Product Description

This landmark work was the first to present a cognitive framework for understanding and treating personality disorders. Now Aaron T. Beck and his distinguished team of coauthors present an extensively rewritten and updated second edition, integrating over a decade's worth of tremendous advances in theory and practice. Part I lays out the conceptual, empirical, and clinical foundations of effective work with this highly challenging population. Cognitive aspects of Axis II disorders are reviewed and general treatment principles delineated, with new chapters covering assessment procedures and issues in the therapeutic relationship. Part II details the process of cognitive-behavioral therapy for each of the specific disorders. Restructured to follow a consistent format, chapters review the current clinical literature; guide the therapist through diagnosis and case conceptualization; and demonstrate the nuts and bolts of cognitive intervention. Richly illustrated with expanded case material, the second edition also includes a wealth of new information on therapeutic impasses and how to overcome them.

Product Details

• Amazon Sales Rank: #540705 in Books
• Published on: 2003-09-26
• Original language: English
• Number of items: 1
• Binding: Hardcover
• 412 pages

Review
"Books from Dr. Beck and his associates have invariably displayed originality, scholarship, and depth, as well as profound sensitivity to the problems of patients with all forms of psychological difficulty. In this singular new edition of a classic treatment guide, the authors once again demonstrate their groundbreaking cognitive model of the personality disorders. Presented is an expanded, even more powerful set of extraordinary conceptual and clinical tools. This volume can be recommended enthusiastically to all who work with this difficult patient population, including experienced clinicians as well as novice practitioners and graduate students. Clinically rich, insightful, and humane."--Theodore Millon, PhD, DSc, Institute for Advanced Studies in Personology and Psychopathology

"Personality disorders cause untold suffering in millions of people, and empirically supported therapies are almost nonexistent. What is the scientist-practitioner to do? Application of cognitive-behavioral conceptualizations and interventions makes obvious sense. This volume, a revised and updated edition of a classic, is essential reading for students, teachers, clinicians, and researchers who seek to understand and treat these debilitating disorders."--Jacqueline B. Persons, PhD, San Francisco Bay Area Center for Cognitive Therapy and University of California, Berkeley

"Remarkably clear and well-articulated, this volume makes substantial new contributions by further elaborating and specifying the cognitive theory of personality disorders, reviewing new research on both the theory and therapy, and providing detailed discussions (with new clinical case illustrations) of assessment and treatment of ten different personality disorders. It also provides recommendations on how to manage the therapeutic relationship and create individualized approaches for particular patients. Informed by the work of thirteen expert practitioners, the volume combines state-of-the art theoretical and technical knowledge with critical clinical experience, judgment, and wisdom. All practitioners of cognitive or behavioral psychotherapy, as well as more psychodynamically oriented clinicians, will benefit immensely from this work, as will clinical psychology students, psychiatric residents, and students in related fields. The clear conceptualization of the personality disorders and practical illustrations of how to apply these concepts in practice will undoubtedly improve the reader's treatment skills, therapeutic results, and day-to-day professional satisfaction."--A. John Rush, MD, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas
-- Review

Review

About the Author
Aaron T. Beck, MD, is University Professor of Psychiatry at the University of Pennsylvania and President of the Beck Institute for Cognitive Therapy. He has authored more than 450 publications and has received numerous honors from professional and scientific organizations. Dr. Beck has worked extensively with personality disorders and has been an investigator on two studies using cognitive therapy with borderline personality disorder.

Arthur Freeman, EdD, ABPP, ACT, is Professor and Chair of the Department of Psychology at the Philadelphia College of Osteopathic Medicine. He is past president of the Association for Advancement of Behavior Therapy and of the International Association for Cognitive Psychotherapy, and a Distinguished Founding Fellow of the Academy of Cognitive Therapy. Dr. Freeman's research and clinical interests include marital and family therapy and cognitive-behavioral treatment of depression, anxiety, and personality disorders.

Denise D. Davis, PhD, a Founding Fellow of the Academy of Cognitive Therapy, completed an extramural postdoctoral fellowship at the Beck Center in 1984. The author of numerous book chapters and articles on cognitive therapy, Dr. Davis was a founding editor of the journal [i]Cognitive and Behavioral Practice[/i]. She currently serves as Assistant Director of Clinical Training in Psychology at Vanderbilt University and maintains an independent cognitive therapy practice.

Customer Reviews

Very well organized and researched
I love Becks work in the field of Cognitive therapy. I have long had the trouble of finding a modality that effectivly works with personality disorders. I bought this book in an attempt to bridge my knowledge from purely Axis I to include Axis II disorders.

The book goes through each and every personality disorder one at a time. This made it very easy to research one specific problem without having to sift through pages and pages of irrelevant information for the task at hand.

Within each chapter Beck defines the typical automatic thoughts, or faulty reasoning, that is commonly associated with the personality disorders. He then gives broad treatment plans and goals to deal with the symptoms.

Beck is very well organized and succienct. You will walk away from even a short reading of this book feeling more confident and better equipped to deal with the disorders without the usually doubts that maybe you didnt get the whole gist of what the author was trying to say.

I felt that this was extremely well done. I also appreciate that Beck does not promise more then he can deliver and he is the first one to say that outcomes for Axis II disorders are still poor compared with Axis I.

Treating clients with personality disorders...
This is a great book! It has a lot of practical information on how to approach treatment for a client who has a personality disorder. Included are case examples and problems that a therapist may have in treating clients. Additionally, the book includes specific intervention strategies and recommendations on how to develop a good working relationship. This is especially important, because a client's interpersonal problems will be played out during session with the therapist. I have used the information in this book to anticipate and prepare for specific issues that have arisen in session.

Fantastic
This is a great book. For example, the chapters on obsessive compulsive and passive agressive personality give some great direction for therapy. Knowing that an obsessive person fears making mistakes, that narcissism is part of obsessionality and that a passive agressive person fears loss of autonomy can really guide treatment well.

On the other hand, the treatment of narcissistic personality disorder is weak. It just concentrates on how the patient should learn that the world does not revolve around them. It ignores the shame, need for validation and driven quality that narcissistic patients have and is reflected in their cognitions. In other words, the case used to treat NPD is of the oblivious type and in practice it is more common to see the hypervigilant type of narcisit. As CBT becomes more psychodynamic, this issue will be better addressed, I anticipate. (The oblivious narcisists are more antisocial and the vigilant ones are more on the anxiou/dependant end of the spectrum - I forget who's classification this is).

Below is a summary of the Histrionic Personality Disorder chapter that I did for my own benefit.

Histrionic Personality Disorder
======================
People with HPD are very vulnerable to separation. Common comorbidities are: panic, alcoholism, substance abuse, conversion disorder, somatization disorder and brief reactive psychosis.

Males and females equally effected. Reliable and valid construct. Emotionality, exhibitionism, egocentricity and sexual provocativeness were strongly clustered together. Women with HPD are more attractive than average. One of the PDs with least functional impairment. Caricature of sex roles. Emotions are expressed intensely, yet seem exaggerated or unconvincing; has the sense of watching a performance. Comments often seem quite striking and powerful at the time but later on the clinician will not know what the patient meant.

Diagnose by getting data about interpersonal relationships, how they handle anger, fights and disagreements. Find out how other people tend to view them. Compared with narcissists, histrionics are more willing to be subservient to avoid abandonment.

On page 223: "Hypomanic periods can be found in patients with HPD as well as in patients with the Axis I syndromes of cyclothymic disorder or bipolar disorder. Millon (1996) describes an urgency, restlessness, and intensity about the hypomanic phase of cyclothymia that is not typical of the histrionic patient. Although the behaviour of the histrionic patient can occasionally be inappropriate, the histrionic generally has learned reasonable levels of social skills and can experience some hypomania without serious interference with routine social and occupational functioning, whereas the hypomanic periods are much more disruptive for the cyclothymic patient."

Cognition is global, diffuse and impressionistic. IB: "I am inadequate and unable to handle life on my own." They will need to find ways to get others to take care of them. Necessary to be loved by everyone for everything one does. Excessive need for attention and a failure to use the appropriate social skills in order to achieve attention from others.

They view themselves as being sociable, friendly, and agreeable. Later, they get demanding and in need of constant reassurance. Learn to value external events over their internal experience. With so little to focus on in their own life, they are left without any sense of identity apart from how other people view them.

As thoughts cause emotions, it follows that histrionic people with have intense emotions. Dichotomous thinking, overgeneralization, emotional reasoning.

Treatment Approach
--------------------------
Challenge automatic thoughts, set up behavioural experiments, activity scheduling, relaxation, problem solving and assertion.

Be collaborative. Expose them to a entirely new way of perceiving and processing experience. Initially they will view you as an all-powerful rescuer. Reinforce assertive and competent responses. Avoid getting too wrapped up in the drama of the patient's presentation.

Have them learn how to focus attention on one issue at a time. Setting a session agenda. One item should be how things went, to get this out of the road. Set goals that are genuinely meaningful to them, what they want not what they should want. They will tend to be short-term with their goals. Have operational definitions. Use fantasy to work out consequences. Gently and persistently find out how actions are related to their goals.

Written homework will be boring, so make it dramatic in content. Role-play with automatic thoughts. Do theatrical behavioural experiments.

Pinpointing ATs can decrease impulsivity. Have them list the advantages and disadvantages of options. Have them work out how to spend the therapy time. "Means-end thinking."

Patients to dominate relationships in indirect ways such as crises, jealousy, charm, nagging and scolding. Have them pinpoint what they want out of a situation.

Identity and sense of self: not a magic thing but through introspection, starting with the basics and with mindfulness and assertion.

Have behavioural experiments that set up small rejections with strangers. Also, show them that they can be competent.

Can have planned depression. Do well in groups. CBT takes 1 to 3 years to work @ 101 sessions over 3 years.