Choosing a patient for Psychodynamic Psychotherapy by Dr Neil Jeyasingam
Dr Neil Jeyasingam is a former research scholar of the Institute of Psychiatry (Sydney) and Institute of Psychiatry (UK) and specialises in phenomenology and personality disorders in the elderly. In public practice, he is the in–patient clinical lead for an old–age psychiatry service, as well as ECT Clinical Director. He is also the Binational New South Wales Representative for the Faculty of Old Age Psychiatry, a Foundation Accredited Member of the Royal Australian and New Zealand Psychotherapy Faculty, a Clinical Lecturer with Sydney University, and Senior Lecturer with Western Sydney University.
That’s a really, really common resistance in therapy – when you forge a therapeutic relationship with a patient you are creating a dependent safe space for the patient to be able to explore themselves – but patients will defend against that…so that they don’t need to actually change.
Borderline is quite good [responding to psychodynamic therapy]. The problem with borderline is that because the aspect of the therapy can be so confronting, they may not be able to tolerate the early phase.
You have to remember that when you are treating a patient with a dynamic intervention, the patient usually becomes worse before they become better – that’s how the process of reparation happens.
This section of Dr Jeyasingam’s talk begins with a discussion of the type of patients you would treat with psychodynamic therapy.
He moves on to discuss good therapy outcomes and the importance of patients having psychological mindedness.
He discusses how the therapist needs to consider what might affect their emotional connection with the patient, and what might influence their ability to encourage mentalisation.
Moving on to discuss the assessment phase, he talks about the treatment contract between therapist and patient, and the importance of honesty regarding patient expectations.
This section of the presentation concludes with an overview of the assessment phase from the therapist and patient point of view and an explanation of the psychodynamic interpretation.
Take Home Points
- Psychodynamic therapy must be a useful training experience for the therapist as well as leading to some beneficial outcome for the patient.
- Patients with psychotic disorders are usually not motivated enough to respond to psychodynamic therapy.
- Interpretation at the early onset is about identifying a pattern and repeating it back to the patient to see how they respond.
- Malan, D. Towards the validation of brief psychotherapy. 1976. New York, NY: Plenum.
- Malan, D. The frontier of brief psychotherapy. 1976. New York, NY: Plenum.