Principles and strategies for treating personality disorder.

This paper proposes a systematic framework for treating personality disorder, based on research on the nature and origins of the disorder and treatment outcome. It adopts an eclectic approach that combines interventions from different therapeutic models and delivers them in an integrated and systematic manner. Coordination of multiple interventions is achieved by emphasizing the nonspecific component of therapy, especially the treatment frame and generic interventions. Specific interventions drawn from different treatment models, including medication, are built onto this foundation as needed to tailor treatment to the individual. Coordination and integration are also achieved by conceptualizing treatment as progressing through a series of phases, each addressing different problems with different specific interventions. Five phases are described: safety, containment, regulation and control, exploration and change, and integration and synthesis. During the earlier phases, structured behavioural and cognitive interventions and medication predominate. Later in treatment, these interventions are supplemented with less structured psychodynamic, interpersonal, and constructionist strategies to explore and change maladaptive interpersonal patterns, cognitions, and traits and to forge a more integrated and adaptive self-structure or identity.