Posted by Dr. Bob on February 12, 2003, at 7:57:28
In reply to Hollon: Candidates for CBT., posted by Dinah on January 23, 2003, at 10:05:03
> You said in your grand rounds presentation that people with obsessive
> compulsive *personality* disorder were at an advantage in CBT
> effectiveness. That makes perfect sense when you think about it.
>
> The sound was poor, but I think you implied that people with
> borderline personality disorder were poor candidates?People with borderline personality disorder are often challenging to treat because of their impulsivity and tendency to "act out" in ways that therapists find threatening, but they can also be quite rewarding, particularly because therapy can make such a difference. My experience is that therapy will have to be intense and will likely take at least a year or two, but often produces some very gratifying changes for all concerned. Marsha Linehan has done some especially nice work with Dialectic Behavior Therapy (DBT) as has Mary Anne Layden and colleagues with respect to cognitive therapy.
> What temperamental characteristics make for a good or bad "fit" to CBT?
Different temperaments call for different approaches within CBT but do not necessarily rule it out. I typically try to start by playing to a client's strengths then help them try new strategies that expand their capacities. If someone is orderly and precise I have them make lists of things they can do to be spontaneous; if someone is overly emotional and imprecise I might encourage them to act "as if" and take on a role that includes the kinds of behaviors they would prefer. I think the approach provides sufficient flexibility to adapt it to a client's temperament and style.
> How about the MMPI? Are there profiles that reveal a good or bad
> match to this particular therapy?It has been years since I have used the MMPI; in general, greater psychopathology suggests longer and more complex treatment but does not necessarily constrain its success.
poster:Dr. Bob
thread:2280
URL: http://www.dr-bob.org/babble/psycho/20030203/msgs/2594.html