Cognitive Therapy of Borderline Personality Disorder

Personality-related disorders of interpersonal behaviour: a developmental-constructivist cognitive psychotherapy approach to treatment based on attachment theory

“…In fact, at least three different developmental con-ceptions inspire the theorizing of various proponents: (1) a prevalently Piagetian approach (Ivey, 1986;Rosen, 1989;Bizzini, 1998); (2) an approach based on an Eriksonian stage model (Freeman, 1993) and (3) the one mainly based on Bowlby's attachment theory (Guidano and Liotti, 1983;Reda, 1986;Guidano, 1987Guidano, , 1991Liotti, 1988Liotti, , 1991Liotti, , 1993Liotti, , 1998Anreoli et al, 1991;Perris, 1992Perris, , 1993aPerris, , 1996aPerris, , 1996bLyddon and Alford, 1993;Turner et al, 1994;Cotugno and Benedetto, 1995;Lorenzini and Sassaroli, 1995;. However, some overlap occurs especially between the Piagetian model and the model based on Bowlby's attachment theory (Perris, 1989(Perris, , 1993aLiotti, 1992;Lehay 1995), and between the Piagetian and the Eriksonian model (Layden et al, 1993).…”

“…Vallis (1998) has recently suggested that the evolution that has taken place in recent years reflects a passage into a second generation of CPT. Young (1990), Padesky (1988), Freeman (1988, Perris (1989Perris ( , 1993aPerris ( , 1996a, Beck et al (1990), Vallis and his group (Rothstein and Vallis, 1991;Howes and Vallis, 1996;Vallis, 1998), Turner, 1993 a and b;Turner et al, 1994); Layden et al (1993), Pretzer and Beck (1996;Pretzer, 1998), Wills and Sanders, 1997;, JS Beck (1995, and in general the majority of CPT therapists working in everyday practice with patients presenting a severe and enduring pathology, concur in pointing out necessary modifications of the standard procedure that went well with moderately depressed or anxious patients. Rothstein and Vallis have summarized these modifications under three main headings (see Table 2).…”

“…Dowd and Courchaine (1996) emphasize that when the focus of CPT turned toward core cognitive structures, theories of tacit or implicit knowledge became particularly relevant. Beck (1987), Freeman (1993, and Layden et al (1993) use the attribute dormant when speaking of schemata which are not currently active, without expounding, however, on the difference from a silent (that is, tacit) organization of knowledge. Beck et al (1990) suggest that schemata in patients with a personality disorder are hypervalent (that is, they have a low activation threshold), and prepotent (that is, they take priority over other schemata) but they do not dwell either on issues of level of awareness, or on their accessibility.…”

Personality disorder: its impact on staff and the role of supervision

“…Even the work of the best-intentioned staff in a personality disorder service is likely to be replete with failures to retain impartiality. Being a therapist of a patient with borderline personality disorder is 'to be acutely reminded that one is a human being' (Layden 1993). If staff feel secure in the support of colleagues, with a sense of purpose in their encounters, they stand some chance of accepting distress, sometimes responding with creativity, and structuring the relational environment such that those in their company might begin to do the same.…”

Le traitement du trouble de la personnalité limite par l’approche centrée sur les schémas

“…Le modèle qui y est pré-senté est celui qui se rapproche le plus du modèle cognitif beckien d'origine. Layden et al (1993), aussi de l'école beckienne, ont ensuite insisté sur l'importance d'ajouter un modèle du développement de la personnalité (Erikson) et de l'intelligence (Piaget) au modèle cognitif de base dans le traitement de la personnalité limite. Linehan (1993), de son côté, a créé un système thérapeutique sophistiqué (techniques cognitives-comportementales, méditation inspirée du Zen, pensée dialectique, encadrement, groupes...) qui vise le remplacement de stratégies dysfonctionnelles par des stratégies fonctionnelles dans un premier temps.…”