Intensive Short Term Dynamic Psychotherapy (ISTDP)
I practice a form of Experiential-Dynamic therapy called Intensive Short Term Dynamic Psychotherapy (ISTDP). ISTDP practitioners understand that emotional attachment to others is an essential human need, like food, water and oxygen. When we feel truly loved and cared for, we feel warm, calm and secure. This gives us confidence and hope to explore the world and develop rewarding relationships. When emotional attachments feel threatened, we experience painful feelings (distress, depression, grief, anger, guilt) along with the more positive feelings (love, compassion, empathy). This mix of feelings instantly triggers the brain's stress-response system, resulting in different symptoms of anxiety. Typically, we are not aware of the feelings or the anxiety, because we have learned through painful experience to block them out or avoid them. Emotional and physical symptoms typically get better if complex feelings can be experienced, instead of ignored or blocked from expression.
ISTDP works by helping a person notice the many automatic and unconscious ways in which they have managed feelings in the past, so they can consciously choose to experience and work through them. Doing this in a safe, supportive setting helps the person develop this practice. This can be challenging, but most people feel relief when these feelings are finally worked through and released. With practice, they can learn new ways to respond to complicated feelings that allow them to interact with their inside and outside worlds in more healthy and productive ways. If these ideas make sense to you or if you are curious to explore them more, then I may be able to help you.
Treating Physical Symptoms with ISTDP
Have doctors told you that they can’t find a reason for your physical problems? That they are caused by stress, anxiety or are 'all in your head'? This can be very confusing and frustrating, especially when you know how real your problems are. This usually means that the problem is less in the 'hardware' of your body, and more in the 'software' of your brain. This doesn't mean you are 'crazy'. It is actually good news! Unlike many 'hardware' problems, many 'software' problems can be solved in psychotherapy by "reprogramming the system." ISTDP can be particularly helpful for people with physical symptoms that are triggered by anxiety about complex feelings, since ISTDP helps the person recognize and manage the feelings that trigger them.
Many unpleasant bodily sensations and symptoms reflect over-activation of the stress-response system. This powerful ‘fight, flight, freeze or please’ brain system protects us from threats to our physical safety and emotional well-being. It sends warning signals (anxiety, fear, pain, discomfort) that urge us to act to avoid these threats, fight them off or neutralize them. The system works automatically and very quickly. We often don’t know that our body is responding or what it's responding to until a symptom develops that forces us to notice that something is happening.
For some people, the system has been programmed by life events to respond with powerful signals and actions to anything that seems like a threat. The source of the threat may not be obvious, because the system is alert to threats that can occur outside our conscious awareness, while we are focused on other things. These signals can show up as a wide range of symptoms, such as light-headedness, tingling, numbness, shaking, tremor, difficulty breathing, loss of bodily sensation or control, slurred speech, tics, physical collapse, paralysis, seizure-like movements or loss of consciousness. Most medical tests come back normal, because there is no medical test that reliably measures this activation of the system in a specific person. However, studies of groups of people with this problem clearly show that the brain structures that control the system are not functioning normally.
Videorecording of Sessions
The practice of ISTDP requires careful attention to the process of client-therapist interactions. ISTDP therapists video-record therapy sessions so we can focus my attention on the process in the moment (instead of taking notes) and can review these interactions carefully afterward. Therapists also improve their skills and effectiveness by reviewing these recordings with senior colleagues and peers who are bound by the same rules of confidentiality.
Before starting treatment, we will discuss the pros and cons of having your sessions recorded. If you choose to have them recorded, you will also be able to choose whether the sessions are viewed only by me or in consultation with senior colleagues with whom I consult to improve my practice or more broadly.
In sharing these recordings with colleagues, I never share identifying information other than what is shown on the recording. Recordings are treated with the same level of confidentiality as all mental health records. All recordings remain in my possession at all times. They are maintained on an encrypted, external hard drive that is stored in a locked safe in my office and is never connected to the internet.