It has been said that there is nothing more practical than a good theory. It was Albert Einstein who stated that "It is the theory that decides what we can observe." These ideas can be applied to our understanding of theoretical approaches to psychopathology and psychological treatment.
The role of theory in clinical practice simply cannot be understated. Early in the treatment process, the clinician must begin to develop a coherent case conceptualization (commonly called a case formulation). Although there is no universal approach to this process, the formulation can generally be described as the clinician's theoretical analysis of the current case, typically addressing the questions: What has caused the person's present difficulties (symptoms) to develop? And what maintains those symptoms? The formulation is thus a set of educated hypotheses about the etiology of the person's problems, which must be grounded in defined theories of the particular disorder or clinical construct of interest.
The case formulation is crucial because it drives treatment: It helps the clinician think critically about the interventions that should be applied and those that should not. Throughout treatment, the case formulation is often revised and reconsidered depending on how the patient is responding. We firmly believe that without a case formulation, treatment is likely going to fail, and this is especially true with personality disorders.
Since publication of DSM-III, in 1980, when the personality disorders were placed on Axis II (separate from the clinical syndromes), personality disorder research has undergone unprecedented growth in the breadth and quantity of empirical studies and in studies that have attempted to account for the etiology and origins of personality disorders.
Etiological theories of personality disorders are nearly as numerous as the paradigms that attempt to describe behavior in general psychology. Focusing on five major paradigms, which have contributed strongly to the advancement of knowledge after decades of personality disorder research, we speculate about possible applications of these paradigms to aging individuals. In this chapter, we examine the cognitive, psychoanalytic, and interpersonal models, which are all prominent psychologically based perspectives for personality disorders. Each of these seeks explanations for personality disorders in the immediate phenomenological and social world of an individual. In Chapter 8, we discuss two prominent biological theories of personality disorders (the evolutionary and neurobiological paradigms).
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