Click here to download

Integrated treatment: a conceptual framework for an evidence-based approach to the treatment of personality disorder
Journal Title: QUADERNI DI PSICOTERAPIA COGNITIVA 
Author/s: W. John Livesley 
Year:  2013 Issue: 33 Language: Italian 
Pages:  33 Pg. 19-51 FullText PDF:  199 KB
DOI:  10.3280/QPC2013-033003
(DOI is like a bar code for intellectual property: to have more infomation:  clicca qui   and here 


Evidence that various therapies are effective in treating personality disorder and that outcome does not differ substantially across treatments suggests that it is time to replace concerns about the efficacy of specific therapies and which form of therapy to use with an evidence- based approach that combines methods that work from all therapies. A framework is proposed for selecting and combining eclectic treatment methods and delivering them in a coordinated way. The framework has two components: (1) a system for conceptualizing personality disorder based on empirical knowledge about the structure, etiology, development, and stability of personality pathology to use as a guide to selecting interventions and planning the sequence in which they will be used; and (2), a model of therapeutic change based on the general literature on psychotherapy outcome and specific studies of PD treatments. The framework proposes that integrated treatment be organized around general principles of therapeutic change common to all effective therapies supplemented with more specific treatment methods taken from the different therapies as needed to tailor treatment to individual patients and treat specific problems and psychopathology. The coordinated delivery of such a diverse array of interventions is achieved by using a phases of treatment scheme that proposes that treatment focus on specific symptoms and problems in a systematic and orderly way according to their stability and potential for change.

  1. Angus L., McLeod J., editors (2004). The Handbook of Narrative and Psychotherapy: Practice, theory and research. Thousand Oaks, CA: Sage.
  2. Bateman A., Fonagy P. (2004). Psychotherapy for borderline personality disorder. Oxford: Oxford University Press. doi.org/10.1521/pedi.18.1.36.32772
  3. Baumeister R.F. (1994). The crystallization of discontent in the process of major life change. In: Heatherton T.F., Weinberger J.L., editors, Can personality change? Washington, DC: American Psychological Association. doi.org/10.1037/10143-012
  4. Beck A.T., Freeman A., Davis D.D. (2004). Cognitive therapy of personality disorders. New York: Guilford Press.
  5. Benjamin L.S. (1993). Interpersonal diagnosis and treatment of personality disorders. New York: Guilford Press.
  6. Beutler L.E. (1991). Have all won and must all have prizes? Journal of Consulting and Clinical Psychology, 59: 226-232. doi.org/10.1037/0022-006X.59.2.226
  7. Blum N., St. John D., Pfohl B., Stuart S., McCormick B., Allen J., Arndt S., Balck D.W. (2008). Systems training for emotional predicability and problem solving (STEPPS) for outpatients with borderline personality disorder: A randomized controlled trial and 1-year follow-up. American Journal of Psychiatry, 165: 468-478. doi.org/10.1176/appi.ajp.2007.07071079
  8. Bowlby J. (1980). Loss. London: Hogarth Press.
  9. Castonguay L.G., Beutler L.E., editors (2006a). Principles of therapeutic change that work. New York: Oxford University Press. Castonguay L.G., Beutler L.E. (2006b). Common and unique principles of therapeutic change: What do we know and what do we need to know? In: Castonguay L.G., Beutler L.E., editors, Principles of therapeutic change that work. New York: Oxford University Press.
  10. Cervone D. (2005). The architecture of personality. Psychological Review, 111: 183-204.doi.org/10.1002/per.576
  11. Choi-Kain L.W., Gunderson J.G. (2008). Mentalization: Ontogeny, assessment and application in the treatment of borderline personality disorder. American Journal of Psychiatry, 165: 1127-1135. doi.org/10.1176/appi.ajp.2008.07081360
  12. Clarkin J.F., Yeomans F.E., Kernberg O. (1999). Psychotherapy for borderline personality disorder. New York: Wiley. doi.org/10.1521/pedi.1999.13.2.142
  13. Cloninger C.R. (2000). Apractical way to diagnose personality disorder: Aproposal. Journal of Personality Disorders, 14: 99-108. doi.org/10.1521/pedi.2000.14.2.99
  14. Cottraux J., Note I.D., Boutitie F., Milliery M., Genouihlac V., Yao S.N. (2009). Cognitive versus Rogerian supportive therapy in borderline personality disorder. Psychotherapy and Psychosomatics, 78: 307-316. doi.org/10.1159/000229769
  15. Critchfield K.L., Benjamin L.S. (2006). Integration of therapeutic factors in treating personality disorders. In: Castonguay J.L., Beutler L.E., editors, Principles of therapeutic change that work. New York: Oxford University Press.
  16. DiClemente C.C. (1994). If behaviors change, can personality be far behind? In: Heatherton T.F., Weinberger J.L., editors, Can personality change? Washington, DC: American Psychological Association. doi.org/10.1037/10143-008
  17. Dimaggio G., Lysaker P.H., editors (2010). Metacognition and severe adult mental disorders: From basic research to treatment. London: Routledge. Dimaggio G., Semerari A., Carcione A., Nicolò G., Procacci M. (2007). Psychotherapy of personality disorders: Metacognition, states of mind, and interpersonal cycles. London: Routledge.
  18. Dimaggio G., Semerari A., Carcione A., Procacci M., Nicolò G. (2006). Toward a model of self-pathology underlying personality disorders: Narratives, metarepresentation, interpersonal cycles and decision-making processes. Journal of Personality Disorders, 20: 597-617. doi.org/10.1521/pedi.2006.20.6.597
  19. Dimaggio G., Vanheule S., Lysaker P.H., Carcione A., Nicolò G. (2009). Impaired selfreflection in psychiatric disorders among adults: A proposal for the existence of a network of semi independent functions. Consciousness and Cognition, 18: 653-664.doi.org/10.1016/j.concog.2009.06.003
  20. Domes G., Schulze L., Herbertz S.C. (2009). Emotion recognition in borderline personality disorder: A review of the literature. Journal of Personality Disorders, 23: 6-19. doi.org/10.1521/pedi.2009.23.1.6
  21. Evans K., Tyrer P., Catalan J., Schmidt U., Davidson K., Tata P., Thornton S., Barber J., Thompson S. (1999). Manual assisted cognitive-behavioral therapy (MACT): A randomized controlled trial of a brief intervention with bibliotherapy in the treatment of recurrent deliberate self-harm. Psychological Medicine, 29: 19-25. doi.org/10.1017/S003329179800765X
  22. Fernandez-Alvarez H., Clarkin J.F., Salguiero M., Critchfield K. (2006). Participant factors in treating personality disorders. In: Castonguay L.G., Beutler L.E., editors, Principles of therapeutic change that work. New York: Oxford University Press.
  23. Fonagy P., Gergely G., Jurist E.L., Target M. (2002). Affect regulation, mentalization, and the development of the self. New York: Other Press.
  24. Giesen-Bloo J., van Dyck R., Spinhoven P., van Tilberg W., Dirksen C., van Asselt T. (2006). Outpatient psychotherapy for borderline personality disorder: Randomized trial of schemafocused therapy vs transferencefocused therapy. Archives of General Psychiatry, 63: 649-658. doi.org/10.1001/archpsyc.63.6.649
  25. Gold J.R. (1990a). Culture, history, and psychotherapy integration. Journal of Integrative and Eclectic Psychotherapy, 9: 41-48.
  26. Gold J.R. (1990b). The integration of psychoanalytic, interpersonal, and cognitive approaches in the psychotherapy of borderline and narcissistic disorders. Journal of Integrative and Eclectic Psychotherapy, 9: 49-68.
  27. Gold J.R. (1996). Key concepts in psychotherapy integration. New York: Plenum Press. Gray J.A. (1987). The psychology of fear and stress. Cambridge: Cambridge University Press.
  28. Heatherton T.F., Weinberger J.L., editors (1994). Can personality change? Washington, DC: American Psychological Association.
  29. Hermans H.J.M., Dimaggio G., editors (2004). The dialogical self in psychotherapy. London: Brunner/Routledge. doi.org/10.4324/9780203314616
  30. Horowitz M.J. (1998). Cognitive psychodynamics: From conflict to character. New York: John Wiley.
  31. Kernberg O.F. (1984). Severe personality disorders. New Haven, CT: Yale University Press. Kohut H. (1971). The analysis of the self. New York: International Universities Press.
  32. Joseph B. (1983). On understanding and not understanding: Some technical issues. International Journal of Psychoanalysis, 64: 291-298.
  33. Layden M.A., Newman C.F., Freeman A., Morse S.B. (1993). Cognitive therapy of borderline personality disorder. Needham Heights, MA: Allyn & Bacon.
  34. Leichsenring F., Leibing E. (2003). The effectiveness of psychodynamic therapy and cognitive behavior therapy in the treatment of personality disorders: A meta-analysis. American Journal of Psychiatry, 160: 1223-1232. doi.org/10.1176/appi.ajp. 160.7.1223
  35. Linehan M.M. (1993). Cognitive behavioral treatment of borderline personality disorder. New York: Guilford Press.
  36. Linehan M.M, Armstrong H.E., Suarez A., Allmon D., Heard H. (1991). Cognitive-behavioural treatment of chronically parasuicidal borderline patients. Archives of General Psychiatry, 48, 1060-1064. doi.org/10.1001/archpsyc.1991.01810360024003
  37. Linehan M.M., Davison G.C., Lynch T.R., Sanderson C. (2006). Techniques factors in treating personality disorders. In: Castonguay L.G., Beutler L.E., editors, Principles of therapeutic change that work. New York: Oxford University Press.
  38. Lipsey M.W. (1995). What do we learn from 400 research studies on the effectiveness of treatment with juvenile delinquents? In: McGuire J., editor, What works: Reducing reoffending: Guidelines from research and practice. Oxford, UK: John Wiley.
  39. Livesley W.J. (2003). Practical management of personality disorder. New York: Guilford Press. doi.org/10.1521/pedi.17.5.371.22969; http://dx.doi.org/10.1521/pedi.17.2.87.23988
  40. Livesley W.J. (2007). Integrated therapy for complex cases of personality disorder. Journal of Clinical Psychology, 64: 207-221. doi.org/10.1521/pedi.2007.21.2.99; doi.org/10.
  41. 1521/pedi.2007.21.5.455; doi.org/10.1521/pedi.2007.21. 2.199
  42. Livesley W.J. (2008). Toward a genetically informed model of borderline personality disorder. Journal of Personality Disorders, 22: 42-71. doi.org/10.1521/pedi.2008. 22.1.42
  43. Livesley W.J., Jang K.L., (2008). The behavioral genetic of personality disorders. Annual Review of Clinical Psychology, 4: 247-274. doi.org/10.1521/pedi.2008.22.1.1; doi.org/10.1521/pedi.2008.22.1.42; doi.org/10.1521/pedi.2008.22.6.547
  44. Luborsky L. (1984). Principles of psychoanalytic psychotherapy. New York: Basic Books. Luborsky L., Singer B., Luborsky L. (1975). Comparative studies of psychotherapies. Archives of General Psychiatry, 32: 995-1008. doi.org/10.1001/archpsyc.1975. 01760260059004
  45. Mayer J.D. (2005). A tale of two visions: Can a new view of personality help to integrate psychology? American Psychologist, 60: 294-307. doi.org/10.1037/0003-066X.60.4.294
  46. Meyer B., Pilkonis P. (2006). Developing treatments that bridge personality and psychopathology. In: Krueger R.F., Trackett J.L., editors, Personality and psychopathology.
  47. New York: Guilford Press.
  48. Miller W.R., Rollnick S. (1991) Motivational interviewing. New York: Guilford Press.
  49. Miller W.R., Rollnick S. (2002). Motivational interviewing: Preparing for change. New York: Guilford Press.
  50. Mischel W. (2004). Toward an integrative science of the person. Annual Review of Psychology, 55: 1-22. doi.org/10.1146/annurev.psych.55.042902.130709
  51. Mischel W., Shoda Y. (1995). A cognitive affective system theory of personality: Reconceptualizing situations, dispositions, dynamics, and invariance in personality structure. Psychological Review, 102: 246-268. doi.org/10.1037/0033-295X.102.2.246
  52. Neimeyer R.A. (2000). Narrative disruptions in the construction of the self. In: Neimeyer R.A., Raskin J.D., editors, Constructions of disorder. Washington, DC: American Psychiatric Association Press.
  53. Nicolò G., Semerari A., Lysaker P.H., Dimaggio G., Conti L., d’Angerio S., (2011).
  54. Alexithymia in personality disorders: Correlations with symptoms and interpersonal functioning. Psychiatry Research, 190: 37-42. doi.org/10.1016/j.psychres. 2010.07.046
  55. Paris J. (2005). Treatment of borderline personality disorder. Canadian Journal of Psychiatry, 50: 435-441. doi.org/10.1521/pedi.19.2.156.62629; doi. org/10.1521/pedi.2005.19.5.557
  56. Piper W.E., Joyce A.S. (2001). Psychosocial treatment outcome. In: Livesley W.J., editor,
  57. Handbook of personality disorders. New York: Guilford Press.
  58. Prochaska J.O., DiClemente C.C., Norcross J.C. (1992). In search of how people change. American Psychologist, 47: 1102-1114. doi.org/10.1037/0003-066X.47.9.1102
  59. Prochaska J.O., Norcross J.C., DiClemente C.C. (1994). Changing for good: The revolutionary program that explains the six stages of change and teaches you how to free yourself from bad habits. New York: William Morrow.
  60. Rogers C.R. (1957). The necessary and sufficient conditions for therapeutic personality change. Journal of Consulting Psychology, 21: 95-103. doi.org/10.1037 /h0045357
  61. Rosengren D.B. (2009). Building motivational interviewing skills: A practitioner workbook. New York: Guilford Press.
  62. Rutter M. (1987). Temperament, personality, and personality disorder. British Journal of Psychiatry, 150: 443-458. doi.org/10.1192/bjp.150.4.443
  63. Ryle A. (1997). Cognitive analytic therapy and borderline personality disorder. Chichester, UK: John Wiley.
  64. Safran J.D., Muran J.C., Samstag L.W. (1994). Resolving therapeutic alliance ruptures: A task analytic investigation. In: Horvath A.O., Greenberg L.S., editors, The working
  65. alliance: Theory, research, and practice. New York: John Wiley.
  66. Safran J.D., Muran J.C., Samstag L.W., Stevens C. (2002). Repairing alliance ruptures. In: Norcross J.C., editor, Psychotherapy relationships that work: Therapist contributions and responsiveness to patients. New York: Oxford University Press. Schmidt U., Davidson K. (2004). Life after self-harm. Hove, UK: Brunner-Routledge.
  67. Segal Z. (1988). Appraisal of the self schema construct in models of depression. Psychological Bulletin, 103: 147-162. doi.org/10.1037/0033-2909.103.2.147
  68. Semerari A., Carcione A, Dimaggio G., Nicolò G., Procacci M. (2007) Understanding minds, different functions and different disorders? The contribution of psychotherapeutic research. Psychotherapy Research, 17: 106-119. doi.org/10.1080/105033005 00536953
  69. Smith T.L., Barrett M.S., Benjamin L.S., Barber J.P. (2006). Relationship factors in treating personality disorders. In: Castonguay L.G., Beutler L.E., editors, Principles of therapeutic change that work. New York: Oxford University Press.
  70. Soloff P.H. (2000). Psychopharmacology of borderline personality disorder. Psychiatric Clinics of North America, 23: 169-190. doi.org/10.1016/S0193-953X(05) 70150-7
  71. Steiner J. (1994). Patient-centered and analyst-centered interpretations: Some implications of containment and countertransference. Psychoanalytic Quarterly, 14: 406-422.
  72. Swenson C. (1989). Kernberg and Linehan: Two approaches to the borderline patient. Journal of Personality Disorders, 3: 26-35. doi.org/10.1521/pedi.1989.3.1.26
  73. Tickle J.J., Heatherton T.F., Wittenberg L.G. (2001). Can personality change? In: Livesley W.J., editor, Handbook of personality disorder. New York: Guilford Press.
  74. Toulmin S. (1978). Self-knowledge and knowledge of the “self”. In: Mischel T., editor, The self: Psychological and philosophical issues. Oxford: Oxford University Press.
  75. Vernon P.E. (1964). Personality assessment: A critical survey. London: Methuen.
  76. Wachtel P.L. (1991). From eclecticism to synthesis: Toward a more seamless psychotherapeutic integration. Journal of Psychotherapy Integration, 1: 43-54.
  77. Widiger T., Simonsen E. (2005). Alternative dimensional models of personality disorder: Finding a common ground. Journal of Personality Disorders, 19: 110-130. doi. org/10.1521/pedi.19.2.110.62628
  78. Young J.E., Klosko J.S., Weishaar M.E. (2003). Schema therapy. New York: Guilford Press.

W. John Livesley, Integrated treatment: a conceptual framework for an evidence-based approach to the treatment of personality disorder in "QUADERNI DI PSICOTERAPIA COGNITIVA" 33/2013, pp. 19-51, DOI:10.3280/QPC2013-033003

   

FrancoAngeli is a member of Publishers International Linking Association a not for profit orgasnization wich runs the CrossRef service, enabing links to and from online scholarly content