What to Expect in Your First ISTDP Session

If you are considering ISTDP, you might be wondering what actually happens when you first sit down with an ISTDP therapist.

An initial session is often referred to as trial therapy. This is because the therapy begins from the first session. Although I will want to understand some of your background, the session isn't primarily an assessment or a process of gathering information before beginning the work at a later point.

Instead, we will begin with what has brought you to therapy and start exploring it together.

We’ll Start With What You Want Help With

At the beginning of the session, I will usually ask what you would like help with.

You might have a very clear answer to this, or you might find it difficult to put into words. Either is completely fine.

It could be anxiety, depression, difficulties in relationships, OCD symptoms, self-criticism, emotional numbness, or a pattern in your life that you keep finding yourself caught in.

From there, I will be interested in understanding the problem more closely. We might look at particular situations where it happens, what seems to trigger it, what you experience emotionally and what tends to happen next.

The aim is to begin getting a clearer picture of the difficulty rather than trying to cover your entire life in one session.

I’ll Pay Attention to What Is Happening in the Session

ISTDP tends to be a fairly active form of therapy.

As well as listening to what you tell me, I will also be paying attention to what seems to happen as we talk.

For example, you might begin talking about something important and then move away from it. You might become anxious, start criticising yourself, struggle to know what you feel or find yourself explaining something rather than experiencing it.

If I notice something that seems important, I may bring your attention to it and ask whether we can look at it together.

This means the session can sometimes feel different from therapy where you are given more space to talk without much interruption. There is likely to be more back and forth between us, with both of us actively trying to understand what is happening.

We’ll Pay Attention to Your Anxiety

I will also be interested in how you experience anxiety, particularly when we are talking about something emotionally important.

I might ask what you notice happening in your body, whether your thinking has changed, or whether you still feel present and able to engage with what we are discussing.

This helps me understand how we need to work and at what pace.

The aim isn't to push you through something regardless of how you are responding. If anxiety becomes too high, that is important information and something we need to pay attention to together.

We May Look at What Happens Between Us

Sometimes the difficulties that bring someone to therapy begin to show themselves in the therapy relationship too.

You might worry about what I think of you, find yourself wanting to give the "right" answer, become distant, or notice that it is difficult to let me know what you are really feeling.

If something like this happens, we may explore it together.

This can be particularly useful because rather than only talking about a pattern that happens elsewhere, we have an opportunity to understand it while it is happening between us.

What Should You Expect to Get From the Session?

There isn't a particular outcome you are expected to reach.

Sometimes an initial session can lead to an important realisation or emotional experience. At other times, what comes from it is simply a clearer understanding of the problem and some of the patterns surrounding it.

The session also gives you an opportunity to experience ISTDP rather than having to decide whether it is right for you based on a description of the approach.

By the end, we should hopefully have a better sense of what you are struggling with, what we might need to work on and whether this way of working feels appropriate for you.

The important thing is that we don't have to wait several sessions before beginning. The first session is an opportunity to start the work and see what we can understand together.

Getting in Touch

If you are considering ISTDP and would like to arrange an initial session, you are welcome to get in touch.