What Is ISTDP and Why It Differs from Talk Therapy

What analysis alone cannot do

Most difficulties do not come from insufficient analysis. The analysis is usually sound. What is missing is the capacity to stay with it. A hard truth, a real conflict, something that carries genuine feeling approaches, and then, without anyone quite deciding, the conversation moves on. A joke lands, the subject gets reframed, a new agenda item appears. What needed saying goes unsaid.

This is the starting point for ISTDP, not the textbook version but the clinical observation that repeats without exception: when something real approaches, we tend to move away. The mechanism is not weakness. It is learned.

On other therapeutic approaches

I have genuine respect for a range of approaches and no interest in the view that one method is right and the others mistaken. But I try to be honest about what different approaches can and cannot do.

Cognitive behavioural therapy is genuinely effective for specific, bounded problems: a phobia, a particular cognitive pattern, a cluster of distorted beliefs. Most people who come to see me are not wrestling with distorted beliefs. They are wrestling with feelings they cannot locate, an anxiety they cannot name, and defences they cannot see.

Dialectical behaviour therapy offers real tools for tolerating emotional intensity. A tool, though, is not the same as understanding where the intensity originates.

Schema therapy reaches somewhere deeper, but tends to stay at the level of narrative: the account of what happened, the patterns it created. What clients often report after working in this way is that the narrative, however accurate, does not in itself move. Something further is needed.

In ISTDP, feeling is observed as it occurs, in the moment, and the approach offers a precise account of what is blocking its experience.

The conflict triangle

This is the framework Davanloo developed through decades of recorded clinical work. The central finding is that psychological suffering does not come from feeling but from the sustained effort to escape it.

When something real approaches, a grief, an anger, a warmth- the body responds. Anxiety rises: in the chest, in the muscles, in the breath, in the hands. Before the feeling fully surfaces, something cuts it off. A defence. A fogginess. A sudden deflection. Sometimes a tear with no feeling behind it.

This triangle- feeling, anxiety, defence- moves in milliseconds, beneath the threshold of awareness. The work of ISTDP is to make it visible. In session, the three components become observable as they happen.

This is when the work stops being conversation and becomes something more immediate.

What actually happens in sessions

The early sessions are about observing the body and its patterns, not collecting history. Where does anxiety settle when something emotionally close approaches? How does the person move away from it without noticing?

I take the defences seriously, without judgment, because the pattern itself carries information. It points toward what was once threatening enough to close off access to feeling in the first place.

From that observation, it becomes possible to stay close to what is actually there, without interpretation and without pressure, in a way that allows feeling to enter awareness.

When that happens, the experience tends to feel like a release. Something that has been held under pressure for a long time is permitted to move. People often describe it as a kind of clearing.

That experience is where real change begins.

The specific thing people often remark on beforehand is knowing without changing. Understanding what is happening, understanding the pattern, understanding the history, and finding that understanding alone does not shift anything. What that usually signals is that what is needed lies underneath the understanding.