1 / 14

Dynamic Issues of Medication within Psychotherapy for BPD

Dynamic Issues of Medication within Psychotherapy for BPD. Dr. Nick Bendit Psychiatrist Centre for Psychotherapy Newcastle (Wollongong: October 08). Context. Partial effectiveness Poor relationship between medication type and effect Ubiquitous Problematic (Zanarini).

constance
Download Presentation

Dynamic Issues of Medication within Psychotherapy for BPD

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Dynamic Issues of Medication within Psychotherapy for BPD Dr. Nick Bendit Psychiatrist Centre for Psychotherapy Newcastle (Wollongong: October 08)

  2. Context • Partial effectiveness • Poor relationship between medication type and effect • Ubiquitous • Problematic (Zanarini)

  3. Why do BPD clients want medication • chronic/unbearable emotional pain • Societal expectations • No pain, no suffering • Scientism • GPs and depression/Beyond Blue • Promotion/Money from Drug Co’s • Personal development of BPD (next)

  4. Developmental • Disorganized attachment/emotional invalidation • When in pain, approach/avoid dilemma • Nonpersonal behaviours • External locus of control

  5. What does this mean? • Can’t heal themselves • someone else ---- something else heals • Positive transference = hope of something different • Someone different (white hat) • Something different (silver bullet) • Both together (metaphor?)

  6. Someone different • Care • Love • Hope

  7. Something different • Powerful placebo effect • Don’t have to approach painful feelings/scary people • transitional object, tool that can be controlled • However, three months later….

  8. Possible Negative transference • Hurt me (side effects: nocebo effect and DA) • Use me (pay for medication, consultation) • Unmanageable (untreatable) • Burden (too much for you) • Desperate health prof (you as much as me) • Unlovable (scumbag)

  9. Possible Countertransference referral/prescribe • Too hard/too slow • Unbearable pain (depression?): theirs, our own • Anxiety (suicide, eating disorder) • separation anxiety/guilt: holidays

  10. What to do in therapy • Subjective meaning, not education/discussion of side effects, etc. • Same principle as any frame alteration

  11. Why discuss frame Frame has two functions • Security • Monitors actions used to reduce painful affect without talk = “enactment” (difficult to discuss, but potentially enormously helpful) • Unspoken positive/negative beliefs (conscious, but hidden) • Unconscious positive/negative expectation of self and others (opening to trauma zone/attachment pattern)

  12. Frame alteration: Integrating Roles • Dr Psychotherapist and prescriber: integrating internally different roles • Psychotherapist and separate prescriber: integrating different carers

  13. But more powerful than most frame changes? Particularly powerful, as concrete, and daily reminders • prescriber consultation • Chemist • Bottle and label • Daily ingestion • Interest/concern from family Also concretised in different roles (previous slide)

  14. So, what do you do? • Simply: action into words (eg Dean) How: Discuss it in therapy (often difficult) +/- Therapist reflection +/- Supervision

More Related