Personality disorder/traits | Alliance challenges | Points of possible engagement in treatment |
Schizotypal | Suspiciousness/paranoia Profound interpersonal discomfort Bizarre thinking | Possible motivation for human connection |
Schizoid | Social detachment Emotional aloofness | Underlying neediness and sensitivity |
Paranoid | Expectations of harm or exploitation Hypersensitivity to perceived criticism Inclination to withdraw or attack | Underlying need for affirmation |
Borderline | Unstable emotional and cognitive states Extremely demanding Proneness to acting-out | Relationship-seeking Responds to warmth and support |
Narcissistic | Need for constant positive regard Contempt for others Grandiose sense of entitlement | Responds over time to empathy and affirmation |
Histrionic | Attempts to charm and entertain Emotionally labile Unfocused cognitive style | Relationship-seeking Responds to warmth and support |
Antisocial | Controlling Tendency to lie and manipulate No empathy or regard for others Use of pseudoalliance to gain some advantage | May engage in treatment if in self-interest or if Axis I symptoms cause sufficient distress |
Avoidant | Expectations of criticism or rejection Proneness to shame and humiliation Reluctance to disclose information | Responds to warmth/empathy Desire for relationships in spite of vulnerabilities |
Dependent | No value placed on independence/taking initiative Submission leading to pseudoalliance | Friendly and compliant Likely to stay in treatment |
Obsessive-compulsive | Need for control Perfectionistic toward self and others Fear of criticism from therapist Restricted affect Stubbornness | Conscientious Use of intellectualization may be helpful at times Will try to be a "good patient" |
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