Therapeutic interaction with an older personality disordered patient

Area of Science:

• Psychology
• Psychotherapy Research

Background:

• This case study examines the long-term therapeutic relationship of an older woman with personality disorders.
• The patient presented with schizoid, avoidant, and depressive personality disorders, along with major depression.

Observation:

• The patient, Ms. Q, underwent an eight-year treatment episode.
• Ms. Q showed significant improvement in adaptive defensive functioning, as measured by the Defense Mechanism Rating Scale (DMRS).
• While avoidant personality disorder traits persisted, schizoid traits and major depression remitted.

Findings:

• Time-series analysis revealed that positive changes in adaptive defenses were predicted by increases in a specific therapeutic interaction style.
• This interaction involved the therapist using a didactic, advice-giving manner, clearly highlighting the patient's role in problems, which could be perceived as tactless.
• A reciprocal relationship was observed, where improved defenses also predicted further increases in this particular therapeutic interaction.

Implications:

• This suggests that a direct, didactic therapeutic approach, even if perceived as tactless, can be effective in enhancing defensive functioning in certain patients.
• The findings highlight the dynamic interplay between therapeutic techniques and patient defense mechanisms over extended treatment periods.
• Further research into specific therapist behaviors and their impact on personality disorder treatment is warranted.