Histrionic Personality Disorder - Various Other Modalities

Psychoanalysis

Psychoanalysis is an effective treatment in patients with histrionic personality disorder who are motivated to obtain the maximum possible degree of personal understanding and self-development. To be most effective, this form of treatment should be used for patients in whom the narcissistic vulnerability and absence of supraordinate self-conceptualizations are not too severe to tolerate the ambiguities of role and reduction in supportive contexts that can occur in such treatments. Such approaches in well-selected patients who meet the criteria of analyzability will require 400 to 1,000 hours of treatment in order to fully explore the childhood antecedents of current irrational beliefs and motivational scenarios, to allow transference regressions to fully evolve and undergo resolution, and to learn and evolve new ways of using the mind as a tool for reflection, planning, and understanding new opportunities.

Marital Therapy

Marital therapy may be a useful addition to an individual treatment program when formulations identify neurotic cogwheeling with the partner. The partner may be reinforcing maladaptive patterns and preventing the patient from learning new and more adaptive patterns. For example, the patient may improve in individual psychotherapy and begin to practice a self-enhancing assertiveness with less masochistic submission in the hope of gaining love and attention. More assertiveness and less passivity may challenge the self-esteem of a narcissistic partner or may threaten a compulsive partner who wants to be in control of the marriage. The uncertainty of new behaviors and new relationship patterns will cause anxiety about the endurance of the attachment. Identification of such concerns can help both partners and the "we" of the marriage advance to greater satisfaction, which will reduce the overall levels of anxiety and depression in both partners.

Group Therapy

Group therapy may also be a useful addition to individual case formulation and treatment sessions. The group begins to help the patient by providing attention and emotional support. Once a sense of safety and commitment to mutual advancement are developed, group members can also help the patient by giving feedback on their reactions to the patient's habitual behaviors. By mass effect, the group can also counteract disavowals that the patient may generate in response to interpretations by the therapist, saying in effect "Well, that's just what you think" to any individual. Of even more utility, the group may help model alternative behavioral styles and engage in role-playing of how to handle prototypically difficult situations for the patient (and also how not to handle them, by role-playing bad outcomes of gambits that may initially relieve tensions).

Time-Limited, Brief Therapy