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lecture 6 full summary personality disorder
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Lecture 6 – Individual TreatmentLearning goals:
• For MBT, TFT, SFT and DBT:
o To identify and distinguish the different models, key components of each model.
o To identify and distinguish the underlying working mechanism of each model.
o To apply this knowledge to clinical examples and illustrations.
o To identify the key characteristics of AIP and EMDR therapy for PD.
o To identify the key characteristics of effective research re: psychotherapy.
o Dodo-bird hypothesis and pitfalls.
o Factors responsible for therapeutic change.
o Differences over time (pre/during/post).
o To apply knowledge re: the effectiveness of psychotherapy to evaluate research findings and
statements.
à Treatment Models of PDs
1. Mentalisation-Based Therapy (MBT) à psychodynamically orientated.
- Mentalization = capacity to understand/interpret underlying mental states of
behaviours
o Involves making sense of self/other actions based on mental states
= desires, feelings, beliefs.
o Capacity that develops through having experienced oneself in the
mind of another during childhood (empathy?) within an attachment
context (developmental achievement)
o Crucial to self-regulation, constructive, intimate relationships.
- How to we learn to mentalize
, - Goal
• To target mentalisation to foster the development of stable internal
representations.
• To aid the formation of a coherent sense of self and enable the patient to
form more secure relationships in which (motivations of) the self/other are
better understood.
- Objective: From pre-mentalizing states to mentalizing
• Teleological mode: actions = reality.
• Psychic equivalence: mental reality = outer reality.
• Pretend mode: external world is shut out.
- Therapist
• Here-and-now
• Not-knowing, empathic attitude.
• (active): “stop-rewind-explore”.
• Short interventions based on feelings.
2. Schema Focused Therapy (SFT) à Cognitive behaviourally orientated.
- Cognitive therapy dealing with early maladaptive schemas, focusing on deepest level
of cognition.
- Schemas are self-defeating emotional/cognitive patterns established from childhood,
repeated through life.
- Early Maladaptive Schemas used as basic unit of analysis, schema modes therapy
developed for PDs, BPD.
3. Dialectical Behaviour Therapy (DBT) à Cognitive behaviourally orientated.
4. Transference Focused Psychotherapy (TFP) à psychodynamically orientated
Emmelkamp 2020, Personality Disorders, Chapter 10 – Treatment of Personality Disorders
Treatment for Mixed Cluster C PDs
- Psychodynamic psychotherapy – confrontational + more supportive approach
• Predominantly cluster C patient sig. improvement on measure or distress,
social functioning.
• ST Dynamic vs. Cognitive Therapy
• Both groups improved and continued to at 2 years, in distress, avoidant
behaviour.
- Schema Therapy vs alternative
• Greater proportion of patients recovered in schema therapy.
• Effective in older Cluster C patients (mean 69), LT results less positive.
• More symptomatic complaints LT, but Cluster B improved in SFT in LT.
, Avoidant PD – formed persistent negative representations that direct their social encounters.
o Behavioural approaches/strategies (exposure, social skills training) effective than controls.
• Interpersonal problems related to distrust; anger decreased from exposure
but not from SST.
• Interpersonal problems related to being coerced, controlled benefitted from
both types of strategies.
- Cognitive therapy, focusing on negative schemas/cognitions.
• Since patients may misinterpret ambiguous social info., includes to infer
rejection they will avoid social situations.
• Cognitive/behavioural strategies challenge these negative
inferences/expectations on social encounters.
• Behavioural exposure helps patients habituate to aversive social stimulation.
- CBT vs Brief Dynamic Therapy
• CBT assumption that anxiety/avoidance = maladaptive beliefs/thoughts.
• Socratic dialogue, monitoring of beliefs, analysis of pro/cons of avoidance,
active monitoring/scheduling, graded exposure assignments, behavioural
experiments, role play.
• BDT assumes anxiety/avoidance = unconscious psychodynamic conflicts
(shame).
• Unconscious conflict can be clarified/resolved with expressive techniques:
clarification, confrontation, interpretations.
• Supportive techniques: suggestion, reassurance, encouragement, therapist
clarifies not confront defences to regulate not provoke anxiety.
• Treatment directs at defence/affect restructuring.
o CBT more effective than BDT.
Psychotherapy for BPD
CBT for BPD
o Identify core dysfunctional beliefs/automatic thoughts (negative, polarized, extreme
helplessness, distrust, fear of abandonment/rejection.
DBT: structured, compassionate approach, focus on problems of dysregulation.
- Emotional dysregulation (from interaction between biologically emotional vulnerable
person and invalidating environment= invalidating the person, leading to
dysregulation of interpersonal/cognitive domains) as core of BPD.
- DBT based on CBT combined with acceptance, mindfulness, and dialects.
- CBT aids change, DBT emphasizes importance of support/acceptance in
promoting/learning changes.
- Differs from CBT as it directed to teaching new skills than emphasizing cognitive
restructuring.
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