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Preview: In Session: Psychotherapy in Practice

In Session: Psychotherapy in Practice

Wiley Online Library : In Session: Psychotherapy in Practice

Published: 1999-12-01T00:00:00-05:00




Challenges in the treatment of personality disorders: When the disorder demands comprehensive integration


Major advances have been made in the theoretical constructs, classification, and treatment of personality disorders. Nevertheless, these disorders remain very challenging to treat and frustrating to many health care providers. Although we have witnessed a paradigmatic shift in the field of personology, there remains much more to do in this exciting field. A number of parallel trends have been made in diagnostic systems, models that make disorders of personality more understandable and more readily treated with both short-term and long-term psychotherapy. In fact, a number of issues in the field of personality disorders can be described as “breakthrough problems” for the field of psychotherapy and the mental health professions as a whole. This article presents the reader with a summary of these trends. © 1999 John Wiley & Sons, Inc.

Group treatment of personality disorders: The power of the group in the intensive treatment of personality disorders


Because personality disorders are resistant to change and difficult to treat, powerful treatments are required. Group therapies are capable of mobilizing strong forces for change. Maladaptive behaviors are commonly demonstrated in the immediacy of the group situation; peer influence can be used to provide feedback and suggestions for change, and new adaptive behaviors can be practiced in the group. Group-oriented day treatment programs are intensive forms of group therapy, and this article describes a particular program that has treated clients with personality disorders for over 25 years. Its intensity is derived from the provision of many hours of group therapy per week to a large number of patients by multiple staff as part of a time-limited integrated system of diverse therapy groups. It is also derived from the implementation of modified principles of the therapeutic community. A case illustration demonstrates how the program is capable of bringing about change at the level of the individual client with a personality disorder. Given the number of clients who can be treated simultaneously, the program is also regarded as time efficient. © 1999 John Wiley & Sons, Inc.

Short-term psychodynamic therapy as a form of desensitization: Treating affect phobias


This article presents an “anxiety-regulating” model of short-term dynamic psychotherapy that uses the behavioral principles of desensitization to treat psychodynamic conflict. In this model, psychodynamic conflict is reinterpreted as an “affect phobia.” In contrast to phobic stimuli that are external (bridges, snakes), intrapsychic phobias occur within us; the phobic stimuli are feelings. Within this framework, behavioral methods of exposure and the prevention of avoidance can be applied to avoided feelings to resolve the psychodynamic conflict. Clients who are afraid of anger, grief, or closeness are exposed to these feelings in imagery in doses they can bear. Defensive avoidance is prevented and the client experiences the conflicted feeling while learning to regulate the associated anxiety, guilt, shame, or pain. A case example with transcripted segments of sessions is presented to illustrate these principles. © 1999 John Wiley & Sons, Inc.

Showing up for your own life: Cognitive therapy of avoidant personality disorder


Cognitive therapy, with its emphasis on structure, time-effectiveness, action, and key thoughts, puts great demands on clients who suffer from Avoidant Personality Disorder (AVPD). Such clients typically shy away from situations in which they feel at risk for failure, rejection, embarrassment, or general discomfort. As such, cognitive therapy potentially presents AVPD clients with the very skills, knowledge, and experience they are lacking, and therefore may be particularly efficacious. On the other hand, the perceived demands of cognitive therapy can scare AVPD clients out of treatment before benefits can accrue; therefore, the therapist must tread lightly. A cognitively based conceptualization of AVPD is presented, along with its concomitant strategies for change. An illustrative case is presented, in which the client learns to chip away at his morbid fear of failure and rejection, and to develop his coping resources through gradual changes in attitudes and daily habits. © 1999 John Wiley & Sons, Inc.

Methods of restructuring personality disorders with comorbid syndromes


This article reviews the current comorbid clinical syndromes often present in the personality disordered client and offers both theoretical and practical guidelines based on research, theory, and clinical experience. A case of a client with a mixed dependent/avoidant personality disorder and comorbid anxiety disorder is presented, along with transcripts of the last phase of treatment, to demonstrate the process and technique of short-term restructuring psychotherapy, an integrative treatment approach based on psychodynamic principles and utilizing three methods of restructuring—defensive, affective, and cognitive. © 1999 John Wiley & Sons, Inc.

Research findings on the personality disorders


The personality disorders, having become officially recognized disorders separate from the symptom disorders with the arrival of DSM-III, are prevalent and debilitating conditions that require therapeutic intervention. However, research on the treatment of these disorders has been hampered by the multitude of complex and difficult issues of client heterogeneity, early dropout from treatment, length of treatment needed, manualization of therapies, and measurement of change. The existing research findings are reviewed, with an eye to the clinical implications in the treatment of these clients at this point in time. © 1999 John Wiley & Sons, Inc.

Editorial and acknowledgment of reviewers