Understanding Mechanisms of Change in Psychotherapies for Personality Disorders

Author(s) : Ueli Kramer, Author(s) : Kenneth N. Levy, Author(s) : Shelley McMain

Book Details

Publisher : American Psychological Association
Published : March 2024
Cover : Paperback
Pages : 272
Category :
Individual Psychotherapy
Catalogue No : 97740
ISBN 13 : 9781433836718
ISBN 10 : 1433836718

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This book presents a holistic approach to treating patients with personality disorders that seeks to inspire psychotherapists and encourage innovation.

Focusing on core mechanisms of change that span different therapeutic approaches, this book invites clinicians and researchers to join a dialogue with the authors, as they examine personality disorders from different theoretical perspectives, including dialectical behavior therapy, transference-focused therapy, plan analysis, clarification-oriented, and emotion-focused therapies.

The authors explore five functional domains that underlie assessment and treatment for personality disorders: emotion dysregulation, disturbed social interaction, identity problems, impulsivity, and cognitive disturbances. Each domain is analyzed through an in-depth case example, with case conceptualizations and the careful evaluation of clinical decisions that must be made at key points in therapy. The authors then compare their different approaches, emphasizing commonalities among them while also pointing out notable differences.

They also offer clear and compelling recommendations for maintaining and strengthening the therapeutic alliance. The final chapter synthesizes key takeaways from across the book to create a clear path towards enhancing clinical practice.

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Table of Contents
About the Author(s)
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Reviews and Endorsements

Beautifully integrating research findings with rich case examples, this engaging book yields clinically relevant, actionable principles to guide therapists as they navigate critical choice points in treatment. The respectful way in which the three authors reflect on their own and each other’s approaches is an exemplary model of the kind of nuanced, thoughtful dialogue that can move the field of psychotherapy forward.
Catherine F. Eubanks, PhD, Professor, Gordon F. Derner School of Psychology, Adelphi University, Garden City, NY, United States

This book provides a clinically sophisticated and empirically sound overview of the treatment for personality disorders. It goes beyond the knee-jerk selection of a treatment package for a diagnostic category. Instead, it provides transtheoretical ways of personalizing the intervention with sound case formulation. What is particularly unique is that the authors go from the therapist’s goals, to interventions to achieve these goals, then to the change processes that are behind these interventions. This is a major contribution to the field as few, if any, therapy guidelines with this population have presented this conceptualization. This could turn out to be a classic in the field—the go-to book on treating personality disorders.
Marvin R. Goldfried, PhD, Distinguished Professor of Clinical Psychology, Stony Brook University, Stony Brook, NY, United States

Great gains have been made in developing effective psychotherapies for personality disorders. What we still don’t know is how and why these therapies work. In this cleverly organized and clearly written book, Kramer and colleagues provide an essential and stimulating synthesis of the most important mechanisms of change in psychotherapy for personality disorders. It is a must-read for clinicians wanting to better articulate their impact, and for researchers wishing to track it more precisely.
Carla Sharp, PhD, John and Rebecca Moores Professor; Associate Dean for Faculty and Research, CLASS; and Director of the Developmental Psychopathology Lab and ADAPT clinic, University of Houston

This book represents an important advance in the treatment of personality disorders: the movement beyond narrow adherence to particular “brand-name” therapies. The authors—all leading figures in personality disorder treatment and research—describe their understanding of how therapy can best work for particular patients from three distinct theoretical orientations, focusing on several important domains of functioning and moving between different levels of evidence. Through detailed clinical case examples, the authors show how various theoretical and evidence-based perspectives can converge and complement one another to maximize benefit for the individual patient. This is essential reading for any clinician who wants to become more effective in their work with patients who suffer from personality disorders. The authors address a wide range of clinical challenges and walk the reader through their thinking in how to proceed, focusing on core principles and mechanisms of change at every turn. Both early-career and seasoned clinicians will appreciate this accessible window into the therapeutic process. Moreover, the book provides a sophisticated, evidence-based rationale for long-held clinical wisdom: that psychotherapy works best when therapists can integrate from different models and personalize their interventions to the individual patient.
David Kealy, PhD, Associate Professor, Psychotherapy Program & Institute of Mental Health, Department of Psychiatry, The University of British Columbia, Vancouver, BC, Canada

Introduction: Synthesizing Diverse Perspectives on Personality Disorders
1. The Importance of Developing a Focus on Mechanisms of Change in Psychotherapy
2. Personality Disorders: A Conceptualization in Functional Domains
3. The First Session of Psychotherapy and Getting Started in Treatment
4. Moving From Emotional Dysregulation to Emotional Balance
5. Moving From Problematic Social Interactions to Interpersonal Effectiveness
6. Moving From Identity Diffusion to an Integrated Sense of Self
7. Moving From Impulsive Behavior to Self-Reflection
8. Moving From Cognitive–Perceptual Disturbances to Coherent and Reality-Based Narratives
9. Challenges in the Therapeutic Relationship and How to Use Them Productively in Psychotherapy
10. Discussing Mechanisms of Change in Psychotherapies for Personality Disorders

About the Author(s)

Ueli Kramer, PhD, is professor for psychiatry and psychotherapy; director of the Institute of Psychotherapy at the department of psychiatry, University of Lausanne, Switzerland; and adjunct professor at the department of psychology, University of Windsor, Canada. His research focuses on process and outcome in psychotherapy, in particular the mechanisms of change in treatments of personality disorders, and case formulation in personality disorders. Dr. Kramer is past president of the European Society for Psychotherapy Research and current president of the European Society for the Study of Personality Disorders.

Kenneth N. Levy, PhD, is a tenured professor, associate director of clinical training, and was interim codirector of the Psychological Clinic in the department of psychology at Pennsylvania State University, where he directs the Laboratory for the Study of Personality, Psychopathology, and Psychotherapy. He is a certified transference-focused therapist, teacher, and supervisor. Dr. Levy’s clinical and research interests are attachment theory, personality disorders, and the psychotherapy process and outcomes. Dr. Levy’s work has led to recognition for organizations such as the American Psychological Association, the North American Society for the Study of Personality Disorders, and the American Psychoanalytic Association.

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Shelley McMain, PhD, is head of the Borderline Personality Disorder Clinic and senior scientist at the Centre for Addiction and Mental Health in Toronto, Canada; director of the Psychotherapy, Humanities and Psychosocial Interventions Division; associate professor of psychiatry at the University of Toronto; and president of the Transitional Board of the World Federation of Dialectical Behaviour Therapy. Dr. McMain's clinical interests include dialectical behavior therapy, borderline personality disorder, emotion regulation, and mechanisms of change. Her work has been recognized by various international professional associations, including the European Society for the Study of Personality Disorders and the American Psychoanalytic Association.

More titles by Shelley McMain