ABSTRACT
OBJECTIVE: This paper examines the evidence base for dialectical behaviour therapy (DBT) in the treatment of patients with borderline personality disorder (BPD). CONCLUSION: DBT has built an impressive reputation within psychology and psychiatry as an effective treatment for deliberate self harm and chronic suicidal behaviours in patients with BPD. However, when each of the randomised controlled trials that comprise this evidence base is examined carefully, the actual results are less convincing about DBT's positive reputation.
Subject(s)
Behavior Therapy , Borderline Personality Disorder/therapy , Humans , Randomized Controlled Trials as TopicABSTRACT
OBJECTIVE: This paper outlines a hypothesis linking the development of implicit memory in infants and chronic suicidal thoughts in adults. In order to do this, the developmental trajectory of memory is reviewed, as well as how attachment experiences are encoded in implicit memory. The cognitive/emotional capacity of infants is then compared to the subjective experience of the chronically suicidal patient. This is used to develop the hypothesis that chronic suicidal thoughts are located in implicit memory, encoded very early in life. This idea is then used to explain why common responses by mental health workers to the chronically suicidal patient may inadvertently reinforce suicidal thoughts. Finally, understanding these concepts helps us to understand how psychotherapy can change chronic suicidal ideation. CONCLUSION: A hypothesis is proposed to link infant memory systems with adult chronic suicidal thoughts, and is used to understand helpful responses for patients who suffer with chronic suicidal ideation.
Subject(s)
Memory/physiology , Suicidal Ideation , Anxiety/psychology , Caregivers , Chronic Disease , Depression/psychology , Humans , Interpersonal Relations , Mental Recall/physiology , Suicide/psychology , Suicide, Attempted/psychologyABSTRACT
OBJECTIVES: The aim of this study was to review psychodynamic formulation with respect to the language used and the evidence it provides about variations of clinical purpose. METHOD: The purpose of the psychodynamic formulation is considered in training and clinical contexts. Three formulations are presented: two written from alternative theoretical perspectives and one designed to be spoken to the patient. Linguistic comparisons are made using these examples, emphasizing differences in grammatical complexity, lexical density ('wordiness') and other qualities. RESULTS: The essential purpose of psychodynamic formulation is to develop an understanding that can be shared in the service of effective care. Significant differences were found between written and spoken versions with greater grammatical complexity and lower lexical density in the spoken form. An intrapsychic theoretical model was more grammatically complex and 'noun-based' compared to an inter-subjective model. Other differences are also described, including the tendency for the intrapsychic account to efface the sense of personal agency. This contributes to the impression of a subject under the influence of 'unseen' forces. CONCLUSIONS: The communicability of psychodynamic formulation is essential to its utility in clinical practice.
