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Personality-Disordered Patients

Treatable and Untreatable

Michael H. Stone, M.D.

  • ISBN 978-1-58562-172-9
  • Item #62172

Description

Determining the amenability of personality disorders to psychotherapy—a patient's capacity to benefit from verbal approaches to treatment—is important in helping clinicians determine the treatability of cases. Michael Stone here shares the factors he has observed over long years of practice that can help practitioners evaluate patients, stressing the amenability of the various disorders to amelioration. By focusing on which patients are likely to respond well to therapeutic intervention and which will prove most resistive, his book will help therapists determine with what kinds of patients they will most likely succeed and with which ones failure is almost a certainty.

Stone establishes the attributes that affect this amenability—such as the capacity for self-reflection, motivation, and life circumstances—as guidelines for evaluating patients, then describes borderline and other personality-disordered patients with varying levels of amenability, from high to low. This coverage progresses from patients belonging to the DSM anxious cluster, along with the depressive-masochistic character and the hysteric character, to patients who demonstrate an intermediate level of amenability to psychotherapy. He introduces the interrelationship between borderline personality disorder and dissociative disorders and discusses treatability among certain patients in Clusters A and C, as well as others with narcissistic, histrionic, depressive disorders. Final chapters address the most severe aberrations of personality and the limitations they impose on the efficacy of therapy. Personality-Disordered Patients is filled with practical, clinically focused information. This guideline structured book:

  • Covers all personality disorders-including ones not addressed in the latest DSM such as sadistic, depressive, hypomanic, and irritable-explosive
  • Identifies both attributes necessary for treatability and factors associated with low treatability
  • Pays particular attention to borderline disorders, which represent the most discussed conditions and are among the most challenging to psychotherapists
  • Reviews personality traits whose presence, if intense-even if unaccompanied by a definable personality disorder-creates severe problems for psychotherapy

Numerous case studies throughout the book provide examples that will help therapists determine which of their own patients are most likely to benefit from their efforts and thereby establish their own limits of effectiveness. By alerting practitioners to when therapy is likely to fail, these guidelines can help them avoid the professional disappointment of being unable to reach the most intractable patients.

Contents

CONTENTS
PREFACE
Chapter 1. AMENABILITY TO TREATMENT IN THE REALM OF PERSONALITY DISORDER
Chapter 2. PERSONALITY DISORDERS MOST AMENABLE TO PSYCHOTHERAPY: BORDERLINE PERSONALITY DISORDER
Chapter 3. PERSONALITY DISORDERS MOST AMENABLE TO PSYCHOTHERAPY: THE ANXIOUS CLUSTER AND RELATED DISORDERS
Chapter 4. PERSONALITY DISORDERS OF INTERMEDIATE AMENABILITY TO PSYCHOTHERAPY: BORDERLINE PERSONALITY DISORDER
Chapter 5. PERSONALITY DISORDERS OF INTERMEDIATE AMENABILITY TO PSYCHOTHERAPY: OTHER PERSONALITY DISORDERS
Chapter 6. PERSONALITY DISORDERS OF LOW AMENABILITY TO PSYCHOTHERAPY: BORDERLINE PERSONALITY DISORDER
Chapter 7. PERSONALITY DISORDERS OF LOW AMENABILITY TO PSYCHOTHERAPY: OTHER PERSONALITY DISORDERS
Chapter 8. PERSONALITY TRAITS AT THE EDGE OF TREATABILITY
Chapter 9. UNTREATABLE PERSONALITY DISORDERS
AFTERWORD
INDEX

About the Authors

Michael H. Stone, M.D., is Professor of Clinical Psychiatry at Columbia College of Physicians and Surgeons.

This is vintage Michael Stone, a sophisticated, substantive and consequential book, a logical and scholarly synthesis that provides a sequence of vivid, differentiated and incisive clinical portrayals. Impressive in scope, organization and balance, this eloquently written work comprises a persuasively argued scaffold of practice-oriented proposals that will be of everyday utility to experienced professionals, as well as to psychiatric residents and graduate students-in-training.—Theodore Millon, Ph.D., D.Sc., Dean and Scientific Director, Institute for Advanced Studies in Personology and Psychopathology, Coral Gables, Florida


Being a seasoned therapist of personality disorders requires the vocabulary of a dedicated linguist because these disorders are captured by the adjectives of our language, especially those spoken in superlatives or written in capital letters. In his latest book on personality disorders, Michael Stone once again proves he is master of both the vernacular of character and the clinical encounter with the character disordered. In richly textured prose he provides the reader with lively descriptions of the remarkable diversity of personality disorders among us, and drawing upon his vast professional experience he teaches us the extent to which we can engage and influence these people and their disorders as clinicians. It is one of the finest pieces among his extensive repertoire of variations on personality disorders.—Thomas H. McGlashan, M.D., Professor, Department of Psychiatry, Yale University School of Medicine and Yale Psychiatric Research at Congress Place, New Haven, Connecticut


Books by Dr. Stone are invariably scholarly and thought-provoking. This timely and much needed analysis of the treatability and untreatability of personality disorders is no exception. It is stimulating, meticulous, informative, and provocative. Personality Disordered Patients: Treatable and Untreatable is an essential read for anyone who treats these conditions.—John Livesley, M.D., Ph.D., F.R.S.C., Professor of Psychiatry, University of British Columbia, Vancouver, British Columbia

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