Acceso usuarios
J. Livesley
This paper argues that evidence of limited efficacy of specialized therapies forpersonality disorder points to the need for trans-diagnostic and trans-theoreticaltreatment models. Current therapies largely adopt a diagnosis-specific and therapeuticschools approach to therapy development; each major school of thought tends todevelop its own treatment model for specific diagnoses. The relevance of a diagnosisspecific approach to treatment is challenged given the well-established problems withcurrent diagnoses and growing recognition that the general features of personalitydisorder and severity are more useful in understanding prognosis than specificdiagnoses. These developments point to the use of a trans-diagnostic treatment model.Similarly, a schools approach to treatment is questioned given the failure to demonstratedifferences in efficacy across therapeutic models and evidence that these therapies donot yield better outcomes that supportive therapy or general clinical care. These findingpoint to the need for a more integrated approach. Implementation of trans-diagnosticand trans-theoretical treatment requires a more detailed assessment of personalitypathology than is provided by current diagnoses in order to identify impairments thatform the targets for change and a scheme for organizing therapy and coordinating theimplementation of an eclectic array of interventions. The article outlines a practical wayto conceptualize assessment for treatment purposes and a framework for organising anddelivering therapy.
