Psychotherapy with Psychotic Patients 2016 Conference


Psychotherapy with Psychotic Patients Conference 2016

Fear, Violence and Psychosis

A Child’s Loss Becomes a Young Man’s Violence

In this talk, I present the case of a neglected and traumatised boy who later had an adolescent psychotic breakdown, which led to a catastrophic matricide. I will illustrate the psychoanalytic treatment of this young man over a decade, from his time in a high security hospital, through decreasing levels of security until he was living back in the community. I will describe the mental structural changes as well as aspects of interpersonal dynamics during this long period of treatment.

To Survive Aggression While Working Through Psychosis

This paper presents a clinical case of a self-harming, borderline psychotic patient. The impact of the patient’s aggressive self-harm in an inpatient setting will be discussed. The paper follows the course of treatment over eight years, from psychotic breakdown to the breakdown of inpatient treatment and further to outpatient treatment which eventually resulted in a return to normal healthy life in the community. The paper will describethe development of an alternative institutional outpatient treatment frame, secure enough to support the
treatment and the patient’s potential for healing. The importance of a trustworthy treatment organisation will be outlined, and the patient’s development will be followed in vital areas such as development of a separate identity, the capacity to relate to others and for cognitive/practical functioning in daily life.

Transference to the Frame in Violence

The frame represents reality to the patient in psychotherapy. The boundaries and ethical ground rules of the psychoanalytic frame have the potential to provide a contained space for thinking together. A patient will have transference not only to the therapist but also to the frame itself. This transference may express a hatred of reality. The psychotic part of the patient will inevitably attempt to subvert or attack the frame. Pressures on, and disruptions of, the frame can give the therapist an objective assay of the psychotic process. Attacks on the frame occur in all analyses but can also be seen in many public acts of terrorism and violence against
institutional frames, resulting in death or injury. This paper offers clinical vignettes and instances of public events which can be understood as attacks on a frame.

Psychosis or Personality Disorder?

Clinical Evidence for a Single Entity Diagnosis
In this talk, I will present cases of patients diagnosed as suffering from Personality Disorders and/or Psychoses. I hope to show that it can be more helpful to consider such patients as suffering from a single entity disorder where at times their mental state is more manifestly psychotic and at other times more manifestly personality disordered. Considering such patients in this way can inform treatment planning and contribute to risk management.


DR CARINE MINNE is Consultant Psychiatrist in Forensic Psychotherapy at Broadmoor Hospital, West London Mental Health NHS Trust, and at the Portman Clinic, Tavistock and NHS Foundation Trust. She is Vice-Presidnet of the International Association for Forensic Psychotherapy. She is also a psychoanalyst and a member of the British Psychoanalytical Society. She is the Training Programme Director for the North West London Specialist Registrar forensic psychotherapy training. She chairs the Royal College of Psychiatrists’ Special Interest Group in Forensic Psychotherapy. One of her particular interests is in providing long-term continuity of psychotherapy for forensic patients as they pass through different levels of security and when they return to the community.

HANNE NIELSEN is a psychoanalytic psychotherapist and neuropsychologist in private practice in Denmark. Her work includes neuropsychological testing, neuro-rehabilitation and neuropsychological therapy.

DR JAMES TELFER is a Consultant Psychiatrist and Psychoanalyst in public and private practice in Sydney. He is a member of the Sydney Institute for Psychoanalysis and a Clinical Lecturer in the Discipline of Psychological Medicine at the University of Sydney. He has published work on the psychoanalytic understanding of place and on psychotic processes in everyday life and clinical work.

DR TIMOTHY KEOGH is a training and supervising analyst with the Sydney Branch of the Australian Psychoanalytical Society. He has a broad range of clinical and published research experience in a variety of forensic settings, including those involving violent offenders.

NEVILLE SYMINGTON is a psychoanalyst in private practice in Sydney. He has a background in philosophy, theology and clinical psychology. A Fellow of the British Psycho-Analytical Society, he migrated to Sydney in 1986, having held senior positions in the Adult and Adolescent Departments of the Tavistock Clinic.Chairman of the Sydney Institute for Psychoanalysis from 1987-93 and President of the Australian Psychoanalytic Society from 1999-2002, he has lectured widely, both in Australia and internationally, and written numerous books on various aspects of psychoanalysis, a novel and a book of poetry. He has a special interest in serious mental disturbance.

Psychotherapy with Psychotic Patients (PPP)
is a multidisciplinary group of clinicians interested in
exploring how psychoanalytic thinking can contribute
to the treatment of psychotic states of mind.

8.30 – 9.00 am Registration
9.00 – 9.15 am Welcome and Introduction- Dr Judith Craig
9.15 – 10.00 am Dr Carine Minne-A Child’s loss becomes a young man’s violence
Chair - Dr Timothy Keogh
10.00 am Dr Timothy Keogh - Discussant
10.35 – 11.05 am Morning Tea11.05 – 11.50 am Hanne Nielsen
To survive aggression while working through psychosis
Chair - Neville Symington
11.50 am Discussion
12.15 – 1.15 pm Lunch
1.15 – 2.00 pm Dr James Telfer
The frame represents reality to the patient in psychotherapy
2.00 pm Discussion
2.30 – 3.00 pm Afternoon Tea
3.00 – 3.45 pm Dr Carine Minne-Psychosis or Personality Disorder? Clinical evidence for a single entity diagnosis
3.45 pm Discussion
4.15 – 5.00 pm Panel Discussion-Dr Carine Minne, Dr James Telfer, Hanne Nielsen, Dr Timothy
Keogh, Neville Symington
5.00pm Close - Dr Judith Craig