About ISTDP Therapy

The ISTDP Therapy Process

Navigating the ISTDP Journey

The ISTDP therapy process unfolds in distinct phases, each critical for emotional breakthroughs. It starts with the ‘dynamic inquiry’  phase, where information is gathered in a collaborative process between therapist and patient, to understand the patient’ s struggles in the context of David Malan’s ‘Two Triangles’.  There is understanding of what is triggering and driving the emotional difficulties and what therapy can do to help the patient.

An important component of ISTDP is to keep the patient’s anxiety regulated during this process to ensure that the therapist and patient are working within the patient’s capacity.  Often capacity building work is necessary before the patient can fully identify and experience emotions.   

Each time the patient reaches a threshold that shows they are at their current capacity for tolerating feelings and anxiety, specific interventions are used to restructure anxiety and defenses and increase ego capacity. This work alone, aside from the work that follows, can help  the patient become better able to stay emotionally regulated and tolerate a greater range and intensity of feelings.

The patient is given the opportunity to identify and experience the specific emotions that are triggering their anxiety and defenses. As these feelings are mobilised in the therapy session, defenses naturally arise, providing the opportunity, in the moment, for the patient and therapist to recognise and understand the patient’s defense mechanisms. The cost of the use of these defense mechanisms becomes evident and the patient can choose whether to stay with the harmful defenses or, with the therapist’s help, overcome them and face the anxiety-evoking feelings involved in the attachment trauma.

Emotions are often explored in real time as they arise  in the session with the therapist.  Sometimes the exploration is of current relationships but often the exploration is of the feelings and reactions that arise towards the therapist. Working in what is known as ‘the transference’ gives a first-hand opportunity, in the moment, to get clear on what feelings trigger anxiety, when they trigger anxiety, and how defenses operate.  Therapy provides a microcosm of the patient’s relational patterns; it shines light on what works and what does not work for them, and enables emotional conflict to be understood and faced.

We understand that when conflicted emotions can be experienced at a deep level, a process known in ISTDP as the ‘Unlocking of the Unconscious’ takes place, resulting in the patient re-experiencing long-suppressed emotions related to attachment relationships. The specific memories of where these feelings were infused with anxiety spontaneously come to the conscious mind, enabling the attachment trauma to be faced, understood, and worked through. This phase is often where significant therapeutic change takes place.

The final phase of ISTDP involves jointly reviewing the therapy process. The patient’s understanding of the interplay between emotions, anxiety, and defense mechanisms is solidified and they gain greater clarity on where ruptures in the attachment process took place. This comprehensive approach is tailored to each individual, ensuring a personalised and effective therapy experience.