Practical Management of Personality Disorder

Practical Management of Personality Disorder

Practical Management of Personality Disorder

Practical Management of Personality Disorder

Synopsis

This volume takes a multi-level approach to understanding and treating personality disorder, identifying core symptoms and problems that many patients share and providing a comprehensive framework for clinical intervention. Rather than presenting a particular model of therapy, W. John Livesley shows how a wide variety of empirically supported interventions can be used to manage specific components of an integrated treatment plan. Drawing on etiological knowledge as well as outcome research, the book identifies effective strategies for addressing key areas of the patient's psychosocial and biological functioning. The clinician learns how to conceptualize the phases of treatment and use the stages-of-change model as a guide for sequencing and selecting appropriate interventions. Pragmatic and flexible, the research-based strategies presented here are applicable in diverse settings, in therapies ranging from crisis intervention to long-term treatment.

Excerpt

This volume deals with the treatment of severe personality disorder. The intent is to describe a practical approach based on what we know about personality disorder and interventions that work. A general framework is presented that will be useful to practitioners and trainees from all mental health disciplines working in such diverse settings as general hospital inpatient units, outpatient departments, community mental health services, managed care programs, and private offices. The approach provides guidelines for treating patients in therapies ranging from crisis intervention to long-term treatment.

In organizing my ideas about personality disorder and its treatment, I have attempted to address the questions posed by clinicians from all disciplines attending lectures and workshops that I have presented for more than two decades. Typically, two kinds of questions are raised: general and situation-specific. Questions of a general nature are usually variations on such themes as: [What is personality disorder?], [How do you treat personality disorder?], and [Can personality disorder really be treated?] More specific questions take the broad form of [What should I do when … ?] followed by a variety of problems including suicide threats, crises developing during long-term treatment, attempts to change the treatment plan, missing therapy sessions, attending sessions under the influence of alcohol, refusing to leave at the end of a session, demanding more time, and so on.

Both types of questions suggest that (1) the questioners would have benefited from a systematic account of personality disorder and a framework for organizing treatment, and (2) many clinicians rely on tactical interventions to deal with problems as they surface during treatment, rather than use an overall treatment strategy based on an understanding of the pathology involved. Although the clinicians were not inexperienced, uninterested, or uninformed, they probably acted in this way because person-

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