Sachse Personality Disorders

A Clarification-Oriented Psychotherapy Treatment Model
2020
ISBN: 978-1-61676-552-1
Verlag: Hogrefe Publishing
Format: PDF
Kopierschutz: 1 - PDF Watermark

E-Book, Englisch, 254 Seiten

This practice-oriented guide presents a model of personality disorders (PDs) based on the latest research showing that “pure” PDs are due to relationship disturbances. The reader gains concise and clear information about the dual-action regulation model and the framework for clarification-oriented psychotherapy, which relates the relationship dysfunction to central relationship motives and games. Practical information is given on how to behave with clients and clear therapeutic strategies based on a five-phase model are outlined to help therapists manage interactional problems in therapy and to assist clients in achieving effective change. The eight pure personality disorders (narcissistic, histrionic, dependent, avoidant, schizoid, passive-aggressive, obsessive-compulsive, and paranoid) are each explored in detail so the reader learns about the specific features of each disorder and the associated interactional motives, dysfunctional schemas, and relationship games and tests, as well as which therapeutic approaches are appropriate for a particular PD. As the development of a trusting therapeutic relationship is difficult with this client group, detailed strategies and tips are given throughout. This book is essential reading for clinical psychologists, psychiatrists, psychotherapists, counselors, coaches, and students.

Zielgruppe

Clinical psychologists, psychiatrists, psychotherapists, coaches, and counselors, as well as students.

Autoren/Hrsg.

Sachse, Rainer

Fachgebiete

• Sozialwissenschaften Psychologie Psychotherapie / Klinische Psychologie Psychopathologie
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Medizinische Fachgebiete Psychiatrie, Sozialpsychiatrie, Suchttherapie
• Sozialwissenschaften Psychologie Allgemeine Psychologie Differentielle Psychologie, Persönlichkeitspsychologie

Inhaltsverzeichnis

1;Foreword and Table of Contents;6
2;1 Essential Basic Concepts of Personality Disorders;12
3;2 Characteristics of Personality Disorders;17
4;3 What Is Clarification-Oriented Psychotherapy?;21
5;4 General Psychological Function Model for Personality Disorders;32
6;5 Diagnostic Features of Personality Disorders;50
7;6 Therapeutic Strategies for Clients With PD: Consequences of the Model;53
8;7 Types of Personality Disorders;77
9;8 Narcissistic Personality Disorder;87
10;9 Histrionic Personality Disorder;125
11;10 Dependent Personality Disorder;151
12;11 Avoidant Personality Disorder;167
13;12 Passive-Aggressive Personality Disorder;178
14;13 Schizoid Personality Disorder;192
15;14 Obsessive-Compulsive Personality Disorder;202
16;15 Paranoid Personality Disorder;218
17;References;231
18;List of Abbreviations;264

Leseproben

Chapter 2 2 Characteristics of Personality Disorders

2.1 Introduction

As a kind of advanced organizer, essential general characteristics of PDs are summarized in this section (also in distinction to Axis I disorders): Thus, the question is, what characterizes clients with PD and what are the particular features they bring into the therapy?

2.2 Ego-Syntony and Ego-Dystony

Fiedler (2007) spotlighted the aspect of ego-syntony: A disorder is ego-syntonic if the person concerned does not perceive essential aspects of the disorder as disruptive, problematic, and necessitating change; moreover, these aspects are perceived as part of the self – as part of one’s identity. By contrast, a disorder is ego-dystonic if the person perceives essential aspects of it as disruptive: The person does not want to suffer these aspects of their disorder and experiences them as foreign and necessitating change.

Contrary to Axis I disorders, which are usually ego-dystonic, PDs are usually ego-syntonic: the degree of ego-syntony depends on the type and severity of the disorder (e.g., avoidant PD is a little ego-syntonic, whereas obsessive-compulsive PD is highly ego-syntonic).

2.3 Motivation for Change

The degree of motivation to change strongly depends on the ego-syntony (motivation to change is the tendency to actively want to change aspects of oneself). Motivation to change implies that
• The person realizes that their belief system produces costs;
• That these costs are relevant, and they do not want these costs;
• That changing can reduce costs and make objectives attainable;
• That these costs are self-produced, and that the client must actively pursue their objectives.

If a disorder is ego-syntonic, the person will be able to recognize the costs and realize that they do not want to suffer them, but the person will not realize that they produce these costs themselves. Thus, the person is motivated to cut costs, meaning they want a cost reduction, but are not inclined to do anything for it. Often these individuals are motivated to remain the same (stabilized), which means that they do not want to change their belief system, they just want to avoid the costs.

This means that at the beginning of the therapy, most of PD clients are not motivated to change concerning aspects of their PD.

In other words, motivation to change is not a basic therapy precondition for clients with PD but has to be established during therapy.

However, the clients may be therapy-motivated: They may be motivated to reduce costs or to have the costs reduced by the therapist. The problem is that therapists sometimes consider this motivation to be the same as motivation to change, which is not true.

2.4 Clients Are Motivated to Seek a Particular Relationship

Clients with PD show strong relationship motives and often come to therapy to get these desires satisfied by the therapist. Due to their high relationship motivation and high ego-syntony, PD clients rarely undergo therapy to do actual therapeutic work, therefore they do not accept therapeutic strategies, something that therapists perceive as sabotage.

The strong relationship motivation implies that clients with PD often access therapy primarily for a certain relationship offered by the therapist – in other words, they look for a certain kind of relationship. Clients might send double messages: “I am miserable, I need help, do something!” and “I can’t do anything, I can’t collaborate, it is all too difficult!” If therapists then proceed in line with the motto “Something must be done,” they will greatly impede the therapy, because the clients are not yet motivated to actively collaborate therapeutically.

Due to the extreme relationship motivation of PD clients, a therapist must concentrate on strong complementary relationship structuring at first; only when a therapist has sufficient relationship credit may they move on to specific therapeutic strategies. (Sachse, Langens, & Sachse, 2012)