Personality disorders
Though I am aware of all the critical comments in- and outside the ACT-field concerning the validity of the concept of personality disorders, I wonder if there is any way in which chronic fusion with disfunctional concepts of self and structural experiential avoidance can somehow be put in a workable ACT-perspective
Of course the concept of the multiproblem patient is used. But as far as I know it is mostly limited to "borderline"-like behavior or symptoms. Is it really simply a matter of quantity or intensity of symptoms or might (for instance) disfunctional concept(s) of self or structural disfunctional avoidance strategies be seen as qualitative different kinds of problems which need a qualitative diferent approach.
I've been wondering wether the AAQ can be seen as an instrument assesing a personality/coping style , or maybe even the concept of pliance as a description of a relevent personality style influencing the amount or form of avoidance and fusion related to more specific symptoms.
Well, maybe this doesnt make any sense to anyone, but I'm sure some of you have relevant thoughts on this subject. So please help me clear my mind on this.
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second attempt
Well, my first message doesn't seem to ring any bells. So I guess I have to try something else.
Everyone of us working in clinical practice has to deal with concepts of personality disorders. Furthermore, we are very often confronted with clients who besides there symptoms, show a behavioral pattern that seems to be disfunctional, but nevertheless is resistant to change. The conceptual self or pliance or tracks are much stronger and convincing then the actual experience. Moerover I think people differ in the amount of avoidance, fusion or pliance they present.
So even if we get rid of categorical PD's, it might be worthwhile to look for a system to understand or conceptualize aspects of personal functioning that goes beyond symptomatic behavior but is highly relevant for treatment.
Personality disorders
Hi Ando,
Quite a complex question you ask. I wonder if concepts like attachment, (lack of) controlability and (lack of) predictability might come in in the learning history of persons who develop inflexible behavior repertoires like people that get the diagnosis personality disorder. It seems to me that attachment (whatever that may be in behavioral analytic terms) makes a person a important deliverer of reinforcement. Without attachment (positive) reinforcement might not work.
And having lived in a environment that lacks predictability and controlability might makes control and prediction very attractive. This might make behavior all the more insensitive to new experiences.
In the FAPbook (Functional Analytic Psychotherapy, by Kohlenberg and Tsai) there is a chapter on how a sense of self is developed (there is much correspondence with the self-as-perspective from RFT) and how maladaptive development of selfexperience may arise (page 141 a.f.).
Just some thoughts.
Jacqueline
personality disorders
Thanks John and Jacqueline for your replies.
Interesting thoughts, assessment of the relevant psychological processes might be part of the answer. The personality characteristics or the psychological processes need not even to be "pathological" or disfunctional to be of relevance for the understanding and treatment of psychological problems.
In the RFT-book there is a chapter on psychological development. Especially the part on emotional development might give an interesting perspective on the development of personality problems:
"Emotional development involves learning to describe and to categorize one's own behavioral predispositions in ways that others in the culture readily understand and will respond to in ways that are reinforcing.
For RFT healthy emotional development involves learning how to respond in accordance with relational networks, which contain emotional terms, in ways that overlap significantly with similar networks operating in the wider verbal community."
For this to happen it is crucial that the learning environment has a certain level of controlability and predictability and acts in accordance with this so called wider verbal community.It involves the development of emotional regulation, selfcontrol, self as perpective, moral behavior etc.. Including about all the concepts that er used to decribe personality problems.
Ando
Personality Disorders
Hi Ando--
I'm no expert on personality disorders, but I think the beginnings of a functional or process-level alternative to syndromal diagnosis is very nicely suggested by your thoughts around how "PD" clients might fuse more tightly with conceptual self (i.e., self as content) and with other bits of verbal behavior like plys. It would be much more useful to have a diagnostic system based on psychological processes than on sets of topographically defined symptoms. If you know where a client lies on various process dimensions (like cognitive fusion, experiential avoidance, etc.) that are closely linked to specific intervention components, you're in a better position to know what to do in treatment. For example, knowing that a client is "borderline" gives you a general idea about what the client might be like and what treatment might be empirically indicated. But it tells you nothing about how specific psychological processes are causing problems in this client's life.
There are at least a couple of problems with this: It's hard to come up with a comprehensive process-based diagnostic system that is thoroughly fleshed out and maximally viable. Alot of us are contributing toward that end in one way or another, and I hope we get there. But it ain't easy--that's why it hasn't been done yet. It would certainly push the field forward, I believe. Another issue is there is so much variation in theoretical orientation in clinical psychology, that it's easy for a relatively sterile "a-theoretical" diagnostic system like the DSM to hold sway.
JT Blackledge
Lecturer
University of Wollongong
New South Wales, Australia