What is an anankastic personality disorder

Compulsive Personality Disorder: Motivation for Change

Only a few patients with an obsessive-compulsive personality disorder can in principle be reached through therapy, namely those whose disorder is not completely ego-syntonic, but rather feels ambivalences and discrepancies. The book focuses on this group of people and shows practicable ways. But therapy is also difficult with these people: the patients have to be motivated to make changes, the therapists have to proceed in a very targeted manner and also be very patient in order to take into account the self-determination aspects of the clients. For this purpose, after a short chapter on diagnostics, the book goes into more detail on the disorder therapy and deals with central relationship motives, dysfunctional schemes, compensatory schemes as well as the peculiarities of the group of people with this disorder profile.

Then it's about therapy. First, some important basic things are clarified. An important aspect of the therapist's general attitude is patience: Because the clients are highly autonomous, but also very sensitive, the therapist has to give the client a lot of control, especially in the initial phase. On the subject of acceptance it is stated that the therapist should check very carefully whether he can really accept the client and adjust to him. Because the norms have no function for the client in terms of content, but an intra-psychological regulatory function as well as a function for the relationship and serve to protect against fear, the norms should never be discussed.

The four therapy phases are outlined based on a case study. After the relationship has been established, an attempt is made in the second phase to begin with a careful clarification of the relevant schemes. Later, careful confrontations can be useful. Biographical work can be helpful in this process; the client recognizes the conditions he was exposed to and which schemes and solutions he had to develop. A problem definition is the goal of this phase. If it is possible to develop a motivation for change, dysfunctional and compensatory schemes can be worked out and worked on in the next phase.

Only when the client follows the question of what function norms have for him can the therapist show step by step that he is following norms, because otherwise he feels worthless or imperfect, and thus he strongly doubts himself and his relationships with others and therefore isolates itself. In the last part of the book, the principles of therapy are illustrated using therapeutic transcripts. Joachim Koch

Rainer Sachse, Stefanie Kiszkenow-Bäker, Sandra Schirm: Clarification-oriented psychotherapy of compulsive personality disorder. Hogrefe, Göttingen 2015, 100 pages, paperback, 22.95 euros