The relevance of an integrated approach to the treatment of personality disordered offenders

This article argues that the treatment of high-risk offenders with severe personality disorder, requires an active focus on the management and treatment of personality pathology. An eclectic and integrated approach is proposed tailored to the patient's needs, learning style, and personality. Interventions are selected where possible on evidence of what works. However, because empirical evidence on treatment efficacy for personality disorder is limited, interventions often need to be selected on the basis of a rational analysis of the most effective way to treat a given problem. It is also argued that the core or defining features of personality disorder involve the failure to develop an integrated self structure and coherent personality functioning. Hence an important treatment goal is to foster more integrated personality functioning. With severe personality disorder, attention needs to be given to delivering an eclectic array of interventions in a systematic and coordinated way to achieve integration. This is achieved first by organizing treatment around the generic or non-specific component of therapy. These general strategies form the general framework of treatment with more specific interventions added to this structure as needed to treat specific problems. Secondly, coordinated delivery of interventions is achieved using a phases of therapy model that recognizes that the problems that are the focus of attention and changes systematically during treatment. This model provides a framework for selecting and delivering interventions in a systematic way.