Intensive Short Term Dynamic Psychotherapy (ISTDP)- A Deeper Look

Jon Frederickson likes to start discussions regarding ITSDP by asking: What causes suffering? Ever since the Buddha, people have been trying to answer that question, and over four hundred therapy models have taken a crack at it. Each one gets at something real. But ISTDP looks at all of them and asks: what if we put the pieces together into something more complete?

Here's the core idea. In life, we inevitably run into conflict with other people. Conflict triggers feelings. Feelings, provided by evolution, tell us what we want and mobilize us to act. But most people who come to therapy can't channel their feelings into effective action. Instead, they get anxious and reach for defenses. Those defenses are what create the symptoms and presenting problems that bring people to therapy in the first place.

Simple enough. But ISTDP defines feelings, anxiety, and defenses very specifically, drawing from neuroscience, biophysiology, and ethology, and those definitions change everything about how you actually do therapy.

Take feelings. Neuroscientists like Antonio Damasio have shown us that feeling is just the conscious awareness of a much larger non-conscious emotional system we share with animals. Emotions organize behavior. The dog that's scared barks and attacks. In humans it's the same thing, except we're also aware of what's happening in our bodies. That awareness is what we call feeling. So a full experience of anger includes a cognitive label ("I'm angry"), an awareness of physiological arousal (heat rising from the solar plexus), and a motoric impulse (hands clenching, arms raising). Most people don't get all three, because their defenses get in the way first.

Anxiety in ISTDP isn't a thought or a fear of something. It's a bio-physiological pattern of activation in the body. And importantly, anxiety can be discharged in three different ways: into the striated muscles (tension, sighing), into the smooth muscles (migraines, gut issues), or into cognitive perceptual disruption (dizziness, dissociation, losing your train of thought). Where someone's anxiety goes tells you a lot about how to work with them and how much feeling they can tolerate at a given moment.

And then there are defenses. Intellectualizing. Deflecting. Going vague. Laughing something off. Changing the subject. In ISTDP these aren't bad habits; they're strategies that originally made sense, usually developed in childhood when showing your feelings felt dangerous to a relationship you depended on for survival. The problem is they become automatic, they follow you into your adult relationships, and they create the symptoms you're suffering from today.

So how does ISTDP actually work? Whenever a defense shows up in the room, I'll name it. Not to criticize you, but because the defense is the thing standing between you and the feeling underneath it. We help you see the defense, understand what it's costing you, and turn against it, so you can get to what you've actually been avoiding. When people finally do access those deeper feelings, usually toward important figures from earlier in their lives, something shifts. The past starts to make sense in a felt way, not just an intellectual one, and that understanding tends to stick.

Throughout, we go at your pace, honor your will, and work together to address your concerns. My clients often ask, what should I work on? And my answer is often, well what is actually a problem for you? I’m not here to tell you what your problems are or to change what is working for you. I’m here to support you to shift what you view as getting in the way of your ideal life. And, because I am not dogmatic, we can slip in some other great therapy modalities too- IFS, AEDP, Narrative Therapy, and Gestalt Therapy wherever that makes sense to do.