Integrated Approach to Disorder Treatment

Integrated Approach to Disorder Treatment

Integrated Approach to Disorder Treatment

An Integrated Approach to Treatment of Patients With Personality Disorders

John F. Clarkin Weill Cornell Medical College

Nicole Cain Long Island University

W. John Livesley University of British Columbia

We describe a framework for the application of treatment modules to the major domains of dysfunction manifested by clients with personality disorder. This integrated approach takes the clinician beyond the existing limited treatment research by using strategies and techniques from all the major treatment schools and orientations. This effort is necessary and timely because the field of personality disorders is currently struggling to further define and understand personality pathology beyond categories by articulating major dimensions of dysfunction across the personality disorder types marked by various degrees of severity.

Keywords: personality disorders, psychotherapy, psychotherapy integration

Personality disorders (PDs) are prevalent and debilitating and have a powerful negative im- pact on work functioning and intimate and in- terpersonal relations. There are many impedi- ments to the treatment of patients with personality pathology, including controversies in defining PD, the rampant comorbidity among PDs and with symptom disorders, the range of severity across the disorders, the difficulties in identifying the key dimensions of personality dysfunction, and the paucity of treatment re- search on the numerous PD types.

In this article, we articulate an integrated modular approach to the treatment of PDs. We describe a framework for the application of treatment modules to the major domains of dysfunction manifested by clients with PD. This is called an integrated approach (Stricker, 2010; Norcross & Wampold, 2011), because it takes the clinician beyond the existing treatment research—which is limited—and uses strategies and techniques from all the major treatment schools and orientations. An integrated modular approach emphasizes: (a) the individuality of the patient, and not the category of disorder, (b) the domains of dysfunction in the individual patient, (c) the therapeutic use of modules of intervention from existing clinical approaches, especially those that have been empirically in- vestigated, and (d) the construction of a smooth fabric of intervention in the context of a devel- oping alliance between therapist and patient.

Our attempt here and elsewhere (Livesley, Dimaggio, & Clarkin, in press) is to further the effort at integration by articulating a treatment framework specifically for those individuals with PDs. This effort is necessary because the field of PDs is currently struggling to further define and understand personality pathology beyond categories by articulating major dimensions of dysfunction across the PD types marked by various degrees of severity (Clarkin, 2013).

There is an emerging consensus that the essence of the PDs across the various categorical types centers on difficulties in self-functioning and interpersonal functioning (Sanislow et al., 2010). The product of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edi- tion (DSM-5) Personality Disorder Work

John F. Clarkin, Department of Psychiatry, Weill Cornell Medical College; Nicole Cain, Department of Psychology, Long Island University; W. John Livesley, Department of Psychiatry, University of British Columbia.

Correspondence concerning this article should be ad- dressed to John F. Clarkin, New York Presbyterian Hospital, Weill Cornell Medical Center—Westchester Division, 21 Bloomingdale Road, White Plains, NY 10605. E-mail: [email protected]