Christine Dunkley: medication and how this impacts upon the therapeutic

Christine began by talking about the brain. We can often forget that the bulk of the brain is not concerned with thinking or feeling but rather with the day to day, minute by minute, regulation of our physiology. The part that deals with the emotions and with cognition takes up only a small part of the brain. After all, our bodies are concerned with keeping us alive: happiness or otherwise is of little concern.

She went on to look at the structure of the neurons in the brain. We each have millions of these; some 100,000 of them would fit onto the head of a pin. Christine discussed the structure of the neuron and its trailing dendrites and axons and how messages between neurons are carried through the synaptic gaps by means of chemical neurotransmitters which fire each time we experience a thought. Once a thought pattern has been constructed by the brain it potentiates it happening again. The next time the same pattern is constructed it will happen more quickly. In this way patterns of thinking can become normalised within the brain. If that thought pattern happens to be, "I am rubbish at this…" then that structure can start to become fixed in the brain, an automatic response to a given situation.

Christine talked about Antonio Damasio's Somatic Marker Hypothesis which describes how emotional processes can guide or even direct in individual to make particular decisions. Further information about this idea can be found in Damasio's book Descartes' Error: Emotion, Reason, and the Human Brain.

Later in the lecture we looked at our own experience of working with clients who are taking antidepressants. There was some debate in the group about this, although the general feeling seemed to me to be that such drugs certainly did not interfere with the therapeutic process, and can often be seen to help. Christine talked to us about the differences between different types of antidepressant drugs including the older style tricyclics, first introduced in the 1950s, Monoamine oxidase inhibitors (MAOIs) and the new SSRI (Selective Serotonin Reuptake Inhibitors). Christina talked about the role these drugs have in helping those with depression to be able to use therapy effectively. The best mix she felt, for some people, was a mix of the two: antidepressant drugs to allow for more thinking capacity and therapy to solve the problem. Christine used the metaphor of ‘Depression Island’. This might not be a very comfortable place to be but it is a lot better than than drowning in the sea! To extend the metaphor, the task of therapy is to help the patient go back into the sea, tolerate the feeling, and swim to the shore. In doing this, however, Christine emphasised that skills training must come first. Exposure can only happen once the client has the skills to survive this.

Christine is running a one-day workshop on Emotion Regulation Treatment at Brunel University, Uxbridge on Saturday 5th July, 2008. The workshop will also be repeated later in the year at Winchester. The workshop costs £110, or if you book before the 5th June then the cost is reduced to £99. For further information or to reserve a place which will be held for a week until payment is received contact psychologicaltherapies@ntlworld.com or telephone Psychological Therapies Training on 0208 1444 707.
Later in the session we looked at the difficulties of working with clients who are on benzodiazepine drugs such as Diazepam (Valium) and Zopiclone. Such medication tends to work against the formation of an effective therapeutic alliance.

Books recommended by Christine:
Linehan, Marsha (1993) Skills Training Manual for Treating Borderline Personality Disorder (Diagnosis & Treatment of Mental Disorders). Guilford Publications.
Matthews, K, Wield, C and Thompson, (2006) Life After Darkness: A Doctor's Journey Through Severe Depression. Radcliffe Publishing
Articles by Christine in CPJ and Therapy Today:
'The Pain Barrier' was in CPJ, Vol 12 No1, Feb 2001, pp13-15
'Supervising Trainee Counsellors in Basic Risk Awareness' was in CPJ, Vol 14 No 10 December 2003, pp50-51
'Supervising in Cases of Suicide Risk was in Therapy Today, Vol 17 No 1, February 2006, pp31-33
'Pacing the Learning' was in Therapy Today, Vol 18 No 9 November 2007, pp41-43

Rob Abbott
March 2008