Attachment perspectives on Borderline Personality Disorder: implications for therapy: Video Course
Speaker: Dr Gwen Adshead
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Attachment theory provides useful perspectives on emotionally unstable or borderline personality disorder (BPD); both in terms of how the disorder develops and in terms of therapy. Both clients and therapists may struggle with trust, high levels of negative affect, and therapeutic ruptures. Attachment needs in such clients are highly aroused and often extremely difficult to assuage. Understandably, BPD clients can not only struggle to participate in the therapeutic alliance, but can also view therapists as aloof, uncaring, antagonistic or unsympathetic.
Full Course Information
At this practical workshop that would be relevant for psychotherapists, clinical psychologists, counsellors and psychiatrists, Dr Gwen Adshead will use a perspective based on attachment theory and the tenets of mentalisation to explore:
- How the psychopathology of emotional instability develops
- Hostile, helpless states of mind and epistemic trust
- The relationship with disorganised attachment and its sequelae
- How this understanding informs our therapeutic approaches
- How this understanding influences the way we think about families and their therapeutic needs
- Language and threat: use of why questions, silence and poor mentalising
- Preventing and managing attachment anxiety
Session 1: Attachment and personality development
In this first session we explore:
- Brief overview of attachment theory and personality development
- Attachment and Affect Regulation – developmental studies and fMRI findings
- Insecure attachment and personality disorder: with emphasis on affect dysregulation
- Mentalising and affect regulation
Session 2: Clinical implications
- Why do people with PD struggle with therapy
- Activation and deactivation of attachment systems
- Repetition of Toxic attachments and lack of Trust
- Mentalising strategies for therapists
Session 3: Psychotherapeutic implications
Our third session of the day builds on and continues the theoretical bases considered so far and illustrates practical therapeutic implications for practitioners. Clinical vignettes will be discussed here. Specifically, we consider:
- Recognising when fragile mentalising capacities are overwhelmed by sudden surges of affect
- Helping our clients with self soothing and other strategies needed to reduce arousal
- Self-reflection and work with co-therapists
Session 4: Group reflection
About the speaker
Dr Gwen Adshead is a Forensic Psychiatrist and Psychotherapist. She trained at St George’s Hospital, the Institute of Psychiatry and the Institute of Group Analysis. She is trained as a group therapist and a Mindfulness-based cognitive therapist and has also trained in Mentalisation-based therapy. She worked for nearly twenty years as a Consultant Forensic Psychotherapist at Broadmoor Hospital, running psychotherapeutic groups for offenders and working with staff around relational security and organisational dynamics. Gwen also has a Masters’ Degree in Medical Law and Ethics; and has a research interest in moral reasoning, and how this links with ‘bad’ behaviour.
Gwen has published a number of books and over 100 papers, book chapters and commissioned articles on forensic psychotherapy, ethics in psychiatry, and attachment theory as applied to medicine and forensic psychiatry. She is the co-editor of Clinical topics in Personality Disorder (with Dr Jay Sarkar) which was awarded first prize in the psychiatry Section of the BMA book awards 2013; and she also co-edited Personality Disorder: the Definitive Collection with Dr Caroline Jacob. She is the co-editor of the Oxford Handbook of Forensic Psychiatry (2013) and the Oxford Handbook of Medical Psychotherapy (2016). She is also the co-editor of Munchausens’s Syndrome by Proxy: Current issues in Assessment, Treatment and Research.
Gwen was visiting professor at Yale School of Psychiatry and Law in 2013; and also honoured with the President’s Medal for services to psychiatry that same year for her work on ethics in psychiatry. She was awarded an honorary doctorate by St George’s hospital in 2015; and was Gresham Professor of Psychiatry 2014-2017. She now works in a medium secure unit in Hampshire in a service for high risk offenders with personality disorder; and in a women’s prison.
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