Personality-Disordered Patients: Treatable and Untreatable / Edition 1

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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.

American Psychiatric Publishing

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Editorial Reviews


In this very well-written and clinically rich text, Personality-Disordered Patients: Treatable and Untreatable, Stone approaches the treatability of personality-disordered patients, from most amenable to untreatable, across 11-at times, interrelated-factors or dimensions.... The greatest strength of Personality-Disordered Patients: Treatable and Untreatable lies in its vast clinical richness and the fact that the information contained within will be useful to mental health professionals from all schools of thought. Clinical vignettes constitute probably more than half the text and beautifully and poignantly illustrate the technical points being made during each phase of the book, which is a pleasure to read.

The Journal of Nervous and Mental Disease

[Personality-Disordered Patients] is enjoyable, readable, and informative. We are invited in for a glimpse of Michael Stone's many therapeutic encounters and learn from his broad range of experience. His organizing the book along the lines of amenability to treatment is useful, and his tables of traits and characteristics can help clinicians evaluate prognosis and course, and can provide comfort to therapists who are having difficulty understanding what is going on their therapists with personality-disordered- patients.

Journal of Clinical Psychiatry

Personality-Disordered Patients is a terrific book for clinicians. It is well written with multiple clinical vignettes. I would highly recommend this book to all clinicians who work with challenging patients.

Doody's Review Service
Reviewer: Steven T. Herron, MD (Assurance Health and Wellness)
Description: Based on the improving realm of research in, and understanding of, personality disorders, this book attempts to identify those Axis II disorders which are most likely to respond to psychotherapeutic interventions.
Purpose: Often the treatment of individuals with personality disorders is fraught with complications and misunderstandings. Residents, and even experienced clinicians, can have significant difficulty working with these patients to provide a structure and vision for their therapy. This book is intended to offer insight to clinicians regarding the likely outcomes for personality disordered patients.
Audience: It is penned primarily for those working with personality disordered individuals. However, it is not designed for the inexperienced or psychotherapeutically naive. Upper level residents, therapists with prior experience, or psychiatrists with some background in treating these individuals are more likely to benefit from this book.
Features: The book begins with chapters addressing personality disorders the author considers treatable progressing to those conditions deemed untreatable. Numerous case examples in the first few chapters illustrate salient points about treating personality disordered individuals, and the author draws upon his own extensive clinical experience and combines it with ideas and concepts borrowed from psychotherapists such as Kemberg.
Assessment: One troublesome aspect of the book is that the structure and layout can be confusing, making the book difficult to read in places. And, like many other individuals in the area of psychotherapy (see Kemberg), this author's writing is at times too dense for immediate understanding. This book is not appropriate for those in the early stages of their training. Many of the concepts are tremendously challenging for trainees, and full comprehension often requires the author to present ideas in plain, straightforward language. This book may be more valuable to those with more clinical experience and training, but beginners might find their learning more productive by choosing basic texts on psychotherapy by authors such as Gabbard.
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Product Details

  • ISBN-13: 9781585621729
  • Publisher: American Psychiatric Publishing, Incorporated
  • Publication date: 1/28/2006
  • Edition description: New Edition
  • Edition number: 1
  • Pages: 277
  • Product dimensions: 6.00 (w) x 9.00 (h) x 0.75 (d)

Meet the Author

Michael H. Stone, M.D., is Professor of Clinical Psychiatry at Columbia College of Physicians and Surgeons.

American Psychiatric Publishing

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Table of Contents

Preface. Amenability to treatment in the realm of personality disorder. Personality disorders most amenable to psychotherapy: borderline personality disorder. Personality disorders most amenable to psychotherapy: the anxious cluster and related disorders. Personality disorders of intermediate amenability to psychotherapy: borderline personality disorder. Personality disorders of intermediate amenability to psychotherapy: other personality disorders. Personality disorders of low amenability to psychotherapy: borderline personality disorder. Personality disorders of low amenability to psychotherapy: other personality disorders. Personality traits at the edge of treatability. Untreatable personality disorders. Afterword. References. Index.

American Psychiatric Publishing

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