Since DSM-III (Diagnostic and Statistical Manual of Mental Disorders, Third Edition), hysterical personality disorder has been known as histrionic personality disorder. Individuals who suffer from this disorder enjoy being the center of attention. In fact, they thrive on being dramatic or provocative in their behavior, all for the purpose of gaining the attention they crave from others. The psychodynamic approach would address self-esteem issues resulting from past conflicts or emotionally-stifling experiences. A therapist using such an approach may seek to address the patient's incomplete resolution of the oral or Oedipal stage. Freud stated that infants should get adequate and regular oral stimulus at this early stage, whether it's through breastfeeding or the bottle. He believed that infants who lacked adequate and regular stimulation at the oral stage would be at a disadvantage; they could not then advance to the next developmental stage (the anal stage). Essentially, a patient who was neglected at this stage in life would mature into an adult who seeks constant validation of his/her worth from others. Such an individual may also be a good manipulator, intent only upon securing the praise and adulation he/she desires.
Psychodynamic therapy would focus on how the patient's unconscious processes affected his/her actions. Therapists who use this approach believe that a thorough and honest evaluation of past conflicts or undesirable experiences would help patients understand how the past affects the present. The idea is that, once patients receive clarity or insight about unresolved, past conflicts, they will be able to live happier and more constructive lives.
So, a possible scenario surrounding such an approach to histrionic personality disorder is:
1) Brief therapy sessions with one major focus for each of the sessions, rather than traditional, longer sessions where the patient freely discusses any and all topics he desires. Sessions may range from between 25-40 sessions.
2) In the first or second sessions, the therapist brainstorms with the patient and discusses what the central topic will constitute. Doing this allows the therapist to address the patient's most pressing issues during therapy sessions. At this early stage of the therapy process, the therapist can help the patient identify the main issues and map out a goal for the sessions.
3) Sessions may incorporate different therapeutic techniques to achieve the main goals of the treatment. For example, the therapist may use what is called dream analysis (favored by many who advocate the psychodynamic approach). During initial sessions, the therapist may ask the patient to write down the recent dreams he/she has had. Usually, these dreams are challenging to the patient in the sense that they are frightening or disturbing in nature. After the patient writes down these dreams, the therapist will help the patient interpret the dreams. Here, the therapist hopes to uncover the disguised, latent content of the patient's dream, so he can help the patient process his repressed feelings.
4) In other sessions, the therapist may use transference analysis to help the patient understand his unconscious habits. For example, the patient may experience difficulty in relating to women. The therapist can help the patient uncover the reasons for this. Perhaps, the patient had a very difficult relationship with his own mother. So, he relates to women today in the same way that he related to his mother in the past. Transference analysis can help this patient discover why he finds it difficult to communicate clearly and effectively with women.
5) In some sessions, the therapist may use the Core Conflictual Relationship Theme (CCRT) to address how childhood experiences continue to affect the patient today. Most importantly, the therapist will address how and why the patient is unaware of these influences. The above is an example of a likely scenario between a therapist and a patient in psychodynamic-structured therapy sessions.
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