In many contemporary psychodynamic therapy approaches, assessment involves understanding the nature of a client’s attachment trauma, and also the mechanism of their defences. Defences are automatic and unconscious behaviours that work (often by distorting reality) to protect us from feelings we learned were not acceptable or tolerable. They develop as survival mechanisms, enabling us once to survive painful or difficult experiences, but they become problems when they persist as we age despite the absence of what initially required them.
Let’s say you had an insecure attachment, and now you experience anxiety whenever you are about to do something you once learned wasn’t safe to do, such as reaching out for connection, for example. Then, instead of reaching out, you detach. A simple example: you’re at a party, and you want to be with people, but you get anxious and end up staring at your phone all night. Is that a problem for you? Do you wish you didn’t have to react that way?
ISTDP interventions are intended to address the unique system of defences which developed in response to your attachment experiences, with the aim of enabling you to feel the feelings you have long denied, and eventually to enable the development of a secure attachment to yourself, and consequently, when in relationship with others.
Thoughts on Therapy and Mental Health