The psychoanalytic movement introduced the study of unconscious processes that influence human activity. The movement was fully consistent with the German model of mental activity, going back to the writings of Leibniz and Kant. Although act psychology and the Gestalt movement were also modern expressions of the German model, psychoanalysis emphasized the goal of a homeostatic balance of unconscious energies within personality. Its founder, Sigmund Freud, used his keen powers of observation to devise much-needed therapeutic approaches, and later expanded his formulations to a psychodynamic theory of personality growth dependent on tension reduction. Other theorists modified Freud’s model to include cultural influences (Jung) and social needs (Adler and Horney). In addition, scholars have integrated the psychoanalytic model with a field approach (Sullivan) and existential assumptions (Fromm). As a contemporary movement, psychoanalysis still exerts considerable influence in psychiatry and clinical psychology, although the movement is fragmented owing to a lack of methodological agreement. In addition, Freud’s statements on the unconscious have led to new interpretations of artistic expression. However, as a viable model for psychology, psychoanalysis has departed from the empirical foundations of psychology and shares little with other systems of psychology that rely on that methodological approach.

This chapter gives an account of the different psychoanalytic traditions and their approaches to PD: the Kleinian/Bionian model, the British object relations perspective, Kohut’s self psychology, the structural object relations model, the interpersonal-relational approach, and mentalizing theory. The chapter goes on to describe two contemporary psychodynamic treatments, along with their evidence base: transference-focused therapy and mentalization-based treatment. Recent developments in the authors’ thinking in relation to PD are then described, partly in the context of recent work in the area of a general psychopathology or “p” factor. In particular, the authors discuss personality disorder in relation to epistemic trust, and suggest that psychopathology might be understood as a form of disordered social cognition, perpetuated by the obstacles to communication that these social cognitive difficulties create. It is postulated that effective therapeutic interventions for PD possess the shared characteristic of stimulating epistemic trust and creating a virtuous circle of improved social communication.