Jeffrey J. Magnavita — Handbook of Personality Disorders

Автор: Jeffrey J. Magnavita
Название книги: Handbook of Personality Disorders
Формат: PDF
Жанр: Психология
Страницы: 603
Качество: Изначально компьютерное, E-book

This comprehensive reference, edited by one of the leading experts in the field, assimilates the newest and most effective treatment techniques for the personality disorders. Each chapter is written by leading scholars in the Cognitive-Behavior, Humanistic and Integrative theoretical models. In addition to a detailed case example in each chapter, additional case studies are integrated and used throughout.

THE INSPIRATION FOR this volume emerged from my work over the past 20 years
conducting psychodiagnostic assessments and practicing psychotherapy with
children, adolescents, adults, and the elderly, first in an inpatient and then
outpatient settings. What struck me was that across the spectrum of individuals
and families that I encountered presenting with complex clinical syndromes was
how many struggled with self-defeating and self-destructive personality patterns
that were so difficult to impact with standard methods and techniques. With most
clinicians, as it is with me, the compelling force that drives us is to reduce human
suffering, and we often gain an understanding of our own suffering and developmental
challenges. During a crisis or a major life transition, many have experienced
personality “dysfunction,” but for most, this is short lived. Yet, for many
others, as addressed in this volume, these patterns or systems are often entrenched,
enduring, and chronically dysfunctioning. These dysfunctioning systems
cause much disruption to the individual, family, and society. Attempting to
understand this complex phenomenon that clinicians are faced with daily is challenging,
fascinating, and often daunting. It is my hope that this volume clarifies
some of these challenges and adds to our hope. It seems clear that the phenomenon
we are dealing with, whether symptoms of clinical syndromes or relational disturbance,
rests on the integrity of the personality system. If the personality system is
not functioning especially well, trouble looms, symptom complexes emerge, and relationships
falter. Clinical syndromes and symptom complexes are expressed
sometimes somatically or psychologically but always in the relational matrix. In
my diverse clinical work with individuals, couples, families, and groups, it has
been clear to me that there is one central system that informs the way in which
we conceptualize psychopathology; understand intrapsychic, interpersonal, and
family functioning; and formulate our psychotherapeutic strategies. This central
organizing system is personality. Although personality has been primarily conceptualized
as housed in the individual or self-system, theoretical advances over the
past century have underscored the necessity of expanding our conceptual field to
other domains such as the interpersonal (dyadic), triadic (threesomes), and larger
family and social systems that form the entire ecological system or biosphere.
When the personality system is vulnerable or not operating effectively at any
of the biopsychosocial domains, the system becomes dysfunctional. When the
level of adaptive functioning meets appropriate diagnostic criteria, a personality
disorder is diagnosed. The diagnostic category and label personality disorder is not
necessarily the best way to classify what we experience in relationships and observe
clinically, as it is necessarily reductionistic. It is, however, what we have at
this phase in the development of the field and some consider the state of the art. I
prefer the term personality dysfunction, but many others represented in this volume
may not agree. For some individuals, personality dysfunction is something
that affects their lives but that they suffer in silence and may go undetected, except
by those in immediate proximity such as spouses, partners, children, and
coworkers. These individuals have been termed neurotic characters in the past.
Yet others show more dramatic signs and may be stuck in chronic maladaptive
patterns that cause severe suffering as well as having major impact on the family
and society. These patterns are often referred to as the severe personality disorders.
Couples and families may have faltering personality systems that can result
in what I have termed dysfunctional personologic systems that can transmit this dysfunction
from one generation to another, often downward spiraling, unless intervention
takes place.
Personality has been an interest to humankind since we became conscious and
able to “observe” ourselves. Over the past century of modern behavioral science,
personality and its disorders has been a subject of interest to many disciplines including
anthropologists, primatologists, academic psychologists, psychopathologists,
clinical psychiatrists, and psychologists, and, more recently, neuroscientists.
We are entering a new phase of the field where interdisciplinary collaboration and
advances in fields such as neuroscience may help us map human consciousness
and develop efficient, effective, and accelerated treatments for even the most refractory
of these dysfunctional systems.
Theories, methods, and techniques have been developed to address these faltering
or dysfunctioning personality systems. Many of these models presented in
this volume offer a rich array of conceptual systems, approaches, and therapeutic
stances. In spite of all these remarkable developments, we should not forget about
the importance of the therapeutic relationship, which tends to be given a back
seat as we head toward an era of empirically validated treatments (EVTs) and the
concomitant pressure to produce treatment manuals. Although they can be useful,
we should not forget that our endeavor is complex and human to human, requiring
clinical intuition and a genuine desire to alleviate human suffering