Beyond management to cure: enhancing the positive dimensions of personality

doi:10.1017/CBO9780511544439.005

4 - Beyond management to cure: enhancing the positive dimensions of personality

Published online by Cambridge University Press: 14 August 2009

Edited by

Salman Akhtar and

C. Robert Cloninger: Affiliation:
Wallace Renard Professor of Psychiatry Genetics, and Psychology, Director, Sansone Family Center for Well-Being Washington University School of Medicine, St. Louis, MO, USA
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

Introduction

Individuals with severe personality disorders have little or no awareness of the satisfactions of life that are derived from an outlook of unity and connectedness with other people and nature. Their lack of awareness of the meaningful connections among all things is rooted in an outlook of separateness and fear, which leads to their self-defeating and often self-destructive thoughts, feelings, and actions. In this chapter on the future of work with patients with severe personality disorders, I will describe empirical findings about the path to well-being by which human character and self-awareness develops. I will also describe tools that are needed for the facilitation of growth in character, self-awareness, and well-being at each step along the path to happiness. This model of character development is supported empirically by both longitudinal studies of character development and findings from several randomized controlled trials about what is effective in psychotherapy.

These empirical findings set the stage for acknowledgement of the many obstacles that can emerge in the treatment of patients with severe personality disorders, so that they can be understood within a general theoretical framework. In this way, the stage for future progress can be well grounded in the scientific tradition of hypothetical-deductive research and guided by the wisdom of experienced clinicians, such as those who have contributed to this book.

Mental health professionals and their patients are increasingly aware of the basic need of all human beings for meaning that is greater than one's self.

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Type: Chapter
Information: Severe Personality Disorders , pp. 59 - 78

DOI: https://doi.org/10.1017/CBO9780511544439.005 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2007

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References

Bateman, A. and Fonagy, P. (2004). Psychotherapy for Borderline Personality Disorder: Mentalization-based Treatment. Oxford: Oxford University Press.CrossRef

Beck, A. T. (1996). Beyond belief: a theory of modes, personality, and psychopathology. In Salkovskis, P. M. (ed.) Frontiers of Cognitive Therapy. New York: Guilford Press, pp. 1–25.

Beck, A. T. and Freeman, A. (1990). Cognitive Therapy of Personality Disorders. New York: Guilford Press.

Bulik, C. M., Sullivan, P. F., Joyce, P. R., Carter, F. A. and McIntosh, V. V. (1998). Predictors of 1-year treatment outcome in bulimea nervosa. Compr Psychiatry 39: 206–214.Google Scholar

Burns, D. D. (1980). Feeling Good: The New Mood Therapy. New York: William Morrow & Co.

Chalmers, D. J. (1996). The Conscious Mind: In Search of a Fundamental Theory. New York: Oxford University Press.

Cloninger, C. R. (2000). A practical way to diagnose personality disorder: A proposal. J Personal Disord 14(2): 99–108.Google Scholar

Cloninger, C. R. (2004). Feeling Good: The Science of Well Being. New York: Oxford University Press.

Cloninger, C. R. (2005). Antisocial personality disorder: a review. In Maj, M., Akiskal, H. S., Mezzich, J. E. and Okasha, A. (eds.) Personality Disorders: Evidence and Experience in Psychiatry, Vol. 8. London: John Wiley and Sons, pp. 125–129.CrossRef

Cloninger, C. R. (2007). The Science of Well-Being: The essentials of psychopathology. New York: Oxford University Press, in press.

Cloninger, C. R. and Svrakic, D. M. (1997). Integrative psychobiological approach to psychiatric assessment and treatment. Psychiatry 60: 120–141.Google Scholar

Cloninger, C. R. and Svrakic, D. M. (2000). Personality disorders. In Sadock, B. J. and Sadock, V. A. (eds.) Comprehensive Textbook of Psychiatry. New York: Lippincott Williams & Wilkins, pp. 1723–1764.

Cloninger, C. R., Svrakic, D. M. and Przybeck, T. R. (1993). A psychobiological model of temperament and character. Arch Gen Psychiatry 50: 975–990.Google Scholar

Cloninger, C. R., Svrakic, N. M. and Svrakic, D. M. (1997). Role of personality self-organization in development of mental order and disorder. Dev Psychopathol 9: 881–906.Google Scholar

Danner, D., Snowdon, D. A. and Friesen, W. V. (2001). Positive emotions in early life and longevity: findings from the nun study. J Pers Soc Psychol 80: 804–813.Google Scholar

D'Souza, R. F. and Rodrigo, A. (2004). Spiritually augmented cognitive behavioral therapy. Austr Psychiatry 12(2): 148–152.Google Scholar

Emmons, R. A. and McCullough, M. E. (2003). Counting blessings versus burdens: an experimental investigation of gratitude and subjective well-being in daily life. J Pers Soc Psychol 84(2): 377–389.Google Scholar

Farmer, A., Mahmood, A., Redman, K., Harris, T., Sadler, S. and HcGuffin, P. (2003). A sib-pair study of the temperament and character inventory in major depression. Arch General Psychiatry 60(5): 490–496.Google Scholar

Fava, G. A., Rafanelli, C., Cazzaro, M., Conti, S. and Grandi, S. (1998a). Well-being therapy: a novel psychotherapeutic approach for residual symptoms of affective disorders. Psychol Med 28(2): 475–480.Google Scholar

Fava, G. A., Rafanelli, C., Grandi, S., Conti, S. and Belluardo, P. (1998b). Prevention of recurrent depression with cognitive behavioral therapy: preliminary findings. Arch Gen Psychiatry 55(9): 816–820.Google Scholar

Fava, G. A., Ruini, C., Rafanelli, C., Fuios, L., Salmaso, L., Mangelli, L. and Sirigatti, S. (2005). Well-being therapy of generalized anxiety disorder. Psychother Psychosom 74(1): 26–30.Google Scholar

Frankl, V. E. (1959). Man's Search for Meaning: An Introduction to Logotherapy. New York: Simon & Schuster.

Frankl, V. E. (1978). The Unheard Cry for Meaning: Psychotherapy and Humanism. New York: Pocket Books.

Hayes, S. C., Strosahl, K. D. and Wilson, K. G., (1999). Acceptance and Commitment Therapy: An Experiential Approach to Behavior Change. New York: Guilford Press.

Hollon, S. D. (1984). Final report: System for rating psychotherapy audiotapes. Bethesda, MD: U.S. Department of Health and Human Services.

Horvath, A. O. and Greenberg, L. S. (1989). Development and validation of the working alliance inventory. J Counsel Psychol 36: 223–233.Google Scholar

Huppert, F. A. and Whittington, J. E. (2003). Evidence for the independence of positive and negative well-being: implications for quality of life assessment. Br J Health Psychol 8: 107–122.Google Scholar

Kandel, E. R., Schwartz, J. H. and Jessell, T. M. (2000). Principles of Neural Science. New York: McGraw-Hill.

Larson, D. B., Thielman, S. B., Greenwold, M. A.et al. (1993). Religious content in the DSM-III-R glossary of technical terms. Am J Psychiatry 150(12): 1884–1885.Google Scholar

Lieberman, J. A., Stroup, T. S., McEvoy, J. P.et al. (2005). Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. New Engl J Med 353(12): 1209–1223.Google Scholar

Linehan, M. M. (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder. New York: Guilford Press.

Luty, S. E., Joyce, P. R., Mulder, R. T., Sullivan, P. F. and McKenzie, J. M. (1999). The relationship of dysfunctional attitudes to personality in depressed patients. J Affect Disord 54: 75–80.Google Scholar

Ma, S. H. and Teasdale, J. D. (2004). Mindfulness-based cognitive therapy for depression: replication and exploration of differential relapse prevention effects. J Consult Clin Psychol 72(1): 31–40.Google Scholar

Murray, C. J. L. and Lopez, A. D. (eds.) (1996). A Comprehensive Assessment of Mortality and Disability from Diseases, Injuries, and Risk Factors in 1990 and Projected to 2020. [The Global Burden of Disease and Injury Series.]Cambridge, MA: Harvard University Press.

Myers, D. G. and Diener, E. (1996). The pursuit of happiness. Sci Am 273: 70–72.Google Scholar

Post, S. G., Puchalski, C. M. and Larson, D. B. (2000). Physician and patient spirituality: professional boundaries, competency, and ethics. Ann Intern Med 132(7): 578–583.Google Scholar

Robins, L. N. (1966). Deviant Children Grown up: A Sociological and Psychiatric Study of Sociopathic Personality. Baltimore, MD: Williams and Wilkins.

Seligman, M. (2002). Authentic Happiness: Using the New Positive Psychology to Realize your Potential for Lasting Fulfillment. New York: Free Press.

Sheppard, L. C. and Teasdale, J. D. (2000). Dysfunctional thinking in major depressive disorder: a deficit in metacognitive monitoring. J Abnorm Psychol 109(4): 768–776.Google Scholar

Svrakic, D. M., Whitehead, C., Przybeck, T. R. and Cloninger, C. R. (1993). Differential diagnosis of personality disorders by the seven factor model of temperament and character. Arch Gen Psychiatry 50: 991–999.Google Scholar

Teasdale, J. D., Segal, Z. V., Williams, J. M., Ridgeway, V. A., Soulsby, J. M. and Lau, M. A. (2000). Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. J Consult Clin Psychol 68(4): 615–623.Google Scholar

Teasdale, J. D., Moore, R. G., Hayhurst, H., Pope, M., Williams, S. and Segal, Z. V. (2002). Metacognitive awareness and prevention of relapse in depression: empirical evidence. J Consult Clin Psychol 70(2): 275–287.Google Scholar

Tichener, V. and Hill, C. E. (1989). A comparison of six measures of working alliance. Psychother Res Pract 26: 195–199.Google Scholar

Tome, M. B., Cloninger, C. R., Watson, J. and Isaac, M. T. (1997). Serotonergic autoreceptor blockade in the reduction of antidepressant latency: personality and response to paroxetine and pindolol. J Affect Disord 44: 101–109.Google Scholar

Vaillant, G. E. and Milofsky, E. (1980). Natural history of male psychological health: IX. Empirical evidence for Erikson's model of the life cycle. Am J Psychiatry 137: 1348–1359.Google Scholar

Walsh, B. T., Seidman, S. N., Sysko, R. and Gould, M. (2002). Placebo responses in studies of major depression: variable, substantial, and growing. J Am Med Assoc 287(14): 1840–1847.Google Scholar

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