Individual ISTDP Treatment
At the Melbourne Centre for ISTDP we conduct an initial 120 minute assessment interview ("Trial Therapy") to complete a thorough assessment of your problems and to determine together whether ISTDP could be effective in helping you resolve your problems.
ISTDP is based upon psychodynamic principles: that symptoms arise as a result of the defensive ways in which we (ego) have learnt to manage the conflicting demands of our emotions (id), our sense of ‘right and wrong’ (super-ego) and the environment in which we live (external reality). The goal of any experiential dynamic psychotherapy is for the patient to become conscious of the unconscious ways that they ward off emotional conflicts. They are then encouraged to work through those emotional conflicts experientially in the present moment, at a pace that does not evoke excessive anxiety. Thus, the patterns that were formed in childhood which are being repeated in the current are undone in the here-and-now of the therapy room, in favour of healthy emotional connection and expression.
Fundamentally, Malan (2010) observed that an ISTDP approach to this therapeutic task differs from the traditional psychoanalytic one in this crucial respect:
“Instead of allowing the client’s defences to operate and then offering interpretations at a time when the client is receptive, an ISTDP practitioner seeks to help the client confront and disown their defences as they are activated, facilitating the here-and-now experiencing of the emotions which they repress.”
Dr Habib Davanloo, the founder of ISTDP, found that when the therapist takes this active and involved stance two things become apparent: defences are not as impenetrable as first thought and the therapeutic alliance between therapist and patient is more powerful than first thought. In fact, the therapist can foster an ‘internal crisis’ whereby the patients healthy longings and desire for change eventually overpowers their defences, leading not only to symptom relief but enduring, robust character change within a much shorter timeframe.
What is the empirical evidence for ISTDP?
Beyond a 2006 Cochrane Review for Short-Term Dynamic Psychotherapy in general, evidence for ISTDP’s particular effectiveness has accumulated over the last three decades, and in the following areas:
- Personality disorders
- Treatment resistant depression
- Anxiety disorders
- Eating Disorders
- Medically unexplained symptoms (Somatic disorders)
- Chronic pain
- Mixed samples
- Clinical and cost effectiveness
Abbass et al.’s (2013) meta-analysis of 13 studies found large improvements for general psychopathology, depression, anxiety and interpersonal functioning before and after therapy. These improvements were maintained at follow-up, which was between six months and ten years. In terms of cost effectiveness, eight studies found that a course of ISTDP led to significant savings through reduced use of health services and medication, less disability claims and increased return to work. The authors conclude that “ISTDP is a systematic set of approaches to treat a very broad range of complex and resistant patients” (p.13).
Abbass A.A., Hancock J.T., Henderson J., Kisely S.R. (2006) Short-term psychodynamic psychotherapies for common mental disorders. Cochrane Database of Systematic Reviews 2006, Issue 4.
Abbass, A.A., Town, J.T., Driessen, E. (2013). Intensive Short-Term Dynamic Psychotherapy: A Review of the Treatment Method and Empirical Basis. Research in Psychotherapy: Psychopathology, Process and Outcome, 16(1), 6 – 15
Malan, D.H. “Introduction to ISTDP.” The Third Oxford Conference on Experiential Dynamic Therapy, ISTDP-UK. St. John’s College, Oxford, UK. 20th May 2010. Keynote Address.