SEPI 37th ANNUAL MEETING

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Principles of Transference-Focused Psychotherapy for Working with Individuals with Personality Difficulties 

Presenters: Kenneth N. Levy, Ph.D., The Pennsylvania State University

This workshop will focus on application of Transference‐Focused Psychotherapy (TFP) in the treatment of individuals with personality difficulties, especially those with borderline and narcissistic features. TFP is a comprehensive and ambitious evidence‐based treatment for patients with severe personality disorders. TFP is a modified and manualized treatment based on Otto Kernberg and colleagues’ writings on object relations theory.  Its efficacy has been demonstrated in multiple studies, both with regard to symptom change and changes in personality structure and both direct comparison and meta-analytic studies suggest it is comparable with other empirically supported treatments. As such, TFP is recognized as one of the “big five” psychotherapies for treating borderline personality disorder in several treatment guidelines and reviews.  The broad goals of TFP are better behavioral control, increased affect regulation, more intimate and gratifying relationships, and the ability to achieve satisfactory life goals consistent with one’s capacities and interests. Specific goals are a reduction of the symptoms, including suicidality, parasuicidality, impulsive hostility, and angry outbursts, resulting in fewer emergency room visits, hospitalizations, and relationship difficulties. While based in the psychodynamic tradition, the treatment has important modifications making it of use to general clinicians today working with patients with significant personality difficulties.  The workshop will avoid jargon and focus on experience-near language meant to resonate with the attendees at all levels of experience and of various orientations. Attendees will learn about essential elements TFP model, including: (1) assessment and providing feedback to the patient, (2) setting a collaborative treatment frame and goals, (3) dealing with challenges to the treatment frame and patient suicidality, (4) how to establish and maintain a non-judgmental stance, (5) dealing with intense affects in session, (6) recognizing transference patterns and differentiating the transference from the therapeutic alliance and the real relationship, (7) using one’s own reaction to the patient as information about the patient’s internal state and/or how the patient may affect others, (8) Clarifying the patient’s subjective experience; Tactfully bringing into awareness disparate aspects of the patient’s experience, and tactfully helping the patient understand the underlying dynamics that contribute to their experience of themselves and others; and (9) recognizing changes in the patient. In addition, the research base for TFP will be reviewed. Clinical vignettes, role plays, and videotaped psychotherapy material will be used throughout. In the spirit of SEPI attention will be paid to similarities and differences with other evidence-based treatments such as DBT, Mentalization Based Therapy, Schema-focused psychotherapy, and Good Psychiatric Management. Also to be discussed is ways of combining TFP with other treatment approaches.

The Intricacies of Working with Emotion in EFT for Couples: Emotional Injuries, Self-soothing, and Forgiveness. 

Presenters: Rhonda Goldman, Ph.D. and Catalina Woldarsky-Meneses Ph.D.

The empirically supported presupposition of the Emotion-focused therapy for couples (EFT-C) model is that partner’s revealing of emotional vulnerabilities to one another is the key process in undoing negative interaction cycles and co-constructing more virtuous ones, and yet the path to achieving this major aim in therapy is sometimes daunting. It is highly common to encounter emotional blocks along the way. Furthermore, emotional injuries related to betrayal and affairs sustained through the relationship, are commonly presenting problems that complicate the matter. The EFT-C model delineates underlying emotional processes related to and driven by shame, seen as at the base of identity concerns, and fear, nestled at the center of attachment processes.

The intricacies of working with such emotional processes in couples will be detailed in this workshop. We will discuss specific updates to the EFT-C model that have been influenced by concurrent advancements in EFT for individuals. The workshop will discuss assessment tools that help therapists delineate cycles and determine core underlying emotional processes, and subsequently work toward their transformation. The workshop will also focus on specific therapeutic interventions designed to deepen emotion, facilitate the sharing of vulnerabilities and expression of compassion by partners, work with emotional blocks and emotional injuries.

We will demonstrate therapist processes of enactments to deepen emotion. We will also outline self-soothing processes in the context of couples’ work. Self-soothing is particularly helpful in the transformation of shame, and a process we have found invaluable in longer term couples work. Finally, we will detail the process of healing of emotional injuries and promoting forgiveness. Videotaped examples will be shown and hands-on, experiential exercises will be undertaken.

Enhancing Emotional Awareness to Promote Change Across Psychotherapy Modalities

Presenters: Richard Lane, M.D., Ph.D., Iftah Yovel, Ph.D., Les Greenberg Ph.D. & Claudia Subic-Wrana, Ph.D.

Although there is widespread agreement that emotion plays an important role in effecting change in psychotherapy, exactly how it plays a role is uncertain. A way forward is to draw upon the preclinical literature for guidance in bridging basic science with clinical application. Here we focus on the promotion of emotional awareness, the recognition and description of one’s own emotional experiences, as foundational to change across a variety of psychotherapy approaches. The first talk will focus on emotion from a preclinical perspective, highlighting how automatic emotional responses provide instantaneous adaptation to changes in interaction with the environment. These automatic responses may be distinguished from awareness of them, which makes changing them possible. An empirically-validated model of levels of emotional awareness will be presented and used throughout this workshop. The role of emotional awareness in change will then be considered from the perspective of three different ways of doing psychotherapy: current cognitive-behavioral approaches, emotion-focused/experiential psychotherapy and psychodynamic psychotherapy. All three modalities consider the developmental process of enhancing emotional awareness to be necessary but not sufficient for change, potentially serving as a common factor comparable in importance to the therapeutic alliance. A roundtable discussion will then be conducted in which each presenter comments on how they would conduct the treatment of a specific depressed client using their own modality, and then comment on similarities and differences across modalities. Time will be reserved for questions after each talk and a 45-minute open discussion with participants.