Clinical Assessment and Management of Severe Personality Disorders


Book Description

Clinical Assessment and Management of Severe Personality Disorders (Clinical Practice 35) offers the clinician working in the community a practicable approach to the treatment of patients with personality disorders. Clearly written, with minimal use of jargon, this book focuses on issues relevant to the clinician in private practice, including the diagnosis of a wide range of personality disorders and alternative management approaches. Recognizing patients with a personality disorder, differentiating one disorder from another, and using psychological tests in the diagnosis and treatment of personality disorders are among the clinical assessment issues covered. Two commonly encountered issues -- the assessment and management of patients using a neuropsychiatric approach and treatment of patients with comorbid symptoms and personality disorders -- are discussed. This book takes a broad approach to the management of personality disorders, moving beyond individual dynamic psychotherapy as the only treatment option. Pharmacological management of patients with personality disorders and differential management for patients in various settings are described. A discussion of the etiological impact and implications of early life experiences on the patient offers valuable insight for psychotherapeutic management. Clinicians are also provided with a useful framework for interacting and intervening with the families of patients with personality disorders.







Psychotherapy for Personality Disorders


Book Description

Defined by stable, long-term, subjective distress and/or social impairment, personality disorders affect up to 18% of the population. Social impairment and health care usage are far more prevalent among people with personality disorders than among people with major depressive disorders. Personality disorders are highly prevalent, variable, and notoriously difficult to treat, and they continue to challenge the therapeutic community and represent a formidable public health concern. This volume ably addresses personality disorders as one of the top priorities of psychiatry for the new millennium, offering a thorough and updated review and analysis of empirical work to point up the issues central to developing a therapeutic model for treatment as well as current research challenges. A review of extant research yields the heartening conclusion that psychotherapy remains an effective treatment for people with personality disorders. An examination of psychodynamic treatment for borderline personality disorder speaks to its efficacy. An analysis of the rationale for combining psychotherapy and psychopharmacology emphasizes the importance of identifying temperament and target conditions. A well-documented and reasoned treatise on antisocial personality disorder makes the crucial point that clinicians must acquire a depth of understanding and skill sufficient to determine what the cut-off point is for treatable versus nontreatable gradations. With the caveat that evidence supporting the efficacy of cognitive treatments for personality disorders is slight and that such approaches require tailoring, a strong case is made for their validity. This timely volume both answers and reframes many stubborn questions about the efficacy of psychotherapy for treating personality disorders.




Treatment of Severe Personality Disorders


Book Description

In Treatment of Severe Personality Disorders: Resolution of Aggression and Recovery of Eroticism, the influential psychoanalyst and psychiatrist Otto Kernberg presents an integrated update of the current knowledge of personality disorders, their neurobiological and psychodynamic determinants, and a specific psychodynamic psychotherapy geared to resolve the psychopathology of these conditions -- namely, the syndrome of identity diffusion and its influence on the capacity for emotional wellbeing and gratifying relationships with significant others. The author updates the findings of the Personality Disorders Institute of the Weill Cornell Medical College Department of Psychiatry, which are derived from the empirical research and clinical investigation of severe personality disorders, and addresses the effectiveness of transference-focused psychotherapy, a specific psychodynamic treatment for these disorders developed at the Institute. The volume focuses particularly on an essential group of techniques common to all psychoanalytically derived treatments and clarifies the corresponding differential features of various psychodynamic treatment approaches. In prose both precise and evocative, the author: Examines the classification of personality disorders, the way competing viewpoints have influenced the evolution of DSM-III and DSM-IV, and the impact of new knowledge on the classification of DSM-5, with emphasis on how conflicts between scientific and political considerations have hindered the classification of personality disorders in the past. Illustrates in detail how present knowledge of neurobiological structures and neurotransmitters intertwines with the psychodynamic determinants of how psychic experience is organized. Explores psychodynamic psychotherapies and contemporary developments and controversies in the field. For example, the role of interpretation in borderline pathology is examined using a clinical case, and a new formulation of supportive psychodynamic psychotherapy is described. Addresses severe narcissistic pathology -- its diagnosis, prognosis, and treatment. Specifically, the book presents an overview of treatment options for severe narcissistic personality disorder, explores the distortions in verbal communication that may arise during psychotherapy with these patients, and focuses on the differential diagnosis of antisocial behavior. Examines the diagnosis and treatment of sexual pathology, and explores the vicissitudes of the love lives of patients with severe personality disorders. Concludes with a chapter on the essential preconditions in the education of psychodynamic psychotherapists to carry out the challenging and complex psychotherapeutic work in this field. In describing both the limits and the advances in therapeutic effectiveness, the Treatment of Severe Personality Disorders: Resolution of Aggression and Recovery of Eroticism performs a great service, and it will surely become a classic of the psychoanalytic literature.




Personality Disorders in Older Adults


Book Description

As the average age of the population rises, mental health professionals have become increasingly aware of the critical importance of personality in mediating successful adaptation in later life. Personality disorders were once thought to "age out," and accordingly to have an inconsequential impact on the lives of the elderly. But recent clinical experience and studies underscore not only the prevalence of personality disorders in older people, but the pivotal roles they play in the onset, course, and treatment outcomes of other emotional and cognitive problems and physical problems as well. Clearly, mental health professionals must further develop research methods, assessment techniques, and intervention strategies targeting these disorders; and they must more effectively integrate what is being learned from advances in research and theory into clinical practice. Inspired by these needs, the editors have brought together a distinguished group of behavioral scientists and clinicians dedicated to understanding the interaction of personality and aging. Offering a rich array of theoretical perspectives (intrapsychic, interpersonal, neuropsychological, and systems), they summarize the empirical literature, present phenomenological case reports, and review psychodynamic, cognitive-behavioral, and pharmacological treatment approaches. This comprehensive state-of-the-art guide will be welcomed by all those who must confront the complexity and the challenge of working with this population.




Transference-Focused Psychotherapy for Adolescents With Severe Personality Disorders


Book Description

Transference-Focused Psychotherapy for Adolescents With Severe Personality Disorders is a manual for clinicians who wish to learn an effective psychodynamic treatment for young people with personality disorders (PDs). Despite converging evidence that PDs emerge in childhood and are clearly evident in adolescence, research on effective treatments has been limited. The editors have therefore created a book that details treatment models with strong theoretical foundations and examines systematic interventions designed to explore and resolve the conflicts and behaviors, common to PDs, that impede normal adolescent development. The book begins with an overview of psychopathology and normal adolescent development from a psychodynamic perspective. The next section offers therapeutic approaches, including a discussion of the major goals and strategies of TFP-A, the clinical evaluation and assessment process, establishment of the treatment framework and collaboration with parents, and finally, the techniques and tactics of TFP-A. The last section of the book reviews the phases of treatment and discusses the strengths and competencies a therapist must have to successfully conduct transference-based therapy. Authored by experts in the field (including Dr. Kernberg, a pioneer in object relations), Transference-Focused Psychotherapy for Adolescents (TFP-A) with Severe Personality Disorders teaches clinicians how to conduct TFP-A, with the ultimate goal of resolving the intrapsychic restrictions that interfere with normal adolescent development.




Severe Personality Disorders


Book Description

This book is about understanding and managing patients with severe personality disorders. It covers biological, psychoanalytic and cognitive behavioral approaches and provides a pragmatic guide to best practice. As well as discussing issues of severity, treatability and the range of appropriate management options, the content explores the common elements of effective interventions and covers early prediction, countertransference, disruptions of the therapeutic alliance, suicidal crises and what to do when dealing with dangerous, refractory and stalking patients. The chapters are authored by an international cast of distinguished investigators and innovators from the field. This is a holistic, practical guide to the treatment of patients with a range of these disorders and it should be read by members of the mental health team dealing with this challenging clinical group.




The American Psychiatric Publishing Textbook of Psychopharmacology


Book Description

Now updated to keep professionals current with the latest research and trends in the field, this edition covers both basic science and clinical practice, and draws on the talents of 53 new contributors to guarantee fresh, authoritative perspectives on advances in psychiatric drug therapy.




Personality Disorder and Serious Offending


Book Description

People with personality disorder who offend tend to be neglected by health services in most countries. In the UK, there has been renewed interest in the field since government initiatives in the end of the 1990s. Government proposals themselves are controversial, but there is growing recognition that it is unsafe, both for the general public and fo