Workshops will be held on the pre-conference day by clinical experts and will give an overview over currently available psychotherapeutic treatment options for patients with personality disorders. Workshops address clinicians treating patients with personality disorders.
*Workshop will be held bilingual in English and German
John G. Gunderson, M.D., is Professor of Psychiatry at Harvard Medical School and Senior Teaching and Clinical Supervisor at Adult Borderline Center and Training Institute, McLean Hospital. His seminal studies on the diagnosis, families, psychodynamics, treatment and pathogenesis of borderline personality disorder helped transform the diagnosis from a psychoanalytic construct into an empirically validated and internationally recognized disorder. He chaired the DSM IV work group on personality disorders, and has led major NIMH-funded studies, including those on the longitudinal stability and family transmission of borderline personality disorders. He has been responsible for conceptualizing the borderline patient’s core problem as interpersonal hypersensitivity, for pioneering collaborative involvement and compassionate attitudes towards their families, and for writing and revising the seminal and major textbook on their treatment. Most recently, he has written a manual for an empirically-validated model of treatment for borderline patients called Good Psychiatric Management (GPM) that promises to elevate their level of care from all clinicians. In honor of these achievements, McLean Hospital opened a residential treatment center in Cambridge named the Gunderson Residence.
GPM is an empirically validated model of treatment designed for all clinicians to become good enough to successfully treat most borderline patients. This workshop will describe practical ways to disclose the BPD diagnosis to patients and their families, offering basic information about course and etiology that establishes the basis for a collaborative treatment. The approach is non-intensive, flexibly integrating medications and family interventions. Therapists are active and supportive while focusing on the patient’s life outside therapy, emphasizing the value of work and insisting on the patient’s agency. Videotapes and case vignette discussions will supplement didactics. The workshop will improve clinician attitudes and sense of competence in treating BPD patients. Learning objectives: 1. Comfortably disclose the BPD diagnosis, 2. Identify the appropriate level of care to ensure safety and remove an undue sense of burden, and 3. Recognize how the borderline patients’ phenomenology changes in response to whether they feel attached and cared for.
Martin Bohus, M.D., holds the chair of Psychosomatic Medicine and Psychotherapy, Heidelberg University and is Medical Director at the Central Institute of Mental Health, Mannheim. He received several awards for psychotherapy research. He is board member of the German Association of Psychiatry DGPPN, President of the European Society for the Studies of Personality Disorders (ESSPD), president of the German Association for DBT and Chair of the International Strategic Planning Meeting for Dialectical Behavior Therapy (SPM). He was president and Initiator: 1st International Congress on Borderline Personality Disorder, Berlin 2010 and since 2012 he is spokesperson of the Clinical Research Unit “Mechanisms of Disturbed Emotion Processing in BPD”. He has currently published 220 articles and book chapters, mainly on mechanisms of psychotherapy, borderline personality disorders and PTSD.
Approximately 60% of patients with Borderline Personality Disorder (BPD) suffer from severe co-occurring Posttraumatic Stress Disorder (PTSD), mostly related to sexual abuse during childhood. Even successful standard Dialectical Behavior Therapy (DBT) requires additional treatment with these clients. In cooperation with M. Linehan, at the Central Institute of Mental Health, Mannheim, Germany specific modular treatment program for this group of patients has been developed. In general, DBT is based on the rules and principles of DBT and adding trauma-focused cognitive and exposure based techniques, as well as components of compassionate focused therapy (CFT; P. Gilbert) and ACT (S. Hayes). Efficacy of DBT-PTSD was first examined in a randomized controlled trial under residential conditions. Data revealed large effect sizes (d=1.4) extremely low drop put rates, and good response rates. Of particular importance seems that neither the severity of borderline personality disorder nor the number of self-harm behavior at the beginning of the therapy had negatively affected treatment outcome. Most recently, a 40-session outpatient treatment program has been designed. Currently, this outpatient version is evaluated on an outpatient basis in a large RCT, funded by the German Ministry of Health. DBT-PTSD is designed to be applicable for a wide range of patients experiencing PTSD after severe interpersonal violence, including individuals who present with a high burden of psychopathology such as highly dissociative symptomatology, chronic suicidality, and ongoing non-suicidal self-injury. This is reflected by its modular multi-component architecture, which allows sufficient flexibility to cover both complex psychopathology and crises within a principle-based structure. The program comprises 3 treatment phases. In Phase I patients receive psychoeducation and learn to identify their individual escape and avoidance strategies from trauma-related primary emotions (e.g., dissociation, non-suicidal self-injury; self-hate). Based on these individualized functional analyses, they learn to use specific DBT skills in order control these behaviors. The focus of Phase II is on trauma-focused cognitive and exposure-based interventions. If patients exhibit strong dissociative features, they are trained to use specific skills in order to balance the memory activation and the awareness of being in the present (skills-assisted exposure). In Phase III patients work on radical acceptance of trauma-related facts and prepare for return to everyday life, with a focus on psychosocial aspects. The 3 phases all include different modules; e.g., for reducing dissociative symptoms or for treating nightmares.
Otto F. Kernberg, M.D., F.A.P.A., is Director of the Personality Disorders Institute at The New York Presbyterian Hospital, Westchester Division and Professor of Psychiatry at the Weill Medical College of Cornell University. Dr. Kernberg is a Past-President of the International Psychoanalytic Association. He is also Training and Supervising Analyst of the Columbia University Center for Psychoanalytic Training and Research. In the past, Dr. Kernberg served as Director of the C.F. Menninger Memorial Hospital, Supervising and Training Analyst of the Topeka Institute for Psychoanalysis, and Director of the Psychotherapy Research Project of the Menninger Foundation. Later, he was Director of the General Clinical Service of the New York State Psychiatric Institute, and Professor of Clinical Psychiatry at the College of Physicians and Surgeons of Columbia University. From 1976 to 1995 he was Associate Chairman and Medical Director of The New York Hospital-Cornell Medical Center, Westchester Division. He is the author of 13 books and co-author of 12 others: His most recent books are Aggressivity, Narcissism and Self-destructiveness in the Psychotherapeutic Relationship: New Developments in the Psychopathology and Psychotherapy of Severe Personality Disorders, New Haven: Yale University Press, 2004; Contemporary Controversies in Psychoanalytic Theory, Techniques and their Applications. New Haven: Yale University Press, 2004; Psychotherapy for Borderline Personality: Focusing on Object Relations, (with John F Clarkin and Frank E. Yeomans). American Psychiatric Publishing, Washington, D.C., 2006; and Handbook of Dynamic Psychotherapy for Higher Level Personality Pathology, (with Eve Caligor and John F. Clarkin). American Psychiatric Publishing, Washington, D.C., 2007. “The Inseparable Nature of Love and Aggression,” American Psychiatric Publishing, Washington, DC, was published in 2011. Transference-Focused Psychotherapy for Borderline Personality Disorder A Clinical Guide, (with Frank E. Yeomans and John F. Clarkin). American Psychiatric Publishing, Washington, DC, was published in 2015. “Psychoanalytic Education at the Crossroads” Routledge, Taylor & Francis Group, 2016.
This workshop will review briefly the essential features of strategies, techniques and tactics of Transference Focused Psychotherapy, with particular stress on the essential techniques of Interpretation, Transference Analysis, Technical Neutrality, and Coutertransference Utilization. We then shall focus on new technical developments, including: 1) consistent focus on self-destructive conflict expression in the patient’s external life situation; 2) dangerous denial of external reality; 3) irresponsibility in protecting and expanding life goals; 4) chronic countertransference developments as a result of narcissistic transferences; 5) management of “silent bastions”; 6) differentiating treatment goals and life goals; 7) indicators of resolution of identity diffusion.
Anthony W. Bateman, M.D., MA, FRC Psych is Consultant Psychiatrist and Psychotherapist and MBT coordinator, Anna Freud Centre, London; Visiting Professor University College, London; Honorary Professor in Psychotherapy University of Copenhagen. He developed mentalization based treatment with Peter Fonagy for borderline personality disorder and studied its effectiveness in research trials. Adapted versions are now being used in multi-center trials for antisocial personality disorder, eating disorders, and drug addiction. He was an expert member of National Institute for Clinical Excellence (NICE) development group for treatment guidelines for Borderline Personality Disorder in UK and is currently Chair of the National Guideline Development Group for Eating Disorders. His NHS clinical services are recognized by the Department of Health as a national demonstration site for the treatment of personality disorder. He was President of the European Society for the Study of Personality Disorders (ESSPD) from 2012-2015. He received a senior scientist award from British and Irish group for the Study of Personality Disorder in 2012 and in 2015 the annual award for “Achievement in the Field of Severe Personality Disorders” from the BPDRC in the USA. He has authored 14 books including Psychotherapy for Borderline Personality Disorder: mentalization based treatment and, most recently, Mentalization Based Treatment for Personality Disorder: a practical guide (2016) (with Peter Fonagy), numerous book chapters, and over 120 peer reviewed research articles on personality disorder and the use of psychotherapy in psychiatric practice.
Svenja Taubner, PhD, is professor for psychosocial prevention at the medical faculty of the University of Heidelberg in Germany. She is the director of the Institute for Psychosocial Prevention at the University-Clinic Heidelberg. She has received the Hamburger fellowship for Research on Personality Disorders twice, was Fellow of the Hanse Institute of Advanced Study in Delmenhorst, Germany as well as visiting scientist at the Anna-Freud-Centre London. She is long-term member of the Society of Psychotherapy Research and the German Psychoanalytic Society. Her research addresses mentalization, juvenile offending and competence development in mental health professionals. She is trained in MBT for adolescents (MBT-A) and also supervisor and trainer in this method. She currently develops an adaption of MBT-A for the treatment of conduct disorder. She is editor of the “Psychotherapeut”, “Praxis der Kinderpsychologie und Kinderpsychiatrie” as well as Editor-in-Chief of Mental Health & Prevention. She has published four books und over 70 articles.
Mentalization is the process by which we implicitly and explicitly interpret the actions of ourselves and others as meaningful on the basis of intentional mental states (e.g., desires, needs, feelings, beliefs, & reasons). We mentalize interactively and emotionally when with others. Each person has the other person’s mind in mind (as well as their own) leading to self-awareness and other awareness. People with CD and ASPD show overlapping problems with a number of different areas of mentalizing. These will be described in this workshop. Treatment interventions originally organized as MBT for ASPD and MBT-A for self-harm have now been adapted for the treatment of young people with CD. Treatment aims to address the specific mentalizing difficulties. The treatment intervention will be outlined using illustrative clinical examples and video. Mentalization Based Treatment for ASPD and CD integrates cognitive and relational components of therapy and has a theoretical basis in attachment theory. MBT was developed for people with borderline personality disorder and therefore focused on mentalizing problems associated with high emotional arousal in the context of attachment relationships. Interventions addressing these problems will be discussed. Adaptation of this basic model is necessary for people with ASPD and CD not only because their mentalizing problems differ from those found in BPD but also for a number of other descriptive reasons. Firstly, people with ASPD are more likely to demonstrate over-control of their emotional states within well-structured, schematic attachment relationships rather than under-control in chaotic attachment relationships, which are more commonly found in people with BPD. Second, people with ASPD tend to seek relationships, which are organized hierarchically with each person knowing their place whereas people with BPD aim for, but tend to struggle to reach, consensus and shared respect. Third, it is, specifically, threats to the hierarchical order of relationships that lead to arousal within the attachment system in people with ASPD; this triggers an inhibition of mentalizing. Loss of status is devastating as it potentially reveals shameful internal states that threaten to overwhelm, so any threat of loss of status becomes firmly rooted as a dangerous reality, which has to be dealt with by physical force. Momentary inability to mentalize reduces the effectiveness of inhibitory mechanisms prohibiting aggression. Fourth, if the reduction in ability to recognize others’ emotions is more pervasive than being restricted to fear and sadness, then a focus in treatment on recognition of all emotions in others is essential. Finally, fear for the self is often absent and violent impulses are uninfluenced by the emotional expressions of others, which go unrecognized. Indeed the consequences and dangers of aggression become secondary. Adolescents with CD tend to remain at a concrete level of mentalizing which challenges classic MBT interventions e.g. stop and rewind because of the striking lack of mentalizing in the whole session. Furthermore, ruptures in the therapeutic relationship are hard to detect and, as a consequence of the deactivating attachment strategies, lead to withdrawal and behavioral disturbance outside the therapeutic session. Thus, working together with families and the social services, improving mentalizing in the ‘system’ is crucial for the success of the therapy as well as slowly stimulating mentalization in the client. The therapist is constantly challenged not to patronize and humiliate the antisocial adolescent if epistemic trust is to be kindled and exploration of minds can be done safely.
John Livesley is Professor Emeritus and former Head of the Department of Psychiatry, University of British Columbia and former Editor of the Journal of Personality Disorders. Dr. Livesley has contributed extensively to the literature on personality disorder, with publications including the edited volumes of The DSM-IV Personality Disorders and the Handbook of Personality Disorders. His research focuses on the classification, assessment, and origins of personality disorder, and his clinical interests center on an integrated approach to treatment based on current empirical knowledge.
This course will describe a unified trans-theoretical, trans-diagnostic treatment model that combines strategies and interventions used by all effective therapies. The rationale for such an approach is based on evidence of similar outcomes across the different therapies. The course begins by offering a framework for understanding the nature and origins of personality disorder that is used to define treatment targets and strategies. Building on this foundation, an integrated approach is presented that has two main components: intervention modules and a model of how personality pathology changes with treatment. Interventions are organized into modules which allows therapists to tailor treatment to the needs of individual patients. Intervention modules consist of general treatment modules based on change mechanisms common to all effective therapies that are used throughout treatment with all patients and specific treatment modules consisting of interventions drawn from the various specialized therapies that are used to treat the specific problems and impairments of individual patients such as emotional lability, hostility, and rejection sensitivity. The general modules consist of interventions to build an effective treatment process by establishing a structured process, an effective therapeutic bond, consistency, and validation and interventions to build motivation and enhance self-reflection. Specific treatment modules are added to this structure created by the general modules as needed to treat the problems of individual patients. The actual modules used varies throughout therapy as different issues become the focus of treatment. Most therapies progress through phases with each phase focusing primarily on a specific set of impairments. The typical sequence for most therapies involves focusing successively on: (i) engagement, safety, and containment: (ii) managing emotional dysregulation and promoting emotion processing capacity; (iii) treating interpersonal problems, and (iv), constructing a new sense of self/identity and building a life worth living. The phase model of therapeutic change allows specific interventions to be used in sequential and coordinated way.
Johannes Zimmermann is a Full Professor of Psychological Methods and Assessment at the Psychologische Hochschule Berlin, Germany. He currently serves as President of the Society for Interpersonal Theory and Research and as an Associate Editor of the Journal of Personality Assessment. He is interested in the conceptualization and assessment of personality pathology as well as the consequences of personality on psychotherapeutic treatments with a focus on underlying dynamic processes. In addressing his research questions he employs a range of advanced statistical methods including multilevel, structural equation, and item response theory models. Recent research projects include studies on the validity of the alternative model for personality disorders in DSM-5, structure and dynamics of daily situations and behaviors, accuracy of personality judgments, mediators and moderators of psychotherapeutic treatments, and predictors and subtypes of Parkinson’s Disease.
Clinical theories of personality disorders do not define personality pathology solely in terms of individual differences, but rather by additionally describing maladaptive within-person dynamics and responses to day-to-day challenges from the environment. In line with this notion, recent research has repeatedly shown that personality pathology is associated with dynamic processes as evident in chaotic, unpredictable patterns of emotions and interpersonal behavior or specific contingencies of symptoms and situational triggers. Thus, a major conclusion that can be drawn from clinical theories and cutting-edge research is that the expression of personality traits and dysfunctions is probably best conceptualized as a dynamic process that is influenced by relatively stable dispositions, current situation experiences, and their interaction. This insight poses significant challenges on data collection and analysis for the study personality traits and dysfunctions. The current workshop will address some of these challenges with a focus on analyzing daily diary data using multilevel modeling and related statistical techniques. Participants will learn how to prepare and analyze daily diary data and how to visualize and interpret the results using the statistical environment R.
Giancarlo Dimaggio: MD, Psychiatrist, psychotherapist, co-founding member of the Centre for Metacognitive Interpersonal Therapy. He has published the books: "Metacognitive Interpersonal Therapy for personality disorders", "Integrated treatment for personality disorders: A modular approach", “Psychotherapy of personality disorders", "The dialogical self in psychotherapy", , "Metacognition and severe adult mental disorders" and "Social cognition and metacognition in schizophrenia: Psychopathology and treatment approaches". He has published over 130 papers in scientific journals. He is senior associate editor of the "Journal of Psychotherapy Integration", associate editor of “Psychology and Psychotherapy: Theory, Research and Practice” and member of the board of the “Journal of Personality Disorders”. He has guest-edited many journal’s special issues on research and treatment for personality disorders and psychosis
Metacognitive Interpersonal Therapy (MIT) for personality disorders is structured and manualized in order to deal with these patients and guide the clinician throughout treatment. Step-by-step operations will be described. One main focus is reconstructing maladaptive interpersonal schemas as they appear in autobiographical narratives. As MIT aims at maximizing effectiveness, the clinician first and foremost tries to elicit autobiographical memories focused on problematic social interactions or happening soon before the experience of psychological symptoms (e.g. anxiety, post-traumatic symptoms, disordered eating, outbursts of anger and so forth). A second goal is enriching the autobiographical memory repertoire. Next, the clinician aims at increasing awareness of mental states (i.e. metacognition): patients are helped to better distinguish what they think and feel that lead them to suffering and maladaptive behaviors. A next step if foster the capacity to realize that their view of interpersonal events is mostly their own construction which does not necessary reflects external reality. In parallel persons with PD are supported in recognizing adaptive and healthy aspects of the self and let them guide their action. A more advanced step is promoting a mature and nuanced theory of mind and a psychological understand of the complexity of human relationships. A constant regulation of the therapy relationship is the basis for any operation. Techniques for dealing with symptoms are also offered in the context of the customized case-formulation. MIT integrated bottom-up and top-down techniques. In this workshop techniques such as guided-imagery, two-chair and behavioral exposure will be described in details and practical exercise will be performed in the class.