Can Personality Theories Offer Anything to Assist Clinical Formulation when the Patient has Personality Disorder

1. Overview role Confidentiality/if recognise client, etc Overview role Confidentiality/if recognise client, etc

2. McMurran �Personality Disorders NHS Programme on Forensic Mental Health Research Personality Disorder Problems with reliability and validity (Blackburn R., 2000, Moreland et al, in press) Atheoretical (closely linked to the political agenda underpinning the development of DSM) Dimensional/categorical Normal/pathological Underlying process/structure

3. McMurran �High Priority Questions� Systematic Reviews of treatment Development of theoretical based interventions Evaluation of theoretically based intervientions Do assessment/treatment models derived from the general population apply to people with LD?

4. Personality Disorder �Personality disorders defined in DSM and ICD are a narrow group compared with personalities recognisable in people ate large and describe maladaptive conditions� (McMurran, p.7) There has been limited integration of �normal� (5 factor) models of personality and personality disorder because of a lack of agreement concerning a unifying model. Work tends to be cross sectional Manual for the Chart of Interpersonal Reactions in Closed Living Environments (CIRCLE, Blackburn in press) This has attempted to integrate interpersonal theory with personality disorder

5. Treatment Does a PD diagnosis define treatment? Treatment categories tend to fall into; Treating criminogenic needs Antisocial attitudes Problem solving CBT Addresses interpersonal behaviour/cognitions/beliefs, etc. Therapeutic Communities Maladative interpersonal style

6. Constructional Approach In learning disability history of interventions being ideographic and constructional (Nb. Pretzer and Flemming, 1989)

7. The constructional approach In apposition to a pathological approach, which focuses on the elimination of problems by a variety of means. These can include medication, psychotherapy, or behavioural approaches. The problem is considered as something to be removed, regardless of how it first occurred or developed or is maintained.

8. Can Personality Theory Contribute to this? Defining somebody by a personality disorder is to characterise them by a narrow range of maladaptive personality characteristics and lends itself to focus on the elimination and management of risky and problematic behaviours. Is the principle utility of a PD diagnosis linked to categorization and risk assessment? Is there any value in placing an assessment of maladaptive personality alongside adaptive/�normal, personality traits?

9. What models to use? Interpersonal Theory (Circumplex) Big 5 Zigler

10. Circumplex It emphasises that much dysfunctional behaviour arises from, and is manifest in, an interpersonal context. A circumplex refers to a structure in which all variables in the circle are positively associated with adjacent variables, and negatively associated with those opposite. Interactions (or transactions) are governed by certain social rules. Leary proposed that behaviour �pulls� a reaction from the other person, and that this is governed by principles of complementarity. Along the dominance-submission axis, complementarity is reciprocal, i. e. a dominant response pulls a submissive reaction A further assumption of interpersonal theory is that normal and abnormal functioning are on a continuum, and that both are captured by the IPC (Leary, 1957).

12. Circumplex Because the circumplex concept implies an ordered patterning in the relationships between variables, it also implies regularities in the interpersonal profiles shown by individuals. For example, a person with a marked dominant style will be characterised by a high frequency of dominant interactions but also usually a relatively high frequency of gregarious and coercive behaviours, while submissive, withdrawn, or compliant interactions are likely to be infrequent.

13. Circumplex Complementarity principles predict how the therapist should respond to the client to create disconfirming experiences and change interpersonal style. a result of genetic factors and developmental experiences, such as early attachment relationships with caretakers, people tend to develop a distinctive interpersonal style. The more pronounced or extreme a style the less a person relies on behaviour from opposite parts of the circle The notion of rigid and inflexible interpersonal styles is consistent with the current concept of personality disorders as inflexible traits (American Psychiatric Association, 1994),

14. Big 5 The �Big Five" dimensions are: Neuroticism vs stability, Extraversion vs introversion, Agreeableness vs antagonism, Conscientiousness vs lack of self-discipline, and Openness to experience vs rigidity

21. Conclusions Principle value in PD diagnosis relates to classification and risk assessment / management Personality theories can contribute to an ideographic constructional approach to assessment and treatment Single case research to explore further