Clinical diagnosis and case formulation in the psychotherapy of personality disorders

PURPOSE: The article aimed to present a case conceptualization in two stages of therapy for PD patients qualifying for a specific therapy modality and diagnosis, including the conceptualization and monitoring of the process and mechanism of changes under the influence of specific therapeutic interventions. The problem is significant as there is a high level of treatment dropout among patients with various personality disorders. VIEWS: The article discusses the current state of knowledge and Kazdin’s methodology of scientific research on the processes and mechanisms of change in patients under the influence of therapeutic interventions. Using the assumptions of this model, the author describes the six steps of a therapeutic procedure which aims at describing and monitoring the process and mechanism of therapeutic interventions, with a special emphasis on the significance of a mediator in the form of the therapeutic alliance. The therapeutic alliance is a significant mediator of changes leading to positive and/or negative therapy outcome and some of its components should be considered as moderators that may significantly modify the influence of the mediator on the strength of the links between a given therapy modality and its effectiveness. CONCLUSIONS: Kazdin’s model and diagnostic principles seem very useful and promising in clinical practice. At our current stage of knowledge and research, the diagnosing and monitoring of the process and mechanism of change in patients, resulting from specific therapeutic interventions, constitutes a considerable challenge for psychotherapists and clinicians.