ISTDP Hub · First Session
What Happens in Your First ISTDP Session?
The first session is different from what follows. It is a genuine two-way assessment — a chance to see whether this approach and working together makes clinical sense. Here is exactly what to expect.
The First Session Is Called a Trial Therapy
In ISTDP, the first session is sometimes called a Trial Therapy. The name reflects what it is: a live test of how you and the therapist work together, and of how your system responds to this particular approach.
Unlike many intake assessments, which are largely informational, a Trial Therapy involves genuine clinical work from the beginning. By the end of the session, both of us should have a clearer picture of what is driving your difficulties, how your anxiety and defenses operate, and whether ISTDP is likely to be useful for you.
If ISTDP is not the right fit — or if I am not the right therapist — I will say so directly, and suggest what might be more useful. The first session is a consultation, not a commitment.
Step by Step: What Happens
- 1You describe what brings you
I begin by listening — without interruption or premature interpretation. Your account of the problem, in your own words and sequence, is itself diagnostic information. I'm listening to what you say, how you say it, and what the body does while you say it.
- 2We look at a specific example
Rather than speaking generally about your difficulties, I will ask for a specific, recent situation — a moment when the anxiety, the low mood, or the relational pattern was active. Specific examples allow us to see the Feeling–Anxiety–Defense sequence in actual detail, rather than working with abstractions.
- 3I follow what happens in your body
While you speak, I am monitoring subtle physical signals — tension, breathing patterns, posture shifts, facial changes. These tell me where your anxiety is discharging (which pathway), and when a defense has just activated. I may ask about what you notice in your body.
- 4We work with what's alive in the room
The most useful information in ISTDP is always what's happening right now — between us, in this conversation. If a feeling starts to rise, we stay with it. If a defense appears, we notice it together. This real-time work is what distinguishes ISTDP from talk-based approaches.
- 5We share observations and next steps
Toward the end of the session, I will share my initial clinical impressions — what patterns I noticed, what the anxiety is pointing toward, and what continued work might look like. You decide whether to continue. There is no obligation or pressure.
Common Questions Before a First Session
Do I need to prepare anything?
Yes — it helps to come with a specific problem or difficulty that is currently active in your life, and ideally a concrete recent situation in which you felt it clearly. ISTDP works best when we have something specific to look at together: a recurring conflict, a moment of anxiety, a relationship pattern that keeps repeating. The more specific the example, the more we can actually see what's happening — rather than speaking in general terms about how things "tend to go."
What if I find it difficult to talk about my feelings?
This is extremely common — and it's actually useful clinical information. Difficulty accessing or expressing feelings is part of what we'll explore together. You don't need to be emotionally fluent to begin.
Will I feel worse after the first session?
Sometimes there is a period of processing after a session in which something real was touched. This usually settles within 24–48 hours. I will check in at the start of each subsequent session about how you've been since the last one.
How long is the first session?
90 minutes — the standard format for ISTDP. The extended length allows genuine clinical work to unfold without being cut short at a critical moment.
Your first ISTDP session can happen online, from wherever you are. The assessment process works exactly the same way — and for many people, being at home makes it easier to show up fully.
Book Online Session →Explore the ISTDP Hub
Each part of the ISTDP framework connects to the others. These pages take the next step.
Anxiety
Understand Your Anxiety Pathway
Anxiety in ISTDP is a signal, not a disorder. It always points toward something — a feeling that hasn't reached awareness yet. This page maps the three distinct ways anxiety discharges through the body, and includes an interactive tool to help you identify which pathway is most active for you.
Explore anxiety →Defenses
Recognise Your Defense Mechanisms
Defenses are intelligent strategies — built in childhood, still running in adulthood. They keep the anxiety manageable and the feelings at bay. But they come at a cost. This page explains the ten most common patterns and includes a self-reflection quiz to help you spot which ones dominate for you.
Explore defenses →Emotions
Why Feelings Matter — Core Emotions Wheel
Anxiety is always a response to a feeling that hasn't surfaced. But what exactly is a core feeling, and how do you distinguish it from a thought, a mood, or a narrative? This page introduces the primary emotional landscape, with an interactive wheel of core emotions and a plain explanation of why access to them — not just understanding — is what produces change.
Explore emotions →Attachment
Your Attachment Style and the Patterns It Created
The anxiety-defense pattern you carry today was built inside your earliest relationships. Depending on how caregivers responded to your feelings, you developed a characteristic way of managing closeness and emotional expression. This page explains the four attachment styles and includes a self-reflection tool to help identify which patterns feel familiar.
Explore attachment →From the Blog
Credentials
IEDTA Membership — What It Means Clinically
IEDTA certification requires demonstrated clinical competence in ISTDP assessed by international peers. What this means for the quality of your sessions.
Read the article →Anxiety
Anxiety Symptoms: How to Manage
Before your first session, a clearer map of how anxiety shows up in your body helps. This article gives you practical language for what you might experience and want to describe.
Read the article →
Your Therapist
Piotr Szmyt — ISTDP Psychotherapist, IEDTA Certified
English-speaking, working in Lisbon and online since 2020. Trained in ISTDP with Josette ten Have-de Labije. Member of IEDTA — International Experiential Dynamic Therapy Association.
Ready for Your First Session?
You now know what to expect. The next step is booking — a genuine consultation, no obligation, and an honest conversation about whether ISTDP is right for you.
Book a ConsultationAlso At This Practice
Psychological Assessment
Sylwia Latacz — Licensed Psychologist
Psychological assessment, psychodiagnostics, and psychotherapy with an OPP-registered psychologist (No. 31224) — in English, Polish, and Portuguese.
Meet Sylwia →Couples Therapy
Working Through It Together
EFT and dynamic-informed couples therapy for partners navigating conflict, distance, or major life transitions — in Lisbon or online.
Explore couples therapy →