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In Personality Disorders, Dr. Jeffrey J. Magnavita demonstrates his approach to working with clients presenting with the spectrum of personality disorders and with clinical syndromes such as obsessive–compulsive or anxiety disorders. Dr. Magnavita uses personality-guided relational psychotherapy, a form of therapy that describes personality as encompassing four domains: biological, interpersonal, relational, and sociocultural.
In this session, Dr. Magnavita works with a recently married woman in her 20s who was neglected and abused as a child. The client is experiencing symptoms of anxiety and obsessive–compulsive disorder. Dr. Magnavita assesses her defenses and personality structure and begins to help her to see how she has coped with her negative childhood experiences and how these coping strategies affect her present life.
Personality-guided relational psychotherapy offers a unified framework that encompasses four domains of human functioning to conceptualize personality dysfunction and focus treatment. These four levels begin at the microlevel of analysis and become increasingly more macroscopic in focus, and can be conceptualized as nested aspects of relational systems. The four levels are
- biological–intrapsychic matrix
- dyadic–interpersonal matrix
- relational–triadic matrix
- sociocultural–familial matrix
All human psychopathology is an expression of a dysfunctioning personality system broadly conceived. Within each of these matrices there is an array of methods that can be incorporated to enhance differentiation and integration among the various component subsystems, and thereby create a more functional personality system.
For example, the primary considerations when working in the biological–intrapsychic matrix are the interrelations among anxiety regulation, defensive operations, and emotion/cognition. Various strategies and techniques from an array of psychotherapeutic models can be incorporated, such as emotional identification, intensification, and processing; anxiety management techniques; cognitive restructuring; and so forth.
All interpersonal processes and structures can be viewed as an expression of early relational schemata within the dyadic–interpersonal matrix. The main foci are relationships with the therapist and with significant others. Thus, while working in this matrix, therapeutic methods and techniques that assist in creating awareness and restructuring relational schemata are useful.
In the relational–triadic configuration, we examine the processes that occur when a third party is triangulated to stabilize a dyad. These triangular configurations are commonly seen in child and adolescent disorders, as well as with couples engaging in affairs. Multigenerational processes are often transmitted in triangular configurations in that generational conflicts that have not been resolved are transmitted to successive generations. Various types of family systems can become dysfunctional and create a fertile environment for personality dysfunction in their members.
The sociocultural system is composed of a number of mesosystems, such as family, social institutions, and community and political systems. Interventions can be made at any level to shape these systems and enhance functioning, such as community interventions, social change, education, and so forth. Using a unified framework, clinicians can orient their treatment interventions to the domains of functioning that are most amenable to change.
Jeffrey J. Magnavita, PhD, ABPP, FAPA, is a licensed psychologist and marriage and family therapist in active clinical practice. A diplomate of the American Board of Professional Psychology and fellow of the American Psychological Association (APA), he is the recipient of APA's Distinguished Contribution to Practice Award for 2006 for his work in unifying psychotherapy.
He authored Restructuring Personality Disorders: A Short-Term Dynamic Approach, Relational Therapy for Personality Disorders, and a textbook, Theories of Personality: Contemporary Approaches to the Science of Personality, and was the volume editor of the Comprehensive Handbook of Psychotherapy: Psychodynamic/Object Relations: Volume 1 and the Handbook of Personality Disorders: Theory and Practice. His most recent volume is Personality-Guided Relational Psychotherapy: A Unified Approach.
In addition, Dr. Magnavita is on the editorial boards of the Journal of Clinical Psychology, In Session: Psychotherapy in Practice and Psychotherapy: Theory, Research, Practice, Training. He is an affiliate professor in clinical psychology at the University of Hartford and is a clinical affiliate at Hartford Hospital.
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- Personality-Guided Therapy Over Time
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- Schema Therapy
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- Treating Clients With Generalized Anxiety Disorder
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- Working With Women Survivors of Trauma and Abuse
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- Personality-Guided Behavior Therapy
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- Personality-Guided Relational Psychotherapy: A Unified Approach
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- Psychological Assessment of Adult Posttraumatic States: Phenomenology, Diagnosis, and Measurement, Second Edition
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Edited by Martin M. Antony, Christine Purdon, and Laura J. Summerfeldt