Understanding the Duration of ISTDP Therapy: What to Expect.

If you’re considering starting therapy, you might understandably be wondering: how long is this going to take before I feel any different?

The answer is different for everyone, but ISTDP is built around the idea that therapy should work towards change as efficiently as possible.

That doesn't mean rushing therapy or promising that a longstanding difficulty can be resolved within a few sessions. It means actively trying to understand what is preventing change and working with it from the beginning.

For some people, this can mean meaningful changes happen surprisingly early.

Can Change Really Happen Quickly?

Sometimes, yes.

One of the things that can be striking about ISTDP is how much can sometimes become clear within an initial session.

Rather than spending the first few sessions primarily gathering a history, the therapeutic work begins straight away. We start with the difficulty you want help with and begin exploring what seems to be maintaining it.

That might lead to recognising a pattern you hadn't previously seen, understanding what is driving particular symptoms, experiencing feelings that have previously been blocked, or seeing more clearly the ways you have learned to protect yourself from difficult emotional experiences.

Sometimes that understanding and emotional experience can produce quite significant shifts. At other times, what we discover gives us a much clearer idea of what needs to happen next.

So How Long Does ISTDP Take?

There isn't a set number of sessions because the length of therapy is partly determined by what becomes apparent as we work.

An important part of ISTDP is understanding someone's capacity for emotional work.

For some people, we can work quite directly with feelings and the defences surrounding them from the outset. This can allow the therapy to progress relatively quickly.

For others, getting closer to difficult feelings may produce much higher levels of anxiety, overwhelm or disconnection. In those situations, trying to work with the same intensity wouldn't make therapy more effective. We may first need to build a greater capacity to recognise and regulate anxiety and experience feelings without becoming overwhelmed by them.

This is an important distinction within ISTDP.

The aim is not simply to go as fast as possible. It is to work as quickly as the person's emotional system can safely and productively manage.

What Makes ISTDP a Short-Term Therapy?

ISTDP is interested in what is preventing change from happening now.

If someone wants closeness but repeatedly withdraws when another person gets close, we want to understand that process. If they want to experience their feelings but automatically move away from them, we want to notice what happens at that point. If anxiety repeatedly interrupts emotional experience, we want to understand how that anxiety operates.

And importantly, we don't only wait for these patterns to be described.

When they appear within the therapy session, we can work with them there and then.

This means that therapy can move from talking about a difficulty to actually seeing and working with the processes involved in it.

That is an important part of what gives ISTDP its potential to be a relatively efficient therapy.

Working at the Right Level

The word "intensive" can sometimes give the impression that ISTDP is about pushing as hard as possible.

I don't think that's a helpful way of understanding it.

The intensity comes from the level of attention we give to what is happening in the session. We are trying to notice, moment by moment, what happens as we approach the difficulty you want to change.

Sometimes that allows us to work very directly. Sometimes what we discover tells us that we need to slow down and work differently.

Both are part of ISTDP.

The aim is always to find the level at which meaningful therapeutic work can happen rather than applying the same level of pressure to everyone.

How Quickly Could Things Change for Me?

We can't know that before we begin.

What we can do is start finding out from the first session.

The initial trial therapy gives us an opportunity to see how you respond when we begin working with the difficulty directly. It can help us understand your anxiety, the patterns that may be getting in the way and how much emotional work is currently possible.

For some people, the first session itself can be significant. For others, it gives us a much clearer map of the work ahead.

Either way, the intention within ISTDP is not to spend longer in therapy than is useful.

It is to understand what is preventing change, work with those barriers as directly as possible, and help change happen as efficiently as your own capacity allows.