What makes ISTDP an effective approach?

A Different Way of Understanding Symptoms

One of the reasons ISTDP can feel different from other forms of therapy is that it begins with a different understanding of psychological symptoms.

Many therapies focus on reducing symptoms and helping people manage them more effectively. ISTDP is interested in that too, but it is also interested in understanding the psychological processes creating and maintaining those symptoms.

From an ISTDP perspective, symptoms are often understood as the result of emotional conflict.

Feelings and impulses arise naturally within close relationships throughout life. Sometimes these feelings can be experienced and integrated without difficulty.

Sometimes they generate anxiety. When this happens, the mind develops ways of managing that anxiety and reducing contact with the underlying emotional experience. Over time these processes become automatic and operate largely outside of awareness. In ISTDP these processes are referred to as defences.

Anxiety and Defence

Defences are not viewed as pathology or weakness. They are understood as adaptations that developed to manage emotional experiences that at some point felt dangerous, overwhelming or unacceptable.

The difficulty is that these adaptations can continue long after the circumstances that gave rise to them have changed.

Someone who learned that anger threatened important relationships may struggle to set boundaries or express disagreement. Someone who learned to suppress sadness may become emotionally shut down or depressed. Someone who experienced closeness as unsafe may continue to withdraw from relationships despite wanting connection.

From this perspective, symptoms are often understood as the consequence of anxiety and defensive processes rather than the underlying problem itself.

Why Insight Is Sometimes Not Enough

This understanding also helps explain why insight alone can sometimes feel insufficient.

Many people already know they avoid conflict, become self-critical, overthink or withdraw from relationships.

The question is often not what they are doing but why their mind continues to rely on those responses despite the costs they create.

Knowing that a pattern exists and understanding the emotional conflicts that maintain it are not necessarily the same thing.

The Theory Behind ISTDP

ISTDP was developed through decades of observing therapy sessions and studying the processes associated with psychological change.

The model focuses on the relationship between feelings and impulses, the anxiety generated by those feelings, and the defences mobilised against them.

From an ISTDP perspective, psychological suffering is often maintained because the mind remains organised around avoiding emotional experiences that continue to be treated as dangerous.

As long as this internal organisation remains in place, symptoms can continue to emerge in different forms despite insight, coping strategies or attempts to manage them.

This is one of the reasons ISTDP places such an emphasis on identifying anxiety, understanding defences and helping patients access emotional experiences that have remained outside of awareness.

Structural Change Rather Than Symptom Management

The aim of ISTDP is not emotional expression for its own sake and it is not simply to help people manage symptoms more effectively.

The theory underpinning ISTDP is that when previously unconscious emotional conflicts are accessed and worked through, the internal structures organised around avoiding those experiences begin to change.

As this internal organisation changes, the defensive processes that were once necessary become less necessary. Symptoms often reduce as a consequence of this change rather than because they have been directly targeted.

This focus on structural change sits at the centre of the model and is one of the reasons ISTDP is considered by many to be an effective form of psychotherapy.

Working With These Processes in Real Time

A further feature of ISTDP is that these processes are not only discussed retrospectively.

The therapist pays close attention to how anxiety and defences emerge during the session and works with them as they happen.

Patterns such as intellectualising, self-criticism, emotional distance, avoidance or pleasing others often appear within the therapeutic relationship in much the same way that they appear elsewhere in a person's life.

Working with these processes as they occur allows therapy to move beyond discussing difficulties and towards working directly with the processes maintaining them.

Get In Touch

If this way of understanding psychological difficulties resonates with you and you would like to explore whether this approach might be helpful for your own difficulties, please feel free to get in touch.