Treatment approaches for personality disorders: what to expect in therapy?
Personality, according to Beck’s model, is a set of specific social and cognitive-emotional patterns and motivations. It comprises of one’s behaviour, thinking, emotional responses and personal needs related to motivation. Each person has personality and develops it from the beginning of their lives. If our personality traits are the source of significant problems in our functioning, we can talk about a personality disorder.
Personality disorder is (after DSM V) an enduring pattern of inner experience and behaviour that deviates from the expectations of the individual’s culture. This pattern is manifested in two or more of the following areas:
- cognition and ways of perceiving and interpreting self and other people and events;
- affectivity;
- interpersonal functioning;
- impulse control.
The enduring pattern is inflexible and pervasive across a broad range of personal and social situations. Its onset can be traced back to adolescence or early adulthood. It causes suffering or impairment of social, family and professional functioning.
We can identify the following personality disorders: paranoid personality disorder, schizoid personality disorder, schizotypal personality disorder, antisocial personality disorder, borderline personality disorder, histrionic personality disorder, narcissistic personality disorder, avoidant personality disorder, dependent personality disorder, obsessive-compulsive personality disorder. The disorder can also be of a mixed nature, i.e. the personality disorder has features of a couple of other personality disorders.
Some patients with personality disorders decide to see a psychotherapist because of experiencing mood disorders (depression, mood swings), anxiety disorders, eating disorders, addictions or because of difficulties in social and professional functioning. Some people also decide to start a therapy because of relationship problems. Sometimes a personality disorder may impair the treatment of other disorders. It happens when the cognitive schemas are very rigid and the coping strategies are highly dysfunctional. Sometimes it may be required to observe a patient for a longer period of time in order to diagnose their personality disorder.
Cognitive-behavioural therapy focuses on changing both core and intermediate beliefs in order to achieve a lasting improvement in a patient’s functioning. Patients’ beliefs in personality disorders are inflexible, very generalized and function as the “truth”. They are easily activated in various situations and are resistant to change. Cognitive schemas and beliefs emerge in the course of various experiences of our lives, primarily in relationships with people. Therefore, the therapeutic relationship is one of the healing factors in therapy. Regardless of the type of personality disorder, a patient works with their therapist on specific goals, the achievement of which will improve their functioning in various areas.
The “third wave” treatment methods are very helpful in treating personality disorders – especially the schema therapy and the dialectical-behavioural therapy. The Dialectical Behaviour Therapy was originally developed for patients diagnosed with borderline personality disorder, but it is now used for treating other disorders as well.
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