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Expression of Personality Across the Domains of Clinical Science Expression of Personality Across the Domains of Clinical Science Application of an Informed Classification to Therapeutic Strategy 35 way to being falsified relative to the individual, and that a truly idiographic understanding of the person is close at hand, ready to be approached in a comprehensive and systematic way therapeutically. Much of the confusion that has plagued diagnostic systems in the past can be attributed to the...

Theoretical Components Of The Model

Cognitive therapy is based on a contemporary understanding of the relationships among thought, emotion, and behavior. It presumes that individuals are constantly and automatically appraising the situations they encounter and that these automatic thoughts (immediate, spontaneous appraisals) play a central role in eliciting and shaping an individual's emotional and behavioral response to a situation. For example, if I arrive on time for an appointment with my physician and am kept waiting for a...

Clinical Case Example

Georgia, a recently divorced woman in her mid-40s, initially called and left a message asking a psychologist (the author) to call, telling his secretary, I may want to hire him. She started her initial session by saying, I have a bunch of problems and described having recently been diagnosed with a recurrence of skin cancer. She continued, I think I'm borderline and described a history of verbal and physical abuse both during childhood and in her marriage. She reported having recurrent problems...

Process Of Therapeutic Change

The process of therapeutic change will be illustrated by a clinical case example discussed in terms of her current living situation and circumstances, background and history, clinical presentation, diagnostic formulation, treatment process, and a dialogue that illustrates the basic components of the model. Jillian was a 26-year-old married, Caucasian female, who was bonded as a housekeeper but not currently employed. Jillian had not finished high school and, at age 16, married an unfaithful and...

References

American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC Author. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC Author. Bandura, A. (1969). Principles of behavior modification. New York Holt, Rinehart and Winston. Barlow, D. H. (1991). Introduction to the special issues on diagnoses, dimensions, and DSM-IV The science of classification. Journal of Abnormal...

Final Acknowledgments

I am very fortunate to have had the opportunity to collaborate on this volume with some of the leading figures in the fields of personality disorders, psychotherapy, research, and pharmacotherapy. The contributors to this volume represent some of the most forward, innovative thinkers and courageous pioneers of approaches developed from their interest in alleviating human suffering and their commitment and passion for clinical work. All contributors toiled on their chapters to bring the material...

The Big Five Model And The Fivefactor Model

A very different approach to identifying the dimensions of personality takes leave of theory and instead draws on an assumption that Cattell articulated in 1943 all aspects of human personality which are or have been of importance, interest, or utility have already become recorded in the substance of the language (p. 483). This lexical hypothesis (Saucier & Goldberg, 1996) assumes that an examination of the natural language will yield a comprehensive taxonomy of personality attributes. It...

Psychopathologic Assessment Can Usefully Inform Therapy A View from the Study of Personality

Grossman A frequently overheard dialogue among psychologists and other human science professionals relates to the clinical utility of diagnostic classifications, be they via the accepted standard of the DSM-IV or alternate schemes. This debate pervades all venues and institutions, from committees currently drafting revisions of the DSM standard, to clinicians and researchers of diverse (often opposing) schools of thought, down to graduate training programs where it...

Application Of An Informed Classification To Therapeutic Strategy

The evolutionary principles from which we derive our conceptualizations of personality, and the clinical domains that underlie personologic structure and function (and in cases of syndromal distress, psychopathology) do, in our judgment, provide a useful framework for identifying both goals and methods of treatment. Before operationally explicating these facets, however, we would like to briefly describe two general clinical constructs that pervade and help structure the blending of treatment...

Complex Syndrome Treatment Goals

Before commencing with an outline of domain-oriented assessment, we would like to make distinctions between three levels of pathogenic processes simple reactions, complex syndromes, and personality patterns (styles disorders Millon et al., 1999). These three levels lie on a continuum such that the former is essentially a straightforward, often dramatic, but essentially singular symptom, unaffected by other psychosocial traits of which the-person-as-a-whole is composed (Millon, 1969). At the...

From Philosophy To Theory

A good theory should allow techniques across many modalities to be dynamically adapted, or integrated as ongoing changes in the patient occur, or as new information comes to light. What has been termed multimodal therapy in the sense of technical eclecticism (e.g., see Lazarus, 1976) is a quantum leap in terms of opening formerly rigid eyes to the many possibilities of blending data levels from different psychotherapy camps. However, eclecticism is an insufficient guide to effective synergistic...

Judith V Jordan

The DSM-III-R (American Psychiatric Association APA , 1987) defines personality traits as enduring patterns of perceiving, relating to and thinking about the environment and oneself, which are exhibited in a wide range of important social and personal contexts (p. 335). It further states that personality disorders develop when personality traits are inflexible and maladaptive and cause either significant functional impairment or subjective distress (p. 335). DSM-IV (APA, 1994) adds attention to...

Millons Evolutionary Model

We begin with the work of Theodore Millon (1969), who drew on Freud's (1915 1925) explication to develop what he initially described as a biosocial-learning theory of personality and personality disorder. Later, Millon (1996) expanded his model to present the dimensions of personality as examples of universal evolutionary principles. The earlier biosocial-learning theory and the current evolutionary model share key elements that define Millon's thinking about the basic dimensions of...

Mechanisms Of Change And Therapeutic Action

Cognitive therapy's view of the mechanisms of change focuses on understanding the persistence of dysfunctional cognitions and behaviors. Many dysfunctional cognitions persist because Many individuals are unaware of the role their thoughts play in their problems. The dysfunctional cognitions often seem so plausible that individuals fail to examine them critically. Selective perception and cognitive biases often result in the individual's ignoring or discounting experiences that would otherwise...

Personality Disorders And Social Sensitivity

Mental disorders whose prevalence changes with time and circumstance can be described as being socially sensitive. Disorders that have a stable prevalence across cultures and time can be described as being socially insensitive. Many of the socially sensitive disorders (e.g., substance abuse, eating disorders, antisocial personality, borderline personality) have externalizing symptoms. Impulsive traits, which tend to be contained by structure and limits and amplified by their absence, are...

Range Of Psychopathology And Personality Disorders Within Scope Of Treatment

Cognitive therapy was initially developed as a treatment for depression (A. T. Beck, Rush, Shaw, & Emery, 1979) and has subsequently been applied with a wide range of disorders such as anxiety disorders (A. T. Beck & Emery, 1985), substance abuse (A. T. Beck, Wright, Newman, & Liese, 1993), marital and family problems (Epstein & Baucom, 2002), and even schizophrenia (Perris & McGorry, 1998). However, although the principles of cognitive therapy apply across the full range of...

Range Of Psychopathology And Personality Disorders Within The Scope Of Treatment

Because working with the personality adaptations involves a nonpathological approach to treatment and focuses on teaching clients to use their adaptive styles in the way that will serve them best in the present, this approach is applicable to a wide range of treatment issues. Essentially, the personality adaptations are seen across the spectrum from health to dysfunction. At the healthier end of the spectrum, more of the positive aspects of the adaptations are seen. As an individual moves...

Summary And Conclusions

The interpersonal reconstructive therapy (IRT Benjamin, 2003) case formulation method requires that problem patterns be linked to learning with important early loved ones via one or more of three copy processes (1) Be like him or her, (2) act as if he or she is still there and in control, and (3) treat yourself as he or she treated you. The processes are respectively named identification, recapitulation, and in-trojection. The copying is maintained by fantasies that important persons'...

Research And Empirical Support

One of the strengths of cognitive therapy is that the approach is based on extensive research. In addition, both the adequacy of cognitive conceptualizations and the effectiveness of cognitive therapy have been tested empirically. The Validity of Cognitive Conceptualizations of Personality Disorder Cognitive conceptualizations of personality disorders are of recent vintage and, consequently, only limited research into the validity of these conceptualizations has been reported. Recent studies...

Role Of Mutual Empathy In The Therapeutic Process

The path of healing and growth both in and out of therapy is via empathy. Mutual empathy involves mutual impact, mutual care, and mutual responsiveness. It depends on repair of empathic failures and altering relational expectations created in earlier formative and nonresponsive relationships. Simply put, therapy involves a dance of responsiveness I (therapist) empathize with you (patient), with your pain (for instance), and I let you see that your pain has affected me. In short, you have...

Summary And Conclusion

The system we have termed synergistic therapy may have raised concerns as to whether any one therapist can be sufficiently skilled, not only in employing a wide variety of therapeutic approaches, but also to synthesize them and to plan their sequence. As the senior author was asked at a conference some years ago Can a highly competent behavioral therapist employ cognitive techniques with any measure of efficacy and can he prove able, when necessary, to function as an insightful intrapsychic...

The Role Of Social Structures In The Treatment Of Patients With Personality Disorders

The social factors affecting personality disorders are structurally rooted in modern society and cannot be changed by clinicians. Thus, patients with personality disorders have difficulty in finding social roles and are more likely to recover if they establish such roles. But there is no way to provide a full range of opportunities for patients. Nor can we offer them the structures provided by traditional families and communities. Nonetheless, personality-disordered patients usually benefit...

Etiology Of Personality Disorders

The causes or etiology of personality disorders is a subject of great interest to clinical scientists and empirical researchers alike. There is no question that the etiology of personality disorders is multifactorial and complex, probably with multiple developmental pathways. Attempts to reduce the cause of a complex phenomenon to one level of abstraction such as trauma, biological, social, or interpersonal are likely to be fruitless. Most clinicians have faced the question posed by family...

Contemporary Theories Of Personality Disorders And Treatment

The dominant theoretical models for understanding and treating personality disorders are generally accepted and understood. There are various other models, too, one of the most exciting of which is Eye Movement Desensitization and Reprocessing (EMDR), that have been developed or are being developed that also have application and appear to offer innovative techniques (Manfield & Shapiro, this volume). Most models, however, fall within the spectrum of the following schools psychodynamic,...

Personalityguided Context

If no one subset of DSM-IV diagnostic criteria are necessary or sufficient for membership in a diagnostic class, and if the structure of the taxonomy and the planning and practice of therapy are to be linked in a meaningful way, it seems likely that no one therapy or technique can be regarded as a necessary or sufficient remediation as well. Diagnostic heterogeneity-therapeutic heterogeneity is a more intrinsically agreeable pairing than diagnostic heterogeneity-therapeutic homogeneity, which...

Borderline Personality Disorder A Critique

We now examine Borderline Personality Disorder as an example of a personality disorder diagnosis that, it could be argued, fails in the intended goals of any diagnosis to clarify etiology, indicate treatment interventions, and determine prognosis. This diagnosis in particular may also have iatrogenic effects on many patients. For instance, one patient commented that other treaters had called her a borderline, and she added that she knew that wasn't good. In fact, she felt they were maligning...

The Relational Stance

The more the therapist practices from some theory of blank screen, neutrality, silence, or distance, the more the PTSD patient will feel anxious pressure to find the real person in the therapist to feel safe and the more the therapist will be setting limits and demarcating boundaries. Although it may seem like a question of semantics, the distinction between stating limits and setting limits gets to the heart of the way authenticity, real engagement, and mutuality operate in relational-cultural...

Prevalence Of Personality Disorders In Contemporary Society

The prevalence of personality disorders in contemporary society depends on the validity of the classification system and diagnostic instruments used to establish the presence of a disorder. As we have discussed, there are problems with classification and nosology that make estimates of prevalence only approximate. Millon and Davis (1996) write No other area in the study of psychopathology is fraught with more controversy than the personality disorders (p. 485). Nevertheless, epi-demiological...

Process Of Therapeutic Approach

The approach used in cognitive therapy has been described as collaborative empiricism (A. T. Beck et al., 1979, chapter 3). The therapist endeavors to work with the client to help him or her recognize the factors that contribute to problems, to test the validity of the thoughts, beliefs, and assumptions that prove important, and to make the necessary changes in cognition and behavior. Although it is clear that very different therapeutic approaches, ranging from philosophical debate to operant...

How Therapeutic Challenges Are Conceptualized And Managed

Although cognitive therapy may seem simple and straightforward when it is presented in a textbook or a workshop, there is no shortage of therapeutic challenges when applying cognitive therapy to the treatment of personality disorders. The complex, deeply ingrained, persistent, and inflexible problems presented by clients with personality disorders are, by all clinical accounts, difficult to treat. Authors often note that a number of problems arise in the course of treatment, including...

Transferencefocused Management Of Affect Storms

In initial interviews, borderline patients usually show far better control of affect than they are able to maintain during effective treatment. The likelihood of periods of inordinate violence of the patient's affect and its expression in action and or countertransference requires, however, that patient and therapist agree in advance on the conditions of the treatment that will make management of such episodes possible. These conditions must include the maintenance of a clear and stable...

Psychoanalytic Model Of Nosology

My classification of personality disorders centers on the dimension of severity Kernberg, 1976 . Severity ranges from 1 psychotic personality organization, to 2 borderline personality organization, to 3 neurotic personality organization. Psychotic personality organization is characterized by lack of integration of the concept of self and significant others, that is, identity diffusion, a predominance of primitive defensive operations centering on splitting and loss of reality testing. The...