Personalizing Psychotherapy for Personality Disorders: Perspectives From Control-Mastery Theory

While several empirically supported models for treating personality disorder (PD) are available, researchers and clinicians have continued to advocate for the personalization of psychotherapy to the particular needs and characteristics of the individual patient with severe personality pathology. Control-Mastery Theory (CMT; Gazzillo, 2016; Silberschatz, 2005; Weiss, 1993; Weiss, Sampson, & The Mount Zion Psychotherapy Research Group, 1986) provides a useful framework for understanding personality pathology, and for guiding treatment with individualized case formulation. The present article introduces the basic concepts of CMT and their application in personalizing psychotherapy for patients with severe PDs. According to CMT, patients come to therapy in order to disprove the pathogenic beliefs that obstruct their pursue of healthy and adaptive developmental goals. These pathogenic beliefs were developed to adapt to early traumatic experiences, but end up causing further suffering, inhibitions, and symptoms. For this reason, patients test these pathogenic beliefs within the therapeutic relationship in search of corrective emotional experiences that disprove them. Among patients with severe PDs, such beliefs may be reciprocally contradictory and may be enacted in therapy in multiple different ways, often challenging therapists to respond appropriately. CMT suggests that therapists' formulation regarding a given patient's plan-including the nature of the patient's goals, traumas, pathogenic beliefs, and testing strategies-allow for a personalized approach that will optimize therapy effectiveness. 尽管目前有几种可应用的治疗人格障碍的实证支持的模型，研究人员和临床医生在 继续提倡给那些有严重人格病理的个体病患的特殊需要和特性提供个性化心理治疗。 控制-掌控理论(CMT; Gazzillo, 2016; Silberschatz, 2005; Weiss, 1993; Weiss, Sampson & 锡安山心理治疗研究小组，1986) 提供了一个有用的框架来理解人格病理学，并以个体化的个案 概念化来指导治疗。本文介绍了CMT 的基本概念，及其在重度人格障碍患者的个性化心 理治疗中的应用。根据CMT，患者来治疗是为了推翻那些致病信念，那些致病信念妨碍 了他们追求健康和适应性的发展目标。这些致病信念是为了适应早期的创伤经历而发展出 来的，却最终导致进一步的痛苦、抑制和症状。因此，患者在治疗关系中测试这些致病信 念，以寻求矫正型情感体验来推翻它们。在严重的人格障碍患者中，这样的信念可能是相 互矛盾的，可能会以多种不同的方式代入到治疗中，常常挑战着治疗师做出适当的回应。 CMT 建议治疗师针对特定患者的个案概念化--包括患者的目标、创伤、致病信念以及测 试策略的这些性质--能考虑到个性化的方案，那会将优化治疗的效果.