Psychotherapy of Personality Disorders: Metacognition, States of Mind, and Interpersonal Cycles

Psychotherapy of Personality Disorders: Metacognition, States of Mind, and Interpersonal Cycles

Psychotherapy of Personality Disorders: Metacognition, States of Mind, and Interpersonal Cycles

Psychotherapy of Personality Disorders: Metacognition, States of Mind, and Interpersonal Cycles

Synopsis

An accurate description of the problems associated with personality disorders can lead to psychotherapists providing better treatment for their patients, alleviating some of the difficulties associated with handling such disorders. The authors draw on existing therapeutic approaches and concepts to offer a treatment model for dealing with personality disorders. Psychotherapy of Personality Disorders clearly discusses the models for different types of personality disorder, along with general treatment principles, focusing on: principles for identifying and classifying types of disorder; theoretical analyses that are characteristic of each type; and practical therapeutic principals that are grounded in the basic theory. The language is clinician-friendly and the therapeutic model is illustrated with clinical cases and session transcripts making this title essential reading for psychotherapists, personality disorder researchers and cognitive scientists as well as professionals with an interest in personality disorders.

Excerpt

Giancarlo Dimaggio, Antonio Semerari, Antonino Carcione, Giuseppe Nicolò and Michele Procacci

Defining personality disorders

The concept that the way in which an individual relates to others can in itself be pathological is today well accepted (Livesley 2001a). Personality gets created out of various mental operations: building self-image, ascribing meaning to the world, performing actions, relating with others and finding solutions to the problems presented by one’s social environment. There can be a malfunctioning of these operations and, when this spreads to wide areas of interpersonal and inner life, it takes a personality disorder (PD) form.

Clinical experience and empirical research show that comorbidity in PDs worsens a prognosis on axis I, slows down any response to treatment and makes it less effective (Pilkonis and Frank 1988). In particular, it worsens the prognosis for depression (Charney et al. 1981; Frances et al. 1986; McGlashan 1987; Shea et al. 1990). There are similar data for anxiety, somatoform and substance abuse disorders (Reich and Vasile 1993; Stein et al. 1993). Taking a wider view, embracing how individuals organise their inner world, together with relations with others and group affiliation (i.e. the functions of the personality), is essential.

Our book is based on the following assumptions: (1) PDs are categorised by prototypes, featuring common aspects, which get expressed in identifiable modes of intrapsychical and interpersonal functioning (Millon and Davis 1996; Westen and Shedler 2000); (2) each different prototype presents separate clinical problems.

It is indispensable that a pathological type and how it functions be diagnosed correctly if we are to deal with the real problems, not waste time in futile tasks, make treatment more effective and reduce drop-out rates. The central question we are trying to answer is: how are we to explain why a disorder persists and perpetuates itself? Let us imagine a man whose life theme is inadequacy, coupled with feeling embarrassed. When he starts a relationship, he expects to be derided and rejected. Let us take this imaginary exercise further: he is not a skilled psychologist and does not . . .

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