Exploring Emotional Experience and Psychotherapeutic Change in Intensive Short-Term Dynamic Psychotherapy for Treatment-Resistant Anxiety

Abstract

This interpretative phenomenological analysis (IPA) study explores how individuals with treatment-resistant anxiety experience emotion and psychotherapeutic change during Intensive Short-Term Dynamic Psychotherapy (ISTDP). While ISTDP has demonstrated clinical efficacy in reducing anxiety symptoms, little is known about how clients subjectively experience emotional processes within this model, particularly following unsuccessful outcomes in previous therapies. Four adult participants were interviewed using a semi-structured protocol designed to elicit rich, first-person accounts of emotional experience, anxiety manifestations, and perceived therapeutic change. Analysis revealed three superordinate themes: (1) encountering anxiety as a somatic gateway to emotion, (2) negotiating defenses and vulnerability in the therapeutic relationship, and (3) experiencing breakthrough moments and their aftereffects. Participants described the emergence of complex emotions—such as rage, grief, and fear—as central to their therapeutic process, often accompanied by physiological symptoms and internal conflict. Across cases, psychotherapeutic change involved shifts in anxiety symptomatology, increased emotional clarity, greater self-acceptance, and improved relational functioning. These findings offer insight into the subjective mechanisms of change in ISTDP and contribute to the broader understanding of emotional experience and emotion-focused therapies for treatment-resistant anxiety. Implications for clinical practice, limitations, and future research directions are discussed.