Behavior OnLine Forums  
The gathering place for Mental Health and
Applied Behavior Science Professionals.
Become a charter member of Behavior OnLine.

Go Back   Behavior OnLine Forums > BOL Forums > Cognitive Therapy


Thread Tools Display Modes
Unread February 21st, 2006, 07:18 AM
James D James D is offline
Join Date: Jul 2004
Location: Australia
Posts: 8
Question Avoidant PD

Hi all,
I have been working with an Avoidant Personality Disorder (AvPD) client (55 y.o.) for some time now. She has made gradual progress and has enrolled in a course at a local educational instution - a big step given the high level of social anxiety she experiences and will confront each time she attends the school.

I'm interested in people's experience of working with AvPD, time it takes to start observing noticable changes, and strategies that have proved useful. I believe I read somewhere that progress is typically quite slow.

Also, this client and another client with strong AvPD traits find it very difficult to close their eyes and keep them closed for relaxation sessions. Is this a feature particular to this group of clients? The client mentioned above feels she has to sit with her back to a wall and states she feels out of control if her eyes are closed; she needs to know what is going on. This also makes getting to sleep difficult at night.

So, i'm also interested thoughts and suggestions on this topic as well.

Many thanks,
James D
Reply With Quote
Unread February 23rd, 2006, 01:11 PM
Janene Cowlishaw Janene Cowlishaw is offline
Join Date: Feb 2006
Location: Gold Coast, Queensland
Posts: 1
Unhappy Re: Avoidant PD

have you thought of assessing her for high shame-proneness. It would definately fit with D. L. Nathansons' Compass of Shame where one of the four poles are avoidance. Does she tend to attack others (verbally) when pushed to 'the wall' rather than attack self. If she is also living in the pain and fear of high or global shame, it would account for her problems with closing her eyes during therapy - because the site of shame is the face - it would be unbearable to think you might (and would be - to her) looking at her face when she cannot see you - because you might spot her reality that she is actually flawed and a fraud as a person with no right of existence.
Reply With Quote
Unread February 27th, 2006, 09:05 PM
James Pretzer James Pretzer is offline
Forum Leader
Join Date: Jun 2004
Posts: 283
Default Shame in Avoidant PD

I don't remember seeing many discussions of dealing with shame in CBT but this is something that can be quite relevant to treating Avoidant PD. There is the option of pinpointing and modifying dysfunctional thoughts that elicit shame and the option of using "shame-attacK exercises" as in REBT. I also like to have the client (gradually) fill me in on whatever it is that they are terribly ashamed of and what the client thinks others would think "if they knew."
Reply With Quote
Unread February 27th, 2006, 08:57 PM
James Pretzer James Pretzer is offline
Forum Leader
Join Date: Jun 2004
Posts: 283
Default Re: Avoidant PD

If you haven't already read the discussions of Avoidant Personality Disorder in Clinical Applications of Cognitive Therapy (second edition) and in Cognitive Therapy of Personality Disorders (second edition), I'd recommend both of them.

It can be quite useful to help the client recognize the drawbacks to avoiding unpleasant emotions (especially anxiety and embarassment) and to help them recognize the value of persistently facing situations and emotions that they have been avoiding.
Reply With Quote

Thread Tools
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Forum Jump

All times are GMT -4. The time now is 12:00 AM.

Powered by vBulletin® Version 3.7.3
Copyright ©2000 - 2022, Jelsoft Enterprises Ltd.
Copyright © 1995-2004 Behavior OnLine, Inc. All rights reserved.