Case Formulation for Personality Disorders: Tailoring Psychotherapy to the Individual Client

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CASE FORMULATION FOR PERSONALITY DISORDERS: TAILORING PSYCHOTHERAPY TO THE INDIVIDUAL CLIENT
Copyright
List of Contributors
About the Editor
Foreword
Introduction
	Case Formulation: From the Theory to the Case
	What Is Case Formulation?
	A Disorder-Specific Approach to Case Formulation
	Constraints to Case Formulation for Personality Disorders: Occasions to Learn from the Individual Client
	Integrative Approach to Case Formulation for Personality Disorders and the Role of Clinical Theory
	Case Formulation as a Means to Increase Therapist Effectiveness
	The Present Volume
	References
1 - Case Formulation in Dialectical Behaviour Therapy
	Introduction
	Theoretical Foundation of Dialectical Behaviour Therapy (DBT)
		Learning Theory
		Zen Philosophy
		Dialectical Philosophy
		Biosocial Theory
	Step-By Step Approach to Developing a Dialectical Behaviour Therapy (DBT) Case Formulation
		Step 1: Obtain a Developmental History
		The Case of Beth: Overview and Application to Step 1
		Step 2: Identifying and Prioritizing Treatment Targets
			Vision for Life
			Primary Treatment Targets: Macrolevel Behaviours
			Secondary Treatment Targets: Microlevel Behaviours
			Treatment Focus
		The Case of Beth: Application to Step 2
		Step 3: Analyzing Factors Controlling Behaviours
		Case of Beth: Application to Step 3
		Step 4: Observing Patterns Across Behaviours
		Case of Beth: Application to Step 4
		Step 5: Identifying Interventions and Solutions
		Case of Beth: Application to Step 5
	Concluding Remarks
	Acknowledgements
	References
2 - Transference-Focused Psychotherapy: Structural Diagnosis as the Basis for Case Formulation
	Review of Object Relations Theory in Relation to an Understanding of Personality Disorders in Terms of Psychological Structure
	The Structural Interview as a Clinical Instrument
	Discussion of the Diagnostic Impression/Formulation With the Patient
	Using the Diagnostic Impression/Case Formulation to Choose a Therapy
	Case Example
		Presenting Problem and Client Description
		Case Formulation
	Review of Research
	Research on the Structural Interview
		Reliability of the Structural Interview
		Validity and Clinical Utility of the Structural Interview
		Research on the Structured Interview of Personality Organization (STIPO)
		Reliability of the Structured Interview of Personality Organization (STIPO)
		Validity and Clinical Utility of the Structured Interview of Personality Organization (STIPO)
	Concluding Remarks
	Acknowledgements
	References
3 - Case Formulations in Mentalization-Based Treatment (MBT) for Patients With Borderline Personality Disorder
	The Heterogeneity of Borderline Personality Disorder
	The Theoretical Grid for Case Formulations for Borderline Patients
	The Mentalization-Based Approach to Case Formulations
	Needed Information
	Working in Concert with the Psychoeducational Group
	Technical Details
	The Mental Activity of the Therapist While Constructing a Case Formulation
	Case Formulations in Mentalization-Based Treatment (MBT) Training
	Two Different Borderline Personality Disorder (BPD) Case Formulations
		Borderline Personality Disorder (BPD) Case Formulation 1
		Borderline Personality Disorder (BPD) Case Formulation 2
	Minding the Difficult Patient
	Implications and Consequences for Therapy
	Summary and Conclusions
	Acknowledgements
	References
4 - The Corrective Experience of Getting a Life: Case Formulation Using General Psychiatric Management as a Framework to Facilitate Remission and Recovery
	Introduction
	Case Vignette
		Case Formulation
		Case Formulation
		Case Formulation
	Conclusions
		Acknowledgements
		References
5 - Case Formulation in Schema Therapy: Working With the Mode Model
	Introduction
		Underlying Theory and Central Concepts Related to Case Formulation in Schema Therapy
	Case Formulation With the Mode Model
		Transdiagnostic and Disorder-Specific Approach
			Disorder-Specific Mode Model of Borderline Personality Disorder
		Assessment of Relevant Information for Case Formulation
			Important Information for Building a Case Formulation
		Linking Symptoms and Problems to the Respective Modes
		Picking the Relevant Modes: Keep It as Simple as Possible
		Introduction of the Case Formulation
			Introduction of the Mode Model and the Vulnerable Part
			Introduction of the Parent Modes
			Introduction of the Coping Modes
			Introduction of the Healthy Adult Mode
		Impact of Case Formulation on the Course of Therapy
	Illustration of Case Formulation With an Example of a Borderline Personality Disorder (BPD) Patient
		Case Example of a Patient With Borderline Personality Disorder (BPD)
	Conclusion
		Acknowledgements
		References
6 - Cognitive Analytic Therapy: A Relational Approach to Young People With Severe Personality Disorder
	Introduction
	What Unique Features Characterize Cognitive Analytic Therapy?
	Cognitive Analytic Therapy (CAT) Model of Development and Psychopathology
	The Attributes of Cognitive Analytic Therapy (CAT) Formulation of Personality Disorder
	Cognitive Analytic Therapy (CAT) Model of Borderline Personality Disorder
	The Process of Reformulation
	Applying Cognitive Analytic Therapy (CAT) to a Case Example
		Case Example: Laura
	Laura’s Reformulation Letter
	Remainder of the Therapy
	Conclusions
		Acknowledgements
		References
		Further Reading
7 - Case Conceptualization in Clarification-Oriented Psychotherapy
	What Is Clarification-Oriented Psychotherapy?
		Relationship Formation
		Creating Motivation for Change
		Clarification of Relevant Schemas
		Processing of Schemas
		Specific Therapeutic Interventions
		Transfer
	The Model of Dual-Action Regulation
		Relationship Motives
		Dysfunctional Schemas
		Intransparent Action and Behaviour
		Compensatory Schemas
		Interaction Tests
	What Characterizes Clients with Narcissistic Personality Disorder?
	What Defines a Narcissist from the Perspective of Dual-Action Regulation Model?
	Therapy
	Case Conceptualization of Narcissistic Personality Disorder
		The Case
		Conceptualization
	Meaning of the Case Conceptualization
		Therapy
	Conclusion
		Acknowledgements
		References
8 - Formulation of Functioning for Avoidant Personality Disorder in Metacognitive Interpersonal Therapy
	Underlying Theory
	Maladaptive Schemas for Self and Others
		Interpersonal Motives
	Impaired Metacognition
	Poor Autobiographical Memory
	Maladaptive Emotional Regulation and Coping
	A Metacognitive Interpersonal Therapy (MIT)-Based Case Formulation: Self-Sustaining Processes
	Clinical Guide to Case Formulation
	Metacognitive Interpersonal Therapy (MIT)-Based Case Formulation and Therapy Planning: Mario’s Story
		Client’s History and Presentation of Problem
		Early Treatment Phases and Refinement of the Case Formulation
		Change Promoting
		Outcome
	Conclusions
	References
	Further Reading
9 - What Might Work When Nothing Seems to Work: Case Formulation in the Treatment of Antisocial Personality Disorder in a Forensic Mental Health Setting
	Introduction
	Antisocial Personality Disorder
		Aetiology
		Diagnostic Criteria
		Treatment Approaches
	Case Formulation Theories
		Cognitive Behavioural Theory
		Cognitive Behavioural Models of Offending
		Case Formulation and Risk Assessment
		Ethical Aspects of Forensic Case Formulation
	Example of Case Formulation for Antisocial Personality Disorder (ASPD)
		Case Report
			Biography
			Psychiatric History
			History of Substance Use
			Criminal Record
			Psychological Assessments
			Monitoring on the Forensic Ward
		Case Formulation
	Conclusions
		Acknowledgements
		References
10 - Formulating Key Psychosocial Mechanisms of Psychopathology and Change in Interpersonal Reconstructive Therapy
	IRT Theory
	Centrality of Attachment Mechanisms, Learning and Development
	Distinguishing Between Adaptive and Maladaptive Patterns Using SASB
	IRT Case Formulation Method in Four Steps
	Step One: Outline Patterns in the Present
	Step Two: Seek Copy Process Evidence to Identify Key Attachment Figures
	Step Three: the Gift of Love (GOL) Hypothesis
	Step Four: Identify Treatment Implications
	Application of the IRT Formulation Method
	Current Patterns
	Developmental History and Copy Process Analysis
	Copy Process-Based Diagnosis of Personality Disorder
	Gift of Love
	Treatment Implications
	Outcome
	Case Formulation Research in IRT
	Conclusion
		Acknowledgements
		Conflict of Interest
		References
11 - Motives, Defences, and Conflicts in the Dynamic Formulation for Psychodynamic Psychotherapy Using the Idiographic Conflict Formulation Method
	Steps in Constructing a Case Formulation
		Information Base
			Motives
			Conflicts and Defences
			Resultants
			Specific Stressors and Best Level of Adaptation
	Case Example
	Case Formulation of Zofia
		Motives
			Wishes
			Fears
		Conflicts and Defences
			Conflicts
			Defences
		Resultants
			Symptomatic Outcomes
			Avoidant Outcomes
		Vulnerability/Best Adaptation
			Vulnerability to Specific Stressors
			Best Available Level of Adaptation to Conflicts
	Treatment and Outcome
	Discussion
	Acknowledgements
	Appendix A
	Appendix B
	Appendix C
		References
		Further Reading
12 - Case Formulation in Cognitive and Behavioural Therapy
	Introduction
	Case Formulation
	Application of Case Formulation to Personality Disorders
		Behavioural Approaches
			Behavioural Assessment and Personality Disorders
	Case Formulation of Personality Disorder: Traits and Processes
		Antisocial Personality Disorder
			Schemas
			Attachment
		Borderline Personality Disorder
	The Case of Arthur
		Formulation I: A Behavioural Case Formulation
			Treatment Plan
		Formulation II: An Attachment and Schema-Informed Formulation
		Comment
	Training to Make Formulations of Personality Disorders
	Conclusion
		Acknowledgements
		References
		Further Reading
13 - Conceptualizing Borderline Personality Disorder Within an Emotional Disorders Framework: Implications for Treatment With the Unified Protocol
	Borderline Personality Disorder (BPD) Is an Emotional Disorder
		Borderline Personality Disorder (BPD) Is Characterized by Strong Negative Emotions
		Borderline Personality Disorder (BPD) Is Characterized by Negative Reactions to Strong Emotions
		Borderline Personality Disorder (BPD) Is Characterized by Avoidant Coping
		Shared Latent Structure Accounts for Co-occurrence of Borderline Personality Disorder (BPD) and Other Emotional Disorders
	Unified, Transdiagnostic Case Conceptualization for Emotional Disorders
	Treating Borderline Personality Disorder (BPD) With the Unified Protocol: A Conceptualization-Focused Case Presentation
		Evidence of an Emotional Disorder at Intake
		Applying Unified Protocol (UP) Skills to Components of the Emotional Disorder Framework
	Conclusions
		Acknowledgements
		References
		Further Reading
14 - Plan Analysis and the Motive-Oriented Therapeutic Relationship
	Underlying Concepts
		General Position
		Theoretical Concepts of Various Origin
			Basic Pillar
			Additional Basic Concepts
			Psychotherapeutic Approaches
			Criteria for the Use of Concepts
	Methodology
		How to Conduct Plan Analysis
			Introduction
				Procedure in Plan Analysis
		Model for Psychological Problems
		Constructing Therapeutic Action
		The Motive-Oriented Therapeutic Relationship (MOTR)
	Clinical Case with Personality Disorder
		Case Example
	Research
	Training
		References
		Further Reading
15 - Tailored Treatment Planning for Individuals With Personality Disorders: The Operationalized Psychodynamic Diagnosis (OPD) Approach
	The Operationalized Psychodynamic Diagnosis (OPD) System
		Aims, History and Dissemination of the Operationalized Psychodynamic Diagnosis (OPD) System
		Conceptual Background and Multiaxial Diagnosis
		Personality Disorders: The Operationalized Psychodynamic Diagnosis (OPD) Levels of Structural Integration Axis (LSIA)
			Research on the Operationalized Psychodynamic Diagnosis (OPD) Levels of Structural Integration Axis (LSIA)
			Operationalized Psychodynamic Diagnosis (OPD) Levels of Structural Integration Axis (LSIA) and DSM/ICD Dimensional Models of Per...
	Practical Applications of the Operationalized Psychodynamic Diagnosis (OPD) System
		Assessing Interpersonal Patterns
		Assessing Conflictual Motivational Topics
		Assessing Levels of Structural Integration
		Making Sense of the Interrelatedness of Interpersonal Patterns, Motivational Conflicts and Personality Function
	Using the Operationalized Psychodynamic Diagnosis (OPD) System as an Integrative Approach to Case Formulations and Treatment Pla...
		Background Information
		Self-Report Data and Formal Expert Ratings of Operationalized Psychodynamic Diagnosis (OPD) Axis II, III and IV
		Operationalized Psychodynamic Diagnosis (OPD) Case Formulation
	Discussion
	Closing Remarks and Future Perspectives
		Acknowledgements
		References
16 - Case Formulation in Interpersonal Defence Theory: A Process Model of Interpersonal Phenomena that Play Key Roles in Psychopathology and Psychotherapy
	Interpersonal Defence Theory
		The Theory’s Tenets
	Case Formulation
		Components
		Analytic Methods
		Procedures for Arriving at a Case Formulation
	Case Example
		Jane’s Noncoordinating Pattern
		Explaining Jane’s Pattern of Interpersonal Behaviour
		Feed-Forward Effects of Jane’s Interpersonal Pattern
		Jane’s Target Problems and Symptoms
		Research
	Treatment Implications
	Concluding Comments
	Acknowledgements
	References
17 - Alliance-Focused Formulation: A Work in Process
	Defining Alliance Ruptures
	Alliance-Focused Process Formulation Methodology
	Case Example
	Future Directions
	References
18 - Emotion-Based Case Formulation for Personality Disorders
	Emotion-Based Case Conceptualization: Theory and Key Concepts
	Mapping out Emotional Change
		Global Distress
		Shame/Fear
		Rejecting Anger
		Existential Needs and Negative Self-Evaluations
		Assertive Anger and Self-Compassion
		Grief/Hurt
		Acceptance and Agency
	Using the Process Map to Guide Clinical Practice
	Empirical Support for Emotion-Based Case Formulation
	Conducting Emotion-Based Case Formulations
		Step 1: Initial Case Assessment
		Step 2: Tailoring the Case Formulation to Model a Clients’ Personal Processes
		Step 3: Referring Back to the Model, Making Inferences and Planning Treatment
		Step 4: Finding Interventions that Facilitate Targeted Client Processes
	Summary and Conclusion
	Acknowledgements
	References
Individualizing Treatment for Clients With Personality Disorders
	Occasions to Learn From the Individual Client
	A Common Pathway to Understanding a Disruptive Experience: The Symbolizing Process
	Case Formulations and the Therapeutic Relationship
	Individualizing Psychotherapy Research Paradigms
	Acknowledgements
	References
Index
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	T
	U
	V
	W
	Z
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