London, 17 June 2016 (Friday)
10:00AM – 4:00PM
Ambassadors Bloomsbury, 12 Upper Woburn Place, WC1H 0HX
Early childhood adversity, neglect and childhood sexual abuse are just some of the risk factors that can directly impact behaviours we associate with Personality Disorders. An explanation for such linkage is that clients with personality disorders experience great difficulty in establishing and sustaining interpersonal relationships that require good affect regulation. Their inability to regulate negative affects increases the likelihood of unregulated hostility and angry responses. This actually puts such clients at an enhanced disadvantage – not only do they tend to alienate caregivers, but they are likely to do so at times of greatest need.
At this practical seminar which would be especially relevant for psychotherapists, psychologists, counsellors and psychiatrists, Dr Adshead suggests that it is impractical to provide therapy for behavioural manifestations without a proper understanding of underlying cognitive schema and neurobiological basis. She presents evidence on the development of affect regulation within attachment relationships that explains both the symptoms of and effective therapeutic strategies for personality disorders. By viewing personality disorders through the lenses of attachment and affect regulation, she equips us to recognise the multiple challenges faced by clients:heightened perception of threats, inability to repair emotional states stimulated by threat or fear and the shift in locus from external to internal affect regulation.
We comprehend the specific nature of affect dysregulation for personality disorders according to clusters:
- Cluster A: paranoid personality disorders
- Cluster B: borderline personality disorders
- Cluster C: anxious / avoidant personality disorders
By drawing our attention to Affect Regulation as only one, but arguably the most critical aspect of personality disorders, Dr Adshead helps us inform our therapeutic approaches when working with mild to moderate disorders across the spectrum.
About the speaker
Dr Gwen Adshead is a psychotherapist, group analyst and forensic psychiatrist. She trained as a psychiatrist, and then as a forensic psychiatrist after completing a master’s Degree in medical law and ethics at King’s College, London. She was lecturer in victimology at the Institute of Psychiatry, where she studied interpersonal trauma and its effects; then trained as a psychotherapist, with a particular interest in Attachment Theory. She first started work at Broadmoor Hospital as a senior psychiatric trainee in 1990; and over the last twenty years has worked as a responsible clinician, as well as a consultant psychotherapist.
Her research interests include moral reasoning in psychopaths and antisocial men; the attachment narratives of abusive mothers; and how psychotherapies work with violent people. Gwen has published over 100 papers, book chapters and commissioned papers; co-edited three books and is working on three more.
Gwen’s principle training is group dynamic; but she also has experience of cognitive approaches to therapy, DBT, and mentalization based therapies.
10:00AM: Session 1: Affect dysregulation and personality disorders
In the first session, we comprehend how individuals who have experienced insecure attachment are at risk of developing dysregulated and disorganised affective systems. Specifically, we consider:
- The move towards a more self-preservative behaviour in personality disordered clients
- The regulation of negative affect
- The heightened expectation of an external solution – creating challenges for the therapist
- Optimal right hemispheric maturation
11:30AM: Coffee Break
11:45AM: Session 2:
The three clusters
Our discussion in the second session examines how affect dysregulation specifically influences affective expression in personality clusters:
- Paranoid, schizoid and schizotypal – consistent under-regulation of fear and terror
- Borderline, antisocial, histrionic and narcissistic – under and over dysregulation of both positive and negative affects
- Avoidant, dependent and anakastic – under regulation of social emotions
1:00PM: Lunch (a light lunch is provided as part of the seminar)
1:45PM: Session 3: Substance misuse and Violence: group discussion
This interactive session builds on our understanding from Session 2 and explains how substance misuse and reactive violence can be explained as a consequence of inadequate regulation.
2:45PM: Coffee Break
3:00PM: Session 4: Implications for Therapy
We look at therapeutic implications of our discussions and consider:
- Affect Regulation as an approach in psychodynamic, cognitive and relationship-based therapies
- Combining psychotherapies for effective work with mild to moderate degrees of personality disorder
- Affect Regulation and group processes
- Recognizing when severe disorders warrant further referral