Rep36 Understanding Personality Disorder

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3.1 Assessment and formulation 
Key points:
I
Psychological perspectives on personality
disorder originate in psychodynamic,
behavioural, cognitive, and interpersonal
theories of psychopathology.
I
Personality assessment is relevant to
individual formulation, specifically the tasks
of establishing goals, tailoring and
maintaining focus in the therapeutic process,
contributing to the choice and sensitivity of
intervention strategies, and monitoring
change over time.
I
Personality disorder may require treatment
in its own right.
I
Personality disorder can also be a
complicating factor in respect of the
assessment, treatment, and successful
management of Axis I clinical syndromes.
I
Unstructured assessments of personality
disorders are not recommended because
they are unreliable, of questionable validity,
and provide almost no basis for the
evaluation of change over time.
I
Instruments designed for the structured
assessment of personality traits and disorders
are recommended and should be carefully
selected for their relevance to the treatment
and management needs of individual clients.
I
A combination of self-report instruments and
semi-structured interview is recommended as
good practice in personality disorder
assessment.
I
Only instruments that have a good history of
application in clinical settings and that have
established and well-documented psychometric
properties should be considered for use.
3.1.1 General issues 
Unstructured assessments of personality
disorders are not recommended because they
are unreliable, of questionable validity, and
provide almost no basis for the evaluation of
change over time (Zimmerman, 1994).
Structured assessments of personality, as with
other psychological constructs, are preferable to
unstructured assessments for a number of
reasons (Pfeiffer 
et al
., 1976): 
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They can help to clarify treatment goals and
facilitate the development of contracting for
new behaviours.
I
They provide for comparisons between
individual clients and normative groups.
I
They can sensitise clients and therapists to
the multifaceted nature of therapeutic
change.
I
Feedback from assessments can be helpful to
clients.
I
They encourage client participation in the
treatment process, improve communication
between client and therapist and help the
therapist to focus and manage therapy more
effectively.
I
They provide a good baseline from which to
measure changes to a client’s functioning as
a result of treatment.
I
They facilitate the longitudinal assessment of
therapeutic change (i.e. before, midpoint,
termination, and on follow-up).
Instruments designed for the structured
assessment of personality traits and disorders
should be carefully selected for their relevance
to the treatment and management needs of
individual clients. Only instruments that have a
good history of application in clinical settings
and with established and well-documented
psychometric properties should be considered
for use (MacKenzie, 2001). It is common to use
several instruments in order to cover several
areas directly applicable to the general features
of personality disorder; for example, symptoms
of psychological distress, personality disorder
diagnostic criteria, personality traits or patterns,
relationship stability and attachments, and social
functioning. It is also common to use more than
one method of assessing personality and
personality dysfunction; for example, self-report
instruments, a semi-structured interview
schedule, collateral information, and observation