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  • Writer's pictureDeric Hollings

Treatment Types

 

When undergoing training to become a certified personality disorder treatment provider, there was significant focus on three specific treatment types: Profound, stylistic, and focal. Herein, I’ll briefly describe what I learned about these methods.

 

Profound, Stylistic, and Focal

 

Profound – For optimal functioning, profound treatment of personality disorders involves analytic psychotherapeutic modalities such as Mentalization-Based Therapy, Transference Focused Psychotherapy, Interpersonal Reconstructive Psychotherapy, Object Relations Developmental Psychotherapy, and Self-Psychology Psychotherapy.

 

This form of treatment applies when a client is seen for more than six months of treatment, there will be regular therapeutic contact, and the person has high treatability and is with good affect tolerance (the ability to respond to a stimulus which would ordinarily be expected to evoke affects by the subjective experiencing of feelings).

 

For personality disorders, the goal of profound treatment is to replace dramas with the ability to problem-solve and the focus is curative in nature. Functionally speaking, profound treatment centers on the here-and-now in a session.

 

As an example, person X has a repeated pattern of mistrusting others. Using profound treatment, I would address person X’s apprehension in the moment by saying something like, “It seems as though you realize that distrust is your most significant issue, yet you don’t trust me enough to help you resolve your issue.”

 

Profound therapy uses confrontation within the session as a means to create a current dilemma upon which a client may practice and receive immediate feedback. As such, it’s the most rigorous and demanding of the three treatments discussed herein.

 

Stylistic – For adequate functioning, stylistic treatment of personality disorders uses a cognitive behavior therapeutic style such as Dialectical Behavior Therapy, Schema-Based Psychotherapy, Personality-Guided Psychotherapy, and Rational Emotive Behavior Therapy (REBT). While trained in the former and latter, I mostly use the latter.

 

Stylistic treatment is used when a client is seen for three to six months of treatment, there is somewhat frequent therapeutic contact, a more generalized treatment effect is possible (i.e., it can apply to various other situations in life), and a person has relatively moderate treatability and motivation.

 

Regarding personality disorders, the aim of stylistic is to moderate disordered functioning with a focus on improvement. In REBT, this is expressed by helping people get better and not to merely feel better. Functionally speaking, stylistic treatment focuses on the there-and-then behavior outside of a session.

 

As an example, person Y has a repeated pattern of self-focus regarding personal appearance—to a pathological and self-disturbing degree. Using stylistic treatment, I would address person Y’s behavior by saying something like, “When no one praised the effort you devoted to how you looked last Saturday, what did you tell yourself about their perceived indifference?”

 

Stylistic therapy mainly addresses cognition and behavior; though not necessarily affect (immediate expression of emotion). As such, there is less risk of emotional escalation in a session. For the type of teletherapy I provide, I find that stylistic is more appropriate then profound treatment.

 

Focal – For targeted improvement, focal treatment uses a brief-psychotherapy style by way of treatments such as Tactical Therapy, Strategic Therapy, and Structural Therapy.

 

This sort of treatment is used when the client will be seen for less than three months, there are specific behaviors that are of greatest concern, there can’t be frequent therapeutic contact, there isn’t an over-riding issue that needs to be addressed, and the person shows low treatability.

 

Concerning personality disorders, the goal of focal treatment is to improve only one thing. Therefore, from a functional perspective, focal treatment focuses on one topic of interest—and usually something that is safety-related.

 

As an example, person Z has a repeated pattern of physically assaulting other people, which has resulted in 32 arrests in the past several years. Using focal treatment, I would concentrate on person Z’s behavior by saying something like, “The justice system has its limits and you’re likely at the edge of that border, so why don’t we focus on conflict de-escalation?”

 

Focal therapy aims to reduce undesired behavior and consequences while adding resources to the self in a single area at a time (e.g., learning to walk away rather than engaging in physical assault). Because many people with personality disorders may initially require skill-building, I may use this form of treatment when beginning work with a new client.

 

Conclusion

 

During the certified personality disorder treatment provider training, I was reminded that profound, stylistic, and focal treatments don’t always work. Truly, this is the case for any psychotherapeutic modality or technique of which I’m aware.

 

Still, the trainer stated that in a head-to-head comparison of profound, stylistic, and focal treatments, “all of the models work, but the only model that reduced excessive affect into normal limits was the profound model.” One wonders about the feasibility of using profound treatment via telehealth sessions.

 

Given my unique treatment setting and the selective personnel with whom I work, I largely use stylistic and focal treatments. For those clients who maintain a strong rapport, and who can tolerate and accept distress of a higher degree, I can employ certain elements of profound treatment.

 

Herein, I’ve shared methods relating to profound, stylistic, and focal treatment for the reader’s benefit. For the perspective client with a personality disorder that was diagnosed from another clinician, and who considers former treatment approaches to have been ineffective, welcome.

 

If you’re looking for a provider who works to help you understand how thinking impacts physical, mental, emotional, and behavioral elements of your life—helping you to sharpen your critical thinking skills, I invite you to reach out today by using the contact widget on my website.

 

As a psychotherapist, I’m pleased to help people with an assortment of issues ranging from anger (hostility, rage, and aggression) to relational issues, adjustment matters, trauma experience, justice involvement, attention-deficit hyperactivity disorder, anxiety and depression, and other mood or personality-related matters.

 

At Hollings Therapy, LLC, serving all of Texas, I aim to treat clients with dignity and respect while offering a multi-lensed approach to the practice of psychotherapy and life coaching. My mission includes: Prioritizing the cognitive and emotive needs of clients, an overall reduction in client suffering, and supporting sustainable growth for the clients I serve. Rather than simply helping you to feel better, I want to help you get better!

 

 

Deric Hollings, LPC, LCSW

 

 

References:

 

Hollings, D. (2022, March 15). Disclaimer. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/disclaimer

Hollings, D. (2023, September 8). Fair use. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/fair-use

Hollings, D. (2023, October 12). Get better. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/get-better

Hollings, D. (n.d.). Hollings Therapy, LLC [Official website]. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/

Hollings, D. (2023, September 19). Life coaching. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/life-coaching

Hollings, D. (2023, November 22). Personality disorders. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/personality-disorders

Hollings, D. (2023, September 15). Psychotherapeutic modalities. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/psychotherapeutic-modalities

Hollings, D. (2022, March 25). Rational emotive behavior therapy (REBT). Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/rational-emotive-behavior-therapy-rebt

Hollings, D. (2022, November 1). Self-disturbance. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/self-disturbance

Hollings, D. (2022, June 20). Teletherapy. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/teletherapy

Hollings, D. (2023, February 16). Tna. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/tna

Hollings, D. (2022, August 8). Was Freud right? Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/was-freud-right

Persi. (2018, October). 3-day personality disorders course: Advanced diagnosis, treatment & management. Manual: ZNM054180. Pesi, Inc.

Sashin, J. I. (1985, April). Affect tolerance: A model of affect-response using catastrophe theory. Journal of Social and Biological Structures. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/0140175085900089

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