10:00AM – 4:00PM
Edinburgh Training and Conference Venue, 16 St Mary’s Street, Edinburgh, EH1 1SU
Dr Anne Alvarez has worked extensively with extremely disturbed and borderline clients and found that therapeutic work with such clients can be very challenging. The clients can be unresponsive to traditional approaches and methods of ascribing meaning. Crucially, such clients appear not to be able to manage spatial, temporal and causal ‘two-tracked thinking‘ (i.e. some capability to think symbolically). She found that due to ego impairment and extreme disturbance, the therapist’s assumption that the client had a sense of self that could be talked to & a clear sense of other people to whom the therapist could refer, proved false. At this practical seminar which would be of particular relevance to psychotherapists, clinical & educational psychologists, counsellors and psychiatrists; Dr Alvarez builds on 50 years of experience as a psychotherapist, and explains how three different levels of analytical work and communication: the explanatory level, the descriptive level & the intensified vitalizing level; can work best to address these challenges. She argues that our traditional understanding of ‘interpretation levels’ needs to be revised taking psychopathological and developmental priorities into account.
Illustrating her explanations with practical case vignettes, Dr Alvarez helps us comprehend as practitioners when we need to progress from traditional therapy and apply a second level of work – that of containment and empathic description – with fragmented, under-integrated or overwhelmed patients. In even more severe cases, where the sense of self and object is very weak, a third, more intensified level of work may be necessary. She also explains how our therapeutic approach can make use of a counter-transference sense of urgency with clients in states of severe chronic dissociation. Blending a solid theoretical foundation with practical case studies at this seminar, Dr Alvarez helps us also understand how the timing of these therapeutic interventions may need to shift from moment to moment even within a single session.
Dr Anne Alvarez, PhD, M.A.C.P is a Consultant Child and Adolescent Psychotherapist (and retired Co-Convener of the Autism Service, Child and Family Department, Tavistock Clinic, London). She is author of Live Company: Psychotherapy with Autistic, Borderline, Deprived and Abused Children and has edited with Susan Reid, Autism and Personality: Findings from the Tavistock Autism Workshop. A book in her honour, edited by Judith Edwards, entitled Being Alive: Building on the Work of Anne Alvarez was published in 2002. She was Visiting Professor at the San Francisco Psychoanalytic Society in November 2005 and her new book, The Thinking Heart: Three Levels of Psychoanalytic Therapy with Disturbed Children was published in April 2012 by Routledge.
10:00AM: Session 1:
Psychoanalytic thought & Analytic levels
In this first introductory session of the day, we draw on the psychoanalytic theories that influence our therapeutic approaches and link these with the levels of analytic work:
- The explanatory level and the works of Freud & Klein
- The descriptive level and the works of Winnicott, Bion and developmentalists such as Stern, Trevarthen and Beebe
- The intensified level as described by authors in the autism field such as Reid and Alvarez
10:45AM: Session 2: Applying analytic levels in practice
We look at analytic levels as existing on a continuum of meaning. Dr Alvarez utilises illustrative case examples to show the different mental states relevant to the use of various levels of interpretation including:
- Mildly neurotic clients – with adequate ego development, hope & trust
- Borderline personality disordered or Borderline psychotic clients who are easily overwhelmed by emotion &
- Autistic or Schizoid clients who experience difficulties in coherent thought
Dr Alvarez explains that these levels are not prescriptive and that clients within a particular category can move up or down the integration continuum at any moment.
11:30AM: Coffee Break
11:45AM: Session 3: Applications to Therapeutic Work
Building on our understanding from the previous two sessions, participants start considering the preconditions in a client that enable them to use or need these three types of intervention. In this session, we discuss the difference between one-tracked & two-tracked thinking (Bruner) and a thinking deficit where the client needs additional help. This session is facilitated by case vignettes.
1:00PM: Lunch (a light lunch is provided as part of the workshop)
2:00PM: Session 4: Practical challenges at the Descriptive Level
Using case vignettes from her clinical work, Dr Alvarez explains the practical challenges encountered at the descriptive level. Here, she distinguishes between the wishes of neurotic clients and the imperative needs of borderline clients. She explains how in certain cases it’s important to describe the clients’ phantasy without the need for unmasking.
3:30PM: Session 5: Plenary
Attendees will be invited to discuss any issues outstanding from the previous sessions.