Psychodynamic Psychotherapy and Addiction Claudio Costanza Addiction Clinical Psychology Service...

Click here to load reader

  • date post

    15-Dec-2015
  • Category

    Documents

  • view

    217
  • download

    3

Embed Size (px)

Transcript of Psychodynamic Psychotherapy and Addiction Claudio Costanza Addiction Clinical Psychology Service...

  • Slide 1

Psychodynamic Psychotherapy and Addiction Claudio Costanza Addiction Clinical Psychology Service SLAM January 2014 Slide 2 Aim of presentation Psychodynamic psychotherapy of addiction, evidence and NICE guidelines Psychodynamic psychotherapy of addiction, evidence and NICE guidelines Psychodynamic models of addiction (object relation theory, attachment theory) Psychodynamic models of addiction (object relation theory, attachment theory) Other considerations: Assessment, Therapeutic relationship.. Other considerations: Assessment, Therapeutic relationship.. Slide 3 A definition of psychodynamic therapy with addiction Central principle : much distress is caused by unresolved unconscious tendencies. Central principle : much distress is caused by unresolved unconscious tendencies. Goal : Increase self-awareness and understanding of the influence of the past on present behaviour and on the quality of clients interactions with others. Through exploration of thoughts and feelings, free associations, memories, fantasies and dreams, and with the help of the therapists interpretation, this model helps clients to better understand their emotions and change their ways of relating to others as well as to substances. This will help clients to eventually feel freer to lead a more fulfilling, creative life without the help of substance Goal : Increase self-awareness and understanding of the influence of the past on present behaviour and on the quality of clients interactions with others. Through exploration of thoughts and feelings, free associations, memories, fantasies and dreams, and with the help of the therapists interpretation, this model helps clients to better understand their emotions and change their ways of relating to others as well as to substances. This will help clients to eventually feel freer to lead a more fulfilling, creative life without the help of substance Slide 4 Psychodynamic therapy and addiction Particular attention is given to the relationship with the therapist, through which, the patient may relive situations, feelings and thoughts from their early life: The transference Particular attention is given to the relationship with the therapist, through which, the patient may relive situations, feelings and thoughts from their early life: The transference Although historically viewed as a long-term psychological work, this approach can also be a short-term intervention. Short-term psychodynamic counselling will have one major focus, which creates a structure and identifies a goal. Although historically viewed as a long-term psychological work, this approach can also be a short-term intervention. Short-term psychodynamic counselling will have one major focus, which creates a structure and identifies a goal. Slide 5 Psychodynamic therapy and addiction This approach can be integrated with more drug-focused intervention such as drug counselling, group programs, therapeutic communities or NA/AA. This approach can be integrated with more drug-focused intervention such as drug counselling, group programs, therapeutic communities or NA/AA. This approach can help to better understand the therapeutic relationship and what the client may experience in recovery. Slide 6 Review of evidence based for psychodynamic therapy with addiction Not a great deal of recent evidence based/randomised controlled trial on psychodynamic therapy with addiction exhists Not a great deal of recent evidence based/randomised controlled trial on psychodynamic therapy with addiction exhists But some research have demonstrated the effectiveness and usefulness of PT with addiction: But some research have demonstrated the effectiveness and usefulness of PT with addiction: Woody and co. (1983) and Luborsky and co. (1985) have showed that adding supportive-expressive therapy (SET) to standard drug counselling for opiates client on methadone maintenance program was beneficial to client with higher levels of psychopathology. Woody and co. (1983) and Luborsky and co. (1985) have showed that adding supportive-expressive therapy (SET) to standard drug counselling for opiates client on methadone maintenance program was beneficial to client with higher levels of psychopathology. They also showed major advancement in their lives, entered the job market and stopped using drugs Slide 7 Review of evidence based for psychodynamic intervention with addiction Woody and co. (1995, 1998) have shown the effectiveness of SET in methadone programs. Clients required less methadone than those who received standard drug counselling and after 6 months, clients maintained their gains or showed continuing improvement Woody and co. (1995, 1998) have shown the effectiveness of SET in methadone programs. Clients required less methadone than those who received standard drug counselling and after 6 months, clients maintained their gains or showed continuing improvement Grenyer and co. (1995) compared brief drug counselling with cannabis dependency with SET (one weekly session over 16 weeks). Results showed that SET produced larger significant reduction in cannabis use, depression and anxiety Grenyer and co. (1995) compared brief drug counselling with cannabis dependency with SET (one weekly session over 16 weeks). Results showed that SET produced larger significant reduction in cannabis use, depression and anxiety Carroll and co. (1991) compared RP treatment with Interpersonal therapy (IPT) for cocaine users over 12 weeks individual sessions (N=42). Both approaches showed favourable outcome, with IPT showing higher rate of attrition. Carroll and co. (1991) compared RP treatment with Interpersonal therapy (IPT) for cocaine users over 12 weeks individual sessions (N=42). Both approaches showed favourable outcome, with IPT showing higher rate of attrition. Slide 8 Evidence-based Some case studies also show the usefulness of psychodynamic therapy (attachment model, object relation model, supportive expressive therapy etc.) with addiction in addition to standard drug counselling interventions or group programs: Some case studies also show the usefulness of psychodynamic therapy (attachment model, object relation model, supportive expressive therapy etc.) with addiction in addition to standard drug counselling interventions or group programs: Hagman (1995) explains the relevance of using ego psychology for methadone maintenance clients Jerry (1997) demonstrated the relevance of object-relations approach in a case study of a young woman using intravenous cocaine Potik and co. (2007) shows the relevance of using object relation theory and in particular the concept of transitional object when working with methadone maintenance clients Potik and co. (2007) shows the relevance of using object relation theory and in particular the concept of transitional object when working with methadone maintenance clients Read (2002) shows the usefulness of using psychotherapy and in particular object relation model with clients on methadone maintenance program and using heroin etc. Read (2002) shows the usefulness of using psychotherapy and in particular object relation model with clients on methadone maintenance program and using heroin etc. Slide 9 NICE and psychodynamic therapy of addiction Demonstrating effectiveness of psychodynamic therapy is complex and not always readily testable in a brief manner: time, clarity of measures, funding and possibly motivation Demonstrating effectiveness of psychodynamic therapy is complex and not always readily testable in a brief manner: time, clarity of measures, funding and possibly motivation As a result, it is difficult to find psychodynamic therapy as a recommended intervention by NICE guidelines As a result, it is difficult to find psychodynamic therapy as a recommended intervention by NICE guidelines Slide 10 Personality Disorder and Addiction NICE consider psychodynamic intervention only in the case of co-morbidities (depression/anxiety) NICE consider psychodynamic intervention only in the case of co-morbidities (depression/anxiety) NICE does not mention PD as co-morbidity when it is fully recognised that it is one of the major co-morbidity with addiction (Oldham, 1990; Stone, 1993; Millon, 1996, Krampe et al., 2006, Verheul, 2001,Van Den Bosh & Verheul, 2007) NICE does not mention PD as co-morbidity when it is fully recognised that it is one of the major co-morbidity with addiction (Oldham, 1990; Stone, 1993; Millon, 1996, Krampe et al., 2006, Verheul, 2001,Van Den Bosh & Verheul, 2007) Van den Bosh & Verheul (2007) in their study on PD and addiction stresses the importance of addressing both the addiction problem and the personality disorder for the treatment to be effective Van den Bosh & Verheul (2007) in their study on PD and addiction stresses the importance of addressing both the addiction problem and the personality disorder for the treatment to be effective Many research have shown the effectiveness of psychodynamic therapy with PD: Many research have shown the effectiveness of psychodynamic therapy with PD:(Shedler 2010, Levy and Ablon 2010) Leichsenrin and Leibing (2003) have conducted a meta-analysis on the effectiveness of psychodynamic therapy with PD by reviewing studies which were published from 1974 to 2001 (N=417) and showed evidence of long-term positive effect of psychodynamic therapy with PD. Leichsenrin and Leibing (2003) have conducted a meta-analysis on the effectiveness of psychodynamic therapy with PD by reviewing studies which were published from 1974 to 2001 (N=417) and showed evidence of long-term positive effect of psychodynamic therapy with PD. Bateman A & Fonagy P (2001) have shown the usefulness of treatment of BPD with psychoanalytically oriented therapy in partial inpatient setting/mentalization based Treatment Bateman A & Fonagy P (2001) have shown the usefulness of treatment of BPD with psychoanalytically oriented therapy in partial inpatient setting/