Table Of ContentPsychotherapy for
Personality Disorders
Review of Psychiatry Series
John M. Oldham, M.D., and
Michelle B. Riba, M.D.
Series Editors
Psychotherapy for
Personality Disorders
EDITED BY
John G. Gunderson, M.D.
Glen O. Gabbard, M.D.
No. 3
Washington, DC
London, England
Note: The authors have worked to ensure that all information in this book
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The correct citation for this book is
Gunderson JG, Gabbard GO (eds.): Psychotherapy for Personality
Disorders (Review of Psychiatry Series, Vol. 19, No. 3; Oldham JO and
Riba MB, series eds.). Washington, DC, American Psychiatric Press,
2000
Library of Congress Cataloging-in-Publication Data
Psychotherapy for personality disorders / edited by John G. Gunderson,
Glen O. Gabbard.
p. ; cm. — (Review of psychiatry ; v. 19, no. 3)
Includes bibliographical references and index.
ISBN 0-88048-273-7 (alk. paper)
1. Personality disorders—Treatment. 2. Psychotherapy. I. Gunderson,
John G., 1942– . II. Gabbard, Glen O. III. Review of psychiatry series ; v. 19, 3
[DNLM: 1. Personality Disorders—therapy. 2. Psychotherapy—methods.
WM 190 P9759 2000]
RC554.P78 2000
616.85´8—dc21
00-024853
British Library Cataloguing in Publication Data
A CIP record is available from the British Library.
Review of Psychiatry Series ISSN 1041-5882
Cover: Digital imagery © copyright 1999 PhotoDisc, Inc.
Contents
Contributors ix
Introduction to the Review of Psychiatry Series xi
John M. Oldham, M.D.
Michelle B. Riba, M.D., Series Editors
Foreword xv
John G. Gunderson, M.D.
Glen O. Gabbard, M.D.
Chapter 1
Empirical Studies of Psychotherapy for
Personality Disorders 1
J. Christopher Perry, M.P.H., M.D.
Michael Bond, M.D.
Effectiveness of Psychotherapy for
Personality Disorders 2
Dropouts From Psychotherapy 18
Findings From Psychotherapy Process Research 21
Summary of Findings 25
References 28
Chapter 2
Psychodynamic Psychotherapy for
Borderline Personality Disorder 33
John G. Gunderson, M.D.
Defining Psychotherapy 33
Background 35
Patient and Therapist “Readiness” for
Psychotherapy 37
Phases of Therapy 40
Psychotherapy’s Role in the Overall Treatment of
Borderline Personality Disorder 58
Conclusion/Summary 59
References 61
Chapter 3
Combining Medication With Psychotherapy in the
Treatment of Personality Disorders 65
Glen O. Gabbard, M.D.
Clinical Rationale for Combined Treatment 66
Temperament and Character 67
Target Symptoms 71
Cognitive-Perceptual Symptoms 72
Impulsive-Behavioral Symptoms 73
Affective Symptoms 75
Comorbid Axis I Conditions 76
Clinical Problems 80
One-Person Model 80
Two-Person Model 84
Risk Management and Liability
Issues in the Two-Person Model 87
Summary 89
References 90
Chapter 4
Gradations of Antisociality and Responsivity to
Psychosocial Therapies 95
Michael H. Stone, M.D.
Gradations of Antisociality 98
The Concept of Psychopathy 99
Gradations of Antisociality:
Clinical and Biographical Vignettes 103
Gradations of Antisociality:
Implications for Treatment 112
Treatment for the Treatable 114
Cognitive Therapy With Antisocial Persons 116
The Therapeutic Community 118
Antisocial Persons Who Commit Sexual Offenses 122
Conclusion 123
References 126
Chapter 5
Cognitive Therapy for Personality Disorders 131
Peter Tyrer, M.D.
Kate Davidson, Ph.D.
Theoretical Rationale for Cognitive Therapy 133
The Practice of Cognitive Therapy
With Personality Disorders 135
Effectiveness of Cognitive Therapy for
Personality Disorders 136
Cognitive Therapy in Patients With
Axis I and Axis II Comorbidity 142
Prediction of Future Developments in the
Cognitive Treatment of Personality Disorders 144
References 146
Afterword 151
Glen O. Gabbard, M.D.
John G. Gunderson, M.D.
Index 155
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Contributors
Michael Bond, M.D.
Associate Professor of Psychiatry, McGill University; Psychiatrist-in-
Chief, Institute of Community and Family Psychiatry, Sir Mortimer
B. Davis–Jewish General Hospital, Montréal, Québec, Canada
Kate Davidson, Ph.D.
Research Tutor and Consultant Clinical Psychologist, Department of
Psychological Medicine, University of Glasgow, Gartnavel Royal
Hospital, Glasgow, Scotland
Glen O. Gabbard, M.D.
Callaway Distinguished Professor of Psychoanalysis and Education,
Karl Menninger School of Psychiatry and Mental Health Sciences at
The Menninger Clinic; Director and Training and Supervising
Analyst, Topeka Institute for Psychoanalysis; Clinical Professor of
Psychiatry, University of Kansas School of Medicine—Wichita
John G. Gunderson, M.D.
Director of Psychotherapy and Psychosocial Research and Chief of
Ambulatory Personality Disorder Services, McLean Hospital,
Belmont, Massachusetts; Professor of Psychiatry, Harvard Medical
School, Boston, Massachusetts
John M. Oldham, M.D.
Director, New York State Psychiatric Institute; Dollard Professor and
Acting Chairman, Department of Psychiatry, Columbia University
College of Physicians and Surgeons, New York, New York
J. Christopher Perry, M.P.H., M.D.
Professor of Psychiatry, McGill University; Director of Research,
Institute of Community and Family Psychiatry, Sir Mortimer B.
Davis–Jewish General Hospital, Montréal, Québec, Canada; Visiting
Professor in Psychiatry, Harvard Medical School at The Austen Riggs
Center, Stockbridge, Massachusetts
Michelle B. Riba, M.D.
Clinical Associate Professor of Psychiatry and Associate Chair for
Education and Academic Affairs, Department of Psychiatry,
University of Michigan Health System, Ann Arbor, Michigan
PSYCHOTHERAPY FOR PERSONALITY DISORDERS ix
