CBT approaches to personality disorders in adolescents and adults

www.babcpconference.com BABCP Spring Workshops and Conference Programme CBT approaches to personality disorders in adolescents and adults 9 and 10 April 2015 King s College London

BABCP Spring Workshops and Conference 2015 9 & 10 April, King s College London One day Workshops, 9 April Working with Antisocial Personality Disorder Jackie Craissati, Oxleas NHS Foundation Trust Mentalisation-Based Treatment Peter Fonagy and Anthony Bateman, University College London and Anna Freud Centre Dialectical Behaviour Therapy for Adolescents at the Maudsley: Experiential workshop in delivering DBT with young people and their parents/carers Katrina Hunt, South London and Maudsley NHS Foundation Trust Cognitive Therapy for Substance Misuse Tim Meynen and Khodayar Shahriyarmolki, King s College, London Borderline Personality Disorder in Adults: Using DBT to treat high-risk behaviours Michaela Swales, Bangor University Working with Adolescents Presenting High Risk and/or Offending Behaviour Troy Tranah, Kate Johnston, Rhianna Watts and Lorna Taylor, South London and Maudsley NHS Foundation Trust and Institute of Psychiatry Conference, 10 April KEYNOTE SPEAKERS Jackie Craissati, Oxleas NHS Foundation Trust 2000 services users, 200 staff and one psychologist: Reflections on the redesign of specialist services for personality disordered offenders Michaela Swales, Bangor University Treating personality disorder across the lifespan and across disorders: Applying principles from Dialectical Behaviour Therapy SYMPOSIA Working with Antisocial Behaviour and Personality Disorder CBT and DBT in the Treatment of Antisocial and Challenging Behaviour in Adolescents Troy Tranah, Kate Johnston, Rhianna Watts and Lorna Taylor, South London and Maudsley NHS Foundation Trust and Institute of Psychiatry Working with Dual Diagnosis Tim Meynen, King s College London Working with Psychopathic Offenders Rachel Atkinson Working with Borderline Personality Disorder and its Sequelae DBT for Adolescents Presenting Borderline Personality Disorder Katrina Hunt, South London and Maudsley NHS Foundation Trust Therapeutic Assessment and Self-harm Dennis Ougrin, King s College London Schema Therapy for Borderline Personality Disorder Anna Lavender, South London and Maudsley NHS Foundation Trust 2 BABCP Spring Workshops & Conference 9/10th April 2015

BABCP Spring Workshops Thursday 9 April 2015 WORKSHOP 1 Working with Antisocial Personality Disorder Jackie Craissati, Oxleas NHS Foundation Trust Antisocial Personality Disorder (ASPD) is not simply a challenge for forensic mental health services, but it is also a common presentation in primary and secondary general mental health often presenting co-morbidly with borderline personality disorder. Anxiety-provoking service users who present in crisis, struggle to engage with longer term psychological therapies; who are perhaps referred for anger management or for work with complex trauma. These are the individuals with whom staff struggle, who usually provoke rejecting responses, and whose risk is difficult to predict. This workshop aims to equip the practitioner with the confidence and skills to understand and manage the challenges posed by service users with ASPD. We will share the learning from developing specialist personality disorder services across London, and adapt this to the needs of non-forensic specialists. By the end of the workshop, participants can expect to have learnt: Assessment and presentation issues Quick and easy ways of arriving at a defensible and evidence-based risk assessment Options and ideas for teaching non-specialist staff about ASPD and its management An opportunity to talk with service users who have been through treatment Some role play experience in a thinking skills group and a mentalisation-based therapy group for ASPD Jackie Craissati is Clinical Director and Head of Forensic Psychological Therapies at Oxleas NHS Foundation Trust. She has a special interest in the development and evaluation of innovative community services for high risk violent or sexual personality disordered offenders. WORKSHOP 2 Mentalisation-Based Treatment Peter Fonagy and Anthony Bateman, University College London and Anna Freud Centre Mentalisation is the process by which we implicitly and explicitly interpret the actions of ourselves and others as meaningful on the basis of intentional mental states (e.g., desires, needs, feelings, beliefs, and reasons). We mentalise interactively and emotionally when with others. The aim of Mentalisation-Based Treatment (MBT) is to increase this capacity in order to ensure the development of better regulation of affective states and to improve interpersonal and social function. In this workshop we will define and practise interventions which promote mentalising, contrasting them with those that are likely to reduce mentalising. In randomised controlled research trials MBT has been shown to be more effective than treatment as usual at the end of treatment and at eight year follow-up for people with borderline personality disorder. Effectiveness was apparent when applied by non-specialist practitioners. Independent replication of effectiveness has been shown in cohort studies and additional randomised controlled trials are in progress. MBT shares a number of principles with CBT and there is overlap of techniques. Interventions used in CBT facilitate the development of mentalising. Participants will become aware of which of their current therapeutic interventions promote mentalising and which, for some groups of patients, may have the opposite effect. An important aspect of MBT is the therapeutic stance. Video and role plays will be used to ensure participants recognise the stance and can use it in their everyday practise. Small group work will be used to practice basic mentalising interventions. The key learning objectives are to: Demonstrate an understanding of the mentalising problems of borderline personality disorder Recognise mentalising and non-mentalising interventions Develop and maintain a mentalising therapeutic stance Use some basic mentalising techniques in everyday clinical work BABCP Spring Workshops & Conference 9/10th April 2015 3

Fonagy P, Bateman A. The development of Borderline Personality Disorder: a mentalizing model. Journal of Personality Disorders. 2008: 22 pp. 4-21. Bateman A, Fonagy P. Randomized controlled trial of out-patient mentalization-based treatment versus structured clinical management for borderline personality disorder. American Journal of Psychiatry. 2009:1666 pp. 1355-1364. Bateman A. Treating borderline personality disorder in clinical practice. American Journal of Psychiatry. 2012: 169 pp.1-4. Professor Peter Fonagy PhD, FBA, OBE is Freud Memorial Professor of Psychoanalysis and Head of the Research Department of Clinical, Educational and Health Psychology at University College London and Chief Executive of the Anna Freud Centre, London. He is National Clinical Lead of the Department of Health/NHS England Children and Young People s Improving Access to Psychological Therapies (CYP IAPT) programme, and a member of the Programme Board for Improved Access to Psychological Therapies. He is Programme Director of the UCLPartners Integrated Mental Health programme, a member of the UCLPartners Academic Board, leader of the Mental Health theme in the North Thames CLAHRC and a Senior Investigator for the National Institute of Health Research. Professor Anthony Bateman FRCPsych is Consultant Psychiatrist and Psychotherapist, Halliwick Unit, Barnet, Enfield, and Haringey Mental Health Trust; Visiting Professor University College London; Honorary Professor in Psychotherapy University of Copenhagen; Consultant to the Anna Freud Centre, London. He developed mentalisation-based treatment with Peter Fonagy for borderline personality disorder and studied its effectiveness in research trials. An adapted version is now being used in a multi-centre trial for antisocial personality disorder. He was an expert member of National Institute for Health and Care Excellence (NICE) development group for treatment guidelines for Borderline Personality Disorder in the UK. His NHS clinical services are recognised by the Department of Health as a national demonstration site for the treatment of personality disorder. WORKSHOP 3 Dialectical Behaviour Therapy for Adolescents at the Maudsley: Experiential workshop in delivering DBT with young people and their parents/carers Katrina Hunt, South London and Maudsley NHS Foundation Trust The National and Specialist CAMHS Dialectical Behaviour Therapy (DBT) Service at the Maudsley Hospital in South London was established in 2009 to meet the ever increasing demand for a specifically tailored evidence-based service for young people with a history of self-harm and suicidal behaviour and traits of emerging borderline personality disorder. In this workshop we will describe the development and therapeutic content of a DBT service adapted for young people and their parents/carers. We will share practical tools and exercises that can be used with young people and carers and share service user experiences of participation in the programme. We will introduce some of the practical elements of DBT that can support therapists and teams working with young people with emotional intensity and suicidal behaviours. This workshop will include practical exercises, role-plays and tools for clinicians. It will include video clips and case examples that demonstrate some of our clinical work and how we have adapted the programme to meet the needs of our young people and carers. The key learning objectives are: To describe the Maudsley adaptation of DBT for adolescents and their parents/carers To experientially demonstrate practical DBT exercises that can be implemented with young people and carers To share service user experiences of participation in the programme To discuss approaches that can support therapists and teams working with emotional intensity and high-risk behaviours Linehan, M.M. (1993a) Cognitive Behavioral Treatment of Borderline Personality Disorder. New York: Guilford. Linehan, M.M. (2015) DBT Skills Training Manual Second Edition. New York: Guilford. Miller, A.L., Rathus, J.H. & Linehan, M. M. (2006) Dialectical Behavior Therapy with Suicidal Adolescents. New York: Guilford. Dr Katrina Hunt is a Consultant Clinical Psychologist working across the National & Specialist CAMHS DBT Service and the Child and Adolescent Eating Disorder Service at the Michael Rutter Centre, Maudsley Hospital. She will be joined by other clinicians working within the National & Specialist CAMHS DBT Service to deliver the workshop. 4 BABCP Spring Workshops & Conference 9/10th April 2015

WORKSHOP 4 Cognitive Therapy for Substance Misuse Tim Meynen and Khodayar Shahriyarmolki, King s College London Research has shown that there is a high prevalence of substance misuse in mental health services. Substance misuse is often a key factor contributing to and maintaining many clinical presentations and can also be a barrier to achieving effective clinical outcomes. The development of cognitive models and therapy in this area has now identified some key factors that maintain problematic use of substances. These include the role of motivation, difficulties managing cravings and urges, substance related cognitions, the reliance on drugs and alcohol in managing mood states and behaviours which maintain the pattern of use. The workshop will present the latest developments in the psychological treatment of substance misuse currently being used in clinical settings. Given the high prevalence of substance misuse across many clinical disorders, it is likely that this workshop will benefit those working in many different clinical settings where clients may be using substances in addition to their main presenting problems. The target interventions demonstrated in the workshop will help clinicians integrate substance misuse into their clinical formulations and provide techniques to help clients effectively address their substance use. The key learning objectives are: To introduce the key principles and core elements of cognitive models of substance misuse To explore how the use of substances can be integrated into a variety of clinical formulations To demonstrate a range of techniques which target the main factors maintaining substance misuse The workshop will consist of didactic teaching, discussion, role play, experiential exercises and small group exercises. Workshop participants are encouraged to bring along their clinical cases to inform the discussions and exercises. Dr Tim Meynen is a Consultant Clinical Psychologist who works for the South London and Maudsley NHS Foundation Trust in the London Borough of Greenwich. He qualified in 2002 from the Institute of Psychiatry, Kings College London and has been working in substance misuse services ever since. As well as delivering individual CBT therapy, Tim is involved in service development and regularly provides CBT training and supervision to staff in both addiction and adult mental health services. Examples of past training have included lectures at the Oxford Cognitive Therapy Centre (2010) and the National Rehabilitation Centre for Maudsley International in Abu Dhabi (2010) and Qatar (2014). He is a co-author of Applied Cognitive and Behavioural Approaches to the Treatment of Addiction: A Practical Treatment Guide (2010). Dr Khodayar Shahriyarmolki is also a clinical psychologist working with Dr Meynen in a community drug and alcohol service in Greenwich. WORKSHOP 5 Borderline Personality Disorder in Adults: Using Dialectical Behaviour Therapy to treat high-risk behaviours Michaela Swales, Bangor University Dialectical Behaviour Therapy (DBT) was first developed as a treatment for repetitive suicidal and self-harm behaviours in adult women with a diagnosis of BPD (Linehan, 1993). Since its inception DBT has become the most well-tested of the treatments for Borderline Personality Disorder (BPD) (Stoffers et al, 2013) and has been adapted for use with a range of different client groups. This workshop will begin with a brief review of the evidence for DBT in people with BPD behavioural patterns before addressing how to conceptualise their problems within a DBT framework. The remainder of the workshop will use clinical examples to illustrate key therapeutic principles and practices for treating this complex and hard-to-reach group. Participants are encouraged to come prepared to discuss clinical material and participate in role-play practices. The workshop leader will adapt the content to address participants needs and their level of experience with DBT. The key learning objectives are: To understand how DBT conceptualises BPD behavioural patterns To understand how DBT treatment programmes address clients deficits in capability and motivation To be able to construct treatment targets for adolescents in DBT To understand the fundamentals of how to conduct behavioural and solution analyses of client problems Linehan, M.M.(1993). Cognitive-Behavioural Treatment of Borderline Personality Disorder. New York: Guilford. BABCP Spring Workshops & Conference 9/10th April 2015 5

Mehlum, L. et al (2014) Dialectical Behavior Therapy for Adolescents With Repeated Suicidal and Self-harming Behavior: A Randomised Trial. Journal of Child & Adolescent Psychiatry. 53 (10) pp.1082-1091 Miller, A.L., Rathus, J. & Linehan, M.M. (2007). Dialectical Behaviour Therapy for Suicidal Adolescents. New York: Guilford. Michaela Swales PhD is a Consultant Clinical Psychologist with Betsi Cadwaladr University Health Board and Senior Lecturer on the North Wales Clinical Psychology Programme, School of Psychology, Bangor University. She trained in DBT at an Intensive Training in Seattle in 1994/95 with Marsha Linehan and for 20 years ran a clinical programme for suicidal young people in an inpatient service. After completing specialist supervision in DBT, she became one of the founder members of the UK DBT Training Team in 1997 and subsequently Director of the Training Team in 2002. She has trained more than 1,000 professionals in DBT, seeding over 200 programmes in both the UK and further afield. Along with Dr Heidi Heard, she won the Cindy Sanderson Outstanding Educator Award at the International Society for the Improvement and Dissemination of DBT at their 2009 conference in New York. Dr Swales was a member of the guideline development groups (GDG) that, on behalf of the National Institute of Health and Care Excellence (NICE), wrote the guidelines on the Treatment and Management of Borderline Personality Disorder (2009) and the Longer-Term Management of Self-Harm (2011). WORKSHOP 6 Working with Adolescents Presenting High Risk and/or Offending Behaviour Troy Tranah, Kate Johnston, Rhianna Watts and Lorna Taylor, South London and Maudsley NHS Foundation Trust and Institute of Psychiatry The workshop will explore the population in question, namely young people who offend but also those at high risk of offending or vulnerable to exploitation due to their challenging behaviour. The client group seen by our service (Adolescent At-risk & Forensic Service) present violence, harmful sexual behaviour, fire-setting or other high risk behaviours (e.g. self-harm, stalking). Our client group has a high percentage of females, and a large number of young people present some level of neurodevelopmental difficulties. The assessment (including risk assessment), formulation and treatment of high risk, forensic adolescents will be explored. The treatment approaches that we have adopted to best address the specific difficulties of our client group will also be considered. The key learning objectives are: To explore presentation of young offenders, particularly females and those with neurodevelopmental disorders To look at the relative merits of CBT and DBT in the treatment of these clients To provide practical advice on the treatment of females presenting high-risk behaviours (including vulnerability) and/or offending and clients with neurodevelopmental difficulties Dr Troy Tranah qualified as a Clinical Psychologist in 1994, gaining an MSc in Clinical Psychology from the Institute of Psychiatry (University of London). Prior to clinical training Dr Tranah completed a PhD (University of London) on the subject of Post-traumatic Stress Disorder. Since qualifying Dr Tranah has worked with children and adolescents in the community, in in-patient units and in various secure settings. Dr Tranah is currently employed as a Lead Psychologist (Maudsley Hospital) and a Lecturer in Clinical Psychology (Institute of Psychiatry, King s College London). Dr Tranah has been involved in forensic psychology, both clinical work and research for over 20 years. In more recent years Dr Tranah has also focused on child abuse, self-harm and borderline personality disorder in adolescents. Dr Kate Johnston is Principal Clinical Psychologist in the Adolescent At-risk & Forensic Service, National and Specialist CAMHS and a Clinical Tutor for the Doctorate in Clinical Psychology Training Course at the Institute of Psychiatry (King s College London). Since qualifying, Kate has specialised in working with young adults with neurodevelopmental disorders in inpatient and outpatient settings. Kate has a particular interest in working with young offenders with developmental disorders and is currently involved in research in this area. Dr Rhianna Watts is a Clinical Psychologist in the Adolescent At-risk & Forensic Service, National and Specialist CAMHS. Since qualifying, Rhianna has specialised in working with adolescents who have offended or who are at high risk of offending, providing intensive community and family-based assessment and intervention (multi-systemic therapy). Dr Lorna Taylor is a Clinical Psychologist in the Adolescent At-risk & Forensic Service, National and Specialist CAMHS. Lorna has a PhD in neuropsychology and has clinical experience working with adolescents who have offended or who are at high risk of offending. Lorna has a particular interest in working with girls with emerging personality disorders taking a DBT-informed approach. 6 BABCP Spring Workshops & Conference 9/10th April 2015

BABCP Spring Conference Friday 10 April 2015, King s College London CBT approaches to personality disorders in adolescents and adults KEYNOTE SPEAKERS Jackie Craissati, Oxleas NHS Foundation Trust 2000 services users, 200 staff and one psychologist: Reflections on the redesign of specialist services for personality disordered offenders Michaela Swales, Bangor University Treating personality disorder across the lifespan and across disorders: Applying principles from Dialectical Behaviour Therapy SYMPOSIA Working with Antisocial Behaviour and Personality Disorder CBT and DBT in the Treatment of Antisocial and Challenging Behaviour in Adolescents Troy Tranah, Kate Johnston, Rhianna Watts and Lorna Taylor, South London and Maudsley NHS Foundation Trust and Institute of Psychiatry Working with Dual Diagnosis Tim Meynen, King s College London Working with Psychopathic Offenders Rachel Atkinson Working with Borderline Personality Disorder and its Sequelae DBT for Adolescents Presenting Borderline Personality Disorder Katrina Hunt, South London and Maudsley NHS Foundation Trust Therapeutic Assessment and Self-harm Dennis Ougrin, King s College London Schema Therapy for Borderline Personality Disorder Anna Lavender, South London and Maudsley NHS Foundation Trust For more information and to register your place online, please visit www.babcpconference.com BABCP Spring Workshops & Conference 9/10th April 2015 7

BABCP Spring Workshops & Conference 9/10th April 2015, Kings College London First Name Surname Title Occupation or Job Title BABCP Member Non Member (PLEASE TICK) Mailing Address Postcode Telephone: Email I want to Attend the Spring Conference on Friday 10 April (PLEASE TICK)................................................ I want to attend a Workshop on Thursday 9 April (PLEASE TICK WHICH ONE YOU WANT TO ATTEND) 1. Working with Antisocial Personality Disorder: Jackie Craissati...................................................... 2. mentalisation Based Treatment (MBT): Peter Fonagy and Anthony Bateman....................................... 3. Dialectical Behaviour Therapy for Adolescents: Katrina Hunt....................................................... 4. Cognitive therapy for substance misuse: Tim Meynen and Khodayar Shahriyarmolki................................ 5. Borderline Personality Disorder in Adults: Michaela Swales........................................................ 6. Working with Adolescents Presenting High Risk and/or Offending Behaviour: Troy Tranah et al..................... Spring Conference: BABCP Member 85, Non-member 115, BABCP Student Member 65 Spring Workshops: BABCP Member 125, Non-member 160, BABCP Student Member 80 Both booked together: BABCP Member 195, Non-member 250, BABCP Student Member 140 Payment: 1. Bank Transfer and cheques should be made payable to 'EYAS Ltd' quoting 15SPR as a reference together with your name. Payment must be made in sterling and free of bank charges. I enclose a cheque for 2. You can pay by credit or debit card. A 3% charge will be levied on credit cards and debit cards carry an 85p charge. Please add this to the total. Please charge Visa/Mastercard number CVV number* *Last 3 digits on the back of all credit cards Name of cardholder Expiry date Address for which card is issued 3. Prepayment may be made by guaranteed authorised payment by relevant employing authority. Please invoice employer. Order number or reference Contact name Telephone: Email D epar tment and address Send to: EYAS Ltd, 7 Temple Bar Business Park, Strettington Lane, Strettington, Nr Chichester, West Sussex PO18 0LA Tel: 01243 775561 Fax: 01243 776738 Email: babcp@eyas.co.uk Confirmation will be sent as acceptance to the workshops after the necessary documentation has been received and cleared. BABCP Spring Workshops & Conference 9/10th April 2015 8