Cognitive Therapy of Personality Disorders

As someone who is avoidant co morbid with OCPD spent perhaps 40 years depressed more than not before reaching out for any professional help I would like to say especially in the chapter on avoidants the book is pretty much dead on. The chapter on avoidants is the one I can most closely relate to but I see myself in others as well my OCDP us most apparent in hoarding issues a spot my therapist and I are having a hard time pushing me through I've been working with a therapist for about a year and half now making progress even if it's slow. My therapist knows I am a person who likes to try and understand my disorders and reads as much material as I can. We have both learned a lot together she being my motivator and supporter. She has been outstanding doing her research to help develop plans of actions that have helped knock down some long standing self built walls. She likes to kid me that I could teach a graduate class in personality disorders with all the reading I have done. To sum this up as a someone who has to deal with these issues as part of my daily life the book is right on with much of the way my thoughts/reactions are if I don't work actively to keep ahead of them to continue on my road to a happier life. And yes even as someone who came to therapy at a high functioning level in many aspects of my life I know at times I can be a frustrating client. But for me the knowledge that both my therapist and I are feeing increasing levels of frustration has been something I have been able to use to finally find the courage to knock down some long standing walls. So a special than you to those of you who choose to try and help those of us who present some special difficulties.

This is a great book. For example, the chapters on obsessive compulsive and passive agressive personality give some great direction for therapy. Knowing that an obsessive person fears making mistakes, that narcissism is part of obsessionality and that a passive agressive person fears loss of autonomy can really guide treatment well. On the other hand, the treatment of narcissistic personality disorder is weak. It just concentrates on how the patient should learn that the world does not revolve around them. It ignores the shame, need for validation and driven quality that narcissistic patients have and is reflected in their cognitions. In other words, the case used to treat NPD is of the oblivious type and in practice it is more common to see the hypervigilant type of narcisit. As CBT becomes more psychodynamic, this issue will be better addressed, I anticipate. (The oblivious narcisists are more antisocial and the vigilant ones are more on the anxiou/dependant end of the spectrum - I forget who's classification this is). If you want to take your understanding of nacrisistic personality disorder to a whole new level, try Psychodynamic Psychiatry in Clinical Practice (4th Edition); don't be put off by the title, it doesn't mention drugs and could just have easily been titled "Psychodynamic Psychology". Below is a summary of the Histrionic Personality Disorder chapter that I did for my own benefit. Histrionic Personality Disorder ====================== People with HPD are very vulnerable to separation. Common comorbidities are: panic, alcoholism, substance abuse, conversion disorder, somatization disorder and brief reactive psychosis. Males and females equally effected. Reliable and valid construct. Emotionality, exhibitionism, egocentricity and sexual provocativeness were strongly clustered together. Women with HPD are more attractive than average. One of the PDs with least functional impairment. Caricature of sex roles. Emotions are expressed intensely, yet seem exaggerated or unconvincing; has the sense of watching a performance. Comments often seem quite striking and powerful at the time but later on the clinician will not know what the patient meant. Diagnose by getting data about interpersonal relationships, how they handle anger, fights and disagreements. Find out how other people tend to view them. Compared with narcissists, histrionics are more willing to be subservient to avoid abandonment. On page 223: "Hypomanic periods can be found in patients with HPD as well as in patients with the Axis I syndromes of cyclothymic disorder or bipolar disorder. Millon (1996) describes an urgency, restlessness, and intensity about the hypomanic phase of cyclothymia that is not typical of the histrionic patient. Although the behaviour of the histrionic patient can occasionally be inappropriate, the histrionic generally has learned reasonable levels of social skills and can experience some hypomania without serious in

This is a great book. For example, the chapters on obsessive compulsive and passive agressive personality give some great direction for therapy. Knowing that an obsessive person fears making mistakes, that narcissism is part of obsessionality and that a passive agressive person fears loss of autonomy can really guide treatment well. On the other hand, the treatment of narcissistic personality disorder is weak. It just concentrates on how the patient should learn that the world does not revolve around them. It ignores the shame, need for validation and driven quality that narcissistic patients have and is reflected in their cognitions. In other words, the case used to treat NPD is of the oblivious type and in practice it is more common to see the hypervigilant type of narcisit. As CBT becomes more psychodynamic, this issue will be better addressed, I anticipate. (The oblivious narcisists are more antisocial and the vigilant ones are more on the anxiou/dependant end of the spectrum - I forget who's classification this is). Below is a summary of the Histrionic Personality Disorder chapter that I did for my own benefit. Histrionic Personality Disorder ====================== People with HPD are very vulnerable to separation. Common comorbidities are: panic, alcoholism, substance abuse, conversion disorder, somatization disorder and brief reactive psychosis. Males and females equally effected. Reliable and valid construct. Emotionality, exhibitionism, egocentricity and sexual provocativeness were strongly clustered together. Women with HPD are more attractive than average. One of the PDs with least functional impairment. Caricature of sex roles. Emotions are expressed intensely, yet seem exaggerated or unconvincing; has the sense of watching a performance. Comments often seem quite striking and powerful at the time but later on the clinician will not know what the patient meant. Diagnose by getting data about interpersonal relationships, how they handle anger, fights and disagreements. Find out how other people tend to view them. Compared with narcissists, histrionics are more willing to be subservient to avoid abandonment. On page 223: "Hypomanic periods can be found in patients with HPD as well as in patients with the Axis I syndromes of cyclothymic disorder or bipolar disorder. Millon (1996) describes an urgency, restlessness, and intensity about the hypomanic phase of cyclothymia that is not typical of the histrionic patient. Although the behaviour of the histrionic patient can occasionally be inappropriate, the histrionic generally has learned reasonable levels of social skills and can experience some hypomania without serious interference with routine social and occupational functioning, whereas the hypomanic periods are much more disruptive for the cyclothymic patient." Cognition is global, diffuse and impressionistic. IB: "I am inadequate and unable to handle life on my own." They will need to find ways

I love Becks work in the field of Cognitive therapy. I have long had the trouble of finding a modality that effectivly works with personality disorders. I bought this book in an attempt to bridge my knowledge from purely Axis I to include Axis II disorders. The book goes through each and every personality disorder one at a time. This made it very easy to research one specific problem without having to sift through pages and pages of irrelevant information for the task at hand.Within each chapter Beck defines the typical automatic thoughts, or faulty reasoning, that is commonly associated with the personality disorders. He then gives broad treatment plans and goals to deal with the symptoms. Beck is very well organized and succienct. You will walk away from even a short reading of this book feeling more confident and better equipped to deal with the disorders without the usually doubts that maybe you didnt get the whole gist of what the author was trying to say.I felt that this was extremely well done. I also appreciate that Beck does not promise more then he can deliver and he is the first one to say that outcomes for Axis II disorders are still poor compared with Axis I.

This is a great book! It has a lot of practical information on how to approach treatment for a client who has a personality disorder. Included are case examples and problems that a therapist may have in treating clients. Additionally, the book includes specific intervention strategies and recommendations on how to develop a good working relationship. This is especially important, because a client's interpersonal problems will be played out during session with the therapist. I have used the information in this book to anticipate and prepare for specific issues that have arisen in session.