Review extract: “The complex nature of the more severe personality disorders, including their characteristic quality of relational difficulty, continues, however, to present challenges to the psychotherapist, who is likely to do the heavy-lifting in treating these disorders in the mental health setting. A distinctive feature of psychotherapy as a treatment is the essentially interpersonal context in which the treatment occurs. These disorders, perhaps most of all psychiatric illnesses, call for a cogent frame for understanding the key relational issues, and great skill in developing and maintaining an effective working relationship, so that treatment itself does not become disordered.
In the video series, THREE APPROACHES TO PERSONALITY DISORDERS, we have the privilege of seeing three world renowned clinicians — OTTO KERNBERG, MARSHA LINEHAN, AND ARTHUR FREEMAN — work from their distinct treatment models, all of which have empirical support, with a challenging “patient” named Alfred (portrayed by Dutch actor Henk Grahuis). Alfred presents for therapy describing a painful life event: several months prior his long-time girlfriend aborted her pregnancy and ended their relationship in a manner he found abrupt and unexpected. However, as the sessions play out, Alfred comes to reveal disturbances of a deeper and more enduring nature as well as challenging clinical issues, including suicidal thoughts, heavy drinking, and a history of domestic violence. Each of the featured experts acknowledges the complex interplay between genetics and temperament with the social environment in the development of personality disorder but maintain distinctive ways of conceptualizing the core therapeutic issues, and utilize different techniques for change that logically flow from their particular frame of understanding. At the same time, each expert models evidence-based relational elements that serve as powerful common factors for
change: in particular, the skilful building of an initial therapeutic alliance with an extremely defensive and brittle client.”
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