Personality Disorders: Tips for Treatment

Mark A. Blais

1. Identify precipitants and symptoms: “Why now?”

Clearly define the reason(s) for seeking treatment, including precipitants and symptomatology. PD patients often seek treatment due to a crisis.

2. Structure, structure, structure:

Jointly establish a treatment contract with clear goals. For outpatients, issues to address include frequency and length of sessions, guidelines for off-hours contact, vacation coverage, and how missed appointments will be handled. Criteria for hospitalization may also be included. This contract can be developed with the patient early in treatment; putting it in written form may be helpful.

3. Look for comorbidity:

Carefully assess for comorbid axis I and II conditions through clinical interview and psychological testing if appropriate. Undiagnosed conditions may slow or even derail and otherwise solid plan.

4. Target symptoms:

Identify symptoms which can be targeted by medication.

5. Use therapy:

Utilize both group and individual therapy. All interventions should be aimed at increasing coping, developing treatment alliance, providing support, and limiting regression.

6. Use teamwork:

Contact family and outpatient treaters to collect collateral information and assess discharge needs. Where will the patient live, and with what sort of follow up? Remember that patients with PD are generally not good self-reporters.

7. Collaborate:

Carefully monitor the patient’s level of involvement in treatment.

8. Expect disagreement:

Communicate openly and frequently with all staff members. Treatment disagreements will undoubtedly develop among the team; resolve them as they arise.

9. Use the contract:

Actively and repeatedly refer to the treatment contract to gauge progress and compliance.

10. Plan ahead:

Anticipate problems around the time of discharge; attempt to hold to the agreed-upon discharge date whenever possible. Remember that periodic brief hospitalization of a patient with severe PD is not unreasonable. Also consider the role of partial hospitalization as an intermediate step.