TRAINING GENERAL PRACTITIONERS IN MENTALIZATION BASED THINKING Annette Sofie Davidsen

Special conditions in general practice Unorganized problems Direct access Time constraint Annette Sofie Davidsen

Special conditions in general practice Unorganized problems Direct access Time constraint Same psychodynamic conditions as in specialist psychotherapy Often not realized Need of training and supervision Annette Sofie Davidsen

Training Imported models No formulated theory for general practice Left to folk psychology Annette Sofie Davidsen

Balints theory Importance of: The process of understanding and the relationship The therapists reflexive insight into him/herself Annette Sofie Davidsen

Mentalization The capacity to understand other peoples thoughts, feelings, imaginations, wishes, desires and so on – also realizing your own thoughts and feelings and their contribution to the relationship Similar to Balints thoughts about the process of understanding Active process Linked to attachment theory Annette Sofie Davidsen

Connection between concepts and theories Attachment theory Balint Psychotherapy in general practice Balint anticipated attachment theory – basic fault (Holmes 2001) Mentalization

The tradition of training and supervision disappeared with the academic specialization Annette Sofie Davidsen

PhD. study of psychological interventions in general practice GPs differ greatly in the form of relationship they form with the patient Both in psychological interventions and in normal consultations Difference in propensity to mentalize Need of training mentalizing capacity Ref.: Davidsen, A.: Psychology and Psychotherapy, theory, research and practice, in press (June 2009) Annette Sofie Davidsen

We propose that therapists mentalizing skills are central to establishing and maintaining an effective treatment relationship and a therapeutic alliance. Thus, we are developing a training programme to foster therapists mentalizing capacities in the treatment process. We aim not only to promote therapists attentiveness to mental states in their patients but also to increase their awareness of their own mental states in the conduct of psychotherapy. (Williams et al., 2006) p Annette Sofie Davidsen

General therapeutic approach Cannot be manualized Manuals cannot teach skillful use and creativity Need for theory and agreed concepts Mentalization a possible concept Dialectic about structure Firm structure can impede mentalization Annette Sofie Davidsen

Therapeutic relationship Mentalizing central for establishing relationship Association between therapeutic relationship and outcome in psychotherapy – and in general practice Annette Sofie Davidsen

Problems with mentalizing Be aware of pseudo-mentalizing Apparent understanding Annette Sofie Davidsen

Training Supervision in groups Illustrative videos Role-playing Own video-clips Shifting between watching an expert and practicing Therapists mentalizing capacity in the forefront Active, inquisitive stance Annette Sofie Davidsen

Problems with mentalizing We allready do that – but it is Difficult to mentalize under emotional stress Annette Sofie Davidsen

Purpose of training GPs Training the mentalizing capacity To train GPs handling of emotional problems To train GPs in talking therapy Carrying out therapy sessions under supervision trains the mentalizing capacity in normal consultations Annette Sofie Davidsen

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