Phase 3: Identifying and Counteracting Defensive Control Processes

Many patients with a histrionic personality disorder have a habitual defensive strategy of not knowing facts that would be emotionally distressing. They use a variety of inhibitory control processes, ranging from inhibiting contemplation of emotionally complex topics to shifting attention away from external sources of threat. If these avoidance maneuvers are not sufficient, the patient may "short-circuit" to closing a topic prematurely or shift to another state of mind, as already described. The result of the assembly of avoidant control processes is a variety of outcomes that can be called suppression, repression, disavowal, denial, and behavioral avoidance.

The therapist may help the patient by counteracting habitual avoidances and fostering sustained attention to topics that contain irrational beliefs, conflicting motives, contradictions in sense of self, and unresolved dilemmas of choice about what to do.

While promoting the sustainability of working states in the therapy, the therapist can focus attention on topics that are usually warded off and unresolved. As mentioned, these may be signaled, because they tend to lead to a shift into shimmering states of both expressing and warding off ideas and feelings. By discussing these topics, the therapist may help the patient to differentiate reality from fantasy by paying closer than usual attention to what is going on in the immediacy of the therapy situation, in current outside relationships, and in reviews of past situations.

As current, past, and potential future relationships are contemplated, the therapist may help the patient learn to link recognition of emotional responses to what intentions of self and other are occurring in social contexts. Part of this is to encourage translation of nonverbal messages into verbal expressions in the immediate therapy context and to learn to monitor nonverbal messages to others outside of therapy. This will also help the patient to learn to focus attention away from "just now" to what is likely to happen as the present leads to probable futures. In the long run, this will help the patient to counteract the apparent "unreality" of some current real acts and also to counteract the apparent "reality" of living in imagination.