|
||||
 |
The Voice of the American Psychiatric Association and the Psychiatric Community
| BACK TO NEWSLETTER | :: | CURRENT ISSUE | :: | PN ARCHIVES | :: | NEWS ALERT | :: | CONTACT US |
|
 |
 |
 |
Personality Disorder Patients Exhibit Typical Overdeveloped and Underdeveloped Strategies  Patients with personality disorders typically develop a dysfunctionally small set of behavioral strategies that they use across situations and time, to help them cope with their highly negative core beliefs, said Judith Beck, Ph.D., at APA’s 2012 annual meeting today. While their behavioral strategies are often maladaptive, it is therapeutically critical for therapists to view these strategies as neither “good” nor “bad.” Rather, they are either more or less adaptive according to the situation and their goals. For example, she said, it is not adaptive for people to be paranoid around their trustworthy friends, to be overly dependent on partners to make them feel better, to compete with their children, or to be unnecessarily dramatic during a medical emergency. It is adaptive (and useful) for people to be vigilant when they are walking in a dangerous part of town, to depend on their family and friends when they are sick, to be competitive when they are trying to advance their careers, and to be detail-oriented when they are doing their taxes. Beck pointed out that there are a small number of overdeveloped strategies specific to each personality disorder that may or may not have been relatively adaptive when they first developed. But they invariably lead to significant difficulty when individuals use them compulsively and are unable to use other strategies adaptively, according to the context. Patients use these strategies in their daily lives, both outside of therapy and also in the therapy session itself. Patients who are vigilant for harm from others, for example, may be suspicious of their therapists as well, she observed. When patients display dysfunctional behaviors in a session, Beck advised, it is important for therapists to recognize that these behaviors stem from difficult—often traumatic—life circumstances and extreme, negative core beliefs. Adopting this stance allows therapists to regard patients more positively, to display empathy, and behave more adaptively themselves. It is also essential for therapists to assess the range and rigidity of patients’ strategies as part of an overall conceptualization of the individual patient, Beck said. This guides treatment and helps develop realistic expectations. It would be unreasonable, for example, to expect a patient with narcissistic personality disorder to suddenly stop acting superior and demanding at the beginning of therapy. Failure to recognize patients’ underdeveloped skills could lead therapists to encourage them to make changes before they have developed requisite skills—a therapeutic error that can have significant consequences, she warned. |
|
Copyright © 2012 American Psychiatric Association. All rights reserved.