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Why I practice ISTDP

Learning the art and science of Intensive Short-Term Dynamic Psychotherapy has been one of the hardest undertakings of my professional life. A few times during the course of my training, I considered the option of quitting.  And I’m not someone who quits. ISTDP is an extremely difficult therapy to master. It requires keeping your eyes and ears on multiple physiological and psychological phenomena at the same time. It puts you in contact with very painful feelings. It triggers unresolved issues from your own past, and it constantly reminds you of your limitations. Once undertaken, it becomes an all-consuming passion that burns up hours of your day and days of your week – and this is apart from actual time spent with clients. Yet I love it for all these reasons. Mostly, I love ISTDP because it has given me the capacity to be a uniquely effective therapist and to witness breathtaking transformations in the people who entrust their care to me.


Long before I completed my own ISTDP training, I had the privilege of watching miracles unfold at the hands of master ISTDP clinicians. One of the things that sets ISTDP apart from other therapeutic modalities is its insistence on videotaping session work to facilitate learning and quality of treatment. This feature offers new practitioners an opportunity to observe the work of master practitioners, specifically their selection, timing and dosage of interventions. Experienced clinicians make the work look easy. It is not. When viewed on time-lapse video, their patients often appear dramatically different – even physically – by the end of treatment. And treatment is relatively fast as far as therapy goes– sometimes concluding in just weeks.


A colleague of mine aptly compared learning the art of ISTDP without videotape to learning the art of surgery without an operating room. I agree.  A stunning amount of information, both verbal and nonverbal, surfaces during an ISTDP session, and because clinicians cannot focus on it all at once, we rely on videotape to review what we may have missed. For example, if I’m busy observing (and intervening on) the automatic way my client avoids eye contact and tenses her entire body when sharing a past event, I might miss a key historical detail embedded in her story. Going back and reviewing what occurred in a given session allows me to address these important details later on. It also significantly shortens the length of treatment.

In this powerful and humbling work, I’m granted rare access to the hidden parts of human experience – the dark and sadistic impulses we prefer not to acknowledge, the crushing guilt and shame we feel about our disavowed aggressions, the intense grief over unfulfilled longings, and the deep reservoir of love we feel toward even the most flawed or destructive people in our lives.


None of this material is easy to come by of course. We keep it hidden, mostly from ourselves. That is the unique challenge of ISTDP.  How do we help our patients face what they’ve spent a lifetime avoiding? As clinicians, we know it’s not painful emotions that cause harm – it’s the self-defeating ways in which we escape them. If we suffer from frequent bouts of anxiety, depression or harmful behaviors, or we find ourselves stuck in unsatisfying and eerily repetitive relationships, we can safely bet there is something very important (and very buried) trying to get our attention.

In ISTDP, we work carefully to unearth these buried experiences so we can face them honesty together and finally put them to rest. Patients often use the same language to describe their experience following a breakthrough of intense emotion and memory. The words I hear most often are “free” and “light.” This is what I appreciate most about my work. It’s a privilege to follow clients into unknown and off-limits territory and emerge in new and surprising places. As a result of my training, I generally know where we’re headed, but I usually have no idea what we’re going to find once we arrive. What we uncover is always unexpected and always deeply moving for patient and therapist alike.  Facing what was once frightening or unbearable has the power to change a paralyzed or hardened or self-destructive person in profound and beautiful ways.

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