Residential therapies do not have much of a role in the treatment of paranoid personalities as such. When patients with paranoid personalities deteriorate and undergo psychotic decompensation, however, hospitalization and associated residential therapies may be called into play. These therapies usually pertain more to the treatment of the psychosis rather than to that of the personality disorder.
Some paranoid personalities are treatable. Often, such patients lead reasonably adaptive and productive lives but encounter difficulties in circumstances of loss or under specific forms of life stress. Their treatment, however, is not easy and requires patience, empathy, and great sensitivity to the vulnerability and hypersensitivity that are inexorably part of the pathology. The therapist must be willing to work slowly toward minimal long-term goals, forgoing any illusion of quick or easy resolution of the patient’s difficulties and aiming for a more enduring and fundamental change in the patient’s personality structure.
The therapeutic progression in such patients can be traced through the gradual undermining of paranoid defenses and attitudes to the emergence of an underlying depression, in terms of which the patient’s inner sense of weakness, defectiveness, vulnerability, and powerlessness gradually comes into focus. In working through this depressive core, the therapist helps the patient to gradually undermine and resolve the narcissistic and aggressive core elements of the pathology and the fundamental motivation underlying the paranoid symptoms.
Revision date: June 14, 2011
Last revised: by David A. Scott, M.D.