treatment of avoidant personality disorder

treatment of avoidant personality disorder Avoidant personality disorder (APD) is characterized
by “the pervasive pattern of social inhibition, feelings of inadequacy,
and hypersensitivity to negative evaluation” (American Psychiatric Association,
2000, p. 718). In addition, these individuals oft en have low self-esteem
and social phobia and tend to enter relationships only when unconditional
acceptance is guaranteed (Maxmen and Ward, 1995).

Jennifer, a graduating senior, comes in for treatment because of an
inability to go on job interviews. Extremely anxious around other people,
she lives at home—unusual for most students at her university—and
hates to leave the house even to go to the store. She has never dated and
doubts anyone would be interested in her, although she wants to get
married one day. She has one friend from elementary school whom she
rarely sees. She feels criticized and oft en misunderstood by her large
family. Despite being an A student, she still views herself as having no
skills, and says that she never can be good enough in her own or others’
eyes. She does not want to go on job interviews and be “examined under
a microscope.”

To help such students, Benjamin (1996) states that “accurate empathy and
uncritical support” are necessary to establish a good therapeutic relationship.
Th e counselor should carefully and consistently ask for feedback to see if the
student feels criticized. Beck et al. (2004) suggest asking students at the end of
the session if they made any assumptions about how the therapist felt about
them. Using a proper pace and having the client report if the clinician is pushing
too hard also builds the therapeutic alliance (Millon et al., 2000). Sometimes
these clients feel criticized by the counselor’s overt or covert push “to
change.” It also can be helpful to explore clients’ ambivalence about their ability
to cope with the various developmental tasks of college. While it’s essential
to help these students recognize their positive traits, this can be diffi cult, since
they are afraid of being seen as arrogant.
Jennifer attended a three-session workshop teaching concrete steps to
fi nding a job. Sometimes such specifi c knowledge can reduce baseline anxiety and increase confi dence. Also eff ective are psychoeducational workshops, to
normalize the student’s feelings and reduce overgeneralizations. Due to her
isolation, Jennifer hadn’t realized that many other seniors were also confused
about their career direction and skills. Also helpful can be role playing and
behavioral rehearsal in sessions, self-image work, assertiveness training, utilization
of relaxation techniques, and systematic desensitization using a hierarchy
of anxiety-provoking situations.
Group-based adjunct treatments can focus on graded exposure, social
skills, or intimacy social skills, depending on the interpersonal diffi culties the client experiences (Crits-Christoph & Barber, 2004). Ongoing therapy groups are appropriate provided the group members are friendly, gentle, and reassuring.
Selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase
inhibitors (MAOIs) have been used to treat the social phobia that most APD
clients experience .
At a college counseling center, the focus is usually on symptom relief or
targeted behavioral change. Changes in the organization of the student’s overall personality typically require longer-term work, beyond the resources of
most college centers. Care must be taken in referral to an off -campus provider so that the student does not feel anxious or rejected.