"Not Psychodynamically Minded"

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"Not Psychodynamically Minded"

Postby bjones » Sat Oct 14, 2017 10:15 am

I am a 1 year post-qualified CP and I have run into a difficulty at work that has shaken my confidence in my competencies a bit - hope you guys can help clear it up one way or another!

For the past year, I have worked in a psychodynamically-oriented forensic therapeutic community for people with personality disorders, and I absolutely love working there and being a member of the therapeutic community. The only difficulty I have had is that there is a psychotherapist (with a Masters degree in psychodynamic psychotherapy) employed in the service. This means that any individual psychotherapeutic work is assigned to him rather than to psychology. I was disappointed by this, but to be honest I am so busy that I wasn't too upset about it - until now.

Psychologists in our team undertake all of the initial assessments and lead the MDT formulation and setting of treatment targets for new patients (who will be in treatment for about 3 years). This is my favourite part of the role. When I was training, I really focused on psychodynamic work in my placements (and managed to get experience in all but one of my placements), including my last placement where I delivered 1:1 and group MBT. So this part of my professional competency is really important to me, and I was glad that I could use those skills in assessments and formulations.

However, it has now been suggested by senior management that the psychotherapist in the team should do a separate "structured psychodynamic assessment" as well, because the rest of the team are "not psychodynamically minded". They and the psychotherapist do not seem to know what this assessment will look like, but they have mentioned that perhaps things like interpersonal patterns and attachments could be included. This is really upsetting and infuriating to me, because these things are explicitly included in our formulations already!

So this whole thing has created an argument in the team, and I now realise that the psychology lead as well as my other band 7 colleague do not feel competent in psychodynamic theory (although they definitely include attachment and interpersonal patterns in their own assessments) and they assumed that I was the same. And the psychotherapist has become quite demeaning, insisting that I do not have the competence to deliver psychodynamic psychotherapy and could not possibly be conducting a full assessment for the needs of a psychodynamic service.

I am really confused. Was the BPS clinical psychology spec that says we must be competent in "CBT and one other (psychodynamic or systemic) model" a lie? Could I not start a private practice or switch jobs in the NHS and practice psychodynamically? Do I need to get a Masters degree as well, or train to be an analyst to prove that I am competent? Am I overreacting and excluding the psychotherapist from assessments for no reason? This whole thing has completely shaken me in my professional identity and I am now panicking and looking up additional training courses...please help!
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Re: "Not Psychodynamically Minded"

Postby Spatch » Wed Oct 18, 2017 8:38 am

This is a long standing problem and sadly all too common, but fortunately there is a well established treatment protocol that goes as follows:

Step 1: First of all, if you are a man, grow a beard and get yourself some circular steel rimmed spectacles and birkenstocks. The impression you want to give is geography teacher's day off. If you are woman get some chunky, distracting jewelry and cultivate your hair as if a bird had started to construct a nest on your heard, but then finally decided against it halfway through. If this is all too expensive or too much bother, try to adopt a stern, sour, pinched expression as if you've spotted someone urinated nearby, but you can't bring yourself to tell them off.

Step 2: At the next team meeting, where the issue of not being psychodynamically minded enough is raised, take an immediate sharp intake of breath culminating with a deep sigh. Practice this if necessary. Stroke your beard and sit as if you've got trapped wind. Talk in a soft and slightly patronising tone that you would make to a five year old who suddenly declares she wants to live on the sun.

Step 3: Start with "That's interesting" before talking about defences, particularly ones around dismissiveness and narcisistic contempt. Shake your head a lot and wonder out loud about what is happening in the room. Recognise the deep sense of threat and existentialist dread that underlies this position. Drop in that you are sensing a wounding.
A deep wound.
A deep deep deep wound.
Muse out loud in a faux naive way where this may be coming from. Then shoot pitying glances at that person.

Step 4: When the client responds (it doesn't matter whether its with hostility, dismissiveness, defensiveness) just stroke your beard some more and point out that's interesting. Of course they would react in that way." You understand completely. Give a wry smile. This is attachment.

Step 5: Start expounding about what makes someone psychodynamically minded enough. Who is the arbiter? Is it possible to be ever psychodynamically minded enough. Perhaps hint that if someone proclaims mastery of any abstract concept ("I am not human enough" "I am not sexy enough") it demonstrates the opposite. Gesticlate wildly and talk about projection. Recognise the deep, deep wound. Talk about internalised Kleinian objects and the need to focus on bad ones and the problems of disavowal.

Step 6: By now you should have polarised the team so it resembles Europe at the start of World War I. Declare that this is good. Thanatos. Destrudo. Truth will emerge from the unconscious. Be clear "we have all learned something from this" although no one exactly knows what.

That should solve all your problems.

Disclaimer: I am not a psychodynamic practitioner. I don't hold a masters degree and this has conferred a feeling of inadequacy resulting in me having to use humour in a defensive and caustic fashion. I can't remember being breast fed but can remember my mother loving me. Your statutory rights are not affected.
Shameless plug alert:

Irrelevant Experience: The Secret Diary of an Assistant Psychologist is available at Amazon
http://www.amazon.co.uk/Irrelevant-Experience-Assistant-Psychologist-ebook/dp/B00EQFE5JW/
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"Not Psychodynamically Minded"

Postby oncourse » Thu Oct 19, 2017 10:29 am

Spatch wrote:This is a long standing problem and sadly all too common, but fortunately there is a well established treatment protocol that goes as follows:

Step 1: First of all, if you are a man, grow a beard and get yourself some circular steel rimmed spectacles and birkenstocks. The impression you want to give is geography teacher's day off. If you are woman get some chunky, distracting jewelry and cultivate your hair as if a bird had started to construct a nest on your heard, but then finally decided against it halfway through. If this is all too expensive or too much bother, try to adopt a stern, sour, pinched expression as if you've spotted someone urinated nearby, but you can't bring yourself to tell them off.

Step 2: At the next team meeting, where the issue of not being psychodynamically minded enough is raised, take an immediate sharp intake of breath culminating with a deep sigh. Practice this if necessary. Stroke your beard and sit as if you've got trapped wind. Talk in a soft and slightly patronising tone that you would make to a five year old who suddenly declares she wants to live on the sun.

Step 3: Start with "That's interesting" before talking about defences, particularly ones around dismissiveness and narcisistic contempt. Shake your head a lot and wonder out loud about what is happening in the room. Recognise the deep sense of threat and existentialist dread that underlies this position. Drop in that you are sensing a wounding.
A deep wound.
A deep deep deep wound.
Muse out loud in a faux naive way where this may be coming from. Then shoot pitying glances at that person.

Step 4: When the client responds (it doesn't matter whether its with hostility, dismissiveness, defensiveness) just stroke your beard some more and point out that's interesting. Of course they would react in that way." You understand completely. Give a wry smile. This is attachment.

Step 5: Start expounding about what makes someone psychodynamically minded enough. Who is the arbiter? Is it possible to be ever psychodynamically minded enough. Perhaps hint that if someone proclaims mastery of any abstract concept ("I am not human enough" "I am not sexy enough") it demonstrates the opposite. Gesticlate wildly and talk about projection. Recognise the deep, deep wound. Talk about internalised Kleinian objects and the need to focus on bad ones and the problems of disavowal.

Step 6: By now you should have polarised the team so it resembles Europe at the start of World War I. Declare that this is good. Thanatos. Destrudo. Truth will emerge from the unconscious. Be clear "we have all learned something from this" although no one exactly knows what.

That should solve all your problems.

Disclaimer: I am not a psychodynamic practitioner. I don't hold a masters degree and this has conferred a feeling of inadequacy resulting in me having to use humour in a defensive and caustic fashion. I can't remember being breast fed but can remember my mother loving me. Your statutory rights are not affected.


BRAVO! I so want you to do not CBT minded enough now!


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Re: "Not Psychodynamically Minded"

Postby ell » Thu Oct 19, 2017 1:30 pm

Oh Spatch, how I've missed you.
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Re: "Not Psychodynamically Minded"

Postby astra » Fri Oct 20, 2017 11:07 am

Not been on ClinPsy for yonks and this is the first post I find with Spatch's perfect response! keep writing Spatch and I'll keep popping back.
From the point of view of mindfulness, as long as you're breathing there's more right with you than wrong with you. Jon Kabat-Zinn
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Re: "Not Psychodynamically Minded"

Postby bjones » Wed Oct 25, 2017 7:06 pm

:lol: Thank you Spatch...that was exactly the response I needed.
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