Adolescent Identity Treatment: An Integrative Approach for Personality Pathology PDF
Preview Adolescent Identity Treatment: An Integrative Approach for Personality Pathology
Adolescent Identity Treatment An Integrative Approach for Personality Pathology Pamela A. Foelsch Susanne Schlüter-Müller Anna E. Odom Helen T. Arena Andrés Borzutzky H. Klaus Schmeck 123 A dolescent Identity Treatment P amela A. F oelsch • S usanne S chlüter-Müller A nna E. O dom • H elen T. A rena A ndrés Borzutzky H. • K laus S chmeck A dolescent Identity Treatment A n Integrative Approach for Personality Pathology P amela A. F oelsch, PhD H elen T. A rena, PhD N ew York-Presbyterian Hospital N ew York-Presbyterian Hospital W eill Cornell Medical College Weill Cornell Medical College W hite Plains, N Y White Plains, NY U SA USA S usanne S chlüter-Müller A ndrés Borzutzky H . P sychiatry and Psychotherapy I nstituto Médico Schilkrut P ractice for Child- and Adolescent S antiago, Las Condes F rankfurt C hile G ermany K laus S chmeck A nna E. O dom, PhD P sychiatric University Hospitals N ew York-Presbyterian Hospital B asel W eill Cornell Medical College S witzerland W hite Plains, N Y U SA I SBN 978-3-319-06867-1 ISBN 978-3-319-06868-8 (eBook) D OI 10.1007/978-3-319-06868-8 S pringer Cham Heidelberg New York Dordrecht London L ibrary of Congress Control Number: 2014944384 © Springer International Publishing Switzerland 2 014 T his work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied specifi cally for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher's location, in its current version, and permission for use must always be obtained from Springer. Permissions for use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable to prosecution under the respective Copyright Law. T he use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. P rinted on acid-free paper S pringer is part of Springer Science+Business Media (www.springer.com) W e dedicate this manual to P aulina Fischer Kernberg w ith deep gratitude for all that she has taught us w ith her extraordinary and unique personality P refa ce In 2000, Paulina Kernberg et al. proposed a model for understanding identity pathology in children and adolescents. Her emphasis was on the need to differentiate adolescents with normal identity crisis from those with identity diffusion. Identity crisis generally resolves into a normal, consolidated identity with fl exible and adap- tive functioning; whereas, identity diffusion is viewed as the source for subsequent personality pathology, including borderline personality disorder (BPD), leading to a broad spectrum of maladaptive and dysfunctional behaviors. In 2005, a clinical supervision study group co-led by Drs. Paulina Kernberg and Pamela Foelsch began to develop a treatment, adolescent identity treatment (AIT), which aims to facilitate the integration of identity. In the same year, Dr. Kernberg was invited to be a Visiting Professor at the Child and Adolescent Psychiatry Department of the University of Ulm, by Klaus Schmeck, which led to a lively collaboration between us. I n subsequent years, several international clinical and research groups in Barcelona, Spain; Basel, Switzerland; Frankfurt, Germany; Mexico City, Mexico; Santiago, Chile; and Sao Paulo, Brazil, have joined the White Plains, NY, USA group. All are dedicated to Dr. Paulina Kernberg’s concept of how to assess and treat adolescents with personality pathology and their families. Members of this international group are working together in acknowledgement and deep honor to Dr. Paulina Kernberg, who passed away in 2006, and maintain the strong desire and will to continue her work, as it was her wish. There are many people who have been essential to the development of this work. At the Weill Cornell Medical College and New York-Presbyterian Hospital, Dr. Foelsch trained and taught for 18 years the Personality Disorders Institute Fellows who participated in the weekly seminars, and especially wishes to thank those who have dedicated their time and energy to the more mundane tasks of data entry and coding videotapes. A special thank you to the staff and trainees of the Outpatient Department of the New York-Presbyterian Hospital in White Plains, especially Dr. James Rebeta, Dr. Steve Hurt, Maura Lehr, Berkeley Cooley, Nina Huza, Carrie Christenson, Julia Ball, and numerous post-doctoral fellows and vol- unteers. We especially want to thank Dr. Jeanne Dietrich for adding depth to our supervision and case discussions. We thank the therapists who courageously allowed vii viii Preface videotaping of their clinical work. We also want to thank our colleagues Ana Maria Rodriguez and Joaquin Celis at the University de los Andes, and the clinicians at the El Salto clinic, as well as the clinical staff at the Schilkrut Institute, all from Santiago de Chile, for providing challenging clinical material to stimulate our thinking through weekly supervisions via the Internet. Through the many clinical case dis- cussions, this manual emerged as an integrative model for the treatment of personal- ity pathology in adolescents, drawing upon object relations, family systems, attachment, neurobiology, and cognitive behavioral approaches. We thank Moises Kassin for his commitment and efforts in adapting this manual in Spanish, and his support and enthusiasm for this project. We also thank our patients and their fami- lies for sharing their experiences with us through their words and actions of what worked and what didn’t. In choosing to name people individually, we run the risk of overlooking others who have contributed, and we sincerely apologize for this. We want to acknowledge you all. W hite Plains, N Y, U SA P amela A . F oelsch, P hD F rankfurt, G ermany S usanne S chlüter-Müller W hite Plains, N Y, U SA A nna E . O dom, P hD W hite Plains, N Y, U SA H elen T . A rena, P hD S antiago, Las Condes, C hile A ndrés Borzutzky H . B asel, S witzerland K laus S chmeck C ontents 1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Normal Identity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Identity Crisis and Identity Diffusion . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2 Description of the Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Terminology and Defi nition. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 D efi nition and Criteria of Personality Disorders According to ICD-10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 D efi nition of Personality Disorders According to DSM-IV-TR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Defi nition and Criteria of Personality Disorders According to DSM-IV-TR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Transition to DSM-5. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Course and Prognosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Diagnostic Procedures and Differential Diagnosis . . . . . . . . . . . . . . . . . 9 Literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 3 Theoretical Models and Rationale . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Models of the Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Neurobiological Vulnerability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Sequence of Growth and Implications for Continued Development. . . . 15 Attachment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Regulation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Theory Underlying the Individual Psychotherapy. . . . . . . . . . . . . . . . . . 18 Object Relations Theory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Developmental Theory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Identity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Further Concepts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Emerging Adulthood. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Theory Underlying the Environmental Interventions . . . . . . . . . . . . . . . 35 Literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 ix
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