Intensive Short-Term Dynamic Psychotherapy
Symptoms are produced by unconscious anxiety generated when forbidden feelings — usually rage and grief toward attachment figures — press for expression, and treatment works by actively pressing against defenses to reach and experience that feeling, while continuously monitoring where the anxiety is being discharged in the body.
Go directly at the defense until the warded-off feeling arrives. And watch the anxiety.
Who built it
Habib Davanloo
1927–2018Psychiatrist, McGill
Developed ISTDP through systematic videotape analysis of thousands of sessions — an unusually empirical method for a dynamic tradition. Developed the central dynamic sequence and the technique of head-on collision with resistance.
ISTDPPatricia Coughlin & Jon Frederickson
Contemporary ISTDP teachers
Softened and systematised the approach, emphasising graded pressure matched to anxiety tolerance rather than uniform confrontation.
ISTDPAllan Abbass
Psychiatrist, Dalhousie
Built the evidence base, particularly for somatic and medically unexplained symptoms, and produced the meta-analyses.
ISTDP
Theory of personality
The model is a straightforward triangle of conflict driven to its logical conclusion. Attachment trauma produces mixed feelings — love and rage toward the same person — which generate guilt, which generates anxiety, which is defended against. The defenses become character, and the anxiety is discharged into the body or into cognition, producing symptoms.
Pathways of unconscious anxiety — the model’s distinctive contribution
| Pathway | Where the anxiety goes | What you observe | What to do |
|---|---|---|---|
| Striated muscle | Voluntary muscle tension | Hand clenching, sighing respiration, tension in neck and shoulders | Tolerable; pressure can continue |
| Smooth muscle | Involuntary muscle | Abdominal pain, migraine, bladder urgency, asthma | Reduce pressure; regulate anxiety first |
| Cognitive-perceptual disruption | Cognition and perception | Going blank, blurred vision, dizziness, dissociation | Stop pressure immediately; restore capacity |
Theory of psychopathology
Character defenses — detachment, compliance, vagueness, intellectualisation, passivity — protect against the anxiety generated by forbidden feeling. They also produce the presenting problem, and Davanloo’s central technical claim is that patients can be helped to turn against their own defenses once they see what those defenses cost.
Theory of change
- 1Inquiry into the problem, with attention to how the patient avoids.
- 2Pressure toward feeling — repeated invitation to identify and experience what is felt.
- 3Challenge to the defenses as they appear.
- 4Head-on collision: a sustained, direct confrontation with the resistance and its cost, aimed at mobilising the patient against their own defenses.
- 5Unlocking the unconscious: a breakthrough to the warded-off feeling — typically rage, then guilt, then grief — experienced somatically as well as psychologically.
- 6Consolidation of the insight and its links to history.
Key concepts
The vocabulary you need to read the literature and to be understood in supervision.
Where it sits in the transtheoretical grid
Which change processes the system leans on, and at what level of content it aims.
- Catharsis / dramatic relief
Experiencing and expressing affect about the problem, whether by corrective emotional experience or by evoking what has been avoided.
- Consciousness raising
Increasing information about oneself and the problem - feedback, interpretation, education, observation.
- Self-reevaluation
Appraising how one thinks and feels about oneself with respect to the problem; values clarification.
- Helping relationship
Being open and trusting about problems with someone who cares; the relationship as vehicle, and as medicine in its own right.
- Intrapersonal conflicts
- Symptom & situational problems
- Current interpersonal conflicts