We present to you Beck and Freeman’s Cognitive Therapy for Personality Disorders, a therapeutic approach that can help those affected by Axis II disorder.
We can think of Aaron Beck as the father of cognitive therapy. This type of therapy has been shown to be effective in a multitude of psychological problems, such as unipolar depression, anxiety, sexual disorders, etc.
In the field of personality disorders, psychotherapeutic treatment is more complex. It is then more productive to identify and modify the “nuclear” problems, that is, the underlying patterns.
The basic premise of the cognitive model in relation to personality disorders is that the main source of affect and dysfunctional behavior in adults is attributive distortion, not motivational or response distortion.
It is common for those affected to see a specialist for depression or anxiety problems, relationship problems, or external situations that prompt them to seek help.
People with personality disorders often see themselves as victims of others or, more broadly, “of the system”. They don’t know why they have this disorder, or how to change their functioning. These people tend to think that other people need to change, an obstacle for their own change.
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The Differences Between Axis I and Axis II Troubles
In the first case, there are automatic negative thoughts. Like “I’m worth nothing”, “a life like this is meaningless” and irrational beliefs. But they are recovering satisfactorily from therapy.
Intervention to change these thoughts and beliefs is generally successful. Sometimes spontaneous remission can even occur after the “neurotic” episode subsides.
This is so because the dysfunctional beliefs of personality disorders are “structured”. That is, incorporated into the “normal” cognitive organization of the person.
The first step, which in turn is a great breakthrough, occurs because the patient recognizes the irrationality of their beliefs and is able to identify the negative effect they have on their life.
Cognitive Therapy Techniques for Personality Disorders
The most important techniques offered by cognitive therapy for personality disorders are:
Conceptualization of The Case
The specific conceptualization of each case is essential in this therapy, because each patient is a world. The goal is the patient’s understanding of their inappropriate behavior.
Diagrams can be shown to the patient, such as an explanatory model of his problem, as well as guides that will lead him to solve it. Some therapists use a chalkboard to show how bad reality construction derives from beliefs.
The therapist uses the data he collects to infer the patient’s self-concept, as well as the rules and formulas the patient follows in their life. The patient’s views on others must also be identified. A consistent pattern of arbitrary conclusions would reflect cognitive distortion. It is said to be “schematic driven.”
The Specification of the Underlying Objectives
Patients pursue general goals, although they sometimes ignore them. The therapist, by identifying the conditional hypotheses, must discover this objective and make it appear to the person.
For example, a patient who says to himself: “I feel bad at parties where few people come to greet me” actually says something like “it is essential for me to be loved by everyone and if not. is not the case, well, I’m not worth it ”. Therefore, in this particular case, the goal would be to “love people”.
Emphasis on the Therapist-Patient Relationship
The strategies used in this regard are:
cooperation, that is, building a spirit of trust;
the guided discovery or transmission of a sense of therapeutic adventure in which the patient sits in a human educational experience;
the use of transfer reactions, a relevant tool in therapy.
The techniques used are cognitive probes with which we teach the patient to capture automatic thoughts and test them.
The therapist can use the down arrow to reach the nuclear diagram. The appearance of a strong sensation in the patient indicates that therapist have reached this pattern. Another technique is to tackle patterns.
In this sense, therapists have three options:
Schematic restructuring or total modification of regimes, which is very difficult and sometimes impossible. The schematic modification involves making changes in the way you respond to the world, smaller than in the previous case.
Reinterpreting diagrams is about helping patients understand and reinterpret their lifestyles.
Another technique used is decision making. The therapist can use the problem solving techniques of D’Zurilla and Goldfried.
The objectives of these techniques are threefold: to modify self-destructive behaviors, to strengthen capacities and to propose behavioral tasks to test cognitions.
The behavioral techniques used are: activity programming, cognitive tests, relaxation, distraction …
Cognitive Therapy and Evocation of Childhood Experiences
Childhood materials are essential in personality disorders. It allows us to discover the origins of unsuitable models.
Dramatization and role reversal are used to mobilize affect and bring about mutating nuclear patterns. Patients must undergo emotional catharsis to become aware of and undertake the schematic modification.
Cognitive Therapy and the use of Image Recall
With this strategy, the patient is expected to relive the childhood experiences in which they learned their patterns. It’s not just about verbalizing them. To generate change, you have to interpret them.
Therapy comes when the patient, now mature, changes their experience as a child. When these dramatizations repeat and change in the adult stage, the disturbing patterns can be altered. It’s like redoing what has been traumatic.
Findings on Cognitive Therapy for Personality Disorders
Some studies are beginning to recognize the effectiveness of cognitive therapy for personality disorders. What we can see is that the connection the patient makes between their current thoughts and past experiences plays an angular role.
Knowing the origin of everything allows us to become aware of “why I am like this, when I don’t want to be”. It is true that the past is immutable, but reinterpreting the situations of the rational adult and giving them a less traumatic ending makes it possible to understand that things could have been otherwise. And that is the key to change today.
So now there are other ways. There are alternatives and all is not lost. The patient understands that he is an adult and that he can change the emotional, cognitive or behavioral habits that are harmful to him.