Key Perspectives for Psychotherapy  Series Three

Module 7: When the therapy stops moving: therapeutic impasse as breakdown in contact, mentalizing and relational flexibility

Whose survival is being protected, and what would genuine contact require?

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Overview

Most therapists do not first encounter severe personality dysfunction through diagnosis. They encounter it through experience: the rescue fantasy, the hopelessness, the deadness, the certainty, the sense that therapy is moving without changing. Participants will explore how contemporary psychodynamic thinking, developmental research, personality disorder theory, and Mentalization-Based Treatment have gradually moved away from categorical understandings of personality pathology toward dimensional models of personality functioning, including the emergence of the Alternative Model for Personality Disorders (AMPD). Participants are encouraged to read the DSM-5-TR Section III description of the AMPD, particularly Criterion A (Level of Personality Functioning), alongside Sharp and Wall (2021), ahead of this session.

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Learning outcomes

 

• Understand the historical development of personality disorder concepts

• Distinguish categorical and dimensional approaches to personality pathology

• Describe the rationale for the DSM-5 Alternative Model for Personality Disorders

• Assess identity, self-direction, empathy, and intimacy as dimensions of personality functioning

• Identify impairments in mentalizing, affect regulation, and reflective functioning

• Determine when treatment requires strengthening fundamental psychological capacities rather than providing additional insight

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Module 8: Mentalizing under pressure: working with severe self and interpersonal dysfunction

What happens when both therapist and client stop being able to mentalize?

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Overview

The most challenging therapeutic encounters are rarely difficult because the therapist lacks knowledge. They become difficult because both therapist and client gradually lose their capacity to remain reflective in the presence of intense affect, attachment activation, shame, fear, dependency, idealization, or hostility. This workshop examines severe self and interpersonal dysfunction through the lens of Mentalization-Based Treatment, contemporary psychodynamic thinking, and relational psychotherapy. Particular attention is given to the therapist's experience as clinical data. Drawing on the concept of the Therapist's Dilemma, participants explore how the therapist's own relational patterns, vulnerabilities, and script system may become activated alongside the client's - not as failures of professionalism, but as opportunities to restore reflective functioning and create new relational possibilities.

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Learning outcomes

 

• Recognise the clinical signs that severe self and interpersonal dysfunction is shaping the therapeutic process

• Identify moments of mentalizing collapse in both client and therapist

• Understand how attachment activation, affective arousal, and interpersonal threat can compromise reflective functioning

• Understand the Therapist's Dilemma as a simultaneous activation of the client's and therapist's relational patterns

• Use your own emotional, cognitive, and bodily responses as sources of clinical information while maintaining a reflective stance

• Develop greater confidence in “putting the therapist's mind on the table” in ways that are clinically useful and ethical

 

Module 9  The efficient therapist: integration, synthesis and what this year has asked of us

Not what do I know — but what have I become?

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Overview

he final session of the year does not introduce new content. It asks participants to do something more demanding: to hold the whole year's argument simultaneously and feel what has shifted in how they sit with a client. This session returns to the organising question that has run through every module: what does each framework uniquely contribute to the therapist's capacity to be present with a particular client at a particular moment? The answer is not a list of frameworks or a set of techniques. It is something more personal and more precise: the therapist who has genuinely inhabited object relations, relational and integrative TA, the AMPD, MBT and Erskine's method has developed a finer quality of attention - the capacity to meet a person wherever they are, and to create the relational conditions in which something genuinely new can emerge.

 

Learning outcomes

 

• Articulate a coherent personal framework for relational practice within your own modality

• Demonstrate the relationship between the year's theoretical frameworks and the quality of clinical attention they develop

• Connect Erskine's inquiry, attunement and involvement triad to MISC's five behavioural components

• Reflect honestly and specifically on your own development across the year

• Leave with a specific and realistic personal development plan for supervision, further reading and ongoing practice