The psychotherapy of character disorder

Patients suffering from character disorder are often rejected as unsuitable for psychotherapy. Those with anxiety and depression often seek help, and should be assessed for their potential to be helped by a carefully structured long term psychotherapeutic relationship controlled by the therapist to reduce acting out behaviour. The therapist acts throughout as a model for the patient. As the patient develops basic trust in the therapist, identification develops and a major sustained improvement can occur. The therapy described is current-behaviour orientated and the importance of clear, unambiguous communication, particularly verbal communications, is stressed. The principles of therapy are applicable to all contacts with character-disordered patients. Briefly described is the long term therapy of two patients with hysterical personality disorders and acting-out behaviour, as examples of one type of the wide variety of character disorders that can be treated, and where the nine year follow up was adequate to ensure that improvement was sustained.