Research on ISTDP

Most of the foundational research has come out of the Centre for Emotions and Health at Dalhousie University in Canada, led by Prof. Allan Abbass. The story across studies is broadly the same: real symptom change in patients who haven't responded to other approaches, and reduced healthcare use afterwards. There is now extensive additional research supporting the efficacy of ISTDP, particularly from British and Scandinavian researchers.

A few numbers

Effect sizes are between-groups against inactive control conditions at post-treatment.

Cost-effectiveness

A series of studies from the Halifax service have shown that adjunctive ISTDP can reduce subsequent healthcare costs. Findings include:

• A pilot for psychogenic non-epileptic seizures showed reduced healthcare costs from pre-treatment through three years post-treatment.²
• A tertiary-service study reported sustained long-term cost reductions across a mixed patient population.³
• Adjunctive ISTDP for psychotic disorders produced sustained reductions in healthcare service usage.⁴
• Adjunctive ISTDP in bipolar disorder showed sustained reduced service usage over follow-up.⁵

Key research themes

• Treatment-resistant depression. Remission rates in patients who'd failed multiple prior treatments.
• Somatic and medically unexplained symptoms. Reductions in symptom burden and healthcare use.
• Anxiety disorders. Particularly mixed and complex presentations that don't fit neatly into manualised CBT.
• Personality disorders. Evidence of meaningful change.⁶
• Process research. Moment-by-moment study of unconscious anxiety and defence using video review.

Process-outcome research in ISTDP is unusual in psychotherapy: because sessions are video-recorded and coded, you can study exactly what the therapist did and what shifted in the patient. At the level of seconds, not sessions.

References

1. Abbass, A. A., et al. Short-term psychodynamic psychotherapies meta-analysis (28 studies, n = 1,782 adult patients; between-groups Cohen's d 0.39–0.71 against inactive controls at post-treatment). See PubMed-indexed Abbass meta-analyses for the full citation.
2. Reduction in healthcare costs following ISTDP for psychogenic non-epileptic seizures — PubMed 27541836.
3. Long-term healthcare cost reduction with ISTDP in a tertiary psychiatric service — J Psychosom Res, 2015 (PubMed 25840829).
4. Sustained reduction in healthcare costs after adjunctive graded ISTDP in psychotic disorders — PubMed 26106054.
5. Sustained reduction in healthcare service usage after adjunctive ISTDP in bipolar disorder — PubMed 30840559.
6. ISTDP for DSM-IV personality disorders: a randomised controlled trial — PubMed 18340256.

Recommended reading

There are several well-written books about this therapy; below are our recommendations.

• Intensive Short Term Dynamic Psychotherapy — Patricia Coughlin Della Selva. ISBN 978-1032881881
• Co-Creating Change: Effective Dynamic Therapy Techniques — Jon Frederickson. ISBN 978-0988378841
• Co-Creating Safety: Healing the Fragile Patient — Jon Frederickson. ISBN 978-0988378803
• The Lies We Tell Ourselves: How to Face the Truth, Accept Yourself, and Create a Better Life — Jon Frederickson. ISBN 978-0988378889
• Healing Through Relating — Jon Frederickson. ISBN 978-0988378827
• Maximizing Effectiveness in Dynamic Psychotherapy — Patricia Coughlin. ISBN 978-1138824973
• Facilitating the Process of Working Through in Psychotherapy: Mastering the Middle Game — Patricia Coughlin. ISBN 978-1032054681
• Individual Psychotherapy and the Science of Psychodynamics — David Malan. ISBN 978-0750623872
• Lives Transformed — Patricia Coughlin Della Selva and David Malan. ISBN 978-1855755116
• Intensive Short-Term Dynamic Psychotherapy — Habib Davanloo. ISBN 978-0471497042
• Unlocking the Unconscious — Habib Davanloo. ISBN 978-0471956112
• Intensive psychodynamische Kurzzeittherapie nach Davanloo — Dr Gerda Gottwik and Ingrid Orbes (Eds). ISBN 978-3662590355
• The Collected Writings of Robert J. Neborsky, MD, and Josette ten Have-de Labije, PsyD — Robert J. Neborsky and Josette ten Have-de Labije. ISBN 978-1-934690-26-0
• Reaching Through Resistance: Advanced Psychotherapy Techniques — Allan Abbass. ISBN 978-0988378865
• The Healing Power of Emotion: Affective Neuroscience, Development & Clinical Practice — Diana Fosha, Daniel Siegel and Marion Solomon. ISBN 978-0393705485
• Psychodynamic Psychotherapy: Learning to Listen from Multiple Perspectives — Jon Frederickson. ISBN 978-0876309629

Organisations & further resources

ISTDP Institute

A website featuring free and paid skill-building exercises, articles, and other resources for learning ISTDP. It is run by Jon Frederickson, MSW, co-chair of the ISTDP Training Program at the Washington School of Psychiatry, where he has been on the faculty since 1988.

Patricia Coughlin

Patricia Coughlin (Della Selva), PhD, is a licensed Clinical Psychologist with over 40 years of clinical experience and Clinical Faculty at the University of New Mexico School of Medicine. She writes, presents and conducts training groups internationally, including in New York, Australia, Denmark and Poland.

ISTDP Norrköping

Johannes Ermagan is a Swedish clinical psychologist who often collaborates with Julie Cochrane, including in providing trainings for ISTDP Australia & New Zealand.

International Experiential Dynamic Therapy Association (IEDTA)

The IEDTA and its psychotherapist members are dedicated to the practice, research and dissemination of Experiential Dynamic Therapies (EDTs) — psychodynamic approaches that emphasise healthy emotional experience in fostering deep, lasting and rapid therapeutic change. The site carries information for therapists and interested laypeople.

ISTDP-UK

An organisation dedicated to the promotion and development of ISTDP. It provides training for mental health professionals in this method and information about accredited ISTDP therapists practising in the UK.