AEDP and ISTDP: The Difference, and Why It Matters
People sometimes ask me what kind of therapy I do, and the honest answer takes more than one word. I work with experiential dynamic therapies. The two I draw on most are AEDP and ISTDP. They are cousins. They come from the same family, and they want the same thing for you, but they go about it differently enough that the difference is worth explaining.
What they have in common
Both are built on a simple observation. Feelings that were too much to feel at the time do not go away. They get managed. We learn to change the subject, to explain instead of feel, to go quiet, to get busy, to be fine. Those strategies made sense once. Years later they are still running as groundwater in your life, outside your conscious awareness, and they cost something: anxiety, low mood, trouble in relationships, a sense of standing at a distance from your own life.
Both therapies go toward the feeling rather than around it. Neither one is mainly about insight or advice. In both, something is meant to actually happen in our room, in your body, while we are together.
What AEDP emphasizes
AEDP begins with safety and with connection. The first task is making sure you are not alone with what you carry. Diana Fosha, who developed it, writes about undoing aloneness, and that phrase is precise. A great deal of what hurts was endured alone, and a great deal changes when it no longer has to be.
AEDP also pays close attention to what happens after something moves. When relief or grief or tenderness arrives, AEDP slows down and stays with it. That is treated as part of the work, not as the end of it.
I trained through AEDP Level III, and it shapes how I work with people.
What ISTDP emphasizes
ISTDP was developed by Habib Davanloo, and it is taught today by clinicians like Jon Frederickson and Allan Abbass. ISTDP looks hard at what stands between you and your own feeling. It works with three things at once: the feeling itself, the anxiety that rises as the feeling gets closer to the surface of your awareness, and the defenses that keep both at a distance.
It is more direct than people expect. Directness is its own kind of compassion. It gets to the pain more quickly, and that is how the pain ends sooner. When I work this way, I will notice when you shift into explaining, and I will say so. When using ISTDP, I watch anxiety carefully, because anxiety shows up in the body in particular ways, and those signs tell us how much you can take on at any given moment.
I am in ongoing ISTDP training. I use it in my work. I am not going to call it my specialty, because I am a beginner in it, and you deserve to know that. I am an experienced therapist. In this particular method I am a student, and I am glad to be one.
What the difference means for you
Roughly: AEDP leans on the relationship to make feeling possible. ISTDP leans on clearing the obstacles to make feeling possible. Both are headed to the same place, which is you having access to what you actually feel and being able to use it.
Which emphasis serves you better depends on you. Some people need a long while before anything in them believes it is safe to let go. Pushing there is not brave; it is careless. Other people have been talking about their lives for years and are tired of it, and what helps is someone who will gently stop the talking.
How I actually work
I am not a purist, and I would be a little suspicious of one. I pay attention to what is in front of me. If your anxiety is high, we regulate it before anything else. If you are guarded, we do not go at the guard; we find out what it is protecting. If something opens, we stay with it.
I also work with grief, with shame, and with chronic pain that has a stress component, and the same principles apply where they are appropriate for you.
If any of this sounds like what you have been looking for, or if you are not sure, I offer a free 15-minute phone consultation. You can ask me anything. This is your therapy, and you get to decide.