Peter Fonagy

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Peter Fonagy
Fonagy in 2008.jpg
Born (1952-08-14) 14 August 1952 (age 68)
Scientific career
Fields Psychoanalysis, psychiatry
InstitutionsProfessor of Contemporary Psychoanalysis and Developmental Science and Head of the Division of Psychology and Language Sciences at University College London, Chief Executive at the Anna Freud Centre in London, Consultant to the Child and Family Program at the Menninger Department of Psychiatry, Baylor College of Medicine.

Peter Fonagy, OBE , FBA , FAcSS , FMedSci (born 14 August 1952) is a Hungarian-born British psychoanalyst and clinical psychologist. He studied clinical psychology at University College London. He is Professor of Contemporary Psychoanalysis and Developmental Science and Head of the Division of Psychology and Language Sciences at University College London, Chief Executive of the Anna Freud Centre, a training and supervising analyst in the British Psycho-Analytical Society in child and adult analysis, a Fellow of the British Academy, the Faculty of Medical Sciences, the Academy of Social Sciences and a registrant of the BPC. His clinical interests centre on issues of borderline psychopathology, violence and early attachment relationships. His work attempts to integrate empirical research with psychoanalytic theory. He has published over 500 papers, 270 chapters and has authored 19 and edited 17 books. [1]

Contents

Fonagy was appointed Officer of the Order of the British Empire (OBE) in the 2013 Birthday Honours for services to psychoanalysis and clinical psychology and received the Wiley Prize of the British Academy for Lifetime Achievements [2]

Contemporary psychoanalysis

Fonagy received the Otto Weininger Memorial Award [3] for his contributions to the development of contemporary psychoanalysis. To this end he has helped to improve the dialogue between analysts and cognitive therapists. Fonagy has played and still plays a major role in the evaluation of psychotherapy research. [4] The evaluation of his research is (mostly) based on the effectiveness of treatment. Evaluation of treatment has led to review, recommendations and implications of psychotherapy. Fonagy has offered detailed evidence for the efficacy of psychological interventions of mental disorders and for special populations, including medical and psychosocial therapies for children and young people and psychological therapies for borderline personality disorder.

Mentalization

In their award-winning [5] book Affect Regulation, Mentalization and the Development of the Self, Fonagy and his colleagues put forth a detailed theory for the way in which the abilities to mentalise and to regulate affect can determine an individual's successful development. They define mentalisation as the ability to make and use mental representations of their own and other people's emotional states. The authors discuss the ways in which bad and insufficient parenting, leading to certain attachment styles, [6] can leave children unable to modulate and interpret their own feelings, as well as the feelings of others. [7] These inabilities to mentalise and regulate affect have implications for severe personality disorders, as well as general psychological problems of self-confidence, and sense of self. [8]

Mentalization-based treatment

Fonagy is particularly interested in borderline personality disorder (BPD), which was for a long time assumed to be treatment-resistant. [9] He and Anthony Bateman proposed a new way to treat BPD in their book Psychotherapy for borderline personalitydisorder: mentalisation based treatment. [10] Mentalization based treatment (MBT), rooted in attachment theory, is based on the idea that people with borderline personality disorder mainly lack a reliable capacity to mentalise, which is caused by an absence of contingent and marked mirroring during development. The primary goals of treatment are to improve mentalisation skills, making connections between the inner experience of relationships and the actual representation, learning how to work with current emotions and how to establish real relationships. In this way they could form a more coherent sense of self and develop new (secure) attachment styles. [11] [12]

See also

Related Research Articles

Psychoanalysis psychological theory and therapy established by Sigmund Freud

Psychoanalysis is a set of theories and therapeutic techniques used to study the unconscious mind, which together form a method of treatment for mental disorders. The discipline was established in the early 1890s by Austrian neurologist Sigmund Freud, who retained the term psychoanalysis for his own school of thought. Freud's work stems partly from the clinical work of Josef Breuer and others. Psychoanalysis was later developed in different directions, mostly by students of Freud, such as Alfred Adler and his collaborator, Carl Gustav Jung, as well as by neo-Freudian thinkers, such as Erich Fromm, Karen Horney, and Harry Stack Sullivan.

Group psychotherapy or group therapy is a form of psychotherapy in which one or more therapists treat a small group of clients together as a group. The term can legitimately refer to any form of psychotherapy when delivered in a group format, including Art therapy, cognitive behavioral therapy or interpersonal therapy, but it is usually applied to psychodynamic group therapy where the group context and group process is explicitly utilized as a mechanism of change by developing, exploring and examining interpersonal relationships within the group.

Borderline personality disorder Personality disorder characterized by unstable relationships, impulsivity, and strong emotional reactions

Borderline personality disorder (BPD), also known as emotionally unstable personality disorder (EUPD), is a mental illness characterized by a long-term pattern of unstable relationships, distorted sense of self, and strong emotional reactions. Those affected often engage in self-harm and other dangerous behavior. They may also struggle with a feeling of emptiness, fear of abandonment, and detachment from reality. Symptoms of BPD may be triggered by events considered normal to others. The behavior in BPD typically begins by early adulthood and occurs across a variety of situations. Substance abuse, depression, and eating disorders are commonly associated with BPD. Approximately 10% of people affected with the disorder die by suicide. The disorder is often stigmatized in both the media and the psychiatric field.

Histrionic personality disorder (HPD) is defined by the American Psychiatric Association as a personality disorder characterized by a pattern of excessive attention-seeking behaviors, usually beginning in early childhood, including inappropriate seduction and an excessive desire for approval. People diagnosed with the disorder are said to be lively, dramatic, vivacious, enthusiastic, and flirtatious. HPD is diagnosed four times as frequently in women as men. It affects 2–3% of the general population and 10–15% in inpatient and outpatient mental health institutions.

Narcissistic personality disorder Personality disorder that involves an excessive preoccupation with personal adequacy, power, prestige and vanity.

Narcissistic personality disorder (NPD) is a personality disorder characterized by a long-term pattern of exaggerated feelings of self-importance, an excessive craving for admiration, and struggles with empathy. People with NPD often spend much time daydreaming about achieving power and success, or on their appearance. This is a pattern of obsessive thoughts and unstable sense of identity, often to cope with a sub-par real life. People with the diagnosis in recent years have spoken out about its stigma in media, and possible links to abusive situations and childhood trauma. Such narcissistic behavior typically begins by early adulthood, and occurs across a broad range of situations.

Dependent personality disorder (DPD) is a personality disorder that is characterized by a pervasive psychological dependence on other people. This personality disorder is a long-term condition in which people depend on others to meet their emotional and physical needs, with only a minority achieving normal levels of independence. Dependent personality disorder is a Cluster C personality disorder, characterized by excessive fear and anxiety. It begins by early adulthood, and it is present in a variety of contexts and is associated with inadequate functioning. Symptoms can include anything from extreme passivity, devastation or helplessness when relationships end, avoidance of responsibilities and severe submission.

Psychodynamic psychotherapy or psychoanalytic psychotherapy is a form of depth psychology, the primary focus of which is to reveal the unconscious content of a client's psyche in an effort to alleviate psychic tension.

Malignant narcissism is a psychological syndrome comprising an extreme mix of narcissism, antisocial behavior, aggression, and sadism. Grandiose, and always ready to raise hostility levels, the malignant narcissist undermines families and organizations in which they are involved, and dehumanizes the people with whom they associate.

Child psychotherapy, or mental health interventions for children have developed varied approaches over the last century. Two distinct historic pathways can be identified for present-day provision in Western Europe and in the United States: one through the Child Guidance Movement, the other stemming from Adult psychiatry or Psychological Medicine, which evolved a separate Child psychiatry specialism.

In psychology, mentalization is the ability to understand the mental state--of oneself or others--that underlies overt behaviour. Mentalization can be seen as a form of imaginative mental activity that lets us perceive and interpret human behaviour in terms of intentional mental states. It is sometimes described as "understanding misunderstanding." Another term that David Wallin has used for mentalization is "Thinking about thinking". Mentalization can occur either automatically or consciously. Mentalization ability, or mentalizing, is weakened by intense emotion.

Emotionally focused therapy and emotion-focused therapy (EFT) are a family of related approaches to psychotherapy with individuals, couples, or families. EFT approaches include elements of experiential therapy, systemic therapy, and attachment theory. EFT is usually a short-term treatment. EFT approaches are based on the premise that human emotions are connected to human needs, and therefore emotions have an innately adaptive potential that, if activated and worked through, can help people change problematic emotional states and interpersonal relationships. Emotion-focused therapy for individuals was originally known as process-experiential therapy, and it is still sometimes called by that name.

Mentalization-based treatment (MBT) is an integrative form of psychotherapy, bringing together aspects of psychodynamic, cognitive-behavioral, systemic and ecological approaches. MBT was developed and manualised by Peter Fonagy and Anthony Bateman, designed for individuals with borderline personality disorder (BPD). Some of these individuals suffer from disorganized attachment and failed to develop a robust mentalization capacity. Fonagy and Bateman define mentalization as the process by which we implicitly and explicitly interpret the actions of oneself and others as meaningful on the basis of intentional mental states. The object of treatment is that patients with BPD increase their mentalization capacity, which should improve affect regulation, thereby reducing suicidality and self-harm, as well as strengthening interpersonal relationships.

Transference focused psychotherapy (TFP) is a highly structured, twice-weekly modified psychodynamic treatment based on Otto F. Kernberg's object relations model of borderline personality disorder. It views the individual with borderline personality organization (BPO) as holding unreconciled and contradictory internalized representations of self and significant others that are affectively charged. The defense against these contradictory internalized object relations leads to disturbed relationships with others and with self. The distorted perceptions of self, others, and associated affects are the focus of treatment as they emerge in the relationship with the therapist (transference). The treatment focuses on the integration of split off parts of self and object representations, and the consistent interpretation of these distorted perceptions is considered the mechanism of change.

A clinical formulation, also known as case formulation and problem formulation, is a theoretically-based explanation or conceptualisation of the information obtained from a clinical assessment. It offers a hypothesis about the cause and nature of the presenting problems and is considered an adjunct or alternative approach to the more categorical approach of psychiatric diagnosis. In clinical practice, formulations are used to communicate a hypothesis and provide framework for developing the most suitable treatment approach. It is most commonly used by clinical psychologists and psychiatrists and is deemed to be a core component of these professions. Mental health nurses and social workers may also use formulations.

Common factors theory, a theory guiding some research in clinical psychology and counseling psychology, proposes that different approaches and evidence-based practices in psychotherapy and counseling share common factors that account for much of the effectiveness of a psychological treatment. This is in contrast to the view that the effectiveness of psychotherapy and counseling is best explained by specific or unique factors that are suited to treatment of particular problems. According to one review, "it is widely recognized that the debate between common and unique factors in psychotherapy represents a false dichotomy, and these factors must be integrated to maximize effectiveness". In other words, "therapists must engage in specific forms of therapy for common factors to have a medium through which to operate". Common factors is one route by which psychotherapy researchers have attempted to integrate psychotherapies.

The mainstay of management of borderline personality disorder is various forms of psychotherapy with medications being found to be of little use.

Schema therapy was developed by Jeffrey E. Young for use in treatment of personality disorders and chronic DSM Axis I disorders, such as when patients fail to respond or relapse after having been through other therapies. Schema therapy is an integrative psychotherapy combining theory and techniques from previously existing therapies, including cognitive behavioral therapy, psychoanalytic object relations theory, attachment theory, and Gestalt therapy.

Narcissistic abuse is a hypernym for the psychological, financial, sexual, and physical abuse of others by someone with narcissistic traits or suffering from narcissistic personality disorder (NPD). Narcissistic Personality Disorder has been referred to as a mental health condition by several medical research and journal organisations, such as, for example, the United States National Library of Medicine, Mayo Clinic, and Cochrane medical journals.

The Goethe Award for Psychoanalytic and Psychodynamic Scholarship is given annually by the Section on Psychoanalytic and Psychodynamic Psychology of the Canadian Psychological Association. The award is given for the best psychoanalytic book published within the past two years and is juried by a peer review process and awards committee.

Andrew J. Gerber

Andrew J. Gerber is an American psychoanalyst and the current president and medical director of Silver Hill Hospital in New Canaan, Connecticut. His principal interests and research lie in studying the neurobiological bases of social cognition, particularly in relation to autism spectrum disorders and change in response to psychotherapy. He is a member of the American Academy of Child and Adolescent Psychiatry, American Psychiatric Association, American Psychoanalytic Association and the Psychoanalytic Psychodynamic Research Society.

References

  1. "Peter Fonagy". UCL Psychoanalysis Unit.
  2. "No. 60534". The London Gazette (Supplement). 15 June 2013. p. 10.
  3. "Otto Weininger Memorial Award". Canadian Psychological Association.
  4. Fonagy 1996.
  5. "Goethe Award for Psychoanalytic and Psychodynamic Scholarship". Canadian Psychological Association.
  6. Mills, Jon (2005). Treating Attachment Pathology. Aronson/Rowman & Littlefield. p. 231. ISBN   978-0-7657-0132-9.
  7. Fonagy et al. 2002.
  8. Fonagy & Target 2006a.
  9. Bateman & Fonagy 2003b.
  10. Fonagy & Bateman 2004b.
  11. Bateman & Fonagy 2004a.
  12. Fonagy & Bateman 2006b.

Works