Psychodynamic Therapy for Personality Pathology by Eve Caligor Otto F. Kernberg John F. Clarkin Frank E. Yeomans

Author:Eve Caligor,Otto F. Kernberg,John F. Clarkin,Frank E. Yeomans
Language: eng
Format: epub
ISBN: 9781615371815
Publisher: American Psychiatric Association
Published: 2018-03-02T16:00:00+00:00

In sum, the consultant’s task is to share with the patient his understanding of the total picture, including the patient’s presenting complaints and additional areas of difficulty, and then help the patient decide on his goals, weighing relative risks and benefits of different treatment options, including the possibility of no treatment.

Differential Therapeutics and Discussing Treatment Options

The nature of the patient’s goals and motivation, combined with her structural and DSM-5 diagnoses, determines treatment options. The consultant will present the options and then help the patient make an informed and autonomous decision in relation to selecting a treatment. Treatment planning will be guided by the consultant’s expertise and recommendations, but ultimately determined by the needs and wishes of the patient, as reflected in her personal goals and level of motivation for treatment. As he reviews treatment options and recommends a particular form of treatment—psychotherapeutic and/or psychopharmacological—the clinician initiates a process of obtaining informed consent (Beahrs and Gutheil 2001). It is incumbent upon the clinician to disclose enough information for the patient to make a reasoned decision about whether to undertake the treatment.

For patients who are financially supported by someone else, such as a family member or significant other, and particularly if someone other than the patient will be paying for the treatment, discussing treatment options with the relevant third party as well as with the patient is recommended. This can best be accomplished in a family meeting with the patient and her significant others in which the consultant shares the treatment plan, including risks and benefits and expected outcomes. During the process of discussing treatment options and selecting a treatment, meeting with family members or significant others of any patient who is at high risk for destructive or self-destructive behavior is also highly recommended. We address this topic in greater depth in the discussion of contracting in Chapter 8.

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