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Dunn, M., 2002. Diagrammatic Psychotherapy File. Reformulation, Spring, p.17.
We are all familiar with the prose Psychotherapy File and how to use it. It was only a matter of time before a Diagrammatic version put in an appearance. Here it is, a first draft or V1.0. You will see that it is divided into the usual chunks, Traps, Dilemmas and Snags, followed by a couple of Borderline-type diagrams and then a Self-States list in "spreadsheet" style. The Unstable States list cannot be easily diagrammed.
The Traps have been slightly expanded to take into account the merging of some ideas in the original, eg. "trying to please" is discriminated from "the inability to say no" and "worthlessness" is separated out from "self-punishment". An "anxious thinking" trap is added to "depressed thinking". The Dilemmas are somewhat re-named and drawn as figure-of-eights with the suggestion to start by following the double arrow to the lower left. The Snags are an attempt to give examples of what is not clearly defined in the original. Each item can be rated on a scale of five rangin from "I don't fell like this at all" to "I feel like this all the time". Respondees are encouraged to cross out and redraw or rewrite elements as well as having "blank" diagrams to fill in in their own way. The Different States sheet encourages respondees to joins identified states with arrows providing a good starting point for the SDR.
Early feedback suggests that this version may be too much or overwhelming for many patients, but has also had a good response from psychologically-minded patients. It is proving useful for therapists and particularly trainees to think about their clients and start putting together elements of the SDR.
We hope you find it a useful addition to the tool box and please feel free to copy and use it. All feedback should be addressed to the Newsletter.
A copy of the new Diagrammatic Psychotherapy File should be included in the Newsletter mailing. If you have not received one then copies can be obtained from:
Jonathan Lopez-Real
ACAT Office,
3rd Floor South Wing
Division of Academic Psychiatry
St Thomas' Hospital
Lambeth Palace Road
LONDON
SE1 7EH
Mark Dunn