Intensive Short Term Dynamic Psychotherapy (ISTDP): A Psychodynamic Model of "Emotion Exposure” Therapy

Contemporary cognitive behavioral therapies (CBTs), such as Barlow’s Unified Protocol as well as third-wave therapies such as acceptance and commitment therapy (ACT) have converged on the avoidance of emotion as a central source of pathological symptoms that maintains suffering across a variety of diagnoses. Exposure to and acceptance of emotional experience has therefore become central to these therapies. Likewise, psychodynamic theory has long held that warded off affects maintain unconscious conflicts that lead to symptoms and suffering. Psychodynamic therapy has been conceived of as a type of exposure therapy for such affects but has not always demonstrated a systematic approach to fostering such exposures. Intensive Short-Term Dynamic Psychotherapy (ISTDP) is an evidence-based experiential dynamic therapy that offers a systematic approach to fostering exposures to avoided emotions including in patients with chronic and refractory psychopathology, who tend to be especially avoidant of their emotional experience. In this presentation, the theory and evidence for ISTDP will be reviewed. The techniques of ISTDP will be demonstrated through use of video from a recorded treatment of a real patient. The intensive techniques of ISTDP can add to the arsenal of exposure-based approaches and may be especially valuable with complex and chronic patients who are highly emotionally avoidant.