Metacognitive interpersonal therapy for personality disorders: A Treatment Manual

278 Pages·1907·14.48 MB·English

by  Giancarlo Dimaggio, Antonella Montano, Raffaele Popolo, Giampaolo Salvatore

M etacognitive Interpersonal
Therapy for Personality
Disorders
Patients with personality disorders need targeted treatments which are able to
deal with the specifi c aspects of the core pathology and to tackle the challenges
they present to the treatment clinicians. Such patients, however, are often diffi cult
to engage, are prone to ruptures in the therapeutic alliance and have diffi culty
adhering to a manualised treatment.
G iancarlo Dimaggio, Antonella Montano, Raffaele Popolo and Giampaolo
Salvatore aim to change this, and have developed a practical and systematic
manual for the clinician using metacognitive interpersonal therapy (MIT) and
including detailed procedures for dealing with a range of personality disorders.
The book is divided into two parts, Pathology, and Treatment, and provides precise
instructions on how to move from the basic steps of forming an alliance, drafting
a therapy contract and promoting self-refl ections to the more advanced steps of
promoting change and helping the patient move toward health and adaptation.
W ith clinical examples, summaries of therapies and excerpts of session tran-
scripts, M etacognitive Interpersonal Therapy for Personality Disorders will be
welcomed by psychotherapists, clinical psychologists and other mental health
professionals involved in the treatment of personality disorders.
G iancarlo Dimaggio is a co-founding member of the Center for Metacognitive
Interpersonal Therapy. He is the author of four books and numerous articles.
A ntonella Montano is a founding member and director of the psychotherapy
school at A. T. Beck Institute for Cognitive Behavior Therapy. He is a teacher
and supervisor of the Associazione Italiana Analisi e Modifi cazione del
Comportamento (AIAMC), a certifi ed trainer/consultant/speaker/supervisor of
the Academy of Cognitive Therapy (ACT), a member of the International
Association for Cognitive Psychotherapy (IACP) and a member of the International
Society for Sexual Medicine (ISSM).
R affaele Popolo is a co-founding member of the Center for Metacognitive
Interpersonal Therapy, a trainer at the Società Italiana di Terapia Comportamentale
e Cognitiva (SITCC) and a trainer of the psychotherapy school ‘Studi Cognitivi’.
He has written papers on psychopathology and the treatment of personality
d isorders and psychosis.
G iampaolo Salvatore is a co-founding member of the Center for Metacognitive
Interpersonal Therapy, a trainer at A. T. Beck Institute for Cognitive Behavior
Therapy. He has written papers about the psychotherapeutic process and the
pathology and treatment of schizophrenia and personality disorders, and in
particular of persons with paranoid features.
M etacognitive
Interpersonal Therapy for
Personality Disorders
A treatment manual
G iancarlo Dimaggio, Antonella
Montano, Raffaele Popolo and
Giampaolo Salvatore
F irst published 2015
b y Routledge
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a nd by Routledge
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R outledge is an imprint of the Taylor & Francis Group, an informa business
© 2015 Giancarlo Dimaggio, Antonella Montano, Raffaele Popolo and
Giampaolo Salvatore
T he right of Giancarlo Dimaggio, Antonella Montano, Raffaele Popolo and
Giampaolo Salvatore to be identifi ed as authors of this work has been
asserted by them in accordance with sections 77 and 78 of the Copyright,
Designs and Patents Act 1988.
A ll rights reserved. No part of this book may be reprinted or reproduced
or utilised in any form or by any electronic, mechanical, or other means,
now known or hereafter invented, including photocopying and recording,
or in any information storage or retrieval system, without permission in
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T rademark notice: Product or corporate names may be trademarks or
registered trademarks, and are used only for identifi cation and
explanation without intent to infringe.
B ritish Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
L ibrary of Congress Cataloging-in-Publication Data
Dimaggio, Giancarlo, author.
[Terapia metacognitiva interpersonale per i disturbi di personalit?. English]
Metacognitive interpersonal therapy for personality disorders : a
treatment manual / Giancarlo Dimaggio, Antonella Montano, Raffaele
Popolo, and Giampaolo Salvatore.
pages cm
1. Personality disorders–Treatment. 2. Metacognition. I. Montano,
Antonella, author. II. Popolo, Raffaele, author. III. Salvatore, Giampaolo,
author. IV. Title.
RC455.4.B5D5613 2015
616.85’81–dc23
2014033799
I SBN: 978-1-138-02415-1 (hbk)
I SBN: 978-1-138-02418-2 (pbk)
I SBN: 978-1-315-74412-4 (ebk)
T ypeset in Times
b y Deer Park Productions
C ontents
List of abbreviations v ii
I ntroduction ix
1 P ersonality disorder psychopathology: form and
contents of subjective experience 1
2 P ersonality disorder psychopathology: functions 33
3 A ssessment and case formulation in metacognitive
interpersonal therapy 52
4 S tep-by-step formalised procedures 6 5
5 T herapeutic relationship 74
6 S hared formulation of functioning: enriching
autobiographical memory, improving access to
inner states and reconstructing schemas 103
7 P romoting differentiation 123
8 C onstruction of new self-aspects: access to self-parts,
exploration, increase in agency, overcoming avoidances 142
vi Contents
9 P romoting the understanding of the other’s
mind and integration 160
1 0 T reating symptoms and promoting mastery of
relational problems 185
1 1 C omparison of metacognitive interpersonal therapy
and cognitive behavioural therapies 217
A ppendix: Diagnostic instruments usually adopted in MIT 231
R eferences 243
I ndex 261
Ab breviations
A BC a ntecedent, belief, consequence
A CT a cceptance and commitment therapy
A PA A merican Psychiatric Association
A -PST A dvanced Picture Sequencing Task
A TT attentional training
B DI Beck Depression Inventory
B LERT B ell-Lysaker Emotional Recognition Task
B VAQ B ermond-Vorst Alexithymia Questionnaire
C AS c ognitive attentional syndrome
C BT cognitive behavioural therapy
C BT-E enhanced transdiagnostic CBT for eating disorders
C CRT core confl ictual relational theme
D BT dialectical-behaviour therapy
D ERS Diffi culties in Emotion Regulation Scale
E IS Emotional Inhibition Scale
E RP e xposure and response prevention
E RQ Emotion Regulation Questionnaire
I IP Inventory of Interpersonal Problems
M AI M etacognition Assessment Interview
M AS-R M etacognition Assessment Scale – Revised
M BSR mindfulness-based stress reduction
M CMI Millon Clinical Multiaxial Inventory
M CT metacognitive therapy
M IT metacognitive interpersonal therapy
M OSST M etacognitive Oriented Social Skills Training
M SCEIT M ayer-Salovey-Caruso Emotional Intelligence Test
P D personality disorder
P DNOS p ersonality disorder not otherwise specifi ed
S CL S ymptom Checklist
S TAI State-Trait Anxiety Inventory
viii Abbreviations
T AS Toronto Alexithymia Scale
T oM t heory of mind
T R thought recording
T ZPD Therapeutic Zone of Proximal Development
Y SQ Young Schema Questionnaire
I ntroduction
Time was ripe. Psychotherapies for personality disorders (PDs) have undergone
a major leap during the last twenty years. We know better their self-sustaining
mechanisms, that they respond to treatment (unlike the pessimism of some
decades ago) and that drop-out can be kept to a reasonably low amount. But it is
a patchy evolution. The majority of progress was made with borderline PD, for
which many treatments of proven effectiveness exist and are currently under
refi nement and further empirical testing. For all the other PDs, except avoidant
and narcissistic, the literature is scanty and fragmented. The clinician wanting to
treat dependent, paranoid, obsessive-compulsive PD or depressive, passive-
aggressive and schizoid traits, has to dig hard to fi nd a well full of water. The bias
towards borderline PD is unjustifi ed, as the other PDs are overall much more
prevalent and can be just as severe as the former.
T here is another problem. Many patients do not present with pure disorder.
Co-occurrence among PDs or of a PD with traits of other disorders is the rule more
than the exception. Knowing how to treat a patient with narcissism is one matter.
A totally different matter is treating a patient with narcissism and obsessive-
compulsive, paranoid and passive-aggressive traits. Leaving specifi c orientations
aside, we thought a guide for the clinician treating these conditions was lacking.
For this reason, this volume deals with the PDs listed above, taking into account
their occurrence. Borderline PD is not discussed here. It was about fi lling a gap.
W e chose to describe common procedures across different PDs, without devot-
ing specifi c chapters to the various disorders. We designed precise sequences of
interventions that can be applied to any kind of personality features the patient
presents with. Leaving the diagnosis aside, we think the best way to understand
a PD in a way that makes treatment planning easier is a carefully devised case
formulation. Needless to say, diagnosing a specifi c PD is relevant for treatment
planning and the model of pathology described in our previous manual are still
valid (Dimaggio, Semerari, Carcione et al., 2 007) .
O ur focus here has been on showing how to make an extremely careful case
formulation. The aim is for both clinician and patient to have a map of the patient’s
mental functioning. This allows for optimisation of therapy work, moving step-by-
step towards healing personality problems and alleviating symptoms.