Information About ISTDP and Frequently Asked Questions
In life, sadly, pain is inevitable. Loved ones pass away, tragedy can happen in an instant, and even the structures and systems designed to care for people can cause terrible psychological and physical injuries. As a result, many people experience unavoidable trauma and interruptions in their attachment relationships. Unfortunately, and quite often, the automatic strategies (or defenses) people learn to use to manage their difficult feelings and anxiety can unintentionally contribute to, or even cause, the suffering they deal with on a day-to-day basis. Because these habitual behaviors are almost always unconscious, people usually need help seeing these patterns and identifying a different way forward to eliminate their suffering. Being able to recognize and effectively address them is an essential part of any effective psychotherapy.
Intensive Short-Term Dynamic Psychotherapy (ISTDP) was first developed in the 1960s by Dr. Habib Davanloo, who recognized that traditional talk therapy often was inefficient and, at times, even ineffective with a number of patients who entered treatment. ISDTP is an evidence-based form of psychotherapy designed to help people rapidly address a variety of psychological symptoms and difficulties they have while functioning in the world.
ISTDP treatment directly brings into focus the relationship between a person's feelings, their anxiety, and their unconscious strategies to manage them (i.e., defenses), examining and addressing these elements on a moment-to-moment basis so psychological difficulties can be resolved. Because defenses and anxiety stem from avoided feelings, the goal in ISTDP is to help people face these feelings as fully as possible in order to eliminate symptoms and suffering as quickly and as permanently as possible. While changing long-standing patterns of thoughts, feelings, and behaviors can be uncomfortable, it is typical that addressing these patterns and their related feelings can yield relief.
ISTDP is likely very different than other therapies you have tried or may have seen. In ISTDP, the therapist takes an active approach in the treatment, working together with the patient to identify and extinguish symptoms and their causes. Often, automatic emotional management habits can actually (and unintentionally) affect the very success of the therapy itself, so working intentionally to also identify and address any unhelpful habitual patterns and behaviors that could cause problems or could stall the treatment is also a central component of ISTDP. Because everyone is different, ISTDP employs a variety of strategies designed to maximize how quickly results are achieved, while working to make sure the process is not more harmful than helpful. For instance, if someone's anxiety tolerance is very low, treatment likely would begin by helping to lower anxiety while also helping to build anxiety tolerance. Other times, treatment may begin by working to help someone quickly identify causes of their struggles and overcome them. From this perspective, each person's treatment is uniquely tailored to the difficulties they are experiencing in any given moment.
In most forms of therapy, the first session is typically 60-90 minutes long and is focused on gathering historical information and potentially assigning a diagnosis. The first session of ISTDP with me typically is about 2.25 hours long, and the focus is more on beginning this "trial therapy" itself (to see if it is a good fit and to begin movement towards relief) rather than on only gathering a subjective history. Many people who seek out therapy only attend an initial therapy consultation, so quickly identifying goals of treatment and beginning the work can be critical for establishing the hope and motivation necessary to keep coming to therapy. ISTDP employs a unique history gathering and psychodiagnostic process that is embedded in the therapy itself. Because of this, I am able to gather a wealth of relevant and necessary information without delaying treatment. Subsequent ISTDP sessions typically will be 80-90 minutes in length.
When we talk about ISTDP, "short-term" does not refer to a specific number of sessions, per se. Rather, it speaks to the shared patient and therapist focus on achieving meaningful change as quickly as possible. While the treatment supports the patient, a main principle of ISTDP's active stance is making sure not to support anything that could prolong suffering or prolong treatment. The goal is to provide meaningful change in each appointment. The duration of ISTDP therapy is based on the difficulties you have, and your motivation and engagement in the process. Meaningful change can take place in just a few sessions of ISTDP, while many spend between 20 and 60 sessions in treatment. For some, treatment is much shorter and for some, treatment can be longer. The changes seen in ISTDP tend to be long lasting, decreasing the likelihood of a relapse and return of symptoms.
Research shows that the use of video recording in psychotherapy tends to improve therapy outcome. Because up to half of all patients fail to fully benefit from psychotherapy (and ten percent actually get worse over time in treatment), it is important we do what we can to give you the best chance possible for a successful therapy.
In ISTDP, videotaping is the norm. Because delivering ISTDP is a complex process and because much of the work is helping to bring unconscious patterns and processes into awareness as quickly (and safely) as possible, my ability to review sessions can have a big impact on your outcome.
With your permission (and there is no obligation to give it; therapy can happen without video taping), I will make video recordings of our therapy session. Depending on what you agree to, these videos can provide a number of benefits:
- Reviewing the videos themselves, looking more closely to identify what is and what isn't working for you in therapy. Therapy sessions can be quite complex, and sometimes unnoticed elements in the therapeutic interaction and process can prevent the therapy from helping you as quickly as you would like.
- Periodically, treatment itself can become stuck. There are times when it can be extremely helpful for the therapist to review the video with one or a few seasoned ISTDP therapists, in a closed consultation setting, in order to identify ways to help you faster. Even therapists benefit from asking for help :)
Session videos are stored on an encrypted (256-bit AES) hard drive separate from a networked computer. They are never uploaded to the internet, and I am happy to share them with you if you would like.
Currently, Dr. Howells is the only therapist in the group providing ISTDP.
When providing formal ISTDP, I charge $425 for an initial 2.25 hour ISTDP session and $325 for a 80-90-minute follow-up session. These fees cover the cost of the services provided directly to you as well as costs for adjunctive clinical services (i.e., reviewing session videos to enhance clinical care).
Dr. Howells is an in-network provider for Blue Cross Blue Shield, TRICARE/Humana, and United Healthcare. Using in-network insurance with ISTDP can be possible; however, it can require a higher out-of-pocket cost to you even if Dr. Howells is listed as in-network. One reason for this is that insurance companies will typically only cover a portion of the total cost of an initial 2.25 hour ISTDP session, and a portion of the cost of a follow-up session (typically 80-90 minutes). The reason for this is that insurance companies do no cover certain professional interventions that are considered essential components of the treatment itself. The initial ISTDP evaluation is significantly more complex than a standard initial diagnostic evaluation for therapy in that it a) takes more time than the standard initial diagnostic evaluation, and, more importantly, includes services that are not a part of a standard initial evaluation. While an initial ISTDP evaluation does consists of a psychosocial history gathering and diagnostic evaluation, it also includes a full integrated extended-length "trial (psycho)therapy" session as well as incorporates substantial professional clinical time for the clinician to review the video of the session itself (other standard charting/documentation time is not billed separately and is included). Insurance companies will pay for only the psychosocial history gathering and diagnostic evaluation at the outset of therapy, and they will not cover a same-day individual psychotherapy session or the professional administrative time. As such, if you would like to begin ISTDP and use in-network insurance, know that you are responsible for all associated costs not covered by in-network insurance for the separate consecutive psychotherapy session and professional case review time. Here are two options to pay for the initial ISTDP session using insurance:
- If you would like to use in-network insurance for the initial evaluation procedure and pay for the additional time out-of-pocket (to cover the additional same-day psychotherapy session services and ISTDP-specific administrative fees), we can determine your cost for the initial evaluation (i.e., your co-pay or co-insurance for that service). We would then separately charge you for the psychotherapy session and for a professional hour of service to review your videotape (typically at at a block rate of $100-200 depending on time required for the session review). This would be covered up front as part of the Good Faith Estimate of your cost of care. Of note, you would be opting out of using insurance for a same-day psychotherapy session.
- If you do not plan to use in-network insurance for this session, you will pay the full amount for the initial 2.25 hour session out-of-pocket.
Subsequent follow-up therapy sessions are generally about 80-90 minutes unless discussed otherwise ahead of time. If you use in-network insurance, these sessions themselves are reimbursed your in-network insurance as a 53+ minute follow-up psychotherapy session; however, similar to the initial evaluation, the professional hour of service fee for video review (typically at at a block rate of $100-200 depending on time required for the session review) will be your responsibility. Again, we can estimate what your in-network insurance will cover and charge you directly for the difference.
If Dr. Howells is considered out-of-network with your insurance, we can provide you with a super-bill to submit to your insurance company. You will be responsible for all appointment service costs at the beginning of the appointment.
Please note: insurance typically covers what they determine to be "medically necessary" treatment. This generally would include individual therapy for diagnosed medical/mental health conditions as determined by the DSM-5-TR (e.g., depression, anxiety, bipolar disorder, PTSD, other trauma conditions) and for which many people seek therapy. On occasion, though, there are people for whom ISTDP can be very helpful but who may not meet criteria for a condition that is covered by insurance. In cases like these, and more generally, you would be responsible for covering any costs not paid by insurance (fees are due at the beginning of the session). We recommend checking your insurance plan for details of what is covered and what is not. We can explain this further if necessary prior to scheduling an initial session.
For additional insurance, online video-based therapy, fee-related questions/information, and cancellation information, please see the For Patients page.
Dr. Howells a member of PsyPact and I am able to provide online ISTDP to residents of 39 states and Washington D.C. The states/areas shaded in dark blue on the map at the bottom of the page are participating PsyPact states.
Please see the For Patients page for additional information about online therapy.
To learn more about ISTDP, please visit the links below: