Dorien Philipszoon & Quin van Dam.
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1 Dorien Philipszoon & Quin van Dam 1
2 Dorien Philipszoon, psychiatrist & psychoanalytic psychotherapist, working at Zaans Medisch Centrum and in private practice, Amstelveen, the Netherlands Quin van Dam, clinical psychologist & psychoanalytic psychotherapist, working in private practice, Reeuwijk, the Netherlands 2
3 What is Affect Phobia Treatment (APT)? Who benefits of APT? Development of disadaptive image of self and others How to treat disadaptive self-image? Role play Training for APT-therapist Discussion & evaluation 3
4 External phobia Avoiding situations from the outside to minimalize anxiety (spiders, mice) Internal phobia = Affectphobia Avoiding internal feelings to minimalize anxiety by using defence (anger) 4
5 You re a crybaby -> Defensive reaction: I don t cry, I don t mind 5
6 - Leigh McCullough - Pragmatic integrative treatment (psychodynamic, behavioral en experiential) - Malan s triangles 6
7 Defence (D) symptoms, behavior, thoughts, maladaptive feelings SELF Inhibition/Anxiety (A) anxiety, guilt, shame, emotional pain anxiety of separation Adaptive Feelings, Activating (F) Sadness, anger/assertiveness, intimacy, interest, excitement, joy, sexual desire, positive feelings toward the self 7
8 Essential to recognize Maladaptive feelings: no relief Adaptive feelings: relief irritation and adaptive anger/assertiveness endless crying and crying due to real sadness (countertransference) 8
9 Therapist (T) Current persons (C) partner, children, boss, friends, SELF Past Persons (P) Family, parents, teachers etc 9
10 - 35 yo, married, 2 children. - studied biology, works as secretary. - three months ago mother suddenly died from a hearth attack. Mary doesn t cry. She doesn t speak about what happened. GP advised her to look for professional help. - she is an aloof person, critical towards herself and others, keeps others at a distance. Feels insecure. - mother was sweet, but always critical towards her. During puberty her parents had severe relational problems and her older sister was a very difficult adolescent. Mary tried to create a good atmosphere at home, helped her mother, sister and younger brother. However mother snubbed regularly to her. 10
11 Mary is sad ( ), but doesn t express this ( ) to Alex, her husband ( ), because she is afraid he ll think she is stupid ( ). This frustrates her and makes her angry at herself ( ). D (Defence), A (Anxiety), F (Feelings). T (Therapist), C (Current relationships), V (Past relationships) 11
12 Mary is sad (F ), but doesn t express this ( D ) to Alex, her husband ( C ), because she is afraid he ll think she is stupid (A). This frustrates her and makes her angry at herself (D). D (defence), A (Anxiety), F (Feelings). T (Therapist), C (Current relationships), V (Past relationships) 12
13 Defence (D) symptoms, behavior, thoughts, maladaptive feelings No expression of feelings Anger towards herself SELF Inhibition/Anxiety (A) anxiety, guilt, emotional pain, shame, anxiety of separation Adaptive Feelings, Activating (F) Anger/assertiveness, intimacy, interest, excitement, joy, sexual desire, sadness/grief, positive feelings toward the self 13
14 Therapist (T) Keeps therapist at a distance? Current persons (C) partner, children, boss, friends, Keeps Alex and boss at a distance? SELF Past Persons (P) Family, parents, teachers etc Keeps father and sibs at a distance 14
15 1. Formulation & triangles agreement 2. Defence restructuring 3. Affect restructuring 4. Restructuring of self image and image of others (THIS WORKSHOP!) 15
16 Indication above all based on level of functioning, less on DSM diagnosis How is/are: relationships, work, psychiatric symptoms, current stressors, mentalizing capacity, ego strength, motivation? Clinical practice: mostly patients with Cluster C PD, depressive- and anxiety disorders 16
17 Substance abuse Psychosis Severe somatic illness Severe stressors Poor impulsecontrol 17
18 Individual Outpatient Group Daytreatment Blended (e-learning & therapist contact) 18
19 What is Affect Phobia Treatment (APT)? Who benefits of APT? Development of disadaptive image of self and others How to treat disadaptive self image? Roleplays Training for APT-therapist Discussion & evaluation 19
20 20
21 21
22 22
23 Defence (D) selfhatred, disregard of the self, negative feelings for the self Inhibition/ anxiety (A) anxiety, guilt, shame, disgust, internal voice: you are nothing, you don t have the right to be. SELF Adaptive Feelings, Activating (F) Positive feelings towards the self 23
24 Therapist (T) Covered distrust, aloof, avoiding, hostile Current persons (C) Get rid of him or humiliate him SELF Past persons (P) Unsafe youth, denigrating and neglecting educators 24
25 Self and other Adaptive or disadaptive? Self-compassion Extreme caring Healthy pride Let himself be used Asks too low price for work Arrogant or devaluing Choosing wrong partners Empatic interest Passivity and initiativeless 25
26 Self and other Self-compassion Extreme caring Healthy pride Let himself be used Asks too low price for work Adaptive or disadaptive? Adaptive Disadaptive Adaptive Disadpative Disadaptive Arrogant or devaluing Choosing wrong partners Empatic interest Passivity and initiativeless Disadapative Disadapative Adaptive Disadpative 26
27 Two steps: 1. Awareness of critical inner voice 2. Affect phobia for positive experiences 27
28 Egosyntone or egodystone? How do inner voices influence thoughts and self-image? Are voices encouraging or critical and undermining? Are voices due to own needs or dominated by others? 28
29 Receptive to: Feelings & needs of the self? Care or compliments? Corrective experience? Experience of loss? 29
30 Quin-Dorien/Mary: demonstration of two steps Practice in pairs Evaluation 30
31 Defence (D) No expression of feelings Anger towards herself Inhibition/Anxiety (A) shame, anxiety of separation SELF Adaptive Feelings, Activating (F) Sadness/grief, positive feelings towards the self 31
32 What is Affect Phobia Treatment (APT)? Who benefits of APT? Development of disadaptive image of self and others How to treat disadaptive self-image? Roleplays Training APT-therapist Discussion & evaluation 32
33 The Netherlands: 1. Introduction course 4 days 2. Core training 9 days with individual and group supervision 3. APT-Register membership of NVPP International: Workshops and core training, see: 33
34 34
35 Questions? Tips and tops? 35
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