TRAINING GENERAL PRACTITIONERS IN MENTALIZATION BASED THINKING

1. TRAINING GENERAL PRACTITIONERS IN MENTALIZATION BASED THINKING Annette Sofie Davidsen

2. Specialconditions in general practice • Unorganized problems • Direct access • Time constraint Annette Sofie Davidsen

3. Specialconditions in general practice • Unorganized problems • Direct access • Time constraint • Same psychodynamic conditions as in specialist psychotherapy • Often not realized • Need of training and supervision Annette Sofie Davidsen

4. Training • Imported models • No formulated theory for general practice • Left to ’folk psychology’ Annette Sofie Davidsen

5. Balint’s theory • Importance of: • The process of understanding and the relationship • The therapist’s reflexive insight into him/herself Annette Sofie Davidsen

6. Mentalization • The capacity to understand other people’s thoughts, feelings, imaginations, wishes, desires and so on –also realizing your own thoughts and feelings and their contribution to the relationship • Similar to Balint’s thoughts about the process of understanding • Active process • Linked to attachment theory Annette Sofie Davidsen

7. Connection between concepts and theories Balint Mentalization Attachment theory Psychotherapy in general practice ”Balint anticipated attachment theory – ‘basic fault’” (Holmes 2001)

8. The tradition of training and supervision disappeared with the academic specialization Annette Sofie Davidsen

9. PhD. study of psychological interventions in general practice • GPs differ greatly in the form of relationship they form with the patient • Both in psychological interventions and in normal consultations • Difference in propensity to mentalize • Need of training mentalizing capacity Ref.: Davidsen, A.: Psychology and Psychotherapy, theory, research and practice, in press (June 2009) Annette Sofie Davidsen

10. We propose that therapists’ mentalizing skills are central to establishing and maintaining an effective treatment relationship and a therapeutic alliance. Thus, we are developing a training programme to foster therapists’ mentalizing capacities in the treatment process. We aim not only to promote therapists’ attentiveness to mental states in their patients but also to increase their awareness of their own mental states in the conduct of psychotherapy. (Williams et al., 2006) p. 224-225. Annette Sofie Davidsen

11. General therapeutic approach • Cannot be manualized • Manuals cannot teach skillful use and creativity • Need for theory and agreed concepts • Mentalization a possible concept • Dialectic about structure • Firm structure can impede mentalization Annette Sofie Davidsen

12. Therapeutic relationship • Mentalizing central for establishing relationship • Association between therapeutic relationship and outcome in psychotherapy – and in general practice Annette Sofie Davidsen

13. Problems with mentalizing • Be aware of pseudo-mentalizing • Apparent understanding Annette Sofie Davidsen

14. Training • Supervision in groups • Illustrative videos • Role-playing • Own video-clips • Shifting between watching an expert and practicing • Therapist’s mentalizing capacity in the forefront • Active, inquisitive stance Annette Sofie Davidsen

15. Problems with mentalizing • ”We allready do that” – but it is • Difficult to mentalize under emotional stress Annette Sofie Davidsen

16. Purpose of training GPs • Training the mentalizing capacity • To train GPs’ handling of emotional problems • To train GPs in ’talking therapy’ • Carrying out therapy sessions under supervision trains the mentalizing capacity in normal consultations Annette Sofie Davidsen

17. Annette Sofie Davidsen