Psychodynamic psychotherapy in the treatment of personality disorders

Personality in the psychodynamic approach

In one of the leading psychodynamic theories, personality is recognized as a dynamic organization of a person’s ways of behaving, thinking, experiencing emotions and motivation. This means that personality is something that allows a person to enter into a relationship with the world. On a more general level, personality is what we think about ourselves, but also what we think about other people and our relationships. There are many factors that influence personality development, such as our genetically conditioned temperament, developmental experiences or early childhood relationships with our carers.

Description of personality and diagnosis of its disorders.

Among clinicians with different theoretical orientations, two methods of personality description are dominant – (1) description based on possessed features and (2) structural description. In psychodynamic diagnosis, we use a structural description that allows us to assess the level of integration of internal psychological structures. There are four levels of integration – healthy, neurotic, borderline and psychotic. In the structural description, special attention is concentrated on the assessment of identity on the basis of which it is possible to distinguish a healthy personality from personality disorders. A healthy personality is characterized by, among others: 1) a well-integrated identity, which reflects a stable and multidimensional image of oneself and others (i.e. we have the ability to perceive and tolerate both strengths and weaknesses of ourselves and others); 2) the ability to set and implement long-term life goals (e.g. planning and consistently following a specific educational or professional path) 3) the ability to create and maintain lasting bonds with others – tolerating conflicts, dependencies and intimacy appearing in relationships; 4) the use of mature defense mechanisms that allow us to flexibly deal with everyday challenges and our internal conflicts (e.g. regarding the expression of aggression or needs related to dependence on others); 5) stable and consistent moral and ethical functioning related to personal values and ideas; 6) the recognition of conventional notions of reality, regardless of the current level of emotional arousal (e.g. experiencing anger that does not distort our ability to rationally assess the situation). When the personality disorder appears, we observe a deterioration in at least one of these areas. The greater the number of areas affected by unfavorable changes, the deeper the level of personality disorder.

Personality types.

When making a structural assessment of personality and the level of the depth of disorders, we also try to determine the type of personality that determines a certain style of interpersonal functioning of a given person. At individual personality levels, i.e. neurotic, borderline (not to be confused with borderline personality disorder) and psychotic, we can meet different types of personality. The neurotic level includes: (1) obsessive-compulsive personality (not to be confused with obsessive-compulsive disorder), (2) depressive personality, (3) hysterical personality. At the borderline level there are: (1) avoidant personality, (2) dependent personality, (3) narcissistic personality, (4) histrionic personality, (5) borderline personality. At low borderline level bordering on psychotic level: (1) paranoid personality, (2) schizoid personality, (3) narcissistic personality, (4) borderline personality, (5) antisocial personality.

In some cases, a psychiatric consultation may be necessary to assess personality disorders.

Goals of psychodynamic psychotherapy.

The aim of psychotherapeutic treatment in the psychodynamic approach is to reduce the reported symptoms, but also to develop in the area of possessed psychological abilities and resources. For each patient, goals are set individually and tailored to their needs and capabilities. These may include, for example, improving the ability to form satisfying relationships, maintaining a realistic and stable self-esteem, a more subtle and differentiated understanding of self and others, broadening tolerance for different emotional states, greater flexibility in dealing with everyday challenges, and others.

The effectiveness of psychodynamic psychotherapy.

Numerous studies prove that psychodynamic psychotherapy is effective in the treatment of many mental disorders, including: anxiety, panic attacks, depression, eating disorders, addiction to psychoactive substances, and personality disorders (Leichsenring, 2005; Milrod et al., 2007 after: Schedler 2010). Meta-analyses of various studies on the use of psychodynamic psychotherapy in the treatment of personality disorders indicate its high effectiveness and effects in the form of e.g. improvement of interpersonal functioning, reduction of reported symptoms (Messer & Abbass, in press, after: Schedler 2010) as well as changes in reflective functions and organization of attachment in patients with a diagnosis of borderline personality disorder (Levy et al., 2006 after: Schedler 2010). More and more scientific reports also indicate that the effects of psychodynamic psychotherapy last long after the end of treatment and, moreover, support further independent development and psychological growth of the patient