Treating Personality Disorders in Children and Adolescents

While personality disorders traditionally have been conceptualized only in adults, it is not uncommon to encounter children and adolescents with the classic diagnostic signs. Youngsters with personality disorders may come across as strikingly arrogant, defiant, and manipulative, yet their demeanor typically masks devastating experiences of vulnerability and pain. This groundbreaking volume offers a framework to make sense of childhood personality disorders, distinguish them from more frequently diagnosed childhood conditions, and respond appropriately to the challenges this population presents. Interweaving neurobiological, psychodynamic, and developmental perspectives, Efrain Bleiberg presents an effective treatment model grounded in research and extensive clinical experience. All therapists working with children and adolescents will find vital insights and strategies in this lucidly written book.The author first explores the nature and clinical presentation of childhood personality disorders. Diverse theoretical and empirical literatures are integrated to show how a combination of constitutional vulnerability, attachment difficulties, and trauma may impair the child's capacity to interpret and respond to the world in human, meaningful terms. Elucidated are the processes by which specific personality disorders develop when children--and caregivers--become trapped in rigid, maladaptive patterns of feeling, coping, and relating. The book then takes the clinician step-by-step through offering multimodal interventions that incorporate individual psychotherapy, family treatment, and pharmacotherapy. Compelling case vignettes and transcripts bring to life the inner worlds of these frightened young people and the clinicians who work with them, showing how treatment can help achieve intrapsychic change, free inhibited development, and modify the child's family context. Emphasizing the importance of the therapeutic alliance, the book gives particular attention to ways that therapists can understand and work with their own emotional reactions in highly charged clinical situations.Providing a unique, research-based approach to working with a notably difficult-to-treat population, this book belongs on the desks of psychologists, psychiatrists, social workers, and other clinicians working with children and adolescents. Rendering complex ideas accessible, it will also be an invaluable resource for graduate-level students and trainees in these fields.Winner--Gradiva Award, National Association for the Advancement of Psychoanalysis

Bleiberg has produced a brilliant, comprehensive, and genuinely innovative work. Presenting an integrated framework for treatment of a complex population of young people, this book retains the most important aspects of the old while presenting exhilarating new perspectives and powerful technical innovations. It offers a rare combination of originality, breadth, conceptual coherence, and clinical wisdom. An immensely valuable and lasting contribution.--Peter Fonagy, PhD, FBA, University of London and The Menninger ClinicDrawing on the clinical wisdom of psychoanalysis, and blending it with current progress in developmental science, this book reminds us that personality can become disordered at a very early age, with devastating consequences. Treatment requires the skillful blending of a multiplicity of intervention approaches, centered on the therapeutic relationship. This book demonstrates--in the best Menninger tradition--how we can approach such problems effectively from a modern developmental perspective.--Hans Steiner, MD, Stanford University School of MedicineThis rewarding text offers practical strategies for clinical work with children and adolescents imprisoned by severe personality disturbances. Bleiberg provides a unique synthesis and application of current thinking about development and interpersonal relationships, incorporating attachment research as well as exciting recent neurobiological findings. In doing so, he lays the foundations for psychotherapeutic and psychopharmacological interventions that can help young people achieve a more reflective and interpersonally rewarding way of living. The book is comprehensive in its discussion of the phases of treatment, and offers insightful perspectives on crucial countertransference issues. Bleiberg has made an important contribution to theory and practice. I highly recommend this book.--Daniel J. Siegel, MD, Department of Psychiatry, UCLA School of Medicine - A feast of ideas and possibilities....Any therapist who works with children with serious problems...will be enriched by reading it. --Psychologist-Psychoanalyst APA Division 39 Newsletter, 2/12/2004ƒƒ This excellent book provides insight into the formation of personality disorders in children. It is useful for the clinician, providing techniques to use in therapy to help the child or adolescent develop meaningful relationships. --Doody's Electronic Journal, 2/12/2004

Efrain Bleiberg, MD, was born in Monterrey, Mexico. He is a graduate of the School of Medicine of the University of Nuevo Leon, the School of Psychology of the University of Monterrey, the Psychiatry and Child Psychiatry residency programs of the Karl Menninger School of Psychiatry and Mental Health Sciences, and the Topeka Institute for Psychoanalysis (adult and child psychoanalysis). He has served as Unit Director, Director of the Child Psychiatry Training Program, Director of the General Psychiatry Residency Program, Dean of the Karl Menninger School of Psychiatry and Mental Health Sciences, Vice-President for Education and Research, Vice President and Director of the Children's Division, and Chief of Staff and President of the Menninger Clinic in Topeka, Kansas. He is currently Senior Executive Vice President of Menninger, the Alice Friedman Professor of Psychiatry and Developmental Psychopathology at the Karl Menninger School of Psychiatry and Mental Health Sciences and Training, and Supervising Psychoanalyst at the Topeka Institute for Psychoanalysis.