Approach

ISTDP is an emotion focused, attachment-based therapy in which psychological problems are viewed as the result of painful experiences in relationships.

Throughout life we need stable and emotionally safe connections with other people for our emotional wellbeing. Painful experiences, e.g., with a parent or partner, can have a negative impact on our self-esteem and ability to express ourselves authentically in the future. Persistent invalidation from another person or a singular traumatic event can evoke strong, mixed feelings that are very anxiety provoking. Love, fear, pain, rage and guilt may then increasingly be repressed by physical anxiety symptoms and defence mechanisms.

Physical anxiety can manifest in the form of tension, nausea, blurred vision, disrupted thought processes and dissociation. Examples of defence mechanisms are emotional detachment, self-critical thoughts, compliance and rumination. These processes are initially adaptive because they help us feel safer in the relationships we depend on. For example, if a parent becomes anxious, judgemental or withdraws when their child is sad, angry or happy, the child will naturally learn to hide those emotions. The child’s attachment with that parent will be more secure if those emotions are hidden by anxiety and defences.

However, physical anxiety and defences operate automatically, often completely outside of conscious awareness. Therefore, even when they are not needed, they persist. As we strive for meaningful, emotionally intimate relationships and pursue fulfilling activities in the present day, the emotions we experience will cause anxiety and activate those old, protective defence mechanisms we relied on in the past. The past has a negative impact on the present.

Inadvertently stuck in an unconscious pattern of emotional suppression, physical anxiety and defences, people may develop symptoms in their bodies, minds and relationships, e.g., depression, anxiety, interpersonal conflicts, emotional detachment, addictions, and physical problems such as pain, chronic fatigue and irritable bowel syndrome. Physical health problems caused by disrupted attachments may not be resolved through approaches that do not address underlying, suppressed emotions. Therefore, invalidating experiences in the healthcare system may further compound the symptoms a person is reaching out for help with.

In ISTDP the therapist and client work together to observe and understand how painful experiences in the past have a negative impact on present day relationships, including with the therapist. As unconscious anxiety pathways and defence mechanisms become conscious people are increasingly able to notice and manage these responses more effectively. In turn this enables the client to be more in touch with their feelings and to heal suppressed emotions from the past. As symptoms decrease they can more freely pursue fulfilling relationships and interests guided by a more authentic connection to themselves.