Psychotherapy

Psychotherapy, which may help to stabilize erratic mood, and prevent depressive and other decompensations, is the treatment of choice.

Supportive therapy is indicated for acutely distressed histrionic patients, as well as for those at the sicker end of the continuum. In order to decrease the risk of self-harm or other impulsive acting-out behaviour, a combination of support, judicious medication, and brief hospitalization may be needed. (45>

Psychoanalysis can be used for patients in the healthier part of the histrionic continuum. Histrionic personalities, functioning on the clear borderline level, should be treated by expressive psychotherapy.(82)

Identification and clarification of the patient's covert inner feelings is an important part of the therapeutic process. Histrionic patients often develop erotic-idealizing transference. They may be sexually provocative in their relationships with the therapist, who should not reward the exaggerated feelings and should be careful in managing the transference. Patients are often demanding, want to take a special place in the therapist's life, and act out during therapy sessions, threatening to abandon treatment or undertake dangerous actions. Clear limits should be set and demanding dependent behaviour should not be rewarded. The treatment should be carefully planned and goals discussed with the patient, who should express a desire and motivation to change his or her behaviour, and not just to change the external world.

Therapists must be aware of their own narcissistic needs for admiration, which are easily evoked by histrionic patients, and should be supervised in order not to become trapped in a vicious circle of dependence, demanding behaviour, and latent aggressive control.

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