Brief Dynamic Interpersonal Therapy A Clinician's Guide

by Lemma, Alessandra; Target, Mary; Fonagy, Peter

• ISBN13: 9780199602452
• ISBN10: 019960245X
• Format: Paperback
• Copyright: 2011-09-05
• Publisher: Oxford University Press

Summary

Dynamic Interpersonal Therapy (DIT) is a brief psychodynamic psychotherapy developed for the treatment of mood disorders. It is being rolled out as part of the Improving Access to Psychological Therapies (IAPT) initiative as the psychodynamic model for the treatment of depression. This book is a user-friendly, practical guide for the implementation of a brief psychodynamic intervention in routine clinical practice as well as in research protocols. It sets out clearly the theoretical framework, as well as the rationale and strategies for applying DIT with patients presenting with mood disorders (depression and anxiety). Throughout, it is illustrated with detailed examples that help the reader to implement the approach in their practice. The book will be required reading to support the national IAPT training initiative, as well as providing a resource for mental health professionals specialising in psychodynamic psychotherapy and wishing to work within a limited time frame.

Table of Contents

List of Abbreviations	p. xvii
Dynamic Interpersonal Therapy: New Wine in an Old Bottle?	p. 1
Evidence-based practice and the fete of psychodynamic psychotherapy	p. 1
The demise of the randomized controlled trial	p. 4
The rationale for developing DIT	p. 19
Are manuals helpful?	p. 21
Specifying the competences required to deliver effective psychodynamic therapy	p. 24
DIT's theoretical framework	p. 33
Object relations theory	p. 34
Ego functioning and theories of attachment	p. 37
Interpersonal psychoanalysis: the contribution of Harry Stack Sullivan	p. 41
Conclusions	p. 43
Why Dynamic Interpersonal Therapy for Mood Disorders?	p. 45
Psychodynamic approaches and diagnostic classification	p. 45
Mood disorders: depression and anxiety	p. 48
Assessing suitability for DIT	p. 55
Core Features and Strategies	p. 63
Aims	p. 63
Trajectory of the therapy	p. 64
The DIT foci	p. 68
Therapeutic stance	p. 73
The Initial Phase	p. 77
Engagement	p. 77
Listening out for "cautionary tales"	p. 80
What do we need to know in order to formulate a dynamic focus for intervention?	p. 82
How many relationships need to be explored before sharing a formulation with the patient?	p. 96
Identifying aims and negotiating the therapeutic content	p. 97
How much information does the patient need about DIT in order to consent to it?	p. 98
Managing risk and self-harm	p. 100
Managing the frame and the setting	p. 100
The use of outcome monitoring and video/audiotaping of sessions	p. 101
The Interpersonal-affective Focus	p. 105
What is a psychodynamic formulation?	p. 105
The interpersonal-affective focus (IPAF): an overview	p. 106
The patient's experience of the IPAF	p. 108
Constructing a formulation: a step-by-step guide	p. 111
The trial interpretation: working towards sharing the IPAF	p. 115
Using the patient's language and metaphors	p. 116
Using the transference and countertransference to inform the formulation	p. 118
How to select a focus	p. 120
Sharing the IPAF with the patient	p. 122
The Middle Phase	p. 129
Aims	p. 129
Sequence of movement in middle sessions	p. 130
Tracking the IPAF: eliciting interpersonal narratives (INs) to illustrate the activation of the IPAF	p. 132
Staying focused	p. 134
Working in the transference	p. 138
Working with defenses	p. 138
Supporting attempts at new behavior in relationships	p. 142
Techniques	p. 145
Listening with an analytic ear	p. 145
Emergence versus structure in the session	p. 148
Expressive/exploratory techniques	p. 149
Focusing on affect	p. 157
Supportive techniques	p. 158
Mentalizing interventions	p. 159
Directive interventions	p. 766
Working in the Transference	p. 169
Using the transference to explore the IPAF	p. 169
Formulating a transference interpretation	p. 172
Criteria for interpreting the transference in DIT	p. 174
The bridge to change	p. 179
When Things go Wrong	p. 183
Managing difficulties in the therapeutic relationship	p. 183
Forms of resistance	p. 189
Working with resistance	p. 195
The Ending Phase	p. 199
The patient's response to endings	p. 199
Preparing for ending	p. 201
Interpreting the unconscious meaning of endings	p. 202
Premature and prolonged endings	p. 204
Ending: the therapist's perspective	p. 205
The goodbye letter	p. 206
Revisiting the attachment descriptors	p. 209
Working with resistances in the ending phase	p. 214
Therapeutic stance in the ending phase	p. 215
Frequently Asked Questions	p. 217
How does DIT differ from interpersonal psychotherapy?	p. 217
How does DIT differ from other brief psychodynamic therapies?	p. 217
Is DIT a supportive psychotherapy?	p. 218
Is DIT an adaptation of mentalization-based therapy for mood disorders?	p. 218
Is DIT suitable with patients with personality disorders?	p. 219
How central is working in the transference in DIT?	p. 220
What training do I need to practice DIT?	p. 220
Does the length of the therapy need to be restricted to sixteen sessions as set out in this protocol?	p. 220
Does the DIT therapist work with dreams and unconscious fantasies?	p. 221
Does the DIT therapist use the countertransference as the basis for intervening?	p. 221
Does DIT focus on the patient's past?	p. 221
What should I expect if I choose to train in DIT?	p. 222
DIT Competences	p. 223
Patient Information Leaflet	p. 231
DIT Rating Form	p. 237
References	p. 241
Index	p. 253
Table of Contents provided by Ingram. All Rights Reserved.