Congress AttAChment And trAumAPersonality development

and Psychotherapy

25-26-27 SEPTEMBER2015

ROME

COngREss AttAChMEnt And tRAuMA

PERsOnAlity dEvElOPMEnt And PsyChOthERAPy

Attachment, and simple and complex trauma can determine not only the individual’s brain development but their personality development as well. In recent years, there is a growing consensus within the science community in outlining important rela-tions between attach-ment, trauma, personality development and pathology. In the last years, there are also been many advances in those therapies that have proved, and are proving, to be effective in the treatment of attachment and trauma related disorders. Moreover, it has been conducted a large number of studies evaluating what works and is important in the therapies for trauma and personality disorders. The leading experts in this field will meet to present their very broad knowledge on attachment, trauma, personality development and psychotherapy.

After the first extraordinary edition, this Con-gress is an opportunity which must not

be missed to take part at a “historic” exchange of knowledge in the in-

ternational landscape of psycho-therapy. In addition to the eleven presen-tations and three round tables, there will be more room for dis-cussion, and for the first time it will be awarded an international prize on research in this area. Furthermore, it will be possible to join the cultural lunches with professional musicians per-forming classical music and,

on Saturday, you can take part at the dinner gala and the sub-se-quent concert, all in the evocative

setting of the Teatro Brancaccio, in the heart of Rome.

Arnoud Arntz NetherlandsFull professor and scientific director of the research institute of Experimental Psychopathology in 2001. Together with Marcel van den Hout he is chief editor of the Journal of Behavior Therapy and Experimental Psychiatry.

sChEMA thERAPy As A tREAtMEnt fOR tRAuMA And insECuRE AttAChMEnt RElAtEd PERsOnAlity disORdERs: stAtE Of thE ARt in tREAtMEnt MEthOds And REsEARCh findings.

Schema Therapy is an integrative treatment developed for severe personality disorders, but also effective for related problems like chronic depression and eating disorders. It is based on the assumption that if childhood needs are not adequately met, chances are high that personality problems develop, based on maladaptive schemas and dys-functional coping. The here-and-now emotional states of the patient are described as “schema modes”, i.e. the combination of an activated schema (e.g., abandonment) and coping (e.g., surrender). The example will lead to a state described as the abandoned child mode, a feeling state in which the patient feels the threat and panic that a child would feel when threatened with abandonment. Schema Therapy has developed basic schema mode models of most personality disorders, and sets of techniques to deal with the modes that are active in the session. The techniques can be grouped in experiential, cognitive and behavioral techniques; and typically all three channels are used to bring about change. The focus of treatment is threefold: on the past, with a specific emphasis on repairing what went wrong in early relationships and on trauma processing; on the therapeutic relationship, with the therapist fulfilling partially the unmet needs of the pa-tients (“limited reparenting”); and on the here-and-now, that is addressing problems in the patient’s current life. Schema Therapy has been found to effective in the treatment of Borderline, cluster-C and other personality disorders, as well as in chronic depression. Preliminary findings indicate that it also an effective treatment for forensic patients with personality disorders, including those that meet criteria for psychopathy.In this contribution I will focus on the main principles underlying the treatment model, with a special emphasis on how attachment and early trauma are addressed. I will discuss the main outcome studies, and pay attention to research that indicates that specific treatment techniques do matter and that it is not the general therapeutic re-lationship, though usually of high quality in the trials so far, but especially the specific techniques that drive the effectiveness of schema therapy.

ProgrAm

giAnCArlo dimAggio Italy

MD, Psychiatrist, psycotherapist. Co-founding member of the Centre for Metacognitive Interpersonal Therapy. He is associate editor of “Psychology and Psychotherapy: The-ory, Research and Practice” and member of the board of the “Journal of Personality Disorders”

MEtACOgnitivE intERPERsOnAl thERAPy fOR PERsOnAlity disORdERs And histORy Of nEglECt

Advances in evaluating outcomes of psychotherapies for personality disorders (PD) are remarkable in the last decades, but evidence is mostly limited to borderline PD. This bias is unjustified given the much larger cumulative prevalence of all the other PD as compared to borderline PD only and the significant symptoms and life adversity associated with having any PD, in particular if that is severe. Many of these persons have histories of neglect which results in difficulties retrieving personal memories, poor emotional awareness and tendencies to over-regulate emotions and distancing from others. Metacognitive Interpersonal Therapy (MIT) has been manualized in details to address the needs of PD featuring these problems and is actually investigated in a series of pilot studies in different countries. The basic tenets of MIT will be described in order to explain how help these persons foster access to mental states, reactivate the autobiographical memory and increase a sense of agency and personal worth.

stePhAn doering AustriaHe is chair and professor of Psychoanalysis and Psychotherapy and head of the Department of Psychoanalysis and Psychotherapy at the Medical University of Vienna, Austria. He has received five scientific awards. He is vice president of the International Society of Transfe-rence-Focused Psychotherapy (ISTFP) and of the German Society for Research and Treatment of Personality Disorders (GePs).

tRAnsfEREnCE-fOCusEd PsyChOthERAPy (tfP)

Transference-Focused Psychotherapy (TFP) is a psychodynamic treatment for Bor-derline Personality Disorder. TFP has been manualized and has demonstrated its ef-ficacy in the treatment of borderline patients in randomized-controlled trials. Thus, it can be regarded empirically validated.TFP was developed by Otto F. Kernberg and is based on psychoanalytic object rela-tions theory. A distinguishing feature of TFP in contrast to many other treatments for BPD is the belief in a psychological structure that underlies the specific symptoms a borderline individual suffers from. In other words, the focus of treatment is on a deep psychological make-up — a mind structured around a fundamental split that deter-mines the patient’s way of experiencing self and others and the environment. In such a psychological organization, thoughts and feelings about self and others are split into dichotomous experiences of good or bad, black or white, all or nothing.TFP is a twice-per-week outpatient individual psychotherapy that combines psycho-dynamic principles with a structured setting and a treatment contract. The treatment focuses on the transference [the patient’s moment-to-moment experience of the thera-pist] because it is believed that the patient lives out his/her predominant object relations dyads in the transference. Once the treatment frame is in place, the core task in TFP is to identify these internal object relations dyads that act as the “lenses” which determine the patient’s experience of the self and the world. It is believed that the information that unfolds within the patient’s relation with the therapist provides the most direct access to understanding the make-up of the patient’s internal world for two reasons. First, it has immediacy and is observable by both therapist and patient simultaneously so that differing perceptions of the shared reality can be discussed in the moment. Second, it includes the affect (feelings) that accompanies the perceptions, in contrast to discussion of historical material that can have an intellectualized quality.

Suggested reading:Clarkin JF, Yeomans FE, Kernberg OF. Psychotherapy for Borderline Personality. Focusing on Object Relations. Washington, DC: American Psychiatric Publishing 2006.

Peter FonAgY United KingdomFreud Memorial Professor of Psychoanalysis, University College of London (UCL). Director, Sub-Department of Clinical Health Psychology, University College of London (UCL).Director of Research, Anna Freud Centre.Co-ordinating Director, Child and Family Center and Center for Outcome Research and Effectiveness, Menninger Foundation.

thE ROlE Of AttAChMEnt EPistEMiC tRust And REsiliEnCE in PERsOnAlity disORdER; A tRAnsthEORtiCAl REfORMulAtiOn

Research over recent years has identified anomalies of attachment and social cogni-tion in the phenomenology of personality disorder. There has also been significant progress in understanding the neurobiology of personality disorder particularly the nature of functional anomalies in amygdala and the prefrontal cortex. The presentation will attempt to draw together evidence from studies of the structure of psychopathol-ogy, developmental science and treatment research. The presentation will outline a model of personality disorder as under pinned by a failure of resilience mechanisms which in turn have led to social adaptation that compromises a process of ongoing social learning and interpersonal flexibility. Clinical implications of this model will be discussed.

russell meAres AustraliaEmeritus Professor of Psychiatry at the University ofSydney. He held the foundation chair of psychiatry at theWestern Clinical School, Sydney University, 1981-2003and was the founding president of the Australia and NewZealand Association of Psychotherapy (ANZAP).

thE COnvERsAtiOnAl MOdEl in thE tREAtMEnt Of RElAtiOnAl tRAuMAtAby RussEll MEAREs

The therapeutic field is governed by two main forces, positive and negative. Positivity is directed towards health and selfhood; it is repeatedly undermined by unconscious trau-matic memory, akin to a repetitive script. Therapy, therefore, has two main themes.An illustrative session demonstrates, first, the effects of traumatic forms of relationship, the result of disorganized attachment in childhood, in creating therapeutic impasse. Secondly, it shows how self is restored and generated by the establishment of a specific form of therapeutic conversation I call “analogical connectedness,” in which the thera-pist has a “picturing” function. “Forms of feeling” (Hobson, 1985) are created which show the “shape” of an immediate reality.The therapeutic language is “right hemispheric” and structured so as to foster the expe-rience of shared subjective space. Beneficial change is conceived as the outcome of a sense of “fit” between the patient’s state and its analogical representation.Change is indicated linguistically, the structure of the conversation reflecting the emer-gence of self.

PAt ogden United StatesShe founded the Sensorimotor Psychotherapy and The Sensorimotor Psychitehrapy Institute.

MOvEMEnt sEquEnCEs And PERsOnAlity dEvElOPMEnt: A PsyChOlOgy Of ACtiOn

The movement of the body speaks clearly to those who know how to listen, visibly revealing what words cannot describe: the legacy of trauma and early or forgotten dynamics with attachment figures. A shift is occurring in psychotherapy that takes into account the dominance of nonverbal, body-based, implicit processes over verbal, linguistic, explicit processes. Movement sequences, such as reaching out or striking out in the face of internal distress, are learned in the context of trauma and attachment relationships. When such actions are executed repeatedly in response to particular cues, they become automatic, enduring reactions. These procedurally-learned action sequences are based on unconscious presumptions that the future will be the same as the past and carry memories that the mind may have forgotten, dissociated, or suppressed. Such habits prevent new responses to current situations, taking pre-cedence over actions that might be more rewarding or more adaptive to the present moment. This presentation will explore attachment- and trauma-related action se-quences that reflect and sustain insecure attachment and dissociation, elucidating the body, per se, as a vehicle for understanding personality development and as a target of therapeutic change.

eCkhArd roediger Germany

Neurologist, psychiatrist and psychotherapist. Trained in psy-chodynamic and cognitive-behavior therapy. Formerly Director of a Psychosomatic Department of a clinic in Berlin (GER), since 2007 working in Private Practice and Director of the Schema Therapy Training Center in Frankfurt (GER). Member of the ISST Board since 2008, currently President.

hEAling RElAtiOnshiPs: sChEMA thERAPy fOR COuPlEs

The schema therapy model describes how unmet core needs, traumatic experience and unsecure attachment lead to maladaptive schemas and coping behavior. Unfor-tunately schema chemistry plays an important role when we choose our partners. So we find ourselves in the same complementary and sometimes re-traumatizing roles that we got used to in childhood and fight the former significant others in our partners by mutually “pushing our buttons” in escalating mode cycles. Unlike most of the other approaches working with couples schema therapy is not working solely with the couple but includes single sessions in an individual treatment plan. This allows treating even severe personality or trauma related disorders while improving the current relationships. Even more: We can start working with one partner and include the other partner later to a smaller or greater extend. Including a healthier partner supports the course of therapy while he or she feels supported by the thera-pist. Schema therapy is very flexible at that point. But balancing these relationships is a challenging issue. The lecture introduces into the theoretical framework and describes how mode cycles work and how they can be changed by realizing the frustrated core needs, emo-tional reconnection through imagery and connection talk between the Healthy Adult modes.

Readings:DiFrancesco, C., Roediger, E., Stevens, B. (2015). Healing Relationships: Schema Therapy for Couples, Oxford, UK: Wiley-Blackwell.

AllAn sChore United StatesAuthor of numerous articles and books ontheory of emotional regulation, he works onthe faculty of the Department of Psychiatryand Biobehavioral Sciences.

thE Right bRAin is dOMinAnt in PsyChOthERAPy

Dr. Schore will discuss how recent studies of the right brain, which is dominant for the implicit, nonverbal, intuitive, holistic processing of emotional information and social interactions, can elucidate the neurobiological mechanisms that underlie the relational foundations of psychotherapy. Interdisciplinary evidence will be offered that docu-ments right brain functions in early attachment processes, in emotional communica-tions within the therapeutic alliance, in mutual therapeutic enactments, and in thera-peutic change processes.This work highlights the fact that the current emphasis on relational processes is shared by, crossfertilizing, and indeed transforming both psychology and neurosci-ence, with important consequences for clinical psychological models of psychothera-peutic change.

dAniel siegel United StatesIs currently clinical professor of psychiatry at the UCLA School of Medicine where he is on the faculty of the Center for Culture, Brain, and Development and the Co-Director of the Mindful Awareness Research Center.

PERsOnAlity: tEMPERAMEnt, AttAChMEnt And thE dEvElOPMEnt Of thE Mind

Psychotherapy enables a clinician to help individuals identify patterns of thought, feel-ing, and behavior that may be restricting them from living a full and rewarding life. Some of these aspects of a person’s presenting profile may be due to experiences from attachment relationships while others may be a function of inborn neural pro-pensities called temperament. This presentation will dive deeply into the study of how experiences interact with temperament in the unfolding human personality throughout the lifespan. A focus on how clinicians can disentangle these important but distinct aspects of human development to optimize therapeutic outcome.

kAthY steele United StatesMember of the International Society for the Study of Trauma and Dissociation, received numerous awards for his research work. Co-author of the book “Haunted Self.”

fROM REsistAnCE tO REAlizAtiOn: intEgRAtivE PsyChOthERAPy APPROAChEs with ChAllEnging tRAuMA PAtiEnts

Many chronically traumatized patients experience protracted crisis, distress, dysregu-lation, and confusion, all of which can be transmitted to the therapist. These patients regularly usedefense and disorganized attachment strategies that make relational sta-bility difficult. We therapists do not always respond at our best when confronted with a patient’s humiliated fury, profound dissociation and disavowal, demands and needs, regression, entitlement, sadomasochism, unbearable suffering and loneliness, empti-ness and numbness, extreme avoidance and silence, and intense self-injury and sui-cidality, etc. Even seasoned therapists can become overwhelmed and find it difficult to remain grounded, present and effective with their most challenging patients. This lecture will address integrative approaches to the highly “resistant” patient. We will ex-plore the protective nature of resistance, particularly with those who have developed enduring personality strategies to avoid inner experience and relational difficulties. We will examine different types of resistance and the diverse approaches to address them. We will also consider strategies to “join the resistance” with the patient, invit-ing him or her to become a participant-observer with us in developing a co-created mentalizing approach to “resistant” behaviors. Using a particular form of collaborative rather than care-giving attachment supports both regulation and mentalization. These are key skills needed for the patient to engage in the hard work of realization: that the trauma happened, that it is now over, and that long-held beliefs and emotional and attachment strategies can safely shift to more effective and meaningful ways of being. Finally, we will examine the challenges of remaining relationally engaged with these patients, attentive to our defenses, but not embedded in them.

internAtionAl AWArd For reseArCh studies on AttAChment, trAumA And PersonAlitY disordersFor the first time it will be awarded a prize to a young investigator chosen among the most internationally deserving. The winner will receive a cash prize and the possibility to present their own study to all the audience. The others, not winners though deserving participants, can display their research posters in the dedicated area. The competition is addressed to investigators who have not reached the age of 40 years. The winner will be chosen by the Scientific Committee.

sCientiFiC Committee For the “AttAChment And trAumA” AWArdAntOniO OnOfRi (scientific Committee chairman), ARnOud ARntz, stEPhAn dOERing, PEtER fOnAgy, giOvAnni liOtti, RussEl MEAREs, PAt OgdEn, ECkhARd ROEdigER, kAthy stEElE, fAbiO vEgliA, AllAn sChORE, giAnCARlO diMAggiO, isAbEl fERnAn-dEz, dAniEl siEgEl, AntOniO OnOfRi, EdwARd tROniCk.

edWArd troniCk United StateAssociate Professor, Department of Society,Human Development and Health, Harvard School of PublicHealth and Child Health, Harvard School of Public Health.

MultilEvEl MEAning MAking, RElAtiOnAl REgulAtiOn And stREss

Humans make meaning about themselves in relation to the world of people, the in-animate world and to their own self. These meanings are held within each individual’s states of consciousness which are expanded when individuals in meaningful exchang-es form dyadic states of consciousness. Failing to make meaning about one’s self in relation to the world of people and things is a psychological catastrophe, a trauma. Importantly, the meaning about ourselves in the world is made at multiple brain and body – psychobiological - levels. Each of these multiple levels of meaning is affected by stressful and traumatic experiences. New research on humans from my laboratory on genetics, physiology, emotions, epigenetics and caretaker-child interactions will be presented to exemplify this psychobiological conceptualization. Implications for therapeutic interventions will be suggested. The talk will use video tapes of the still-face in infants and children and other contexts will be used to illustrate my thinking.

Friday 25th sePtemBer 8.00 Registration

10.00-11.30 Daniel Siegel: Personality: Temperament, Attachment and the De-velopment of the Mind

11.30-12.00 COFFEE BREAK

12.00-13.30 Edward Tronick: Multilevel Meaning Making, Relational Regulation and stress

13.30-15.00 LUNCH BREAK accompanied by classic music

15.00-16.30 Pat Ogden: Movement Sequences and Personality Development: A Psychology of Action

16.30-17.00 COFFEE BREAK17.00-18.30 Panel (chairman Onofri) : DANIEL SIEGEL, EDWARD TRONICK, PAT

OGDEN“Temperament, Attachment, Mind and Personality Develop-ment”

18.30 - 19.00 Research award for the best young researcher on the “attachment, trauma and personality disorders” field

Saturday 26th sePtemBer9.00-10.30 Peter Fonagy: The role of attachment epistemic trust and resilience

in personality disorder; a trans theoretical reformulation10.30-11.00 COFFEE BREAK11.00-12.30 Kathy Steele: From Resistance to Realization: Integrative Psycho-

therapy Approaches with Challenging Trauma Patients12.30-13.30 Giancarlo Dimaggio: Metacognitive Interpersonal Therapy for Per-

sonality Disorders and history of neglect13.30-15.00 LUNCH BREAK accompanied by classic music15.00-16.30 Arnoud Arntz: Schema Therapy as a treatment for trauma and in-

secure attachment related personality disorders: State of the art in treatment methods and research findings.

16.30-17.00 COFFEE BREAK17.00-18.30 Panel (chairman Liotti): PETER FONAGY, KATHY STEELE, GIAN-

CARLO DIMAGGIO, ARNOUD ARNTZ: “Psychotherapy for Trauma-tized Human Beings: What is Important and What Works?”

19.30 GALA DINNER 21.30 CONCERT

TIMETABLE

Sunday 27th sePtemBer9.00-10.30 Allan Schore: The Right Brain is Dominant in Psychotherapy10.30-11.00 COFFEE BREAK11.00-12.30 Eckhard Roediger: Healing relationships: Schema Therapy for cou-

ples12.30-13.30 Stephan Doering: Transference-Focused Psychotherapy (TFP)13.30-15.00 LUNCH BREAK accompanied by classic music15.00-16.30 Russel Meares: The Conversational Model in the Treatment of Rela-

tional Traumata 16.30-17.00 COFFEE BREAK17.00-18.30 Panel (chairman Veglia): Allan Schore, Eckard Roediger, Daniel Sie-

gel, Stephan Doering, Russel Meares “Trauma, Relationships, Right Brain and Psychotherapy”

LAnGuAGE English

LOcATiOn Teatro Brancaccio, Via Merulana, 244, 00185 Rome

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