Psychotherapy of the Personality Disorders

The history of psychotherapy is fraught with dogmatism. Popular forms of therapy reflected various popular schools and inherited their disciplinary rivalries. The arguments were fueled by different theoretical assumptions. The behavioral school, for example, denied the existence of mind and asserted that therapy should proceed through classical and operant principles of reinforcement. In contrast, the psychodynamic school held that behavior reflects only the surface expression of deeply repressed or transformed motivations, percolating up from their origin in a deeper, biologically instinctive nature. A psychodynamically trained therapist would administer psychody-namic therapy. A behaviorally trained therapist would administer behavioral therapy. Rather than fit therapy to the patient, clinicians fit the patient to their own preconceived dogma. While such loyalties reigned, psychotherapists were condemned to treat only a part of the whole person.

In the past few decades, however, dissatisfaction with school-oriented therapy, together with a new emphasis on efficacy motivated by managed care, has led to the development of compromise approaches. As in previous decades, the total number of therapies continues to explode. Nevertheless, three trends currently dominate. First, brief therapy claims to achieve as much or greater progress in less time by carefully selecting patients and providing highly structured forms of intervention specific to the presenting problem. Second, the common factors approach seeks to unify much of psychotherapy by identifying factors common to all effective therapies. The argument here

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