A Cognitive-Interpersonal Approach to the Treatment of Personality Disorders

By Safran, Jeremy D.; McMain, Shelley | Journal of Cognitive Psychotherapy, January 1, 1992 | Go to article overview

A Cognitive-Interpersonal Approach to the Treatment of Personality Disorders


Safran, Jeremy D., McMain, Shelley, Journal of Cognitive Psychotherapy


In recent years there has been a growing interest in the application of cognitive therapy procedures to clients with personality disorders. In this article it is suggested that the interest in personality disorders is consistent with a renewed interest in the basic concept of personality, and that there is a need for systematic theory regarding the fashion in which consistencies in construal style and interpersonal patterns develop. A number of relevant theoretical developments are briefly summarized and their implications for treatment are explored.

PERSONALITY AND COGNITIVE THEORY

Recent years have seen a growing interest in the application of cognitive therapy to clients with personality disorders. Concurrent with this has been an interest in the articulation of appropriate conceptual and procedural refinements. These developments reflect an acknowledgment of the limitations of traditional cognitive therapy techniques with a number of patients.

They also reflect a growing trend toward broadening cognitive conceptualizations and procedures by incorporating theoretical and technical developments from other psychotherapy traditions. This in turn is consistent with a movement toward integration in the psychotherapy field in general. Finally, the current interest in the adaptation of cognitive therapy procedures for personality disorders is congruent with renewed interest in personality and personality disorders in the psychological literature in general. This focus stems in part from the development of Axis II diagnoses in the DSM III and DSMIII-R. In addition, there has been a reconceptualization of personality as theorists move beyond the original behavioral objection to the concept of personality toward an understanding of personality which is more cognitive in nature (Mischel, 1973; 1979).

While an interest in personality constellations has always been central in psychodynamic theory, cognitive therapists have traditionally avoided such theorizing. This avoidance is consistent with the critical perspective on the concept of personality which was characteristic of the behavioral tradition from which the cognitive tradition in part emerged.

The behavioral rejection of the concept of personal!ty is well marked historically by MischeFs influential book Personality and Assessment (Mischel, 1968), in which he masterfully documented the difficulty of demonstrating consistencies in personality. As Mischel (1973, 1979) has suggested, this book was widely misunderstood as an attack on the very concept of personality and as a situationalist' s manifesto. In fact, however, Mischel's intention was to document the potential hazards involved in the common clinical practice of inferring dispositions on the basis of flimsy evidence. As Mischel (1979) stated:

My intentions in writing that book were not to undo personality but to defend the individuality and the uniqueness of each person against what I saw as the prevalent form of clinical hostility: the tendency to use a few behavioral signs to categorize people enduringly and into fixed slots on the basis of the assessor's favorite nomothetic trait dimensions and to assume that these slot positions were sufficiently informative to predict specific behavior and to make extensive decisions about a person's whole life (p. 740).

The criticism of the traditional approach to personality is not that people do not display regularities or consistencies in behavior. Instead the objection is to the practice of inferring broad dispositions on the basis of behavioral signs and then interpreting future behaviors as reflections of these underlying dispositions. It is this type of self-fulfilling prophecy in which clinicians succumb to the "illusion of validity" (Kahneman & Tversky, 1973) which is particularly problematic. Cognitive therapists, by excluding the concept of personality from their purview in the past, have hopefully avoided some of the pitfalls of careless dispositional attribution. …

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