Moment-to-Moment Analysis: How ISTDP Uncovers the Hidden Meaning Behind What We Say.

A client sits down in their first session, leans forward slightly, and says,

“I would like you to help me with my anxiety.”

It sounds clear enough. After all, isn’t that exactly what therapy is for?

But in Intensive Short-Term Dynamic Psychotherapy (ISTDP), we don’t rush to respond. We slow down. We listen. We notice.

Because in that one simple sentence, there can be a whole world of emotional experience — much of it outside of the client’s awareness. Through moment-to-moment analysis, we uncover what’s really happening beneath the surface. And often, it’s not what either of us expected.

What Is Moment-to-Moment Analysis?

In ISTDP, moment-to-moment analysis means tracking feelings, anxieties, and defences as they unfold in real time.

Rather than working with ideas about emotions, we work directly with what’s happening right now — in the body, in the voice, in the mind.

This close attention is crucial. Without it, therapy can stay at the surface: talking about problems without ever truly accessing the emotions that drive them.

By slowing down and tuning into the moment, we create a path for deep, lasting change.

Breaking Down the Sentence: “I Want Help with My Anxiety”

Even a simple statement like “I want help with my anxiety” can have many different layers. Here’s how moment-to-moment analysis might unfold:

1. Heightened Anxiety Without Awareness

The client might already be flooded with anxiety — shallow breathing, muscle tension, dry mouth — without realising it.

In this case, part of the work is helping them slow down and notice their own bodily signals.

We might say, “As you say that, I notice you’re speaking very quickly. Can we pause and see what’s happening in your body right now?”

By bringing awareness to the immediate experience of anxiety, we open the door to understanding it — and eventually regulating it, without doing so this person may not know the sgn of anxiety in their body and then wonder why even after talking it through, or being given some techniques to regulate it, they still struggle with anxiety.

2. Vague Generalisation as a Defence

Sometimes, clients speak in broad, general terms as a way of avoiding specific feelings.

“My anxiety” could be a defence against naming something more vulnerable: fear of failing at work, anger towards a partner, grief over a loss.

In ISTDP, we gently invite specificity:

“When you mention your anxiety, that statement can be quite vague, and we might lose what that means to you, can you be more specific on what you are referring to?"

By being precise, this can bring up a whole host of things. Maybe the person thinks they're talking about anxiety, but what they're referring to is rumination or obsessional thoughts. Or when you ask them to be more specific, they get more anxious because paying careful attention to them triggers something traumatic, like times when they were uncared for.

If you’d like to explore how emotional defences shape your thoughts and feelings, download my free guide.

3. Passive Position: Help Me, Don’t Involve Me

Sometimes, the phrasing itself reflects a passive stance toward change:

“I want you to help me” can imply that the therapist should somehow fix or remove the anxiety, with the client remaining relatively passive.

This is important to notice because real emotional change requires the client’s active participation.

Through moment-to-moment work, we might gently bring attention to this dynamic:

“I notice you’re asking for help, and I wonder — as you sit here, what’s it like to stay with your own experience, even briefly?”

The goal is not to criticise, but to help the client shift from passive wishing to active engagement with their inner world.

4. Lack of Self-Observation: “Something’s Happening, But I Don’t Know What”

Another possibility is that the client genuinely doesn’t know what’s happening inside them.

They feel overwhelmed by sensations labelled as “anxiety” but have no clear access to the specific feelings, memories, or conflicts underneath.

This lack of self-observation is very common — and it’s exactly what ISTDP helps to build.

In the moment, we might slow things down further:

“Right now, as you mention anxiety, what do you notice in your body? Is there tension, pressure, movement?”

Helping the client learn to track their internal experience is foundational for gaining mastery over their emotional life.

5. Anxiety About the Therapy Relationship Itself

Finally, the statement might mask deeper anxieties about the therapy relationship:

• Will I be judged?

• Will I be overwhelmed?

• Can I trust this person with my inner world?

Small shifts — a sudden hesitation, averted eye contact, a tightening of the voice — can signal these unspoken fears.

In ISTDP, we pay close attention to these signals and work with them directly, often bringing them gently into words:

“I notice as you talk about wanting help, there’s a slight catch in your voice. Is something coming up for you right now?”

By doing so, we help the client feel seen at a deeper level — sometimes for the first time.

Why It Matters: Unlocking the Path to Real Change

Without moment-to-moment attention, therapy can stay trapped at the surface, circling around symptoms without ever reaching the emotional roots underneath.

By slowing down and attending to the immediacy of feelings, anxiety, and defences, ISTDP helps clients build real emotional insight — not just intellectual understanding.

This, in turn, allows them to experience emotions more fully, regulate anxiety more effectively, and begin to let go of longstanding patterns that have kept them stuck.

Real healing doesn’t happen in broad conversations about “anxiety” or “stress.”

It happens in the tiny, often-overlooked moments:

• A flicker of emotion across the face

• A tightening in the throat

• A quickening of speech or breath

Moment by moment, we follow these clues — not to analyse the client, but to help them find their way back to themselves.

A Way to 'Fully Listen' to What is Being Said.

So when a client says, “I want help with my anxiety,” it’s not just a request — it’s an opening.

An opportunity to slow down, look closer, and discover the emotional reality beneath the words.

And it’s in this kind of deep, moment-to-moment work that real, lasting change becomes possible. Want to understand emotional defences on a deeper level? Download the free guide and take the first step toward meaningful change