Therapist Insights / How Therapy Works / §09 OF 09
ISTDP works on emotional defenses directly: in real time, in session which is why it reaches what traditional talk therapy often cannot.
For executives, attorneys, physicians, and founders whose previous therapy felt slow or surface-level, with a licensed clinical psychologist trained in ISTDP-informed work.
§ 6 / SECT.
THE QUICK TAKEAWAY
ISTDP, developed by Habib Davanloo through decades of video-recorded clinical research, is an emotion-focused therapy that works actively with defenses in real time. The clinical mechanism is unlocking the unconscious: helping the client experience the emotions that defenses have been holding back. The evidence base is substantial (over 120 outcome studies, 50+ randomized controlled trials), with large effect sizes for depression, anxiety, somatic symptoms, and personality difficulties. For analytical professionals whose intellectual defenses make traditional talk therapy ineffective, ISTDP is often the modality that produces the breakthrough.
§01 / 09 / Definition
What ISTDP actually is
ISTDP is an emotion-focused, defense-oriented therapy developed by Habib Davanloo through several decades of video-recorded research at McGill University. The clinical method is active: the clinician identifies defenses as they appear in session and helps the client move past them to the underlying emotion. The therapeutic work is intensive, structured, and significantly shorter in duration than traditional psychodynamic therapy.
You have done therapy before. The conversations felt thoughtful. The insights accumulated. The change did not. The reason is often that your intellectual defenses have been doing exactly what they were trained to do: keeping you safe from the emotions the work needs to reach. ISTDP is built for this exact problem. It works with the defenses rather than around them, in real time, in the room.
Six features of analytical-mind defense structure that ISTDP addresses
Intellectualization as primary defense
The default response to emotional content is to analyze it. The session becomes a discussion about emotions rather than an experience of them. ISTDP names the pattern in real time and helps the client move past it.
Composure as professional skill
Years of training have produced the ability to remain composed under pressure. The skill generalizes to therapy, where composed engagement keeps the emotional material at arm's length. The work helps the client risk losing composure in the contained setting of the room.
Strategic detachment from feeling
The capacity to detach from feeling and operate from analysis is a professional asset and a clinical obstacle. ISTDP works directly with the detachment rather than ignoring it.
Somatic conversion
Emotions that cannot be experienced consciously often show up in the body: headaches, GI symptoms, chronic tension, sleep dysregulation. The literature on ISTDP for somatic symptom conditions is particularly strong; resolving the underlying emotion frequently resolves the physical complaint.
Alexithymia (difficulty naming feelings)
Many high-achievers have measurable difficulty identifying and describing their emotions. The pattern is common in the population and well-documented. ISTDP specifically addresses this disconnect.
Treatment-resistance to standard modalities
When CBT, SSRI medication, and traditional talk therapy have produced limited change, the modality is often not the wrong choice but the wrong layer. ISTDP reaches the emotional layer that other approaches have not.
▶ Research
The literature is mature. The effects are large, durable, and have been demonstrated specifically for the treatment-resistant presentations where other modalities have plateaued.1
What the work tends to produce
On the symptom layer
Symptoms that have been holding (anxiety, depression, somatic complaints) begin to release as the underlying emotional material is processed.
On relational patterns
The same defenses that block emotion in session block intimacy in relationships. Working with them in session generalizes to the relationships that matter.
On the duration of treatment
Average ISTDP treatment is approximately 20 sessions, significantly shorter than traditional psychodynamic therapy. The pace is intensive by design.
Who ISTDP-informed work fits
Clients with sophisticated intellectual defenses, treatment-resistant presentations, and somatic symptom patterns that have not responded sufficiently to other modalities.
Access to emotion in real time
The capacity to experience emotion as it arises rather than process it intellectually after the fact. The shift transfers from session to life.
Somatic symptom resolution
Physical symptoms with strong emotional drivers often resolve as the underlying material is processed. The mind-body connection is real and clinically actionable.
Structural change rather than just symptom relief
ISTDP outcome research shows changes in personality structure and adaptive functioning, not just symptom reduction. The change tends to hold and to compound after treatment ends.
§02 / 09 / Telehealth
Why analytical minds in particular benefit
High-achieving professionals have well-trained intellectual defenses. Composure, intellectualization, strategic detachment, and analytical reframing all served the career. They also block the emotional work that traditional talk therapy depends on. ISTDP is specifically built to work with this defense structure rather than be defeated by it.
Executives, founders, attorneys, physicians
Analytical training produces exactly the defense structure ISTDP is built for. The work fits the cognition.
Clients with treatment-resistant depression or anxiety
When SSRI, CBT, and traditional talk therapy have not produced sufficient change, ISTDP often reaches the layer that has been blocked.
Clients with somatic symptom presentations
Chronic headache, GI dysregulation, chronic pain, sleep dysregulation with strong emotional component. The ISTDP literature on somatic symptom conditions is particularly strong.
§03 / 09 / Mechanism
How an ISTDP session unfolds
An ISTDP session is active, collaborative, and structured. The clinician helps the client identify a specific focus (a relational conflict, a feeling that has been buried, a recurring pattern), tracks defenses as they appear, and helps the client move past them toward the emotion underneath. The pace is calibrated; the depth is the point.
The session opens with the clinician helping the client identify a specific focus. Not the whole life. A specific person, situation, or feeling that has been holding back. This focusing move is the foundation; ISTDP does not work well with diffuse 'how was your week' conversations.
The middle of the session is defense work. As the client engages with the focus, defenses appear: intellectualization, vagueness, deflection, somatic shifts. The clinician marks them gently and helps the client see them as defenses rather than as the work. The therapeutic alliance does this together; it is collaborative rather than confrontational.
The third phase is the emotional work. As defenses are recognized and set aside, the underlying emotion becomes accessible. The clinician helps the client experience the emotion in a safe, contained frame, with attention to somatic signals and the relational dynamic in the room. This is what ISTDP calls 'unlocking the unconscious.' Research consistently shows that this experience is the central predictor of treatment outcome.
► Standard advice vs. CEREVITY's approach
Standard therapy
"Use therapy as a place to discuss your feelings intellectually."
CEREVITY
"Use it as a place to experience them, with clinical support."
Standard therapy
"Let the defenses run the session."
CEREVITY
"Work with them directly so the underlying material can move."
Standard therapy
"Wait for symptom relief from approaches that have already plateaued."
CEREVITY
"Try the modality designed for exactly the defense structure that is producing the plateau."
| Standard insurance-based therapy | CEREVITY's specialized approach |
|---|---|
| "Use therapy as a place to discuss your feelings intellectually." | "Use it as a place to experience them, with clinical support." |
| "Let the defenses run the session." | "Work with them directly so the underlying material can move." |
| "Wait for symptom relief from approaches that have already plateaued." | "Try the modality designed for exactly the defense structure that is producing the plateau." |
A break from the page
The therapy that works when traditional therapy has not.
ISTDP-informed therapy with a licensed clinical psychologist trained for analytical minds. Confidential, telehealth nationwide, with 50-minute, 90-minute, and 3-hour formats.
§04 / 09 / Cases
Common challenges we address.
I have done therapy before and it did not change much
The patternPrevious work has produced insight without consolidated change.
What we addressThis is exactly the indication for ISTDP. The modality is built for clients whose intellectual defenses have made content-focused therapy ineffective. The active, in-room work often produces change where previous work has plateaued.
I am not sure I am ready to feel intense emotions
The patternThe fear of being overwhelmed by suppressed emotional material is common and reasonable.
What we addressISTDP is paced. The clinician does not push for emotional access faster than the system can hold. The trial therapy session that often opens the work serves precisely this assessment function: determining what pace the system can actually carry.
§05 / 09 / Methods
Evidence-based treatment approaches.
ISTDP has Tier 1 evidence for depression, anxiety, and somatic symptom disorders. The treatment-resistant data is particularly strong. The literature includes over 120 outcome studies and 50+ randomized controlled trials.
Licensed clinicians with ISTDP training
ISTDP-informed work at CEREVITY is delivered by licensed clinical psychologists with the specific training the method requires.
Three session formats
50-minute, 90-minute, and 3-hour formats. Trial therapy often uses 90-minute or 3-hour blocks for the depth the opening phase requires.
Confidentiality
Private-pay only. No insurance claim, no diagnostic code submitted to external databases.
Telehealth nationwide
The clinical work translates cleanly to video. The clinician can track posture, breath, somatic shifts, and micro-expressions over the video format.
Continuity across the arc
The intensive nature of ISTDP benefits from continuity. The same clinician across the 20-session average arc supports the depth the work produces.
§06 / 09 / Investment
Understanding the investment in private-pay care.
ISTDP-informed therapy adapted for analytical professionals whose defense structure has made other modalities ineffective.
At CEREVITY, our online individual therapy sessions are structured as a direct investment in your mental agility and overall well-being. The investment includes:
- Licensed mental health professional specializing in ISTDP-informed therapy
- Evidence-based, one-on-one approaches proven effective for Emotional defenses and somatic symptoms in high-achieving professionals
- Flexible online scheduling including evenings and weekends
- Complete privacy with no insurance involvement or red tape
- Executives, founders, attorneys, and physicians whose intellectual defenses have made traditional talk therapy ineffective expertise and understanding
- Outcome tracking and progress measurement
The cost of ISTDP going unaddressed
Consider what is at stake when ISTDP goes unaddressed:
What unresolved emotional material costs
Anxiety and depression that have not responded to standard treatment. Somatic symptoms that medical specialists cannot explain. Relational patterns that repeat across years. The pattern compounds; the cost is paid in life quality and in healthcare utilization.
What treatment-resistance costs over time
Years of partial improvement that does not hold. Multiple modality attempts that produce insight without sufficient change. The duration of treatment-resistant presentations often exceeds the cost of trying the modality that fits the defense structure.
§07 / 09 / Evidence
What the research shows.
The empirical literature on ISTDP is substantial. Abbass, Town, and Driessen's systematic review and meta-analysis of 21 studies documented pre-to-post effect sizes (Cohen's d) ranging from 0.84 to 1.18, with the average treatment course approximately 20 sessions. Critically, post-treatment to follow-up effect sizes suggest gains are maintained or continue to increase, a pattern uncommon in psychotherapy outcome research generally.
Town and colleagues' 2020 randomized controlled trial in the Journal of Affective Disorders documented ISTDP producing complete remission in 36% of treatment-resistant depression patients compared to 3.7% in standard care at 6 months, with the effect cost-effective and sustained at 18-month follow-up. Abbass and colleagues' 2022 meta-analysis on ISTDP for chronic pain documented large and lasting effects in 10 studies including 6 RCTs, with superior outcomes compared to CBT in both short and medium-term follow-up. The convergent picture is that ISTDP is one of the better-evidenced interventions for treatment-resistant presentations and somatic symptom conditions specifically.
§§ / 09 / Recap
Key takeaways.
Five things to remember
- Active defense work The clinician identifies defenses as they appear in session (intellectualization, deflection, vagueness, somatic shifts) and brings attention to them in real time rather than allowing them to run the session.
- Emotion-focused The clinical target is the emotion the defenses have been suppressing. The work helps the client experience that emotion in a safe, contained therapeutic frame, which is what produces durable change.
- Significantly shorter duration Average treatment is approximately 20 sessions. The intensive trial therapy session that often opens the work can produce substantial symptom relief in 1 to 3 hours.
- Strong evidence across conditions Over 120 outcome studies and 50+ randomized controlled trials document large effect sizes for depression, anxiety, somatic symptom disorders, and personality difficulties.
- CEREVITY provides this through online individual therapy nationwide, with full privacy through its private-pay concierge network and no insurance involvement.
§08 / 09 / FAQ
Frequently asked questions.
How is ISTDP different from CBT?
CBT targets the cognitive content driving symptoms. ISTDP targets the emotional defenses driving the cognitive content. For analytical clients whose intellectual defenses have made content-focused work ineffective, ISTDP often produces change CBT alone has not.
How long does ISTDP usually take?
Average treatment is approximately 20 sessions, significantly shorter than traditional psychodynamic therapy. The trial therapy session (often 1 to 3 hours) can produce substantial symptom relief and helps both clinician and client determine fit.
Is ISTDP appropriate for somatic symptom conditions?
Yes. The ISTDP literature on chronic pain, GI dysregulation, chronic headache, and other somatic symptom conditions is particularly strong. The 2022 Abbass meta-analysis documented large and lasting effects with superior outcomes to CBT for several somatic conditions.
How does your private-pay pricing structure work?
As a private-pay concierge network, we offer structured investments in your mental health without the restrictions or privacy risks of insurance. You can review our full fee schedule and specific session lengths directly on our website. While this costs more than insurance copays, it provides the flexibility, total privacy, and highly specialized care that standard options cannot offer. View our current rates here.
How do you protect my privacy?
Privacy is foundational to our network. As a private-pay network, your sessions never appear on insurance records or EOBs that could be seen by employers, boards, or family members. We use HIPAA-compliant nationwide telehealth platforms, and you can attend sessions from anywhere with a private internet connection.
§09 / 09 / Begin
Work where the defenses are, not just where the content is.
ISTDP-informed therapy with a licensed clinical psychologist. Confidential, telehealth nationwide, with 50-minute, 90-minute, and 3-hour formats.
Available by appointment 7 days a week, 8 AM to 8 PM (PST)§§ / Author
About Maria Gonzalez, PsyD.
Maria Gonzalez, PsyD
Dr. Gonzalez is a Licensed Psychologist offering therapy for executives, entrepreneurs, and high-achieving professionals. Her work integrates cognitive behavioral therapy, acceptance and commitment therapy, and psychodynamic approaches, calibrated to the demands of high-responsibility careers. She sees clients via CEREVITY's nationwide telehealth network. View full bio →
§§ / Sources
References.
- Abbass, A., Town, J., and Driessen, E. (2012). Intensive short-term dynamic psychotherapy: A systematic review and meta-analysis of outcome research. Harvard Review of Psychiatry, 20(2), 97-108.
- Johansson, R., Town, J., and Abbass, A. (2014). Davanloo's Intensive Short-Term Dynamic Psychotherapy in a tertiary psychotherapy service: Overall effectiveness and association between unlocking the unconscious and outcome. PeerJ, 2, e548.
- Lilliengren, P., and colleagues (2024). Experiential dynamic therapies: A comprehensive systematic review and meta-analysis of randomized controlled trials. Psychotherapy Research.
- Town, J., Abbass, A., Stride, C., and Bernier, D. (2020). Efficacy and cost-effectiveness of intensive short-term dynamic psychotherapy for treatment resistant depression: 18-month follow-up. Journal of Affective Disorders, 273, 194-202.
- ISTDP Institute. Training resources and the original Davanloo framework, with bibliography of the broader research base.
⚠ Crisis resources
If you are experiencing a mental health crisis or having thoughts of suicide, please reach out immediately. 988 Suicide & Crisis Lifeline · Call or text 988 Crisis Text Line · Text HOME to 741741 National Alliance on Mental Illness · 1-800-950-NAMI (6264)
