How Much Change Can Happen in One Therapy Session?

The Relationship Between Time and Change

One of the ideas that has always set ISTDP apart is the observation that significant change can sometimes occur within a single therapy session. That observation sits at the heart of the model and follows directly from how it understands psychological symptoms and psychological change.

If therapy is working directly with the unconscious processes organising and maintaining a person's difficulties, then there is no obvious reason why change should necessarily be slow. The amount of time spent in therapy and the amount of change that occurs are not always closely related.

How ISTDP Understands Symptoms

From an ISTDP perspective, symptoms such as anxiety, depression, compulsions, physical symptoms, self-criticism and difficulties in relationships are often understood as consequences of unconscious emotional conflict.

Feelings and impulses arise naturally within close relationships throughout life. When these feelings generate anxiety beyond what can be tolerated, the mind develops ways of managing that anxiety and limiting contact with the underlying emotional experience. Over time these processes become automatic and operate outside of awareness. In ISTDP these processes are referred to as defences.

Symptoms are often less important than the emotional conflicts, anxiety and defensive processes that sit underneath them. As long as that internal organisation remains intact, symptoms may continue to emerge in one form or another regardless of how well they are understood intellectually.

Restructuring the Internal World

The aim of ISTDP is not simply to reduce symptoms or develop better ways of coping with them. The aim is to help bring unconscious emotional conflicts into awareness and work through them directly.

The theory underpinning the model is that when previously unconscious feelings and impulses are experienced consciously, the internal organisation built around avoiding them begins to change. As that internal world changes, the defensive system organised around keeping those feelings out of awareness becomes less necessary and symptoms can begin to reduce as a consequence of that shift.

This idea of restructuring the unconscious sits at the centre of the model and is one of the reasons ISTDP can sometimes produce changes that appear disproportionate to the amount of time spent in therapy.

What Can Change in a Session?

When change occurs at this level it is not unusual for the effects to be felt quickly.

Anxiety that has been present for years can reduce significantly. Longstanding symptoms can lose some of their intensity or disappear altogether. Emotional experiences that have remained inaccessible can become available for the first time.

Relationship patterns that have repeated for decades can suddenly become understandable in a way that allows something genuinely different to happen.

The point is not that every difficulty can be resolved in a single session. The point is that significant change can occur within a session if therapy reaches the level at which the problem itself is organised and maintained.

Why This Matters

One of the contributions ISTDP made to psychotherapy was to challenge the assumption that depth and speed are necessarily opposed to one another.

The possibility of significant change occurring within a single session is not an accidental feature of the model. It follows directly from the theory on which it was built and from the level at which it attempts to work.

For many people this remains one of the most compelling aspects of ISTDP and one of the reasons it continues to be regarded as a powerful and effective form of psychotherapy.

Get In Touch

If you are interested in this way of working, or would like to explore whether it might be helpful for your own difficulties, please feel free to get in touch.