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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
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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.

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

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