Transcript Understanding Personality Disorders

Understanding
Personality Disorders
Catherine R. Barber, Ph.D.
Institute for Brain Potential
Copyright 2010, C. Barber, IBP
Primary Objectives
1. List key brain regions influencing social
reasoning and conduct.
2. Identify features of and effective treatments
for paranoid, schizoid, schizotypal,
antisocial, borderline, histrionic, narcissistic,
dependent, avoidant, obsessive-compulsive,
passive-aggressive, and depressive
personality disorders.
Copyright 2010, C. Barber, IBP
Primary Objectives (cont.)
3. Describe personality disorders that
may underlie hypochondriasis, body
dysmorphic disorder, selected eating
disorders, and substance abuse.
4. Review principles that facilitate the
transformation of personality.
Copyright 2010, C. Barber, IBP
Secondary Objectives
1. Differentiate categorical and dimensional
models of personality pathology.
2. Describe basic theoretical models of
personality disorder etiology.
3. Identify practical strategies for working with
personality-disordered clients.
4. Recognize and learn to cope with countertransference.
Copyright 2010, C. Barber, IBP
Personality Style
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Consists of the ways in which a person
relates to others, world, and self.
 Traits (internal tendencies – mostly inherited)
 Habits (behavioral tendencies – mostly
learned)
 These may be adaptive or maladaptive,
depending on the context.
Copyright 2010, C. Barber, IBP
Personality Disorder
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Enduring and pervasive pattern of
perception, thought, and behavior
Falls outside social/cultural norms
Inflexible and maladaptive
Causes impairment or distress
Copyright 2010, C. Barber, IBP
Disorder or Quirk?
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No clear line!
Some people are just “eccentric.”
Level of impairment/distress is usually
the determining factor.
Example: Grey Gardens
Copyright 2010, C. Barber, IBP
Models of Personality Pathology
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Categorical: DSM-IV-TR
Dimensional: “Big Five”
Prototypical: SWAP
Copyright 2010, C. Barber, IBP
DSM: A (Mostly) Categorical Model
DSM-IV-TR Personality Disorders
Cluster A
Cluster B
Cluster C
Paranoid
Antisocial
Avoidant
Schizoid
Borderline
Dependent
Schizotypal
Histrionic
Obsessive-Compulsive
Narcissistic
Copyright 2010, C. Barber, IBP
What makes DSM categorical?
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Well-defined criteria
Cut-off scores indicate presence/
absence of disorder
“Clusters” are based on common
features
Copyright 2010, C. Barber, IBP
DSM: Pros
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Most widely used system
Excellent tool for facilitating
communication
Easy to use
Many categories match well-established
clinical syndromes
Copyright 2010, C. Barber, IBP
DSM: Cons
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Possibility of multiple diagnoses
Overlap in criteria
Polythetic criteria set  greater heterogeneity
within diagnostic categories
Cut-offs established by consensus (not
empirically)
“Reification” trap: Not all categories represent
true constructs
Copyright 2010, C. Barber, IBP
Big Five: A Dimensional Model
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5 higher-order personality dimensions
Extraversion
Agreeableness
Conscientiousness
Neuroticism/Emotional instability
Openness to Experience
30 sub-dimensions
Personality disorders are on a
continuum with normal personality
Copyright 2010, C. Barber, IBP
Personality in Two Dimensions
Neuroticism
Introversion
Extraversion
Emotional Stability
Copyright 2010, C. Barber, IBP
Dimensional Model: Pros
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Empirically-based
Dimensions appear to be heritable
Provides more information
Can be used to predict behavior
Recognizes personality strengths (not
just pathology)
Copyright 2010, C. Barber, IBP
Dimensional Model: Cons
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Can be unwieldy
No clear cut-off for determining the
presence of disorder
Not user-friendly for clinicians who use
DSM categories
Copyright 2010, C. Barber, IBP
SWAP: A Prototypical Model
From Westen, Shedler, and Bradley, 2006
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Descriptions of personality disorder
“prototypes” (similar to DSM descriptions)
Clinician rates the degree to which a patient
matches the prototype
Very good match – patient exemplifies diagnosis
Good match – patient has diagnosis
Significant match – patient has significant features
Slight match – patient has minor features
Little or no match – diagnosis does not apply
Copyright 2010, C. Barber, IBP
Coming (not so) soon to a
bookstore near you: DSM-5!
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Expected to be published ca. 2013
“Best of both worlds”: Dimensional and
Prototype models may be included
Proposed “types” include antisocial/
psychopathic, avoidant, borderline,
obsessive-compulsive, and schizotypal
(all pending empirical validation)
Copyright 2010, C. Barber, IBP
Assessment Tools:
Semi-structured Interviews
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Examples: SCID-II, SIDP-IV, DIB-R
Pros:
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Very thorough
Diagnoses generally map onto DSM constructs
Highly reliable
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Cons:
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May require extensive training
Validity is only as good as DSM construct validity
Can take a long time to administer
Copyright 2010, C. Barber, IBP
Assessment Tools:
Objective Personality Tests
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Examples: MMPI-2, PAI, MCMI-III
Pros:
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Empirically-based
Self-administered
Well-studied
Useful for describing and predicting behavior
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Cons:
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Not all objective measures provide diagnoses
Can be complex to interpret
Copyright 2010, C. Barber, IBP
Assessment Tools:
Projective Tests
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Examples: Rorschach, TAT, Projective
drawings, sentence-completion tests
Pros:
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Especially useful for psychodynamic work
May tap unconscious processes
Useful for testing defensive clients
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Cons:
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More subjective interpretation
Do not provide a diagnosis
Copyright 2010, C. Barber, IBP
Caveats!
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Gather enough information: Don’t rely
on a single encounter to tell you
everything about a person’s personality.
Don’t diagnose from afar: Beware of
the “US Weekly” phenomenon.
Not all difficult people have a
personality disorder!
Copyright 2010, C. Barber, IBP
Caveats!
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Don’t rely on diagnosis alone—a label cannot
capture the uniqueness and complexity of the
individual.
Bottom line on diagnosis and treatment:
Try to identify, understand, and address
problematic thoughts, emotions, behaviors,
motivations, etc., rather than simply assigning
a diagnosis.
Copyright 2010, C. Barber, IBP
A Few More Basics About PDs
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Community sample prevalence
estimates range from 0.5-2.5% to 1015% (10-30% in clinical samples).
PDs emerge in childhood/adolescence,
but caution is used in diagnosing before
18 years of age.
Considerable stigma still attaches to
PDs.
Copyright 2010, C. Barber, IBP
A Few More Basics About PDs
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Treatment is challenging but not
impossible.
Treatment involves modification and
management of patterns and
tendencies, not “cure” of illness.
Nature AND nurture appear to cause
and contribute to PDs.
Copyright 2010, C. Barber, IBP
Theories of Personality
Disorders
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Psychodynamic/
Psychoanalytic
Theories:
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Developmental
explanations
Role of the
unconscious
Defense mechanisms
Example: Object
Relations Theory
Copyright 2010, C. Barber, IBP
Theories of Personality
Disorders
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Cognitive-Behavioral
Elements:
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Automatic thoughts
Schemas
Cognitive distortions
Principles of
reinforcement
Observation and
modeling
Copyright 2010, C. Barber, IBP
Theories of Personality
Disorders
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Biological elements
Everything we do has a biological basis!
The brain responds to stimuli—it is constantly
receiving and processing information.
Both physical and environmental factors
cause brain processes to go awry, leading to
symptoms.
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Physical factors: Genetics, head injury, medical diseases
Environmental factors: Learning history, trauma
Copyright 2010, C. Barber, IBP
Theories of Personality
Disorders
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Biological elements
Virtually all aspects of brain functioning are
involved in personality.
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Examples: perception, memory, speech, executive
functioning, social reasoning, etc.
No single region is associated with any
personality disorder.
However, key regions include the prefrontal
cortex and the limbic system.
Copyright 2010, C. Barber, IBP
Prefrontal Cortex
From http://universe-review.ca/I10-80-prefrontal.jpg
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Executive
functioning center
Planning
Decision making
Behavioral activation
Behavioral inhibition
Reasoning
Implementation of plans
Copyright 2010, C. Barber, IBP
Limbic System
From http://www.geocities.com/hotsprings/3468/9/brain-limbic.jpg
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Cortical and subcortical structures
that support and
regulate:
Emotion
Long-term memory
Autonomic functions
Reward center
Copyright 2010, C. Barber, IBP
Brain – Behavior Links:
Temporal Lobe Epilepsy (TLE)
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Most frequent form of partial epilepsy in adults.
Characterized by abnormal electrical changes in
temporal lobe, including amygdala.
Emotional disturbances (e.g., fear, anxiety) are
common after seizures.
Some evidence suggests increase in obsessional traits
in TLE.
“Interictal” personality is controversial: Minimal
evidence suggests a link between other proposed
behaviors and epilepsy.
Copyright 2010, C. Barber, IBP
Brain – Behavior Links:
Frontal Lobe Damage
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Damage to frontal lobes is often associated
with disinhibition.
Some individuals with frontal lobe damage
display “acquired psychopathy.”
However, deterioration of moral and social
behavior is likely due to damage to other
areas in addition to the frontal lobes (e.g.,
temporal lobes).
Copyright 2010, C. Barber, IBP
Neurotransmitters and
Personality: Serotonin
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Regulation of mood and behavior
Related to appetitive behaviors
Low serotonin  cravings for sweets
and carbohydrates
Implications for emotional eating and
binge eating
Copyright 2010, C. Barber, IBP
Neurotransmitters and
Personality: Norepinephrine
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Modulation of basic bodily processes
and behavioral tendencies
Plays a starring role in the “fight or
flight” response (with its relative,
epinephrine)
Implicated in risk-taking behaviors
Involved in the “rush” experience
Copyright 2010, C. Barber, IBP
Neurotransmitters and
Personality: Dopamine
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Involved in pleasure-seeking and
exploratory behaviors
Appears to be related to brain’s natural
opioids
Highly reinforcing when released
Also implicated in hallucinations and
delusions
Copyright 2010, C. Barber, IBP
An Integrative Approach
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Characteristics and prevalence
Defense mechanisms
Object relational patterns
Cognitive schemas
Key biological mechanisms
Copyright 2010, C. Barber, IBP
Cluster A: Odd/Eccentric
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Paranoid
Schizoid
Schizotypal
Copyright 2010, C. Barber, IBP
Paranoid Personality Disorder
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0.5-2.5% of general population. (*4.4%)
Projection, projective identification, reaction
formation.
Others are dangerous or “users.”
“I’m vulnerable.”
More common in relatives with schizophrenia.
Copyright 2010, C. Barber, IBP
Schizoid Personality Disorder
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1.7-4.9% of general population. (*3.1%)
Withdrawal, intellectualization.
The social world is engulfing.
“I’m a misfit.”
May be more prevalent in relatives of people
with schizophrenia.
Copyright 2010, C. Barber, IBP
Schizotypal Personality Disorder
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0.6-3.3% of the general population.
Withdrawal, fantasy.
Others are experienced as piecemeal and
incoherent.
“I am defective.”
Dopamine (excess – psychotic symptoms;
deficit – cognitive symptoms); ventricular
enlargement.
Copyright 2010, C. Barber, IBP
Cluster B: Dramatic/Emotional
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Antisocial
Borderline
Histrionic
Narcissistic
Copyright 2010, C. Barber, IBP
Antisocial Personality Disorder
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0.7-1.0% of the general population. (*3.6%)
Omnipotent control.
Others are selfish, manipulative, and not worthy of
respect.
“I’m vulnerable.”
Serotonin involved in impulse control and aggression;
decreased autonomic arousal; overactive pleasure
center.
Copyright 2010, C. Barber, IBP
Psychopathy, ASPD, and
Criminality
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Psychopathy involves:
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Manipulation and deception
Grandiosity
Shallow emotions
Lack of empathy and remorse
Impulsive, irresponsible lifestyle
Persistent violation of social norms and expectations
People with ASPD may or may not be
psychopaths.
Many criminals don’t meet criteria for either.
Copyright 2010, C. Barber, IBP
Borderline Personality Disorder
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0.7-1.6% of the general population. (*5%)
Splitting, projective identification.
Others are unpredictable and inconstant.
“I’m defective.” “I’m vulnerable.” “I’m helpless.” “I’m
bad.”
Serotonin implicated in impulse control and emotion
regulation. Differences in brain functioning (reduced
response in anterior insula, which senses violation of
social norms)  less social cooperation/baseline
trust.
Copyright 2010, C. Barber, IBP
Identifying At-risk Youths
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Developmental Psychopathology
Oppositional defiant disorder
Conduct disorder
Non-suicidal self-injury
Copyright 2010, C. Barber, IBP
Histrionic Personality Disorder
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<1.0-2.0% of the general population.
Repression, regression, conversion,
sexualizing, acting out.
Same-sex others are of little value; those of
the opposite sex are powerful, exciting,
“I’m nothing.”
Biological mechanisms unknown.
Copyright 2010, C. Barber, IBP
Narcissistic Personality Disorder
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<1.0% of the general population. (*6%; M>F)
Subtypes: Malignant/Oblivious, Fragile/Shy/
Hypervigilant
Idealization, devaluation.
Others are better than I am; I must be better than
they are to feel good.
“I’m inferior.”
Biological mechanisms unknown.
Copyright 2010, C. Barber, IBP
Cluster C: Anxious/Avoidant
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Avoidant
Dependent
Obsessive-Compulsive
Copyright 2010, C. Barber, IBP
Avoidant Personality Disorder
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5.0-5.2% of the general population. (*2.4%)
Displacement, projection, rationalization,
avoidance.
Others who are more powerful can provide
safety.
“I’m undesirable.”
Related to social phobia; dopamine deficits?
Copyright 2010, C. Barber, IBP
Dependent Personality Disorder
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0.6-1.5% of the general population.
Regression, reversal.
Others are powerful and their care is
essential.
“I’m helpless.”
Biological mechanisms unknown.
Copyright 2010, C. Barber, IBP
Obsessive-Compulsive Personality
Disorder
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2.0-2.4% of the general population. (*7.9%)
Isolation of affect, reaction formation,
moralizing, undoing.
Others try to exert control, which must be
resisted.
“My world can go out of control.”
Biological mechanisms unknown.
Copyright 2010, C. Barber, IBP
Other Problematic Styles
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Passive-Aggressive (Negativistic)
Personality
Deny negative emotions while acting them out in a
covert or indirect way.
Prevalence estimates unreliable (e.g., 20% of
adolescents!)
Projection, externalization, rationalization, denial.
Others require conforming to their rules.
“I should only have to do what I want; others’ needs
are not as important.”
Biological mechanisms unknown.
Copyright 2010, C. Barber, IBP
Other Problematic Styles
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Depressive Personality
Self-criticism, judgment, intense guilt, dejection.
Prevalence estimates unreliable.
Introjection, reversal, idealization of others,
devaluation of the self.
Others will criticize, reject, or abandon.
“I am fundamentally bad.”
Biological mechanisms unknown.
Copyright 2010, C. Barber, IBP
Copyright 2010, C. Barber, IBP
Common Co-Morbid
Conditions
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Hypochondriasis
Involves somatic/physical expression of emotions.
Common in people with Histrionic, Dependent,
Obsessive-Compulsive PD’s.
Functions: obtain attention, keep others close,
express emotions.
Fears are not easily assuaged by “proof” of no illness.
CBT appears to be an effective treatment.
Interpersonal function of symptoms must also be
addressed; expressive writing may also be helpful.
Copyright 2010, C. Barber, IBP
Common Co-Morbid
Conditions
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Body Dysmorphic Disorder
Involves severely distorted perceptions of one’s
appearance
Often comorbid with Borderline and Avoidant PD’s
Treatment focuses on modifying distorted thoughts
and preventing problematic responses.
Plastic surgery is rarely effective.
Psychopharmacology (especially SSRI’s) may be
helpful.
Copyright 2010, C. Barber, IBP
Common Co-Morbid
Conditions
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Eating Disorders
Several diagnoses: anorexia nervosa, bulimia
nervosa, binge-eating disorder.
Borderline PD is a common diagnosis.
Obsessive-compulsive PD may be involved in
anorexia.
CBT, DBT, family therapy can be helpful.
Presence of PD greatly complicates treatment of
eating disorders.
Copyright 2010, C. Barber, IBP
Common Co-Morbid
Conditions
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Substance Abuse
A large percentage of people with PD’s abuse
substances.
Especially common in Antisocial and Borderline PD’s.
Presence of PD makes treatment significantly more
difficult.
Dual diagnosis-focused programs may be most
appropriate.
Interesting developments in psychopharmacology,
e.g., cocaine vaccine.
Copyright 2010, C. Barber, IBP
Treatment Models
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Pharmacotherapy
Schema Therapy (Young et al.)
Mentalization-Based Therapy (Batement
& Fonagy)
Motivational Interviewing (Miller &
Rollnick)
Dialectical Behavior Therapy (Linehan)
Many others!
Copyright 2010, C. Barber, IBP
Pharmacotherapy: Benefits
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Antidepressants
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Depression, anxiety
Common for Clusters B, C
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Mood stabilizers
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Mood lability, aggression
Common for Cluster B
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Antipsychotic agents
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Paranoia, illusions, odd beliefs
Common for Clusters A, B
Copyright 2010, C. Barber, IBP
Pharmacotherapy: Drawbacks
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Insufficient for changing complex
behavior patterns.
Polypharmacy is common but carries
greater risk.
Potential for medication misuse is high.
Copyright 2010, C. Barber, IBP
Schema Therapy
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Maladaptive Coping Styles
Overcompensation
Avoidance
Surrender
Copyright 2010, C. Barber, IBP
Schema Therapy
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Strategies for change
Cognitive
Behavioral
Experiential
Copyright 2010, C. Barber, IBP
Mentalization-Based Therapy
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What is mentalization?
How is this different from perspectivetaking?
Promoting mentalization through
modeling and empathy.
Copyright 2010, C. Barber, IBP
Motivational Interviewing
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Stages of Change model
Precontemplation
Contemplation
Preparation
Action
Maintenance/Relapse
Copyright 2010, C. Barber, IBP
Motivational Interviewing
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Resistance is interpersonal (not
intrapersonal)
“Rolling” with resistance
Eliciting and strengthening change talk
Help! This sounds like “therapese.”
Does this work outside of therapy?
Copyright 2010, C. Barber, IBP
A Biopsychosocial Framework for
Understanding BPD
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Temperamental vulnerabilities
Invalidating environment
Emotion dysregulation and its effects on
behavior
Copyright 2010, C. Barber, IBP
Components of DBT
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Individual psychotherapy
Skills training
Telephone consultation
Case consultation meetings for
therapists
Ancillary treatments
Copyright 2010, C. Barber, IBP
The DBT Framework
Functions of DBT:
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Enhance patient capabilities
Improve patient motivation
Generalize learning to all relevant contexts
Structure the environment
Enhance therapist capabilities and motivation
From Linehan, 1993
Copyright 2010, C. Barber, IBP
The DBT Framework
Stages of Treatment (and associated
goals):
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Level 1: Behavioral control
Level 2: Non-anguished emotional
experiencing
Level 3: Ordinary happiness and unhappiness
Level 4: Capacity for joy and freedom
From Linehan, 1993
Copyright 2010, C. Barber, IBP
The DBT Framework
Stage 1 Target Hierarchy:
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Decrease life-threatening behaviors
Decrease therapy-interfering behaviors
Decrease quality of life-interfering behaviors
Increase behavioral skills
From Linehan, 1993
Copyright 2010, C. Barber, IBP
DBT Skills Training Overview
Skills Training Target Hierarchy:
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Reduce therapy-destroying behaviors
Increase skill acquisition and strengthen skills
Reduce therapy-interfering behaviors
From Linehan, 1993
Copyright 2010, C. Barber, IBP
DBT Skills Training Overview
PROBLEMS in BPD
SKILLS in DBT
Identity confusion
Core mindfulness skills
Impulsivity
Distress tolerance
Emotional instability
Emotion regulation
Relationship problems Interpersonal effectiveness
Self-punishment
Self-management
Copyright 2010, C. Barber, IBP
Core Mindfulness Skills
States of Mind
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Emotion mind
Reasonable mind
Wise mind
From Linehan, 1993
Copyright 2010, C. Barber, IBP
Core Mindfulness Skills
“What” Skills
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Observe
Describe
Participate
“How” Skills
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Non-judgmentally
One-mindfully
Effectively
Copyright 2010, C. Barber, IBP
From Linehan, 1993
Interpersonal Effectiveness
Involves the balancing act of obtaining/
maintaining:
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One’s personal objectives (i.e., “wants”)
A healthy relationship
One’s self-respect
From Linehan, 1993
Copyright 2010, C. Barber, IBP
Interpersonal Effectiveness
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Describe
Express
Assert
Reinforce
Mindfully
Appear confident
Negotiate
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Gentle
Interested
Validate
Easy manner
Fair
Apologies (no undue)
Stick to values
Truthful
From Linehan, 1993
Copyright 2010, C. Barber, IBP
Emotion Regulation
Involves managing emotions through:
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Identifying and labeling emotions
Decreasing vulnerability to negative emotions
Increasing positive emotions through behavioral
activation
Decreasing suffering through mindfulness of
emotions
Changing emotions through opposite action
From Linehan, 1993
Copyright 2010, C. Barber, IBP
Distress Tolerance
Crisis Survival Skills
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Distraction
Self-soothing
Improving the moment
Pros and cons
From Linehan, 1993
Copyright 2010, C. Barber, IBP
Distress Tolerance
Guidelines for Accepting Reality
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Observing the breath
Half-smile
Awareness exercises
Radical acceptance
Turning the mind
Willingness
From Linehan, 1993
Copyright 2010, C. Barber, IBP
Treatment of PDs: Principles
1. Social Awareness: Help clients
recognize and modify maladaptive
social behaviors.
 Self-monitoring – logs, diary cards, etc.
 Modeling, role-plays
 Judicious self-disclosure and feedback
Copyright 2010, C. Barber, IBP
Treatment of PDs: Principles
2. Disabling thoughts: Help clients
modify thoughts and beliefs.
 Identifying automatic thoughts
 Examining and weighing the evidence
 Creating alternative, realistic, helpful
thoughts
Copyright 2010, C. Barber, IBP
Treatment of PDs: Principles
3. Attributional Style: Help clients
develop optimism.
 Optimism is associated with better physical
health and improved mood.
 Strategies:
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Recognizing attributional biases (e.g., fundamental,
depressive, borderline)
Generating alternative explanations
Testing new ideas with behavioral experiments
Copyright 2010, C. Barber, IBP
Treatment of PDs: Principles
4. Gratitude, empathy, and forgiveness:
Help clients give thanks, take
perspectives, and let go of grudges.
 Benefit-finding, focusing on positives, listing
assets
 Mentalizing and perspective-taking
 Expressive writing about past wrongs
Copyright 2010, C. Barber, IBP
Treatment of PDs: Principles
5. Self-care: Help clients take care of
their physical, emotional, and spiritual
needs.
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Sleep hygiene
Nutrition
Exercise
Productivity and mastery
Finding meaning and purpose
Copyright 2010, C. Barber, IBP
Practical Strategies for
the Helping Professions

Managing counter-transference
 Using theory to increase empathy and
decrease judgments
 Avoiding taking things personally
 Staying attuned to your own behavior and its
role in the treatment
 Using consultation
Copyright 2010, C. Barber, IBP
Practical Strategies for the
Helping Professions

Dealing with “difficult” behavior
 Help-rejecting/resistance
 Applies to virtually all PD’s
 Strategies:
 “Tiffany’s” approach
 MI strategies
 Pros and cons
Copyright 2010, C. Barber, IBP
Practical Strategies for the
Helping Professions

Dealing with “difficult” behavior
 The “button radar”
 Especially common in Antisocial and
Borderline PD’s
 Strategies:
Practice acceptance of counter-transference
 Be curious with the patient about his/her
button-pushing

Copyright 2010, C. Barber, IBP
Practical Strategies for the
Helping Professions

Dealing with “difficult” behavior
 Lack of trust
 Especially common in Paranoid PD and BPD
 Strategies:
 Provide objective information
 Address concerns directly
 Be as consistent as possible
Copyright 2010, C. Barber, IBP
Practical Strategies for the
Helping Professions

Dealing with “difficult” behavior
 Decreased attachment capacity
 Especially common in Schizoid and
Schizotypal PD’s
 Strategies:
Stay solution-focused (vs process-oriented)
 Provide a safe environment
 Engage in rapport-building throughout
treatment
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Copyright 2010, C. Barber, IBP
Practical Strategies for the
Helping Professions

Dealing with “difficult” behavior
 Attention-seeking
 Especially common in Histrionic, Narcissistic,
and Borderline PD’s
 Strategies:
Use non-pejorative language
 Refrain from reinforcing undesired behavior
 Determine motivation and help client find other
ways to get needs met
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Copyright 2010, C. Barber, IBP
Practical Strategies for the
Helping Professions

Dealing with “difficult” behavior
 Aggression (Active/Passive; others/self)
 Especially common in Antisocial PD but can
be seen in Borderline PD and others
 Strategies
Conduct a thorough risk assessment
 Create a safety plan
 Link behavior with consequences and desired
goals
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Copyright 2010, C. Barber, IBP
Practical Strategies for
(almost) Anyone!
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Setting limits and boundaries (e.g., contract)
Self-monitoring and judicious self-disclosure
Providing rationales and practicing non-defensiveness
Balancing validation with change
Highlighting consequences
Encouraging mentalizing
Taking an empirical approach
Copyright 2010, C. Barber, IBP
Conclusions
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Q&A
Evaluation
Thanks for attending!
Catherine R. Barber, Ph.D.
[email protected]
Institute for Brain Potential
Copyright 2010, C. Barber, IBP