Research Deep Dive: ISTDP in the Treatment of Resistant Depression

A breakdown of current research findings supporting ISTDP's effectiveness for complex and treatment-resistant cases.

Therapists often feel disheartened when a session starts with silence, irritation, or intellectualizing. But in ISTDP, these are not roadblocks—they're signposts.

One of my clients—a young professional dealing with chronic anxiety—spent the first few sessions rationalizing everything. He spoke about emotions without ever accessing them. Most therapies might interpret this as insight. But ISTDP sees this as defensive functioning—a way to avoid emotional pain.

As we began to name and confront these subtle defenses, something shifted. He became tearful. Not because of what he remembered—but because he finally felt what he had been avoiding.

That’s the power of ISTDP: it doesn’t settle for surface-level insight. It waits, confronts, and gently presses until the person beneath the defenses begins to emerge.

And that emergence—that moment of emotional honesty—is where therapy actually begins.

🧠 Interested in clinical supervision on cases like this? [Book a Supervision Session]