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Dynamic Issues of Medication within Psychotherapy for BPD

Dynamic Issues of Medication within Psychotherapy for BPD. Dr. Nick Bendit Psychiatrist Centre for Psychotherapy Newcastle (Wollongong: October 08). Context. Partial effectiveness Poor relationship between medication type and effect Ubiquitous Problematic (Zanarini).

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Dynamic Issues of Medication within Psychotherapy for BPD

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  1. Dynamic Issues of Medication within Psychotherapy for BPD Dr. Nick Bendit Psychiatrist Centre for Psychotherapy Newcastle (Wollongong: October 08)

  2. Context • Partial effectiveness • Poor relationship between medication type and effect • Ubiquitous • Problematic (Zanarini)

  3. Why do BPD clients want medication • chronic/unbearable emotional pain • Societal expectations • No pain, no suffering • Scientism • GPs and depression/Beyond Blue • Promotion/Money from Drug Co’s • Personal development of BPD (next)

  4. Developmental • Disorganized attachment/emotional invalidation • When in pain, approach/avoid dilemma • Nonpersonal behaviours • External locus of control

  5. What does this mean? • Can’t heal themselves • someone else ---- something else heals • Positive transference = hope of something different • Someone different (white hat) • Something different (silver bullet) • Both together (metaphor?)

  6. Someone different • Care • Love • Hope

  7. Something different • Powerful placebo effect • Don’t have to approach painful feelings/scary people • transitional object, tool that can be controlled • However, three months later….

  8. Possible Negative transference • Hurt me (side effects: nocebo effect and DA) • Use me (pay for medication, consultation) • Unmanageable (untreatable) • Burden (too much for you) • Desperate health prof (you as much as me) • Unlovable (scumbag)

  9. Possible Countertransference referral/prescribe • Too hard/too slow • Unbearable pain (depression?): theirs, our own • Anxiety (suicide, eating disorder) • separation anxiety/guilt: holidays

  10. What to do in therapy • Subjective meaning, not education/discussion of side effects, etc. • Same principle as any frame alteration

  11. Why discuss frame Frame has two functions • Security • Monitors actions used to reduce painful affect without talk = “enactment” (difficult to discuss, but potentially enormously helpful) • Unspoken positive/negative beliefs (conscious, but hidden) • Unconscious positive/negative expectation of self and others (opening to trauma zone/attachment pattern)

  12. Frame alteration: Integrating Roles • Dr Psychotherapist and prescriber: integrating internally different roles • Psychotherapist and separate prescriber: integrating different carers

  13. But more powerful than most frame changes? Particularly powerful, as concrete, and daily reminders • prescriber consultation • Chemist • Bottle and label • Daily ingestion • Interest/concern from family Also concretised in different roles (previous slide)

  14. So, what do you do? • Simply: action into words (eg Dean) How: Discuss it in therapy (often difficult) +/- Therapist reflection +/- Supervision

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