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- Impact of Axis II disorders on outpatient psychotherapy and counseling
- comorbidity increases challange of clinical work
- many clients seen chronically in outpatient settings have personality disorders comorbid with their presenting Axis I complaints
- therapists are often more pessimistic regarding outcomes with clients who have Axis II conditions
- Particular challanges in working with clients who show personality disorder diagnoses
- identification/naming/recognition of the problems
- ego-syntonic nature of the problems
- ambivalence in therapists regarding goals
- My thoughts:
- What does your client want?
- What do your want?
- What helps:
- 1. a dialectical stance
- 2. clear conceptualization and communication of therapeutic plan
- 3. particular attention to establishing and maintaining therapeutic relationship
- 4. a joint emphasis of evaluation of outcome
- 5. a skill training/hypothesis testing model
- 5. a psychodynamic model/understanding and insight
- 6. patience (with them, with yourself)
- 7. therapeutic breaks/holidays
- 8. supervision/consultation
- countertransference/overinvolvement in client’s life/boundary problems
References
Kaner, A. & Prelinger, E. (2005). The Craft of Psychodynamic Psychotherapy. NY: Jason Aronson.
MsWilliams, N. (2004). Psychoanalytic psychotherapy. NY: Guilford Press.
Panksepp, J. & Biven L. (2012). The Archaeology of Mind: Neuroevolutionary origins of human emotions. NY: Norton.
Rafaeli, E., Bernstein, D.P., & Young, J. (2011). Schema Therapy. NY: Routledge