Impoverished Dialogical Relationship Patterns In Paranoid Personality Disorder

Changes of intuition in paranoid personality disorder

Wherever psychopathology operates with the concept of (disorders of) the self and personality, it can address the role of the intuitive access we have toward ourselves, others, and the world. This study discusses the concept of oikeiôsis. It examines its role in explaining paranoia as a change in intuitive self-and-world relatedness. In the first step, symptomatic features of paranoid personality disorder are sketched, with a focus on the explanatory role of attentional and interpretative biases, which correlate with significant changes in intuitive processing. In the second step, the prototypical phenomenality of feelings of unfamiliarity and mistrust are discussed against the backdrop of changes of oikeiôsis in paranoid personality disorder. In the third step, the main therapeutic challenge in treating paranoid personality disorder-building a trustful relationship-is explored. It is concluded that the notion of oikeiôsis resonates particularly with introspection-based therapeutic approaches.

A case study on a severe paranoid personality disorder client treated with metacognitive interpersonal therapy

Paranoid personality disorder (PPD) is a severe condition, lacking specialized and empirically supported treatment. To provide the clinician with insights into how to treat this condition, we present a case study of a 61-year-old man with severe PPD who presented with ideas of persecution, emotionally charged hostility, and comorbid antisocial personality disorder. The client was treated with 6 months of Metacognitive Interpersonal Therapy, which included: creating a shared formulation of his paranoid attitudes; trying to change his inner self-image of self-as-inadequate and his interpersonal schemas where he saw the others as threatening. Guided imagery and rescripting techniques, coupled with behavioral experiments, were used to promote a change. At the end of the therapy the client reported a reliable change in general symptomatology and, specifically, in interpersonal sensitivity, hostility, and paranoid ideation; he could no longer be diagnosed as PPD and only some paranoid and antisocial characteristics remained.

Toward a model for assessing level of personality functioning in DSM-5, part I: a review of theory and methods

Personality disorders are associated with fundamental disturbances of self and interpersonal relations, problems that vary in severity within and across disorders. This review surveyed clinician-rated measures of personality psychopathology that focus on self-other dimensions to explore the feasibility and utility of constructing a scale of severity of impairment in personality functioning for DSM-5. Robust elements of the instruments were considered in creating a continuum of personality functioning based on aspects of identity, self-direction, empathy, and intimacy. Building on preliminary findings (Morey et al., 2011 /this issue), the proposed Levels of Personality Functioning will be subjected to extensive empirical testing in the DSM-5 field trials and elsewhere. The resulting version of this severity measure is expected to have clinical utility in identifying personality psychopathology, planning treatment, building the therapeutic alliance, and studying treatment course and outcome.

Health and Adaptation in a Multiple Self

It has been suggested recently that the self consists of multifaceted aspects which are not reducible to a singular core or entity. It is unclear whether the degree of multiplicity that individuals with significant pathology experience is linked with health and adaptation. Both an excess and a restricted degree of activity among multiple aspects of the self have been associated with pathology. We explore the evidence that the impact of degree of multiplicity of self upon adaptation may be mediated by: (a) the capacity of the various aspects of the self to engage in a dialogue among each other—that is, to discuss, build upon, or argue with one another; and (b) metacognitive capacity, or the ability to think about one’s own thinking and the thinking of others in a nuanced way and to build an integrated view of different aspects of oneself and others. Implications for conceptualizing psychopathology and psychotherapy research are discussed.

Psychotherapy in light of internal multiplicity

The view that the self has multiple parts and that these appear in people seeking psychotherapy--and people conducting psychotherapy--is shared by clinicians of various orientations and supported by psychological research. It is useful for clinicians to think of patients as multifaceted and pay attention to the changes between facets that occur during therapy. They can thus help hidden parts to surface, facilitate dialogue between parts not in contact with each other, and convince excessively dominant or oppressive parts to make room for other adaptive facets. The authors contributing to this issue of Journal of Clinical Psychology: In Session describe, from their different theoretical perspectives, how they deal with patients' and therapists' inner multiplicity in clinical practice.

Early narcissistic transference patterns: an exploratory single case study from the perspective of dialogical self theory

Persons exhibiting narcissistic personality traits are difficult to treat in psychotherapy, in particular because of the problems they have in building up a sound therapeutic relationship. We discuss the hypothesis that the threats to a therapeutic alliance emerge both from patients' maladaptive patterns of behaving towards others and from therapists being affected by these patterns and becoming a part of a dysfunctional dialogue. We examine this phenomenon in terms of Dialogical Self Theory and suggest that a patient can be conceptualised as embodying a cast of characters weaving a problematic dialogue both within the self and with other selves. Via the analysis of the transcripts of the first four audiotaped sessions of a psychotherapy involving a woman with narcissistic traits we identified one early dominant dialogical pattern in which a contemptuous and a contemptible character faced each other, shadowing characters in search for help. Such a pattern is consistent with the literature on interpersonal processes in narcissism. The therapist was involved in the pattern from the third session, suggesting that countertransference with individuals displaying narcissistic personality traits is caused more by the pathology than by their therapist's characteristics. Implications for treatment are discussed.