Affiliated member of the WPA – World Psychiatric Association

Abstract Beggi, Mattia, Doctor, Ronald

Workshop

Chair Botbol, Michel (Paris)

The Interpersonal Dynamics Consultation: mentalising transference and countertransference dynamics

The Interpersonal Dynamics (ID) Consultation (Gordon et al., 2017; Kirtchuk et al., 2008; Kirtchuk et al., 2013; Reiss and Kirtchuk, 2009) is a structured and systematic method to better understand severely disturbed patients from a relational point of view, by looking at the subjective experiences of patients and staff which result from their interactions. It is based on the Axis II of the Operationalised Psychodynamic Diagnostics (OPD) Task Force (2001; Cierpka, 2007), which is a valid method to capture how patients repeat their early relationship patterns with staff in the treatment setting (Stasch et al., 2002).

The ID consultation usually takes the form of group reflective practice for staff, focused on one patient, but it can also be utilised by staff individually (Doctor, 2017; Papaspirou and Maret, 2017).

It requires staff to explicitly mentalise (Bateman and Fonagy, 2013) about both their (his/her) patient’s mental experience and the impact of that experience upon themselves (him/herself). This is achieved by going through the four (A, B, C, D) interpersonal perspectives: A. how the patient perceives others, B. how the patient perceives him/herself in response to others, C. how others perceive the patient, and D. how others perceive themselves in response to the patient. For each perspective the most salient interpersonal dynamics items (out of an  clusters list, see Appendix I in Gordon et al., 2017) are identified.

Perspective A and B represent the patient’s transference to staff, whilst perspective C and D the staff’ countertransference to the patient. Indeed, these four perspectives usually describe one or more dysfunctional cycles that repeat relationship patterns from past to present, so that we can hypothesize the patient’s internal object relationships and how these may influence his/her relationships with staff.

Our workshop aims at familiarising the audience with this ID consultation. In the first part of the workshop we will explain what it is, including what the theory behind is, and we will also exemplify its application with staff from an inpatient therapeutic community for patients with severe personality disorders. In the second part of the workshop we will present a clinical case, and we will then invite the audience to participate to an ID consultation based on it.

References

  • Cierpka, M, Grande, T, Rudolf, G, Von Der Tann, M, and Stasch, M 2007 The operationalized psychodynamic diagnostics system: Clinical relevance, reliability and validity, Psychopathology, 40 (4). pp. 209-220. ISSN 0254-4962
  • Doctor, R. 2017 An individualised approach to using the ID consultation: elucidation of psychosis, in: J. Gordon, G. Kirtchuk, M. McAlister, and D. Reiss (Eds.) Consulting to Chaos: And Approach to Patient-Centred Reflective Practice, 63-77, London: Karnac Books
  • Gordon, J., Kirtchuk, G., McAlister, M. and Reiss, D. 2017 Consulting to Chaos: And Approach to Patient-Centred Reflective Practice, London: Karnac Books
  • Kirtchuk, G., Reiss, D. and Gordon, J. 2008 Interpersonal dynamics in the everyday practice of a forensic unit, In: J. Gordon & G. Kirtchuk (Eds.) Psychic Assaults and Frightened Clinicians: Countertransference in Forensic Settings, 97-112, London: Karnac Books
  • Kirtchuk, G., Gordon, J., McAlister, M. and Reiss, D. 2013 Interpersonal Dynamics Consultation: A Manual for Clinicians, London: Karnac Books
  • OPD Task Force 2001 Operationalised Psychodynamic Diagnostic: Foundations and Manual, Seattle WA: Hogrefe & Huber
  • Papaspirou, K. and Maret, J. 2017 Consulting on Oedipus: then and now, in: J. Gordon, G. Kirtchuk, M. McAlister, and D. Reiss (Eds.) Consulting to Chaos: And Approach to Patient-Centred Reflective Practice, 63-77, London: Karnac Books
  • Reiss, D. and Kirtchuk, G. 2009 Interpersonal dynamics and multidisciplinary teamwork, Advances in Psychiatric Treatment, 15: 462–469
  • Stasch, M., Cierpka, M., Hillenbrand, E. and Schmal, H. 2002 Assessing re-enactment in inpatient psychodynamic therapy, Psychotherapy Research 12(3): 355-368

Dr. Mattia Beggi obtained his M.D. (Doctor of Medicine) in Italy; his thesis was on sexual dysfunctions in HIV patients. He furthered his interest in the relationship between mind and body by doing psychoneuroimmunology research in London, where he then started a clinical training to become a Psychiatrist. He is now a Member of the Royal College of Psychiatrists specialising in Medical Psychotherapy and General Adult Psychiatry whilst doing a MSc (Master of Science) in Psychotherapeutic Approaches to Mental Health. For his MSc thesis, he is conducting Interpersonal Dynamics (ID) consultations for staff at the Cassel Hospital, an inpatient therapeutic community for patients suffering with severe personality disorders.

Speciality Trainee (ST6) in Medical Psychotherapy and General Adult Psychiatry, Cassel Hospital, 1 Ham Common, Richmond, Surrey, TW10 7JF

Dr. Ronald Doctor is a Consultant Psychiatrist in Medical Psychotherapy and Forensic Psychotherapy, West London Mental Health NHS Trust, a Fellow of the British Psychoanalytical Society, member of the IPA committee of Psychoanalysis and Law, board member of the International Association for Forensic Psychotherapy, and Hon. Clinical Lecturer, Imperial College, London.  He has edited two books: Dangerous Patients: A Psychodynamic Approach to Risk Assessment and Management (2003) and Murder; a Psychotherapeutic Investigation (2008) and published History, murder and the fear of death, International Journal of Applied Psychoanalytical Studies (2015) 12.2 152-160.

Lakeside Mental Health Unit, Twickenham Road, Isleworth, TW7 6AF

 

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