Psychoanalytic perspectives on substance use and antisocial personality disorder

Psychoanalysis and related psychodynamic psychotherapies have historically had a limited engagement with substance use and antisocial personality disorders. This in part reflects an early preoccupation with ‘transference neuroses’ and in part reflects later de-emphasis of diagnosis and focus on therapeutic process. Nonetheless, psychoanalytic perspectives can usefully inform thinking about approaches to treatment of such disorders and there are psychoanalytic constructs that have specific relevance to their treatment. This paper reviews some prominent strands of psychoanalytic thinking as they pertain to the treatment of substance abuse and antisocial personality disorders. It is argued that, while Freudian formulations lead to a primarily pessimistic view of the prospect of treatment of such disorders, both the British object relations and the North American self psychology traditions suggest potentially productive approaches. Finally the limited empirical evidence from brief psychodynamically informed treatments of substance use disorders is reviewed. It is concluded that such treatments are not demonstrably effective but that, since no form of psychotherapy has established high efficacy with substance use disorders, brief psychdynamic therapies are not necessarily of lesser value than other treatments and may have specific value for particular individuals and in particular treatment contexts.

Group Dynamics in Sex Offender Treatment Involving Individuals with Personality Disorders

This qualitative investigation primarily employing a phenomenological perspective and psychoanalytic interview approach intends to provide contextual understanding of group dynamics in sex offender treatment involving individuals with strong features of personality disorders or Axis II psychopathology according to the Diagnostic and Statistical Manual of Mental Disorder (4 ed., text rev.; DSM-IV-TR; American Psychiatric Association, 2000). Of note, this study particularly focuses on the cluster B type (Narcissistic, Borderline, Histrionic, and Antisocial Personality Disorders), based on the assumption that this type is more interpersonally operational in its nature. The present study is based on semi-structured interviews of three clinicians who arecurrently providing group treatment for sex offenders. The interview was designed to elicit the participants' clinical observations of group dynamics involving group members with features of the Axis II, Cluster B type. In this study, 11 therapeutic factors postulated by Yalom (2005) were utilized to qualitatively investigate group dynamics. Analyses of qualitative data highlighted how group members with features of the Axis II, Cluster B type may distinctively affect group dynamics. Based on the results, group members with Axis II diagnoses, as reported bythe therapists who responded to this study, were observed to present with altruistic behaviors in group. In addition, motivation appeared to be one of the most influential factors in promoting and maintaining therapeutic group behaviors. Group members with antisocial features appeared to present with low motivation for treatment, and individualswith a pervasive history of criminal institutionalization seemed more prone to disengagement in group. Individuals with borderline and histrionic traits seemed to be interpersonally oriented and affectively engaged in group process. Persons with a narcissistic tendency also appeared to be interpersonally invested and showed altruistic behaviors, yet the importance of confirming their superiority seemed to outweigh the need for acceptance or approval from other group members. As briefly discussed above, the qualitative analyses of the current data showed that individuals with Axis II disorders, Cluster B type uniquely affect group dynamics, which suggest clinical considerations foreffective treatment planning, maintenance, and outcomes.

Psychoanalytic perspectives on substance use and antisocial personality disorder

Psychoanalysis and related psychodynamic psychotherapies have historically had a limited engagement with substance use and antisocial personality disorders. This in part reflects an early preoccupation with 'transference neuroses' and in part reflects later de-emphasis of diagnosis and focus on therapeutic process. Nonetheless, psychoanalytic perspectives can usefully inform thinking about approaches to treatment of such disorders and there are psychoanalytic constructs that have specific relevance to their treatment. This paper reviews some prominent strands of psychoanalytic thinking as they pertain to the treatment of substance abuse and antisocial personality disorders. It is argued that, while Freudian formulations lead to a primarily pessimistic view of the prospect of treatment of such disorders, both the British object relations and the North American self psychology traditions suggest potentially productive approaches. Finally the limited empirical evidence from brief psycho dynamically informed treatments of substance use disorders is reviewed. It is concluded that such treatments are not demonstrably effective but that, since no form of psychotherapy has established high efficacy with substance use disorders, brief psychdynamic therapies are not necessarily of lesser value than other treatments and may have specific value for particular individuals and in particular treatment contexts.

Personality disorders

This chapter explains the main categories of personality disorders and their diagnosis.Nursing interventions are described, and challenges working with people who have personality disorders are discussed.Limitations in our understanding of personality disorders, and problems of categorisation, diagnosis and treatment are also discussed.

Antisocial personality disorder and therapeutic justice court programs

It has become commonplace for courts to supervise an offender as part of the sentencing process. Many of them have Anti Social Personality Disorder (ASPD). The focus of this article is how the work of specialist and/or problem solving courts can be informed by the insights of the psychology profession into the best practice in the treatment and management of people with ASPD. It is a legitimate purpose of legal work to consider and improve the well-being of the participants in the legal process. Programs designed specifically to deal with those with ASPD could be incorporated into existing Drug Courts, or implemented separately by courts to aid with reforming offenders with ASPD and in managing the re-entry of offenders into the community as part of their sentence. For the success of this initiative on the part of the court, ASPD will need to be specifically diagnosed and treated. Close co-operation between courts and psychologists is required to improve the effectiveness of court programs to treat people with ASPD and to evaluate their success.

Psychotherapy for Personality Disorders in a Natural Setting: A Pilot Study over Two Years of Treatment.

Long-term assessment of the effects of psychotherapy for personality disorders (PDs) in a natural environment is an important task. Such research contributes to enlarge the practice-based evidence, embedded in broad collaborations between clinicians and researchers in psychotherapy for PDs. The present pilot study used rigorous assessment procedures and incorporated feedback loops of outcome information to the therapists in demonstrating the effects of psychotherapy for PD in a natural setting. The number of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), criteria for any PD was the primary outcome (along with psychological distress, depression, impulsiveness, and quality of life as secondary measures), assessed at intake, 6, 12, 18, and 24 months of psychotherapy for N = 13 patients with PD. Data were analyzed using hierarchical linear modeling. Results demonstrated a large pre-post effect (d = 2.22) for the observer-rated measure (primary outcome), and small to medium effects for the secondary outcomes; these results were corroborated by a steady decrease of symptoms over all five time points, which was significant for several outcomes. These results add a piece to the literature by demonstrating the effects of long-term psychotherapy for PDs in increasingly diverse contexts and suggest that practice-oriented research can be carried out in a collaborative and systematic manner.

Examining the incremental validity of psychopathy versus antisocial personality disorder in understanding patterns of criminal behavior

La psychopathie et le trouble de personnalité antisociale sont deux syndromes reliés qui ont été identifiés comme prédicteurs importants de comportements violents et de criminalité. Cependant, la recherche indique que les facteurs de la psychopathie centrés sur la personnalité ne sont pas des prédicteurs fiables de récidive violente chez les personnes atteintes de maladies mentales. Toutefois, peu d’études se sont centrées sur l’identification des facteurs associés au patron des antécédents criminels. Les 96 hommes de l’étude ont été déclarés non criminellement responsables en raison de troubles mentaux. Ils ont été évalués quant au trouble de la personnalité antisociale ainsi qu’à la psychopathie. Les dossiers criminels de la Gendarmerie Royale du Canada ont également été consultés afin de reconstituer l’histoire criminelle. Les résultats suggèrent que ni les traits de personnalité antisociaux, ni les facteurs de la psychopathie ne démontrent une validité prédictive incrémentielle les uns sur les autres quant au nombre ou à la sévérité des délits. La présence d’un grand nombre de traits antisociaux est associée à un plus grand nombre et à une plus importante sévérité d’actes criminels non-violents. Les résultats sont discutés en termes de l’utilité d’une classification du trouble de personnalité antisociale, et de la pertinence du construit de la psychopathie pour les personnes atteintes de maladies mentales graves.

The Experience of Treatment of Persons Presenting with Concomitant Psychotic and Borderline Personality Disorders

Essai doctoral présenté à la Faculté des arts et des sciences en vue de l'obtention du grade de doctorat en psychologie (D.Psy.) option psychologie clinique