Dynamic psychotherapist tracks the patients anxiety pathways and helps the patient to notice that when the conversation/dialogue turns to focus on the patient's feelings that the patient gets anxious or defends.

 

Anxiety is expressed in Striated Muscle Anxiety eg, Fibromyalgia (muscle tension neck back shoulder pain) Smooth muscle, reflux, stomach cramps, bloating, diarrhea, constipation. IBS,  Pelvic issues, UTI’s etc. Cognitive Perceptual Disruption, headaches, pseudoseizures, conversion disorder. 

 

Defenses are there to amplify a pattern that wants to keep the patient safe from others, their perceived criticism becomes self criticism to block the emotional pain of rejection. The therapist notices and helps the patient notice their repressive defenses to emotional closeness and encourages the patient to be more open while helping them see that by intellectulising, creates  focus on the patients thoughts about a problem, rather than their feelings about the problem. As does minimisation, generalisation, vagueness, sarcasm all play a role in keeping the patient away from their feelings in their body.


Can it help treat stress illnesses, and which specific symptoms can it treat, and how does it compare to other forms of psychotherapy?

 

Feedback from a patient: "ISTDP unearths the reasons why we are stuck in self-sabotaging patterns and chronic pain/TMS that befriend us and keep us safe from looking at our suppressed emotions. It is like unraveling knots, one string at a time, to discover the anger, shame, and guilt that is enforcing the patterns of behavior. By pulling the strings, through the ISTDP process, you come to the realization that it doesn't matter why the knots were there in the first place, only that they were seen and untangled with LOVE.”

Origins of ISTDP

Dr. David Malan is quoted as saying that Freud discovered the unconscious and Dr. Habib Davenlo opened the unconscious. Intensive Short-Term Dynamic Psychotherapy had its birth in psychoanalysis, (Freud) and Attachment theory (Bowlby, Main, Ainsworth, Abbass, Neborsky). 

 Dr. Allan Abbass, along with Dr. Patricia Coughlain, Jon Frederickson, and many others who trained under Davenloo provide the next generation of therapists with the same training. ISTDP Therapists complete a three year Core Training program, then proceed to several years of advanced training. 

Long Term Effects of ISTDP Treatment

ISTDP creates character change, old patterns of interaction, and communication become redundant, as does the pain/TMS symptoms. The patient no longer needs the warning signal that something is worrying them, they become articulate and feel empowered. Dr. Patricia Couglain in her book ”Lives Transformed” cites five year follow-up on patients. Their consensus is that ISTDP is the ‘gift that keeps on giving’ with stress illnesses no longer holding the patient back from their life.