Supportive-expressive psychotherapy for comorbid personality disorders: a case study.
Supportive-expressive psychotherapy (SEP) has generated some empirical evidence supporting its effectiveness for treating a variety of Axis I disorder; however, no evidence supporting its use for patients with severe personality disorders has been published. This article describes a patient suffering from several personality disorders-avoidant, obsessive-compulsive, paranoid, narcissistic, and antisocial--using the core conflictual relationship theme (CCRT) method. Supportive-expressive psychotherapy focuses on connecting the CCRT with symptoms and maladaptive personality traits, with the goal of resolving these conflicts. Most maladaptive traits for such a complex patient are ego-syntonic, not experienced as internal conflicts, and therefore not easily accessible to therapeutic exploration. Such a patient is likely to experience the external environment as hostile once his ego-syntonic wishes are not automatically granted and thus the therapeutic alliance may suffer. This article will show the interpersonal processes that are activated when a patient is treated with time-limited, manualized psychotherapy.
Vinnars
Bo
B
Karolinska Institute. bo.vinnars@sll.se
Barber
Jacques P
JP
D000328:Adult; D015897:Comorbidity; D003220:Conflict, Psychological; D005500:Follow-Up Studies; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008960:Models, Psychological; D010554:Personality Disorders / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy*; D010555:Personality Inventory / Q000706:statistics & numerical data; D011369:Professional-Patient Relations; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D013811:Psychotherapeutic Processes; D011613:Psychotherapy / Q000379:methods*; D016896:Treatment Outcome