Intensive Short-Term Dynamic Psychotherapy

07/19/2025

Supervision Course – Year 4 (2025–2026)
Co-Creating Effective and Safe Therapy

We’re excited to welcome you to the fourth year of the Supervision Course!

This year, we continue our commitment to helping you develop your therapeutic skills — with a deep focus on connecting to the patient’s wish to heal, and supporting therapists to feel more secure and effective in their work.

💡 Our Focus
In both groups, we will:

Deepen your ability to connect with the patient’s unconscious wish to heal

Strengthen the therapist’s capacity to help from a grounded and clear stance

Work in the real relationship, paying close attention to the conditions needed for collaborative, safe therapy

👥 Who is it for?
Therapists of all levels

Teachers who want to develop their supervision and teaching skills (can join either group)

📅 Group Options & Initial Dates
Each course includes 15 sessions.
🗓 Additional dates will be posted later in the year.
🟦 Pre-Core Group (Thursdays)
Time:
🕘 9:00–10:50 a.m. EST
🕒 3:00–4:50 p.m. CET
🕓 4:00–5:50 p.m. Israel time
🕟 4:30–6:20 p.m. Iran time
Initial Dates:

September 18, 25

October 2

November 20

December 4, 11 (no session on Dec 12 – conference)

December 18

🟨 Advanced Group (Fridays)
Time:
🕘 9:00–10:50 a.m. EST
🕒 3:00–4:50 p.m. CET
🕓 4:00–5:50 p.m. Israel time
🕟 4:30–6:20 p.m. Iran time
Initial Dates:

September 19, 26

October 3

November 21

December 5, 19

🧠 Session Format
0:00–0:20 — Learning with Yuval
Focus: Exploring the patient’s wish to heal and the therapist’s wish to help
0:20–1:20 — Supervision with Jon (based on participants’ cases)

1:20–1:50 — Group practice and discussion based on the case

✅ All sessions are recorded and shared with a written summary and key learning points.

💳 Fees
Group Early Bird (until July 30) Regular
Thursday (Pre-Core) $720 $800
Friday (Advanced) $980 $1100
🌍 India, Iran, and low-income countries $250 flat rate

✅ How to Register
Send payment via PayPal to: istdpisrael@gmail.com

Please add 5% to the total to cover PayPal processing fees.

For questions or to request a sliding scale: a.yuval7@gmail.com

🤝 Join us on this shared journey of growth, clarity, and connection.
--
בקרו באתר שלנו - visit our website

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06/12/2025

If rage is usually the result of splitting without complex feelings, why are we encouraging murderous rage portrayals in ISTDP?

Here are my potential answers: 1.We must ALWAYS portray ONLY if the patient indicates through signaling that there is complexity present.
2. We are talking about imaginal rage in ISTDP, as opposed to the rage being spoken of on this admirable listserve.
Help me out here if you get a moment. Thanks to one of our community members for these questions!

We explore murderous rage in portrayals ONLY if it is rage toward someone the patient LOVES.

Rage + Love = mixed feelings.

Anxiety rising in the body = "Careful, this is rage toward someone you love. Quick, use a defense to protect that person from your rage."

When a patient engages in splitting, they feel ONLY rage toward the other, having split off and denied their love. They do NOT feel mixed feelings. They split off, deny, and/or project the other feeling.

If you explore only their rage, no anxiety will rise because there is no love to trigger the anxiety.
There will be no defenses to ward off the rage either because there is no love to lead them to protect the other.
Think of people who get into physical fights or criminals: they split, view the other as all bad, and act out their rage without
any anxiety rising and without any defenses to protect the other from their violent urges. Through splitting, they view the other as all-bad and believe that person deserves the absolute worst treatment in life, even death.

That's why we do not ask for portrayals of rage with patients who split. We would be encouraging splitting and acting out.
Instead, we address the structural problem: the inability to tolerate mixed feelings toward another person.

Here, we use pressure to consciousness of splitting.
Th: You say she is a bitch, yet she is also the same person who took you to the hospital when you overdosed, and saved your life. That must be confusing to feel such rage toward someone who has been so loving."

Pressure to consciousness of splitting reminds the patient of mixed feelings so he can tolerate them and the anxiety they trigger without splitting them apart. This is a common kind of pressure we use with fragile patients to build their affect tolerance. And here, the term affect tolerance means the ability
to tolerate one's angry and loving feelings at the same time without splitting them apart.

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06/05/2025

How Can I Deal with a Narcissistic Bully in the Workplace?
How can I deal with a narcissistic bully in the workplace who has massive issues with envy and hatred of female authorities? Why do organizations find it so difficult to deal head-on with bullies? And how can victims learn to manage constant objections, nit-picking, passive aggression, 'turning the tables', and gaslighting?

For instance, when we address his problematic behaviors, he becomes visibly angry-almost menacing - i.e., stoney faced; silent; staring. He then replies, "I don't accept that,” and argues. We then feel as if we are being interrogated, as if we are wrong and unfair to give this feedback. And we fear he will retaliate since he claims we are bullying and harassing him.
I am not singling him out. He IS the only team member who challenges all the colleagues with his adversarial, defensive, and argumentative behavior. He is also extremely elitist and wants anyone more "junior" in the team to address him as "Doctor." No other therapists insist on this. Further, he tries to get them to do all of his administrative work.

When I give him feedback, he interrogates me and claims, "You are getting mixed up and confused".

He also tells lies about me to other colleagues, denigrating me and pointing out my mistakes behind my back. He is well known in the organization as someone who denigrates others, elevates himself, and claims that only he knows how to run things.

In supervision, he brings no relevant material. Instead, he only talks about the good work he is doing and the positive feedback he gets from patients. When I point out a blind spot, he becomes defensive, argumentative, angry, and disengages.

When we ask him to do something, he never ever just does it. Instead, he picks holes, objects, and enters into lengthy emails until we give up and do it ourselves.

Thanks to one of our community members for this important question!

The narcissistic bully seeks admiration more than anything because he lacks all self-worth. Any mistake plunges him into self-hatred, so he immediately turns the tables to make you feel the worthlessness that would otherwise drown him. That is why he cannot accept feedback.

Thus, his next step: “I did nothing wrong. YOU did something wrong to me and are being unfair to me by offering critical feedback.”
Since your criticism “attacked” his grandiosity, he will reverse the roles. “Now I will attack you, criticize you, and nitpick you continually so that you are the one feeling worthless and bad. When you gave me this feedback, YOU bullied me and harassed me. So I should report YOU as the victimizer.”

“Since I need constant admiration to ward off my sense of worthlessness, you must call me Doctor. If you ask me to do any task, you are attacking my grandiosity. YOU should take the one-down position and do this lowly work. I, the great one, should never have to do such lowly tasks. So I will argue with you until I get you to submit and do my work for me. Then, when you do my work, you will have rewarded me for bullying you into submission.”

“When you offer feedback, I will tell you that you are confused and mixed up. That’s how I try to convince you that you are crazy if you have any critical idea about me or my performance. I ask you to hold my craziness so that I can judge it in you.”

To be clear, these bullies do not stop themselves. They try to attack your self-esteem because they have none. They will always claim to be the victim when they victimize you.

Understanding the Problem
Common Behaviors of Workplace Narcissistic Bullies
• Defensive reactions to feedback: Becomes visibly angry, stony-faced, silent, or staring when confronted
• Role reversal tactics: Claims "I don't accept that" and turns criticism back on the feedback provider
• Gaslighting: States things like "You are getting mixed up and confused" to undermine confidence
• Reputation damage: Spreads lies and denigrates colleagues behind their backs
• Grandiosity demands: Insists on titles like "Doctor" and refuses to do administrative work
• Supervision avoidance: Only discusses positive feedback, becomes defensive about blind spots
• Task resistance: Never complies directly; instead, picks holes and objects until others give up

Why These Behaviors Persist
Narcissistic bullies lack genuine self-worth and desperately need constant admiration. Any criticism triggers intense self-hatred, which they immediately deflect by:
• Reversing victim/perpetrator roles
• Attacking the critic's competence and worth
• Creating confusion about who is being inappropriate
• Demanding special treatment to maintain their grandiose self-image

Why Organizations Struggle to Address This
• Fear factor: Management is often as intimidated as other employees
• Lack of boundary-setting skills: Leaders may not know effective limit-setting techniques
• Legal intimidation: Bullies often threaten lawsuits when confronted
• Documentation gaps: Without clear evidence patterns, action is difficult

Effective Response Strategies
Core Principle: Disengage, Don't Engage
The goal is not to change the bully (which is impossible), but to protect yourself from manipulation and gaslighting. In essence, these strategies are designed to help protect you from an emotional predator.
Specific Response Scripts
When they reject feedback:
• Bully says, "I don't accept that."
• Your response: "That's okay. You don't have to accept my feedback. I will make a note that you did not accept my feedback."
• Then, walk away immediately. Document the interaction.

When they try to delegate their work:
• Bully says, "I don't want to do this. Will you do it for me?"
• Your response: "No thanks."
• Then: Walk away. Do not argue or explain.

When they gaslight you:
• Bully says, "I think you are getting mixed up and confused."
• Your response: "No. I'm quite clear."
• Then, walk away and disengage.

When they claim not to understand:
• Bully says, "I don't understand."
• Your response: "That's okay. I don't need you to understand for me to understand."
• Then: End the discussion. Walk away and disengage.

When they send continuous emails:
• Your response: Say "No" in the first email only
• Then: Ignore all subsequent emails. Your "no" is not up for negotiation. You do not need to read the “analyses” a narcissist offers about why you refuse to be a satellite orbiting his grandiosity. Save the emails for future evidence. But do not read them. If you read them, he will be able to manipulate you through them. Deprive him of this pleasure.

Universal Guidelines
• Walk away immediately after delivering your response.
• Never explain, argue, or convince - this only fuels his need for conflict.
• Remain emotionally neutral - they feed off emotional reactions. If they see your pain, they will continue to harass you to get pleasure from your pain. Hide it to deprive them of that pleasure.
• Minimize all contact when possible. When next to him, walk away. When he invites you to argue, do not pick up the bait. When he devalues others, leave the room.
• Remember: "Never get into a fight with a pig. You just get dirty and make the pig happy."

Common Myth
A common myth is that if you punch a bully in the nose, he will back down. That is true in situations where you are in a position of power, which he will have to respect. But in this work situation, there is no power in the organization that he respects. If you verbally punch him in the nose, he just punches back. If you argue, he argues. Thus, however tempting it may be to let him have it verbally, he will just fight back more. If you humiliate him, he will lash out with more narcissistic rage.

Build Your Defense
Create a comprehensive evidence file by:
• Writing precise notes immediately after each incident
• Emailing notes to yourself to establish timestamps
• Recording patterns of behavior across multiple incidents
• Including witness information when available
• Tracking all communications (emails, messages, etc.)
This documentation serves two purposes:
1. Protection: If the bully tries to target you with HR.
2. Action: Provides evidence for potential harassment claims you might file.

Working with Management
When management finally acts, they can use your documented evidence to respond effectively:
Example Management Response:
• Bully: "Here you go attacking me, just like the others! I could sue you for harassment."
• Management: "Rather than taking advice from your supervisor and management, you threaten us with a lawsuit. As a result of your threat, we now face a legal situation. Therefore, this conversation is over. I will inform HR to take the necessary steps."

Key Reminders
• These bullies do not stop themselves - external boundaries are essential.
• Bullies ask you to have no boundaries to their abuse.
• You must set boundaries to survive in the presence of a bully.
• They will always claim to be the victim when they victimize others.
• Your goal is self-preservation, not his rehabilitation.
• Consistent documentation is your strongest protection.
• You are not alone - this behavior often affects multiple colleagues. Encourage all of them to secretly document his behaviors to protect each other as a group.

When All Else Fails
Disengagement strategies may not stop the harassment. The bully may continue because he can't do anything else. Remember that the purpose of your plan is not to change a bully, but to protect yourself against his emotional manipulation. To get rid of him, you and your colleagues need to document his harassment. Then, your documented timeline becomes the foundation for:
• HR intervention with clear evidence of patterns
• Potential legal action for workplace harassment
• Protection for yourself and colleagues who may also be targeted
The comprehensive evidence you've gathered will be difficult for any organization to ignore and provides the foundation for serious consequences if the behavior continues.

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06/04/2025

What does the interpersonal perspective reveal to us about our work?

Read what Oliver Sacks writes and think about the implications. If the therapy is stuck, we are helping to keep it stuck. We just know how we are doing it. There are two people in therapy, both influencing what is happening.

05/25/2025

"How is the causal relationship and its direction established when it comes to theorizing about chronic pain or illness? (I believe Dr. Allan Abbass says something similar to what you wrote in your post about Ulcerative Colitis and, more generally, those conditions that are currently categorized as "functional somatic disorders".)

Does this theory only apply to functional somatic disorders? What about something like Lupus - how does ISTDP understand/explain it? Has that changed as our understanding of these conditions has changed?

How could one know if the psychological issues predate the onset of the condition?

As one moves through the medical system with a condition that is not well understood, one often experiences dismissal, neglect, even abuse. Is it possible that these experiences lead to the anger that gets buried - that therapy then uncovers?

Does everyone with chronic pain/other functional somatic disorders have the same/similar attachment histories?
What a set of wonderful questions from a community member! Okay. Here goes.

1. "How is the causal relationship and its direction established when it comes to theorizing about chronic pain or illness? Sometimes the patient tells you that there condition started after an emotionally triggering event or trauma. Many times, patients see no link to the past.

So, the way we assess whether there is a causal relationship between emotions and pain is by inviting feelings in the session and observing the patient's responses. If pain repeatedly rises in response to a rise of feelings, we are dealing with a psychogenic condition that will respond to therapy. If pain does not fluctuate in response to fluctuations in the rise of feelings, the pain is not psychogenic, and the patient requires more thorough medical assessments to determine the cause.

2. Does this theory only apply to functional somatic disorders? What about something like Lupus - how does ISTDP understand/explain it? Has that changed as our understanding of these conditions has changed?

Lupus is an autoimmune disorder. While emotional triggers can exacerbate the disorder, they are not the sole cause. That is why psychotherapy that helps patients face feelings they usually avoid, regulates anxiety, and helps patients develop more affect and anxiety tolerance, can reduce the severity and frequency of episodes.

Why? High anxiety is discharged in the parasympathetic branch of the autonomic nervous system, which becomes over-activated. Instead of regulating the body and immune response, over-activation of the parasympathetic nervous system suppresses immune response making patients more vulnerable to autoimmune disorders.

Previously, autoimmune disorders were understood primarily at the biological level. More recent research has found that psychotherapy helps with anxiety regulation, reducing over-activation of the parasympathetic nervous system, so that it regains more of its regulatory capacity. As a result, we see a reduction of the frequency and severity of relapses in multiple sclerosis. This has been shown in a number of research studies. Interestingly, multiple sclerosis is often triggered by a major emotional event. I don't believe that is the case for Lupus. However, this shows that autoimmune conditions may have purely genetic causes but are influenced by psychological factors, which we can address in therapy to improve the patient's mental and physical health.

3. How could one know if the psychological issues predate the onset of the condition? The clinician can find this out through a detailed inquiry. However, keep in mind that autoimmune disorders are not usually caused by psychological factors, though they can be influenced by them. For instance, no one claims that ISTDP can "cure" Lupus or multiple sclerosis. However, ISTDP has helped a number of patients recover from IBS, irritable bowel syndrome, a condition highly influenced by anxiety going into the smooth muscles.

4. As one moves through the medical system with a condition that is not well understood, one often experiences dismissal, neglect, even abuse. Is it possible that these experiences lead to the anger that gets buried that therapy then uncovers? Sadly, some medical patients have had experiences that led to anger toward physicians. When therapy helps patients face their anger toward specific physicians, that often reduces their anxiety and ends their tendency to turn anger upon themselves. Those two changes alone will lead to a reduction in physical symptoms. It's an area of medical trauma.

5. Does everyone with chronic pain/other functional somatic disorders have the same/similar attachment histories? No. For instance, someone can have chronic pain due to scoliosis. That pain is caused medically. If we narrow our question to patients who have chronic pain that has a psychological cause, most likely the patient's anxiety is going into the smooth muscles or cognitive perceptual disruption. Most likely, the patient is using the resistance systems of repression (turning on the self) or splitting and projection. Thus, they will have physical symptoms resulting from anxiety. And they will have physical symptoms resulting from identification with the body of the person they unconsciously want to attack.

A variety of attachment histories can generate these symptoms. Physical abuse, psychological abuse, sexual abuse, neglect, abandonment, traumas of living in a war zone, traumatic accidents, and on and on. Usually, these patients have a great deal of difficulty dealing with rage toward someone they loved, and that rage goes back onto their body. That defense happens unconsciously, outside their awareness. So we start by helping them notice how pain arises just after they mention feelings toward others. Tolstoy said something to the effect that all happy families look the same, but troubled families look very different. There are many paths to suffering. So we must pay close attention to the details

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05/24/2025

"I was wondering if you could do a post on the relationship between trauma & grief, and chronic pain?" Thanks to Katie for this question!

Let's assume a particular kind of trauma to give some context. Suppose a patient suffered physical abuse as a child from her parents. In response, of course, she will feel anger toward the abuser whom she loved. She would have experienced fear of the abuser. She would also have experienced grief over the loss of safety and love. Complex feelings.

Naturally, she is wired to connect. She will have a desire to share those feelings to get help from her parents. But now she has learned it may be dangerous to share feelings because she may get hit. So she learns to hide her feelings to remain safe from abuse and to regulate the anxiety of her parents/abusers.

Those defenses start as very adaptive responses to an abusive environment. They enable her to survive under difficult circumstances. They operate automatically and unconsciously throughout her childhood. And, all together, they constitute her insecure or disorganized attachment pattern in adulthood.

Sadly, defenses that were adaptive in a past abusive relationship are maladaptive in adulthood. First of all, when she uses these defenses, she is recreating the insecure or disorganized attachment of her past, leading to a series of painful relationships.

Secondly, these unconscious defenses in adulthood create her current presenting problems and symptoms. Since she doesn't see her defenses, she doesn't know what is causing her difficulties. All she knows is that she is suffering.

Thus, a central task of the therapist is helping the patient see what she cannot see yet: the defenses causing her suffering. So what defenses do we need to point out?

That depends on the kind and extent of abuse, the level of disturbance in the parents, the patient's own genetic resilience, and the relational resources that were available to the child.

The resulting picture may be a patient who was abused but uses defenses in isolation of affect, who can intellectualize and detach from her feelings so she is not overwhelmed by anxiety. Her anxiety is regulated, in the striated muscles.

Or we might see a patient who was abused but uses defenses in the system of repression where she suffers from self-attack, somatization, and conversion. Her anxiety is discharged in the smooth muscles.

Or in the most severe cases, we see patients who were severely abused and use defenses such as splitting, projection, and denial, and whose anxiety is in cognitive/perceptual disruption.

Patients who suffer from chronic pain usually use the resistance system of repression, or splitting and projection. They are often unaware of their rage toward abusers. As soon as any anger rises, unconscious defenses turn the anger against the patient. Anger toward abusers may be redirected onto oneself in the form of self-attack, self-dismissal, or self-devaluation. And anger toward abusers may be redirected onto one's body in the form of specific physical pain symptoms (e.g., stabbing pain in the heart) or in chronic pain throughout the body. Usually, this is because of an unconscious massive rage impulse, a wish to attack and destroy the abuser's entire body. And the patient unconsciously identifies with the destroyed body of the abuser to avoid the unconscious guilt over that impulse.

Since feeling rage in childhood was so dangerous (It could trigger abuse.), the patient learned to hide it. Further, since the tiniest amount of anger can trigger self-attack or somatization, the therapist must explore feelings toward abusers in a very gradual manner to build the patient's capacity.

Interestingly, as soon as you explore feelings toward abusers, self-attack and somatization will occur. We need to help the patient see the link between feelings, anxiety, and turning the anger upon herself. But, here is the big surprise for the therapist. At the moment the patient is turning anger upon herself IN THE RELATIONSHIP, she is unconsciously protecting YOU. "Since this anger is going back onto you right now, hurting you, naturally I'm concerned about any feelings coming up here toward me that could make you hurt yourself like that in our relationship. So, I wonder what feelings are coming up here with me?"

The patient will say things like, "I don't have any feelings toward you." [Don't worry mom and dad."] "I have only positive feelings." ["Don't worry mom and dad. I have only positive feelings. Do you feel okay now?"] The patient begins to protect you the way she had to protect her parents. She is enacting her past relationship, the childhood attachment pattern. And this we call the transference.

The therapist who understands this transference, this attachment pattern she uses in all her relationships, will continue. "Of course you have positive feelings. But if that was all you felt, you wouldn't be anxious and depressed. So, IN ADDITION to those positive feelings WHAT OTHER FEELINGS are coming up here with me?"

Here, the therapist is exploring the feelings previously hidden under the patient's defenses. On the relational level, the therapist is offering a secure attachment: "You can share any feelings here. And I will not get anxious or ward off any feelings you have toward me." You do not say this to the patient in words. You demonstrate it through your actions: continuing to invite feelings toward you.

As you explore feelings toward you, self-attack may come up. Then you can show her the triangle of conflict: "When feelings come up here toward me, that makes you anxious, and then you could protect me by letting the anger go back onto you. If you are nice to yourself and let the feelings come toward me, what feelings are coming up toward me?" Now, she learns to see how defenses that make her depressed are happening constantly in THIS RELATIONSHIP WITH YOU. Experiential learning. And this is what happens in all her relationships.

Or as you explore feelings toward you, perhaps she feels pain in her body. Again, you describe the triangle of conflict. "When you feel this anger toward me, notice how your body takes the hit? If you are nice to your body and let the anger come this way, how do you experience that anger toward me if you let come this way?" Here, you help her feel the anger outward so it doesn't go inward. You keep building this capacity, what we call affect tolerance. Eventually, as her affect tolerance increases, she will become aware of violent impulses toward you and others without having to turn the rage upon herself. And as she experiences those impulses with you, she will learn toward whom those impulses really belong, and then she will feel the previously unconscious guilt over that previously unconscious rage. Then that unconscious guilt will no longer drive her self-punishment.

And now that she can face her rage toward the abusive parents, she will no longer have to use the defense of identifying with her abusers. She will no longer have to unconsciously abuse herself by inflicting verbal or physical abuse upon herself. Perhaps you ask, "Why would she identify with an abuser?"

When the abuser hits her, she loses the safe relationship she had. She has been abandoned. She has no one else to turn to. So she must identify with the abuser to maintain the bond. When she identifies with the abuser, the abuser's anxiety drops, and an insecure or disorganized attachment is re-established. A bad bond is better than no bond because no bond equals death. The child cannot survive on her own.

Thus, in self-attack, the patient verbally abuses herself as she was abused. In self-dismissal, the patient dismisses herself as she was dismissed. The patient who claims to be incapable may be identified with the parent who called her an idiot. "If I agree with your abuse, can you love me then?"

I have focused her on the issue of chronic pain because these patients usually have little difficulty feeling their grief. The problem is that often grief comes in to cover up their anger. "It sounds like you are really good at feeling grief. I don't think that is something you need help with. It seems to me that you have more trouble feeling your anger. Shall we look underneath the tears and see what they might be covering? If we look under the depression, could we find the rest of you? So if we look under the grief, what other feelings are coming up toward your father?"

Is the grief real? Of course it is! The question is not whether it is real. The question is its function. Does the grief lead to greater emotional freedom for the patient, or does it leave her feeling more depressed and stuck? Does it help her feel her anger, or does it inhibit her from having access to her anger and power? So if encouraging grief and tears is leading to progress, keep up the good work! But if the patient remains stuck, then consider the option of exploring the feelings that might be hidden underneath the tears and depression. These patients do not need to feel more depression. That is a painful symptom. They need help accessing the feelings hidden underneath the depression.

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