Information About ISTDP and Frequently Asked Questions
What is ISTDP and Does it Make Sense for Me?
Many people come to therapy after years of pain, trauma, or disappointment — sometimes from relationships and systems that failed to provide support. What makes change so difficult is that the very ways of coping that once offered protection can, over time, begin working against them. These automatic responses may inadvertently reinforce the very struggles a person longs to escape, keeping the cycle of suffering alive for years. Because such reactions often operate outside of awareness, it usually takes skilled therapeutic guidance to bring them into focus, interrupt the cycle, and open the door to lasting change.
Intensive Short-Term Dynamic Psychotherapy (ISTDP) was developed in the 1960s by psychiatrist Dr. Habib Davanloo. His work created a focused and experiential approach designed to accelerate change by helping patients identify and overcome the very obstacles that block progress, while still preserving the depth and effectiveness of therapy.
ISTDP is an evidence-based, trauma-informed psychotherapy that helps people rapidly address a wide range of psychological symptoms, self-defeating behaviors, and relationship difficulties to provide lasting relief. The therapy focuses on the interplay between a person’s feelings, anxiety, and defenses—automatic strategies that were once adaptive (often in response to trauma), but which may now interfere with growth and connection. Because these responses often occur outside of awareness, ISTDP brings them into focus. By understanding their role and facing the underlying feelings directly, patients can move beyond long-standing struggles, resolve symptoms, and achieve meaningful, sustainable change in both personal well-being and relationships.
Decades of clinical research support ISTDP’s effectiveness for a broad range of conditions, including anxiety, depression, trauma, personality disorders, medically unexplained symptoms, and treatment-resistant cases where other therapies have fallen short.
Active and Collaborative Treatment
ISTDP differs from many other therapies in that the therapist takes a highly active role, working with you to identify, understand, and address symptoms and their underlying causes. Because automatic anxiety and emotional management strategies can affect the success of therapy, ISTDP also helps you recognize these responses when they occur so you can address them and reduce their impact on treatment outcomes.
The First Session
In most forms of therapy, the first session is typically 60–75 minutes long and focused on gathering historical information and potentially assigning a diagnosis. The first session of ISTDP with me is about 2.25 hours long, and the emphasis is on beginning this “trial therapy” itself—both to see if it’s a good fit and to start moving toward relief immediately. Because many people only attend an initial consultation, ISTDP prioritizes quickly identifying treatment goals and beginning the work. This session also uses a unique process of history gathering and clinical psychodiagnosis that is embedded within the therapy itself, allowing me to collect a wealth of information directly connected to why you have come to therapy.
Ongoing Sessions
Subsequent ISTDP sessions typically last 80–90 minutes. Each appointment is designed to balance depth with efficiency—helping you build insight, work through emotional barriers, and make steady progress toward meaningful change.
Length of Treatment
When we talk about ISTDP, “short-term” does not mean a fixed number of sessions. Instead, it reflects the shared patient–therapist focus on achieving meaningful change as quickly as possible. While the treatment supports you, a central principle of ISTDP’s active stance is helping you address anything that might prolong suffering or extend treatment unnecessarily. The goal is to create meaningful change in each session. The length of ISTDP therapy depends on your specific difficulties as well as your motivation and engagement. Some people experience significant change in just a few sessions. On average, treatment ranges from 20 to 60 sessions, though it may be shorter or longer. The changes gained in ISTDP tend to be long-lasting, reducing the likelihood of relapse or a return of symptoms.
Why Recordings Help
Research shows that the use of video recording in psychotherapy tends to improve treatment outcomes. Because up to half of all patients do not fully benefit from psychotherapy—and around ten percent actually worsen over time—it’s important to do what we can to give you the best chance of success.
In ISTDP, video recording is standard practice. Delivering ISTDP is complex, and much of the work involves bringing unconscious patterns and processes into awareness as quickly and safely as possible. Reviewing recordings allows me to refine the process and improve your outcome.
With your permission (never required—therapy can proceed without recording), sessions are recorded for these purposes:
- Improved precision: Reviewing videos helps me notice subtle elements that may speed up progress or address barriers that went unseen in the moment.
- Consultation support: If treatment becomes stuck, it can be extremely helpful for me to review the recording with a small group of seasoned ISTDP therapists in a confidential consultation setting. Even therapists benefit from expert feedback to ensure you get the most effective help.
- Patient access: If you wish, I can share recordings with you so you can review your own progress.
Privacy & Security
Recordings are treated as psychotherapy process notes—they are not part of your official medical record or progress notes. They are stored securely on an encrypted (256-bit AES) hard drive, kept off the internet and separate from any networked computer. They cannot be shared with insurance companies or third parties, and they are destroyed after they have served their purpose in assisting your treatment.
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).
Insurance and ISTDP
Dr. Howells is an in-network provider with Blue Cross Blue Shield, TRICARE West, Aetna, Medicare, and United Healthcare. You are always welcome to use your in-network benefits; however, because ISTDP often uses extended sessions and, importantly, includes professional video review time (a key component to the ISTDP model), your out-of-pocket costs may be higher than in standard therapy—even when using in-network insurance.
The Initial Evaluation
The first ISTDP session is about 2.25 hours. Unlike a standard initial intake evaluation (medical insurance generally covers the diagnostic interview and assessment), the initial ISTDP evaluation includes the following:
- Psychosocial history gathering and diagnosis (insurance typically covers this portion).
- Extended therapy work built into the evaluation (insurance does not cover a same-day psychotherapy session when you have already had your initial session that day).
- Professional video review time—Dr. Howells reviews recordings outside of session for 30-60 minutes to refine the treatment plan and improve outcomes (insurance does not cover this cost; my fee, typically $100-200, is based on the time this takes).
As a result, insurance generally pays only for the diagnostic portion. The remaining services (same-day therapy work and video review) are your responsibility. These fees are included in your Good Faith Estimate before treatment begins.
Ongoing Sessions
Follow-up ISTDP sessions are generally 80–90 minutes. Insurance companies typically reimburse your psychotherapy session; however, similar to the initial evaluation process, the separate professional fee for video review ($100–200) is not covered by insurance and will be billed directly to you.
Why Some People Choose Not to Use Insurance
While you can use insurance for ISTDP, some people prefer to pay fully out-of-pocket. Reasons may include:
- Privacy: Insurance requires a formal mental health diagnosis, which becomes part of your permanent health record. Paying privately allows you to engage in therapy without creating an insurance record.
- Flexibility: Self-pay patients are not limited by insurance rules about session length or structure. This allows ISTDP sessions to follow the clinical model more closely (i.e, longer therapy sessions), rather than being shaped by what insurance will reimburse.
- Simplicity: Some people prefer a straightforward fee structure instead of navigating co-pays, deductibles, and unforeseen costs later.
Whether or not you use insurance, my goal is to make ISTDP accessible in a way that fits your needs
Options for Payment
- Using insurance + paying for additional ISTDP services out-of-pocket: You use your in-network benefits for the portion covered by insurance, and pay separately for the psychotherapy services insurance does not cover. For this initial appointment, the separate additional payment would cover: a) the same-day extended session, and b) the professional video review for the session. For follow-up appointments, the separate additional payment would cover: the professional video review for the session. *Note: because of how I manage my schedule and account for video review of sessions, follow-up appointments sometimes can naturally run 10–15 minutes longer without additional charge incurred to you.
- Self-pay for all parts of treatment: You may also choose to pay for the entire 2.25-hour initial session or follow-ups out-of-pocket, and opt-out of using insurance.
If Dr. Howells is out-of-network for your insurance, a superbill can be provided for you to submit directly to your plan.
Medical Nature of Insurance Coverage
Medical insurance typically only covers services deemed “medically necessary” for a DSM-5-TR mental health diagnosis (e.g., depression, anxiety, PTSD, bipolar disorder). Generally, people seeking ISTDP do meet criteria for a mental health diagnosis that insurance covers. That said, ISTDP also is helpful for people outside those categories: those without a medically covered diagnosis, but who are still looking to make meaningful change. In those such cases, you would be responsible for all costs not paid by insurance.
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 40 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: