A new approach to preventing and treating psychoses

Course overview

A workshop by Andrea Landini, MD and Patricia M. Crittenden, PhD

Psychotic disorders are particularly frequent during periods of developmental transition. They are disabling for patients and their families and require extensive treatment resources. Despite long-standing efforts, there is lack of consensus regarding the diagnostic criteria, etiology and pathophysiology of these disorders. This course will offer a general functional formulation of psychotic disorders using the Dynamic-Maturational Model of Attachment and Adaptation (DMM), with practice planning services for specific cases.



Developmental transitions (for example, the birth of a child or the transition to adulthood) require a radical re-shaping of family attachment structures. This can threaten families when their structure is rigid and based on denied information, particularly information tied to trauma. In these cases, a family member may try to stop the transition because, without conscious awareness, they fear the consequences of the transition. For example, a pregnant mother might fear failure as a mother or the parents of a teen might fear the dissolution of their family if the teen left. Because such transitions are normative and desirable, these fears cannot be expressed openly, nor even thought about clearly.

Instead, the person in transition might exhibit seemingly irrational (psychotic) behaviour that functions to halt the transition. Diagnosing a psychotic state can ‘protect’ everyone by hospitalizing the diagnosed person or prescribing medication (that restores inhibition of the forbidden ‘psychotic’ behaviour). The outcome can inadvertently maintain the family dysfunction by preventing the transition.

The DMM General Functional Formulation for psychotic disorders highlights this impass between past and future. It considers psychosis to be a response to irresolvable developmental conflict between the approaching context that requires new behaviour and the ‘old’ context that requires incompatible behaviour. The family’s inability to resolve the conflict precipitates the ‘psychotic’ crisis. For example, older adolescents need to leave home to start their own families while some parents need them to remain at home. Or a woman might believe that she cannot meet both her current life demands and also those of being a mother, with the outcome being post-natal psychosis. The family member whose behaviour must both change and not change can experience extreme peaks of anxious arousal, displayed either as explosive forbidden behaviour or somatic anomalies. This signals that the family system has exhausted its resources, and needs help from professional systems to manage the crisis. However, as noted above, diagnosing a psychiatric illness might maintain the problem.

 

This course formulates psychotic disorders in terms of information processing (displaced, denied, and delusionally transformed information) and protective attachment strategies (especially compulsive compliance and delusional idealisation). Notably, psychotic symptoms are similar to DMM inhibitory strategies when these are accompanied by explosively disinhibited negative affect. This formulation can generate opportunities for prevention (that is, points when a risky developmental pathway could be changed to a more adaptive pathway) and novel approaches to treatment (when the opportunity for prevention was already missed).

Course participants will be given a General Functional Formulation of psychotic disorders and asked to use case-specific information to develop treatment plans from Family Functional Formulations that incorporate the principles of DMM Integrative Treatment. This will give participants practice in applying the principles to real cases.

1. Recognise new approaches to prevention and treatment that can resolve extreme developmental conflicts.


2. Identify principles underlying treatment of psychotic disorders based on Generalized Functional Formulation and compare them to standard treatment of psychoses.


3. Practice principle-based treatment planning for specific families with a psychotic patient, using principles derived from GFFs.


Andrea Landini, MD is a Child and Adolescent Psychiatrist, specializing in cognitive-constructivist and family psychotherapy. He is the Director of the Family Relations Institute in Reggio-Emilia, Italy and Miami, USA. His clinical practice includes psychotherapy with adolescents and families and supervision of professional staff caring for out-of-home youth. For two decades, he has taught the DMM, published research on attachment, and collaborated with Dr. Crittenden in the development of the Dynamic-Maturational Model (DMM) of Attachment and Adaptation. He co-authored Assessing Adult Attachment and Attachment and Family Therapy.

Patricia M. Crittenden, PhD, has degrees in special education (M. Ed.), developmental psychopathology (Ph.D.), and sexual abuse (post-doc). She trained with Mary Ainsworth and John Bowlby, ultimately developing the Dynamic-Maturational Model (DMM) of Attachment and Adaptation. She has published empirical research, treatment guidelines, and several books, including Raising Parents: Attachment, Representation, and Treatment. She developed a life-span set of DMM assessments of attachment.

Code:
CPD109C
Qualification:
Certificate of attendance
Location:
The Tavistock Centre, London
Admission status:
Closed

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