20.3: Treating Personality Disorders
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It is generally accepted that personality disorders are highly resistant to treatment. Personality is well-established in childhood, or at least by adolescence. Since many theorists consider it difficult to significantly change personality once it is established, even in a normal individual, by the time an adult is diagnosed with a personality disorder it has become a deeply embedded aspect of their personality. Thus, individuals suffering from personality disorders, individuals who typically lack insight into their problems, are simply unlikely to realize a need for change or to put any effort into making changes. And since change can only come from the individual, it cannot be forced by the therapist, if the individual suffering from a personality disorder does not cooperate with or put any effort into therapy, there can be no possibility for change. The evolutionary perspective on personality disorders offers another possible reason why they would be resistant to change. Personality disorders may be adaptations to abnormal, most likely abusive, conditions present during personality development. Therefore, even though they are viewed as abnormal, they have served an adaptive purpose for the individual suffering from the disorder.
Nonetheless, progress is being made. There is evidence to support the efficacy of some therapeutic approaches in the treatment of personality disorders, including cognitive, behavioral, interpersonal/psychosocial, and psychoanalytic treatments (Benjamin, 2005; Fonagy, 2006; Kernberg & Caligor, 2005; Leichsenring, 2006; Pretzer & Beck, 2005). Perhaps the most thoroughly studied and effective approach to the treatment of personality disorders is dialectical behavior therapy (DBT), developed by Marsha Linehan specifically for the treatment of borderline personality disorder and its commonly associated element of suicidal behavior (Linehan, 1987, 1993; Robins et al., 2004). DBT emphasizes the complete process of change, incorporating both the acceptance of the patient’s real suffering and the desire for change. Since a natural conflict arises between acceptance and the desire/need for change, a conflict that can arouse intense negative emotion, DBT involves teaching patients mindfulness skills necessary to “allow” experiences without the need to either suppress or avoid them. These mindfulness skills were drawn primarily from Zen principles, but are similar to and compatible with Western contemplative practices (Robins et al., 2004).
Discussion Question: Does it surprise you to learn that the most promising treatment for personality disorders is based largely on the practice of Zen? What might this say about the importance of therapists being versed in a variety of techniques and being well-educated in cross-cultural perspectives?