Relational Therapy for Personality Disorders

The unsuspecting reader may assume that the “relational therapy” referred to in the title of this book is a variant of relational psychoanalysis, the increasingly popular theoretical school deriving from the work of Stephen Mitchell, Lewis Aron, and others. However, Jeffrey Magnavita uses “relational therapy” to refer to integrative relational psychotherapy, a model of conceptual understanding and treatment that leans heavily on familiar theories of family systems. To his credit, Magnavita avoids the frequent problem of reductionism by fully acknowledging the necessity of thinking in biopsychosocial terms. Genetic factors and temperament are taken into account. He also values psychodynamic thinking in understanding how early attachment relationships create patterns of internal object relations that are played out within family systems. He reviews much of the existing literature on personality disorders in a scholarly fashion and comes up with his own classification of dysfunctional personological systems. The subtypes involved in this taxonomy take some getting used to. For example, the paranoid dysfunctional personological system is abbreviated as “Par Dps,” the somatic dysfunctional personological system is abbreviated “Som Dps,” and so forth.

The author goes over a number of treatment interventions in a truly pluralistic manner, drawing from many different theoretical schools. Unfortunately, what readers gain in the breadth of the author’s coverage is not matched by the depth of case material. What is sorely lacking in the book is a detailed and extended clinical case that illustrates the author’s method in great detail. The clinical examples provided are quite sketchy and unsatisfying. So the reader is left with headlines but no details. The other major deficiency in the book is lack of any empirical evidence that the approach is useful. Even in the absence of systematic research, the author might have at least outlined a way to study the method that he is proposing.

Psychiatrists and other mental health professionals who are interested in family approaches to personality disorders might find this book interesting and useful. However, much more testing of the method is needed before one can endorse broad use of the treatment described.