Lived Experience of Treatment for Avoidant Personality Disorder: Searching for Courage to Be

Abstract

Objective: To inquire into the subjective experience of treatment by persons diagnosed with avoidant personality disorder. Methods: Persons with avoidant personality disorder (n = 15) were interviewed twice, using semi-structured in-depth interviews, and the responses subject to interpretativephenomenological analysis. Persons with first-hand experience of avoidant personality disorder were included in the research process. Results: The super ordinate theme emerging from the interviews, "searching for courage to be" encompassed three main themes: "seeking trust, strength, and freedom," "being managed," and "discovering the possibility for change and development." The main theme, "being managed," included the subthemes: "getting a diagnosis," "receiving medication," and "attending therapy." Conclusion: Although this may not be specific to avoidant personality disorder, the findings highlight the importance of being met inter-subjectively as a person with intentionality and agency, even when one does not feel like one. The importance of establishing an emotional bond and emergent trust for open therapeutic collaboration, learning, and becoming able to build courage to begin to approach that which one fears is emphasized.

Agency in avoidant personality disorder: a narrative review

“…People diagnosed with AvPD report seeking help when their avoidant strategies no longer give them sufficient relief ( Sørensen et al, 2019b ). Practicing tolerating emotions is suggested to be an important therapeutic factor ( Gordon-King et al, 2017 ).…”

“…Patients diagnosed with cluster C with cold-submissive interpersonal problems improve more when the alliance is good ( Ryum et al, 2010b ). Meeting others in the same situation in group therapy helps participants feel community and provides support to try out new interpersonal behaviors ( Alden, 1989 ; Renneberg et al, 1990 ; Sørensen et al, 2019b ; Bachrach and Arntz, 2021 ). At the same time, group therapy elicits anxiety and dropout ( Simonsen et al, 2022 ).…”

“…After a while of being told what to do, the therapy starts to feel like being handled, and they feel misunderstood, passive, and discontent. They can have difficulties understanding the therapists’ techniques, but they dare not question them and pretend that the therapy works ( Sørensen et al, 2019b ). It can be difficult to notice ruptures as patients give little or disguised signals, such as not doing the work or missing the appointments, avoiding confrontation, and submitting to the therapists’ wishes.…”

“…Episodes of repair are less likely with more severe PDs and interpersonal problems ( Strauss et al, 2006 ). People diagnosed with AvPD describe developing agency when therapists meet them with curiosity ( Sørensen et al, 2019b ; Pettersen et al, 2021 ). This therapeutic stance seems more productive for supporting them to speak up and influence the therapists, compared to making inferences about conflict in the therapeutic relationship.…”

“…This might be due to a bias of overvaluing the therapists’ methods in effect studies, also leading therapists to focus on the method ( Bohart, 2000 ). It might be particularly important to be aware of this bias with people diagnosed with AvPD as they report feeling handled by their therapists and that influencing their therapeutic process feels impossible ( Sørensen et al, 2019b ) – indicating a low sense of agency in therapy. It also seems to be an important barrier for therapists, as they report oscillating between taking over the therapeutic project or being too passive when treating people diagnosed with AvPD ( Pettersen et al, 2021 ) – perhaps struggling to support their patients’ agency.…”