Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal...

91
Psychodynamic –interpersonal therapy: applications Else Guthrie: Professor of Psychological Medicine, Leeds Institute of Health Sciences

Transcript of Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal...

Page 1: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

Psychodynamic –interpersonal therapy: applicationsElse Guthrie: Professor of Psychological Medicine, Leeds Institute of Health Sciences

Page 2: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute
Page 3: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

Plan

• Some Facts • Some Fancy

Page 4: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute
Page 5: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

Study Design No Outcome

Shapiro D, Firth J. BJP 1987

PIT vs CBTCross-overN=40

40 Broad EquivalenceNo effect of order of therapy62% improvement

Shapiro et al, J Con Clin Psychol, 1995.

PIT 16 PIT 8CBT 16 CBT 8

117 CB and PI broadly effective. No advantage to 16 vs 8 session, except for severe depression 60% improvement

Barkham et al (1996) J Con Clin Psychol

PIT 16 PIT 8 CBT 16 CBT 8

36 Broad equivalence40% improvement

Barkham et al, (1999).

PIT 2 +1CBT 2 +1

116 67% improvementEquivalence

Evidence base for PIT/Conversational Model for Depression

Page 6: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

Study Condition Design No Outcome

Guthrie et al, Archives of General Psychiatry June 1999: 56; 519-526

High utilisers of psych services

PIT 8Usual Care

110 Greater improvement in depression and lower costs

Guthrie et al, British MedicalJournal 2001; 323: 135-138

Self harm PIT 4Usual care

119 Greater improvement in depressionReduced self harm in PIT group vs control

Shaw et al, European JournalPsychotherapy, Counselling &Health. Vol 4(1) Apr 2001, 87-10

Psychotherapy patients

PIT 8 Wait list

40 PIT better than wait list

Burns et al, British Journal ofPsychiatry. 187:143-7, 2005

Early dementia

PIT 6Usual care

40 No difference between treatment and control for patientsCarer improvement following PIT

Other RCTs of PIT/Conversational Model

Page 7: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

Study Design No OutcomeGuthrie et al, Gastroenterology 1991: Chronic IBS

PIT 8Supp

102 Greater improvement in IBS symptoms for PIT than control

Hamilton et al, Gastroenterology 2000: Chronic FD

PIT 8Support 8

83

Creed et al 2003,Gastroenterology.Chronic /severe IBS

PIT 8 SSRIUsual treat

257 PIT and SSRI > usual care for QOLPIT more cost effective

Henningsen’s GroupMultisomatoform DisorderSattel et al

PIT 12EMC

221 Improvement in Quality of Life: treatment > controlES 0.6

Medically Unexplained Symptoms

Page 8: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

Study Design No OutcomeStephenson and Meares, 1992

Matched control

30 Significant reduction in self-harm, violence, substance misuse in comparison with controls.

Hall et al 2001 Economic analysis

30 A saving of $18,000 per patient

Korner et al 2006 Allocated by chance to therapist but not RCT

29 patients who received therapy signifcantly better than wait list controls on most measures Continued improvement with more than 1 year of treatment

Walton and BenditCompleted but not published

RCT PIT v DBT. ?????

Borderline Personality Disorder

Page 9: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

Applications

• Depressive disorders• Anxiety disorders• Persistent physical symptoms (high users)• Persistent psychological symptoms (high users)• Self-harm• BPD• Routine clients referred to psychological services

in UK

Page 10: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

Format

• 2+1 • 4 sessions • 8 sessions• 12 sessions• 16 sessions• 1 year twice weekly• 2 years twice weekly

Page 11: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute
Page 12: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

Simple and Effective

• Most components of the training are not unique to PIT

• Emphasis that is placed upon getting the simple things right and putting the basic building blocks of therapy into place

• Unique characteristic of the PIT model.

Page 13: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

Simple but profound

• About getting to know someone, not a lot of facts about them

• Takes what we know are effective components of therapy and focuses relentlessly on these aspects

• Bond and expectations

Page 14: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

Who can use it?

• Nurses• Health professionals• Therapists

• Some interpersonal skills

• Some emotional intelligence

Page 15: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute
Page 16: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

PIT

• Stage 1 competencies• Stage 2 competencies• Stage 3 competencies

Page 17: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

“Beauty lay not in the thing, but inwhat the thing symbolized.

Thomas Hardy: Tess of the D’Urbervilles

Page 18: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute
Page 19: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

One man and his book

1985

Page 20: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

Experience

Page 21: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

JoeChapter 3: Experience

Page 22: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

Joe

• “I feel ………..queer.”

Page 23: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

Experience

• It is pre-conceptual• Incommunicable• It is felt in the body• It is in relation to things, persons and situations• In the flow of experiencing the past is taken up as

an experience which is immediately present.• It is not static. There is movement.• Hobson does not distinguish between physical

and mental

Page 24: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

Experience

• “No verbal or non-verbal expression of the complexity and interrelatedness of such particular experiences can convey the immediacy of the raw, sensed and felt stuff of awareness.”

• Hobson emphasized the importance of staying with experiencing

Page 25: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

• I feel queer• ‘Queer’ denotes an experience; a symbol

intimating experiencing which is felt by Joe in his body.

• “Let’s stay with that feeling”

Page 26: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

Feelings, experiences in ‘here and now’

Specific images, memories

Key relationships

Key Learning Point: Form of Feeling

Page 27: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

Feelings, experiences in ‘here and now’

Specific images, memories

Key relationships

Key Learning Point: Form of Feeling

“A form of feeling is not just an imaginative emotion which when vividly conceived generates an idea. Forms of feeling are elaborations of presentational symbols.

Page 28: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute
Page 29: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

Coronary Care Unit

Page 30: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute
Page 31: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

Feelings, experiences in ‘here and now’

Specific images, memories

Key relationships

Form of Feeling

“A form of feeling is not just an imaginative emotion which when vividly conceived generates an idea. Forms of feeling are elaborations of presentational symbols.

Page 32: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute
Page 33: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

Language

Feeling Language Jam-Jar Language

Page 34: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

Language

Feeling Language Jam-Jar Language

“So we beat on, boats against the current, borne back ceaselessly into the past.”

“To open the jam jar, you unscrew the lid anticlockwise”

Page 35: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

Conversational Model

• Bodily experience: being both physical and mental

• Language• A personal relationship• Forms of Feeling• Self

Page 36: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

Teresa

IBS for the last 30 years. Numerous investigations. Constant deep pain in her tummy. Always there.

Page 37: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

Teresa

• As you know, no two people with IBS ever have the same symptoms

• “I’m very loud”

Page 38: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

• “With my IBS, my body, my whole body hurts.” • “It just shuts down.” • “If the damn thing works at all.” • “The only loo that I’ll use is my own.”• “I keep myself behind closed doors.”

Page 39: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

Metaphor

• “A creative relation between hitherto unrelated terms. By terms I do not mean merely a written or spoken word but rather a pattern of meaning, an idea, a schema, a complex system”.

“I’m very loud”

Page 40: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute
Page 41: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

The only loo I can use is my own

Page 42: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

The only loo I can use is my own

Terrible fear of someone hearing me

Page 43: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

The only loo I can use is my own

Terrible fear of someone hearing her

Behind closed doors

Page 44: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

The only loo I can use is my own

Behind closed doors

Don’t you tell anyone anything

Form of Feeling

Page 45: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

Angela

Page 46: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

Angela

“I feel like a beached whale”

I feel like a beached whale

I feel like a beached whale

Page 47: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

• A beached whale

Page 48: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute
Page 49: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute
Page 50: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute
Page 51: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

Symbols and symbolic transformation

Images in the mind• Symbols enable us to

elaborate and connect inner forms

Page 52: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

A personal relationship

• Therapy occurs in the context of a personal relationship

• It’s about getting to know someone, not about getting to know a lot of facts about them

Page 53: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

Julia

• “Like a cold chill, ringing through me, I can’t stop shivering, and shaking with pain.”

• Bereaved 18 months earlier. Husband had had a sudden MI and died . Went to work and never came back.

Page 54: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

Why do you stand in the dripping rye,Cold-lipped, unconscious, wet to the knee,When there are firesides near?' said I.'I told him I wished him dead,' said she.

'Yea, cried it in my haste to oneWhom I had loved, whom I well loved still;And die he did. And I hate the sun,And stand here lonely, aching, chill;

'Stand waiting, waiting under skiesThat blow reproach, the while I seeThe rooks sheer off to where he liesWrapt in a peace withheld from me.'

The Woman in the Rye

Thomas Hardy

Page 55: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

Julia

• Stand in the dripping rye,• Cold-lipped, unconscious,

wet to the knee,

• Stand waiting, waiting under skies

• That blow reproach

Page 56: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

Forms of Feeling

• Differentiation and integration of psychic phenomena and bodily experiences to produce a commanding form

• Building blocks of ourselves……threads that weave forwards, backwards, sideways to create a sense of connectiveness

Page 57: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute
Page 58: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

Conversational Model

An attempt to get to know someone

rather than know a lot about them

Use of statements rather questions to

encourage ‘feeling’ as opposed to ‘jam jar’

langauge

Staying with experience to see

what ‘comes to mind’

Use of symbolic images and metaphor to access

forms of feeling and deeper meaning

Connecting and organisation of form in

an interpersonal relationship

Page 59: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

The model

• Statements not questions• Pick up cues• Stay with bodily experiences to see what

comes to mind

Page 60: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

Symptoms

“It’s there constantly, can’t get away from it. It just dominates my life. I can’t go anywhere or do anything. I’m a virtual recluse, trapped.If I go out, I’m constantly checking for toilets, I just don’t feel safe…no one understands what it’s like….they just think I’m always complaining. I’ll go all day without eating, cos I know if I do, I’ll be in for trouble.I can’t bear going out now, it’s just become an ordeal. I’m better by myself. It’s difficult if someone comes round, I can’t bear it. I feel…supposing I need to go to the loo and I’m in there for hours…what are they going to think? I have to pretend to everyone I’m alright. If they only knew!I’m so worn down by it. Like my insides are rotting away.

Page 61: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

“It’s there constantly, can’t get away from it. It just dominates my life. I can’t go anywhere or do anything. I’m a virtual recluse, trapped.If I go out, I’m constantly checking for toilets, I just don’t feel safe…no one understands what it’s like….they just think I’m always complaining. I’ll go all day without eating, cos I know if I do, I’ll be in for trouble.I can’t bear going out now, it’s just become an ordeal. I’m better by myself. It’s difficult if someone comes round, I can’t bear it. I feel…supposing I need to go to the loo and I’m in there for hours…what are they going to think? I have to pretend to everyone I’m alright. If they only knew! I’m so warn down by it….like my insides are rotting away.”

Page 62: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

“It’s there constantly, can’t get away from it. It just dominates my life. I can’t go anywhere or do anything. I’m a virtual recluse, trapped.If I go out, I’m constantly checking for toilets, I just don’t feel safe…no one understands what it’s like….they just think I’m always complaining. I’ll go all day without eating, cos I know if I do, I’ll be in for trouble.I can’t bear going out now, it’s just become an ordeal. I’m better by myself. It’s difficult if someone comes round, I can’t bear it. I feel…supposing I need to go to the loo and I’m in there for hours…what are they going to think? I have to pretend to everyone I’m alright. If they only knew! I’m so warn down by it….like my insides are rotting away.”

Page 63: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

“It’s there constantly, can’t get away from it. It just dominates my life. I can’t go anywhere or do anything. I’m a virtual recluse, trapped.If I go out, I’m constantly checking for toilets, I just don’t feel safe…no one understands what it’s like….they just think I’m always complaining. I’ll go all day without eating, cos I know if I do, I’ll be in for trouble.I can’t bear going out now, it’s just become an ordeal. I’m better by myself. It’s difficult if someone comes round, I can’t bear it. I feel…supposing I need to go to the loo and I’m in there for hours…what are they going to think? I have to pretend to everyone I’m alright. If they only knew! I’m so warn down by it….like my insides are rotting away.”

Page 64: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

“It’s there constantly, can’t get away from it. It just dominates my life. I can’t go anywhere or do anything. I’m a virtual recluse, trapped.If I go out, I’m constantly checking for toilets, I just don’t feel safe…no one understands what it’s like….they just think I’m always complaining. I’ll go all day without eating, cos I know if I do, I’ll be in for trouble.I can’t bear going out now, it’s just become an ordeal. I’m better by myself. It’s difficult if someone comes round, I can’t bear it. I feel…supposing I need to go to the loo and I’m in there for hours…what are they going to think? I have to pretend to everyone I’m alright. If they only knew! I’m so warn down by it….like my insides are rotting away.”

Page 65: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

“It’s there constantly, can’t get away from it. It just dominates my life. I can’t go anywhere or do anything. I’m a virtual recluse, trapped.If I go out, I’m constantly checking for toilets, I just don’t feel safe…no one understands what it’s like….they just think I’m always complaining. I’ll go all day without eating, cos I know if I do, I’ll be in for trouble.I can’t bear going out now, it’s just become an ordeal. I’m better by myself. It’s difficult if someone comes round, I can’t bear it. I feel…supposing I need to go to the loo and I’m in there for hours…what are they going to think? I have to pretend to everyone I’m alright. If they only knew! I’m so warn down by it….like my insides are rotting away.”

Page 66: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

“It’s there constantly, can’t get away from it. It just dominates my life. I can’t go anywhere or do anything. I’m a virtual recluse, trapped.If I go out, I’m constantly checking for toilets, I just don’t feel safe…no one understands what it’s like….they just think I’m always complaining. I’ll go all day without eating, cos I know if I do, I’ll be in for trouble.I can’t bear going out now, it’s just become an ordeal. I’m better by myself. It’s difficult if someone comes round, I can’t bear it. I feel…supposing I need to go to the loo and I’m in there for hours…what are they going to think? I have to pretend to everyone I’m alright. If they only knew! I’m so warn down by it….like my insides are rotting away.”

Page 67: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

“It’s there constantly, can’t get away from it. It just dominates my life. I can’t go anywhere or do anything. I’m a virtual recluse, trapped.If I go out, I’m constantly checking for toilets, I just don’t feel safe…no one understands what it’s like….they just think I’m always complaining. I’ll go all day without eating, cos I know if I do, I’ll be in for trouble.I can’t bear going out now, it’s just become an ordeal. I’m better by myself. It’s difficult if someone comes round, I can’t bear it. I feel…supposing I need to go to the loo and I’m in there for hours…what are they going to think? I have to pretend to everyone I’m alright. If they only knew! I’m so warn down by it….like my insides are rotting away.”

Page 68: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

“It’s there constantly, can’t get away from it. It just dominates my life. I can’t go anywhere or do anything. I’m a virtual recluse, trapped.If I go out, I’m constantly checking for toilets, I just don’t feel safe…no one understands what it’s like….they just think I’m always complaining. I’ll go all day without eating, cos I know if I do, I’ll be in for trouble.I can’t bear going out now, it’s just become an ordeal. I’m better by myself. It’s difficult if someone comes round, I can’t bear it. I feel…supposing I need to go to the loo and I’m in there for hours…what are they going to think? I have to pretend to everyone I’m alright. If they only knew! I’m so warn down by it….like my insides are rotting away.”

Page 69: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

I remember my mother saying to me, “Don’t you tell anyone our business, and here I am telling you everything!

Page 70: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

The central role of ‘experience’

• Avoids the mind body split.

Page 71: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

Written on the Body

Page 72: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

“Written on the body”

Page 73: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

Key point: Bodily symptoms in MUS

• Not conversion• Not somatisation• Descriptions of feelings

Page 74: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

Key Point

• For every mental experience there is a corresponding physical experience

• We feel love, hate, fear in our bodies• Even the little feelings in the background are

felt in the whole of ourselves

Page 75: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

Self-harm

Page 76: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

Self-harm• Therapist: I wonder if we could start by you telling me a little about

what happened on Saturday,........ how you came to take the overdose

• JB: I dunno really……..I just got fed up………

• Therapist: umh ……..you felt a bit low’ (statement, understanding hypothesis)

• JB: Well, I’ve been feeling down for a bit now…….since my mum died………I thought I’d coped OK…..but it’s my sister…. She’s got her ashes and she won’t tell me what she’s done with them…….

Page 77: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

• Therapist I see….. your mum died recently? I’m so sorry

• JB: three weeks ago…..but my sister….Lorraine’s got her ashes and she won’t tell me where they are or what she’s done with them….it’s tearing me apart

• Therapist: An awful situation and Very distressing for you (statement understanding hypothesis)

• JB: Yes…yes (tears in her eyes)

• Therapist: You’re very upset…….I mean you are very upset nowabout it when you talk with me” (statement, focus on feelings in the here and now)

Page 78: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

• JB: I can’t stand it….not knowing where my mum is

• Therapist: like you can’ t place her ……talk to her anymore? (understanding hypothesis)

• JB: I don’t know where she is

• Therapist: I wonder if you can stay with that feeling…… (focus on feelings)

Page 79: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

• JB: I can’t be with my mum…….(tearful)

• JB: Yes….. Therapist: I wonder if we can go back to the way you were feeling on Saturday……it feels ….a bit like how you are feeling now (focus on feelings, here and now)…I’m not sure

• JB: I want my mum…..I can’t not think of her resting anywhere….I can’t be with her……I can’t think of her being settled…..

Page 80: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

• Therapist: you’re in a lot of pain….right now (here and now)

• JB: ….I can’t bear it….I feel so alone….I can’t go on until I know where she is….I’d rather be dead….

• Therapist: Umh……

• JB: I might as well be dead…..

• Therapist: Umh…

Page 81: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

• Therapist: Errr….. keep that feeling…..I know it’s very painful….wanting to die….missing your mum……I wonder if something comes to mind….an image or picture..ormemory…..it may not… (focus on feelings, here and now)

• JB: being bottom of everything

• Therapist: umh

Page 82: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

• JB: Trampled on ……not listened to….I always say sorry eventually…and then well….I’ve lost again…and everyone knows that they can just trample all over me, cos I’ll give in…I’m always bottom of the heap

Page 83: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute
Page 84: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

• Therapist Not a nice place to be or a nice way to feel…(focus on feelings)

• Pause• JB: No ….• Therapist: Can we stay with this ….this feeling of being at the

bottom…..the lowest of the low……perhaps ….(focus on feelings) • JB: …….I get all the shit……all of it…… (tears) ..I’m not worth

anything….no body cares about me..• Therapist: all alone……no one cares…wanting your mum….?

(understanding hypothesis) • JB: yeah…but she was never there…..you know….• Therapist: a bit like how you felt on Saturday……you feel that now

with me….(focus on feelings)

Page 85: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

• JB: yeah… no one ever gave gave a toss about me, except for my mum….she did care..she just couldn’t look after me….she were too poorly….sick…I realized later she was a big drinker ……

• Therapist: and you feel cut off from her…this is a big feeling for you….big because of her ashes….big because it’s been there running deep inside for many years …..(focus on feelings, linking)

Page 86: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

The bigger picture

• JB: I always wanted my mum…….it’s a terrible feeling• Therapist: this hope that you would get her back

….…..but now you’ve lost her again…….her ashes……her….. and you don’t know where she is…….like a little girl abandoned…… I’m not sure if that’s right or it’s a bit much (understanding hypothesis, linking)

• JB: No,….that’s exactly how I feel……

Page 87: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

The bigger picture

• Therapist: this feeling was unbearable on Saturday…..feeling alone and unloved

• JB: uh……yes……• Therapist: and you feel it here (pointing to middle of tummy)• JB: yes like somethings missing inside• Therapist: sometimes when we face something…..with

someone…something big…..it becomes….less big……less overwhelming……and when it’s less big..we can find ways to deal with it….

Page 88: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

Genetics

CSANeglect

Loss

Parental Modelling of illness and behaviour

PhysiologyExperience

Experience

GPMedicVisits

A simple model of experience

Page 89: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

Hobson’s model

• “Near fusion of body and mind experiences”• Memories are stored and recreated as images• Memories are approximations and are

reconstituted and re-worked • Feeling is important in decision making but is

often out of conscious awareness• We react to outside experiences and inner

memories with feelings before time to ‘think’• Our self is a stream of consciousness which may

be grounded more in feeling states

Page 90: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

“ But who shall parcel outHis intellect by geometric rulesSplit like a province into round and square?

In weakness, we create distinctions, thenDeem that our puny boundaries are thingsWhich we perceive, and not which we have made”

Wordsworth The Prelude

Page 91: Psychodynamic –interpersonal therapy: applications Else ......Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds Institute

Forms of Feeling: The Heart of Psychotherapy.

(R F Hobson, 1985, Tavistock, London)

Intimacy and Alienation: Memory, Trauma and Personal Being.

(R Meares, 2000, Routledge, London)

The Metaphor of Play: Origin and Breakdown of Personal Being

(3rd Edn).(R Meares, 2005, Routledge,

London)

The Conversational ModelTavistock Vidoetapes: Hobson

and Margison


BRIEF PSYCHODYNAMIC - MDProblemGambling.com

BRIEF PSYCHODYNAMIC - MDProblemGambling.com

AS Psychodynamic approach abnormality

AS Psychodynamic approach abnormality

Psychodynamic Psychotherapy Training

Psychodynamic Psychotherapy Training

The psychodynamic perspective: NeoFreudians

The psychodynamic perspective: NeoFreudians

The Psychodynamic Approach

The Psychodynamic Approach

The Psychodynamic Perspective

The Psychodynamic Perspective

PSYCHODYNAMIC THEORY & SOCIAL FUNCTIONING

PSYCHODYNAMIC THEORY & SOCIAL FUNCTIONING

Psychodynamic-interpersonal psychotherapy of somatic ...al2898/columbia_psychosomatics/conference-2017...Psychodynamic-interpersonal psychotherapy of somatic symptom disorders (PISO)

Psychodynamic-interpersonal psychotherapy of somatic ...al2898/columbia_psychosomatics/conference-2017...Psychodynamic-interpersonal psychotherapy of somatic symptom disorders (PISO)

Applying Psychodynamic Concepts to Sport Psychology …€¦ · Psychodynamic Concepts in Sport Psychology 209 What Is Psychodynamic Theory? Many sport psychology professionals have

Applying Psychodynamic Concepts to Sport Psychology …€¦ · Psychodynamic Concepts in Sport Psychology 209 What Is Psychodynamic Theory? Many sport psychology professionals have

Clients experiences of dynamic interpersonal therapy (DIT ... · experiences of dynamic interpersonal therapy (DIT): opportunities and challenges for brief, manualised psychodynamic

Clients experiences of dynamic interpersonal therapy (DIT ... · experiences of dynamic interpersonal therapy (DIT): opportunities and challenges for brief, manualised psychodynamic

Archived Content Contenu archivé 9509.b7 i5 1998-eng.… · Interpersonal Psychodynamic Group Psychotherapy 42 Staff Debriefing Sessions 51 REBT AND DIDACTIC GROUPS 52 Rational Emotive

Archived Content Contenu archivé 9509.b7 i5 1998-eng.… · Interpersonal Psychodynamic Group Psychotherapy 42 Staff Debriefing Sessions 51 REBT AND DIDACTIC GROUPS 52 Rational Emotive

AS Psychodynamic treatments

AS Psychodynamic treatments

Psychodynamic treatments/Psychoanalysis AS

Psychodynamic treatments/Psychoanalysis AS

Psychodynamic Hbs e

Psychodynamic Hbs e

Psychodynamic Therapy Meta Analysis

Psychodynamic Therapy Meta Analysis

Psychodynamic –interpersonal therapy: applications Else ...€¦ · Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds

Psychodynamic –interpersonal therapy: applications Else ...€¦ · Psychodynamic –interpersonal therapy: applications. Else Guthrie: Professor of Psychological Medicine, Leeds

Psychodynamic presention copy

Psychodynamic presention copy

Psychoanalytic/Psychodynamic Approaches to Personality ......Psychodynamic thinking has made some vital contributions to the ways in which we now understand PD. However, the psychodynamic

Psychoanalytic/Psychodynamic Approaches to Personality ......Psychodynamic thinking has made some vital contributions to the ways in which we now understand PD. However, the psychodynamic

Psychodynamic Theories Part 2

Psychodynamic Theories Part 2

BRIEF PSYCHODYNAMIC

BRIEF PSYCHODYNAMIC