What is ISTDP, in plain words?
It is a therapy based in the psychoanalytic or psychodynamic tradition. It’s based on resolving unconscious emotional problems. So it descends from Freud, but it’s not psychoanalysis.
The easiest way to think of it is psychoanalysis on steroids. Instead of three times a week for two years, it’s once a week for six months.
Who did you train with?
I’ve been working in treatment for over 15 years. I trained in ISTDP with Jon Frederickson and Allan Abbass, and I’ve had supervision with John Rathauser.
I’m a Licensed Marriage and Family Therapist, license 136869. ISTDP is the main way I work. I got really into it, and I haven’t found much reason to look outside of it. I also offer training and supervision to other clinicians, and I teach at Pacifica Graduate Institute.
How is it different from the therapy I’ve tried before?
Part of it is designed specifically for people who have been stuck in long-term therapies that haven’t worked. So it’s a very direct and active form of therapy, where both the therapist and the client are working hard. Every minute of every session, the goal is to try and find a focus, an emotional focus, that will lead to progress.
So there’s as little chit-chat as possible. There’s no “How was the parking? How was the week?” It’s very much “What would you like to work on this week?” So it’s very goal-focused.
Will I become dependent on my therapist?
It’s not my intention to keep [people] in therapy long term. It’s not my intention to have a therapy where they become dependent on me, and it’s like, “Oh, I’ve got to speak to my therapist this week.” The idea is to talk about the problems, resolve them as quickly as possible, and that’s why we have the six-month limit.
What do you expect from a client? Who is this therapy not for?
They just have to be motivated. They have to want to work on the problem. Because a lot of people come to therapy, their wife will send them, the husband will send them, they think they should. They have to be motivated for themselves, and they have to want to do an emotionally focused therapy. They have to be willing to look at their emotions.
If those things aren’t in place, the therapy I do won’t work. But as long as they’re there, there’s potential for growth, potential for change.
What happens after I get in touch?
They reach out to me, say they email me: “I’m interested in doing therapy.” There’s a 20-minute Zoom call, free of charge, and I will try and ascertain if what I do can help them.
So the first 20 minutes is really assessing, honestly: can I help them? And if I don’t think I can, I wouldn’t accept the case. I would refer them to another [therapist].
What happens in the first session?
I also tell them: you’ll know by the end of the first session whether this is for you. By the end of the first paid session. I ask for two hours, but it normally just goes for an hour and a half, and then I scale down the fee.
Even if it’s not for you, you would have learned some things about yourself. And at the end of the first session, if it’s not for them, we can just part ways.
How many sessions does ISTDP take?
An initial session of up to two hours, followed by one-hour sessions, to a maximum of 26 sessions, roughly six months. Treatment may finish sooner.
Why is there a limit, and what if I need longer?
There are some people that do need more than six months of therapy. I could probably figure that out at the first session, or within the first meeting. Some people with personality disorders are going to need probably a year of therapy, so I could have a conversation with them about it.
But most people that are successful, they’re well enough to hold a job, they’ve made some progress in a career, they have a family, they’ve been able to go through life with some success: most of them can probably benefit from 26. And the point of the 26 is to put some pressure on them to show up and work as hard as possible.
I want people to feel that there’s an end in sight. I’m not guaranteeing anything, I can’t guarantee anything, but if we both work hard, you’ll get something out of it within six months.
What does it cost?
It’s $300 an hour. The first session is up to two hours, which is $600 if it runs the full two hours, and the fee comes down if it’s shorter. After that it’s one-hour sessions at $300.
You pay for the hours we spend together. I don’t bill insurance directly, but I give you a superbill, which some plans reimburse. Check with your plan. The 20-minute introduction call is free.
Are sessions recorded?
As is traditional in ISTDP, sessions are videotaped so that I can review the work and streamline the treatment. Another clinician cannot view a recording without your consent. The introductory call is not recorded.
Where do you see people, and can I do this online?
Yes, online. I see people on video, and in person in Los Angeles by appointment.
I work with adults, 18 and over, individuals only, no couples. I’m currently accepting new clients. The first step is a free 20-minute Zoom call, where we see whether I can help. Sessions are weekly, and as is traditional in ISTDP they’re videotaped so I can review the work.
How did you come to ISTDP?
When I was very early on in my training, I didn’t know what I was doing. […] I checked out this model, and it really made sense to me, in terms of having a framework where I could really see what’s going on. It really boosted the level of my effectiveness as a therapist. And then I just got really obsessed with it, and I haven’t found much reason to look outside of it.
I’ve been training in ISTDP about five years.