Individuals who suffer from this disorder typically have poor self-esteem and issues surrounding any type of social interactions. They often see only the negative in life and have difficulty in looking at situations and interactions in an objective manner. This can also interfere with their self-report when they present for an initial evaluation, which can lead to important life history and medical information being missed (because the patient deems it and him or herself too unimportant to bother). It is necessary to take a more detailed evaluation than usual, while doing so in a relatively unobtrusive fashion. The clinician should be sensitive to nonverbal cues of the client during this session, to evaluate when information is being withheld. This is essential to making a differential diagnosis with similar-looking but vitally different disorders, such as someone who suffers from schizoid or borderline personality disorder. As with other personality disorder, the individual is not likely to present him or herself to therapy unless something has gone wrong in their life with which their dysfunctional personality style cannot adequately cope.
As with other personality disorders, psychotherapy is usually most effective when it is relatively short-term and oriented toward finding solutions to specific life problems. While self-esteem issues will undoubtedly present themselves in treatment, serious self-enhancement is unlikely. The negative self-valuation is a life-long, pervasive cognition not conducive to regular methods of increasing one's self-esteem. As with all therapy, a solid therapeutic relationship founded with good rapport and listening to the client is important to the therapist's effectiveness.
Forming initial rapport is likely to be more difficult with someone who has this disorder, since early termination is often an issue. Once rapport is formed, therapy is usually quite stable, unless issues are brought up which are extremely difficult for the client to deal with. Care should be used by the clinician in exploring new material, therefore.
Termination of therapy is an important issue as well, because a successful ending to therapy and the therapeutic relationship reinforces the possibility of new relationships.
Last reviewed: By John M. Grohol, Psy.D. on 1 Jun 2010
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