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Managing the clinical encounter with patients with personality disorder in a general psychiatry setting: key contributions from neuropsychoanalysis

Published online by Cambridge University Press:  09 August 2023

Tennyson Lee Open the ORCID record for Tennyson Lee [Opens in a new window]  and
Mark Solms
Tennyson Lee*
Affiliation:
Consultant psychiatrist in medical psychotherapy with Deancross Personality Disorder Service and co-director of the Centre for Understanding of Personality (CUSP), London, UK. He trained in public health in South Africa and then in psychiatry and psychoanalysis in London. He is on the International Society of Transference Focused Psychotherapy (TFP) certification board.
Mark Solms
Affiliation:
Director of Neuropsychology, University of Cape Town, Rondebosch, and Groote Schuur Hospital, Cape Town, South Africa. He is also Director of Training in the South African Psychoanalytical Association, Science Director of the American Psychoanalytic Association and Co-chair of the International Neuropsychoanalysis Society. He is an honorary fellow of the American College of Psychiatrists.
*
Correspondence Tennyson Lee. Email: tennysonlee@doctors.org.uk
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Summary

Patients view their negative emotions as troublesome and they expect psychiatrists to deal with them, often wanting them taken away. We present a neuropsychoanalytical understanding of the essential biological function of emotion and how it influences behaviour. Through a vignette, we demonstrate how this understanding can contribute to the psychiatrist's management of the clinical encounter, in particular regarding the patient's expectations about their emotions and the pressures placed on the clinician.

Keywords

Clinical managementconsciousnessemotionneuropsychoanalysispersonality disorder

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Type
Article
Information
BJPsych Advances , Volume 30 , Issue 5 , September 2024 , pp. 303 - 310
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Copyright
Copyright © The Author(s), 2023. Published by Cambridge University Press on behalf of Royal College of Psychiatrists

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References

Bargh, JA, Chartrand, TL (1999) The unbearable automaticity of being. American Psychologist, 54: 462–79.CrossRefGoogle Scholar
Chartonas, D, Kyratsous, M, Dracass, S, et al (2017) Personality disorder: still the patients psychiatrists dislike? BJPsych Bulletin, 41: 12–7.CrossRefGoogle Scholar
Davis, KL, Montag, C (2019) Selected principles of Pankseppian affective neuroscience. Frontiers in Neuroscience, 12: 1025.CrossRefGoogle ScholarPubMed
Freud, S (1920) Beyond the pleasure principle. Reprinted in the Standard Edition of the Complete Psychological Works of Sigmund Freud (vol 18) (trans. & ed. J Strachey): 1–64. Hogarth Press, 1957.Google Scholar
Kanter-Bax, O, Neranzis, G, Lee, T (2022) Transference-focused psychotherapy as an aid to learning psychodynamic psychotherapy: qualitative analysis of UK psychiatry trainees’ views. BJPsych Bulletin, 46: 57–63.CrossRefGoogle ScholarPubMed
Konstantinidou, H, Chartonas, D, Rogalski, D, et al (2023) Will this tablet make me happy again? The contribution of relational prescribing in providing a pragmatic and psychodynamic framework for prescribers. BJPsych Advances, 29: 265–73.CrossRefGoogle Scholar
Lee, T, Hersh, G (2019) Managing the clinical encounter with patients with borderline personality disorder in a general psychiatry setting: key contributions from transference-focused psychotherapy (TFP). BJPsych Advances, 25: 229–36.CrossRefGoogle Scholar
Lee, T (2021) Personality disorder. In Seminars in the Psychotherapies (eds Gibbons, R, O'Reilly, J): 190–206. Cambridge University Press.Google Scholar
Lee, T, Grove, P, Garrett, C, et al (2022) Teaching trainee psychiatrists a mentalization based treatment approach to personality disorder: effect on attitudes. BJPsych Bulletin, 46: 298–302.CrossRefGoogle ScholarPubMed
Leishsenring, F, Leibing, E (2003) The effectiveness of psychodynamic therapy and cognitive behaviour therapy in the treatment of personality disorders: a meta-analysis. American Journal of Psychiatry, 160: 1223–32.CrossRefGoogle Scholar
Lorenzini, N, Fonagy, P (2013) Attachment and personality disorders: a short review. Focus, 11(2): 155–66.CrossRefGoogle Scholar
Luria, AR (1973) The Working Brain: An Introduction to Neuropsychology (trans. B Haigh). Basic Books.Google Scholar
Maltsberger, JT, Buie, DH (1974) Countertransference hate in the treatment of suicidal patients. Archives of General Psychiatry, 30: 625–33.CrossRefGoogle ScholarPubMed
Mizen, C, Hook, J (2020) Relational and affective neuroscience: a quiet revolution in psychiatric and psychotherapeutic practice. BJPsych Advances, 26: 356–66.CrossRefGoogle Scholar
National Institute for Health and Care Excellence (2009) Borderline Personality Disorder: Treatment and Management (Clinical Guideline CG78). NICE.Google Scholar
Panksepp, J (1998) Affective Neuroscience: The Foundations of Human and Animal Emotions. Oxford University Press.CrossRefGoogle Scholar
Panksepp, J (2011) Cross-species affective neuroscience decoding of the primal affective experiences of humans and related animals. Plos ONE 6(9): e21236.CrossRefGoogle ScholarPubMed
Paton, C, Crawford, MJ, Bhatti, SF, et al (2015) The use of psychotropic medication in patients with emotionally unstable personality disorder under the care of UK Mental Health Services. Journal of Clinical Psychiatry, 76: 512–18.Google ScholarPubMed
Silk, KR (2011) The process of managing medications in patients with borderline personality disorder. Journal of Psychiatric Practice, 17(5): 311–9.CrossRefGoogle ScholarPubMed
Solms, M (2018a) The scientific standing of psychoanalysis. BJPsych International, 15: 5–8.CrossRefGoogle ScholarPubMed
Solms, M (2018b) The neurobiological underpinnings of psychoanalytic theory and therapy. Frontiers in Behavioral Neuroscience, 12: 294.CrossRefGoogle ScholarPubMed
Solms, M (2021) The Hidden Spring: A Journey to the Source of Consciousness. Profile Books.Google Scholar
Turner, EH, Matthews, AM, Linardatos, E, et al (2008) Selective publication of antidepressant trials and its influence on apparent efficacy. New England Journal of Medicine, 358: 252–60.CrossRefGoogle ScholarPubMed
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