AST is a recent adaptation of Intensive Short-Term Dynamic Psychotherapy (ISTDP) that focuses more on attachment theory and modern neurobiological understandings of the brain and its responses to different psychotherapy interventions.

“Classical” ISTDP is known for its “intense” focus, which activates the patient’s self-regulation (stress management) and interactional patterns towards the therapist in the therapy session. Thus, the therapist and patient can observe how the patient acts and reacts in emotionally intense situations. In contrast, AST is more “user-friendly” but maintains a focused, psychological-problems resolution approach to therapy.

AST works from the theory that attachment patterns develop through repeated early-life interactions with caregivers. Attachment patterns are ways of interacting with oneself and others, leading to a familiar internal state of being. Our interactions with our caregivers in our early life lead to a consistent internal state. As small children, we automatically associate the way our caregivers treat us as being good for us and a state of “safety”. Therefore, the way we’re left feeling after interactions becomes associated with being “safe” and the “right” way for us to feel. This works well if most of our interactions are positive, supportive, kind and loving. However, if the majority of our interactions leave us, for example, uncertain, flat, anxious, rejected, feeling not enough or not good enough, then these internal states gradually become unconsciously associated with being “safe” and the "right" way for us to feel.

We unconsciously learn ways of behaving that enable us to find a place within the family, as we’re dependent on the care of others, and rejection from the family group would be a death sentence. Everyone unconsciously finds a place or a role within their family. In some families, that place or role may not be good. However, it is necessary as it helps to maintain the core state of the person as well as the other members of the family, in particular, the caregivers. This is not to suggest that parents aren’t doing their best. In most situations, parents are doing their absolute best to help their children grow up to feel confident, competent, worthwhile and loved. But often, parents’ automatic patterns result in children developing beliefs about themselves that are unhelpful or even destructive.

The behaviours that help us find a place in the family group and maintain the core state associated with “safety” gradually evolve as we mature and our relationships change. However, these evolving behaviours continue to ensure that the core state that we experienced as children, which became associated with “right” and “safe,” continues to be maintained.

These automatic behaviours are often particularly intense in our interpersonal relationships, where we often experience a sense of distance or not feeling genuinely connected to the people we care about. Automatic patterns can become the problems in our lives. They are experienced in a range of ways, including depression, anxiety, compulsive actions, physical complaints that have no medical explanation, avoidance behaviours, obsessive and ruminative thinking, self-sabotaging actions in relationships and careers, and problems with intimacy and closeness.

It is in situations where the internal experiential state is, or could be, “threatened” that anxiety is triggered. This is why people can get anxious in objectively positive situations: the positive experience is contrary to the person’s core experiential state. The anxiety then activates the automatic patterns, and the person avoids, acts to sabotage, collapses, becomes self-destructive, excessively demanding, dependent, or subordinate, or automatically engages any of a myriad of behavioural patterns that ensure that their internal experience remains within that of their core state.

Often, these behavioural patterns have benefits at an interpersonal/relational level. However, they never have objective benefits at an internal, experiential level. So, things may appear to be going well externally, but internally, we feel miserable. Or we can have a pattern where things don’t even appear to go well in our interactions with others. Perhaps we avoid everyone, isolate, and endlessly berate ourselves over perceived inadequacies. Or, possibly, we find ourselves automatically driving everyone away through our behaviours. Or maybe we find ourselves in situations where we’re used and abused, hating it, but somehow feeling that it’s “right” for us to think like this, even though it’s clear it’s objectively wrong.

In AST treatment, the patient and therapist focus on recent examples of their problems, looking to recognise and understand the automatic behavioural patterns that operate to ensure the maintenance of the person’s core state. The differences between internal and external experiences in those examples are examined with a particular emphasis on the perceived benefits of those automatic behavioural patterns. Gradually, as the behavioural patterns are recognised, understood, and overcome, it becomes possible to examine more profound beliefs around worth and “fundamental flaws” connected to the core state. As these beliefs are worked through, the person’s relationship with themselves and others changes to one of care, respect and confidence. Symptoms rapidly resolve through this treatment process, from the first meeting onwards, and the person’s relationships with self and others become increasingly optimistic, fulfilling and satisfying.