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Table 84-3 Phase 2 in the treatment of histrionic personality disorder: identifying and dealing with shifts in state of mind

Table 84-3 Phase 2 in the treatment of histrionic personality disorder: identifying and dealing with shifts in state of mind
Objective: Help the patient maintain more authentic working states.
Shifts to undermodulated states
1. When the patient is in an undermodulated state, encourage restraint from actions that will provide immediate relief but risk harm. Reinforce the adaptive value of planning in advance. Rehearse plans such as "thinking before acting."
2. Help the patient bolster working states of mind in which emotional topics can be examined in a well-modulated manner. Model such routes of contemplation by speaking clearly, slowly, and calmly while stating ideas and emotions that have been unspeakable for the patient.
3. Help the patient slow down ideation to avoid emotional flooding. Repeat frequently, and organize the sequence of expressions during an hour. Deal with implications of ideas in a dose-by-dose manner.
Shifts to overmodulated states
4. Encourage authentic expression as a way to get attention (rather than feigning states that then feel unauthentic).
5. Do not respond to behavioral provocations to shift social roles. Avoid flirtation, inappropriate humor, or excessive "sympathy."
6. Interpret the defensive purposes of shifting into a state displaying pretended emotions. Compassionately label feelings that are like those feigned and that can be felt authentically in working states.
7. Avoid common pitfalls: do not use directive techniques for a fast cure or withdraw interest because techniques for helping the patient change do not work swiftly.