Programme

Monday, September 23

Opening Plenary: Transform clinical challenges into opportunities for change

Chairs : Ueli Kramer and Michaela Swales

Speakers:

Plenary: Changing the wheels: Dimensional conceptions of personality disorders

The change in classification in personality disorders in ICD-11, as well as DSM-5, has generated much discussion and is changing the landscape in research and clinical practice. In this plenary session, three experts will discuss core questions in our field of personality disorders from the perspective of this new context.  Each expert will give their perspective on the questions followed be a brief discussion amongst the group and with the audience. What is a personality disorder, really? How can we assess personality disorder, and personality pathology? How can dimensional constructs contribute to lessen stigma among those affected, and their loved ones? What are the implications of changing the wheels for prevention and intervention?

Tuesday, September 24

Master Clinician Semi-Plenaries 

Antisocial personality: are we getting better at offering interventions they want and can benefit from?

Anthony Bateman, MD

Treatment in the community of people with characteristics of antisocial personality (ASPD) – failure to conform to social norms with respect to lawful behaviours; irritability and aggressiveness; impulsiveness; disregard for the feelings and safety of others; and disregard for one’s safety and for the consequences of one’s behaviour – is problematic. Most studies evaluating interventions for antisocial behaviour have not looked at personality disorder itself, and no intervention has been established as the treatment of choice. In community clinical services clinicians tend to avoid offering treatment and patients show a high drop-out rate from any treatment offered.

The contribution of ASPD to violent criminal behaviour is clear. In this session a mentalizing perspective on understanding the relationship between ASPD and violence will be summarised and an outline given of the intervention process that results from this. Mentalization Based Treatment (MBT) integrates cognitive and relational components and provides a structured therapeutic process during which the patient’s mind becomes the focus of treatment, centring on their capacity to accurately interpret the meaning of actions in terms of mental states (e.g. beliefs, thoughts, feelings, or desires). People with ASPD show impaired recognition of basic emotions in themselves and others, impaired capacity to link mental states to behaviour, difficulty with perspective-taking problems and in reading others’ mental states. They perform far worse than controls on subtle tests of mentalizing. Antisocial behaviour and violence tend to occur when an understanding of others’ mental states is developmentally compromised, most often from early trauma, and prone to being lost when the attachment system is activated by perceived threats to self-esteem, such as interpersonal rejection or disrespect. Normally, mentalizing, recognising the subjective state of the victim for example, prevents interpersonal violence. Interventions for ASPD should be geared to enabling individuals to examine more reflectively their own states of mind and understand others’ minds, and to behave more prosocially. Some evidence for this approach will be discussed.

Lars Mehlum, PhD

Suicide is a leading cause of death globally in youths, and suicidal behaviour and self-harm are major public health concerns.. To develop effective treatment approaches is critical for preventing premature deaths. Promising interventions have indeed been identified in recent years, and though many questions are still left unanswered, we have sufficient knowledge to effectively treat adolescents who self-harm, attain reasonably favourable treatment response rates and long-term outcomes. In this presentation we will review key findings from clinical studies with emphasis on what seem to be effective and practical treatment strategies, for whom and for what they work best and through what mechanisms of change they operate. The presentation will highlight some common tricky dilemma and pitfalls clinicians face when working with self-harming adolescents and their families and offer solutions and strategies that have been developed and tested over recent years. While keeping a focus on the here and now and the need for rapid progress in the treatment of suicidal and self-harming behaviour, the presentation will also discuss implications for longer-term change and sustainability of treatment gains.

Presidential Discussion

In this presidential discussion, the ESSPD President chairs the discussion on how psychotherapy for personality disorders work. Both state-of-the-art presentations of current research within a functional domain perspective will be presented and discussed by each expert. Then the group moves beyond the state of the art and outlines the perspectives of what is required in the mechanistic conception of psychotherapy for individuals with personality disorders. What are research designs that foster a knowledge base on mechanisms? What are understudied areas which will boost a differentiated understanding? Which are take-home messages for the practice of psychotherapy?

Ueli Kramer (Switzerland)

Sabine Herpertz (Germany)

Shelley McMain (Canada)

Kenneth N. Levy (USA)

Wednesday, September 25

Semi-Plenaries: Master Clinicians

Martin Bohus, MD

Elsa Ronnningstam. PhD

Recent developments in studies and treatment strategies have highlighted the range and complexity in pathological narcissism, PN, and narcissistic personality disorder, NPD. This has inspired different approaches to understand and mobilize changes towards improvement in narcissistic pathology, which can occur in different treatment modalities as well as in different life contexts.

This presentation will focus on summarizing recent major empirical and clinical contributions that can be integrated and guide assessment and treatment of PN and NPD. The dimensional diagnostic approach to NPD applied in DSM 5 Section III and ICD 11 has encouraged attention to the range of functioning and interactive fluctuations in narcissistic pathology. Neuroscience and studies of attachment, self-esteem and emotion regulation, especially emotional trauma, shame, and aggression, have furthered identification of common underpinnings in narcissistic pathology. Studies of interactions between PN and comorbid conditions such as substance use, depressive disorder and other personality disorders have also contributed to advance assessment and treatment strategies.

Recent developments in treatment modalities and therapeutic interventions have pointed to different mechanisms and paths that can implicate change in narcissistic personality pathology. Patient related factors, i.e., motivation, curiosity, reflective ability, life stage, and functioning including both work and close relationships, are essential for progress in treatment. Similarly, commitments to therapeutic contract, goals, and problem focus are necessary. Present range of modalities and interventions now allow for adjusting treatment to the individual patient’s motivation and capabilities. Symptomatic and functional improvements as well as challenges and obstacles for change will be discussed.

Closing Plenary: Changing contexts: dissemination of good practice in personality disorders

Chairs: Ueli Kramer and Michaela Swales

Providing specialized assessment and treatment in a fast-changing world can be challenging. Cultural diversity, disruptive political contexts, social changes and needs of special populations, including youth, are additional challenges to be taken into account. This plenary aims to lay out the groundwork for a worldwide dissemination strategy of good practice in assessment and treatment of personality disorders. It starts off with the illustration of the situation in Lithuania, followed by the discussion of proposed solutions related with the increased use of technology in assessment, treatment and training, the broad dissemination of knowledge on a population level, as well as to targeted groups in need of help.

Speakers:

Rasa Barkauskiene (Lithuania)

Anthony Bateman (United Kingdom)

Ulrich Reininghaus (Germany)

Brin Grenyer (Australia)

Lois Choi-Kain (USA)

Therapeutic Assessment in Clients with Personality Disorders 

Hilde De Saeger & Jan Henk Kamphuis

Overcoming (understandable) Epistemic Hypervigilance (Fonagy, Luyten, Allison, 2015) is a particularly salient concern in working with clients with personality pathology. Therapeutic Assessment (TA), a semi-structured model of clinical assessment (Finn, 1996, 2007), is both philosophically as well as procedurally well-suited to overcome such motivational challenges (Kamphuis & Finn, 2018). TA distinguishes itself from traditional assessment methods by prioritizing collaborative exploration, maintaining a “not knowing” attitude, and consistently striving to understand the client. The assessor’s attitude emphasizes curiosity, humility, and empathy, fostering self-efficacy, epistemic trust, and facilitating self-discovery and validation in clients. Evidence suggests that TA (De Saeger et al. 2014; Aschierri et al., 2022) can be an effective intervention, and is specifically tested in clients with personality pathology. More specifically, it has demonstrated a robust ability to prepare, motivate, and inspire patients for therapy, co-constructing focus and goals for treatment. In the context of treatment-resistant personality pathology, we belief this is of crucial treatment utility (Kamphuis, Noordhof & Hopwood, 2021). The present workshop aims to explore the foundational principles of the TA model and illustrate the semi-structured approach flow in the context of a case-analysis.