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Book Reviews   |    
Practical Management of Personality Disorder
Reviewed by Anita Everett, M.D.
Psychiatric Services 2005; doi: 10.1176/appi.ps.56.1.115-a
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by W. John Livesley; New York, Guilford Press, 2003, 420 pages, $48

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Practical Management of Personality Disorder is not just another pretty face in the recent lineup of quick reference guides, evidence-based treatment algorithms, and clinical treatment manuals. It is a serious and scholarly synthesis of contemporary theory and science merged together into a single text that may be the best resource currently available for clinicians who work in settings in which persons with personality disorders are treated—and don't we all.

The extensive clinical and academic experience of author W. John Livesley in this arena is well represented in Practical Management of Personality Disorder. The book begins with several chapters that frame personality traits, characteristics, and disorders. For readers who are rusty on the theoretical underpinnings of personality function and structure, these chapters are a useful warm-up for the chapters that follow. Chapter 4, "The Process of Change," includes a thorough review of contemporary literature that provides insight into features of a personality that are amenable to change and those that are particularly resistant and maybe even unrealistic as a target for change through a psychotherapeutic venue. The conclusions of this chapter are based on available evidence as well as Livesley's experience.

A refreshing aspect of this book is that it does not overemphasize or expound on the diagnostic and treatment intricacies of borderline personality disorder. Rather, it includes a general discussion of many types of maladaptive personality features that are found in a variety of personality disorders. Chapter 5 begins with a review of diagnosis and then progresses to a presentation of various personality patterns, dimensions, systems, and schemata. The level of detail is presented in order to encourage readers to think beyond the current DSM-IV presentation of personality disorders. This presentation of assessment veers a bit from the book's overall "practical" theme. However, several of these concepts are referred to in later sections of the book, so it is useful to include them as a reference.

The remaining chapters focus on clinical strategies. Included are chapters on safety and containment, regulation and control, exploration and change, and integration and change. These chapters are well referenced and include bold-faced section titles that would facilitate use as a reference during the challenging situations that clinicians inevitably encounter. The writing style and organization of these chapters renders them as useful for seasoned clinicians as for early-career professionals.

Seasoned clinicians would find this text useful as an update on contemporary evidence and as a refresher in providing intellectual insight into aspects of working with a challenging group of patients. In addition, for a clinician working in an isolated setting, the book may serve as validation and support for the challenges associated with day-to-day treatment. Early-career therapists would be particularly likely to benefit from the later chapters, which focus on practical treatment applications. In addition, this text would be very useful in training settings to round out traditional theoretical and didactic presentations with this practical approach.

Dr. Everett is senior medical advisor with the Substance Abuse and Mental Health Services Administration in Rockville, Maryland, and community psychiatrist at Johns Hopkins University in Baltimore.

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