"is avoidant personality disorder CHARACTERIZED by stability or instability? a study of mode fluctuation in the course of schema therapy sessions"
hot topic by ofer peled & eshkol rafaeli
APD is among the most prevalent personality disorders, but has received little empirical attention. This study characterize mode change patterns among APD clients in the course of ST. A newly-developed client mode rating scale was used to code every 5-minute segment of 60 ST sessions from 15 clients. The avoidant/detached mode was present in 3/4 of segments and was the most intense and fluctuating mode. Its great fluctuation implies that therapists can crack this coping mode and gain access to the clients' emotional needs. The over-compensator & compliant-surrenderer modes were less prominent (present only in 1/3 of segments); this implies that therapists can primarily focus on overcoming avoidance & detachment, implementing strategies for overcoming dependence or self-absorption less frequently. The vulnerable child mode was present in more than half of segments and was the second most intense and unstable mode. The presence of this mode provides a possible access point for corrective therapeutic experiences, but its instability may block the chances for healing emotional pain. The dysfunctional parent mode was present in less than 1/2 of segments, but was the third most intense and unstable mode. In contrast, the healthy adult mode, present in 1/3 of segments, was by far the most stable. It seems that APD clients were more prone to self-punitive criticism than to self-compassion. This study offers 4 innovations: (a) It documents the considerable instability of APD, using mean-square-successive-difference (MSSD) scores; (b) It offers rich data on the mode-based description of APD and its possible implications for intervention; (c) It demonstrates the utility of the mode concept as a lexicon for capturing personality states and their instability; and (d) It illustrates the use of in-session segment-by-segment ratings to assess client change within psychotherapy.
Eshkol Rafaeli, Bar Ilan University, Ramat Gan, Israel
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