INTENSIVE SHORT-TERM DYNAMIC PSYCHOTHERAPY (ISTDP) FOR OLDER ADULTS? EVIDENCE, THEORY, TECHNIQUE, AND CASE PRESENTATION

Abstract

Psychotherapy is an evidence-based treatment for older adult mental health patients and is preferred by many older patients over pharmacotherapy. Conventional wisdom asserts that psychotherapy with older adults must be slow and limited to the pursuit of only modest goals. Yet clinical experience and recent research conducted by Brandon C. Yarns, MD, indicates that some older adults can make rapid, profound, and lasting change with a psychotherapeutic modality called Intensive Short-Term Dynamic Psychotherapy (ISTDP). ISTDP was developed by Habib Davanloo, MD, between the 1970s and early 2000s and is an experiential, emotion-focused, and psychoanalytically-oriented psychotherapy based on Freud's Second Theory of Anxiety. ISTDP is known for its rapid challenge to patients’ defenses, intensely emotional moments, and the use of specific techniques to pursue substantial treatment goals in a relatively short duration of treatment compared to psychoanalysis and long-term psychodynamic psychotherapy. ISTDP has been tested in many clinical trials and now meets evidence-based criteria for complex and challenging clinical problems, which include somatoform disorders, personality disorders, and treatment-resistant depression in adults. This session aims to introduce participants to the utility of ISTDP for some older adults. First, emerging evidence of the success and advantages over standard psychotherapy of an ISTDP-based group modality in older adults with chronic pain will be reviewed. Second, participants will be introduced to the theory and technique of ISTDP. The focus of this section will be not only to review basic ISTDP metapsychological and technical concepts but to address the rationale for why this technique is applicable to some older adults, appropriate patient selection, and the challenges commonly encountered in performing ISTDP with older adults. Practical information on how to provide ISTDP-based psychoeducation to patients about their clinical problems will be provided, including how clinicians can explain problems in terms of defenses against unwanted feelings (i.e., the Triangle of Conflict). Third, a video recorded patient session will be presented which demonstrates the successful application of ISTDP techniques to an older adult mental health patient. Finally, ample time will be provided to address questions, discuss audience reactions, and debate whether ISTDP is of potential utility for some older adults. Session presenters, including Brandon C. Yarns, MD, Ali Najafian Jazi, MD, and Allan A. Anderson, MD, have extensive research and clinical experience in the application of ISTDP to older adults.