AAAPDP on Psychotherapy, Trauma and Borderline Personality Disorder
I recently attended the AAAPDP (American Academy of Psychoanalytic and Dynamic Psychiatry) annual
meeting in New Orleans as a guest of my father who was also to present a paper. Being the only MFT amongst psychiatrists who are psychodynamically trained was fascinating to observe on a number of levels.
One thing that was interesting was to watch this group trying to re-think their theory in a way that can incorporate brain science (neuroscience) in a way that resonates with their beliefs about therapy and change (which in and of themselves have certainly changed since the days of Freud’s influence). The jury is still out on what this ultimately looks like for them – but it’s clear many are doing so.
Another topic that came up a great deal was attachment and the role of relationships as the source for many of our wounds – but the power relationships have to heal (and rewire the brain). Being a therapist with a strong attachment and neuroscience focus (the latter am studying currently) – this was really neat and validating to hear.
I will now lay out a smattering of information I obtained on the practice of psychotherapy, trauma and related issues such as borderline personality disorder. These quotes, facts and ideas stood out for me and I’d like to share them:
On Psychotherapy, the Mind and the Brain:
- “The human condition involves looking for ultimate meanings.” – C.E. Brookes, MD
- “Psychotherapy changes the molecular structure of patients with depression.” – Glen O. Gabbard, MD
- “We (therapists) are in danger using a “treating” approach. Psychotherapy has to be a relational event.” – C.E. Brookes, MD
- “Therapy choice (modality) should be dictated by patient need.” – Richard Friedman, MD
- “The latest neuroscience research has shown that gene expression in the brain can be effected by behavior.” – MD workshop participant
- “Self directed neuroplasticity research suggests the way a person directs attention will affect both the state of the brain and the experiential state.” – Glen O. Gabbard, MD (“mindfulness” being an example)
On Childhood Trauma and Attachment:
- In 2006, 1 of 43 infants less than 1 year of age suffered abuse or neglect. (probably low due to under-report).
- Children who are more vulnerable (exposed to other traumatic events) are more sensitive to being traumatized by the media.
- Children exposed to trauma have an increased risk for gene expression for depression or aggression.
- “Early relationships form the basis of all other relationships.” – Joy Osofsky, PhD
- According to Dr. Osofsky, it’s important to use a relational approach to healing trauma in children; to restore trust, empathy and reciprocity of relationships.
- “People who work with trauma need to think about self-care… to avoid vicarious trauma.” – Joy Osofsky, PhD
- If intervened early enough, a replacement attachment figure can much of the damage from earlier attachment deficiencies. (The Bucharest, Romania Early Intervention Project - comparing community children, institutionalized children and foster children).
On Borderline Personality Disorder:
- “(In borderline personality disorder) there is an amygdalla hypersensitivity that manifests in facial expression reading.” – Glen O. Gabbard, MD
- Those with BPD adapted to childhood trauma by assessing moment to moment facial expression shift by parent.
- In BPD, neutral facial expressions may represent the most ambiguous threat.
- Many people with BPD see the world/others as dangerous and they are powerless and unacceptable.
Lisa Brookes Kift is a psychotherapist and creator of Notes from a Therapist’s Chair: The Therapy and Counseling Blog; a feature of The Toolbox at LisaKiftTherapy.com. To stay updated on the most recent therapy / therapist related posts subscribe to Notes from a Therapist’s Chair Blog RSS Feed.
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I am not sure whether your father is a therapist and if he is, whether he is trained psychoanalytical, but if he is, I wonder what he thinks about you, a therapist, having an open blog for all your clients to find and read. You talk about BPD and attachment wounds but seem to be totally unaware of the pain an open blog like this can cause for your clients. I strongly suggest you talk to your father about this or get some psychoanalytical supervision.
It is not fair on your clients.
UnmotheredChild,
I appreciate your feedback and respect your position. My father is a psychoanalytically trained psychiatrist of 45 years plus – and over the years has embraced other ideas and modalities.
I’m sure you’re aware of the changing landscape of how psychotherapists, psychologists and psychiatrists are presenting themselves online. I have a series of articles on PsychCentral.com on this topic that I’ve written over the last few years, the first one about an exchange between my father and I on this subject and his initial distaste for me having a picture on my website at all, particularly having the psychoanalytic underpinnings in training that he has. You might be interested in reading my article series as it discusses the “ins and outs” of this changing landscape and the questions facing therapists navigating it (including the social networking aspect).
Early on in my series, there were many strong voices leading the charge against therapists being so open, writing a blog, issues of transference, etc – all of what you’re alluding to. The comments on some of the pieces clearly indicate the mix of opinions. Over time, there has been a massive surge of therapists online, many of them writing their own blogs.
In case you’re interested, here are the articles in order of being written:
Psychotherapists Unmasked on the Internet
Therapists, Social Networking and Blogging, Oh My!
Therapists, Why Are You Using Social Networking?
Therapists Busting Out Online, Where Are We Now?
The bottom line is that the rules have changed in our field. Many people are so accustomed to seeing therapists with their own websites, pictures, profiles – and yes blogs – that I think those who don’t have at least some kind of internet presence are finding it more difficult to obtain new clients at the rate at which those who have embraced technology and the changing times do. The exception would be well established clinicians who have been in their communities for years and have a solid word of mouth referral network established, but even those folks may be finding that not having a website offering a more personal connection with potential clients may suffer.
In my case, I have two websites – one for my local private practice and this site which is targeted globally as a resource for marriage, relationship and emotional health. Though the two now get intermingled by nature, I never encourage my therapy clients to follow me on social networking, sign up for my monthly newsletter or engage with me online.
Again, I appreciate and understand your feedback. If the day comes where I become aware of a client’s work being tainted and damaged by what I’ve put out online, I will certainly do the best I can to address this in session. Your comment is a good reminder that though things have significantly changed for those of us who do this work, there are those who still have genuine concerns about it.
It’s a new world for our field – and I happen to have embraced this early on. In addition, I am very grateful to be able to do the work of psychotherapy – and to write. It’s a combination that resonates a lot with me.
Lisa Brookes Kift, MFT
The Toolbox at LisaKiftTherapy.com
Hi Lisa!
I saw you post the link to this on Twitter, so I thought I would hop in with a few comments.
I think that, as therapist (of a variety of sorts), it is our responsibility to put valid information on the internet because so many of the things that are published on the internet about mental health, relationships, etc is inaccurate and potentially harmful. There are of course, laws in place to protect patient confidentiality and information, and these must be followed by any clinicians who publish on the internet. However, I would much rather a client (or in the case of my practice, a client’s caregiver), come to me asking questions about information they saw on my blog or website as opposed to assuming the most recent article on ask.com or yahoo questions was accurate without a source of other information.
Just my two cents :)
Natalie Mullis, MT-BC
Clients seeking therapy are in a wonderful position to be able to choose a therapist that fits them. Clients who are not comfortable having a therapist who blogs and is active on social media sites can choose a therapist who does not have an online presence. Many clients choose therapists who have an online presence as they feel comfortable knowing their therapist is knowledgeable and has expertise via reading their blogs/articles. I believe it is important for clients to be informed consumers when it comes to their mental and emotional health. Choosing a therapist that fits their personality and needs is important, especially when so much of the efectiveness of therapy rests on the quality of the therapeutic relationship. Having an online presence helps clients with this important choice.
Natalie,
Well said. The internet is not particularly regulated so anyone can write about any topic they desire. Unfortunately, there are many only motivated by potential ad money and the topic of “relationships” in particular seems to be a popular and perhaps high yield avenue…
People really need to practice due diligence when getting information on any topic online and keep in mind the source. Are they credible? One good rule of thumb is looking for an “about” section to learn about the author. If there is nothing like this, beware.
Thanks for your “two cents!”
Lisa
The Toolbox at LisaKiftTherapy.com
Kerry,
I completely agree. The increase of therapist online visibility brings more transparency and choices for consumers. Many of my therapy clients seek me out because they have a sense of how I work with individuals and couples by my writing.
Yes, at the end of the day it is all about the quality of the therapeutic relationship. If consumers feel that this might be tainted by someone with a strong online presence then they should absolutely seek out another clinician.
There are plenty of us to around!
Lisa
The Toolbox at LisaKiftTherapy.com
There are lots of reliable information online regarding psychology. Our clients can freely choose their counsellors or psychologist. Not forcefully, but independently. There are no problems with the facts posted online as long as it is supported by studies and research.