Let’s face it, if you are like most people, you sometimes bury feelings and memories that are just too anxiety provoking, painful, or frightening. If your childhood was painful and chaotic, stuffing frightening and uncomfortable emotions was likely the only choice you had at the time. For many, continuing the strategy of avoidance into adulthood, however, typically comes at a steep price. Depression, anxiety, panic reactions, self-esteem issues, feeling lost and without a rudder, temper outbursts, social and emotional isolation, superficial and unfulfilling relationships are some of the common consequences of walling off from our true thoughts and feelings. The avoidance strategies that helped you get through the day in your childhood become the prison that cripples your wellbeing and your potential as an adult.

If getting better means facing the feelings that have been swept under the rug (at a tolerable pace), how do you do that? This is where a model of psychotherapy called Intensive Short-Term Dynamic Psychotherapy (ISTDP) comes in. Empirical studies are showing that this form of psychotherapy can be very effective in treating a host of mental health difficulties (Abbas, 2015). What makes ISTDP so uniquely suited to addressing and resolving emotional pain is the knowledge that the ISTDP therapist has in terms of understanding your individual and unique needs and capacities – knowing when to do what and with whom. The well trained ISTDP therapist will know when to be gentle, supportive, and soothing, and when it is safe and appropriate to use more challenging interventions.

The other thing that makes ISTDP uniquely suited to addressing and resolving emotional pain is the attention to the healthy parts of you that want freedom while at the same time attending to what has been called “resistance,” the part of you that might take the attitude of, “hell freezes over before I let myself experience these feelings and memories” (Marvin Skorman, personal communication, 2016). The two-fold attention of the ISTDP therapist – on the one hand repeatedly reminding you of your healthy longings for health and freedom and inviting you to experience your true feelings, and on the other hand, when resistance gets in the way of progress, highlighting the crippling and paralyzing effects of the resistance in real time, creates a powerful climate for change and healing. If the forces of resistance are strong in you, the ISTDP therapist will, at a specific juncture when you are ready and willing, use challenging interventions so as to model for you how to stand up to the forces of avoidance that have outlasted their usefulness.

If the “hell freezes over before I face my emotions” part of you is particularly strong, chances are you not only avoid your emotions, but also emotional contact and closeness with others. Resistance against emotional closeness can easily derail and sabotage psychotherapy. That is why the ISTDP therapist addresses in real time what you do to avoid your emotions and to keep others, including your therapist, at a distance, and doing so in real time is a key element of ISTDP. Highlighting what you are doing in real time and helping you actually experience the results and consequences of your walls is what tends to help you to find the inner strength and motivation to let go of the outdated defenses that have crippled your potential in life, and face the truth of your inner life (Davanloo, 1995).

In order to make these ideas more concrete, I want to look at a fictional example of how an ISTDP therapist might work with you in the context of a trusting professional relationship. For the sake of the example, let’s assume that you have a lot of resistance and avoidance patterns but you have given your therapist permission to use more challenging interventions to help you. In this example, you want to be more emotionally present while also better at setting clear and consistent boundaries with your children.

Therapist: So I have asked you about your feelings a couple of times now in the context of this problem you’re telling me about with your children, where you feel resistance to being affectionate and you notice that your children don’t confide in you. You have responded with your thoughts, and your body is almost totally immobile. Is this detached way you have about you how you are with your children as well? You say it’s hard for you to connect to them, to express affection.

Client: I suppose so.

Therapist: You’re not sure? This would be important to be sure about.

Client: Yeah I guess.

Therapist: Do you notice that as I try to get a clear picture of how your difficulties with your children operate, that you take a noncommittal position, you become vague and noncommittal. Could this be the barrier to having an emotional connection with your children, operating live here with me right now?

Client: That makes sense. I don’t know why, I just don’t like to agree with you.

Therapist: It sounds like you’re having some emotional reactions to the way I am trying to understand you. What feelings are coming up in here with me, or towards me, right now, as I try to understand the nature of your difficulties?

Client: I’m neutral.

Therapist: Neutral seems like code for detached. Do you notice that as I ask about feelings and invite you to form an emotionally intimate relationship with me, you take a detached position, in inviting me to form an emotionally dead and detached relationship with you?

Client: I do see what you mean… Well I am not sure actually. Isn’t this normal?

Therapist: Notice how you are on both sides of the fence, in one breath you say you see what I mean, and in the next you say you’re not sure and go to “normal.” So it’s not clear where you really stand on this issue, and in that regard I am now flying blind as your therapist.

Client: I guess so.

Therapist: You guess, which again is noncommittal. You can continue to take this noncommittal position, but do you realize that when you do, you really end our relationship, end what is possible here between you and me, because the ground between us keeps shifting. First you say you see what I mean, and then you take it back. This forms a wall of emotional distancing between us.

Client: I can’t argue with you on that. This is pretty much what I do.

Therapist: So we see that the way you have emotionally distant relationships with your children, which you have said is quite painful to you, and that way of being distant is being replicated here with me. So this wall is not just here with me, it’s this wall that distances you emotionally from your children, too. Do you see what I mean?

Client: That is true, but I just… I don’t know. I feel some kind of resistance.

Therapist: I am glad you notice that. I hope you don’t mind me being honest: if you maintain this wall here between us, this wall of detachment, this wall of being noncommittal, which seems like it comes from a need to keep me at arms’ length, then I am useless to you, and this becomes another emotionally dead relationship where you don’t get out of it what you need. Is that OK with you?

Client: No, it’s not (takes a sigh). I’m really anxious.

Therapist: It looks quite painful. Walling off like this only perpetuates your anxiety. Do you want to spend any more time feeling like this?

Client: No.

Therapist: Not another minute? Another second?

Client: No, I can’t stand this anxiety and anguish of feeling so cut off.

Therapist: So can we see what you are prepared to do about this wall, can we see what emotions are coming up here with me?

Eventually the client manages to lower his walls and face an outpouring of emotions. Grief about the pain of having created distance with her children, anger towards his own parents for having been more focused on their own needs rather than the client’s needs, and remorse in seeing how this anger which had been unconscious till now, had been displaced on his children, who because of being needy, had triggered the client and reminded the client of his needy parents. Sorting through these previously unconscious feelings and gaining insight into their origin, offers the client great relief, and in consequent sessions he reports much improved relations with his children.

Key points

This example illustrates how direct the ISTDP therapist is in identifying the barriers and defense mechanisms that get in the way of you experiencing your true feelings — defenses that if left unaddressed, would likely continue to wreck havoc and exact steep costs in terms of impaired relationships. The therapist here uses the real time relationship with you and addresses your the real time behaviors to help shed light on the core of your conflict and difficulties. The ISTDP therapist in this example highlights the cost to you that comes with maintaining the defensive postures, first and foremost by pointing out that when you keep the therapist at an emotional distance, you are really ending what is possible in the relationship with the therapist and defeating your own goals.

The ISTDP therapist’s way of working in this example might seem harsh or overly “in your face,” and for some people seeking out psychotherapy, this would absolutely be the wrong approach. For other clients, at very specific moments, this very direct and no-nonsense approach can be the exact thing that the client needs in order to break through old pain-inducing patterns. The skilled ISTDP therapist knows how to determine when and with whom to use a more gentle and supportive approach, and when to “turn on the heat” and invite you to stand up to and challenge your own resistance.

Blocked from your emotions and hindered in your spontaneity and ability to emotionally connect with others, the self becomes a crippled and paralyzed version of what it could be. It can be painful to face these realities, but in facing the reality of how you might have become a crippled version of your true self, you might find the motivation to do the hard work often required in overcoming and resolving emotional difficulties. A good ISTDP therapist might prove invaluable in helping you on your journey towards healing and freedom.

Acknowledgment

ISTDP was founded and developed by Habib Davanloo, M.D., emeritus professor of psychiatry out of McGill University in Canada. ISTDP is the result of Dr. Davanloo’s life’s work.

References

Abbas, A. (2015). Reaching through resistance: Advanced psychotherapy techniques. Retrieved from USA

Davanloo, H. (1995). Unlocking the unconscious. West Sussex: John Wiley and Sons.

Fredrickson, J. (2013). Co-creating change: Effective dynamic therapy techniques. Kansas City: Seven Leaves Press.

Author: Johannes Kieding

I have a passion for practicing ISTDP informed psychotherapy and I enjoy writing about it. For more information and what I do, visit my website: www.johanneskieding.com