Is cognitive therapy suitable for treating individuals with personality dysfunction?

In this study, the impact of personality dysfunction on suitability for cognitive therapy was examined empirically. Thirty-six (36) mental health outpatients were evaluated with regard to the extent of personality dysfunction and suitability for short-term cognitive therapy. All participants were interviewed by a psychiatrist using the Personality Disorders Examination (PDE) to assess personality dysfunction, and by a psychologist using the Suitability for Short-Term Cognitive Therapy Scale (SSCT) to assess cognitive therapy suitability. Participants also completed the Millon Clinical Multiaxial Inventory-Revised (MCMI-II) to provide a multimethod assessment of personality dysfunction. Analysis of the correlations between suitability for cognitive therapy and personality dysfunction for both the independent-interviewer rated method (the PDE) and the self-report method (MCMI-II) indicated that greater dysfunction was significantly associated with poorer suitability for cognitive therapy. Results were most clear for the general therapy subscale of the SSCT relative to the cognitive therapy specific subscale. A tentative item analysis of the SSCT scale indicated that alliance potential (both in-session and out-of-session ratings), security operations, chronicity, personal responsibility for change, and compatibility with the cognitive therapy rationale were most strongly affected (negatively) by personality dysfunction. These data suggest that, although personality dysfunction has an impact on suitability, cognitive therapy may not be any more contraindicated than any other form of psychotherapy. Theoretical developments within cognitive therapy to address personality dysfunction specifically also support the use of cognitive therapy with this population. Suggestions for specific process and procedural modifications to cognitive therapy when working with personality dysfunction that address the factors that contribute to poor suitability are outlined.