Nancy McWilliams and Allan Abbass: What Psychoanalysis and ISTDP Have in Common

A leading psychoanalyst reconsiders a decades-old stereotype about ISTDP after watching Allan Abbass work live — and arrives at a conclusion that matters for how we think about defenses in therapy.

Nancy McWilliams is not a casual observer of psychotherapy. Her books Psychoanalytic Diagnosis and Psychoanalytic Psychotherapy: A Practitioner’s Guide are standard reading in psychodynamic training programs around the world, prized for translating dense theory into something a working clinician can actually use with a patient in the room. So when, in a recent interview for The Journal of Contemporary ISTDP, she described watching Intensive Short-Term Dynamic Psychotherapy (ISTDP) change her own long-held assumptions about the approach, it was worth paying attention.

A Stereotype Built on Old Tapes

McWilliams’ first exposure to ISTDP came in the 1970s, as a graduate student watching videos of the method’s founder, Habib Davanloo — described at the time as “the relentless healer.” What she saw was confrontational work, pressing hard and directly toward a patient’s anger. It left an impression that stuck for decades.

“I thought that’s a very male way of working with people,” she said. “Going after the defenses. I worked with defenses in a more, what would now be called, attachment way. You make the relationship and gradually, as they feel safe, they’ll come to you with their feelings.”

It’s a fair description of how many clinicians outside the ISTDP world still picture it: a single, forceful technique built almost entirely around confronting resistance and provoking feeling. McWilliams admits she carried that stereotype for most of her career — despite having read Allan Abbass’s own writing on resistance, which should have told her otherwise.

What Changed in Bergen

The shift happened in April 2025, at the Emotion Revolution conference in Bergen, Norway, where McWilliams watched Abbass present a recorded session live. His patient was a woman with a psychogenic disorder who found substantial symptom relief within just a few sessions. What struck McWilliams wasn’t the technique — it was Abbass’s own reaction to his patient’s progress.

“What moved me was his being so moved by her progress — he teared up. … I saw that he was very open to anger, but he often worked with other affects as well. And he felt them himself and could be on the journey with the patient, not just being an expert, telling the patient where to go emotionally.”

That was the opposite of the “relentless healer” she remembered from the 1970s tapes. Instead of a fixed, one-size-fits-all confrontation, she watched a therapist tracking a patient’s full emotional range in real time — attuned as much to what wasn’t being said as to what was.

Is ISTDP Psychoanalysis?

The conversation with interviewer Thomas Hesslow then turned to a bigger question: where does ISTDP actually sit relative to psychoanalysis? McWilliams’ answer was direct.

“I think that ISTDP is a psychoanalytic therapy.”

For McWilliams, psychoanalysis was never a single technique to begin with — classical couch-and-analyst work is, in her words, “a wonderful form of psychoanalysis,” but only one form. What actually defines the tradition, she argues, is a body of knowledge: a way of thinking about personality dynamics, defenses, affect regulation, self-esteem, and the difficult work of accepting what can’t be changed. By that definition, ISTDP — with its own detailed theory of defense and affect — belongs squarely inside it, not alongside it as a separate, rival school.

Where Contemporary ISTDP Goes Further

One thing McWilliams noticed specifically: today’s ISTDP, as practiced by Abbass and by Robert Neborsky, incorporates attachment theory far more explicitly than Davanloo’s original model did. That mattered to her, because attachment-informed thinking about defenses — reading them as strategies a person once needed, not flaws to be broken down — is close to how she herself already worked.

She was also struck by ISTDP’s range. She had assumed, like most outsiders, that it was by definition a short-term therapy. But hearing Abbass describe work with more fragile patients that stretched over months or years changed that picture too.

She sees the same pattern across the whole field, not just ISTDP. Every approach tends to promote itself first as a fast way to help people, then has to adapt once it meets real, serious problems. “That was true of Freud too,” she pointed out — he originally spoke of “an analysis” meaning six weeks of treatment. The same was true of Carl Rogers, and of the original behaviorists. Today, she noted, any experienced psychoanalyst, humanistic therapist, or CBT clinician working with people who need more simply spends more time with them — short-term versions of these approaches exist, but so do long-term ones, born out of clinical necessity rather than marketing. She sees an almost identical pattern emerging right now in psychedelic-assisted therapy: effective as a brief course for some patients, clearly not a short-term treatment for others.

A Gap in the Diagnostic Literature

One limitation McWilliams sees in ISTDP training is more practical than theoretical: not enough has been written connecting it to a systematic diagnostic framework. Hesslow, who trains other ISTDP therapists himself, uses her Psychoanalytic Diagnosis as a companion text for exactly this reason — ISTDP’s own diagnostic thinking is sophisticated, but hard for beginners to absorb from the ISTDP literature alone. McWilliams tried to build a bridge from the other direction, corresponding with Abbass while revising the Psychodynamic Diagnostic Manual (PDM) and folding some of his thinking into its newest edition.

She’s candid about the limits of that effort. Describing ISTDP’s theory of anxiety discharge, she said: “I studied it enough to understand it, enough to put it in there. But I haven’t embodied it yet.” It’s a useful admission — even a scholar of her stature treats real clinical fluency in a specific method as something earned through supervised practice, not something absorbed from reading alone.

A Tradition Passed Down by Video

There’s a generational note to the interview as well. Much of ISTDP’s teaching leans on videotaped sessions reviewed in supervision — precisely the medium McWilliams never built into her own training, having started out in the early 1970s, before recording a session was practical for most clinicians. She isn’t dismissive of it; she has taught from student video at Rutgers and sees real value in it. It simply isn’t how she was socialized into the work, and she still relies mainly on detailed oral case presentation in her ongoing consultation groups. It’s a useful reminder when comparing therapy schools: some differences are theoretical, but plenty of others come down to how a particular generation of clinicians happened to be trained, not which method is inherently superior.

Attunement, Not a Script

McWilliams also raised a sharper clinical question: doesn’t Abbass’s constant verbal activity — the frequent, direct check-ins on a patient’s feelings toward the therapist — risk overwhelming some patients? The answer, grounded in how ISTDP is actually taught, is that technique like “stacked pressure” is never applied uniformly. It depends entirely on moment-to-moment attunement to the patient in front of you. With a resistant, higher-functioning patient there is room to press; with a more fragile patient, pushing past their threshold risks a misalliance — anxiety, projection, or worse. The skill isn’t the pressure itself. It’s knowing, session by session, whether this particular person can tolerate it right now.

What This Means in Practice

This is the same clinical stance our own ISTDP-informed therapy is built on: defenses read as attachment strategies that once made sense, not pathology to defeat, and technique adjusted to what a specific person can actually work with — not applied as a fixed script regardless of who is in the room. It’s also why McWilliams’ broader point about psychoanalytic diagnosis resonates in training: understanding a patient’s overall personality structure, not just their presenting symptom, shapes how — and how fast — the work can safely go. (Readers interested in that diagnostic lens may also want our related piece on personality organization levels according to Nancy McWilliams.)

McWilliams closed the interview on a note that any clinician, regardless of school, tends to find true in practice:

“What seems to be the most healing is the relationship and whether the therapist is as experienced as they are genuine, interested, empathic, competent, wise, and so forth. That’s replicated again and again.”

The brand name of the therapy, in other words, matters less than most trainings assume. What matters is a therapist who can stay present, stay honest about the limits of what they know, and adapt the approach to the person actually sitting across from them — which is, in the end, exactly what changed Nancy McWilliams’ mind about ISTDP in Bergen.

Source: Hesslow, T. (2026). Nancy McWilliams: Davanloo’s tapes led me to have a stereotypical idea of ISTDP [Interview]. The Journal of Contemporary ISTDP, (4), 30–37.