Cognitive Therapy of Personality Disorders This page intentionally left blank Cognitive Therapy of Personality Disorders SECOND EDITION Aaron T. Beck Arthur Freeman Denise D. Davis and Associates THE GUILFORD PRESS New York London ©2004TheGuilfordPress ADivisionofGuilfordPublications,Inc. 72SpringStreet,NewYork,NY10012 www.guilford.com Allrightsreserved Nopartofthisbookmaybereproduced,translated,storedin aretrievalsystem,ortransmitted,inanyformorbyanymeans, electronic,mechanical,photocopying,microfilming,recording, orotherwise,withoutwrittenpermissionfromthePublisher. PrintedintheUnitedStatesofAmerica Thisbookisprintedonacid-freepaper. Lastdigitisprintnumber: 9 8 7 6 5 4 3 2 1 LibraryofCongressCataloging-in-PublicationData Beck,AaronT. Cognitivetherapyofpersonalitydisorders/AaronT.Beck,Arthur Freeman,DeniseD.Davis&associates.—2nded. p.cm. Includesbibliographicalreferencesandindex. ISBN1-57230-856-7(hbk.:alk.paper) 1. Personalitydisorders—Treatment. 2. Cognitivetherapy.I. Freeman, ArthurM. II. Davis,DeniseD. III. Title. RC554.B432004 616.85′8—dc22 2003017118 About the Authors Aaron T. Beck, MD, is University Professor of Psychiatry at the University of Pennsylvania and President of the Beck Institute for Cognitive Therapy. He has authored more than 450 publications and has received numerous honors from professional and scientific organizations. Dr. Beck has worked extensively with personality disorders and has been an investigator on two studies using cognitive therapy with borderline personality disorder. Arthur Freeman, EdD, ABPP, ACT, is Professor and Chair of the Depart- mentofPsychologyatthePhiladelphiaCollegeofOsteopathicMedicine.He has been the president of the Association for Advancement of Behavior Therapy and of the International Association for Cognitive Psychotherapy. He is a Distinguished Founding Fellow of the Academy of Cognitive Ther- apy and has earned diplomates in Clinical Psychology, Behavioral Psychol- ogy, and Family Psychology from the American Board of Professional Psy- chology. Dr. Freeman’s research and clinical interests include marital and family therapy, and cognitive-behavioral treatment of depression, anxiety, and personality disorders. Denise D. Davis, PhD, is a Founding Fellow of the Academy of Cognitive TherapyandhascollaboratedwithDrs.BeckandFreemanandotherassoci- atesoftheBeckCentersincecompletinganextramuralpostdoctoralfellow- shiptherein1984.Acontributortothefirsteditionofthisvolumeaswellas to numerous other chapters, articles, and workshops on cognitive therapy, Dr. Davis was a founding editor of the journal Cognitive and Behavioral Practice. She currently serves as Assistant Director of Clinical Training in PsychologyatVanderbiltUniversityandhasalsomaintainedanindependent practice of cognitive therapy for 20 years. v This page intentionally left blank Contributing Authors James Pretzer, PhD, Cleveland Center for Cognitive Therapy, Cleveland, Ohio;DepartmentofPsychiatry,CaseWesternReserveUniversitySchoolof Medicine, Cleveland, Ohio BarbaraFleming,PhD,ClevelandCenterforCognitiveTherapy,Cleveland, Ohio;DepartmentofPsychiatry,CaseWesternReserveUniversitySchoolof Medicine, Cleveland, Ohio ArnoudArntz,PhD,DepartmentofMedical,ClinicalandExperimentalPsy- chology, Maastricht University, Maastricht, the Netherlands Andrew Butler, PhD, Beck Institute for Cognitive Therapy and Research, Bala Cynwyd, Pennsylvania; Department of Psychiatry, University of Penn- sylvania School of Medicine, Philadelphia, Pennsylvania Gina Fusco, PsyD, Philadelphia College of Osteopathic Medicine, Philadel- phia, Pennsylvania; Alternative Behavioral Services, Yardley, Pennsylvania Karen M. Simon, PhD, Cognitive Behavioral Therapy of Newport Beach, Newport Beach, California Judith S. Beck, PhD, Beck Institute for Cognitive Therapy and Research, Bala Cynwyd, Pennsylvania; Department of Psychiatry, University of Penn- sylvania School of Medicine, Philadelphia, Pennsylvania vii viii ContributingAuthors Anthony Morrison, ClinPsyD, Department of Psychology, University of Manchester, Manchester, United Kingdom Christine A. Padesky, PhD, Center for Cognitive Therapy, Huntington Beach, California, www.padesky.com Julia Renton, ClinPsyD, Bolton, Salford and Trafford Mental Health Trust, Manchester, United Kingdom Authorsarelistedbytheextentoftheircontributions,andalphabeticallywithinequivalent groups. Preface In the more than two decades since Aaron T. Beck and his colleagues publishedCognitiveTherapyofDepression,cognitivetherapyhasdevel- oped in an almost exponential fashion. From the early work of treating depression,themodelhasbeenadvancedandappliedtothetreatmentof allthecommonlyseenclinicalsyndromes,includinganxiety,panicdisor- der, eating disorders, and substance abuse, as well as disturbances of thinkingassociatedwithpsychoses.Outcomestudieshavedemonstrated its efficacy in a wide range of clinical disorders. In addition to its appli- cationtopracticallyalltheclinicalpopulations,withmodifications,cog- nitive therapy has been applied to all ages (children, adolescents, geriat- ric patients) and has been used in a variety of settings (outpatient, inpatient, couples, groups, and families). The interest in and development of the clinical work in treating those patients with personality disorders have grown with the clinical sophistication and skill of the cognitive therapists. The first edition of thisvolumewasthefirstcognitiveapproachtofocusspecificallyonthis diverseanddifficultgroup.Oursecondeditionreflectsbothourgrowing clinical sophistication and the expanding potential of cognitive therapy to effectively treat these disorders that often have been regarded as un- treatable. The work in cognitive therapy has drawn interest from around the world, and centers for cognitive therapy (or cognitive therapy study groups) have been established on every continent except Antarctica. ix