The approach
What is ISTDP?
A plain-language explanation of Intensive Short-Term Dynamic Psychotherapy: what it is, how it works, what a session looks like, and why it produces lasting change.
The basics
ISTDP is emotion-focused therapy that goes to the root
Intensive Short-Term Dynamic Psychotherapy, ISTDP, is an evidence-based, emotion-focused psychodynamic therapy. It was developed by psychiatrist Habib Davanloo in Montreal between the 1960s and 1990s through something methodical and unusual: meticulous video analysis of his own patient sessions. He watched, repeatedly, what actually produced change and what did not.
Davanloo was a trained analyst who had grown genuinely frustrated with traditional psychoanalysis: the years-long, open-ended, and at times directionless nature of Freudian therapy, where breakthroughs happened unpredictably and therapists had little clarity about what was actually producing them. He took what genuinely worked in psychoanalysis, things like defense mechanisms, the unconscious, and emotional breakthrough, and built a framework that was direct, purposeful, and teachable. A therapy where the therapist knew what they were doing and why.
That work has since been developed further by Jon Fredrickson at the ISTDP Institute into its current, most teachable and evidence-based form. The approach is now supported by more than 120 published outcome studies. Nobel Prize-winning neuroscientist Eric Kandel has referenced the effectiveness of Davanloo's technique. The evidence base is substantial, and it continues to grow.
What the name actually means
Intensive, short-term, dynamic
The three words in the name each describe something precise about how the therapy works.
Intensive means that the therapist actively works to maximise the patient's experience of previously avoided emotion. This is not a passive, reflective process. The therapist notices what is happening and responds to it in real time.
Short-term means that change is pursued as efficiently as possible. Not across years of open-ended exploration, but with a clear direction and a genuine intention to get there.
Dynamic means working with unconscious forces: defenses, transference, the emotional material that operates below the level of conscious awareness and shapes how we feel and relate.
Together, these three things describe a therapy that is active, direct, and purposeful. This is the opposite of the passive, reflective listener model most people imagine when they think of a psychologist.
The underlying model
What ISTDP is actually working with
At the heart of ISTDP is what Davanloo called the triangle of conflict. Repressed, impulse-laden feelings generate anxiety. That anxiety is managed by defense mechanisms, which push the emotion back out of conscious awareness. This produces symptoms. ISTDP works at that level, directly, rather than at the level of thoughts or behaviours above it.
The model understands that as children, we are born with a full, innate emotional world: the capacity to know what we feel, what we need, and to seek that out. Babies cry when they need something. They reach for comfort. They express anger, joy, fear, and love without filter.
Over time, that expressiveness gets shaped by the responses of the people around us. When our emotions make our caregivers anxious, uncomfortable, or unavailable, we learn, unconsciously, to shut those emotions down in order to protect our relationships with the people we depend on. It is an adaptive response. It works, as a child.
But the shutdown does not disappear. What happens instead is that when those feelings rise up in the body in adulthood, they trigger anxiety. And to manage that anxiety, we reach for defense mechanisms: patterns of thinking, behaving, and relating that keep us away from the feelings underneath. These defenses regulate the anxiety. They also, over time, cause suffering.
ISTDP works with all three layers simultaneously: the feelings, the anxiety, and the defenses. The goal is not simply to manage symptoms better, but to help you reconnect authentically with your own emotional world, your feelings, your needs, your desires, and your capacity to act from them.
Timeframe
How long does ISTDP take?
The honest answer is that it varies enormously. Some people experience significant, life-changing shifts within two sessions. Others make profound progress within ten. The research suggests that around twenty sessions is typically the point at which most people recognise meaningful change from where they started.
For others, particularly those with more complex or longstanding presentations, the work takes longer. Some people are in therapy for a year or two. Others do longer-term work over many years, or return periodically for maintenance therapy: continuing to develop their understanding of themselves over time.
What ISTDP does not do is keep you in therapy indefinitely without clear purpose. The direction of travel is always toward greater autonomy.
Some people experience significant change in only a few sessions. Others are making great progress within ten, and others still will spend several years in therapy. The work finds its own length.Taylor Sweetnam, Clinical Psychologist
What to expect
Is ISTDP gentle or confronting?
Both, and that is not a contradiction.
ISTDP is direct. The therapist is not neutral. They are active, relational, and present in the room in real time.
Traditional ISTDP had a reputation for being quite intense. Davanloo himself spoke of detesting defenses while loving the person. Modern ISTDP has evolved considerably from this. The approach used at Sweetnam Psychology understands defenses not as something to be defeated but as having been genuinely protective to the child who developed them. They are met with curiosity and care, and then, when the time is right, gently moved aside.
That said, there will be moments of intensity. Sessions can be emotionally activating. This is not incidental to the work. It is the work. But it happens within a relationship that is fundamentally safe, collaborative, and on your side.
In the room
ISTDP sessions are active and collaborative, nothing like the silence of traditional analysis. Think of two people standing together, looking at a problem, working it out in real time. The therapist is engaged, present, and purposeful. There is no homework, no worksheets, no structured programme to follow. The work happens in the conversation itself.
ISTDP vs CBT
How is ISTDP different from CBT?
This is worth understanding carefully, because the difference is not simply about which is better. Both therapies emerged from a frustration with traditional psychoanalysis. Aaron Beck, the founder of CBT, was also a trained analyst who wanted something more focused and directive.
The key difference is in where each therapy directs its attention. CBT works primarily with thoughts, specifically cognitive distortions. From an ISTDP perspective, attending to thoughts is attending to a high-level defense mechanism. Working at the level of thought keeps things relatively surface. It can produce real change, and CBT is a genuinely effective therapy that helps many people move through depression and anxiety.
But what CBT is doing, essentially, is moving you from more destructive defenses to more functional ones. You learn to think differently, to challenge unhelpful patterns. This is valuable. It is not the same as getting beneath the defenses entirely, to the emotional experience they were built to protect against.
CBT
Works with thoughts and behaviours. Moves from destructive defenses to healthier ones. Effective for symptom reduction. Tends to require ongoing use of techniques to maintain gains.
ISTDP
Works beneath the defenses to the emotional experience underneath. Aims for lasting change at the root level. Research shows continued improvement after therapy ends.
ISTDP does cognitive work too. Moving from destructive to healthier defenses is part of the process. But it takes that one step further: attending to the defenses themselves, so you can access what is beneath them. Your actual feelings. Your needs. Your capacity to experience anger, grief, love, and desire, and then decide what to do with them, rather than rationalising them away.
If someone makes you angry and you use CBT, you might learn to challenge the thought that their behaviour was intentional. If someone makes you angry and you use ISTDP, you are going to feel that anger, and then figure out what you actually want to do with it.
In practice
What does an ISTDP session actually look like?
The first session always opens with a version of the same question: what are the emotional problems that bring you to therapy? From there, the focus moves inward, exploring how what is happening is showing up emotionally, understanding your anxiety and symptoms in detail, and beginning to build a clear picture of the internal process operating beneath the surface.
Traditionally, ISTDP initial sessions ran for three hours. That is not practical for most people any more. Taylor begins with a standard fifty-minute session, with the understanding that arriving at a clear shared conceptualisation, a real map of what is going on and where the work is headed, typically takes around three sessions. For some people it happens faster. For others, particularly those with well-developed defense systems, it takes longer before the work really opens up.
The first session is often called trial therapy, and it gives you an accurate preview of what ongoing sessions will feel like. In every session, the work centres on three things: what feelings are present in a given relational situation, what anxiety those feelings are generating, and what defenses are operating to keep those feelings at a distance. Understanding each of these, and what to do about them, is the ongoing work of ISTDP.
Who it is for
Who is ISTDP suited to?
The easiest way to answer this is to start with who it is not suited to, because the evidence base for ISTDP is broad enough that most people presenting for therapy are good candidates.
ISTDP has strong transdiagnostic evidence, meaning it performs well across a wide range of presentations: anxiety disorders, mood disorders, trauma and PTSD, personality disorders, relationship difficulties, and more. This makes sense because the model works at root-level emotional and relational dynamics rather than targeting specific symptom clusters.
Well suited to ISTDP
Adults experiencing anxiety, depression, trauma, burnout, relationship difficulties, or persistent patterns they have not been able to shift through other approaches. People who sense something deeper is driving their difficulties.
Not suited to ISTDP
Active psychotic disorders such as schizophrenia, where the intensity of the approach carries risk and the evidence base is limited. Taylor does not work with this presentation. ASD Level 3 also requires significant modification of the approach.
For people with neurodivergent presentations, ISTDP can still be effective but requires adaptation, with more cognitive focus and awareness that emotional access may differ in nature, not simply be blocked by childhood experience.
The research
What does the evidence actually show?
There are now more than 120 published outcome studies on ISTDP across a range of presentations. The findings are consistently positive, but one finding in particular stands out.
When ISTDP and CBT are compared at the end of a treatment block, outcomes are broadly similar. Both produce meaningful symptom reduction. On the surface, it looks like a draw.
The difference emerges in the follow-up data. CBT gains tend to plateau or require ongoing maintenance: the strategies need to keep being used to sustain the improvement. ISTDP gains, by contrast, continue to develop after therapy ends. People keep improving. The internal change the work produces keeps working, even without the ongoing support of a therapist.
This is consistent with what the model predicts. If you have addressed the root of the problem rather than managed its surface, the change is self-sustaining.
A personal note
Why I use ISTDP
I did not come to ISTDP through research or training. I came to it as a patient.
During my honours degree, I found myself needing therapy. Another therapist recommended someone who worked in ISTDP. I had no idea what that meant at the time, and I did not do any research before going. I just went.
I chose to be one of the people that continued to attend therapy in an ongoing manner, and have been in ISTDP therapy for 6 years. And somewhere in the early part of that, I remember thinking: this is life-changing. Not in the abstract way that people say things are life-changing. In the specific, felt, this-is-different-from-anything-I-have-experienced way.
It shaped everything about how I wanted to work. I wanted to offer people the same experience I was having: the same access to themselves, the same shift in their relationship with their own emotional world, the same capacity to be authentic and strong and genuinely free rather than just better at managing. I wanted that for the people sitting across from me.
ISTDP is one of the harder therapies to train in and to do well. It asks a lot of the therapist and a lot of the patient. I chose it anyway, because I believe the people I work with deserve that level of commitment to the work.
Common questions
Frequently asked questions
Is ISTDP available on the Gold Coast and Northern Rivers?
Yes. Taylor offers ISTDP in person at the Miami clinic on the Gold Coast and at the Kingscliff clinic in the Northern Rivers. Telehealth sessions are available across Australia. Evening and weekend appointments are available at both locations.
I have tried CBT and it helped but did not fully resolve things. Is ISTDP worth trying?
This is one of the most common presentations Taylor works with. CBT often produces real but incomplete change, which makes sense given that it operates at the level of thoughts rather than the emotional root beneath them. ISTDP is frequently a good fit for people in exactly this position.
Is ISTDP covered by Medicare?
Yes. ISTDP is delivered within a standard psychology session, which is covered by Medicare rebates for eligible patients with a Mental Health Treatment Plan from their GP. DVA funding is also accepted.
Does ISTDP work for trauma?
Yes. ISTDP has a strong evidence base for trauma presentations including PTSD and complex trauma. The approach is well suited to trauma because it works with the emotional and relational roots of traumatic experience, not just its symptoms.
How do I know if ISTDP is right for me?
The initial session is the best way to find out. It functions as trial therapy, so you will experience the approach directly and both you and Taylor will get a clear sense of whether it is the right fit before committing to ongoing work.
Curious whether ISTDP is right for you?
The first session is trial therapy. You will experience the approach directly and work out together whether it is the right fit.
Book an Initial Session