Theory Therapy Levy, Meehan, Kelly, Research Proposal
Excerpt from Research Proposal :
Kellogg & Young in Schema Therapy for Borderline Personality Disorder offer a comprehensive explanation of the use of Schema Therapy for patients with BPD, by first explaining the disorder and how it is particularly prime for the use of schema therapy as the disorder itself and the behavior and emotions exhibited from it can be seen as an individual traversing through a short list of schemas and are reflective of the childhood origins of BPD. The modes of BPD are described by the authors as consisting of the angry and impulsive child mode, the detached protector mode, the punitive parent mode and lastly the healthy adult mode. According to the authors if these modes are lacking in integration and emotions cannot be traversed across each, or if the modes are significantly unbalanced they become schemas that override normal adult behavior. The particulars of Schema Therapy are then described after a brief explanation of other modes of treatment, particularly simple cognitive therapy, which is not abandoned but used in a systematic manner to help educate the patient of the need for change and restructuring of behavior. The Schema Therapy used is described by the authors through a stepped system including; (1) limited reparenting, (2) experiential imagery and dialogue work, (3) cognitive restructuring and education, and (4) behavioral pattern breaking, all in three phases of treatment; (1) bonding and emotional regulation, (2) schema mode change, and (3) development of autonomy. (pp. 444-456) the only empirical aspect of the work is that which describes ongoing research associated with schema therapy, most of which are case study works that include but are not limited to BPD. (p. 457)
Clarkin, Levy, Lenzenweger, & Kernberg in Evaluating Three Treatments for Borderline Personality Disorder: A Multiwave Study provide a comparative study of three varied treatments for BPD in a multiwave study. The three forms of outpatient treatment evaluated are; dialectical behavior therapy, transference-focused psychotherapy, and a dynamic supportive treatment. In the empirical study 90 patients with BPD were randomly assigned to the three varied treatment plans and all received medication if it was indicated. The subjects were subjected to pre-study evaluations and were also evaluated at 4-month intervals during the year long study period. The factors assessed during evaluation were: suicidal behavior, aggression, impulsivity, anxiety, depression, and social adjustment, all in a multiwave study design. Results of treatment, over the year were as follows; " Individual growth curve analysis revealed that patients in all three treatment groups showed significant positive change in depression, anxiety, global functioning, and social adjustment across 1 year of treatment. Both transference-focused psychotherapy and dialectical behavior therapy were significantly associated with improvement in suicidality. Only transference-focused psychotherapy and supportive treatment were associated with improvement in anger. Transference- focused psychotherapy and supportive treatment were each associated with improvement in facets of impulsivity. Only transference-focused psychotherapy was significantly predictive of change in irritability and verbal and direct assault." (p. 922) the conclusions of the researchers were that though all three variations of structured treatments seem to be effective and the 12-month BPD period were affective for patients each was affective in different ways and that each should be evaluated specifically for its strengths and weaknesses with regard to BPD, a very difficult disorder to treat. Overall the researchers found that transference-focused psychotherapy was the most effective across the most dimensions, of those evaluated in this study and they call for additional research.
Van Kessel, Lambie & Stewart in the Impact of Brief Planned Admissions on Inpatient Mental Health Unit Utilisation for People With a Diagnosis of Borderline Personality Disorder provide empirical research not on a particular treatment for BPD but on a treatment regimen that stresses the decreased utilization of long inpatient stays for individuals with BPD. (2007) BPD is acknowledged as one of the most pervasive and difficult disorders to treat and one that is significant in resource utilization for inpatient alternatives in treatment. These long periods of inpatient treatment are disruptive for the individual, in his or her life and tax the system significantly. In the work the authors evaluate the utilization of brief planned inpatient treatment phases and stress that such plans tend to decrease the utilization of inpatient facilities significantly for such patients. Two groups of inpatient patients were studied comparatively to see if over a long period of time their utilization of inpatient treatment was decreased if they either did or did not experience brief planned admissions.
There was significant differences in the long-term with regard to the randomized groups. Given that the decrease in inpatient stays over a year of care was 75% lower for the test group the researchers support the fact that this treatment protocol is appropriate and may have significant implications for how effective inpatient treatment, of any kind is for individuals. Quality of life might also be said to be improved when such patients can plan and implement inpatient care, allowing them the opportunity to see forward to a time of greater emphasis on therapy and structure their personal and professional lives accordingly. The research also supports the fact that structured care is most effective with BPD, in both treatment regimens and therapeutic interventions and may be a result of the need for structured care in other areas of treatment as a result of the BPD dynamic. (p. 93)
Sherry, Lyddon & Henson in Adult Attachment and Developmental Personality Styles: An Empirical Study develop a comprehensive empirical research study regarding the development of particular personality styles/disorders in correlation to the attachment theory protocols. (2007) According to the researchers the development of personality in both the normal and abnormal states are in many ways associated with the environmental developmental aspects of ones life, though there is a clear sense of genetics the environment plays and important role. Dysfunction in childhood environments has been strongly linked with devastating and nominal personality styles that can and often do disrupt how an individual behaves as an adult but most importantly how negatively or positively he or she views him or herself and others and therefore how they interact as adults. The work first defines attachment theory through the varied research and theorists as it has evolved over the years to help explain both normal and abnormal patterns of attachment and how these patterns help determine personality in both normal and abnormal ways. Participation in the empirical study was among 277 undergraduates, rather than clinically presenting patients. Attachment styles among these individuals are then evaluated, using three varied attachment instruments and grouped according to both normal and abnormal scales and difficulties. The three instruments used are: "Relationship Scales Questionnaire (RSQ," Griffin & Bartholomew, 1994b). Attachment in adulthood was assessed using the RSQ. The RSQ is a short, 30-item instrument that draws from Hazan and Shaver's (1987) attachment measure, Bartholomew and Horowitz's (1991) Relationship Questionnaire, and Collins and Read's (1990) Adult Attachment Scale." (p. 337) the work provides a baseline of "normal" individuals with regard to adult attachment and justifies the idea that such attachment is demonstrative of both normal and abnormal personality development. Among the "normal" population the researchers were able to find evidence of specific personality styles that could be considered detrimental to an individual's adult view of self and others; Dependent Personality Style, Avoidant Personality Style, Paranoid Personality Style, Borderline Personality Style, Schizotypal Personality Style, Schizoid Personality Style, Histrionic Personality Style. Among all these personality styles, excluding the histrionic personality style, the researchers found that all those who did not exhibit one of these difficult patterns or styles shared a single characteristic, i.e. secure attachment.
The findings from this study have at least three important implications for counseling. First, it is important to note that many of the personality styles accounted for in the analysis displayed a negative view of self. This finding might serve to guide counselors in the counseling process, noting that a negative core sense of self is fundamental to the presenting dysfunction. In addition to using cognitive behavioral strategies supported in the literature for this population constructing a therapeutic alliance that facilitates the client's exploration into her or his ability to appropriately elicit need-meeting responses from the counselor may prove beneficial. With this approach, it is hoped that learning new interpersonal behaviors will generalize to the client's relationships outside of counseling and gradually begin to facilitate the development of a more positive sense of self. An example of an attachment theory approach to the treatment of borderline personality is outlined by Sherry (2007).
2007, p. 337)
The work demonstrates that those therapies that specifically utilize new emotional, healthy and appropriate attachments are the most likely to be effective in the clinical setting, among both a "normal" and disorder diagnosed population.
Pickover in Breaking the Cycle: a Cclinical Example of Disrupting an Insecure Attachment System provides the reader with a clinical case study style empirical demonstration of how one might develop a system that effectively breaks a developing system of insecure attachment, in a child. (2002) it is not unusual for theorists…
Sources Used in Documents:
Clarkin, J.F. Levy, K.N. Lenzenweger, M.F. Kernberg, O.F. (June 2007) Evaluating Three Treatments for Borderline Personality Disorder: A Multiwave Study Ameican Journal of Psychology 164:6, 922-928.
Clarkin, J.F. & Levy, K.N. (April 2003) a Psychodynamic Treatment for Severe Personality Disorders: Issues in Treatment Development Psychoanalytic Inquiry 23:2 248-268.
Kellogg, S.H. Young, J.E. (February 2006) Schema Therapy for Borderline Personality Disorder Journal of Clinical Psychology 62:4 445-458.
Kimball, J.S., & Diddams, M. (2007). Affect Regulation as a Mediator of Attachment and Deliberate Self-Harm. Journal of College Counseling, 10(1), 44.
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