A brief overview of safety planning in interpersonal reconstructive therapy

Abstract

Most research to date with Interpersonal Reconstructive Therapy (IRT: Benjamin, 2006) involves application with patients who qualify for the acronym 'CORDS': Comorbid, Often Rehospitalized, Dysfunctional, and Suicidal. A case formulation (CF) based on interpersonal copy process theory defines links between presenting symptoms and patterns of affect, cognition, and behavior that invoke safety or threat and were learned and internalized in close relationships. The 'gift of love' (GOL) hypothesis is that the wish to receive love and acceptance from specific internalized attachment figures organizes and propels problem patterns and their associated symptoms. Through a series of steps, IRT seeks to help patients become aware of and learn about their copied patterns, including where they were learned, the role they play in maintaining connection with internalized attachment figures, and their functions in the present. The goal is to help a patient differentiate from their 'family in the head' and pursue healthy behaviors and self-concepts. With awareness and differentiation comes the possibility of letting go of problematic quests for love and acceptance from the internalized attachments and to choose healthy alternatives instead. As an integrative method, safety planning in IRT shares much with other approaches. What is unique is how therapists utilize the CF to guard against unsafe behavior as an ongoing part of the treatment process with patients with suicidality. This article provides an overview and illustration emphasizing these unique aspects of the IRT approach to safety planning in the context of individual psychotherapy with adults. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

_Impact Statement:_ Question : The article describes how safety planning and crisis management are implemented in Interpersonal Reconstructive Therapy (IRT: Benjamin, 2006, 2018). Findings : IRT emphasizes tailored intervention based on a case formulation that links current problems and symptoms to messages about safety and threat internalized in close attachment relationships. Meaning : A clinical case example is used to illustrate helpful application of the approach. Next Steps : Ongoing work is underway to validate IRT principles and train their use. (PsycInfo Database Record (c) 2022 APA, all rights reserved)