PADT draft for Working Group review
This is about assessing whether the style of working with and relating to a therapist in analytic/dynamic therapy is suitable for a particular individual. The process is a model or trial and is, potentially, important learning in its own right. In introducing the individual to the analytic/dynamic process it could be the single most important event in therapy for that person.
Performance criteria
You need to:
respond sensitively to the individual’s current preoccupations and distress
balance the gathering of information about the individual and their difficulties with the opportunity for them to experience how they manage without therapist imposed structure
enable the individual to make connections between the current, real-life preoccupations and their unconscious internal world of subjective experience
listen to the content of the individual’s report of their difficulties and life and the manner and form of their narrative
be aware of and respond sensitively to the patient’s affective and transferential responses to the assessment process within the limitations of the assessment frame.
explore the relationship, if any, between the client’s external context and values and their difficulties
assess the individual’s capacity to work within an analytic frame
evaluate the individual’s capacity to consider how their present relationships and behaviour relate to the past
encourage the individual to discuss and explore their perceptions of, and feelings about, you as therapist and how you may feel or think about them
accept the individual’s view of you as therapist to allow a particular experience of the individual’s self in relationship to you to emerge in the session
evaluate the impact of a transference interpretation at any given point in the light of:
the individual’s conscious and unconscious response to the interpretation
your evaluation of the quality of the working alliance following an interpretation
the individual’s level of disturbance following an interpretation
critically reflect on assumptions, biases and prejudices that may be operating consciously and unconsciously in you as therapist with respect to difference
reflect on the emotional impact of the individual’s narrative and general presentation on you as a source of information to understand the underlying interpersonal patterns that have been activated in the assessment process
enable the individual to reflect on their experience of the assessment by interpreting their conscious and unconscious experience of it
explore the individual’s external context to inform the treatment plan and identify the need for any additional resources
consider the setting, length, intensity and format of the treatment in the light of:
developmental factors
the individual’s psychological state
level of risk
the nature of the problem
the individual’s particular needs
explain to the individual your assessment of the suitability of analytic/dynamic therapy for or your reasoning and suggested alternatives if you consider it is not suitable
K1. a working knowledge of developmental factors that shape an individual’s experience of themselves and others
K2. a working knowledge of the different types of personality organisation
K3. a working knowledge of developmental psychopathology
K4. a working knowledge of the nature of mental life
K5. a working knowledge of the different structures of the mind and their contribution to personality development
K6. a working knowledge of the nature of the unconscious inner world of object-relations
K7. a working knowledge of the importance of the client’s imaginative life as a vehicle for understanding their unconscious experience of himself and others
K8. a working knowledge of various analytic/dynamic models and techniques
The rationale for an analytic/dynamic approach
K9. a working knowledge of the affective and interpersonal focus of the therapy
K10. a working knowledge of the rationale for an analytic/dynamic approach
K11. a working knowledge of the rationale for closely tracking the therapeutic process
K12. a working knowledge of how to adopt a non directive stance in relation to the individual’s communications
K13. a working knowledge of how to explore the internal, unconscious world of experience with sensitivity to the individual’s external reality and value systems
K14. a working knowledge of the importance of maintaining an open mind during therapy
K15. a working knowledge of the primary target of therapy
K16. a working knowledge of the factors indicating suitability of an analytic/dynamic approach
K17. a working knowledge of unsuitability for brief and more intensive analytic/dynamic therapy
Frame for the assessment
K18. a working knowledge of how to assess an individual’s capacity to engage in the analytic process in the context of assessment of risk
K19. a working knowledge of how to elicit the individual’s history of relationships and assess its contribution to the quality of internalised relationships
K20. a working knowledge of how to manage acting out by an individual within the therapy setting
K21. a working knowledge of alternative psychological therapies as a basis for considering more suitable alternatives for the individual
K22. a working knowledge of external resources available to support individuals during therapy.
Work in the Transference
K23. a working knowledge of the forms of transference
K24. a working knowledge of how to develop and work in the transference
K25. a working knowledge of how to formulate the dominant transference theme(s) from an individual’s assessment
K26. a working knowledge of how to make a transference interpretation
K27. a working knowledge of the emotional impact of transference interpretations
K28. a working knowledge of the rationale and features of the analytic setting and stance
K29. a working knowledge of how to formulate the dominant transference theme(s) from an individual’s assessment
Diversity in therapy
K30. a working knowledge of the psychodynamics of difference
K31. a working knowledge of how to work with the psychodynamics of difference within the therapeutic relationship
K32. a working knowledge of the process of self-reflection by the therapist on their conscious and unconscious assumptions, biases and prejudices around difference
P
This is about responding to the individual’s presenting issues in a concerned, non-judgemental manner to enable the analytical relationship to develop with sufficient trust to allow the emergence of unconscious life. It includes identifying and agreeing therapeutic aims.
1. communicate understanding thoughtfully in response to the individual’s conscious and unconscious communications
2. evaluate when it is most productive to focus primarily on the individual’s external or internal reality
3. respect the individual’s need for defences
4. contain the individual’s level of anxiety by engaging with the their conscious and unconscious anxieties about the therapy and therapist
5. allow the individual’s narrative about their difficulties to emerge without imposing a structure
6. ask clarifying questions so as to understand the individual’s perspective without making assumptions
7. communicate clearly the boundaries and frame of the therapy
8. explore the differential expectations of both therapist and individual so as to orient them to the particular style of therapy
9. provide the individual with sufficient direct information about the therapy, including its risks and benefits so as to make consent meaningful
10.adjust technique with those individuals who are unproductively disturbed by a more passive stance in the early stages of therapy
11.give the individual early experience of an analytic/dynamic approach and the challenges it might present for them
12.assess whether the individual may require a strengthening of the supportive aspects of the therapeutic relationship
13.provide a tentative account of the individual’s subjective experience and how you understand their issues early on in the therapy
14.help the individual to make connections between their current, real life preoccupations and their unconscious internal world of subjective experience
15.encourage the individual to reflect on their reactions to the treatment and its focus on feelings and relationships and the ways in which unconscious dynamics affect conscious processes
16.allow the individual an opportunity to ask questions, explore, clarify and agree treatment aims
17.enquire about what the individual hopes to achieve
18.communicate understanding that in addition to the stated aims there might be less conscious aims
19.reflect to the individual your understanding of their resources and vulnerabilities in relation to the stated aims
20.enable the individual to reflect on their expectations of therapy (to introduce some realism about what might and might not be achievable).
21.gain and review/retain the individual’s valid, informed consent
22.respond openly to the client’s conscious and unconscious experience of difference
23.respond openly and sensitively to the individual’s experience of difference in the therapeutic relationship
24.explore with the individual the unconscious use that may be made of actual differences between you as therapist and the individual
25.critically self-reflect on assumptions, biases and prejudices that may be operating consciously and unconsciously in you as therapist with respect to difference
You need to apply:
K1. a working knowledge of developmental factors that shape an individual’s experience of themselves and others
K2. a working knowledge of developmental theory
K3. a working knowledge of the different types of personality organisations
K4. a working knowledge of developmental psychopathology
K5. a working knowledge of the psychoanalytic theories which inform the specificity of the practitioner’s clinical practice
K6. a working knowledge of the nature of psychic life
K7. a working knowledge of the different structures of the mind and their contribution to personality development
K8. a working knowledge of the importance of the individual’s imaginative life as a vehicle for understanding their unconscious experience of themselves and others
K9. a critical understanding of the psychoanalytic theories which inform the specificity of the practitioner’s clinical practice
The rationale for an analytic/dynamic approach
K10. a working knowledge of the rationale for an analytic/dynamic approach
K11. a working knowledge of the affective and interpersonal focus of the therapy
K12. a working knowledge of the rationale for closely tracking the therapeutic process
K13. a working knowledge of how to adopt a non directive stance in relation to the individual’s communications
K14. a working knowledge of the importance of maintaining an open mind during therapy
Diversity in therapy
K15. a working knowledge of the psychodynamics of difference
K16. a working knowledge of how to work with the psychodynamics of difference within the therapeutic relationship
K17. a working knowledge of the process of self-reflection by the therapist on their conscious and unconscious assumptions, biases and prejudices around difference
PADT 3 Derive an analytic/dynamic formulation
Material for the formulation comes a range of sources, including from questions answered by the individual, from interpretation of the individual’s experience and from the transference and countertransference experienced in sessions. A formulation is itself dynamic, changing as therapy progresses.
You need to:
1. show interest in and acceptance of the individual’s subjective experience
2. identify recurring interpersonal themes through questioning and from the transference-countertransference themes that emerge in the session
3. develop hypotheses about the unconscious meaning of the individual’s presenting symptoms and the significance of your emotional response(s) to the client
4. develop hypotheses about the individual’s defences and resistance
5. develop a provisional formulation of the individual’s difficulties based on information directly provided by the client, which may include the experiential information derived from the here-and-now of the therapeutic interaction
6. communicate your understanding of the individual’s experience and difficulties in a manner that promotes the therapy
7. critically self-reflect on assumptions, biases and prejudices that may be operating consciously and unconsciously in you as therapist with respect to difference
8. identify if the interpretation relieves the individual’s anxiety and/or is difficult or distasteful to them
9. engage the individual in responding to your formulation and elaborating it or revising it
10. revise the formulation in the light of new evidence and/or the individual’s response to the therapy
11. remain open to your failure to develop useful formulations
You need to apply:
K1. a working knowledge of developmental factors that shape an individual’s experience of themselves and others
K2. a working knowledge of the different types of personality organisations
K3. a working knowledge of developmental psychopathology
K4. an in-depth understanding of psychodynamic formulation
K5. a working knowledge of the activities of ‘maintaining an analytic focus’:
K6. a working knowledge of exploration of the client’s internal, unconscious world of experience
K7. a working knowledge of the nature of psychological life
K8. a working knowledge of the different structures of the mind and their contribution to personality development
K9. a working knowledge of the importance of the client’s imaginative life as a vehicle for understanding their unconscious experience of themself and others
K10. a working knowledge of analytic/dynamic models and techniques
Interpretation knowledge and skills
K11. a working knowledge of the aims and work of interpretation
K12. a working knowledge of the collaborative process of interpretation
Interpersonal and reflective skills
K13. a working knowledge of different interpersonal styles of relating
K14. a working knowledge of skills of clarification
K15. a working knowledge of skills of confrontation
K16. an in-depth understanding of self reflection
K17. an in-depth understanding of the experience of psychotherapy
Working with defences
K18. a working knowledge of the nature and processes of human defences
K19 a working knowledge of the functions of defences and how to identify them
K20 a working knowledge of how to gauge the level of personality functioning in an individual
K21. a working knowledge of the priority of the link between anxiety and defence over the interpretation of content
K22. a working knowledge of why individuals deploy defences
K23. a working knowledge of how to gain and maintain a reflective stance
Diversity in therapy
K24. a working knowledge of the psychodynamics of difference
K25. a working knowledge of how to work with the psychodynamics of difference within the therapeutic relationship
K26. a working knowledge of the process of self-reflection by the therapist on their conscious and unconscious assumptions, biases and prejudices around difference
PADT 4 Work with the therapeutic frame and boundaries
In maintaining the therapeutic frame and boundaries the therapist creates another learning opportunity - to enable the emergence of experiences, feelings and understandings. The therapist also has the responsibility of maintaining clear limits and dealing with risks to the individual.
You need to:
1. agree with the individual clear parameters within which the treatment will take place
2. maintain your analytic attitude
3. explore with the individual the meaning for them of any changes to the agreed setting, whether planned or unplanned
4. enable the individual to explore their experience of any changes
5. make an intervention or interpretation about what the client/patient has said about their experience of separations/discontinuities in the treatment frame
6. enable the emergence of the individual’s conscious and unconscious experience of the setting and its boundaries
7. consider whether and how to make an intervention or interpretation about what may have been indicated but not consciously expressed in what the individual says
8. enable the emergence of the individual’s conscious and unconscious feelings and fantasies about the therapy
9. consider as therapy continues how an intervention or interpretation may enable the individual to explore previously unconscious or unrecognised feelings or fantasies
10. be sensitive to transference patterns in an individual’s history that may present an opportunity for interpretations
11. respond to the individual’s requests for modifications to the parameters of the therapy on the basis of your evaluation of the meaning of those requests
12. choose your responses to the individual so that their experience of unverbalised feelings and unconscious conflicts is not intensified in a way that threatens the viability of the therapy
13. maintain or regain an analytic stance when managing forms of acting out in relation to the setting
14. develop clear limits
15. recognise when limits may need to be explicit allowing for the transference implications of such an overt action
16. in advance of planned interruptions in the treatment, enable the emergence of the individual’s conscious and unconscious responses to breaks and an opportunity for a valuable intervention
17. assess risk during breaks in the treatment and to make arrangements for additional support when required
You need to apply:
K1. an in-depth understanding of the meaning of boundaries for the client, the therapist and the therapeutic relationship
K2. an in-depth understanding of the impact of the physical setting of the therapy room on the relationship with the therapist
K3. an in-depth understanding of interruptions in the treatment and their impact
K4. an in-depth knowledge of the dynamics of separation, loss and mourning as the basis for understanding the client’s subjective experience of breaks during the treatment
K5. an in depth understanding how to manage the breaking of boundaries
K6. a working knowledge of psychoanalytic understanding of the developmental factors that shape an individual’s experience of themselves and others
K7. a working knowledge of differing psychoanalytic understandings of personality organisations
K8. a working knowledge of psychoanalytic conceptions of developmental psychopathology
K9. a working knowledge of the role of language, both generally and in ways specific to individuals, in the formation of the individual’s sense of identity
K10. a working knowledge of the range of psychoanalytic theories concerning the nature of mental life
K11. a working knowledge of the range of psychoanalytic conceptions of different structures of the mind and their contribution to personality development
K12. a working knowledge of the range of psychoanalytic conceptions of the nature of the unconscious
K13. a working knowledge of how the client’s imagination can be a vehicle for exploring previously unconscious experience
K14. a working knowledge of various psychoanalytic/dynamic models and techniques
The rationale for an analytic/dynamic approach
K15. a working knowledge of the transference relation, which often may include differing affective and interpersonal aspects, being the focus of the therapy
K16. a working knowledge of the rationale for an psychoanalytic/dynamic approach
K17. a working knowledge of the rationale for closely tracking the psychotherapeutic process
K18. a working knowledge of how to adopt a non directive stance in relation to the individual’s communications
K19. a working knowledge of how to promote the exploration of the client’s unconscious with sensitivity to the individual’s external reality and value systems
K20. a working knowledge of the importance of maintaining an open mind during psychotherapy
K21. a working knowledge of the complex and multifaceted aims and effects of psychotherapy the outcomes of which cannot be defined in advance with any guarantee
K22. a working knowledge of the factors indicating suitability of an psychoanalytic/dynamic approach
K23. a working knowledge of practice-based indications and contra-indications suggesting appropriacy of different forms of psychoanalytic/dynamic therapy
K24. a working knowledge of how to assess for appropriacy of psychoanalytic therapy
K25. a working knowledge of when and to what extent the existence of external resources available to support individuals may be necessary during psychotherapy.
K26. a working knowledge of how to assess an individual’s capacity to engage in the psychoanalytic process in the context of assessment of risk
Working with defences
K27. a working knowledge of psychoanalytic conceptions of the nature and processes of unconscious defences
K28. a working knowledge of the functions of unconscious defences and how to identify them
K29. a working knowledge of how to gauge the effects and implications of an individual’s psychological functioning on their personality presentation
K30. a working knowledge of the potentially dangerous effect of giving priority to the interpretation of content over the link between anxiety and defence
K31. a working knowledge of the purpose of unconscious defences
K32, a working knowledge of how to gain and maintain an analytic stance
Interpersonal and reflective skills
K33. a working knowledge of psychoanalytic conceptions of different interpersonal styles of relating
K34. a working knowledge of skills of clarification
K35. a working knowledge of skills of confrontation
K36. an in-depth understanding of self reflection
K37. an in-depth understanding of the experience of psychotherapy
PADT 5 Maintain an analytic/dynamic focus
This competence shows how the therapist’s analytic stance extends into the selection and use of interventions that help explore interpersonal, affective, and unconscious themes, material presented in the transference and material from reflection on the countertransference. It also shows when they might use a more supportive style to protect the therapeutic relationship.
You need to:
1. show interest in and acceptance of the client’s subjective experience
2. respond sensitively to the client’s current preoccupations and distress
3. focus of the interventions on the here-and-now therapeutic interaction whenever it is likely to promote the therapy
4. identify a focus outside the here-and-now if you need to attend to other material that carries a strong affective charge
5. direct your interventions towards:
the interpersonal and affective, and unconscious themes that the formulation identifies as the focus of the therapy
material presented in the transference relationship
material from your reflection on the countertransference
6. hold open a space and select intervention techniques that allow the individual to explore themes relevant to the direction of the treatment/therapy
7. enable the emergence of understandings of resistance
8. enable the emergence of the client’s relevant interpersonal and affective patterns through exploration of interpersonal narratives and their elaboration in the transference
9. evaluate when it is most productive to focus primarily on the client’s external or internal reality
10. enable the client to explore the meaning of diversions from the current focus
11. be receptive to the individual’s reduced toleration of the interpretative approach
12. focus on conscious experience and strengthen the individual’s resilience when there is a clear need to alleviate the individual’s immediate problems and risk to the working alliance
13. evaluate the impact a more supportive stance may have on the therapeutic relationship
14. communicate to the individual an understanding of the meaning for them of any shift in style
15. explore with the individual the unconscious use that may be made of actual differences between you as therapist and the individual
16. critically self-reflect on assumptions, biases and prejudices that may be operating consciously and unconsciously in you with respect to difference
Knowledge and understanding
You need to apply:
K1. a working knowledge of developmental factors that shape an individual’s experience of themselves and others
K2. a working knowledge of the different types of personality organisations
K3. a working knowledge of developmental psychopathology
K4. a working knowledge of the nature of psychological life
K5. a working knowledge of the different structures of the mind and their contribution to personality development
K6. a working knowledge of the importance of the client’s imaginative life as a vehicle for understanding their unconscious experience of themself and others
K7. a working knowledge of analytic/dynamic models and techniques
Interpretation knowledge and skills
K8. a working knowledge of the aims and work of interpretation
K9. a working knowledge of the collaborative process of interpretation
Interpersonal and reflective skills
K10. a working knowledge of different interpersonal styles of relating
K11. a working knowledge of skills of clarification
K12. a working knowledge of skills of confrontation
K13. an in-depth understanding of self reflection
K14. an in-depth understanding of the experience of psychotherapy
Working with defences
K15. a working knowledge of the nature and processes of human defences
K16. a working knowledge of the functions of defences and how to identify them
K17. a working knowledge of how to gauge the level of personality functioning in an individual
K18. a working knowledge of the priority of the link between anxiety and defence over the interpretation of content
K19. a working knowledge of why individuals deploy defences
K20. a working knowledge of how to gain and maintain a reflective stance
Diversity in therapy
K21. a working knowledge of the psychodynamics of difference
K22. a working knowledge of how to work with the psychodynamics of difference within the therapeutic relationship
K23. a working knowledge of the process of self-reflection by the therapist on their conscious and unconscious assumptions, biases and prejudices around difference
PADT 6 Work with unconscious communication
This competence is about creating space for unconscious communication to emerge. It is highly reflective for the therapist and makes demands on both therapist and the individual who has come for therapy to tolerate and make effective use of silence and seeming lack of structure in the session.
You need to:
1. allow the client to talk without imposing any formal structure or direction in the sessions (e.g. by using questions infrequently)
2. communicate understanding to the client of the internal obstacles to free association
3. help the client explore their feelings about not being understood or helped
4. understand and manage your own feelings of anxiety about ‘not knowing’
5. consider the possible meaning of your own emotional reactions to the client as a basis for an intervention
6. be aware of and reflect upon, latent meanings conveyed through non-verbal communications
7. allow your own subjective associations and ideas to form in response to the client’s communications
8. be curious about what anxieties may lie behind the client’s questions and draw the client’s attention to these
9. recognise and help the client to reflect on unverbalised feelings
10. help the client elaborate on their idiosyncratic use of language/imagery/dreams
11. allow silence that permits the emergence of the client’s uninterrupted flow of associations and communications
12. tolerate the anxiety to break silences
13. manage the anxiety evoked in the therapist by silences
14. identify the client’s response to your use of silence
15. monitor and interpret the client’s anxiety in response to silence
16. limit silences if the client’s anxiety risks undermining engagement with the therapy
17. increase your level of activity when appropriate
18. explicate the client’s use of silence in the session
19. communicate to the client an understanding of the anxiety silence can generate
20. attend and respond to the conscious as well as the unconscious meaning of the client’s preoccupations
21. respond sensitively to the client’s current preoccupations and distress
22. evaluate when it is most productive to focus primarily on the client’s external or internal reality
23. help the client to make connections between their current, real-life preoccupations and their unconscious internal world of subjective experience
24. explore with the client the unconscious use that may be made of actual differences between therapist and client
You need to apply:
K1. an in-depth understanding of meaning in latent communication
K2. a working knowledge of conditions under which unconscious communication is likely to emerge
Developmental theory
K3. a working knowledge of developmental factors that shape an individual’s experience of themselves and others
K4. a working knowledge of the different types of personality organisations
K5. a working knowledge of developmental psychopathology
K6. a working knowledge of the nature of mental life
K7. a working knowledge of the different structures of the mind and their contribution to personality development
K8. a working knowledge of the nature of the unconscious inner world of object-relations
K9. a working knowledge of the importance of the client’s imaginative life as a vehicle for understanding their unconscious experience of himself and others
K10.a working knowledge of various analytic/dynamic models and techniques
Work in the Transference
K11. a working knowledge of the forms of transference
K12. a working knowledge of how to develop and work in the transference
K13. how to formulate the dominant transference theme(s) from an individual’s assessment
K14. a working knowledge of how to make a transference interpretation
K15. a working knowledge of the emotional impact of transference interpretations
K16. a working knowledge of the rationale and features of the analytic setting and stance
K17. a working knowledge of how to formulate the dominant transference theme(s) from an individual’s assessment
Working with defences
K18. a working knowledge of the nature and processes of human defences
K19. a working knowledge of the functions of defences and how to identify them
K20. a working knowledge of how to gauge the level of personality functioning in an individual
K21. a working knowledge of the priority of the link between anxiety and defence over the interpretation of content
K22. a working knowledge of why individuals deploy defences
K23. a working knowledge of how to gain and maintain a reflective stance
Interpretation knowledge and skills
K24. a working knowledge of the aims and work of interpretation
K25. a working knowledge of the collaborative process of interpretation
Resources
K26. a working knowledge of alternative psychological therapies as a basis for considering more suitable alternatives for the individual
K27. a working knowledge of external resources available to support individuals during therapy.
Interpersonal and reflective skills
K28. a working knowledge of different interpersonal styles of relating
K29. a working knowledge of skills of clarification
K30. a working knowledge of skills of confrontation
K31. an in-depth understanding of self reflection and the effects it can optimally elicit
K32. an in-depth understanding of the experience of psychotherapy
PADT 7 Enable an individual to explore the unconscious dynamics influencing their relationships
This competence centres on the interpretation of influences on the individual’s relationships by the therapist from a range of sources of information, and the sharing of that interpretation with the individual. It includes evaluating whether the interpretation is helpful to the individual and whether they offer in response thinking or feelings that change the interpretation.
You need to:
1. identify recurring configurations of ‘self’ and ‘other’ representations in the client’s past and current relationships
2. explore areas of omission from the client’s descriptions of their relationships
3. use the experience and observation of the client’s ways of relating within the session to inform your understanding of the client’s internal world of relationships
4. help the client identify and understand recurring affective patterns in their relationships, particularly through exploring how these play out in the relationship with the therapist
5. help the client identify areas of difficulty in their relationships
6. help the client understand the unconscious strategies that emerge to manage areas of difficulty in their relationships
7. help the client reflect on behaviours and feelings which perpetuate or exacerbate interpersonal difficulties
8. communicate to the client an interpretation that captures multiple levels of meaning about the client’s interpersonal and affective experiences (i.e. it goes beyond what the client consciously reports feeling)
9. share with the client a clear interpretation in a manner that:
matches what the client can bear to think about at any given point
Is not too close to the end of a session
moves gradually from pre-conscious content to more unconscious content
is pertinent to the interpersonal focus of the session
makes it clear to the client how you arrived at the interpretation
10. integrate information gathered from various sources
11. help the client make links and draw parallels between their subjective experience with others outside the therapy (past and present) and with the therapist (and vice versa)
12. exploration the client’s defences as they arise in relation to the therapist and significant others and help the client become more aware of how they manage problematic aspects of their relationships
13. manage the anxiety generated by the exploration of defences
14. receive client feedback about the helpfulness or otherwise of an interpretation openly
15. critically appraise the helpfulness and correctness of an interpretation and incorporate this into an ongoing process of evaluation
16. help the client become aware of incongruent elements in their communication
17. be open to the client’s view that the interpretation may be incorrect or badly timed and to respond to this non-defensively
You need to apply:
K1. a working knowledge of developmental factors that shape an individual’s experience of themselves and others
K2. a working knowledge of the different types of personality organisations
K3. a working knowledge of developmental psychopathology
K4. a working knowledge of the nature of mental life
K5. a working knowledge of the different structures of the mind and their contribution to personality development
K6. a working knowledge of the nature of the unconscious inner world of object-relations
K7. a working knowledge of the importance of the client’s imaginative life as a vehicle for understanding their unconscious experience of himself and others
K8. a working knowledge of various analytic/dynamic models and techniques
Work in the Transference
K9. a working knowledge of the forms of transference
K10. a working knowledge of how to develop and work in the transference
K11. How to formulate the dominant transference theme(s) from an individual’s assessment
K12. a working knowledge of how to make a transference interpretation
K13. a working knowledge of the emotional impact of transference interpretations
K14. a working knowledge of the rationale and features of the analytic setting and stance
K15. a working knowledge of how to formulate the dominant transference theme(s) from an individual’s assessment
Working with defences knowledge and skills
K16. a working knowledge of the nature and processes of human defences
K17. a working knowledge of the functions of defences and how to identify them
K18. a working knowledge of how to gauge the level of personality functioning in an individual
K19. a working knowledge of the priority of the link between anxiety and defence over the interpretation of content
K20. a working knowledge of why individuals deploy defences
K21. a working knowledge of how to gain and maintain a reflective stance
Interpretation knowledge and skills
K22. a working knowledge of the aims and work of interpretation
K23. a working knowledge of the collaborative process of interpretation
Assessment knowledge and skills
K24. a working knowledge of alternative psychological therapies as a basis for considering more suitable alternatives for the individual
K25. a working knowledge of external resources available to support individuals during therapy.
K26. a working knowledge of how to assess an individual’s capacity to engage in the analytic process in the context of assessment of risk
Interpersonal and reflective skills
K27. a working knowledge of different interpersonal styles of relating
K28. a working knowledge of skills of clarification
K29. a working knowledge of skills of confrontation
K30. an in-depth understanding of self reflection
PADT 8 Enable an individual to become aware of unexpressed or unconscious feelings
T
Is this too much in one go? Are there different aspects we could describe separately?
his competence is about exploring the individual’s world of feelings through enabling the individual to find ways of expressing their feelings and the sharing of interpretations with them.1. communicate to the individual that their feelings can be tolerated and thought about by you
2. link the individual’s non-verbal cues to unexpressed or unconscious feelings
3. help the individual express the subjective meaning of their use of particular words, dreams, fantasies or non-verbal behaviours
4. encourage the individual to stay with a current feeling as it emerges in the session and to articulate what they are experiencing
5. help the individual explore internal and interpersonal obstacles to the awareness, and expression, of particular feelings (especially in the context of the relationship with the therapist)
6. maintain the primary focus of interpretations on:
dynamically unconscious content
the individual’s interpersonal and affective experiences.
7. communicate to the individual an interpretation that captures multiple levels of meaning beyond what the individual consciously reports feeling
8. help the individual to explore and become more aware of painful conflicts through unacceptable or uncomfortable feelings that are otherwise managed by being kept out of the individual’s conscious awareness
9. encourage the individual to elaborate on communication that is unclear, vague, puzzling or contradictory
10. help the individual become aware of incongruent elements in their communication
11. be open to the potential latent content in the individual’s communications through:
12. a) be curious about what anxieties may lie behind the individual’s questions, even if ostensibly legitimate, and draw the individual’s attention to these
b) identify and point out to the individual unverbalised affect when it is manifested in the session
13. share with the individual an interpretation in a manner that is, clear, appropriately timed, of appropriate depth, pertinent to the affective and/or interpersonal focus of the session
14. encourage the individual to discuss and explore their perceptions of, and feelings about, the therapist and how they think the therapist may feel or think about them
15. accept the individual’s view of you and allow a particular experience of the individual’s self in relationship to the therapist to emerge in the session
16. maintain the focus of exploration on the transference relationship when necessary
17. evaluate the impact of a transference interpretation at any given point in time
respond non-defensively to the individual’s view that the interpretation may be incorrect or badly timed
use your experience of the transference in order to inform their understanding of the individual’s patterns of relating and of their defences
hypothesise about what the individual may be expressing indirectly
appraise the relevance of your own thinking about, and affective responses to, the individual and to use this as a basis for an interpretation of what the individual may be struggling to articulate explicitly
maintain an “observing distance” from the part of yourself that is involved in the process
consider critically the meaning of your emotional reactions to the individual and minimise the risk of unsubstantiated speculation or of misattributing your own feelings to the individual
draw attention to the individual’s states of mind that seem unacceptable or uncomfortable
point out how the individual may unconsciously protect themselves and help them explore the meaning of their defensive structures empathically
accept and tolerate the individual’s experience of anxiety if they feel too exposed
remain with the anxiety generated by the exploration of defences
help the individual understand why they need to protect themselves from the experience of particular feelings /states of mind
You need to apply:
K1. a working knowledge of developmental factors that shape an individual’s experience of themselves and others
K2. a working knowledge of the different types of personality organisations
K3. a working knowledge of developmental psychopathology
K4. a working knowledge of the nature of mental life
K5. a working knowledge of the different structures of the mind and their contribution to personality development
K6. a working knowledge of the nature of the unconscious inner world of object-relations
K7. a working knowledge of the importance of the individual’s imaginative life as a vehicle for understanding their unconscious experience of himself and others
K8. a working knowledge of various analytic/dynamic models and techniques
Work in the Transference
K9. a working knowledge of the forms of transference
K10 a working knowledge of how to develop and work in the transference
K11. how to formulate the dominant transference theme(s) from an individual’s assessment
K12. a working knowledge of how to make a transference interpretation
K13. a working knowledge of the emotional impact of transference interpretations
K14. a working knowledge of the rationale and features of the analytic setting and stance
K15. a working knowledge of how to formulate the dominant transference theme(s) from an individual’s assessment
Working with defences
K16. a working knowledge of the nature and processes of human defences
K17. a working knowledge of the functions of defences and how to identify them
K18. a working knowledge of how to gauge the level of personality functioning in an individual
K19. a working knowledge of the priority of the link between anxiety and defence over the interpretation of content
K20. a working knowledge of why individuals deploy defences
K21. a working knowledge of how to gain and maintain a reflective stance
Interpretation
K22. a working knowledge of the aims and work of interpretation
K23. a working knowledge of the collaborative process of interpretation
K24. a working knowledge of alternative psychological therapies as a basis for considering more suitable alternatives for the individual
K25. a working knowledge of external resources available to support individuals during therapy.
K26. a working knowledge of how to assess an individual’s capacity to engage in the analytic process in the context of assessment of risk
Interpersonal
K27. a working knowledge of different interpersonal styles of relating
K28. a working knowledge of skills of clarification
K29. a working knowledge of skills of confrontation
K30. an in-depth understanding of self reflection
T
Are these performance criteria best here in a set, or would they be better distributed among other draft NOS
his competence is about prioritising the experiential focus of the here-and-now of the session as the basis for interventions, making use of the therapist’s experience with the individual to inform the treatment. It involves exploring – and the therapeutic relationshipPerformance criteria
You need to:
1. establish and maintain emotional contact with the individual
prioritise the experiential focus of the here-and-now of the session as the basis for interventions
monitor your own reactions to the individual
critically consider the relevance of your current experience with the individual as the basis for furthering your understanding of the individual
respond to the current state of the relationship
protect the individual’s therapy by identifying professional developmental and/or supervisory needs
re-establish a focus onto the transference relationship when the individual, you as therapist (or both) are unproductively pulled away from this
evaluate the impact of a transference interpretation at any given point in time in light of:
a) the individual’s conscious and unconscious response to the interpretation
b) your assessment of the quality of the working alliance following an interpretation
c) the individual’s level of disturbance following an interpretation
be open to the individual’s view that the interpretation may be incorrect or badly timed and to respond to this non-defensively
be receptive to the individual’s level of anxiety
facilitate the individual’s reflection on the meaning of their anxiety as it manifests in the therapeutic relationship
contain the individual’s experience of anxiety if they feel too exposed
relate to your interpretations as hypotheses to be tested with the individual
be open to individual feedback about the helpfulness or otherwise of an interpretation
arrive at hypotheses regarding unconscious processes by integrating information gathered from various sources
facilitate the patient’s own attempts to link related material
maintain the primary focus of interpretations on dynamically unconscious content and the individual’s interpersonal and affective experiences
monitor and avoid the temptation to make interpretations to manage your own anxiety
respond sensitively to the individual’s preoccupations and distress
evaluate when it is most productive to focus primarily on the individual’s internal or external reality
respond openly and respectfully to the individual’s conscious and unconscious experience of difference
be curious about the meaning and impact of differences between therapist and the individual
respond openly and sensitively to the individual’s experience of difference in the therapeutic relationship
explore with the individual the unconscious use that may be made of actual differences between therapist and individual
25. critically self-reflect on assumptions, biases and prejudices that may be operating consciously and unconsciously in the therapist with respect to difference
Knowledge and understanding
You need to apply:
K1. a working knowledge of developmental factors that shape an individual’s experience of themselves and others
K2. a working knowledge of developmental theory
K3. a working knowledge of the different types of personality organisations
K4. a working knowledge of developmental psychopathology
K5. a working knowledge of the nature of mental life
K6. a working knowledge of the different structures of the mind and their contribution to personality development
K7. a working knowledge of unconscious processes
K8. a working knowledge of the nature of the unconscious inner world of object-relations
K9. a working knowledge of the importance of the individual’s imaginative life as a vehicle for understanding unconscious experience of self and others
K10. a working knowledge of various analytic/dynamic models and techniques
The rationale for the analytic/dynamic approach
K11. a working knowledge of the affective and interpersonal focus of the therapy
K12. a working knowledge of the nature of exploratory therapy
K13. a working knowledge of how to explore an individual’s internal unconscious world of experience, external reality and value systems
K14. a working knowledge of the rationale for an analytic/dynamic approach
K15. a working knowledge of the primary focus of therapy
K16. a working knowledge of the rationale for closely tracking the therapeutic relationship
K17. a working knowledge of the rationale and features of the analytic setting and stance process
K18. a working knowledge of how to track and explore the therapeutic relationship in detail
K19. a working knowledge of how to adopt a non directive stance in relation to the individual’s communications
K20. a working knowledge of the importance of maintaining an open mind during therapy
Working with defences knowledge and skills
K21. a working knowledge of the nature and processes of human defences
K22. a working knowledge of the functions of defences and how to identify them
K23. a working knowledge of how to gauge the level of personality functioning in an individual
K24. a working knowledge of the priority of the link between anxiety, defence and hidden impulse
K25. a working knowledge of how to gain and maintain a reflective stance
Transference knowledge and skills
K26. a working knowledge of the forms of transference
K27. a working knowledge of how to develop and work in the transference
K28. a working knowledge of how to make and titrate a transference interpretation
K29. a working knowledge of how to identify the emotional impact of transference interpretations
K30. a working knowledge of when to avoid transference interpretations
Interpretation knowledge and skills
K31. a working knowledge of the aims and work of interpretation
K32. a working knowledge of the collaborative process of interpretation
Interpersonal and reflective knowledge and skills
K33. a working knowledge of different interpersonal styles of relating
K34. a working knowledge of skills of clarification
K35. a working knowledge of skills of confrontation
K36. an in-depth understanding of self reflection
Diversity in therapy
K37. a working knowledge of the psychodynamics of difference
K38. a working knowledge of how to work with the psychodynamics of difference within the therapeutic relationship
K39. a working knowledge of the process of self-reflection by the therapist on their conscious and unconscious assumptions, biases and prejudices around difference
PADT 10 Manage difficulties in the therapeutic relationship
The therapist has to be alert to signs of the relationship breaking down or obstacles to it emerging. This competences shows how the therapists response has to be as creative as possible, seeking therapeutic benefit from what is occurring.
You need to:
1. identify therapeutic ruptures or impasses
engage with the individual in understanding what is felt to have disrupted and/or distorted the therapeutic relationship:
demonstrate to the individual that their relationship with you is something they can discuss
respond non-defensively to the individual’s negative experience of the therapeutic work and of you
help the individual understand the emotional impact of the work, including the impact of your interventions as therapist
help the individual understand that the therapeutic relationship (like any relationship) operates at different levels such that positive and uncomfortable/negative feelings towards you (as therapist) can co-exist
draw the individual’s attention to the feelings they may be avoiding
make use of ruptures or impasses in the therapy as opportunities for deepening understanding of the individual’s subjective experience and of their difficulties
appraise critically when therapy may have reached an unresolvable impasse such that ending and/or referral onwards may be the most helpful way forwards
clarify your possible contribution to a difficulty in therapy and understand its meaning
consider the respective contributions of you (as therapist) and you as an individual to their perception of you
distinguish between instances when resistance to therapy is a manifestation of the individual’s difficulties and instances when the individual is responding to an accurate perception of differences of opinion between themselves and you
where you identify your contribution to a therapeutic impasse, consider the most helpful way of using this awareness to resolve the issue.
protect the individual’s therapy by identifying professional developmental and/or supervisory needs
use transference interpretations in a sensitive and timely manner in order to manage clients’ projections that (if not attended to) are likely to disrupt the therapeutic relationship
help the client explore and become more aware of areas of conflict by drawing attention to feelings/ states of mind that are experienced by the individual as unacceptable or uncomfortable
draw the individual’s attention to communication that is unclear, vague, puzzling or contradictory with the aim of encouraging the client to better express their thoughts and feelings
respond openly and sensitively to the individual’s experience of difference in the therapeutic relationship
explore with the individual the unconscious use that may be made of actual differences between you as therapist and the individual
critically self-reflect on assumptions, biases and prejudices that may be operating consciously and unconsciously in you as therapist with respect to difference
You need to apply:
K1. a working knowledge of developmental factors that shape an individual’s experience of themselves and others
K2. a working knowledge of developmental theory
K3. a working knowledge of the different types of personality organizations
K4. a working knowledge of developmental psychopathology
K5. a working knowledge of the nature of mental life
K6. a working knowledge of unconscious processes
K7. a working knowledge of the different structures of the mind and their contribution to personality development
K8. a working knowledge of the nature of the unconscious inner world of object-relations
K9. a working knowledge of the importance of the individual’s imaginative life as a vehicle for understanding unconscious experience of self and others
K10. a working knowledge of various analytic/dynamic models and techniques
The rationale for an analytic/dynamic approach
K11. a working knowledge of the nature of exploratory therapy
K12. a working knowledge of the affective and interpersonal focus of the therapy
K13. a working knowledge of the rationale for closely tracking the therapeutic process
K14. a working knowledge of the rationale and features of the analytic setting and stance
K.15 a working knowledge of how to adopt a non directive stance in relation to the individual’s communications
K.16 a working knowledge of the importance of maintaining an open mind during therapy
K17. a working knowledge of the primary target of therapy
K18. a working knowledge of the rationale for an analytic/dynamic approach
K19. a working knowledge of the nature and processes of human defences
K20. a working knowledge of the functions of defences and how to identify them
K21. a working knowledge of how to gauge the level of personality functioning in an individual
K22. a working knowledge of the priority of the link between anxiety and defence over the interpretation of content
K23. working knowledge of why individuals deploy defences
K24. a working knowledge of how to gain and maintain a reflective stance
Working with transference knowledge and skills
K25. a working knowledge of the forms of transference
K26. a working knowledge of how to develop and work in the transference
K27. a working knowledge of how to make and titrate a transference interpretation
K28. a working knowledge of how to identify the emotional impact of transference interpretations
Interpretation knowledge and skills
K29. a working knowledge of the aims and work of interpretation
K30. a working knowledge of the collaborative process of interpretation
Interpersonal and reflective skills
K31. a working knowledge of different interpersonal styles of relating
K32. a working knowledge of skills of clarification
K33. a working knowledge of skills of confrontation
K34. a working knowledge of self-reflection
K35. an in-depth understanding of the experience of psychotherapy
K36. a working knowledge of how analytic/dynamic approaches privilege the exploration of the individual’s internal, unconscious world of experience
Diversity in therapy
K37. a working knowledge of the psychodynamics of difference
K38. a working knowledge of how to work with the psychodynamics of difference within the therapeutic relationship
K39. a working knowledge of the process of self-reflection by the therapist on their conscious and unconscious assumptions, biases and prejudices around difference
PADT 11 Apply the analytic/dynamic model flexibly in response to the client’s level of disturbance and to their individual needs and context
The prime consideration of this competence is the wellbeing of the individual who has come for therapy. Therapy is adapted according to risks to the individual or evidence that something that has happened or not happened is causing harm.
You need to:
1. systematically monitor any harmful impacts of the therapy on the individual
identify the need for consultation/supervision if there are indications that the individual is at risk
adapt relevant elements of the therapy in response to:
the needs of the individual at a given moment in the session and during particular phases of the therapy
the quality of the therapeutic alliance
changes in the individual’s external context
changes in the treatment setting
m
Nothing against a NOS being short, but are there any other considerations here?
onitor and explore the meaning for the client of any adaptations to the originally agreed treatment plan.
You need to apply:
K1. a working knowledge of developmental factors that shape an individual’s experience of themselves and others
K2. a working knowledge of developmental theory
K3. a working knowledge of the different types of personality organisations
K4. a working knowledge of developmental psychopathology
K5. a working knowledge of the nature of mental life
K6. a working knowledge of the different structures of the mind and their contribution to personality development
K7. a working knowledge of the nature of the unconscious inner world of object-relations
K8. a working knowledge of the importance of the client’s imaginative life as a vehicle for understanding their unconscious experience of himself and others
K9. a working knowledge of various analytic/dynamic models and techniques
K10. a working knowledge of when to adapt analytic/dynamic models in response to changes in the individual’s presentation
The rationale for an analytic/dynamic approach
K11. a working knowledge of the affective and interpersonal focus of the therapy
K12. a working knowledge of the rationale for an analytic/dynamic approach
K13. a working knowledge of the rationale for closely tracking the therapeutic process
K14. a working knowledge of how to adopt a non directive stance in relation to the individual’s communications
K15. a working knowledge of the importance of maintaining an open mind during therapy
K16. a working knowledge of the primary target of therapy
PADT 12 Adapt the level of therapist activity
T
Question here is whether this is covered elsewhere.
his is about titrating the level of therapist activity in response to your own levels of arousal and that of the individual who has come to therapy.
You need to:
1. closely monitor your own experience of the therapy and your level of arousal throughout the therapy
monitor your own feelings within therapy sessions and understand what may contributing to them
maintain an empathic, thoughtful response to the individual’s affective engagement with you
communicate understanding in response to the individual’s conscious and unconscious communications
respond affectively in an way that takes into account your understanding of the individual and their attachment style
respond to unproductive levels of anxiety or other feelings in therapy by adapting technique flexibly
sustain the relationship in the face of primitive states of mind and intense emotion.
You need to apply:
K1. a working knowledge of developmental factors that shape an individual’s experience of themselves and others
K2. a working knowledge of developmental theory
K3. a working knowledge of the different types of personality organisations
K4. a working knowledge of developmental psychopathology
K5. a working knowledge of the nature of mental life
K6. a working knowledge of the different structures of the mind and their contribution to personality development
K7. a working knowledge of the nature of the unconscious inner world of object-relations
K8. a working knowledge of the importance of the client’s imaginative life as a vehicle for understanding their unconscious experience of himself and others
K9. a working knowledge of an analytic/dynamic model of the mind
K10. a working knowledge of various analytic/dynamic models and techniques and how to adapt them flexibly
The rationale for an analytic/dynamic approach
K11. a working knowledge of the rationale for an analytic/dynamic approach
K12. a working knowledge of the affective and interpersonal focus of the therapy
K13. a working knowledge of how to monitor levels of arousal in an individual
K14. a working knowledge of the rationale for closely tracking the therapeutic process
K15. a working knowledge of how to adopt a non directive stance in relation to the individual’s communications
K16. a working knowledge of the importance of maintaining an open mind during therapy
K17. a working knowledge of the primary target of therapy
K18. a working knowledge of the rationale for an analytic/dynamic approach
K19. a working knowledge of how to assess an individual’s capacity to engage in the analytic process in the context of assessment of risk