Unified Psychotherapy Project

Introduction to Clinical Science

steve — Mon, 16 Jun 2014 13:32:07 +0000

Jeffrey J. Magnavita, Ph.D.

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Introduction to Clinical Science

steve — Mon, 16 Jun 2014 13:30:31 +0000

Jeffrey J. Magnavita, Ph.D.

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Experiential Psychodyanmic Psychotherapy

steve — Mon, 16 Jun 2014 13:23:38 +0000

Jon J. Frederickson, MSW

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Short-Term Dynamic Psychotherapy

steve — Mon, 16 Jun 2014 12:01:17 +0000

Allan Abbass, M.D.

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Hello world!

steve — Mon, 16 Jun 2014 09:06:56 +0000

Welcome to WordPress. This is your first post. Edit or delete it, then start blogging!

Trauma, Personality Systematics, & Psychotherapy

steve — Fri, 02 Apr 2010 23:11:37 +0000

One of the most surprising things that I experience in my clinical practice is how often trauma is overlooked by psychologists and psychiatrists. This is an unfortunate event as trauma victims often suffer needlessly when they don’t receive appropriate treatment and more often are placed on a regime of psychotropic medications that have severe side-effects. Why does this continue to be the case with such highly trained Doctoral level clinicians? This is a complex issue but I believe one level of this problem is related to the lack of understanding of personality systematics or how the personality system operates at various levels of the total ecological system. Practitioners are often so focused on symptom complexes that they want to treat with medications and standard psychotherapy that they fail to listen with a third ear as Reich spoke of the need to listen beyond the words and symptoms. Another problem is that many clinicians have a very narrow view of trauma and don’t realize that little “t” trauma as Francine Shapiro terms it is severely derailing of personality development and can create a trajectory to adult psychopathology that becomes so obscure that those without the necessary framework don’t suspect that the story is one of developmental trauma. The issue of unrecognized trauma becomes even more apparent with patients who are professionals and have achieved a lot in their lives. There is a tendency by many to offer biological explanations and then prescribe medications which although can be helpful if not understood as only one level of the personality system can divert treatment and things can get worse. There are wonderful frameworks that assist me in my work at identifying these developmental traumata. Jeffrey Young’s Schema-Focused work is very elaborate and helpful in ascertaining early maladaptive schema that were learned in attachment experiences. I also think Francine Shapiro’s TICES using aspect of the memory network that are active is also a brilliant development in that it allows clinicians to identify the early trauma that has not been processed. Another good way to identify trauma is in re-enactment patterns. I have had quite a few patients who have shown patterns whereby they have acted out toward others when they were children in ways that are difficult to understand. Sometimes these individuals are labeled as predators when in fact they are re-enacting traumatic experiences that have happened to them and which are unintegrated psychic phenomena. I will discuss how our understanding of personality systematics can help with complex cases. Check out Wikipedia for a review of personality systematics.

Neglect: The Silent Scream-Magnavita

steve — Thu, 01 Apr 2010 00:55:33 +0000

One of the most challenging clinical issues that psychotherapists face in practice is treating individuals who have suffered from parental neglect. Unfortunately this is a much more common occurrence than most people realize. When treating the spectrum of those who suffered physical, sexual, or emotional abuse there is usually a narrative that is told and can be deciphered by careful listening to developmental history and examining symptom formation, as well as explicit memory where there is often clear recall of abuse. On the other hand, neglect, which results in a “silent scream” in many patients is much more difficult to decode. I call the effects of neglect the silent scream because if the psychotherapist listens closely you can hear the scream in the bound up symptom formation. The scream is often expressed in a rebellion by the body and is in a sense narrated by the soma as opposed to the psyche. Many patients I have treated with severe neglect have been previously seen for a spectrum of somatic disorders including chronic fatigue, fibromyalgia, depression, and severe GI tract disturbances. The are in a sense screaming in the only way they can for someone to orient to them. There is a failure of what I call the “protest-orient” system which is a central part of the early attachment system. Infants naturally protest when they have a need that requires an adult to orient to them. In neglect there is an extinction of the protest response to a state similar to Seligman’s learned helplessness where the dog stops moving and doesn’t try to escape the shock. The protest response has been squelched, and the the squelched response is expressed in the silent scream. One of the most challenging aspects of treating these patients is create an awareness of the impact of neglect on self-other schema. In successful treatment a narrative is co-constructed that allows for metabolization of affects related to the neglect. Cognitive schemata and beliefs about the self need to be identified. These are often related to beliefs of being insignificant, unlovable, worthless and even that survival is threatened. Roy Kiessling an EMDR trainer has been helping outline these survival beliefs that are fundamental to self-structure. If you are neglected you may not survive when you are an infant. There is much converging evidence that shows the basic attachment if not sufficient can result in failure to thrive and potential death. Spitz showed this a half century ago in his studies of infants in foundling homes, Harlow showed it with a primate model, and Beatrice Beebe shows it in her early infant attachment tapes and research. When I am evaluating patients I try to get as clear a developmental history as possible and then if symptoms are not related to current issues in the persons life I begin to look at the diffuse psychopathology as an adaptive response to unbearable loss of never experienced attachments. We know that when severe this neglect can result in reactive attachment disorders but at a lower threshold listen for the silent scream.

Paranoid Dysfunctional Personologic System-Magnavita

steve — Tue, 30 Mar 2010 00:25:47 +0000

In the news today there is a story about a group of about 9 individuals who were heavily arming themselves and preparing for the “anit-Chirst”. They decided they were going to kill a policeman and then at the funeral kill others who were attending. The ex-wife of the leader of the group spoke of becoming increasingly uncomfortable with her husband (Level I) as he went from praying to amassing heavy arms and spreading his vitriol on his website. In addition to her ex-husband two of his sons were also inditced. I was immediately struck by the dynamics of this group and how it seems to represent a category of dysfunctional family (paranoid dysfunctional personologic system-ParDPS), that I wrote about in Relational Therapy for Personality Disorders. Although these dysfunctional systems are generally rare, as they tend to keep themselves isolated from society, we can see in this example how a the paranoia gets transmitted from one generation to the next via the mutigenerational transmission process (Level III). The paranoid process keeps these families out of the mental health system because of their suspiciousness of outsiders. I have treated a few members of these systems over the years and these ParDPS can be quite toxic and as in this case potentially dangerous. It will be interesting to see if there is an upsurge in these family/social systems coming to the attention of the authorities, as more and more stress in placed on our sociopolitical system (Level IV) as a result of economic hardship, high unemployment and rapid technological advances. In this case we can see how the individual psychopathologies, family system dynamics, and potential sociocultural forces are heating up these dynamics. Politically, we can see this vitriolic stirring up of listeners to various talk shows who are able to mobilize these paranoid dynamics and creating a systemic acting-out not seen in more stable times. Unified theory of human functioning seeks to understand how the four levels of the unified system inter-relate and potentially can be used to predict social and individual behavior. In times of societal stress the family and individual personality system is going to be stressed at the weakest point or at the “stress-diathesis”.

The Components of Unified Psychotherapy-Magnavita

steve — Thu, 25 Mar 2010 22:03:21 +0000

Unified psychotherapy is a term that was coined by David Allen to describe a model of treatment that he developed and has manualized. Many people have asked what unified psychotherapy is and how it is different from integrative therapy or other forms of therapy. Unified psychotherapy is a conceptual system that honors the meta-framework in which all domains of human functioning are expressed from the micro-level to the macro-level. There are different ways to divide any complex system and the divisions are an artifice as any complex system is inter-related in ways that are not always evident. With regards to psychotherapy unification, it requires that the psychotherapist be cognizant of techniques/methods, relationship principles, and patient-therapist factors, as well as ecological effects. Unified psychotherapy also requires some knowledge of not only the meta-framework in which all human behavior and change occurs and operates but necessitates some knowledge of how the specific component subsystems operate. For example, in previous blogs I discussed the attachment system which is a vital domain of human relationships and neurodevelopment. A knowledge of this sub-system is a requirement for understanding how interpersonal relationships operate and how various attachment systems suggest different techniques, methods, and relational emphasis. One of our goals with UPP and psychotherapedia is to catalogue the techniques using a basic system of classification and in this case we are using four levels. Eventually, when we have a sufficiently populated database we can begin to look at clinical algorythms which will allow us to offer some suggestions about how to sequence methods and incorporate various techniques into the treatment process. This type of sequencing also needs to include modalities and formats since they are important components of treatment. Clarkin and Frances called this type of planning differential therapeutics and with an expanding database we may come closer to offering some useful guidelines for clinicians and some interesting projects for researchers.

Attachment, Mentalization, and Trauma-Magnavita

steve — Tue, 16 Mar 2010 20:25:34 +0000

A group of us shrink types visit Austen Riggs an eminent psychiatric hospital located in West Stockbridge, MA to attend their Friday night lecture series. After a lovely dinner at the Red Lion Inn across the street from the bucolic Riggs campus we were delighted to hear Peter Fonagy lecture on mentalization, a concept that he has articulated and on which he has based an approach to psychotherapy which has shown efficacy with severe personality disorders. Of course as you might expect Fonagy is a master at conceptualizing theoretical constructs, describing technical interventions, and carrying out research which he combines rather seamlessly. The concept of mentalization refers to having a theory of mind both self and other which is essential for interpersonal relationships and self-coherence. Fonagy draws from attachment theory to ground his work as well as psychodynamics. I found myself thinking that mentalization is akin to psychological mindedness and observing ego, which are parts of what I think he means by mentalization. His therapeutic approach strives to enhance mentalization in patients and he and Mary Target have developed a manualized treatment for this which is evidence-based. In fact, I was honored to have them collaborate with me in my Handbook of Personality Disorders for which they wrote a chapter. Upon introduction, Peter told me the volume is prominently featured on his bottom shelf in his office. I teased him about it being on the bottom shelf and he was very good natured in return.

Basically I think most everything we do as psychotherapists and medical docs comes down to attachment styles so I am in total agreement with Fonagy about the basis of Bowlby and Ainsworth’s attachment paradigm. He also showed some interesting studies he conducted using PET scans and showing differential activation of brain structures comparing borderline to normal subjects. One of my good friends muttered phrenology which inspired some interesting discussion amongst us.

I always try to understand at what level of the unified system a particular theory-method set is operating and clearly placed mentalization in the intrapsychic-biological and interpersonal-dyadic domain. Mentalization occurs in a relational configuration and essentially structures the developing infants mind probably by strengthening connections in related brain regions especially between the frontal cortext and limbic system but certainly more complex connections are occuring.

The concept of trauma is essential for any theory of psychopathology and is well established as the common pathway to many forms of psychopathology. Trauma not only causes distress but disrupts the attachment system and if not repaired creates ongoing issues that can derail development. I thought it was interesting that Fonagy believes, as I have seen in my clinical practice, that neglect is really a malignant form of trauma. At least when someone is overtly abused they exist to the other but when neglected they are insignificant which has many serious implications.

I suspect that all experienced therapists are activating mentalization systems in the brain through sophisticated self-other methods of restructuring which is basically internalizing objects or formulating schemata. One could say that the interpersonal processes are captured in intrapsychic structures in an iterative process. If you get a chance Fonagy is certainly worth listening to or reading about.