Integrative therapy for personality disorders: Experiences in developing integrative approaches for treatment-refractory personality-disordered clients

Abstract

Personality Disordered (herein referred to as PD) clients are challenging to statutory mental heal-thcare programmes. They can be difficult to di-agnose: their disorders can be obscured by se-cond-order problems such as anxiety and de-pression, caused by PD cognitive processes. Treatment-as-usual (the predominant model of psychiatric intervention) for PD clients in crisis tends to focus on these second-order presen-tations, but provide no means of identifying underlying PD. The purpose of this paper is to describe how heuristic methods of diagnosis can be used to reframe the client's distress in the context of personality disorders (according to DSM-IV criteria), and how subsequent appli-cation of integrative therapies can break their cycle of recidivism. Method: Two case studies of treatment-refractory individuals with cyclical pat-terns of crisis-point service engagement for self-harm or psychotic depression where heuristic/ integrative therapies were used. Results: The use of integrative therapies in the case studies presented resulted in a marked change in re-cidivism and quality of life for each client, as measured by a significant reduction in pres-entation of symptoms and hypervigilance. Dis-cussion: By understanding the maladaptive cog-nitive-behavioural processes of PD clients, they can be modified to reduce the client's self-de-feating behavioural patterns, breaking the cycle of recidivism. However, a new diagnostic strate-gy must first be formulated that looks at the clients past use of mental health services to de-tect underlying PD.