Cover Page

* Denotes Elaboration of Dimensional Structure in Appendix A.

image Indicates that selected Objectives/Interventions are consistent with those found in evidencebased treatments.

Title Page
Title Page

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The Personality Disorders
Treatment Planner

Second Edition

Neil R. Bockian
Julia Christine Smith
Arthur E. Jongsma, Jr.

 

Title Page

Dedicated to the memory of Theodore Millon (1928–2014)—a great scholar, and my personal mentor and friend. His contributions to the field of psychology have been beyond measure, while his contributions to his family, friends, and those close to him, have been immeasurably greater.

And dedicated to my brother Jeffrey, a man of honor and integrity, my role model and hero.

And dedicated to my uncle Alan Brodsky, a fountain of kindness and generosity, a blessing to all who know him, and a major influence in my life.

—Neil R. Bockian

This book is dedicated to my husband, Mike; my parents, William and Janis; and my mentor, Alina Suris, whose ongoing support and acceptance gives me the energy to challenge myself and continue growing, even when it's difficult.

—Julia Smith

To Ruth and Rodger Rice, whose spiritual directedness and focus is a model for all to emulate.

—Art Jongsma

FOREWORD*

Professor Bockian and Dr. Jongsma have found an intriguing way to organize an important therapeutic subject. I am especially impressed by the balance among diverse methods these authors have given and the skill with which they have executed the task of representing alternative therapeutic models. They have condensed as well as sharpened my own earlier efforts to develop a guide for treating the personality disorders. Employing an integrative framework, they have succeeded in organizing a pioneering work, one that will be valuable to mature professionals of diverse orientations, as well as being eminently useful for students.

The authors have outlined solutions to the personality treatment task with a series of powerful, concrete, and readily implemented tools that draw from numerous treatment methodologies. What has been especially helpful to the reader is that their approach to therapy not only addresses the patient's initial complaint—such as depression, anxiety, or alcoholism—but is designed to undercut the patient's long-standing habits and attitudes that give rise to these manifest symptoms. They fully recognize also that personality disorders are themselves pathogenic, that is, these disorders set into motion secondary complications that persist and intensify the patient's initial difficulties. Presenting symptoms not only discomfort the patient, but the forces that undergird them diminish life's potentials by creating persistent unhappiness, undoing close relationships, disrupting work opportunities, and undermining future aspirations.

I was extremely pleased to see the authors' willingness to grapple with the many subtypes of the classical personality disorders. Here they have sought to differentiate the conflicted avoidant from the hypersensitive avoidant as well as to separate the different ways in which one should deal with a petulant borderline compared to a self-destructive one. Their book is more than a simple listing of techniques—it shows sensitive awareness of the uniqueness of each patient and the subtle differences that are called for in their treatment.

My hat is off to Drs. Bockian and Jongsma for undertaking the awesome task of guiding others who treat their patients with personality difficulties—and for carrying out their work with clarity and utility. Most textbooks shy away from discussing the treatment of personality disorders owing to their intricacies and uniqueness. By contrast, the good doctors have organized a treatment model that can be understood by all well-trained and motivated students and professionals.

Theodore Millon, Ph.D., D.Sc.

ACKNOWLEDGMENTS

First and foremost, I would like to thank my series editor, coauthor, and friend, Dr. Art Jongsma, whose clinical acumen and pragmatic wisdom provided a solid anchor throughout the writing of the manuscript. My coauthor, former student, and friend, Julia Smith, Psy.D., made invaluable contributions to this draft. There is a particular and indescribable pleasure in seeing one's former student exceed one's own knowledge in a particular area (in this case, Dr. Smith's expertise with Acceptance and Commitment Therapy), which enhanced the quality of this manuscript. In addition, Art's excellent assistant, Sue Rhoda, was extremely helpful. Sue reformatted my drafts, without which the process would have bogged down completely. I will always be grateful for the patience, persistence, and encouragement of these three colleagues. I would also like to thank my (really, our) editor, Marquita Flemming, for her patience and support throughout this project. On those occasions when we met, she was both gracious and thoughtful, and it has been a pleasure working with her.

Undertaking a project as large as writing a book is inevitably a family effort. I would like to thank my wife, Martha, and my children, Chaya and Yaakov, for their love and support as I plowed ahead. Similarly, I owe a debt of gratitude to my parents, Fred and Sandra Bockian, my brother, Jeffrey, as well as my uncle and aunt, Alan and Barbara Brodsky, who were with me in spirit throughout this journey. I am truly blessed to have all of these people in my life.

There are also several professional colleagues to whom I owe a debt of gratitude. From the first edition of this volume, several of my colleagues provided key insights into several different theoretical approaches. Marc Lubin, Ph.D., provided essential feedback on operationalizing the psychodynamic approaches to treating personality disorders. In a similar vein, Marge Witty, Ph.D., provided feedback on client-centered interventions, while Jill Gardner, Ph.D., was instrumental in developing interventions using the self-psychology approach. My continued gratitude goes to Garry Prouty, Ph.D., who provided insights into his unique approach to connecting with extremely detached and psychotic clients; his memory is a blessing to all who knew him. From the current volume, several additional colleagues were instrumental in the development of some important interventions. Sue Johnson, Ph.D., was generous with her time and support, helping me to operationalize several key interventions in Emotion-Focused Therapy. Similarly, Leigh Johnson-Migalski, Psy.D., provided support that allowed me to include Adlerian interventions in several chapters. Tim Bruce, Ph.D., provided us with a pithy review of the status of evidence-based practice in the personality disorders area. Erin Fletcher, Psy.D., my former student, friend, and a talented clinician, gave invaluable feedback on the use of exposure therapy. I thank Anthony Bateman, Ph.D., for his outstanding feedback on mentalization, as well as my colleagues Cathy McNeilly, Psy.D., and Richard Rutschman, Ed.D., for their invaluable feedback on operationalizing Motivational Interviewing. Aimee Daramus, M.A., my teaching assistant and soon-to-be colleague, did important work on the reference section and helped with the research on evidence-based practice; Gesa Kohlmeier, B.A., also my teaching assistant, provided much-needed help in organizing the various chapters in during the later stages of the project. Special thanks go to my exuberant former student and current colleague and friend Stacy Zeidman, M.A., for her drafting of several sections of the dimensional appendix. Finally, I would like to thank my insightful and talented former student and current colleague and friend Tatiana Zdyb, Ph.D., for her comments on last-minute drafts and for her encouragement during the project's final phases.

Last, but certainly not least, I would like to thank Ted Millon, Ph.D., of blessed memory, for his ongoing guidance and support during my career. He taught me how critically important a relationship with a mentor can be. His teachings and support are gifts that I could never reciprocate. I can only pay it forward by sharing what he has taught me with my students and with the readers of my writings.

Neil r. Bockian