Treatment of Personality Disorders

Psychotherapy (talk therapy) is a core and central component of therapy. There are several effective approaches to psychotherapy, There are several effective approaches to psychotherapy, all of which are research-based, and in order to choose the most appropriate treatment, personalization between the patient and the therapeutic approach is critical.  
These are the main rights:

Cognitive-Behavioral Therapy (CBT) 

A therapeutic method that helps identify and change patterns of thinking, perception, beliefs, positions and behaviors that cause suffering to the individual. The therapy includes individual sessions and focuses on the present. It emphasizes the way an individual thinks about himself and his environment, advances development of a more positive self-perception and provides tools for emotionally coping with everyday challenges.   

Dialectical Behavior Therapy (DBT) 

Helps in the acquisition of skills to regulate powerful emotions, self-acceptance, crisis management and improve interpersonal communications. The therapy focuses on the present, emphasizing the practice of new skills and their application in everyday life, to reduce dangerous or destructive behaviors. Therapy includes individual sessions, skills learning group and, if necessary, telephone supervision and coaching. In certain cases, therapy also incorporates parental education in a group or individual setting.  

Mentalization-based Treatment (MBT) 

Helps develop an individual's ability to identify and understand their own mental states as well as that of others through emotions, thoughts, beliefs, intentions, and desires. This therapeutic method focuses on the present while emphasizing the development of self-awareness, improves identification of emotional reactions, understands the relationship between mental states and behaviors in addition to improves the ability to emotionally regulate. The therapy includes individual sessions, group therapy and parental education. 

Psychodynamic therapy (Transference Focused Psychotherapy (TPF)) 

Facilitates an understandingof the impact of pastexperiences, and particularly childhood, on current behavior. Therapy focuses on the individual’s inner world and the way itaffects the perception of the external world, while emphasizing an understanding of subconscious content and early relationship patterns as a source of distress in the present. Thecommunication between the practitioner and the patient andthe interpretations that emerge from the conduct of the therapeutic relationship is one of the important features of the therapy. This therapy includes individual sessions tobuild a more stable own identity , improvethe ability toemotionally regulate, reduce destructive behaviors and improve interpersonalrelationships.  

Schema therapy (ST) 

Helps map and change patterns including thoughts, perception, emotions, memories and physical sensations, that originate in the past, for example: childhood experiences, early family relationships, trauma, etc. All of these may make it difficult for the patient to adapt and deal with the present reality. These patterns repeat themselves throughout life, filtering experiences and creating biases in the perception of various situations. Therapy focuses on the roots of the patterns in order to change fundamental beliefs and to reconstructing early experiences and traumas in order to process and change. Treatment is carried out through experiential emotional work, guided imagination, behavioral change exercises, etc. Therapy involves individual sessions that focus on improving self-esteem, development of healthy relationships, minimizing harmful behaviors.    

Group Therapy 

Unlike the other approaches we presented, which are based on individual sessions, group therapy is based on a framework that includes several people, generally 6-12 participants. Participants meet with the therapist in order to work together on a common subject. The format of group therapy is occasionally a difficult challenge for patientsdueto concerns about individual exposureanddifficulty in communicating beforea group. At the same time, thisformat can offer many advantages:thegroupsession with other people coping with similar difficulties may alleviate the sense of isolation, increase the sense of belonging, help obtain support, enable an opportunity for mutual learningfrom experience, practice communication skillsetc. The recommendation for group therapy is formed based on an examination of the person's degree of personal suitability, for example: the type and severity of the difficulties, the degree of stability in the mental state, the severity of reckless behavior, the degree of ability for interpersonal communication in a group, etc. 

Family and couples counseling  

In the past, the family was generally blamed for everything pertaining to mental health disabilities in general, and personality disorders in particular. Although the family environment decisively influences the individual’s development, clinical studies and trials have show that explanations on the formation of personality disorder are are far more multidimensional and complex. The inclusion of family and the immediate environment in therapy can significantly contribute to the success of therapeutic intervention in the following ways:  

• The session with the family facilitates a greater in-depth and comprehensive understanding of the patterns of relationships, communication and conduct within the family. 
• The family can be a main support that facilitates coping as well as emotional and behavioral stability of the individual suffering from a personality disorder. 
• It is important that the family receive professional guidance on the nature of the personality disorder, its characteristics, and ways to deal with it.  

Family counseling aims to provide an understanding, support and practical ability to the family that is coping with a member with the disorder. The family may also need specific professional assistance, such as: improving interpersonal communication skills, developing ways to deal with crises, reinforcing mutual support, etc. 

Important to note: Many families find themselves coping with social stigma that may isolate them and cause them communication difficulties with the immediate environment and as a result to subsequently withdraw, feel shame and hide their distress. Professional support, including couple or family counseling and dedicated support groups for parents and family members, that recognizes the difficulties of all family members and enables shared growth, is the key to success.  

Other therapeutic methods 

It is important to note that in addition to the approaches listed here, there are other approaches that are applied to treat various personality disorders, including acceptance and commitment therapy (ACT), interpersonal psychotherapy (IPT), emotion-focused therapy (EFT), psychodrama, art therapy (expression and creation), bibliotherapy, animal therapy, etc. 

The psychiatric evaluation is a key component in diagnosis and treatment. Important to note: medication does not cure personality disorders but can alleviate the intensity of certain symptoms, such as depression, anxiety, sleep difficulties, recklessness, mood swings, etc. 

Several other points that must be known about psychiatric treatment:  

• Medication is an extremely important supplemental component in the therapeutic plan. A targeted medication response may occasionally moderate the individual’s suffering, thereby improving their ability to benefit from psychological therapy. 
• Medications that are typically prescribed to individuals with specific diagnoses, such as depression, anxiety, manic-depression (bipolar disorder), psychosis, etc., are also used to treat certain symptoms of personality disorders. For example, anti-anxiety medications, antidepressants, mood stabilizers, antipsychotic medications, etc. This fact may create confusion and concern among the individual or their family, that they may be receiving the wrong treatment or that there was an error in diagnosis. It is therefore worth asking your treating doctor for an explanation on the subject.   
•  The administration of medication is not a one-time event. Regular follow-up is necessary, including a reevaluation of progress and degree of efficacy of the type of medications, dosage, duration, etc. As with any other health condition, side effects may occasionally increase the risk of quitting therapy, so regular follow-ups in order to improve personalized treatment is important. 
  

Clinictherapy 

There are various frameworks for clinic-based therapy for personality disorders: 

• Mental health clinics of the HMOs where therapy is provided free of charge or at a quarterly cost. 
• Mental health stations and public clinics of the Ministry of Health. 
• Independent practitioners who work in conjunction with the HMOs, which participate in funding the therapy. 
• Counseling services in academic institutions. 
• Private institutions and practitioners (full payment). 

More information about Mental Health Services 

Psychiatric Hospitalization 

The preferred therapeutic framework for personality disorders is a community clinic. In this format, the individual can maintain his relationship with his natural environment as well as maintain, to the best of his ability, standard functional areas (society, employment, etc.) At the same time, there are special circumstances for which psychiatric hospitalization is the best option to receive comprehensive and intensive help. 

These circumstances include: 

• Severe mental state that manifests as powerful distress with concerns about physical injury - including life-threatening injury. 
• The inability of the individual or his environment to cope with the crisis in a home setting. 
• Lack of option for intensive therapy in the community. 

Psychiatric hospitalization, or any other any other form of hospitalization, is designed to provide a safe environment for an individual suffering from a personality disorder and subject to severe crisis. For the most part, when discussing personality disorders, the recommendation is to rely on brief hospitalizations, to the extent permitted by the situation.      

For more information about psychiatric hospitalization 

Psychiatric Outpatient Care  

Outpatient settings, an intermediate link between community therapy and full hospitalization, are designed to provide an intensive response, in a relatively flexible format, without disconnection from the natural environment. An individual with a personality disorder who is in crisis may find outpatient care a suitable framework for acquiring tools to help them cope with the disorder, for example: dealing with difficult emotions, managing interpersonal relationships, managing stress, etc. Outpatient care may also prevent another deterioration in the condition, and reduce the need for full hospitalization in the future.  

Participation in therapeutic groups

 allow sfor direct learning and observation of patterns of behavior in social contexts, while receiving feedback from other group members and from the practitioners. For people with personality disorders, the sense of isolation and alienation may be overwhelmingly difficult. Outpatient care allows for social interaction with other patients who may be a source of emotional support. 

More information on psychiatric outpatient treatment