Personality-Disordered Patients: Treatable and Untreatable

Determining the amenability of personality disorders to psychotherapy-a
patient's capacity to benefit from verbal approaches to treatment-is important
in helping clinicians determine the treatability of cases. Michael Stone here
shares the factors he has observed over long years of practice that can help
practitioners evaluate patients, stressing the amenability of the various
disorders to amelioration. By focusing on which patients are likely to respond
well to therapeutic intervention and which will prove most resistive, his book
will help therapists determine with what kinds of patients they will most likely
succeed and with which ones failure is almost a certainty.

Stone
establishes the attributes that affect this amenability-such as the capacity for
self-reflection, motivation, and life circumstances-as guidelines for evaluating
patients, then describes borderline and other personality-disordered patients
with varying levels of amenability, from high to low. This coverage progresses
from patients belonging to the DSM "anxious cluster," along with the
depressive-masochistic character and the hysteric character, to patients who
demonstrate an intermediate level of amenability to psychotherapy. He introduces
the interrelationship between borderline personality disorder and dissociative
disorders and discusses treatability among certain patients in Clusters "A" and
"C," as well as others with narcissistic, histrionic, depressive disorders.
Final chapters address the most severe aberrations of personality and the
limitations they impose on the efficacy of therapy. Personality-Disordered
Patients is filled with practical, clinically focused information. This
guideline structured book: Covers all personality disorders-including ones not
addressed in the latest DSM such as sadistic, depressive, hypomanic, and
irritable-explosive Identifies both attributes necessary for treatability and
factors associated with low treatability Pays particular attention to
borderline disorders, which represent the most discussed conditions and are
among the most challenging to psychotherapists Reviews personality traits whose
presence, if intense-even if unaccompanied by a definable personality
disorder-creates severe problems for psychotherapy

Numerous case studies
throughout the book provide examples that will help therapists determine which
of their own patients are most likely to benefit from their efforts and thereby
establish their own limits of effectiveness. By alerting practitioners to when
therapy is likely to fail, these guidelines can help them avoid the professional
disappointment of being unable to reach the most intractable patients.