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Overcoming Resistant Personality Disorders: A Personalized Psychotherapy Approach

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With this, I've now waded through four of Dr. Millon's (and his various colleagues') tomes on the character disorders... and uniformly found them all to be terrifically informative and useful. But from the git (with his =Personality Guided Therapy=, 1999), I wondered why it was that Millon and his teams have had so precious little to say about the etiology of the specific disorders.

I may be a "neuropsychological cognitive-behavioralist" in the trenches, but psychodynamic principles have always helped me to deepen my empathy, emotional congruity and unconditional regard for troubled - and troubling - patients. And those Rogerian qualities have reliably proven to be entirely necessary to finesse the process of cognitive restructuring, as well as convincing the patient to surrender his will and his life to the higher power of EMDR, SIQR or some other messing about with his limbic system.

Blame it on Alice Miller, Claudia Black, Pia Mellody, Richard Kluft and Frank Putnam, I suppose. But it really does help (me, anyway) to have a firm grip on "what happened way back when" that's driving the patient's compulsions to repeat the trauma with his relentlessly dysfunctional defense mechanisms.

Over time, and surely with help from Beck's and Freeman's lists of what the specific personality disorder tends to believe, I began to figure that narcissistic injuries of one sort or another had occurred, and that it was likely that the perpetrators demonstrated no mean degree of the same sort of thing that I was seeing and hearing right there in front of me. Some time after that I began to sense that what had worked "well" for the perps was now working "well" for the patient, too.

And that moved me to theorize etiologies that I could then explore in real collaboration with the patient even as we moved right into identifying, exploring, questioning and revising their core beliefs, values, idea(l)s, assumptions, convictions, and attitudes. Millon and Grossman =touch= here and there on childhood suffering in this and the companion volume, =Moderating Severe Personality Disorders=; I suppose I just wish for the sake of those who are newer to the game that they'd expanded those notions a bit further.

Beyond that, there are some especially dandy sections in ORPD, including a fine treatise on the specific differences between the narcissistic and antisocial personalities, on the antisocial's specific mechanisms of imitating his abusers, and on the (obsessive-) compulsive's ironclad fixation with self-abuse driven by "learned perfectionism."

I know that the APA's knocked out a pretty slick (and comprehensive) tome of their own on the PDs, and one does well =as= well to look at Livesley, at Stone, at Clarkin and Lenzenwegger, and at the aforementioned Beck and Freeman. If one asserts oneself to be a true "expert" on the Axis II disorders, however, considerable exposure to Dr. M. seems warranted.