This book describes yet another model of personality disorder, outlining a cognitive constructivist model. The authors clearly have a predetermined perspective of personality and its functioning. However, rather than simply engaging in polemic, they have sought evidence to show not only that their view has clinical utility but also that there is empirical evidence, albeit single case study clinical evidence for the most part, to support it. The result is a book linking theory and treatment in a way that is recognisable to the clinician.
But what is the cognitive constructivist model? In essence, it is a deconstructivist model. Personality is seen as being made up of essential elements which become dysfunctional personality disorders: a meaning system which incorporates states of mind and the capacity to build a personal narrative; metacognitive processes – how you represent your own and others' mental states and understand motivation; monitoring capacities that link emotional and cognitive aspects of states of mind; and integrative and de-centering abilities with which we smooth out inconsistencies in our narratives and which we also use to put a brake on our tendency to be self-centred. The theory becomes increasingly complex and the authors identify other essential cognitive processes commonly dysfunctional in personality disorder. But, importantly, they link the cognitive dysfunctions to interpersonal interactions, which instantly brings clinical relevance to the subject.
The authors have organised each chapter to ensure that relevant aspects of their theory are illustrated clinically, using sessional material for each of the personality disorders. This brings the book to life. The reader who is interested in psychotherapy discourse will find this book a veritable treasure trove. What the book does not do is tell you how to implement the treatment. But it does provide handy ‘hints’ – for example most individuals with personality disorder cannot easily self-reflect so techniques stimulating within-session scrutiny between patient and therapist are best left until later in treatment.
Overall, this book forms part of an ambitious attempt to create a coherent understanding of personality disorders and to offer treatment consistent with that understanding. For some it will be a little too deconstructivist as a model. It is also not for the reader who is naïve about treatment methods or who has limited understanding of personality disorder. But I would urge those who are well-versed in the literature on personality disorder to read this book.
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