12 Treatments for Narcissists, Other Cluster B Personality Disorders (Borderlines, Psychopaths)
Channel: Prof. Sam Vaknin
Date: 2021-01-17

Overview of Psychotherapies for Cluster B Personality Disorders

Behavior Therapy

Replaces problem behaviors with constructive ones via conditioning and reinforcement

Cognitive Therapy

Changes negative automatic thoughts and schemas that lead to attributional and other biases as well as errors in order to alter problematic behaviors and dysfunctional feelings and behaviors.

CBT

Third wave of behavior therapy:

Primacy of therapeutic relationship, learning principles, analyze triggers and environmental cues, explore schemas and emotions, utilize modelling, homework, and imagery.

Dialectical Behavior Therapy (DBT)

Developed by Linehan in 1993 to treat BPD, but used with other personality disorders and disorders of mood, anxiety, eating, and substance abuse. It is deployed mainly with female patients in inpatient or residential settings.

Emphasizes emotional and affect regulation rather than cognitions. 

Concerned with how were schemas formed via dialectic conflicts: seeks to connect affect and need to cognitive inference processes and belief systems so as to be reinterpreted with greater self-awareness

Identifies fixation or perseveration causes by early developmental deprivation and protective attentional constriction

Examines effects of negative reinforcement through emotional avoidance or inadequate coping skills rewarded through the partial reinforcement effect

Involves individual therapy, group skills training, phone contact, and therapist consultation. Focuses on using validation and problem solving to counter severe behavioral dyscontrol, issues of quiet desperation, problems of living, and reducing incompleteness.

Cognitive Behavior Analysis System of Psychotherapy (CBASP)

Developed by McCullough and adapted by Sperry. Not used with BPD.

Clients learn to analyze life situations and manage daily stressors. They evaluate which thoughts and behaviors prevent desired outcomes.

Elicitation and remediation: questions about the situation, the client's role and functioning in it, and the desired outcome lead to a revision of counterproductive behaviors and cognitions. 

Replaces emotional reasoning with consequential one.

Mindfulness-based Cognitive Therapy (MBCT)

Developed by Teasdale.

Fosters aware focus on thoughts, feelings, and experiences in the present with an attitude of acceptance and without analysis or judgment. 

Pattern-focused Psychotherapy

Developed by Sperry

Pattern: predictable, consistent, self-perpetuating style of thinking, feeling, acting, coping, and self-defense. Can be adaptive (competent) or maladaptive (inflexible, ineffective, inappropriate, cause symptoms, impair functioning and satisfaction).

Therapy consists of replacing hurtful maladaptive patterns (situational interpretations and behaviors) with helpful adaptive ones. 

Schema Therapy

Developed by Young

Changes maladaptive schemas: 18 enduring and self-defeating ways of regarding oneself and others, arranged in 5 domains. Schemas are perpetuated through coping styles: schema maintenance, avoidance, and compensation.

Schemas can be reconstructed, modified, interpreted, or camouflaged. 

Transference-focused Psychotherapy

Developed by Kernberg

Infants form internal representations of self-others (objects) connected via affect. A personality disorder occurs when positive and negative representations fail to integrate later in life. Such splitting affects all relationships, including the therapeutic one.

Transference to the therapist exposes the faulty relationship template and allows for its empathic correction. Identity integration is accomplished as the patient experiences negative emotions in a safe environment.

Mentalization-based Treatment (MBT)

Developed by Bateman and Fonagy.

Experience secure attachment and enhancing impulse control by empathically and insightfully reflecting on and correctly labelling one’s state of mind, especially one’s powerful emotions, and cognitive errors. This leads to improves relational skills.

Developmental Therapy

Developed mainly by Blocher, Citright, and Sperry

Regards problems in personal growth and needs satisfaction on a dimensional continuum from disordered to adequate to optimal. 

Cold Therapy

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Sperry, Len, “Handbook of Diagnosis and Treatment of DSM-5 Personality Disorders: Assessment, Case Conceptualization, and Treatment”, 3rd Edition, 2016, Routledge