Beyond the Borderline: Expanding Our Repertoire to Address Relational Patterns and Power Dynamics Attendant to Diverse Personality Disorders
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A present challenge in our field is that diverse and frequently comorbid patterns of personality disorder are not sufficiently addressed by existing evidence-based treatments. Authors in the special section describe promising efforts to address this challenge, including case examples illustrating the utility of each approach. Each approach is consistent with evidence-based principles of change, suggesting the possibility of placing them together within a meta-theoretical integration frame (Magnavita and Anchin in Unifying psychotherapy: Principles, methods, and evidence from clinical science, Springer Publishing Co, New York, 2014). Common threads include use of an individualized case formulation to tailor treatment to diverse patterns; incorporation of affect, behavior, and cognition; and modification of attachment-linked, internal templates using both didactic and experiential forms of learning. Interpersonal Reconstructive Therapy (IRT), our favored approach, offers a similar language and framework, leaving technical choices to the clinician so long as they are consistent with an attachment-based, interpersonal case formulation, and are helpful in establishing new patterns toward adaptive goals. Work with IRT suggests ways to extend further the focus on internalized representations. Direct conversation with “family in the head” can be used to enhance ways of being, thinking, and feeling that allow distance and differentiation from problematic internalizations of loved ones. The authors present suggestions for future research, emphasizing the therapeutic relationship as well as the need to measure therapeutic optimality in a tailored, context-specific manner focused on mechanisms of psychopathology and change.
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Conflict of Interest
The authors have no conflict of interest.
Research Involving Human and Animal Rights
This article does not contain any studies with human participants or animals performed by any of the authors.
- Benjamin, L. S. (2003/2006). Interpersonal reconstructive therapy: Promoting change in nonresponders. New York: Guilford Press.Google Scholar
- Critchfield, K. L., & Benjamin, L. S. (in preparation). Activating mechanisms of change to enhance outcomes during Interpersonal Reconstructive Therapy (IRT) with comorbid, often rehospitalized, dysfunctional and suicidal patients. James Madison University & University of Utah.Google Scholar
- Critchfield, K. L., Benjamin, L. S., & Levenick, K. (2015). Reliability, sensitivity, and specificity of case formulations for comorbid profiles in interpersonal reconstructive therapy: Addressing mechanisms of psychopathology. Journal of Personality Disorders, 29(4), 547–573. https://doi.org/10.1521/pedi.2015.29.4.547.CrossRefPubMedGoogle Scholar
- Gordon-King, K., Schweitzer, R. D., & Dimaggio, G. (2018). Metacognitive interpersonal therapy for personality disorders: the case of a man with obsessive–compulsive personality disorder and avoidant personality disorder. Journal of Contemporary Psychotherapy. https://doi.org/10.1007/s10879-018-9404-0.CrossRefGoogle Scholar
- Kernberg, O. F., & Caligor, E. (2005). A psychoanalytic theory of personality disorders. In M. F. Lenzenweger & J. F. Clarkin (Eds.), Major theories of personality disorder (pp. 114–156). New York: Guilford Press.Google Scholar
- Magnavita, J. J., & Anchin, J. C. (2014). Unifying psychotherapy: Principles, methods, and evidence from clinical science. New York: Springer Publishing Co.Google Scholar
- Popolo, R., MacBeth, A., Canfora, F., Rebecchi, D., Toselli, C., Salvatore, G., & Dimaggio, G. (2018). Metacognitive interpersonal therapy in groups for over-regulated personality disorders: A single case study. Journal of Contemporary Psychotherapy. https://doi.org/10.1007/s10879-018-9401-3.CrossRefGoogle Scholar
- Simonsen, S., Eikenæs, I. U. M., Nørgaard, N. L., Normann-Eide, E., Juul, S., & Wilberg, T. (2018). Specialized treatment for patients with severe avoidant personality disorder: experiences from Scandinavia. Journal of Contemporary Psychotherapy. https://doi.org/10.1007/s10879-018-9395-x.CrossRefGoogle Scholar