An active, emotion-focused psychotherapy for anxiety, relationship patterns, burnout, and stress that shows up physically

ISTDP (Intensive Short-Term Dynamic Psychotherapy) is the primary framework I use in my work with adults in Central London (W1W) and online.

Many people come to me after years of coping: they understand their difficulties intellectually, but their anxiety, shutdown, people-pleasing, overcontrol, or physical stress symptoms keep repeating. ISTDP is designed for exactly these situations, where insight alone hasn’t created meaningful change.

Who ISTDP is most helpful for

ISTDP is particularly helpful if you:

• feel “high-functioning” externally but overwhelmed internally
• experience anxiety that shows up as tension, overthinking, or bodily symptoms
• notice repeating relationship patterns (e.g., people-pleasing, withdrawal, conflict avoidance)
• feel stuck in chronic pressure, burnout, or emotional numbness
• have persistent physical symptoms linked to stress (PPS)

ISTDP is not about talking around problems. It is about working directly with what happens in the moment, so the pattern shifts where it actually lives.

The ISTDP view: why symptoms persist

From an ISTDP perspective, many symptoms are maintained by a cycle:

• Something emotionally meaningful is triggered (pressure, closeness, disappointment, conflict)
• Feelings rise (often outside awareness)
• Anxiety increases in the body (tension, gut symptoms, breath restriction, dizziness, mental overactivity)
• We automatically use unhealthy internal mechanisms to manage discomfort/anxiety
  • overthinking
  • reassurance seeking
  • overcontrol or perfectionism
  • withdrawal or emotional shutdown
  • people-pleasing
• Short-term relief happens
• The underlying pattern remains, and repeats

In other words: anxiety and symptoms are not random. They are often the nervous system’s way of managing emotions that feel unsafe, unfamiliar, or costly to experience.

ISTDP therapy helps you build the capacity to feel and respond differently, so the system no longer needs to rely on anxiety, tension, or avoidance.

What ISTDP looks like in practice (not theory)

ISTDP is active and collaborative. In sessions we pay close attention to what is happening right now:

• what you feel in your body
• what emotions are emerging
• what the mind does to move away (defences)
• how patterns show up between us (often the same patterns that show up elsewhere)

The goal is not “expressing feelings” for its own sake. The goal is changing what keeps you stuck, so you can think more clearly, feel more grounded, and respond more flexibly in relationships and daily life.

Anxiety in ISTDP: a signal, not the enemy

Many approaches treat anxiety as the primary target. In ISTDP, anxiety is often treated as a signal: it rises when important feelings are activated but not yet conscious and/or tolerable.

We work on:

• recognising how anxiety shows up in your body
• reducing the need for internal mechanisms that maintain anxiety
• increasing emotional capacity so anxiety doesn’t need to take over

This is often particularly helpful when anxiety is linked to:

• chronic self-pressure and perfectionism
• relationship conflict or fear of closeness
• suppressed anger or sadness
• “holding it together” at all costs

ISTDP and stress-related physical symptoms (PPS)

Many people experience stress primarily through the body, chest tightness, gut symptoms, headaches, dizziness, fatigue, chronic tension, especially when medical tests have not explained the severity of symptoms.

ISTDP can help by:

• identifying how emotional activation is expressed through the nervous system
• reducing fear and monitoring loops
• increasing tolerance for internal experience so the body does not need to “signal danger” so strongly

(If this is a main difficulty for you, see my Persistent Physical Symptoms (PPS) page.)

What to expect: the first phase and beyond

Early sessions

• Clarify what brings you to therapy and what you want to change
• Map the repeating cycle (triggers → anxiety → internal mechanisms → consequences)
• Understand how anxiety is expressed in the body and how patterns operate in relationships

Ongoing work

• Work directly with the pattern in-session
• Reduce reliance on avoidance and overcontrol
• Develop emotional capacity so change holds outside the therapy room

Sessions are usually weekly initially and reviewed over time.

How this integrates with other approaches (without diluting the work)

ISTDP provides the organising framework of the work. Where it is clinically useful, I may integrate:

• CBT – to reduce avoidance and safety behaviours (e.g., panic loops, health anxiety checking, OCD patterns)
• EMDR – when specific memories are central to current symptoms
• DIT – when a focused, time-limited relational formulation is the best fit
• Psychodynamic principles – to understand deeper patterns and attachment themes

You don’t need to choose a method in advance. We decide together based on what will help you change most effectively.

(For the overall hierarchy and how I decide, see Therapy Approaches.)

Related pages

• Anxiety
• Health Anxiety
• Burnout
• Stress
• Panic Attacks & Agoraphobia
• Relationship Difficulties
• Family issues
• Persistent Physical Symptoms (PPS)

Frequently asked questions

Is ISTDP a short-term therapy?

ISTDP is often more focused and active than many therapies. Length varies depending on complexity and goals.

Will this feel intense?
The work is active, but it is paced carefully. The aim is increased capacity and clarity, not overwhelm.

Do you offer ISTDP in person in Central London?
Yes, I work in Central London (W1W) and online.

What if I’ve tried therapy before?
Many people come after therapy that improved insight but didn’t shift the underlying cycle. ISTDP is designed to work directly with what maintains patterns.

Next step

If you recognise this pattern: feeling stuck despite insight, coping on the surface but strained underneath, ISTDP may be a good fit.

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