Evidence-based Treatment of Personality Dysfunction: Principles, Methods, and Processes

334 Pages·2010·1.353 MB·English

by  Dr Jeffrey J Magnavita PhD (editor)

Evidence-Based Treatment
of PersonalityDysfunction
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Evidence-Based Treatment
of Personality Dysfunction
Principles, Methods, and Processes
Edited by
Jeffrey J.Magnavita
AmericanPsychologicalAssociation
Washington,DC
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Copyright © 2010 by the American Psychological Association. All rights reserved. Except as
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Library of Congress Cataloging-in-Publication Data
Evidence-based treatment of personality dysfunction : principles, methods, and processes /
edited by Jeffrey J. Magnavita.
p. cm.
Includes bibliographical references and index.
ISBN-13: 978-1-4338-0747-3 (print)
ISBN-10: 1-4338-0747-5 (print)
ISBN-13: 978-1-4338-0748-0 (electronic)
ISBN-10: 1-4338-0748-3 (electronic)
1. Personality disorders—Patients—Treatment. I. Magnavita, Jeffrey J.
RC554.E94 2010
616.85'8106—dc22
2009039872
British Library Cataloguing-in-Publication Data
A CIP record is available from the British Library.
Printed in the United States of America
First Edition
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CONTENTS
Contributors............................................................................................... vii
Preface......................................................................................................... ix
Acknowledgments....................................................................................... xi
Chapter 1. Theory and Practice of Evidence About
Treatment of Personality Dysfunction............................. 3
Jeffrey J. Magnavita and William B. Stiles
Chapter 2. Evidence-Based Assessment and
Instrumentation for Personality Disorders..................... 19
Stephen Strack
Chapter 3. Dialectical Behavior Therapy........................................ 49
Clive J. Robins, M. Zachary Rosenthal,
and Prudence F. Cuper
Chapter 4. Evidence-Based Psychodynamic Therapy
With Personality Disorders............................................ 79
Stanley B. Messer and Allan A. Abbass
v
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Chapter 5. Evidence-Based Interpersonal Psychotherapy
With Personality Disorders: Theory,
Components, and Strategies......................................... 113
Jack C. Anchin and Aaron L. Pincus
Chapter 6. A Relational Approach to the Treatment
of Personality Dysfunction........................................... 167
J. Christopher Muran, Catherine Eubanks-Carter,
and Jeremy D. Safran
Chapter 7. Couples and Family Therapy
for Personality Disorders............................................... 193
Jay L. Lebow and Amanda A. Uliaszek
Chapter 8. Integrated Treatment: Combining Effective
Treatment Principles and Methods.............................. 223
W. John Livesley
Chapter 9. Methods, Components, and Strategies
of Unified Treatment: Using Evidence
and Personality Systematics to
Enhance Outcome........................................................ 253
Jeffrey J. Magnavita
Chapter 10. Treatment Planning and Formatting:
Combining Science and Art in
Implementing the Framework of Therapy................... 287
Jeffrey J. Magnavita, Kenneth L. Critchfield,
and Louis G. Castonguay
Index........................................................................................................ 307
About the Editor...................................................................................... 321
vi CONTENTS
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CONTRIBUTORS
Allan A. Abbass, MD, FRCPC,Centre for Emotions and Health, Dalhousie
University, Halifax, Nova Scotia, Canada
Jack C. Anchin, PhD, Department of Psychology, University at Buffalo—
SUNY, Buffalo, NY
Louis G. Castonguay, PhD,Department of Psychology, Pennsylvania State
University, University Park
Kenneth L. Critchfield, PhD,Utah Neuropsychiatric Institute and Depart-
ment of Psychology, University of Utah, Salt Lake City
Prudence F. Cuper, MA, Department of Psychology, Duke University,
Durham, NC
Catherine Eubanks-Carter, PhD, Brief Psychotherapy Research Program,
Beth Israel Medical Center, New York, NY
Jay L. Lebow, PhD, ABPP,The Family Institute at Northwestern Univer-
sity, Evanston, IL
W. John Livesley, MD, PhD, Department of Psychiatry, University of
British Columbia Vancouver, British Columbia, Canada
Jeffrey J. Magnavita, PhD, ABPP,Glastonbury Psychological Associates, P.C.
Clinical Affiliate Staff, Department of Psychiatry Hartford Hospital, Uni-
fied Psychotherapy Project, Glastonbury, CT
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Stanley B. Messer, PhD,Graduate School of Applied and Professional Psy-
chology, Rutgers University, Piscataway, NJ
J. Christopher Muran, PhD, Derner Institute for Advanced Psychological
Studies, Adelphi University, Garden City, NY; Brief Psychotherapy
Research Program, Beth Israel Medical Center, New York, NY
Aaron L. Pincus, PhD,Department of Psychology, Pennsylvania State Uni-
versity, University Park
Clive J. Robins, PhD, ABPP, ACT,Department of Psychiatry and Behav-
ioral Sciences, Duke University Medical Center, Durham, NC
M. Zachary Rosenthal, PhD,Department of Psychiatry and Behavioral Sci-
ences, Duke University Medical Center, Durham, NC
Jeremy D. Safran, PhD,Department of Psychology, New School for Social
Research, New York, NY; Brief Psychotherapy Research Program, Beth
Israel Medical Center, New York, NY
William B. Stiles, PhD, Department of Psychology, Miami University,
Oxford, OH
Stephen Strack, PhD, United States Department of Veterans Affairs, Los
Angeles, CA; Fuller Graduate School of Psychology, Pasadena, CA
Amanda A. Uliaszek, MS,Northwestern University, Evanston, IL
viii CONTRIBUTORS
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PREFACE
The treatment of personality disorders—or, more broadly, personal-
ity dysfunction—is a rapidly evolving focus of contemporary mental health
practice. The study of personality, which fell out of favor for a period in aca-
demic psychology and now is in resurgence, remains a useful construct for cli-
nicians and clinical researchers. Personality offers a tool that helps clinicians
organize complex interrelated sets of phenomena in a manner that allows for
optimal clinical strategizing. Most contemporary theorists and clinical scien-
tists view personality as a complex system that has self-organizing qualities
and, although prone to chaos, also has discernable patterns for which tools of
science and pattern recognition can be used. Many of these ways of using pat-
tern recognition are presented by the authors in this volume, who have consid-
erable clinical and research experience and have been able to distill and refine
these in a manner that will be of great benefit to clinical practitioners.
This volume was conceived during a period of critical transition for clin-
ical science and practice. The need for clinical services has never seemed
greater in contemporary time than since the return of the veterans after World
War II. The demands of contemporary society and the need to adjust to rapid
global changes, economic stressors, technological change, climate change,
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population shifts, and cultural blending is stressing many members of society
beyond their ability to cope and adapt. Personality dysfunction seems ubiqui-
tous and can be seen taking its toll at every level of society. We live in a time
where those tasked with leading our major institutions have shown levels of
deviant behavior that previously seemed unimaginable to those who entrusted
them to safeguard society. Social, political, economic, and global stressors have
trickled down to families who must adapt to ever-decreasing resources and
institutional safeguards.
Clinicians are under siege as well. We are asked to provide assistance to
increasingly more difficult conditions with greater pressure to get results in a
cost-effective manner. The cost of personality disorders to society is enormous,
and yet there is little in the way of political will to identify and address these
conditions. There still remains a stigma and a denial of the problem in regard
to clinical mental health treatment. Unfortunately, personality disorders,
although they likely have some genetic underpinnings, are transferred from
generation to generation via the multigenerational transmission process. These
patterns of dysfunction are transmitted through a variety of mechanisms,
including not only child abuse and neglect but also poverty, discrimination,
marginalization, and social factors.
Clinicians need to base their best practices on the most current research
available to them to maximize their treatment impact; however, the available
evidence for clinicians is not so readily accessible. The sources of evidence that
are required to provide an evidence-based practice are not so easy to find.
Complicated treatment decisions require lines of evidence from multiple
sources that for many clinicians are beyond their resources to efficiently find.
This volume was conceived as a way for those who are at the forefront of the-
ory, research, and practice to distill what is most important from the extant
evidence base. Clearly, a volume of this size can never present all the informa-
tion a clinician needs to know, but the authors in this volume did their best to
bring together the evidence they think is critical to guide practice. Each con-
tributor worked diligently within stringent space constraints to offer readers
the best that he or she could find in the evidence and show how it can be used
to optimize treatment. It was truly a pleasure and a labor of love to work with
such an esteemed group of clinical scientists, and I hope readers will share our
excitement about what can be done in the hands of a compassionate clinician
who is using the best evidence available to enhance personality adaptation and
functioning at all levels in our society.
x PREFACE