Ethical considerations in treatment of personality dysfunction: Using evidence, principles, and clinical judgment.

Abstract

Clinical work with clients suffering from personality disorders can be among the most challenging for psychologists. These clients may have a wide range of clinical presentations, and many practitioners may lack the specialized training needed to provide successful treatment to these clients. Clinicians are faced with several challenges in making treatment decisions that are ethically informed and based on available research findings. Because of the relative dearth of evidence-based treatments for these clients, clinicians are encouraged to use a cost-benefit analysis approach when weighing the benefits versus disadvantages of specific interventions and treatment approaches. Recommendations for effective and ethical treatment of clients with personality dysfunction are provided that are based on an empirically grounded framework. Three expert commentators provide insights into the state-of-the-art of clinical work with these clients.

Borderline Personality Disorder: To diagnose or not to diagnose? That is the question

“…These behaviours can be frequent and resource‐intensive, and they are often confronting for health professionals (Antai‐Otong 2016). Most mental health clinicians have had frequent contact with people diagnosed with BPD, yet the associated behaviours may continue to challenge clinicians’ ethical capacities (Magnavita et al 2010), leading to the development of stigma towards the diagnosis of BPD.…”

“…Ethical clinical decision‐making surrounding diagnosis can present as a challenge for healthcare professionals for a number of reasons (Magnavita et al 2010). People with BPD have high rates of unmet needs, such as adequate treatments and access to services (McMahon & Lawn 2011).…”

“…It is well documented that both clinicians and people diagnosed with BPD do not believe there are adequate services available for people with a diagnosis of BPD (Acres et al 2018; McMahon & Lawn 2011). Even if services are available and accessible, the negative attitudes expressed by treating healthcare professionals and the subsequent negative attitudes towards the diagnosis of BPD can result in premature termination of treatment potentially causing harm (Magnavita et al 2010).…”

The value of psychological treatment for borderline personality disorder: Systematic review and cost offset analysis of economic evaluations

“…Concurrent with the debate on health care reform, and the relative dearth of evidence-based treatment for Personality Disorders (PD), clinicians have become increasingly interested in evaluating the cost-effectiveness of psychological treatments [ 3 ]. Attention to the cost-benefit analysis is crucial in weighing the benefits versus disadvantages of specific interventions and treatment approaches [ 4 ], clearly defining the method, duration and outcomes of interventions. Managed care providers demand that treatments have demonstrated efficacy, minimize costs, and reduce future utilization of expensive resources.…”

The Many Complexities in Treating and Studying Narcissism

“…Whereas there is a vast amount of theoretical and clinical writing about how best to conceptualize and treatment individuals with vary degrees of narcissism, there is very little empirical data about how best to proceed in terms of established, articulated treatment packages. Additionally, although, broad reviews of the empirical literature including developmental data, epidemiological data, and experimental data can often help the clinician generate evidence based principles (see Levy et al, 2006;Magnavita, Levy et al, 2010), very little research on data is available on NPD in these realms too. The existing treatment literature is clear that NPD (or even NPD traits) increase the likelihood of dropout and slows symptom change (Campbell, Waller, & Pistrang, 2009;Ellison, Levy, Cain, & Pincus, in press;Hilsenroth et al, 1998).…”