Kyle MacDonald

Segar House - Rauaroha

ADHB, New Zealand

GENDER DIFFERENCES IN A PERSONALITY

TREATMENT PROGRAMME

Fears about the implications for the group therapy process

Most male client referrals were inclined towards low-level acts of aggression, normally towards intimate partners

HISTORY OF GENDER CONSIDERATIONS IN THE

PROGRAMME

Added a Mentalization aspect to our DBT based therapeutic approach

Allowed us to understand the process of attachment based aggression in an adult presentation

How did our treatment approach need to be different?

HISTORY OF GENDER CONSIDERATIONS IN THE

PROGRAMME

Had only occurred in the context of intimate and family relationships

Was followed by shame and contrition Had not resulted in serious injury Distinguish this from a more sociopathic or

narcissistic pattern:more random pattern to the offending absence of remorse and accountability

ASSESSMENT OF AGGRESSION

42 year old New Zealand European man Hospitalised after relationship breakdownThreatening and aggressive towards

rejecting partner whilst in a dissociated state

Followed by a profound depressionHistory of failed relationships“Not an angry man.”

CASE EXAMPLE: “DAVE”

Alien self is a term used in Mentalization Based Therapy

Outcome of “chronically insensitive or misattuned caregiving.”

Self representation internalises aspects of the other, “creating a fault in the construction of the psychological self”

If later trauma occurs, it can “force the child to dissociate from the pain by using the alien self to identify with the aggressor.” (Fonagy et.al. 2002)

CASE EXAMPLE: “DAVE”

CASE EXAMPLE: “DAVE”

Trauma Symptom Inventory at Intake

CASE EXAMPLE: “DAVE”

FormulationWhen Dave didn’t acknowledge his anger, due to a fear he would be “like his father,” he denied a part of himself and in his denial and dissociation lost control and kept repeating the very thing he sought to dis-own.

CASE EXAMPLE: “DAVE”

Dave’s “alien self” can then be understood as an example of identifying with the aggressor

Dave utilises the defensive structure of projection to protect against painful affect, most notably shame

This angry aggressive part felt to Dave like “not me.”

He alternates between: persecutory rage and aggression/ and the persecution of the self via suicidal depression and self harm.

CASE EXAMPLE: “DAVE”

CASE EXAMPLE: “DAVE”

Trauma Symptom Inventory at Discharge

CASE EXAMPLE: “DAVE”

Trauma Symptom Inventory at Intake

Application of MBT seems more helpful to our team when thinking about aggression and interpersonal violence

Primary author of DBT is female, and most of it’s application has been to female borderline clients targeting self harming behaviour

MBT’s lead authors are male; it’s literature talks more freely about interpersonal violence, and the model’s therapeutic application to anti-social personality disorder

MBT AND DBT: GENDERED MODELS?

Have we treated our female clients as “fragile”?

In our fear of treating “violent men” were we failing to mentalize our male referrals?

Because we feared, did we make them frightening?

TEAM RESPONSES

To be open to wondering and thinking about their experiences,

to see the whole person, in all their complexity and to hold their

mind in mind