Very practical, directive strategy

books:

	• Cognitive Therapy of Personality Disorders Aaron T. Beck MD, EdD Arthur Freeman EdD The Guilford Press, 1990 - 396 pages average customer review:based on 8 reviews view larger image
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highly recommended

Fantastic

This is a great book. For example, the chapters on obsessive compulsive and passive agressive personality give some great direction for therapy. Knowing that an obsessive person fears making mistakes, that narcissism is part of obsessionality and that a passive agressive person fears loss of autonomy can really guide treatment well.

On the other hand, the treatment of narcissistic personality disorder is weak. It just concentrates on how the patient should learn that the world does not revolve around them. It ignores the shame, need for validation and driven quality that narcissistic patients have and is reflected in their cognitions. In other words, the case used to treat NPD is of the oblivious type and in practice it is more common to see the hypervigilant type of narcisit. As CBT becomes more psychodynamic, this issue will be better addressed, I anticipate. (The oblivious narcisists are more antisocial and the vigilant ones are more on the anxiou/dependant end of the spectrum - I forget who's classification this is). If you want to take your understanding of nacrisistic personality disorder to a whole new level, try Psychodynamic Psychiatry in Clinical Practice (4th Edition); don't be put off by the title, it doesn't mention drugs and could just have easily been titled "Psychodynamic Psychology".

Below is a summary of the Histrionic Personality Disorder chapter that I did for my own benefit.

Histrionic Personality Disorder
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People with HPD are very vulnerable to separation. Common comorbidities are: panic, alcoholism, substance abuse, conversion disorder, somatization disorder and brief reactive psychosis.

Males and females equally effected. Reliable and valid construct. Emotionality, exhibitionism, egocentricity and sexual provocativeness were strongly clustered together. Women with HPD are more attractive than average. One of the PDs with least functional impairment. Caricature of sex roles. Emotions are expressed intensely, yet seem exaggerated or unconvincing; has the sense of watching a performance. Comments often seem quite striking and powerful at the time but later on the clinician will not know what the patient meant.

Diagnose by getting data about interpersonal relationships, how they handle anger, fights and disagreements. Find out how other people tend to view them. Compared with narcissists, histrionics are more willing to be subservient to avoid abandonment.

On page 223: "Hypomanic periods can be found in patients with HPD as well as in patients with the Axis I syndromes of cyclothymic disorder or bipolar disorder. Millon (1996) describes an urgency, restlessness, and intensity about the hypomanic phase of cyclothymia that is not typical of the histrionic patient. Although the behaviour of the histrionic patient can occasionally be inappropriate, the histrionic generally has learned reasonable levels of social skills and can experience some hypomania without serious interference with routine social and occupational functioning, whereas the hypomanic periods are much more disruptive for the cyclothymic patient."

Cognition is global, diffuse and impressionistic. IB: "I am inadequate and unable to handle life on my own." They will need to find ways to get others to take care of them. Necessary to be loved by everyone for everything one does. Excessive need for attention and a failure to use the appropriate social skills in order to achieve attention from others.

They view themselves as being sociable, friendly, and agreeable. Later, they get demanding and in need of constant reassurance. Learn to value external events over their internal experience. With so little to focus on in their own life, they are left without any sense of identity apart from how other people view them.

As thoughts cause emotions, it follows that histrionic people with have intense emotions. Dichotomous thinking, overgeneralization, emotional reasoning.

Treatment Approach
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Challenge automatic thoughts, set up behavioural experiments, activity scheduling, relaxation, problem solving and assertion.

Be collaborative. Expose them to a entirely new way of perceiving and processing experience. Initially they will view you as an all-powerful rescuer. Reinforce assertive and competent responses. Avoid getting too wrapped up in the drama of the patient's presentation.

Have them learn how to focus attention on one issue at a time. Setting a session agenda. One item should be how things went, to get this out of the road. Set goals that are genuinely meaningful to them, what they want not what they should want. They will tend to be short-term with their goals. Have operational definitions. Use fantasy to work out consequences. Gently and persistently find out how actions are related to their goals.

Written homework will be boring, so make it dramatic in content. Role-play with automatic thoughts. Do theatrical behavioural experiments.

Pinpointing ATs can decrease impulsivity. Have them list the advantages and disadvantages of options. Have them work out how to spend the therapy time. "Means-end thinking."

Patients to dominate relationships in indirect ways such as crises, jealousy, charm, nagging and scolding. Have them pinpoint what they want out of a situation.

Identity and sense of self: not a magic thing but through introspection, starting with the basics and with mindfulness and assertion.

Have behavioural experiments that set up small rejections with strangers. Also, show them that they can be competent.

Can have planned depression. Do well in groups. CBT takes 1 to 3 years to work @ 101 sessions over 3 years.

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came as ordered

The book came in a timely manner and arrived in new condition exactly as I ordered it. Very pleased.

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From a patients view

As someone who is avoidant co morbid with OCPD spent perhaps 40 years depressed more than not before reaching out for any professional help I would like to say especially in the chapter on avoidants the book is pretty much dead on. The chapter on avoidants is the one I can most closely relate to but I see myself in others as well my OCDP us most apparent in hoarding issues a spot my therapist and I are having a hard time pushing me through I've been working with a therapist for about a year and half now making progress even if it's slow. My therapist knows I am a person who likes to try and understand my disorders and reads as much material as I can. We have both learned a lot together she being my motivator and supporter. She has been outstanding doing her research to help develop plans of actions that have helped knock down some long standing self built walls. She likes to kid me that I could teach a graduate class in personality disorders with all the reading I have done.

To sum this up as a someone who has to deal with these issues as part of my daily life the book is right on with much of the way my thoughts/reactions are if I don't work actively to keep ahead of them to continue on my road to a happier life. And yes even as someone who came to therapy at a high functioning level in many aspects of my life I know at times I can be a frustrating client. But for me the knowledge that both my therapist and I are feeing increasing levels of frustration has been something I have been able to use to finally find the courage to knock down some long standing walls. So a special than you to those of you who choose to try and help those of us who present some special difficulties.

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All Hail Aaron Beck!

I love Aaron Beck, the founder of cognitive therapy. I think he has great insight into the various personality disorders. This book is incredibly helpful. It includes all of the disorders, their way of thinking, they co-morbidity, their treatment, case studies, and more. If you want one book on the treatment of personality disorders, this is the one to get.

Very practical, directive strategy

Beck has done a great job describing a very pragmatic, common sense cognitive-behavioral methodology for the treatment of challenging personalities. The research he has done builds confidence in practitioners interested in and using these methods. Each personality style is well-described, and several strategies are provided for addressing these problematic dispositions. The book is very well-organized and easy to read. Assignments and case examples further add to the utility of this text.

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reviews: page 1, 2

Center for Cognitive Therapy, University of Pennsylvania.

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