Annual Research Lecture 2016

Perversions, paraphilias and personality disorder: Implementing psychoanalytic research at the Portman Clinic

Jessica Yakeley, Stephen Blumenthal and Felicitas Rost

8.00 for 8.15pm at the Institute of Psychoanalysis

The Portman Clinic, now part of the Tavistock and Portman NHS Foundation Trust, is an out-patient forensic psychoanalytic psychotherapy clinic offering assessments and treatment to children, adolescents and adults presenting with enactments of violence, perversions, criminality and delinquency.  The Clinic also offers psychoanalytically-informed consultations to forensic institutions, teaching and training to professionals working in a range of settings including health, the criminal justice system and social services, and is involved in a number of research studies.

With this brief, the Clinic effectively straddles two ‘cultures’, the culture of psychoanalysis and the culture of the modern NHS. On the one hand, the Clinic identifies with the tradition and culture of psychoanalysis which focuses on unconscious processes in the patient and intrapsychic change. On the other hand, the NHS increasingly emphasizes accountability, monitoring and evaluation of interventions, and the development of an ‘evidence-base’ to guide the choice of intervention.

As for all NHS services today, we are required to demonstrate the safety, quality and effectiveness of our treatments. However, most available outcome measures focus on overt changes in behaviours and symptoms, and there are few existing instruments that measure meaningful intrapsychic change in a population of patients presenting with problematic sexual behaviours. Within a psychiatric classification, such patients are diagnosed as suffering from ‘paraphilias’, with a focus on overt sexual symptomatology whilst neglecting personality pathology. From a psychoanalytic viewpoint, however, abnormal sexual fantasies and behaviours may be conceptualized as perversions and seen to be symptoms of underlying personality difficulties, and it is these which become the focus of treatment, rather than the behaviours themselves.

One measure that we have found relevant, and have been using on all patients accepted for treatment since 2010, is the Shedler-Westen Assessment Procedure (SWAP-200, Westen & Shedler, 1999). The SWAP is a psychoanalytically-informed clinician-rated assessment of personality disorder as well as personality functioning. In this lecture we would like to present, with case examples, both our diagnostic results as well as possible changes that have occurred in patients as the result of long-term psychoanalytic psychotherapy. In discussing our findings, we propose that in some cases, paraphilias are not just constellations of fantasies and behaviours, but may be considered diagnostically to be disorders of personality in their own right. This clearly has implications for future assessment and treatment of these disorders, which we are looking forward to discuss with you.

Cost:  £5.00 

To book a place please click here

Enquiries:  Marjory Goodall at marjory.goodall@iopa.org.uk