Individual Therapy · Lisbon & Online
ISTDP Therapy in Lisbon with Piotr Szmyt, IEDTA Certified Psychotherapist
Struggling with recurring anxiety, emotional blocks, or patterns that feel impossible to break? ISTDP is a focused, evidence-based approach that works directly with buried emotion and the body's anxiety response to create rapid, lasting change.
Piotr Szmyt · ISTDP Psychotherapist & IEDTA Certified
What Is the ISTDP Model?
In my practice in Lisbon, I use ISTDP — a dynamic therapeutic approach developed by Habib Davanloo and researched further by clinicians including Allan Abbass, Jon Frederickson, and Josette ten Have-de Labije. Unlike therapies that work mainly through intellectual insight, ISTDP focuses on the somatic, bodily experience of emotion in the present moment, aiming for structural change rather than symptom management alone.
Two frameworks guide the work: the Triangle of Conflict, which maps how feelings, anxiety, and defenses interact inside you right now, and the Triangle of Person, which tracks how those same patterns show up across your past, present relationships, and the therapy room itself.
The Triangle of Conflict: Feelings, Anxiety, Defenses
Every psychological symptom reflects a struggle inside you. The Triangle of Conflict maps this process:
In session, we track a specific sequence in real time: a feeling arises — say, anger. The body activates along that feeling's own pathway, and a moment later anxiety appears, a kind of physiological "freeze." Almost immediately after, the mind switches on a defense mechanism, whose job is to stop you from fully feeling the feeling and to pull your attention away from both the feeling and the anxiety.
It can help to think of these defenses not as flaws, but as intelligent strategies a child once relied on — unconscious ways of adapting to a parent in order to preserve the bond.
- Changing the subject — steering the conversation away from what just touched a nerve.
- Repression — pushing the feeling out of awareness before it's even registered.
- Self-attack — turning the feeling (often anger) inward as self-criticism.
- Intellectualizing — analyzing or explaining the feeling instead of experiencing it.
- Minimizing — "it's not a big deal" — shrinking the feeling down to make it manageable.
- Humor or deflection — joking to release the tension without touching what's underneath.
- Vagueness — staying general and unclear so the feeling never has to be named.
- Somatization — the feeling surfaces as a headache, fatigue, or tension instead of an emotion.
- Projection — attributing your own feeling to someone else ("they're the angry one").
- Compliance — becoming agreeable or apologetic to avoid the conflict the feeling implies.
Core Feelings & Impulses
Difficult life experiences trigger intense feelings — grief, rage, love, guilt — that sit underneath the symptom you came in with.
Somatic Anxiety
When these feelings threaten to surface, your nervous system automatically generates physical anxiety to keep them contained.
Defenses
To reduce that anxiety, the mind deploys unconscious defenses — intellectualizing, detaching, self-criticism, rationalizing.
The work is to identify and gently reduce these defenses so you can face the true feeling underneath without being overwhelmed by anxiety. If you want to check which anxiety symptoms apply to you, our Symptoms of Anxiety – Check List is a useful starting point.
The Triangle of Person: Past, Current, Therapist
Your emotional patterns tend to repeat across your whole life timeline. The Triangle of Person tracks where they show up:
Past
The original source — usually early relationships with parents or caregivers, where the emotional pattern first took shape.
Current
How the same pattern plays out today, with partners, friends, or colleagues.
Therapist
How the pattern shows up live, between us, in the therapy room — giving us a real-time way to work with it safely.
The Feeling–Anxiety–Defense pattern in the Triangle of Conflict didn't appear at random — it was built inside your earliest attachment relationships, as a way to keep those relationships working. If a parent struggled to tolerate a child's anger, sadness, joy, or excitement, the child learns, unconsciously, to turn that feeling into something else instead.
Here's how it plays out: anger or sadness starts to rise in you, and in that same moment you sense the parent pulling away. Over time, the feeling itself becomes linked to anxiety — an internal alarm that says, in effect, "if I show this, they'll leave." So a defense steps in automatically: smiling, joking, going quiet — anything that covers the anxiety and the original feeling, and brings the parent back. Decades later, the same sequence can still run on autopilot, long after the relationship that created it is gone.
Understanding Anxiety in ISTDP
In ISTDP, anxiety isn't treated as a vague mood — it's a measurable physiological response of the autonomic nervous system, and recognizing your specific pattern is often the first useful step. For practical, day-to-day strategies once you've identified your pattern, see Anxiety Symptoms: How to Manage.
Striated Muscle Pathway
Tension in the neck, shoulders, or chest. This is generally the healthiest pathway, and indicates a good capacity for emotional work.
Smooth Muscle Pathway
Gastrointestinal distress, migraines, or similar. This suggests anxiety tolerance is currently exceeded and we need to focus on regulation before going deeper.
Cognitive-Perceptual Pathway
Dizziness or mental fog — a sign of nervous system overload, where grounding comes before exploration.
3 Signs ISTDP Might Be a Good Fit for You
- You've done "talking therapy" before, understand your patterns intellectually, but nothing actually changes.
- You notice physical tension, gut issues, or fatigue that shows up alongside stress or difficult emotions.
- You tend to intellectualize, over-explain, or go numb whenever a conversation gets emotionally close.
Session Recording in ISTDP
Reviewing session recordings is considered a standard of care in advanced ISTDP practice — it lets me study subtle somatic shifts and micro-expressions that happen in fractions of a second, which sharpens how I work with you session to session.
Your choice, always
Recording only happens with your explicit, written consent, confirmed when you book your first session. If you'd rather not be recorded, you'll receive exactly the same quality of care. All recordings, when used, are kept in a secure, encrypted environment.
Doing ISTDP Work Online
ISTDP leans more heavily on visible bodily signals than most talk therapies, which is exactly why people sometimes assume it doesn't translate to video. In practice, the opposite tends to be true: with the camera framed to show the upper body, the same anxiety signals — tension, restlessness, shifts in breathing — remain fully visible, and being in a familiar space at home can lower some of the usual social defenses.
For the broader research on video-based therapy outcomes and how we run online sessions generally, see the full breakdown on Therapy Online.
ISTDP Intensive Session
€120
90-minute extended intensive · with Piotr Szmyt (IEDTA certified)
- Deep, focused work on core emotional patterns
- Body-aware, somatic approach
- Suited to complex or long-standing presentations
Official invoices (recibos) provided for every session — many EU, UK, and US private insurance plans offer partial or full reimbursement.
Frequently Asked Questions
Meet Your ISTDP Therapist
Piotr Szmyt
ISTDP Psychotherapist · IEDTA Certified
I've conducted ISTDP sessions online since 2020, adapting the somatic and psychodynamic approach to the video format without losing clinical depth. I'm a certified member of IEDTA (International Experiential Dynamic Therapy Association).
Full profile →What Tools Can Help Manage Anxiety Between Sessions?
ISTDP works with anxiety directly in the room, but two simple tools can help you recognize and regulate it in daily life, between appointments.
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Symptoms of Anxiety – Check List
A quick way to map your anxiety to one of the three pathways described above — striated muscle, smooth muscle, or cognitive-perceptual — so you understand what your body is doing under stress.
Open the checklist → -
Jacobson Training (Progressive Muscle Relaxation)
A structured tensing-and-releasing exercise that lowers striated muscle anxiety — useful as a short daily practice, not a replacement for the deeper work done in session.
Open the training guide →
Go Deeper
Explore the ISTDP Hub
Each section below expands on a topic covered on this page — with interactive tools to apply the ideas to your own experience.
Understanding Your Anxiety Pathway
A deeper look at the three anxiety pathways introduced above, with an interactive self-check to identify which is most active for you.
Explore anxiety → Defenses · InteractiveYour Defense Mechanisms
Ten common defense patterns explained in depth, with a quiz to help you spot which ones tend to run on autopilot for you.
Explore defenses → Emotions · InteractiveWhy Feelings Matter — Emotions Wheel
What a core feeling is, explored further through an interactive Plutchik wheel with somatic signatures for each primary emotion.
Explore emotions → Attachment · InteractiveAttachment Styles and the Patterns They Create
How the four attachment styles shape emotional expression in adulthood, with a self-reflection tool to identify familiar patterns.
Explore attachment → ResearchThe Evidence Base for ISTDP
A deeper summary of the key studies behind ISTDP, including the 2012 Abbass meta-analysis referenced in the sources below.
See the research → ComparisonISTDP vs CBT — What's the Difference?
An honest side-by-side comparison of how the two approaches work, and when each is more likely to be the better fit.
Compare approaches → ReadingEssential Reading on ISTDP
A curated list building on the scientific sources below — for clients, students, and the curious who want to go further.
See reading list → First SessionWhat Happens in Your First ISTDP Session?
A step-by-step expansion of the Trial Therapy mentioned above — what to expect, how to prepare, and what comes next.
Learn what to expect →ISTDP Principles in Couples Work
The Triangle of Conflict doesn't stop being useful outside individual sessions — the same pattern of feeling, anxiety, and defense plays out between partners, often driving the exact cycles of distance or conflict that bring couples into therapy. When that's the case, I draw on ISTDP's focus on underlying emotion alongside EFT (Emotionally Focused Therapy) in Couples Therapy sessions.
From the Blog
Learn more about ISTDP, anxiety, and expat life from our articles.
Struggling with Anxiety?
Anxiety shows up in the body long before it's named — tension, racing thoughts, a sense of dread that won't settle. Understanding your pattern is often the first step (read more about anxiety).
Prestigious Membership
At Psychotherapy Lisbon, continuous professional development is a priority — including certified membership in IEDTA, the international body for experiential dynamic therapies (read more about IEDTA membership).
The Expat Adjustment Curve
Why some expats find the "blues" persist long past the expected settling-in period — and what that signals clinically (read the full article).
Why Couples Struggle After Relocation
Relocation surfaces pre-existing dynamics and creates new ones. Understanding the mechanism makes intervention possible (read the full article).
Ready to Take the Next Step?
The first session is a genuine consultation — no obligation to continue. If ISTDP or working together isn't the right fit, we'll say so honestly.
Contact Me to Book a ConsultationAlso considering couples work? See Couples Therapy Lisbon. Prefer to meet remotely first? Read more on Therapy Online. Prefer therapy in Polish? Visit Terapia ISTDP online po polsku.
Scientific Background
Davanloo, H. (2000). Intensive Short-Term Dynamic Psychotherapy: Selected Papers. Wiley.
Frederickson, J. (2013). Co-Creating Change: Effective Dynamic Therapy Techniques. Seven Leaves Press.
Ten Have-de Labije, J., & Neborsky, R. J. (2012). Mastering Intensive Short-Term Dynamic Psychotherapy: A Roadmap to the Unconscious. Karnac.
Abbass, A., Town, J., & Driessen, E. (2012). Intensive Short-Term Dynamic Psychotherapy: A systematic review and meta-analysis of outcome research. Harvard Review of Psychiatry, 20(2), 97–108. https://doi.org/10.3109/10673229.2012.677347
Also At This Practice
Sylwia Latacz — Licensed Psychologist
Psychological assessment, psychodiagnostics, and psychotherapy with an OPP-registered psychologist (No. 31224) — in English, Polish, and Portuguese.
Meet Sylwia → Couples TherapyWorking 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 →