Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-8448b6f56d-qsmjn Total loading time: 0 Render date: 2024-04-19T11:08:56.367Z Has data issue: false hasContentIssue false

13 - Common elements of effective treatments

Published online by Cambridge University Press:  14 August 2009

By
W. John Livesley
Edited by
Bert van Luyn ,
Salman Akhtar  and
W. John Livesley
W. John Livesley
Affiliation:
Professor Emeritus in the Department of Psychiatry University of British Columbia, Canada
Bert van Luyn
Affiliation:
Symfora Group, The Netherlands
Salman Akhtar
Affiliation:
Thomas Jefferson University, Philadelphia
W. John Livesley
Affiliation:
University of British Columbia, Vancouver
Get access

Summary

Treatments for personality disorder have increased substantially in recent years. The initial domination of the field by psychoanalytic therapies changed in 1990 with the publication of Cognitive Therapy by Beck, Freeman, and Associates. This publication was quickly followed by volumes on interpersonal (Benjamin, 1993) and dialectical behavioral therapies (Linehan, 1993). Subsequently, other cognitive approaches were developed (Layden et al., 1993; Young et al., 2003), Kernberg's transference-based therapy was manualized (Clarkin et al., 1999), and additional psychoanalytically based treatments such as mentalization-based therapy (Bateman and Fonagy, 2004) were proposed. The growth in psychotherapeutic treatments has been accompanied by increasing interest in pharmacological interventions to both manage the symptomatic component of personality disorder and modulate the expression of important traits such as impulsivity, affective lability, and cognitive dysregulation (Soloff, 2000).

The clinician now has a range of treatment options and treatment modalities to choose from. Unfortunately, however, the evidence needed to make an informed choice among these alternatives is limited. This need not be an insurmountable problem. Rather than opting for any one form of therapy, the clinician could adopt an eclectic and integrated approach using intervention strategies common to all effective therapies. If needed, these generic strategies can be supplemented with an array of specific interventions selected from different treatment models to treat problems not addressed by generic mechanisms. This is in effect what most experienced clinicians do. They use a combination of interventions that they have found effective and tailor these to the problems of individual patients.

Type
Chapter
Information
Severe Personality Disorders , pp. 211 - 239
Publisher: Cambridge University Press
Print publication year: 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Argyle, M., Tower, P. and Bryant, B. (1974). Explorations in the treatment of personality disorders and neuroses by social skills training. Br J Med Psychol 47: 63–72.Google Scholar
Barnett, J. (1980). Self and character. J Am Acad Psychoanal 8: 337–352.Google Scholar
Bateman, A. W. and Fonagy, P. (2004). Psychotherapy for Borderline Personality Disorder: Mentalization-Based Treatment. New York: Oxford University Press.
Beck, A. T., Freeman, A. and Associates. (1990). Cognitive Therapy of Personality Disorders. New York: Guilford Press.
Beck, A. T., Freeman, A. and Davis, D. (2003). Cognitive Therapy of Personality Disorders, 2nd edn. New York: Guilford Press.
Beck, J. S. (1995). Cognitive Therapy: Basics and Beyond.New York: Guilford Press.
Benjamin, L. S. (1993). Interpersonal Diagnosis and Treatment of Personality Disorders, 1st edn. New York: Guilford Press.
Beutler, L. E. (1991). Have all won and must all have prizes? Revisiting Luborsky et al.'s verdict. J Consult Clin Psychol 59: 226–232.Google Scholar
Beutler, L. E. and Harwood, T. M. (2000). Prescriptive Psychotherapy. Oxford: Oxford University Press.
Borden, E. S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychother, Theory Res Pr 16: 252–260.Google Scholar
Borden, E. S. (1994). Theory and research in the therapeutic working alliance: new directions. In Horvath, A. and Greenberg, L. S. (eds.) The Working Alliance. New York: John Wiley & Sons, Inc., pp. 13–37.
Bowlby, J. (1980). Attachment and Loss. Vol. 3. Loss, Sadness and Depression. London: Hogarth Press.
Chessick, R. (1979). A practical approach to the psychotherapy of the borderline patient. Am J Psychother 33: 531–566.Google Scholar
Clarkin, J. F., Yeomans, F. E. and Kernberg, O. (1999). Psychotherapy for Borderline Personality Disorder. New York: John Wiley & Sons, Inc.
Cottraux, J. and Blackburn, I. M. (2001). Cognitive therapy. In Livesley, W. J. (ed.) Handbook of Personality Disorders. New York: Guilford Press, pp. 377–399.
Davidson, K. M. and Tyrer, P. (1996). Cognitive therapy for antisocial and borderline personality disorders: single case study series. Br J Clin Psychol 35: 413–429.Google Scholar
Eells, T. D. (1997). Psychotherapy case formulation: history and current status. In Eells, T. D. (ed.) Handbook of Psychotherapy Case Formulation. New York: Guilford Press.
Gaston, L. (1990). The concept of the alliance and its role in psychotherapy: theoretical and empirical considerations. Psychotherapy 27: 143–153.Google Scholar
Gold, J. R. (1990a). Culture, history, and psychotherapy integration. J Integrative Eclectic Psychother 9: 41–48.Google Scholar
Gold, J. R. (1990b). The integration of psychoanalytic, interpersonal, and cognitive approaches in the psychotherapy of borderline and narcissistic disorders. J Integrative Eclectic Psychother 9: 49–68.Google Scholar
Gold, J. R. (1996). Key Concepts in Psychotherapy Integration. New York: Plenum Press.
Grilo, C. M., Shea, M. T., Sanislow, C. A.et al. (2004). Two-year stability and change in schizotypal, borderline, avoidant and obsessive-compulsive personality disorders. J Clin Consult Psychol 72: 767–775.Google Scholar
Guidano, V. F. (1987). Complexity of the Self: A Developmental Approach to Psychopathology and Therapy. New York: Guilford Press.
Guidano, V. F. (1991). The Self in Process: Toward a Post-Rationalist Cognitive Therapy. New York: Guildford Press.
Hall, C. S. and Lindzey, G. (1957). Theories of Personality. New York: John Wiley & Sons, Inc.
Hollin, C. R. (1995). The meaning and implications of “programme integrity.” In McGuire, J. (ed.). What Works: Reducing Reoffending: Guidelines from Research and Practice. Oxford: John Wiley & Sons, pp. 195–208.
Holt, R. R. (1989). Freud Reappraised: A Fresh Look at Psychoanalytic Theory. New York: Guilford Press.
Horowitz, L. M. (1988a). Introduction to Psychodynamics.New York: Basic Books.
Horowitz, M. J. (1998b). Cognitive Psychodynamics. New York: Wiley and Sons.
Horowitz, M. J. and Marmar, C. (1985). The therapeutic alliance with difficult patients. In Hales, R. E. and Frances, A. J. (eds.) Psychiatric Update: American Psychiatric Association Annual Review. Washington, DC: American Psychiatric Association Press, pp. 573–585.
Horvath, A. O. and Symonds, D. B. (1991). Relation between working alliance and outcome in psychotherapy: a meta-analysis. J Counsell Psychol 38: 139–149.Google Scholar
Hurt, S. W., Clarkin, J. F., Munroe-Blum, H. and Marziali, E. (1992). Borderline behavioral clusters and different treatment approaches. In Clarkin, J. F., Marziali, E.et al. (eds.) Borderline Personality Disorder: Clinical and Empirical Perspectives. New York: Guilford Press, pp. 199–219.
Joseph, B. (1983). On understanding and not understanding: some technical issues. Int J Psychoanal 64: 291–298.Google Scholar
Karasu, T. B. (1986). Specificity versus non-specificity. Am J Psychiatry 143: 687–695.Google Scholar
Kernberg, O., Selzer, M. A., Koenigsberg, H. W., Carr, A. C. and Appelbaum, A. M. (1989). Psychodynamic Psychotherapy of Borderline Patients.New York: Basic Books.
Kohut, H. (1971). The Analysis of the Self. New York: International Universities Press.
Kohut, H. (1975). Introspection, empathy, and psychoanalysis: an examination of the relationship between mode of observation and theory. J Psychother Pr Res 4: 163–177.Google Scholar
Komatsu, L. K. (1992). Recent views of conceptual structure. Psychol Bull 42: 500–526.Google Scholar
Lambert, M. J. (1986). Some implications of psychotherapy outcome research for eclectic psychotherapy. Int J Eclectic Psychother 16: 16–45.Google Scholar
Lambert, M. J. (1992). Psychotherapy outcome research: implications for integrative and electical therapists. In Norcross, J. C.et al. (eds.) Handbook of Psychotherapy Integration. New York: Basic Books, pp. 94–129.
Lambert, M. J. and Bergen, A. E. (1994). The effectiveness of psychotherapy. In Bergin, A. E.et al. (eds.) Handbook of Psychotherapy and Behavior Change, 4th edn. New York: John Wiley & Sons, Inc, pp. 143–189.
Layden, M. A., Newman, C. F., Freeman, A. and Morse, S. B. (1993). Cognitive Therapy of Borderline Personality Disorder. Needham Heights, MS: Allyn and Bacon.
Leichsenring, F. and Leibing, E. (2003). The effectiveness of psychodynamic therapy and cognitive behavior therapy in the treatment of personality disorders: a meta-analysis. Am J Psychiatry 160(7): 1223–1232.Google Scholar
Lichtenberg, J. D., Lachmann, F. M. and Fosshage, J. L. (1992). Self and Motivational Systems: Toward a Theory of Psychoanalytic Technique. Hillsdale, NJ: Analytic Press, Inc.
Lieberman, R. P. and Eckman, T. (1981). Behavior therapy versus insight-oriented therapy for repeated suicide attempters. Arch Gen Psychiatry 38: 1126–1130.Google Scholar
Linehan, M. M. (1993). Cognitive-Behavioural Treatment of Borderline Personality Disorder. New York: Guilford Press.
Linehan, M. M., Armstrong, H. E., Suarez, A., Allmon, D. and Heard, H. (1991). Cognitive-behavioural treatment of chronically parasuicidal borderline patients. Arch Gen Psychiatry 48: 1060–1064.Google Scholar
Livesley, W. J. (1998). Suggestions for a framework for an empirically based classification of personality disorder. Can J Psychiatry 43: 137–147.Google Scholar
Livesley, W. J. (2001). Conceptual and taxonomic issues. In Livesley, W. J. (ed.) Handbook of Personality Disorders. New York: Guilford Press, pp. 1–38.
Livesley, W. J. (2003). Practical Management of Personality Disorder. New York: Guilford Press.
Livesley, W. J. (2007). The relevance of an integrated approach to the treatment of personality disordered offenders. Psychol Crime Law (in press).Google Scholar
Livesley, W. J., Jang, K. L., Jackson, D. N. and Vernon, P. A. (1993). Genetic and environmental contributions to dimensions of personality disorder. Am J Psychiatry 150: 1826–1831.Google Scholar
Livesley, W. J., Jang, K. L. and Vernon, P. A. (1998). The phenotypic and genetic architecture of traits delineating personality disorder. Arch Gen Psychiatry 55: 941–948.Google Scholar
Luborsky, L. (1984). Principles of Psychoanalytic Psychotherapy. New York: Basic Books.
Luborsky, L., Singer, B. and Luborsky, L. (1975). Comparative studies of psychotherapies. Arch Gen Psychiatry 32: 995–1008.Google Scholar
Marzillier, J. S., Lambert, C. and Kellett, J. (1976). A controlled evaluation of systematic desensitization and social skills training for socially inadequate psychiatric patients. Behav Res Ther 14: 225–238.Google Scholar
Meissner, W. W. (1984). The Borderline Spectrum: Differential Diagnosis and Developmental Issues. Northvale, NJ: Jason Aronson.
Meissner, W. W. (1991). What is Effective in Psychoanalytic Therapy. Northvale, NJ: Jason Aronson.
Miller, W. R. and Rollnick, S. (1991). Motivational Interviewing. New York: Guilford Press.
Miller, W. R. and Rollnick, S. (2002). Motivational Interviewing: Preparing People for Change. New York, Guilford Press.
Norcross, J. C. and Newman, J. C. (1992). Psychotherapy integration: setting the context. In Norcross, J. C.et al. (eds.) Handbook of Psychotherapy Integration. New York: Basic Books, pp. 3–45.
Orlinsky, D. E. and Howard, K. I. (1986). Process and outcome in psychotherapy. In Begin, A. E. and Garfield, S. L. (eds.) Handbook of Psychotherapy and Behavioral Change, 3rd edn. New York: John Wiley & Sons, pp. 311–381.
Orlinsky, D. E. and Howard, K. I. (1987). A generic model of psychotherapy. J Integrative Eclectic Psychother 6: 6–27.Google Scholar
Padesky, C. A. (1994). Schema change processes in cognitive therapy. Clin Psychology and Psychother 1: 267–278.Google Scholar
Paris, J. (2005). Outcome and epidemiological research on personality disorders. J Pers Disord 19(5): 557–562.Google Scholar
Perris, C. (1994). Cognitive therapy in the treatment of patients with borderline personality disorders. Acta Psychiatr Scand 89: 69–72.Google Scholar
Piper, W. E. and Joyce, A. S. (2001). Psychosocial treatment outcome. In Livesley, W. J. (ed.) Handbook of Personality Disorders. New York: Guilford Press, pp. 323–343.
Prochaska, J. O. (1984). Systems of Psychotherapy: A Transtheoretical Analysis, 2nd edn. Holmewood, IL: Dorsey Press.
Prochaska, J. O. and DiClemente, C. C. (1992). The transtheoretical approach. In Norcross, J. C. and Goldfried, M. R. (eds.) Handbook of Psychotherapy Integration. New York: Basic Books.
Robins, C. J., Ivanoff, A. M. and Linehan, M. M. (2001). Dialectic behavior therapy. In Livesley, W. J. (ed.) Handbook of Personality Disorders. New York: Guilford Press, pp. 437–459.
Rumelhart, D. E. (1980). On evaluating story grammars. Cogn Sci 4: 313–316.Google Scholar
Ryle, A. (1990). Cognitive Analytic Therapy: Active Participation in Change. Borderline Personality Disorder. Chichester: John Wiley & Sons.
Ryle, A. (1997). Cognitive Analytic Therapy and Borderline Personality Disorder. Chichester: John Wiley & Sons.
Safran, J. D. and Muran, J. C. (2000). Negotiating the Therapeutic Alliance. New York: Guilford Press.
Segal, Z. (1988). Appraisal of the self schema construct in models of depression. Psychol Bull 103: 147–162.Google Scholar
Seltzer, L. F. (1986). Paradoxical Strategies in Psychotherapy: A Comprehensive Overview and Guidebook.Chichester: John Wiley & Sons.
Shapiro, D. (1989). Psychotherapy of Neurotic Character. New York: Basic Books.
Shea, M. T., Stout, R. L., Gunderson, J. G.et al. (2002). Short-term diagnostic stability of schizotypal, borderline, avoidant, and obsessive-compulsive personality disorders. Am J Psychiatry 159: 2036–2041.Google Scholar
Skodol, A. E., Gunderson, J. G., Shea, M. T.et al. (2005). The Collaborative Longitudinal Personality Disorders Study (CLPS). J Pers Disord 19(5): 487–504.Google Scholar
Soloff, P. H. (2000). Psychopharmacology of borderline personality disorder. Psychiatr Clin North Am 23: 169–190.Google Scholar
Steiner, J. (1994). Patient-centered and analyst-centered interpretations: some implications of containment and countertransference. Psychoanal Q 14: 406–422.Google Scholar
Strupp, H. H. and Hadley, S. W. (1979). Specific vs nonspecific factors in psychotherapy: a controlled study of outcome. Arch Gen Psychiatry 36(10): 1125–1136.Google Scholar
Strupp, H. H., Fox, R. E. and Lessler, K. (1969). Patients View their Psychotherapy. Baltimore, MD: Johns Hopkins Press.
Swenson, C. (1989). Kernberg and Linehan: two approaches to the borderline patient. J Pers Disord 3: 26–35.Google Scholar
Torgersen, S., Lygren, S., Oien, P. A.et al. (2000). A twin study of personality disorders. Compr Psychiatry 41(6): 416–425.Google Scholar
Vaillant, G. E. (1992). The beginning of wisdom is never calling a patient a borderline. J Psychother Pr Res 1: 117–134.Google Scholar
Waldinger, R. J. (1987). Intensive psychodynamic therapy with borderline patients: an overview. Am J Psychiatry 144: 267–274.Google Scholar
Waldinger, R. J. and Gunderson, J. G. (1989). Effective Psychotherapy with Borderline Patients. Washington, DC: American Psychiatric Association.
Weinberger, J. (1995). Common factors aren't so common: the common factors dilemma. Clin Psychol 2(1): 45–69.Google Scholar
Weiss, J. (1993). How Psychotherapy Works: Process and Technique. New York: Guilford Press.
Widiger, T. A. and Simonsen, E. (2005). Introduction to Part Two of the Special Section on the Research Agenda for the Development of a Dimensional Classification of Personality Disorder. J Pers Disord 19(3): 211.Google Scholar
Winnicott, D. W. (1960). Ego distortion in terms of true and false self. In The Maturational Process and the Facilitating Environment. New York: International Universities Press, pp. 158–165.
Winnicott, D. W. (1965). The Maturational Process and the Facilitating Environment. Oxford: International Universities Press.
Winston, A. and Muran, J. C. (1996). Common factors in the time-limited psychotherapies. Section editor K. R. MacKenzie. In Dickstein, L. J., Riba, M. B. and Oldham, J. M. (eds.) Review of Psychiatry, Vol. 15. Washington, DC: American Psychiatric Association Press.
Yalom, I. D. (1975). The Principles and Practice of Group Psychotherapy. New York: Basic Books.
Young, J. E. (1990). Cognitive Therapy for Personality Disorders: A Schema-Focused Approach. Sarasota, FL: Professional Resource Exchange, Inc.
Young, J. E. (1994). Cognitive Therapy for Personality Disorders: A Schema-Focused Approach (Revised Edition). Sarasota, FL: Professional Resource Exchange, Inc.
Young, J. E. and Lindemann, M. D. (1992). An interpretative schema-focused model for personality disorders. J Cogn Psychother 6: 11–23.Google Scholar
Young, J. E., Klosko, J. S. and Weishaar, M. E. (2003). Schema therapy: A Practitioner's Guide. New York: Guilford Press.
Zanarini, M. C., Frankenburg, F. R., Hennen, J., Reich, D. B. and Silk, K. R. (2005). The McLean Study of Adult Development (MSAD). J Pers Disord 19(5): 505–523.Google Scholar
Zetzel, E. (1971). A developmental approach to the borderline patient. Am J Psychiatry 127: 867–871.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×