TRAINING GENERAL PRACTITIONERS IN MENTALIZATION BASED THINKING

Annette Sofie Davidsen

Special conditions in general practice Unorganized problems Direct access Time constraint

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Annette Sofie Davidsen

Special conditions in general practice Unorganized problems Direct access Time constraint Same psychodynamic conditions as in

specialist psychotherapy Often not realized Need of training and supervision

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Annette Sofie Davidsen

Training

Imported models No formulated theory for general

practice Left to ’folk psychology’

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Annette Sofie Davidsen

Balint’s theory

Importance of: The process of understanding and

the relationship The therapist’s reflexive insight

into him/herself

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Annette Sofie Davidsen

Mentalization

The capacity to understand other people’s thoughts, feelings, imaginations, wishes, desires and so on –also realizing your own thoughts and feelings and their contribution to the relationship

Similar to Balint’s thoughts about the process of understanding

Active process Linked to attachment theory

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Annette Sofie Davidsen

Connection between concepts and theories

Attachment theory

Balint

Psychotherapy in general practice

”Balint anticipated attachment theory – ‘basic fault’” (Holmes 2001)

Mentalization

The tradition of training and supervision disappeared with the academic specialization

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Annette Sofie Davidsen

PhD. study of psychological interventions in general practice GPs differ greatly in the form of

relationship they form with the patient Both in psychological interventions and

in normal consultations Difference in propensity to mentalize Need of training mentalizing capacity

Ref.: Davidsen, A.: Psychology and Psychotherapy, theory, research and practice, in press (June 2009)

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Annette Sofie Davidsen

We propose that therapists’ mentalizing skills are central to establishing and maintaining an effective treatment relationship and a therapeutic alliance. Thus, we are developing a training programme to foster therapists’ mentalizing capacities in the treatment process. We aim not only to promote therapists’ attentiveness to mental states in their patients but also to increase their awareness of their own mental states in the conduct of psychotherapy. (Williams et al., 2006) p. 224-225.

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General therapeutic approach Cannot be manualized Manuals cannot teach skillful use and

creativity Need for theory and agreed concepts Mentalization a possible concept Dialectic about structure Firm structure can impede mentalization

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Annette Sofie Davidsen

Therapeutic relationship

Mentalizing central for establishing relationship

Association between therapeutic relationship and outcome in psychotherapy – and in general practice

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Annette Sofie Davidsen

Problems with mentalizing

Be aware of pseudo-mentalizing Apparent understanding

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Annette Sofie Davidsen

Training

Supervision in groups Illustrative videos Role-playing Own video-clips

Shifting between watching an expert and practicing

Therapist’s mentalizing capacity in the forefront

Active, inquisitive stance

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Annette Sofie Davidsen

Problems with mentalizing

”We allready do that” – but it is Difficult to mentalize under emotional stress

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Annette Sofie Davidsen

Purpose of training GPs

Training the mentalizing capacity To train GPs’ handling of emotional

problems To train GPs in ’talking therapy’ Carrying out therapy sessions under

supervision trains the mentalizing capacity in normal consultations

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Annette Sofie Davidsen

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