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OXFORD MEDICAL PUBLICATIONS

Medical
Psychotherapy
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 Oxford Specialist
Handbooks
in Psychiatry
Medical
Psychotherapy
Edited by

Jessica Yakeley James Johnston

Fellow of the British Consultant Psychiatrist in
Psychoanalytical Society, Psychotherapy, Leeds and York
Consultant Psychiatrist in Partnership NHS Foundation
Forensic Psychotherapy, Portman Trust, Leeds, UK; British
Clinic, Director of Medical Psychoanalytic Council Registered
Education and Associate Medical Member, North of England
Director, Tavistock and Portman Association of Psychoanalytic
NHS Foundation Trust, London Psychotherapists (NEAPP),
UK; Editor of Psychoanalytic UK; Visiting Lecturer, Tavistock
Psychotherapy, UK and Portman NHS Foundation
Trust, London, UK; Chair, Royal
Gwen Adshead College of Psychiatrists Medical
Psychotherapy Faculty Education
Consultant Forensic Psychiatrist and Curriculum Committee
and Psychotherapist, Southern 2011–​2015; Member of the
Health Foundation Trust, UK Association for Psychoanalytic
Psychotherapy in the NHS, UK
Laura Allison
Consultant Psychiatrist, South
London and Maudsley NHS
Foundation Trust, London, UK

1
1
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 v

Foreword

This book comes to birth at a propitious moment. Its cradle, to use

the authors’ metaphor borrowed from Bevan’s founding vision for the
NHS, is beset by a series of interlinked crises, affecting medicine, psychi-
atry, and indeed books themselves. For all its spectacular advances—to
some extent a product of them—medicine is increasingly fragmented
and super-specialized. The role of the physician with a synoptic and on-
going relationship with her patient—a deep knowledge of the strengths
and vulnerabilities of the individual in a family and social context—is
evanescent. Even in a free at the point of access service, consultation
is increasingly viewed as a quasi-commercial transaction, in which the
patient is a ‘customer’ for whom doctors proffer a ‘service’—rather
than an attachment relationship based on security, sensitivity, continuity,
and epistemic trust. There is a consequent plague of over-diagnosis and
over-treatment. Prevention and health promotion are downgraded and
starved of funds. The pervasiveness of chronic illness is unmatched by
appropriate theory and practice.
Psychiatry has not been immune to these changes. Lip service is played
to continuity of care, but the reality is a plethora of teams, professions,
and special interests. Patients move—are passively ‘moved’—from one
clinical encounter to another, with little acknowledgement of the speci-
ficity of the attachment relationship, or the inevitability of grief on sepa-
ration. Flanked by the rival disciplines of neurology/neuroscience and
clinical psychology, psychiatry struggles to define its unique role. A life-
course, developmental perspective fades in a culture that favours fiscal
‘illness-episodes’ over the uniqueness of the individual. The protesting
user’s voice is increasingly heard, but responses are typically superficial
and dismissive.
Medical psychotherapy—psychotherapeutic psychiatry—has suffered
its own wounds in this maelstrom. Psychotherapy services have become
marginalized within the psychiatric family, depicted as ‘soft’, ‘Freudian’
(i.e. antediluvian), and lacking an evidence base. Without a clearly identi-
fiable client group (the claim that psychotherapy is relevant to all aspects
of psychiatric work merely provokes all-things-to-all-men dismissal),
managers cut psychotherapy and psychotherapists with impunity, bet-
ting that protest will be muted and can be dubbed as self-interest. Some
wounds have been self-inflicted. Compared with the USA and Germany,
UK medical psychotherapists have been slow to engage in research or
penetrate academe; psychoanalytic psychotherapists, the majority of the
workforce, have been at best ambivalent about admitting their CBT and
systemic colleagues into the fold; the need for free and respectful com-
munication with other psychiatric colleagues has been neglected; cases
cherry-picked; the cabal of true believers has sometimes perversely cel-
ebrated marginalization rather than facing up to its weaknesses.
But, as this book so brilliantly exemplifies, crisis also equates to oppor-
tunity. Here, I believe, spelt out in magnificent detail, lies the psychiatry,
vi FOREWORD

not just the medical psychotherapy, of the future. Its practitioners claim
legitimacy through triple expertise in medicine, psychiatry, and psycho-
therapy. Developmental perspectives and doctor–patient collabora-
tion come as second nature. The individual life-history is paramount.
Psychological therapies’ robust evidence base equals or surpasses that of
pharmacotherapy, and has remarkable ‘sleeper’ effects which mean that
its benefits accrue well beyond therapy completion. Internecine wars—
Freud’s ‘narcissism of minor differences’—finally overcome, the different
schools of psychotherapy work respectfully together. Medical psycho-
therapy has an essential role in helping people suffering from personality
disorders. Consultation-liaison and group therapy skills, together with a
specialized understanding of developmental processes, mean that medi-
cal psychotherapy can contribute directly or indirectly (through staff sup-
port) to the entire spectrum of psychiatric illnesses.
Finally, Gutenberg outlives its obituarists: there is confirmation here
of the extraordinary staying-power, virtue, and value of ‘the book’. This
future Bible for psychiatric trainees comprehensively brings together
in-depth theoretical exposition, amusing cartoons, exam-friendly lists,
touching case histories, and fluid communication amongst psychothera-
peutic modalities and psychiatric specialisms. All this is done in ency-
clopaedia format in which the four editors and 56 contributors remain
individually anonymous, yet speak with a collective voice of reason,
authority, and hope. This lovely volume is a true phoenix, and one which
all psychiatrists and psychotherapists should and will have open on their
desks for a generation.
Jeremy Holmes, MD FRCPsych,
Visiting Professor,
School of Psychology,
University of Exeter, UK
 vii

Preface

Listening with medicine in mind

The Oxford Specialist Handbook of Medical Psychotherapy aims to evoke
the experience of listening to patients with medicine in mind. What do
medicine and mind have in common? What do doctors and psychothera-
pists have in common? Why is it helpful to be a medically qualified profes-
sional when working with psychological distress?
In this book, we will argue that the medical approach to studying the
body and its disorders has much in common with the psychothera-
pist’s approach to the study of mind and psychological distress, and
vice versa. In general practice, it is well known that the psychological is
closely related to the physical; general physicians and even surgeons are
now accepting that the study of the mind is crucial to working with the
body. Psychotherapists too need to pay close attention to diagnosis and
symptoms, and to the careful exercise of technical skill in helping people
recover.
The common values of medicine and psychotherapy lie in trying to
understand a patient’s problems within the limitations imposed by the
ailment and the patient’s own capacities. The therapeutic medical atti-
tude is not unique to the practice of psychotherapy—​it is the quotidian
medical skill of the doctor, within the doctor–​patient relationship, which
defines psychotherapeutic medicine.
When a doctor can move from their skill in the identification of the
medical or psychiatric problem to identification with the person with
the problem, not being bound in this identification or spellbound by
the problem, moving in mind reflexively between the external and
internal problem, they are embodying psychotherapeutic medicine.
Psychotherapeutic medicine is the guiding principle of this book, with
medical psychotherapy expressing the integration of the values of the
importance of the doctor–​patient relationship and psychotherapeutic
psychiatry. The OSH of Medical Psychotherapy connects psychiatrists and
therapists with medical psychotherapy, exemplifying the relationship
between the body of medicine, the mind of psychiatry, and the spirit of
psychotherapy.
Who is this book for?
The book is a unique compendium of psychotherapies commonly deliv-
ered in the NHS by medical psychotherapists, psychotherapists, psy-
chologists, and psychiatrists. It is aimed at the ‘cradle to grave’ range of
nascent, newly qualified, training, and senior doctors—​an audience of
medical students, foundation year doctors, core and advanced psychia-
try trainees, consultant psychiatrists, GPs, specialty doctors in psychia-
try, and academics. It will also be of interest to professionals from other
disciplines practising within the fields of health and social care such as
nurses, psychologists, counsellors, child psychotherapists, social work-
ers, and many others, as well as carers, patients, and service users,
viii   PREFACE

many of whom may have experienced some form of talking therapy

first-​h and.
What we hope will connect all of the patients, doctors, profession-
als, and members of the public who read this book will be an inter-
est in contemporary psychotherapies and seeking to learn about their
distinctive, and their overlapping, theories, concepts, training, and
research evidence, and how the therapies are applied in practice, illus-
trated by anonymous case vignettes. The OSH of Medical Psychotherapy
is written by therapeutic specialists in their fields in a house style which
aims to be succinct, accessible, and evocative—​a n echo of what a ther-
apist might try to offer the person or people with whom they seek to
communicate.
Why is this book important?
The importance of the OSH of Medical Psychotherapy lies in its attempt to
offer an overview of psychotherapies under the umbrella of the ontology
of medical psychotherapy. It provides a link between different profes-
sions and ways of thinking about the problems of being human, without
synthesis and without becoming a Tower of Babel with a confusion of
tongues. Each therapy is given its own voice, and the reader is invited to
hold in mind, and to integrate, the disparate array of myriad ways of heal-
ing minds. The illustrations by James Johnston, introducing and linking
the twelve chapters of the Handbook, aim to be emotionally evocative,
drawing from life in ways which echo the text they mirror.
Origins of this Handbook
The book has had a long gestation—​from James Johnston’s initial idea
of the book in 2008 conceived in the confluence of a past comforting
memory in anxious moments of the need for the Oxford Handbook of
Clinical Medicine in his white coat pocket as a house officer and present
extinction anxiety about the disappearance of medical psychotherapy,
another vital vade mecum needed in uncertain times …
The OSH of Medical Psychotherapy would not exist without the recep-
tivity to its conception by the Oxford University Press Commissioning
Editor Chris Reid who was unfamiliar with the world of medical psycho-
therapy, more used to publishing the work of other medical specialists,
including anaesthetists. James joked that perhaps his welcome support
for this book was because he was used to doctors who work with the
unconscious.
The first editorial group led by James (Gwen Adshead, Chess Denman,
Chris Mace, and Stirling Moorey) was reduced to James and Gwen, fol-
lowing Chris’s untimely death in 2010. After Chess and Stirling stepped
down, Gwen’s experienced tenacity helped keep the idea of the book
alive, inspiring James to form a new editorial group with Jessica Yakeley
as a tireless and thoughtful lead editor and Laura Allison as an editor rep-
resenting the vitality of younger and more recently qualified consultant
medical psychotherapists. The OUP staff Pete Stevenson and Lauren
Dunn reassured us that this long gestation is not unusual—​a s a symbol of
the survival of medical psychotherapy, we hope the book inspires thera-
peutic development in psychiatrists, other doctors, and others.
 PREFACE  ix

We are indebted to our sixty contributors who have written the

individual sections which make up each of the 12 main chapters of the
Handbook. Many of our authors are senior specialists in their fields, but
others, of equal importance, are higher trainees in medical psychother-
apy who represent the voices of the future.
The OSH of Medical Psychotherapy, like therapy, like life, like the cradle
to grave career of a doctor, is a work in progress. It reflects the human
diversity in which there can be no way of settling on a consensus of what
makes for a good life or a good therapy. We hope that readers will find
it useful in their work as psychotherapists, wherever they are, and that
they will contribute to future editions.
JY, JJ, GA, LA, 2016
 xi

Contents

Contributors xii
Symbols and abbreviations xix

1 Introduction   1
2 Concepts and models   13
3 General therapeutic competencies   95
4 Assessment 109
5 Treatment 153
6 Problems through life 283
7 Psychotherapy and psychiatric disorders 313
8 Personality disorder 377
9 Ethics and boundaries 441
10 The system 461
11 Psychotherapy research 507
12 Psychiatric specialties: medical psychotherapies,
applications, and research 543
Appendix: Key UK-based psychotherapy
organizations 581

Index 586
xii

Contributors

Gwen Adshead Jan Birtle

Consultant Forensic Psychiatrist Consultant Psychiatrist, Medical
and Psychotherapist, Southern Psychotherapy Tutor, and
Health Foundation Trust, UK Associate Medical Director,
Chapter 2: Group therapy and Worcestershire Health and Care
group analysis Trust, Malvern, UK; Honorary
Chapter 5: Group therapy and Senior Lecturer, University of
group analysis Worcester, UK
Chapter 8: Theories of personality Chapter 5: Therapy in clinical
development practice
Chapter 9: Ethics and boundaries Chapter 12: Rehabilitation and
social psychiatry: psychotherapies,
Laura Allison applications, and research
Consultant Psychiatrist, South
London and Maudsley NHS Julia Bland
Foundation Trust, London, UK Consultant Psychiatrist in
Chapter 6: Problems through life Psychotherapy, Maudsley
Hospital, London, UK
Penelope Aspinall Chapter 2: Systemic family and
Head of Counselling, University couple therapy
of Bradford, UK Chapter 5: Systemic family and
Chapter 2: Counselling couple therapy
Chapter 5: Counselling
Jane Blunden
Jina Barrett Consultant Psychiatrist
Adult Psychotherapist and in Psychotherapy and
Organisation Consultant, The Psychotherapy Tutor, Sussex
Tavistock and Portman NHS Partnership NHS Foundation
Foundation Trust, Portman Clinic, Trust, Sussex, UK
London, UK Chapter 2: Cognitive analytic therapy
Chapter 6: Older adults Chapter 5: Cognitive analytic therapy
Chapter 7: Dementia
Luigi Caparrotta
Dinesh Bhugra Fellow British Psychoanalytical
Professor of Mental Health and Society, Consultant Psychiatrist
Cultural Diversity, Section of in Psychotherapy, Camden &
Cultural Psychiatry, Institute of Islington Psychodynamic
Psychiatry, London, UK Psychotherapy Service,
Chapter 7: Sexual dysfunction Camden and Islington Foundation
Trust, St Pancras Hospital,
London, UK
Chapter 6: Problems through life
Chapter 7: Psychotherapy and
medication; Anxiety and anxiety
disorders
 CONTRIBUTORS xiii

Anne Cooper Catherine Goodwin

Consultant Psychiatrist in CBT, Dramatherapist, Avon and
Leeds and York Partnerships Wiltshire Mental Health
Foundation Trust, Leeds, UK Partnership NHS Trust, Secure
Chapter 2: Cognitive behavioural Services LDU, Bristol, UK;
therapy Visiting Lecturer, Dramatherapy
Chapter 4: Cognitive behavioural MA, Department of Psychology,
assessment and formulation University of Roehampton,
Chapter 5: Cognitive behavioural London, UK
therapy Chapter 2: Drama therapy
Chapter 5: Drama therapy
Sandra Evans
Consultant Psychiatrist/​Senior Else Guthrie
Lecturer in Psychiatry, East Consultant in Psychological
London Foundation NHS Trust, Medicine and Honorary Professor
Vice Chair, Faculty of Old Age of Psychological Medicine,
Psychiatry, Royal College of Manchester Mental Health and
Psychiatrists, London, UK; Social Care Trust, Manchester
Associate Dean for Psychiatry Royal Infirmary, Manchester, UK
and Deputy Dean for Students, Chapter 2: Psychodynamic
Barts & the London SMD, interpersonal therapy
London, UK Chapter 5: Psychodynamic
Chapter 12: Psychiatry of old age: interpersonal therapy
psychotherapies, applications, and Chapter 12: Liaison psychiatry:
research psychotherapies, applications,
and research
Gearóid FitzGerald
Consultant Psychiatrist in Rex Haigh
Psychotherapy, Leeds and York Consultant Psychiatrist in Medical
Partnerships NHS Foundation Psychotherapy, Berkshire
Trust, Leeds, UK Healthcare NHS Foundation
Chapter 10: Balint groups Trust, Bracknell, UK; Professor
of Therapeutic Environments
Christian Foerster and Relational Health, School
Charité –​Universitätsmedìzin of Sociology and Social Policy,
Berlin, Germany Nottingham University, UK
Chapter 7: Sexual dysfunction Chapter 2: Therapeutic
communities
Rachel Gibbons Chapter 5: Therapeutic
Consultant Psychiatrist in communities
Psychiatry and Psychotherapy,
Complex Care Service, Az Hakeem
Halliwick, St Ann’s Hospital, Consultant Psychiatrist and Medical
Barnet Enfield & Haringey MHT, Psychotherapist, The Priory
London, UK Hospital Roehampton, London,
Chapter 10: Teaching UK; Visiting Professor of Psychiatry
­psychotherapy to mental and Applied Psychotherapy,
health professionals University of Bradford, UK
Chapter 7: Gender dysphoria and
intersex conditions
xiv CONTRIBUTORS

Rob Hale Jason Hepple

Honorary Consultant Chair of the Association for
Psychotherapist, Portman Clinic, Cognitive Analytic Therapy,
Tavistock and Portman NHS Consultant Psychiatrist in
Foundation Trust, London, UK Psychological Therapies,
Chapter 6: Suicide and self-harm Somerset Partnership NHS
Foundation Trust, UK
Donna Harrison Chapter 2: Cognitive analytic
Forensic Psychologist in therapy
Training, Partnerships in Care, Chapter 5: Cognitive analytic
Nottinghamshire, UK therapy
Chapter 2: Dialectical behaviour
therapy Jeremy Holmes
Chapter 5: Dialectical behaviour Visiting Professor, School of
therapy Psychology, University of
Exeter, UK
Angela Hassiotis Foreword
Professor of Psychiatry of
Intellectual Disability, UCL James Johnston
Division of Psychiatry, London, Consultant Psychiatrist in
UK; Consultant Psychiatrist, Psychotherapy, Leeds and
Camden Learning Disability York Partnership NHS
Service, London, UK Foundation Trust, Leeds, UK;
Chapter 7: Intellectual disability British Psychoanalytic Council
Chapter 12: Psychiatry of intellectual Registered Member, North
disability: psychotherapies, applica- of England Association of
tions, and research Psychoanalytic Psychotherapists
(NEAPP), UK; Visiting
Nick Hayman Lecturer, Tavistock and
Music Psychotherapist, Avon Portman NHS Foundation
and Wiltshire Mental Health Trust, London, UK; Chair,
Partnership NHS Trust, Royal College of Psychiatrists
Bristol, UK Medical Psychotherapy Faculty
Chapter 2: Music therapy Education and Curriculum
Chapter 5: Music therapy Committee 2011–​2 015;
Member of the Association for
Kevin Healy Psychoanalytic Psychotherapy in
Consultant Psychiatrist in Medical the NHS, UK
Psychotherapy, New Dawn NHS Chapter 1: Psychotherapeutic
England Commissioned Inpatient m­edicine: thinking cradle to
Tier 4 Assessment, Treatment grave
and Consultation Service for Chapter 4: Consultation
Women with a Diagnosis of Chapter 7: Integrating
Severe Personality Disorders, psychotherapy in psychiatry
Cygnet Healthcare, Ealing, UK; Chapter 10: Reflective practice
Independent Practitioner in groups
Private Practice, London, UK Chapter 12: General adult
Chapter 11: Neuroscience and ­psychiatry: medical psychotherapies,
psychotherapy applications, and research
 CONTRIBUTORS xv

William Rhys Jones Kath Lovell

Consultant Psychiatrist, Yorkshire Managing Director, Emergence
Centre for Eating Disorders, CIC, London, UK
Leeds and York Partnership Chapter 10: Service user
NHS Foundation Trust, Seacroft involvement
Hospital, Leeds, UK
Chapter 7: Eating disorders Vikram S Luthra
Consultant Psychiatrist, Becklin
Ian Kerr Centre, Leeds, UK; Hon.
Honorary Consultant Psychiatrist Lecturer, University of Leeds,
and Psychotherapist, NHS Leeds, UK
Lanarkshire, Coathill Hospital, Chapter 4: Is my patient suitable
Coatbridge, Scotland for psychotherapy?
Chapter 2: Cognitive analytic therapy
Chapter 5: Cognitive analytic therapy Paul MacAllister
Consultant Psychiatrist in
Wale Lagundoye Forensic Psychotherapy,
Clinical Director and Consultant Wells Road Centre for
Addiction Psychiatrist, Sheffield Community Forensic Psychiatry,
Health & Social Care NHS Nottingham, UK
Foundation Trust, Sheffield, UK Chapter 8: Personality disorder
Chapter 7: Substance misuse services
Chapter 12: Psychiatry of
­addictions: psychotherapies, Brian Martindale
­applications, and research Consultant Psychiatrist,
Nuffield Health Newcastle
Roslyn Law upon Tyne Hospital,
Consultant Clinical Psychologist, Newcastle-​upon-​Tyne, UK
IPT Lead, Anna Freud Centre, Chapter 7: Psychoses
London, UK; Assistant
Director of Psychology and Tristan McGeorge
Psychotherapies, South Consultant Forensic Psychiatrist,
West London and St George’s Central and North West
Mental Health NHS Trust, London NHS Foundation Trust,
Springfield Hospital, London, UK London, UK
Chapter 2: Interpersonal Chapter 8: Psychological therapy
psychotherapy in secure settings
Chapter 5: Interpersonal psychotherapy
Anuradha Menon
Alessandra Lemma ST8 Dual Trainee in
Professor of Psychological Psychoanalytic Psychotherapy
Therapies, Tavistock and and General Adult Psychiatry,
Portman NHS Trust/​Essex Leeds and York Partnerships
University, UK; Visiting NHS Foundation Trust,
Professor, Psychoanalysis Department of Psychotherapy,
Unit, University College Leeds, UK; Department of
London, UK Liaison Psychiatry, Leeds General
Chapter 2: Dynamic interpersonal Infirmary, Leeds, UK
therapy Chapter 3: General therapeutic
Chapter 5: Dynamic interpersonal competencies
therapy
xvi CONTRIBUTORS

Marilyn Miller Shari Mysorekar

Art Psychotherapist, Complex Consultant Forensic Psychiatrist
Psychological Interventions Team, and Medical Psychotherapist,
Bristol Mental Health, Avon and Stockton Hall Hospital, York, UK
Wiltshire NHS Mental Health Chapter 3: General therapeutic
Trust, Bath, UK competencies
Chapter 2: Art psychotherapy
Chapter 5: Art psychotherapy Anton Obholzer
Emeritus Consultant, Tavistock
Sue Mizen
and Portman NHS Foundation
Consultant Psychiatrist in Trust, London, UK; Senior
Medical Psychotherapy Devon Faculty, INSEAD French
Partnership NHS Trust, Wonford International Business School
House Hospital, Exeter, UK; Global Leadership Centre,
Chair of the Psychotherapy Fontainebleau, France
Faculty Exec., Royal College of Chapter 10: Psychotherapeutic
Psychiatrists, UK understanding of organizational
Chapter 8: Personality disorders processes
John Morgan
Phil Osborne
Consultant Psychiatrist, Yorkshire
Centre for Eating Disorders, Consultant Psychiatrist in
Leeds, UK; Senior Lecturer in Medical Psychotherapy,
Eating Disorders, St George’s Specialist Psychotherapy Service,
University of London, UK Stockton-​on-​Tees, Tees Esk and
Chapter 7: Eating disorders Wear Valleys NHS Foundation
Trust, UK
Lou Morgan Chapter 4: Formulation
Executive Director, Emergence
CIC, London, UK Zoe Otter
Chapter 10: Service user Forensic Psychologist in
involvement Training, Partnerships in Care,
Nottinghamshire, UK
Mary Murphy-​Ford Chapter 2: Dialectical behaviour
Consultant Child and Adolescent therapy
Psychiatrist, Tavistock and Chapter 5: Dialectical behaviour
Portman NHS Foundation Trust, therapy
London, UK; Locum Consultant
Psychiatrist and Psychotherapist
in Perinatal and Parent-​Infant
Mental Health Service, Chelsea
and Westminster Hospital,
Central and North West
London NHS Foundation Trust,
London, UK
Chapter 6: Problems through life
Chapter 12: Child and adolescent
psychiatry: child and adolescent
psychotherapies, applications, and
research
 CONTRIBUTORS xvii

Aleksandar M Pavlovic Anna Seymour

Higher Trainee in Medical Senior Lecturer in Dramatherapy,
Psychotherapy and General Department of Psychology,
Adult Psychiatry, Leeds and York University of Roehampton,
Partnership NHS Foundation London, UK
Trust, Leeds Psychology and Chapter 2: Dramatherapy
Psychotherapy Service, Chapter 5: Dramatherapy
Leeds, UK
Chapter 4: What type of therapy?, Eman Shweikh
Assessing the course of therapy, Specialist Registrar (ST5) in
Assessing the outcome of therapy Forensic Psychiatry, Barnet,
Enfield and Haringey Mental
Giovanni Polizzi Health NHS Trust, London, UK
Consultant Psychiatrist in Medical Chapter 8: Psychological therapy
Psychotherapy, South London in secure settings
and Maudsley NHS Foundation
Trust, London, UK Dinesh Sinha
Chapter 2: Mentalization-based Consultant Psychiatrist in
treatment Psychotherapy, East London NHS
Chapter 5: Mentalization-based Foundation Trust, London, UK
treatment Chapter 10: Planning ­psychotherapy
services within psychiatric care,
Ruta Rele Psychotherapy and management
Consultant Psychiatrist in
Substance Misuse, Sheffield Gail Skillington
Health and Social Care NHS Consultant Forensic Psychologist,
Foundation Trust, Sheffield, UK Partnerships in Care,
Chapter 7: Substance misuse Nottinghamshire, UK
Chapter 12: Psychiatry of Chapter 2: Dialectical behavioural
addictions: psychotherapies, therapy
applications, and research Chapter 5: Dialectical behavioural
therapy
Florian Ruths
Consultant Psychiatrist & Cognitive Julian Stern
Therapist, South Lambeth Consultant Psychiatrist in
Assessment and Treatment Team, Psychotherapy, Adult Dept,
Mood, Anxiety & Personality Tavistock and Portman NHS
Clinical Academic Group, Trust, London, UK
London, UK Chapter 7: Medically unexplained
Chapter 2: Schema therapy, symptoms
Mindfulness-based interventions
and therapies
Chapter 5: Schema therapy,
Mindfulness-based interventions
and therapies
xviii CONTRIBUTORS

Jo Stubley Jessica Yakeley

Consultant Psychiatrist in Fellow of the British
Psychotherapy, Adult Dept, Psychoanalytical Society,
Tavistock and Portman NHS Consultant Psychiatrist in
Trust, London, UK; Clinical Forensic Psychotherapy, Portman
Lead, Adult Trauma Services, Clinic; Director of Medical
Tavistock and Portman NHS Education and Associate Medical
Trust, London, UK; Member Director, Tavistock and Portman
British Psychoanalytic NHS Foundation Trust, London
Society, UK UK; Editor of Psychoanalytic
Chapter 7: Trauma-related Psychotherapy, UK
conditions Chapter 1: Medical psychotherapy:
what is it?
Kristy Summers Chapter 2: Concepts and mod-
Forensic Psychologist in els: introduction, Psychoanalytic
Training, Partnerships in Care, psychotherapy
Nottinghamshire, UK Chapter 4: Psychodynamic
Chapter 2: Dialectical behaviour ­assessment and psychotherapy
therapy Chapter 5: Psychoanalytic
Chapter 5: Dialectical behaviour psychotherapy
therapy Chapter 6: Violence and aggression
Chapter 7: Paraphilias
David Taylor
Chapter 8: Antisocial personality
Visiting Professor, Psychoanalysis disorder, Narcissistic and histrionic
Unit, Research Department personality disorders
of Clinical, Educational & Chapter 11: Research in
Health Psychology, University psychotherapy
College London, UK; Honorary Chapter 12: Forensic psychiatry:
Consultant Psychotherapist, forensic psychotherapies, applica-
Tavistock and Portman NHS tions, and research
Foundation Trust, London, UK
Chapter 7: Affective disorders
Antonio Ventriglio
Section of Psychiatry, University
of Foggia, Department of Clinical
and Experimental Medicine,
Foggia, Italy
Chapter 7: Sexual dysfunction
 xix

Symbols and abbreviations

£ pound sterling
$ dollar
AAI Adult Attachment Interview
ACAT Association for Cognitive Analytic Therapy
ACT acceptance and commitment therapy
ADHD attention-​deficit/​hyperactivity disorder
A&E accident and emergency
AIS androgen insensitivity syndrome
AMT analytical music therapy
AN anorexia nervosa
APA American Psychiatric Association
APT adaptive pacing therapy
ASC altered state of consciousness
ASD acute stress disorder
ASPD antisocial personality disorder
AvPD avoidant personality disorder
BAAT British Association of Art Therapists
BABCP British Association of Behavioural and Cognitive
Psychotherapies
BACP British Association for Counselling and
Psychotherapy
BADth British Association of Dramatherapists
BAMT British Association of Music Therapists
BCT behavioural couples therapy
BDD body dysmorphic disorder
BDNF brain-​derived neurotropic factor
BED binge eating disorder
BMGIM Bonny Method of Guided Imagery and Music
BMI body mass index
BMT behavioural music therapy
BN bulimia nervosa
BPA British Psychoanalytic Association
BPAS British Psychoanalytical Society
BPC British Psychoanalytic Council
xx SYMBOLS AND ABBREVIATIONS

BPD borderline personality disorder

BPF British Psychotherapy Foundation
BPSD behavioural and psychological symptoms
of dementia
CAH congenital adrenal hyperplasia
CAMHS child and adolescent mental health services
CAT cognitive analytic therapy
CBT cognitive behavioural therapy
CBTp cognitive behavioural therapy for psychosis
CCRT Core Conflictual Relationship Theme
CCT Certificate of Core Training; Certificate
of Completion of Training
CFS chronic fatigue syndrome
CM contingency management
CMHT community mental health team
COPP Commission on Psychotherapy by Psychiatrists
CORE Centre for Outcomes Research and Effectiveness;
Clinical Outcomes in Routine Evaluation
CORE-​OM Clinical Outcomes in Routine Evaluation–​Outcome
Measure
CPA Care Programme Approach
CPD continuing professional development
CPN community psychiatric nurse
CRM comprehensive resource model
CROM clinician-​r ated outcome measure
DANOS Drug and Alcohol National Occupational Standards
DBT dialectical behavioural therapy
DEXA dual-​energy X-​r ay absorptiometry
DIP Drug Intervention Programme
DIT dynamic interpersonal therapy
DLB dementia with Lewy bodies
DNA deoxyribonucleic acid
DPD dependent personality disorder
DRA differential reinforcement of alternate behaviour
DRI differential reinforcement of incompatible behaviour
DRO differential reinforcement of other behaviour
DSM-​5 Diagnostic and Statistical Manual of Mental Disorders,
fifth edition
 SYMBOLS AND ABBREVIATIONS xxi

DSPD Dangerous and Severe Personality Disorder

DZ dizygotic
EBD emotional and behavioural difficulties
EBP evidence-​based practice
EFT energy-​focused therapy
EMDR eye movement desensitization and reprocessing
EPR embodiment– ​projection– ​role
FPS Forensic Psychotherapy Society
FSS functional somatic syndromes
GA group analysis
GAD generalized anxiety disorder
GET graded exercise therapy
GIM guided imagery and music
GLM Good Lives Model
GMC General Medical Council
GMP Good Medical Practice
GP general practitioner
GPSQ Gender Preoccupation and Stability Questionnaire
HCPC Health and Care Professions Council
HPC Health Professions Council
HPD histrionic personality disorder
IAFP International Association for Forensic Psychotherapy
IAPT Improving Access to Psychological Therapies
IBS irritable bowel syndrome
ICATA International Cognitive Analytic Therapy Association
ICD International Classification of Diseases
IDD intellectual and developmental disorder
IDTS Integrated Drug Treatment System
IGA Institute of Group Analysis
IPA International Psychoanalytic Association
IPAF interpersonal affective pattern
IPP Imprisonment for Public Protection
IPT interpersonal therapy
IQ intelligence quotient
JCHPT Joint Committee on Higher Psychiatric Training
kcal kilocalorie
kg kilogram
xxii SYMBOLS AND ABBREVIATIONS

KUF Knowledge and Understanding Framework

LHRH luteinizing hormone-​releasing hormone
LPPU London Pathways Progression Unit
LTC long-​term condition
m metre
MA Master of Arts
MAPPP multi-​agency public protection panels
MBCT mindfulness-​based cognitive therapy
MBI mindfulness-​based interventions
MBRP mindfulness-​based relapse prevention
MBSR mindfulness-​based stress reduction
MBT mentalization-​based treatment
MBT-​ASC MBT adherence and competence scale
MCI mild cognitive impairment
mg milligram
MHA Mental Health Act
MI motivational interviewing
mRNA messenger ribonucleic acid
MSc Master of Science
MSSM multiple self-​states model
MUS medically unexplained symptoms
MZ monozygotic
NCD mild neurocognitive disorder
NHS National Health Service
NICE National Institute for Health and Care Excellence
NMDA N-​methyl-​D -​a spartate
NMT neurologic music therapy
NPD narcissistic personality disorder
OCD obsessive– ​compulsive disorder
OMPFC orbitomedial prefrontal cortex
OPCD obsessive–​compulsive personality disorder
OSAP Offender Substance Abuse Programme
OSFED other specified feeding or eating disorder
OT occupational therapy/​therapist
PBE practice-​based evidence
PCL-​R Psychopathy Checklist-​Revised
 SYMBOLS AND ABBREVIATIONS xxiii

PCPCS Primary Care Psychotherapy

and Consultation Service
PET positron emission tomography
PFC prefrontal cortex
PhD Doctor of Philosophy
PICU psychiatric intensive care unit
PIPE Psychologically Informed Planned Environment
PIT psychodynamic interpersonal therapy
PPD paranoid personality disorder
PROM patient-​reported outcome measure
PRU pupil referral unit
PSI psychosocial interventions
PSQ Personality Structure Questionnaire
PTSD post-​traumatic stress disorder
QALY quality-​adjusted life-​year
RCT randomized controlled trial
RMO resident medical officer
RNR risk– ​need– ​responsivity
RR reciprocal role
RRP reciprocal role procedure
SCIE Social Care Institute for Excellence
SCM structured clinical management
SD somatization disorder
SDR sequential diagrammatic reformulation
SFT solution-​focused therapy
SIG Special Interest Group
SIGN Scottish Intercollegiate Guidelines Network
SMC specialist medical care
SMI serious mental illness
SOTP Sex Offender Treatment Programme
SPD schizoid personality disorder
SSRI selective serotonin reuptake inhibitor
StPD schizotypal personality disorder
TC therapeutic community
tf-​CBT trauma-​focused cognitive behavioural therapy
TFP transference-​focused psychotherapy
TPP target problem procedure
xxiv SYMBOLS AND ABBREVIATIONS

UK United Kingdom
UKCP United Kingdom Council for Psychotherapy
USA United States
USP unique selling point
VBP values-​based practice
VCM vulnerable child mode
VRAG Violence and Risk Appraisal Guide
WEMSS Women’s Enhanced Medium Secure Services
WFMT World Federation of Music Therapy
WMA World Medical Association
WPF Westminster Pastoral Foundation
YSQ Young Schema Questionnaire
ZPD zone of proximal development
 Chapter 1 1

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