Changing character: A narrative review of personality change in psychotherapies for personality disorder. (30th September 2019)

• Record Type: Journal Article
• Authors: Keefe, John R.; Derubeis, Robert J.
• Is Part Of: Psychotherapy research. Volume 29:Number 6(2019)
• Page Start: 752
• Page End: 769
• Publication Date: 2019-09-30
• Subjects: Long-term psychotherapy -- outcome research -- personality disorders -- process research -- attachment -- psychoanalytic/psychodynamic therapy -- cognitive behavior therapy; psicoterapia a lungo termine -- ricerca sull'outcome -- disturbi di personalità -- ricerca sul processo -- attaccamento -- terapia psicoanalitica/psicodinamica -- terapia cognitivo comportamentale; Psicoterapia de longo prazo -- pesquisa de resultados -- transtornos de personalidade -- pesquisa de processo -- apego -- terapia psicanalítica / psicodinâmica -- terapia cognitivo-comportamental; 長期心理治療 -- 效果研究 -- 人格疾患 -- 歷程研究 -- 依附 -- 精神分析/心理動力治療 -- 認知行為療法; Psychotherapy -- Periodicals; Psychotherapy -- Research -- Periodicals; Psychotherapy -- Periodicals; Psychothérapie -- Périodiques; Psychothérapie -- Recherche -- Périodiques; 616.891405
• DOI: 10.1080/10503307.2018.1425930
• Languages: English
• ISSNs: 1050-3307

Abstract

Abstract: Objective: Personality disorder (PD) is a negative prognostic indicator for treatment, and absolute improvements in functioning among these patients are often modest. This may be because personality features that give rise to dysfunction in PD are not targeted optimally during most treatments. Method: Attachment, mentalization, core beliefs, and personality organization/defense use were identified as personality constructs that have been pursued in treatment studies and that are proposed to underlie PD. Results: All constructs correlate with psychiatric symptoms, PD diagnosis, and functioning. Defense mechanisms and core beliefs further distinguish specific PDs, whereas personality organization separates more versus less severe PDs. Evidence from treatment and naturalistic studies indicate that maturation of defense mechanisms temporally precedes improvements in symptoms and functioning. Changes in attachment and mentalization correlate with some outcomes, but mediation of improvement has not been established. In psychodynamic therapy, transference interpretations may promote amelioration of personality dysfunction. With the exception of attachment, the experimental literature is lacking that could explicate the mechanisms by which these personality constructs maintain psychosocial dysfunction. Conclusions: Future research should aim to identify changes in these mechanisms that mediate positive outcomes in PD, as well as the specific therapeutic procedures that best promote positive change in PD.