Health> Vol.5 No.5, May 2013
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Integrative therapy for personality disorders: Experiences in developing integrative approaches for treatment-refractory personality-disordered clients

ABSTRACT

Personality Disordered (herein referred to as PD) clients are challenging to statutory mental healthcare programmes. They can be difficult to diagnose: their disorders can be obscured by second-order problems such as anxiety and depression, caused by PD cognitive processes. Treatment-as-usual (the predominant model of psychiatric intervention) for PD clients in crisis tends to focus on these second-order presentations, but provide no means of identifying underlying PD. The purpose of this paper is to describe how heuristic methods of diagnosis can be used to reframe the client’s distress in the context of personality disorders (according to DSM-IV criteria), and how subsequent application of integrative therapies can break their cycle of recidivism. Method: Two case studies of treatment-refractory individuals with cyclical patterns of crisis-point service engagement for self-harm or psychotic depression where heuristic/ integrative therapies were used. Results: The use of integrative therapies in the case studies presented resulted in a marked change in recidivism and quality of life for each client, as measured by a significant reduction in presentation of symptoms and hypervigilance. Discussion: By understanding the maladaptive cognitive-behavioural processes of PD clients, they can be modified to reduce the client’s self-defeating behavioural patterns, breaking the cycle of recidivism. However, a new diagnostic strategy must first be formulated that looks at the clients past use of mental health services to detect underlying PD.

KEYWORDS


Cite this paper

Hussain, N. (2013) Integrative therapy for personality disorders: Experiences in developing integrative approaches for treatment-refractory personality-disordered clients. Health, 5, 847-854. doi: 10.4236/health.2013.55112.

References

[1] Gunderson, J. and Links, P. (2005) Borderline personality disorder: A clinical guide. 2nd Edition, American Psychiatric Press, Washington DC.
[2] Sieswerda, S., Arntz, A. and Kindt, M. (2007) Successful psychotherapy reduces hyper vigilance in borderline personality disorder. Behavioural and Cognitive Psychotherapy, 35, 387-402. doi:10.1017/S1352465807003694
[3] Dimaggio, G., Carcione, A., Salvatore, G., Semerari, A., and Nicolò, G. (2010) A rational model for maximizing the effects of therapeutic relationship regulation in personality disorders with poor metacognition and overregulation of affects. Psychology and Psychotherapy: Theory Research and Practice, 83, 363-384. doi:10.1348/147608310X485256
[4] National Institute Collaborating Centre for Mental Health (2009) Borderline personality disorder: Treatment and management. National Institute for Health and Clinical Excellence, Holborn.
[5] Foerstch, C., Manning, S.Y. and Dimeff. L. (2003) Difficult-to-treat patients: The approach from dialectical behaviour therapy. In: Leahy, L.R., Ed., Roadblocks in Cognitive Behavioural Therapy, The Guildford Press, New York, 225-273.
[6] Goin, K.M. (2001) Borderline personality disorder: The importance of establishing a treatment framework. Psychiatric Services, 52, 167-168. doi:10.1176/appi.ps.52.2.167
[7] Leahy, L.R. (2003) Emotional schemas and resistance. In: Leahy, L.R., Ed., Roadblocks in Cognitive Behavioural Therapy, The Guildford Press, New York, 91-115.
[8] Leahy, L.R. (2003) Roadblocks in cognitive-behavioural therapy. The Guildford Press, New York.
[9] Sarkar, J. (2012) Clinical topics in personality disorder. Royal College of Psychiatry, London.
[10] Linehan, M.M. (1993) Dialectical behavior therapy for borderline personality disorder. The Guildford Press, New York.
[11] Paris, J. (1996) Social factors in the personality disorders: A biopsychosocial approach to etiology and treatment. Cambridge University Press, New York. doi:10.1017/CBO9780511722165
[12] Paris, J. (2008) Treatment of borderline personality disorder: A guide to evidence-based practice. The Guildford Press, New York.
[13] Bateman, A. and Fongay, P. (2008) Mentalization-based treatment for BPD. Social Work in Mental Health, 6, 187-201. doi:10.1300/J200v06n01_15
[14] Hayes, S. (2012) Acceptance and commitment therapy (theories of psychotherapy). The American Psychological Association, Washington DC.
[15] Jones, B. and Miller, S. (2011) Emerging as a personality disorder service. Psychoanalytic Psychotherapy, 25, 191- 208. doi:10.1080/02668734.2011.576499
[16] Bourke, E.M. and Greyner, F.S.B. (2010) Psychotherapists’ response to borderline personality disorder: A core conflictual relationship theme analysis. Psychotherapy Research, 20, 680-691. doi:10.1080/10503307.2010.504242
[17] Holland, J.S. (2003) Avoidance of emotion as an obstacle to progress. In: Leahy, L.R., Ed., Roadblocks in Cognitive Behavioural Therapy, The Guildford Press, New York, 116-131.
[18] Allen, M.D. and Whitson, S. (2004) Avoiding patient distortions in psychotherapy with borderline personality disorder patients. Journal of Contemporary Psychotherapy, 44, 211-227.
[19] Gunderson, J. (2010) Update on borderline personality disorder. Gatineau, Quebec.
[20] Zanarini, M.C. (2009) Psychotherapy of borderline personality disorder. Acta Psychiatrica Scandinavica, 120, 373-377. doi:10.1111/j.1600-0447.2009.01448.x
[21] Bateman, A., Ryle, A., Fongay, P. and Kerr, B.I. (2007) Psychotherapy for borderline personality disorder: Mentalization based therapy and cognitive analytic therapy compared. International Review of Psychiatry, 19, 51-62. doi:10.1080/09540260601109422
[22] Chapman, A. and Gratz, K. (2011) The dialectical behavior therapy skills workbook for anxiety: Breaking free from worry, panic, PTSD & other anxiety symptoms. New Harbinger Publications, Oakland.
[23] Hanh, H.T. (2006) Anger: Wisdom for cooling the flames. Riverhead Books, New York.

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