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Evidence-Based Treatment of Personality DysfunctionReview - Evidence-Based Treatment of Personality Dysfunction
Principles, Methods, and Processes
by Jeffrey J. Magnavita (Editor)
American Psychological Association, 2010
Review by Nora Bunford
Aug 2nd 2011 (Volume 15, Issue 31)

The topic of Evidence-Based Treatment of Personality Dysfunction: Principles, Methods, and Processes is the theoretical conceptualization and treatment of disordered personality, accompanied by a discussion of empirical evidence supporting both. The theme of the book is well in line with the field’s current emphasis on the development and dissemination of evidence-based treatments: the chapters in the middle center around diverse empirically supported therapeutic approaches to the treatment of personality dysfunction. These are framed by the beginning chapters, which (1) provide a general summary of the theory and practice of treating pathological personality and (2) outline best practices in evidence-based assessment and treatment of such pathology. In the final chapters, the editor’s theory and unified treatment (personality systematics) of personality dysfunction as well as guidelines for treatment planning are presented.

As briefly outlined above, the initial chapters focus on assessment and evidence-based practice. Because these chapters are limited in terms of space, the authors’ discussion of the topics are, unavoidably, not completely exhaustive. Nevertheless, the issues summarized are done so in a refreshingly up-to-date manner. For example, the important distinction between assessment and testing (Suhr, 2008) is attended to throughout the chapter on assessment and instrumentation. The focus of the middle chapters is on specific treatments of personality pathology. These chapters discuss the theoretical groundwork for- and conceptualization of personality pathology as postulated by proponents of each therapy; provide an overview of clinical applications; and highlight the relevant empirical literature on the efficacy and effectiveness of the treatment. There are numerous strengths of these chapters. For example, they are well-balanced: while there is a more general way in which the different personality disorder clusters are discussed, whenever a personality disorder presents with idiosyncratic features from a treatment perspective, such issues are also attended to. Further, not only are the particular personality disorders discussed by the authors of these chapters, but also are Axis I comorbidities and ways in which these inform and complicate treatment. Strengths of the case examples presented in each chapter are that (1) they are realistic yet not too complex (i.e., not so complex that the demonstration of the technique gets lost) portrayals of clients and that (2) they are accompanied by commentary illustrating why the therapist responded the way in which he/she did. Such commentary is via the language and terminology of the therapy under discussion, allowing for the reader to refer back to earlier parts of the chapter where the technique is described.

As previously noted, the book is concluded with a chapter on treatment planning and one on the editor’s fairly new (2004) approach to psychotherapy, one grounded in the component system model of clinical science termed personality systematics. This chapter, in addition to the one on treatment planning, is an appropriate concluding chapter of the book, given its focus on a unified approach to psychotherapy and its incorporation of elements from third-wave therapies, such as dialectical behavior therapy (e.g., the adoption of certain aspects of the dialectical worldview informing dialectical-behavior therapy; Linehan, 1993).

A particular strength of the book pertains to its multi-aspect impartiality. For example, when in the first chapter evidence-based and empirically-supported treatments are discussed, the advantages and disadvantages of these are considered and juxtaposed with the utility of clinical case studies, noncontrolled studies, and convergent findings from other disciplines. The content and organization of this and other chapters allows for an appreciation of both the scientist and the practitioner perspective, and implicitly promotes a scientist-practitioner model. Similarly, the book is theoretically neutral. While psychodynamic theory and treatment of personality dysfunction appear to receive special attention, seemingly, this is not because of theoretical bias but because of the unique contribution to the conceptualization of personality dysfunction psychodynamic theory offers (i.e., above and beyond that of categorical diagnostic criteria and dimensional models of personality). It is noteworthy that multiple chapters, where applicable, attend to the pertinent categories and definitions utilized by both the Diagnostic and Statistical Manual of Mental Disorders and International Classification of Diseases.

Perhaps Borderline Personality Disorder (BPD) receives the most attention across chapters, with a slight neglect of Antisocial Personality Disorder, which, from a societal standpoint is an equally destructive and costly but more prevalent personality disorder (Grant, 2004; Swartz, 1990). However, given the availability of treatments for particular personality disorders, this distinction is warranted. Further, when it comes to theoretical discussion of the disorders or their correlates (e.g., attachment patterns, inter- and intra-personal dynamics), roughly equal attention is given to all. Also, when the authors rely on empirical evidence on treatments for BPD, they theorize on how such research could be extrapolated to the other forms of personality pathology (e.g., chapter 7). Similarly, although cognitive-behavioral therapy and certain other modes of treatment do not have an entire chapter dedicated to them, whenever fitting, the efficacy and effectiveness of these approaches is described in the context of other chapters.

Evidence-Based Treatment of Personality Dysfunction is appropriate for a wide range of audiences, such as clinical practitioners, researchers, and graduate students. In terms of the technicality of the writing, a graduate-level understanding of personality pathology and the theoretical underpinnings of the therapies described in the book is necessary for one to be able to fully appreciate this book. The individual chapters are valuable in-and-of themselves but also are well enough connected that the overlap between them does not tire the reader. In sum, this book is a valuable resource for anyone interacting with or interested in persons with dysfunctional personalities.

 

References

Grant, B. F., Hasin, D. S., Stinson, F. S., Dawson, D. A., Chou, S., P., Ruan, W. J., & Pickering, R. P. (2004). Prevalence, Correlates, and Disability of Personality Disorders in the United States: Results From the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry, 65, 948-958.

Linehan, M. M. (1993). Skills Training Manual for Treating Borderline Personality Disorder. New York: Guilford.

Suhr, J. A. (2008). Assessment versus testing and its importance in learning disability diagnosis. In E. Fletcher-Janzen & C.R. Reynolds (Eds.), Neuropsychological perspectives on learning disabilities in the era of RTI: Recommendations for diagnosis and intervention. New York: Wiley. pp 99-114.

Swartz, M., Blazer, D., George, L., & Winfield, I. (1990). Estimating the prevalence of borderline personality disorder in the community. Journal of Personality Disorders, 4, 257-272.

 

 

© 2011 Nora Bunford

 

Nora Bunford is pursuing a PhD in Clinical Child Psychology at Ohio University. She received her B.A. degrees in Psychology and Philosophy from Southern Illinois University Carbondale and her M.S. degree in Clinical-Counseling Psychology from Illinois State University. While completing her doctoral studies in Psychology, Nora is also concurrently pursuing a master's degree in Philosophy. Her academic interests center around Bioethics, Psychology and its theoretical underpinnings, and research science. E-mail: nb243610@ohio.edu

 


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