I WAS DELIGHTED to see an edition of the Monitor devoted to the subject of personality disorders. Despite a good deal of information included in these articles, one comment troubled me. In the article "Where personality goes awry," Valerie Porr makes the statement when talking about the "parent blame" problem that in some circumstances the child's "behavior is so off the wall [that] the family's responses are off the wall." Research such as that by Allan Schore and others indicates that there has been abuse and/or neglect in almost every case where there is the development of a borderline personality. In fact, 91 percent of people with BPD report having been abused and 92 percent report a history of neglect, according to Zanarini. Granted, blaming the caregivers instead of attempting to provide them with care is probably not helpful, but let us not ignore or look away from the original picture of abuse or neglect. When we do so, we allow a disservice to those who have suffered the personality-rupturing effects of violence. Let's acknowledge the painful and at times nearly unbearable truth that some children are abused and neglected--and not jump on the bandwagon of blaming "those borderlines."
SARA K. SEXTON, PSYD
I WAS SURPRISED BY WHAT I read in the March Monitor about cognitive treatment for personality disorders. According to the article, cognitive treatment for personality disorders includes helping "patients revisit and reinterpret early-childhood experiences" to "understand the underpinnings of dysfunctional beliefs" and examining "dysfunctional beliefs about the therapist or therapy," including a patient's belief that he/she can't trust the therapist or that the patient may feel weak if he/she listens to the therapist.
These three elements of treatment are fundamental components of a psychodynamic approach. Attention to the importance of early-childhood experiences, a focus on what underlies dysfunctional beliefs and the importance of working with the patient's transference in the therapy are hallmarks of dynamic therapy. Yet I didn't find any mention that cognitive approaches now adopt aspects of dynamic therapy. I am wondering how cognitive therapists explain their use of these facets of psychodynamic treatment.
The article noted that "Preliminary trials of cognitive therapy for BPD lend support to Beck's theory," but if that cognitive therapy included the dynamic elements discussed in the article, I fail to see how cognitive therapy for BPD is meaningfully distinguishable from a psychodynamic approach. To the extent that the treatment approach described in the article is attributed with successful outcomes with BPD, the value of the psychodynamic contribution should be acknowledged.
RHONDA K. REINHOLTZ, PHD
THE FEATURE ON PERSONALITY disorders in your March 2003 issue titled "Treatment for the 'untreatable'" was extremely one-sided and did not in any way present a complete picture of evidence-based treatment options for those individuals diagnosed with a personality disorder. I believe that, as an organization that is supposed to present the unbiased facts by at first minimally completing a literature review, you have failed in this regard.
If you would have done a basic search, you would have found in "A Guide to Treatments that Work," by Nathan and Gorman, that psychodynamically based treatments are being found to be as effective as CBT or DBT in the treatment of personality disorders. Please do better work at research before you present these articles as being fully representational of the facts.
LAWRENCE LEDESMA, PHD
Huntington Beach, Calif.
Psychology and spirituality
I AM WRITING IN RESPONSE TO George Albee's comments in the February issue of the Monitor about the December articles on spirituality. I am a bit perplexed on how to respond. I have appreciated Dr. Albee's work over the years, and so I will just assume that he is not familiar with the history of the psychology of religion, either in its early form when its architects included individuals such as G. Stanley Hall and William James, or its resurgence during the latter half of the 20th century under influence of psychologists like Gordon Allport. In fact, there are now many empirical studies, both clinical and nonclinical, on religiousness and spirituality that are being published in top-tier research journals.
Dr. Albee may have assumed that the point of the Monitor articles on spirituality was that psychologists should now replace evidence-based practice (assuming they are using something that would appropriately receive that moniker) with Bible studies or meditation on Zen koans. If his aversion arose from such fears, then I would encourage him to pick up any of the texts published on these topics by APA books. Yet maybe Dr. Albee's equation of the clinical psychology of religion (a substantial focus of an entire APA division) with "astrology" was not entirely voluntary. Perhaps Mars was in ascension when he wrote the letter.
WILLIAM L. HATHAWAY, PHD
APA Div. 36 (Psychology of Religion) Council Representative
Reconsidering health status
HOW WONDERFUL TO SEE THAT APA is so involved in trying to create a more reasonable, more humane way to classify people's psychological problems ("A new way of looking at health status," January Monitor). It looks as though this new method, described in the article as focused not on diagnostic criteria related to an illness but rather on "how [patients] live their lives with that illness," may also carry fewer risks than the DSM of loss of custody of children, employment, health insurance, legal rights and self-confidence to those who are diagnosed.
Hopefully, it will also reduce the opportunities for bias (against virtually every nondominant group) in diagnosis that so plague the current system. And hopefully, APA will be inspired to stop offering CE courses and videos that teach people about the DSM without critical thinking components.
PAULA J. CAPLAN, PHD