Book contents
- Frontmatter
- Contents
- List of contributors
- Preface
- 1 Treatability in severe personality disorders: how far do the science and art of psychotherapy carry us?
- 2 The treatment of choice: what method fits whom?
- 3 Countertransference: recent developments and technical implications for the treatment of patients with severe personality disorders
- 4 Beyond management to cure: enhancing the positive dimensions of personality
- 5 Personality disorders from the perspective of child and adolescent psychiatry
- 6 Disruptions in the course of psychotherapy and psychoanalysis
- 7 Managing suicidal crises in patients with severe personality disorders
- 8 Borderline personality disorder, day hospitals, and mentalization
- 9 Pharmacotherapy of severe personality disorders: a critical review
- 10 Severe cases: management of the refractory borderline patient
- 11 Dangerous cases: when treatment is not an option
- 12 Stalking of therapists
- 13 Common elements of effective treatments
- Index
- References
2 - The treatment of choice: what method fits whom?
Published online by Cambridge University Press: 14 August 2009
- Frontmatter
- Contents
- List of contributors
- Preface
- 1 Treatability in severe personality disorders: how far do the science and art of psychotherapy carry us?
- 2 The treatment of choice: what method fits whom?
- 3 Countertransference: recent developments and technical implications for the treatment of patients with severe personality disorders
- 4 Beyond management to cure: enhancing the positive dimensions of personality
- 5 Personality disorders from the perspective of child and adolescent psychiatry
- 6 Disruptions in the course of psychotherapy and psychoanalysis
- 7 Managing suicidal crises in patients with severe personality disorders
- 8 Borderline personality disorder, day hospitals, and mentalization
- 9 Pharmacotherapy of severe personality disorders: a critical review
- 10 Severe cases: management of the refractory borderline patient
- 11 Dangerous cases: when treatment is not an option
- 12 Stalking of therapists
- 13 Common elements of effective treatments
- Index
- References
Summary
Two dominant methods can be utilized today for matching the individual patient with the most optimal treatment. The method receiving extensive attention at this time is the empirically supported treatment movement (Chambless and Hollon, 1998). In this methodology, the patient who presents with a particular DSM disorder is matched with a therapist who is armed with a specific treatment, usually cognitive-behavioral, that will focus on and alleviate the symptom in a brief period of time. The suggestion that it is unethical to do otherwise implies that our training programs for clinicians should be focused on this match of patient symptoms with cognitive-behavioral technology.
However, a number of issues make one pause and resist joining the band-wagon of the empirically supported psychotherapy movement:
Most patients present with more than one, clearly defined, DSM disorder. This is especially true of those individuals with severe personality disorders.
Focused cognitive-behavioral treatments are limited in their effectiveness in the short-run, and often seem inadequate in the long-run. At termination from short-term treatment, a majority but not all patients has been helped with his/her symptoms. Upon follow-up, a much smaller group of patients has maintained their gains (Westen and Morrison, 2001).
The emphasis on therapy as a set of technical interventions tends to ignore the attributes of the therapist beyond just his/her skill in delivering specific techniques. This metaphor of a therapist as a dispenser of techniques leads logically to a computer providing programmed direction.
If a treatment fails and the patient drops out prematurely, it is often assumed that the patient's characteristics are the major contributor to the disruption. We have examined data describing such patients, including but not limited to diagnosis (Clarkin and Levy, 2004). The therapist's contribution to the failure has been less frequently examined.
- Type
- Chapter
- Information
- Severe Personality Disorders , pp. 30 - 41Publisher: Cambridge University PressPrint publication year: 2007