How ISTDP Can Address Two Major Barriers to Mindfulness

iron gate before treesMindfulness is kind of a craze these days, in the psychotherapy world and elsewhere, and for good reasons. The capacity to accept and reflect upon inner states is an important part of any therapy experience and, in my opinion, an important part of experiencing life. Because mindfulness meditation can be a personal practice, many people use it as a form of self-help.

Lately, however, I have been hearing from people that their self-help efforts at using mindfulness have not been fruitful. Why is that? they wonder. How can I help them? I wonder.

The Forces That Block Mindful Awareness and Acceptance of Inner States

When we set an intention to look inside, anything can rise up into the light of our awareness. In an ideal world, we meet our inner life with acceptance and tolerance. In the real world, those of us who have been trained to fear or hide our inner lives meet the emergence of inner truths with anxiety and avoidance. This can make a major barrier to the therapeutic use of mindfulness. The inner truths we seek can become terrifying, or may be obscured by defensive mechanisms.

When Anxiety Is a Barrier to Mindfulness

One person said to me, “When I look inside, all that comes up is anxiety.” When she turned her awareness toward inner states, they all seemed to get buried under muscle tension and racing heart. What was it her mind was so terrified of?

When we face ourselves with an open mind and heart, previously disowned parts of the self, such as painful or taboo thoughts and emotions, call out to us and ask if we will finally accept them. The pain of past traumas, rage toward loved ones, guilt about wrongdoing—any emotion we tried to bury—will reach up to us and ask to be felt. For people who can let these emotions in and reintegrate them, mindfulness is very effective therapy indeed!

For many of us, however, the same anxiety that led us to disown or bury those emotions in the first place may reappear, coaching us to continue to fear and avoid. When anxiety is a barrier to mindfulness, we look inside and re-experience our old fears of ourselves and our feelings, rather than experience the reintegration we sat down looking for.

When Avoidance Is a Barrier to Mindfulness

Another self-help meditator told me, “When I sit down to explore my deeper self and feelings, my thoughts run off to my grocery list.” Avoidance can be another barrier to mindful awareness.

In the face of our old anxieties about our inner lives (e.g., emotions, wants, needs), many of us are tempted, consciously and unconsciously (read: intentionally or unintentionally), to avoid. Avoidance can take many forms: the grocery list, the self-critical list of imperfections, the to-do list, etc. Hyper-focus on goals and perfectionism about the task—“Am I doing this right?”—can also suck us out of the moment and away from our inner reality. Any thought or behavior, especially self-critical ones, can be called upon to avoid the task of being present with and accepting of our inner states.

Possible Origins of the Problem

We were not born with anxiety about and avoidance of our inner states. If you’ve spent any time with newborn babies, you may have noticed that they seem pretty comfortable being honest about wants, needs, and gut reactions. However, the sometimes-traumatic conditioning processes we undergo throughout development can make our natural inner states something we fear and avoid. Why?

My impression is that emotions become frightening when we have to bear them alone. The primitive nature of the emotions of childhood, and the child’s inability to differentiate feeling from action, turns feeling into a terrifying experience. When we can’t process these reactions with a supportive other, or when our loved ones turn away from us or coach us to hide our emotions, we lose the sense of security that is necessary to face anything painful and challenging in life. If our feelings and self-states are met with anxiety or avoidance from caregivers repeatedly throughout development, this only compounds our anxiety and encourages our avoidance.

How Instensive Short-Term Dynamic Psychotherapy Can Help

Facing our formerly warded-off inner lives is sometimes impossible to do alone, but with the support of a caring person we may find the strength to reunite with ourselves. All therapy models offer support and caring, but intensive short-term dynamic psychotherapy (ISTDP) is unique in its systematic approach to developing the capacity for mindfulness, and in its system for helping people overcome their barriers to mindfulness.

Facing our formerly warded-off inner lives is sometimes impossible to do alone, but with the support of a caring person we may find the strength to reunite with ourselves. All therapy models offer support and caring, but intensive short-term dynamic psychotherapy (ISTDP) is unique in its systematic approach to developing the capacity for mindfulness, and in its system for helping people overcome their barriers to mindfulness.

Though treatment will look different for everyone, some basic principles will always be a part of ISTDP treatment (Abbass, 2015): If a person presents with tension that blocks inner awareness of other emotions, they will be systematically supported to feel the feelings that are making them tense. If a person presents with avoidance mechanisms blocking their mindfulness capacities, they will be systematically supported to evaluate and, if they wish, turn against and relinquish those mechanisms so they can bear their feelings.

Perhaps even more valuable is the capacity of ISTDP therapists to work with people’s walls. If a man comes to therapy for help in reducing anxiety or avoidance and accepting his inner life, but then puts up a wall of interpersonal avoidance between himself and the therapist, this wall will defeat the goals he came to therapy with. In ISTDP, we have an elegant system of interventions for helping people to notice, question, and, if they want, lower their walls.

Finally, what about people who experience severe dysregulation such as dissociation, panic, depression, or cognitive and perceptual problems when trying to use mindfulness meditation? For folks whose anxiety is channeled in these potentially frightening ways, ISTDP offers a “graded approach”—a form of mindfulness coaching that can, in an incremental way, support the ability to experience and reflect about your emotions rather than become overwhelmed when they enter your attention. ISTDP therapists are trained to monitor the verbal and nonverbal reactions that are triggered as you try to face your emotions, and will help you face as much feeling as you can while working with you to make sure you do not become overwhelmed or symptomatic.

In my experience, at the end of a successful ISTDP treatment course, people have a very high capacity for mindfulness. They can observe their inner states and emotions in a more accepting way, without anxiety and avoidance blocking them, and in this way they can get to know themselves better and use their reactions in the service of living more wisely and authentically.

If you are having difficulty using mindfulness as a form of self-help, consider contacting an ISTDP therapist to see if he or she can help with the anxiety or avoidance patterns that are keeping you from more fully connecting with yourself.


Abbass, A. (2015). Reaching through resistance: Advanced psychotherapy techniques. Kansas City, MO: Seven Leaves Press.

© Copyright 2015 All rights reserved. Permission to publish granted by Maury Joseph, PsyD, Intensive Short-Term Dynamic Psychotherapy Topic Expert Contributor

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

  • Leave a Comment
  • natalie

    November 17th, 2015 at 8:11 AM

    um yes i am the one who lives via avoidance. I just ignore those things that I determine will be unpleasant even though I know that ultimately this is holding me back from achieving the success that I want.

  • Chad M

    November 18th, 2015 at 7:17 AM

    Those lines of defense should of course be used to protect us but I think that we will come to see that the more we throw up those walls then the more things we are refusing to see and deal with.

  • Orphan Izzy

    November 19th, 2015 at 10:19 PM

    I’ve learned through necessity that in order to learn to deal with the pain we all want to avoid ( and I mean live with it easily as well as manage future pain with ease as well comparatively) you literally have to survive through feeling it and understanding it and learning any way that is a healthy way to deal with it. It’s just not possible to be truly happy and at peace if you haven’t allowed yourself to go through that process and come out the other side. Nothing worth anything is easy to get and that goes for happiness and peace as well. Nobody wants to engage painful feelings but at the end of the day it is worth it beyond words. And even more importantly every person is worthy of that peace and happiness and deserves to get there somehow. That is a fact …unless you’ve murdered somebody or you’re a pedophile or something like that which I guess goes without saying but who am I to judge of course. You know what I mean.

  • Orphan Izzy

    November 19th, 2015 at 10:15 PM

    Through the trauma and isolation I’ve experienced over the last nine years I have become like a ninja when it comes to mindfulness and dealing with things as they come up and I think a huge part of being able to do that is recognizing your self-worth and learning to forgive yourself for things that had you been able to do better at the time you would have, and therefore have to try to move forward from and just do better next time. If anxiety is blocking a person from inner awareness then dealing with the anxiety and the feelings of it seem to be the first step once you allow yourself permission to take your own inventory because you’re worth happiness and therefore what you may find you must forgive yourself for. Personally I think that being able to remain constantly cognizant of what is real and whether or not your response to the world around you is reasonable or not is everything. Oh yeah, let me add to that the ability to deal with all of these things in a healthy way. It should be the goal of therapy no matter what type or issue, at the core I mean. as GI Joe (I think) said, knowing is half the battle! And as Dr. Phil always says, you can’t change what you don’t acknowledge. Therapy is useless without the ability to be self-aware and first be able to love yourself enough to do that.

  • Seth

    November 23rd, 2015 at 8:02 AM

    only works as a short term treatment option?

  • Maury Joseph, Psy.D.

    November 23rd, 2015 at 1:24 PM

    Loving the honest and insightful comments in response to my post. Thank you all. Seth, in ISTDP we use interventions that can catalyze change with the goal of shortening treatment length, but the actual length of treatment depends on the goals the person brings to therapy, and the intensity of the difficulties they struggle with. The research definition of “short-term” therapy is 40 session, but for people with more severe presenting concerns a 3-year therapy is the shortest possible treatment course that would help them. Make sense?

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