Brief Dynamic Interpersonal Therapy A Clinician's Guide
by Lemma, Alessandra; Target, Mary; Fonagy, PeterFormat: Paperback
Pub. Date: 2011-09-05
Publisher(s): Oxford University Press
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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. |
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