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Psychodynamic Therapy of BPD:
Developing Expertise
John Gunderson, MD |
| Abstract:
This talk will describe: 1)
historical developments concerning
the role, values and styles of
psychodynamic psychotherapies,
noting why traditional
psychoanalytic techniques were
harmful; 2) three stages in
developing expertise (with personal
vignettes) i.e., fearful, protective
and pragmatic; 3) the lack of
adequate in training for
psychotherapeutic competence, with a
proposal to link training to
reimbursement, and 4) why clinicians
should choose to do this work. |
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Neurobiologically-informed
Psychotherapy of Borderline
Personality Disorder
Glen Gabbard, MD |
Abstract:
Neurobiological research ahs made
remarkable strides in identifying
fundamental features of
psychopathology in borderline
personality disorder. The mechanisms
of psychotherapy are still shrouded
in mystery as we ponder the reasons
that divers approaches to
psychotherapeutic treatment seem to
be effective with BPD patients.
However, with some reflection on the
implications of the neurobiological
findings, psychotherapist can now
begin to think about
psychotherapeutic strategies that
derive naturally from the
accumulated data. These include
self-directed reflection of
emotional response with the intent
of activating the prefrontal cortex.
The presumptive evidence of a
hyperreactive amygdale and a
hypoactive orbitofrontal cortex
suggests that actively rethinking or
reappraising feelings may modulate
limbic-based negative feelings as a
result of prefrontal nonhippocampal
learning… These two modes of
learning may respond to different
types of therapeutic action-one
based on insight and the other based
in repetitive interaction. The
research on reading faces in
borderline personality disorder
suggests that therapists must adapt
their nonverbal and verbal
approaches to the heightened
sensitivity with which faces can be
read, as well as the problematic
assumptions derived from those
perceptions. Clinical examples will
be given.
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Mentalization as a Common Factor
in Psychotherapy for Borderline
Personality Disorder
Anthony Bateman, MD |
Abstract:
A number of psychotherapies appear
to be effective for the treatment of
borderline personality disorder, the
best documented of which is
dialectical behavior therapy. But
other therapies with limited
evidence about the process of change
and whether it is related to the
aims of the treatment interventions.
It has been suggested that what is
important is treatment being
structured, coherent and
well-integrated with crisis
management. This has recently been
emphasized in the UK in national
guidance for the treatment of BPD. I
will propose that the enhancement of
mentalization which can only take
place within a structured and
supportive framework in which the
patient feels taken seriously, is
the feature which is common to all
of the effective interventions and
may be the primary mediator of
change.
Mentalization is the process by
which we implicitly and explicitly
interpret the actions of ourselves
as meaningful on the basis on
intentional mental states (e.g.,
desires, needs, feelings, beliefs
and reasons). Considerable evidence
has been accumulated to suggest that
mentalizing develops in the context
or early attachment relationships.
Maintaining this ability is a core
problem for patients with borderline
personality disorder; mentalizing is
lost rapidly in the context of
emotional states, particularly
during interpersonal interactions.
Mentalization-based Treatment (MBT)
specifically focuses on mentalizing
but it is proposed that all
treatments for BPD promote
mentalizing amidst emotional states
whether their focus is on behaviors
or mental processes. Some additional
evidence for this proposal will be
presented using outcome data from a
randomized controlled trial of
out-patient MBT versus supportive
clinical management in which
structure, support and crisis
management were important elements
of treatment. |
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