A psychodynamic therapy that often enables patients to rapidly identify and resolve core emotional conflicts in months, rather than years. It aims at both symptom relief and lasting personality change.
Intensive Short Term Dynamic Psychotherapy is an accelerated form of psychodynamic psychotherapy designed to provide rapid access to the unconscious. It was created by Dr Habib Davanloo, a Montreal-based psychiatrist, and Dr David Malan, a UK-based psychoanalytic psychotherapist. Both were dissatisfied with the duration of, and unpredictable outcome with, psychoanalysis. With the help of video-recorded sessions of therapy, Dr Davanloo spent years refining ISTDP. He focused on getting to the core of the problem more quickly, rapidly breaking through the patient’s resistance, and reaching the underlying unconscious emotional conflict in a way that, once activated, enabled the understanding, working through, and resolution of early attachment trauma. Drs Davanloo and Malan found that this working through and resolution freed patients from their current suffering, and that the positive changes are stable over time.
The model treats faulty cognitions as defence mechanisms against unconscious feelings, not as primary targets. Gentle but persistent and focused pressure is exerted on the patient to acknowledge and turn against the defences that block the experience of the true feelings and create suffering in the present. It is not considered sufficient to have insight into our true feelings; the direct experience of the feelings triggered in present relationships, including in the relationship with the therapist, during the therapy session, is essential. This process activates painful feelings towards early attachment figures, so they can be faced and understood. In the process they lose their power to trigger anxiety and the need for harmful defence mechanisms to avoid them.
ISTDP has demonstrated effectiveness for most DSM-5 diagnoses including anxiety disorders, depression, personality disorders, somatisation, and Functional Neurological Disorder. ISTDP facilitates both symptom relief and personality restructuring. The approach is consistent with research on memory reconsolidation, the process by which emotional memories can be updated when they are reactivated (Lane, Ryan, Nadel & Greenberg, Behavioral and Brain Sciences, 2015), and can break through lifelong defences within a single session.
The aim of every session should be to put the patient in touch with as much of their true feelings as they can bear, and the long-term outcome should demonstrate deep and permanent change. David Malan
The Triangle of Conflict and the Triangle of Person illustrate the core psychodynamic principle: feelings and impulses that created problems in early attachment relationships, trigger anxiety and are avoided by the use of defences. Emotional suffering is the result of symptoms of anxiety and/or defences. The therapist's job is to help the patient see this sequence as it happens, and to turn against the defences so the true feelings can break through and be experienced.
ISTDP is a collaborative and compassionate therapy. The therapist appeals to the patient’s innate drive towards health, so the patient can relinquish defences and directly experience avoided emotions.
ISTDP Australia was co-founded in 2010 by Julie Cochrane and psychologist Peter Watt. Julie had introduced ISTDP to Australia eleven years earlier, in 1999, organising the country's first ISTDP training with Dr Patricia Coughlin.
The organisation exists to train beginners through to advanced levels of training in Australia and New Zealand, and further afield: Pre-Core, Core and Advanced programs, supervision, and an ongoing calendar of immersions led by Australian ISTDP Therapists and international faculty. Trainings are certified by the International Experiential Dynamic Therapy Association (IEDTA) and recognised by The ISTDP Institute.
Julie Cochrane is a clinical psychologist who has been practising short-term dynamic psychotherapy for over 30 years. She introduced ISTDP to Australia in 1999 with the country's first three-day ISTDP training with Patricia Coughlin.
Julie first discovered and began training in Dr David Malan's short-term dynamic psychotherapy, which facilitated her learning of the work of Dr Habib Davanloo. From the early days of her training she noticed a significant change in the style and efficacy of her therapeutic work. In 1998 she began supervision with Dr Patricia Coughlin, the U.S.-based author of Intensive Short-Term Dynamic Psychotherapy, Lives Transformed, and Maximising Effectiveness in Dynamic Psychotherapy.
Over the years, Julie gained extensive experience as an ISTDP Therapist, before undertaking Core Training with Patricia Coughlin, Advanced Training (five years) with Jon Frederickson, and Teacher and Supervisor Training (3.5 year Training of Trainers course) with Jon Frederickson. She has also undertaken training with a number of senior teachers in ISTDP including Dr Davanloo, Josette ten Have-de Labije, Allan Abbass and Kees Cornelissen.
Julie's trainings are certified by the International Experiential Dynamic Therapy Association (IEDTA) and recognised by The ISTDP Institute. She runs short courses, Core Trainings and Advanced Trainings in ISTDP, offers individual and group supervision, and has a private practice in Melbourne. Dynamic Psychotherapy, the Melbourne practice, has 28 therapists, most of whom are fully trained in ISTDP or are in ISTDP training.
She teaches and supervises mental health professionals in ISTDP locally and internationally, including New Zealand, Finland, India, Iran, Israel, Lebanon, Malaysia, Portugal and Turkey.
Julie Cochrane is that rare therapist who combines presence, empathic attunement and active engagement with highly refined skills designed to assess and treat a wide variety of patients effectively and efficiently. In addition to her superb clinical skills, she is a talented teacher and supervisor. With her extensive training in Intensive Short-Term Dynamic Psychotherapy, an empirically validated treatment for a wide variety of emotional and psychological disorders, she is at the forefront of the field. Whether you are a patient seeking treatment or a therapist searching for top-notch training, you will be well served to contact Julie Cochrane. Patricia Coughlin, PhD · Clinical Psychologist
Author of Intensive Short-Term Dynamic Psychotherapy, Maximising Effectiveness in Dynamic Psychotherapy, and (with David Malan) Lives Transformed.
ISTDP has things in common with CBT, which is also active and time-limited; with EFT and AEDP, which are also emotion-focused and attachment-aware; and with classical psychodynamic therapy, which also works with the unconscious. It differs in the directness of the work, in building a strong unconscious therapeutic alliance as well as a conscious one, in using the Triangle of Conflict to understand the internal conflict, and in rapidly identifying and dismantling resistance to facing the emotions beneath it. Therapist and patient watch the patient's defensive processes unfold in the room and intervene as they appear.
Two criticisms come up most often. Here is how ISTDP practitioners answer them:
In practice, ISTDP centres on a collaborative therapeutic alliance. Davanloo strongly emphasised the conscious and unconscious therapeutic alliance as vital factors in successful therapy. ISTDP should never be authoritarian and patient autonomy is essential in working collaboratively. The work helps the patient see how anxiety and defences result in emotional suffering and restrict their authenticity, and the patient, together with the therapist, decides what is causing them suffering and what they want to address in therapy. The patient is helped to make decisions aligned with their own desires and values. Therapists actively monitor for compliance. The goal is the patient taking responsibility for their emotional experience, not deferring to the therapist.
Anger is one of several feelings that may emerge in treatment, but it should never be deliberately triggered or provoked. We distinguish between iatrogenic anger and unconscious anger. Iatrogenic anger is inadvertently triggered by an intervention made by the therapist, usually where there is a lack of attunement between therapist and patient. It should be recognised and addressed quickly, so the patient is not left with a negative experience.
Unconscious anger is different: it is already part of the patient’s unconscious conflict. It can be mobilised in a session because it is an anxiety-provoking feeling, one that was problematic in a recent interaction and, before that, with attachment figures. Anger becomes fused with anxiety when attachment figures habitually ignore, dismiss, punish or otherwise react badly to a child’s healthy, developmentally-appropriate anger. The adult then becomes very anxious whenever their own normal anger is mobilised in a relationship.
We also see that unconscious impulses that are mobilised with unconscious anger trigger anxiety, including because the patient very rarely wants to hurt someone in reality.
Lastly, therapy results in the patient becoming more conscious of their choices: to either face what gets them anxious, or to continue to avoid and suffer. Patients often feel anger towards their therapist because they would rather avoid the reality that they have a choice to make. It is their choice, not the therapist’s. Only the patient can decide what feelings to look at and what feelings to continue to avoid. An unconscious wish for an omnipotent therapist to make “the right choice” for them can evoke anger when the therapist takes the position that only the patient can decide on their own behalf. There can also be anger mobilised towards the therapist that the patient can no longer “unsee” what has been seen.
An important point here is that anger should be experienced in conjunction with positive feelings, including a deep appreciation for the therapist that the patient is being seen and helped at the core of their suffering.
So, anger often arises for a number of reasons in ISTDP, but it should always be anger in the context of mixed feelings, including positive feelings, and should never be provoked or induced by the therapist.
I highly recommend Julie Cochrane as a therapist, supervisor, and teacher. She brings great compassion and understanding to her work. And this is reflected in the large and growing ISTDP community she has built and fostered in Australia. Jon Frederickson, MSW · Co-chair of the ISTDP Training Program, Washington School of Psychiatry
Our Pre-Core, Core, and Advanced programs run across Melbourne, Sydney, Brisbane and online.
