Attachment Informed Therapy for Personality Disorders A 2-day training workshop at London with Dr Gwen Adshead London, 29 and 30 September 2017 (Friday and Saturday) 10:00am - 4:00pm on both days
Personality Disorders (PD), when viewed as social manifestations of pathological processes, can present clearly identifiable developmental disturbances. Across the spectrum clusters identified by DSM-IV and V, we can identify dysregulations of arousal, affect, stress-response and interpersonal attachment patterns. These dysregulations manifest in pervasive, maladaptive patterns of interpersonal behaviour, extreme difficulties of cognition and affect regulation, and diminished levels of impulse control – all of which translate into an extremely challenging therapeutic journey. Not all ‘treatment’ choices have demonstrable efficacies. It takes learned skills for therapists to correctly identify, diagnose and work therapeutically with personality disorders. As therapists, we could benefit from a deeper understanding of personality disorders (across the spectrum) that allows us to comprehend the neurobiology of personality, the role of attachment and trauma in the development of PD, the impact of PD on the trauma narrative, the linkage of attachment classifications with PD sub-types and evidence-based therapies for PD. At this therapeutically oriented workshop, Dr Adshead relies on an attachment-informed approach, while drawing on her long-standing clinical expertise to help us comprehend personality disorders in a structured and methodical manner. Over 4 modules and 2 days, the workshop helps us understand the aetiology and psychopathology of personality disorders (Day 1) and relevant therapeutic approaches (Day 2). The workshop starts by looking at the key features of ICD-11 and DSM classifications and draws distinctions between: Schizoid, paranoid and schizotypal dysfunctions Antisocial, narcissistic and borderline dysfunctions and Avoidant, dependent and obsessive-compulsive behaviours We rely on both neurobiological and attachment theory for our discussions and especially consider the role of adverse childhood experience and trauma. We look at the disavowal process of distress and the failure of mentalisation. We identify the social attachment manifestations of each cluster and consider its developmental causalities. Through case-vignettes and discussions, we consider Arousal, Affect, Cognition, Somatic self-identity, psychological self-identity and the possible manifestations we see in clients, including: Substance misuse and dependence Unstable relationships Vexatious social interactions Deceptive behaviour Attacks on attachment figures Self-harming and suicidal behaviours On Day 2, we start looking at therapeutic options available to us, as therapists. We consider the controversies around ‘treatability’ of PD and understand how our approach should include considerations for: The nature and severity of pathology The impact on function and somatic manifestations Comorbid conditions and risk factors The timing of interventions and Cultural considerations We look at the linguistic markers of attachment security, coherence of narrative; agency, idealization and meta-cognition; reflective function and the experience of negative affects – so as to be able to consider different therapeutic techniques for different aspects of personality dysfunction. We compare and contrast the evidence base for different kinds of therapies including: Dynamic psychotherapies Cognitive therapies Dialectical behaviour therapy (DBT) Mixed therapeutic approaches With specific attention to attachment-informed therapeutic approaches that have proven efficacies for PD. Overall, the 2-day course uses theoretical discussions and case vignettes to explain an attachment-informed psychological approach to personality and its disorders; with the aim of helping therapists become more confident in their therapeutic engagement with PD clients. About the speaker Dr Gwen Adshead is a psychotherapist, group analyst and forensic psychiatrist. She trained as a psychiatrist, and then as a forensic psychiatrist after completing a master’s Degree in medical law and ethics at King’s College, London. She was lecturer in victimology at the Institute of Psychiatry, where she studied interpersonal trauma and its effects; then trained as a psychotherapist, with a particular interest in Attachment Theory. She first started work at Broadmoor Hospital as a senior psychiatric trainee in 1990; and over the last twenty years has worked as a responsible clinician, as well as a consultant psychotherapist. Her research interests include moral reasoning in psychopaths and antisocial men; the attachment narratives of abusive mothers; and how psychotherapies work with violent people. Gwen has published over 100 papers, book chapters and commissioned papers; co-edited three books and is working on three more. Gwen’s principal training is group dynamic; but she also has experience of cognitive approaches to therapy, DBT, and mentalization based therapies. Workshop Schedule Day 1, Friday, 29 September 2017 9:30AM: Registration 10:00AM: Module 1: Personality and the Social Self We start the course with a review of the literature on the structure and development of personality across the life span. Specifically, we look at: What is personality? What does it do? Personality and the social self: Traits, dispositions and character Arousal and affect regulation How does personality develop Neurobiology of personality The role of early attachment and relationships Personality and the narrative Lunch (a light lunch is provided as part of the workshop) Module 2: Disorders of the Personality: trauma and the self In module 2, we build on our conceptual understanding of personality and how this might help us understand what happens when personalities fail to function well. Specifically, we discuss: What is the problem in disorders of personality? Classifications and dimensions of personality disorders: ICD11 and DSM 5 How does trauma affect personality development? Different effects of different traumatic experiences Attachment insecurity and personality development Disavowal of distress, Somatisation and external control Risk to others in personality disorder Defences and personality disorders The social mind and the failure of mentalisation We also start looking deeper at the signs of psychopathology in personality disorder as ground work for our discussions on Day 2. 4:00PM: Close Day 2, Saturday, 30 September 2017 9:30AM: Registration 10:00AM: Module 3: Therapy planning for personality disorders We start the second day by consolidating our conceptual understanding from Day 1 and proceed with practical applications. Specifically, we look at: Aims and objectives of therapy for PD Attachment systems activation confusion Abstraction, experience of negative affects, novelty appreciation Relevance of Attachment Classifications in therapeutic interactions Lunch (a light lunch is provided as part of the workshop) Module 4: Disorders of the Personality: trauma and the self In the last module, we look at: Different techniques for different aspects of personality dysfunction Technical problems in therapy: timing of interventions, ruptures, affect storms, drop-out Therapy as strange situation Reversion to pre-mentalising modes when faced with uncertainty and distress Therapeutic moments of impasse – taking up the third position Hate in the countertransference 4:00PM: Close

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