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Histrionic Personality Disorder

Treatments

Interpersonal Therapy and Functional Analytic Psychotherapy

Treatment Summary: The treatments typically provided to clients meeting criteria for HPD are psychodynamic, are longer-term treatments and focus on interpersonal process. The interpersonal psychotherapy approach used here, Functional Analytic Psychotherapy (FAP) allows the therapist and supervisor to gather data to demonstrate the effectiveness of this treatment for this type of client consistent with other behavioral and cognitive behavioral approaches. FAP is based upon a simple theory, that all people act the way we do because of the contingencies of reinforcement we have experienced in past relationships. Based on that, it follows that clinical improvements, healing, or psychotherapeutic change, all of which are certain acts of the client, also involve contingencies of reinforcement that occur in the relationship between the client and therapist. Important therapeutic implications, to be discussed below, follow from the combination of this theory of change and behavioral definitions of "act" and "contingency." We complete this section on theory with discussions of context, rule governance, and functional similarity, all of which provide guidance for FAP as an integrative approach.

  • Reference: Callaghan, G., Summers, C. & Weidman, M. (2003). The Treatment of Histrionic and Narcissistic Personality Disorder Behaviors: A Single-Subject Demonstration of Clinical Improvement Using Functional Analytic Psychotherapy. Journal of Contemporary Psychotherapy, 33 (4),321 - 339.
  • Submitter: Barry Crum

Functional Analytic Psychotherapy

Treatment Summary: "This article presents single-subject data for the treatment of histrionic and narcissistic personality disorder behaviors using relatively brief course of interpersonal therapy, Functional Analytic Psychotherapy (Kohlenberg & Tsai, 1991)." (Callaghan, Summers, & Weidman, 2003, p. 321). "Functional Analytic Psychotherapy (FAP) is an interpersonally oriented psychotherapy that uses basic, behavioral concepts to specify the process of clinical change as a function of the therapeutic relationship. The therapy is especially helpful with client problems that are interpersonal in nature."(Callaghan, Summers, & Weidman, 2003, p. 323). Based on the findings of this research, the clients were able to report that they had experienced a decreased in histrionic and narcissistic symptomology over the course of the treatment.

  • Reference: Callaghan, G., Summers, C., & Weidman, M. (2003). The Treatment of Histrionic And Narcissistic Personality Disorder Behaviors: A Single-Subject Demonstration Of Clinical Improvement Using Functional Analytic Psychotherapy. Journal of Contemporary Psychotherapy, 33(4), 321-339. Kohlenberg, R., & Tsai, M. (1991). Functional Analytic psychotherapy: Creating intense and curative therapeutic relationships. New York: Plenum.
  • Submitter: N/A

Cognitive Analytic Therapy

Treatment Summary: Treatment for Histrionic disorder involves the use of cognitive-analytic therapy (CAT) that is a structured time-limited focal psychotherapy. Once the patient has been assessed the patient's history is drawn up in a sequential diagrammatic reformation (SDR) that describes their current "triggers" and what may have caused this. From the SDR, the therapist can outline the target problems. CAT involves the active use of the SDR in constructing therapeutic 'exits' from the roles and procedures identified on the SDR. In the beginning, the therapist uses a letter created by the therapist that is read to the patient to reformulate the origins of their distress and stating target problems and procedures. Throughout the therapy sessions, the patient works on the different "triggers" and techniques that will help the patient. The last session set up between the patient and the therapist, both will prepare and read a 'goodbye letter'. The function of the letter from the therapist is to summarize achievements made in the therapy, to signal challenges that appear to lie ahead for the patient and acknowledge the abandonment issues that can be brought up at termination of therapy.

  • Reference: Kellett, S. (2007). A time series evaluation of the treatment of histrionic personality disorder with cognitive analytic therapy. Psychology and Psychotherapy: Theory, Research and Practice, 80, 389-405.
  • Submitter: Melva Terpstra

Psychodynamically Oriented Individual Therapy

Treatment Summary: Psychodynamically oriented therapy is the most common form of treatment for Histrionic Personality Disorder (HPD). Other forms of treatment are gaining recognition as possible treatments, such as cognitive and behavioral approaches, but currently neither have enough empirical evidence to be a definitive form of treatment (Callaghan, Summers, & Weidman, 2003; Kellett, 2007). DR Horowitz a professor at the University of California San Francisco has done extensive research on the treatment of HPD (Horowitz, M.J. 1997). His recommendation is a three phase approach. These three phases consist of stipulating the problems of the patient, then the states of mind are defined, and the last phase is clarifying topics of concern and defensive obstacles. This treatment attempts to bring together psychodynamic and cognitive conceptualizations. In phase one the client is encouraged to restrain from harmful and immediately gratifying behavior. Phase two consists of modifying defensive processes. These defenses are identified and explored while more rational choices are identified. The third phase consists of encouraging the client to modify interpersonal behavior. This phase focuses on modifying what internal events mean; this being their irrational beliefs about themselves and others. The focus is to develop more healthy patterns of though, feeling and action.

  • Reference: Callaghan, G.M., Summers, C.J., & Weidman, M. (2003). The treatment of histrionic and narcissistic personality disorders behaviors: a single subject demonstration of clinical improvement using functional analytic psychotherapy. Journal of Contemporary Psychotherapy, 33(3), 321-339. Horowitz, M.J. (1997). Psychotherapy for histrionic personality disorder. Journal of Psychotherapy Practice and Research, 6, 93-107. Kellett, S. (2007). A time series evaluation of the treatment of histrionic personality disorder with cognitive analytic therapy. Psychology and Psychotherapy: Theory Research and Practice, 80, 389-405. Doi: 10.1348/147608306X161421
  • Submitter: Carina M. Robinson