Video | 02:46:37

CBT for Personality Disorders

by Arthur Freeman
In this final installment of our comprehensive Three Approaches to Personality Disorders video series, watch renowned CBT expert Art Freeman assess cognitive schemas and set concrete therapeutic goals for Alfred, a challenging client who demonstrates significant Axis II issues and suicidal inclinations after being left by his girlfriend.

Part of the 3-video series: 3 Approaches to Personality Disorders

CBT for Personality Disorders
We tend to think of CBT as a short-term, symptom-focused treatment—so how can we apply it to clients with deep-seated personality disorders? Prepare to have your clinical horizons broadened in this video with Art Freeman, who demonstrates classic CBT with a refreshing, world-wise simplicity while integrating skills and techniques from other approaches. Here, Freeman illustrates how attention to client schemas, cognitions, and the therapeutic alliance can be integrated into a full course of treatment for Axis II conditions, and offers a real contrast to traditional views of CBT.

Alfred, ambivalent about therapy and emotionally disturbed, comes to Freeman after the latest in a string of unexpected relationship breakups struggling with feelings of anger, blame and suicidality. At first believing Alfred to be overly dependent, Freeman uncovers narcissistic beliefs, substance abuse, and physical violence that point to a more troubling personality disorder. Honing in on Alfred’s maladaptive schemas—or core beliefs regarding relationships—he asks direct questions that challenge Alfred’s perceptions, while maintaining an attuned and nonjudgmental stance.

Freeman offers informative commentary throughout two full sessions, giving us insight into his thought process and rationale for specific interventions. The use of metaphor plays prominently in his work, and helps Alfred make sense of his experience in a way that eases his fragile self-concept and builds trust. Plain-spoken and practical, Freeman guides the sessions toward concrete goals while highlighting the cognitions that threaten to impede the work for this “scary” client. By the end of the video, Alfred has committed to further therapy and finds hope at the prospect of gaining control over his life.

A wonderful cap to our series, this video is a must-see if you’re interested in CBT, personality disorders, assessment, or weaving together different clinical perspectives.

Note: This video is part of a series, 3 Approaches to Personality Disorders, in which two other masters—psychoanalyst Otto Kernberg and DBT creator Marsha Linehan—work with the same client.

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"A masterful example of skilled work with an extremely difficult patient. Dr. Freeman provides wonderful examples of accurate empathy and engagement and the artful use of metaphor to help facilitate reflection. Additionally, attention to the therapeutic alliance and repair and countertransference are realistically depicted, including remaining calm in a crisis and deploying tools to facilitate a decrease in suicidal thinking and instilling hope. This is a must-see for anyone who deals with patients who have personality issues and behavioral dyscontrol."
-- Donna Sudak, MD, Professor of Psychiatry and Director of Psychotherapy Training, College of Medicine, Drexel University

"Dr. Freeman provides an excellent overview of cognitive conceptualization for personality disorders, and expertly demonstrates how to tailor sessions and overall therapy goals based on the individual client’s needs. Clients who meet diagnostic criteria for personality disorders can experience significant challenges when developing and maintaining professional relationships with their therapists—so this is an excellent resource for the practicing clinician, and a must-see for anyone developing their CBT skills for more pervasive client difficulties."
-- Nikolaos Kazantzis, PhD, Director of the Cognitive Behavior Therapy Research Unit and Associate Professor in Clinical Psychology, Monash University 
In Depth
CE Test
Expert CBT clinician Art Freeman brings a no-nonsense yet relational style to his work with 40-year-old Alfred (played by Dutch actor Hank Grashuis), whose pain over a recent breakup reveals troubling symptoms and an underlying personality disorder. Altering his initial assessment upon inquiring into the client’s dominant schemas, Freeman attends empathically to Alfred’s narcissistic need to “give 100% or nothing” in his relationships while simultaneously gaining buy-in to explore ways of gaining more, not less, control over his anger, drinking, relationships, and emotions. Employing CBT interventions of supporting clients in linking thoughts, emotions, and behavior, Freeman nonetheless does so in an attuned way, even while addressing (to us in voiceover commentary) his own countertransference, and builds a trusting alliance with Alfred, who ultimately feels safe enough to commit to further therapy.

By watching this video, you will:
  • Understand how a CBT therapist assesses for personality disorders and obtains commitment to therapy.
  • Learn how CBT can be integrated with psychodynamic principles such as countertransference and the therapeutic alliance.
  • Identify elements of CBT style and strategy to use with your own clients.
Length of video: 02:46:37
Number of Discs: 1
English subtitles available on: Stream, DVD
Individual ISBN-10 #: 1-60124-396-0
Group ISBN-10 #: 1-60124-397-9
Arthur FreemanArthur (Art) Freeman, EdD is Clinical Professor of Psychology at the Philadelphia College of Osteopathic Medicine. He is a past president of the Association for Advancement of Behavior Therapy and of the International Association for Cognitive Psychotherapy. He has published 63 professional books including Cognitive Therapy of Personality Disorders, Clinical Applications of Cognitive Therapy, and The Comprehensive Casebook of Cognitive Therapy. He has also published two popular books, including Woulda, Coulda, Shoulda: Overcoming Mistakes and Missed Opportunities, and The Ten Dumbest Mistakes Smart People Make, and How to Overcome Them.

See all Arthur Freeman videos.
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CE credits: 2.5
Learning objectives:

  • Understand how a CBT therapist assesses for personality disorders and obtains commitment to therapy.
  • Learn how CBT can be integrated with psychodynamic principles such as countertransference and the therapeutic alliance.
  • Identify elements of CBT style and strategy to use with your own clients.