Integration in the Psychodynamic Psychotherapy of Severe Personality Disorders: The Conversational Model

The psychotherapy of commonly occurring severe personality disorders-borderline, narcissistic, avoidant, dependent, obsessive compulsive, and schizoid-presents the therapist with a unique therapeutic challenge, as each personality disorder rarely occurs alone. Integration of what is most useful and what works in each model is being proposed to enable a more successful approach to the diversity of presentations. We describe the conversational model, some outcome research, and descriptive studies to illustrate this. Based in psychoanalytic theory, the conversational model is integrated with trauma theory, findings in memory research, linguistics, neurophysiological data, and, above all, on the observations of clinical experiences. Our emphasis in this article is on the treatment principles, methods, and techniques, along with case examples to illustrate what we mean. Case material is taken from audio recordings for which written informed consent was obtained for presentations and journal articles. Some changes have been made to maintain confidentiality.