What to Expect in Your First ISTDP Session

Starting the Work

An initial ISTDP session is often referred to as trial therapy because the work begins immediately. The session is not separate from the treatment and it is not simply about gathering information before deciding what to do later.

The aim is to understand the difficulty that has brought you to therapy and to begin understanding the emotional processes that may be maintaining it.

The session will usually begin with the problem that feels most important to you. That may be anxiety, depression, OCD symptoms, difficulties in relationships, self-criticism, emotional numbness or a sense of repeatedly finding yourself in the same patterns despite your efforts to change them.

The question within ISTDP is not only what the problem is but what prevents it from changing.

Feelings, Anxiety and Defence

A central task of an initial ISTDP session is understanding the relationship between feelings, anxiety and defence.

From an ISTDP perspective, feelings and impulses naturally arise within close relationships throughout life. When those feelings generate more anxiety than can comfortably 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 largely outside of awareness.

In ISTDP these processes are referred to as defences.

Part of the first session involves beginning to understand the feelings associated with the problem, how anxiety is experienced and the ways anxiety is being managed. From an ISTDP perspective, this sequence often provides a direct route into understanding how difficulties are maintained and where change becomes possible.

Working With What Happens in the Room

One of the central ideas within ISTDP is that the processes that maintain difficulties outside the therapy room will often appear within the therapy room as well.

A tendency to move away from feelings may appear in the session. Self-criticism may appear in the session. Intellectualising, humour, emotional distance, pleasing others or changing the subject may appear in the session. Anxiety itself may become visible as feelings come closer into awareness.

This allows the work to move beyond talking about patterns and towards observing and working with them directly as they happen. Rather than discussing difficulties from a distance, the session begins to focus on the emotional processes actively maintaining them.

Understanding Capacity for Emotional Work

Part of trial therapy also involves understanding how anxiety is experienced and how much emotional closeness and emotional experience can currently be tolerated. This helps determine the pace of the work and the types of interventions likely to be most helpful moving forwards.

Different people require different approaches and understanding this early is an important part of ISTDP.

What the Session Is Trying to Achieve

By the end of an initial ISTDP session it is often possible to have a clearer understanding of the difficulties bringing someone to therapy, the emotional conflicts associated with them, the anxiety generated by those conflicts and the defensive processes involved in maintaining them.

For some people important shifts occur during the session itself. For others the most important outcome is a clearer understanding of the internal processes that have been shaping their difficulties and a clearer sense of where the work needs to go next.

Either way, the work has already begun.

Get In Touch

If you are considering ISTDP and would like to explore whether this approach may be helpful for you, please feel free to get in touch.