ISTDP Therapy

There's a particular kind of frustration that brings people to ISTDP (Intensive Short-Term Dynamic Psychotherapy). They've done therapy, sometimes years of it. They understand where their patterns come from. And still: the self-blame that runs on a loop regardless of how much they intellectually know it isn't deserved. The experiences they know should move them but somehow don't; a numbness where feeling should be. The disconnection that has quietly spread across every area of their life. The person they keep meaning to stand up to, only to find themselves frozen or appeasing when the moment arrives.

The insight is real. The understanding is genuine. Something just hasn't moved.

If that's where you are, you are in good company. Many people find themselves stepping into an ISTDP therapist's office disheartened that their hard-earned insight hasn't carried them farther along. ISTDP works at a different level — not through intellectual understanding, although that is important too, but through emotional experience.

What ISTDP Actually Is

ISTDP is an evidence-based form of psychodynamic therapy developed by psychiatrist Habib Davanloo in the latter half of the 20th century. What made it distinctive then, and what makes it distinctive now, is its focus on the experience (not the analysis) of emotion, and close, sustained attention to restructuring defenses that were once protective and now present as symptoms.

Depression, anxiety, relationship difficulties, chronic patterns that don't respond to insight: these aren't the problem so much as the signal. When we pay close attention to the way they present in session, we gain clues into what emotions are safe or not safe to the nervous system. As we follow the thread, we find emotions that couldn't be fully experienced at the time they arose. They didn't disappear. They went underground.

How I Practice ISTDP

An ISTDP therapist works with you to identify the purpose of these defenses, their cost, and what you want to do about them (if anything!) so that you can rebalance your emotional life. What that requires from the therapist is active engagement. Not passive listening, not a steady stream of reflections, but genuine presence. A therapist who notices you just looked away out the window and invites you to be curious about what led you to leave the room. Who can read the micro-expressions the body produces when it is subtly holding something down. Who invites you to actually slow down and notice yourself — not just talk past yourself and past the therapist. The work moves toward what's alive in the heart rather than what's at the surface in the head.

My practice of ISTDP has been shaped by important innovations in the model, including those brought by AEDP, that approach defenses with generosity and curiosity rather than confrontation. Defenses aren't obstacles to be dismantled. They're old heroes — the parts of us that showed up when we needed protection and have been doing their job ever since. The work isn't to defeat them. It's to understand how they've been trying to help us and, when the time is right, to offer them some relief.

The therapist's role isn't to take a sledgehammer to your defenses. It's to approach them with genuine curiosity: what is this wall protecting? What might become possible if it weren't needed? And if these bricks no longer have to hold this particular structure together, what else might they be used for?

I am certified in ISTDP, one of relatively few therapists in the Northern Virginia and D.C. area with formal certification in the model. That certification reflects not just training hours but supervised clinical work and demonstrated competency in the approach. This matters because ISTDP done well requires a specific kind of clinical skill, and ISTDP done poorly can feel destabilizing rather than therapeutic.

What I offer honors ISTDP's core mission of restructuring emotional experiencing and pairs it with the attunement and pacing that makes that experience healing rather than overwhelming.

What ISTDP Can Help With

ISTDP has a strong evidence base across a range of presentations. In my practice I use it most often with:

• Depression and anxiety that hasn't responded to other approaches

• Chronic relationship difficulties — patterns of conflict and distance that repeat regardless of how well you understand them

• Complex and developmental trauma, where the work requires accessing emotional experience rather than just processing narrative

• Low self-esteem and negative self-concept rooted in relational experiences

• Somatization and medically unexplained symptoms, where emotions find physical expression

• Grief and complicated bereavement

What People Often Wonder

What does "intensive" actually mean?

Not multiple sessions per week, though that's possible if clinically indicated. "Intensive" refers to the depth and focus of the work within each session. ISTDP sessions are concentrated. The therapist is actively engaged, the work moves toward emotional material rather than around it, and sessions tend to cover more ground than conventional therapy. The intensity is internal, not logistical.

Is ISTDP Confrontational?

ISTDP has a reputation for being confrontational. In its earlier Davanloo form, it could be. That approach has evolved significantly, and my practice reflects that evolution.

Confrontational implies an opposed relationship: therapist against patient. That's not what this is. The work is collaborative. The only conflict that exists in the room is the one you bring with you: the tension between defenses that once kept you safe and the growing awareness that they may be keeping you from something you actually want now. An attuned therapist helps you compassionately face that conflict within yourself. They don't shame. And they certainly don't take a sledgehammer to the wall.

What Do Sessions Actually Look Like?

This isn't a casual recapitulation of life updates. You didn't decide to come to therapy to talk about the weather. You came to address something real. We begin by getting clear on what you actually want — not just what you want to stop, but what you want to move toward.

Then we get to work. I'm tracking what's happening in your body, your affect, the moments where something unknowingly gets managed away. The tear that forms and gets blinked back. The laugh that arrives when something painful is on the table. The voice that flattens when you're describing something that should hurt. The sudden pivot to logistics when the conversation was just getting somewhere real. The way you start to shame yourself when unwanted feelings of anger toward someone you care about come up.

We focus on noticing and interrupting those patterns so you can finally face what's been underneath all along. The emotions that haven't been able to breathe. When those emotions start to move, you start to move.

Working Together

If you're in McLean, Arlington, Bethesda, Fairfax, or the D.C. area and you're looking for therapy that doesn’t let you talk yourself in circles, reach out to schedule a free initial consultation. I see clients in person at my office on Chain Bridge Road in McLean and via telehealth throughout Virginia, Maryland, and D.C.