Psychological therapies for personality disorder have two broadly different conceptualisations of the way in which change can occur: through the development of insight or through the learning of new skills. Most utilise both, but some have a particular emphasis on enhancing insight. The main goal of insight-oriented therapies is to increase the client's awareness of their inner experience (i.e. of core needs, emotional experiences, beliefs and value bases). The therapist helps the person to make sense of their current problems in the context of their past experiences through the use of techniques aimed at accessing or intensifying inner experience.

The insight-oriented therapies that we focus on in this chapter are: psychodynamic/psychoanalytical approaches such as transference-focused psychotherapy (Kernberg, 2004); attachment-based approaches such as mentalisation-based treatment (Bateman & Fonagy, 2004); schema therapy (Young, 1990); and cognitive analytic therapy (Ryle, 1990).

Psychodynamic/psychoanalytical approaches

Psychodynamic/psychoanalytical therapies have developed from the work of Freud and those described as the psychoanalytical ‘deviationists’ (Gelso & Hayes, 1998), including Adler, Jung, Sullivan and Fromm. Practitioners of these therapies tend to view psychological distress as being related to unconscious mental processes (Jacobs, 1998). Freud's psychoanalytical approach has been developed by others, some following his basic assumptions, others taking more independent paths. The term psychodynamic describes a wider perspective that encompasses the various analytical approaches. Jacobs suggests that psychodynamic refers to the way in which the psyche (mind/emotions/spirit/self) is seen as active and not static. This activity is not confined to our interactions with other people: it is also suggestive of internal mental processes as dynamic forces that influence our relations to others.