0.18 Cognitive perspectives on personality development  (Page 27/30)

Personality Theory in Real Life: Beck’s Cognitive Therapy

and the Treatment of Personality Disorders

Aaron Beck and a number of his colleagues, as well as others, have attempted to apply cognitive therapy to the treatment of personality disorders. It is widely accepted that personality disorders are highly resistant to treatment, but aside from the problems they present by themselves, there is another important reason to continue trying to address these serious psychological disorders. Personality disorders often co-occur with other psychological conditions (Axis I disorders), and they may be the primary reason why psychotherapy does not work well with certain patients (Pretzer&Beck, 2005). Since cognitive therapy in particular requires that the therapist gain an understanding of what the client is thinking, in order to then help the client recognize their own dysfunctional cognitions so that the client may work toward change, it is necessary for the therapist to have a complete understanding of the client’s psychological make-up. As a prelude to treating personality disorders with cognitive therapy, one needs to understand personality disorders in cognitive-behavioral terms.

As with depression, or any other psychological disorder, the cognitive-behavioral perspective suggests that individuals suffering from personality disorders have formed dysfunctional schemas that create an attributional bias, which then causes the person to interpret life’s experiences in dysfunctional ways, but in ways that nonetheless support and maintain the dysfunction of the personality disorder. If this theory is accurate, one should be able to identify typical patterns of dysfunctional schemas that match the characterization of different personality disorder diagnoses. Indeed, Beck and Freeman (1990) have offered those patterns in Cognitive Therapy of Personality Disorders . What distinguishes the negative schemas that characterize personality disorders from schemas that characterize other psychological disorders reflects the basic difference between Axis II and Axis I in the DSM system:

The typical schemas of the personality disorders resemble those that are activated in the symptom syndromes, but they are operative on a more continuous basis in information processing. In dependent personality disorder, the schema “I need help” will be activated whenever a problematic situation arises, whereas in depressed persons it will be prominent only during the depression. In personality disorders, the schemas are part of normal, everyday processing of information. (pg. 32; Beck&Freeman, 1990)

What might the typical schemas associated with other personality disorders be? Beck and his colleagues offer detailed examples for all ten of the personality disorders listed in the DSM, as well as for the passive-aggressive (negativistic) personality disorder (Beck&Freeman, 1990; Pretzer&Beck, 2005). To cite just a few examples, the antisocial individual thinks that “people are there to be taken,” the narcissistic individual thinks “I am special,” and the histrionic individual believes “I need to impress.” As a result of these basic beliefs and attitudes, these individuals adopt corresponding behavioral strategies. The dependent person seeks attachment, the antisocial person attacks, the narcissist engages in self-aggrandizement, and the histrionic person performs dramatically (Beck&Freeman, 1990).