Soft Signs Suggesting the Need for the Assessment of PDs

Beck, Freeman, Davis, and Associates (2004) and Fusco and Freeman (2004) provide the following clinical clues or heuristic signs that might suggest comorbid Axis II problems or disorders:

1. The chronicity of behavior patterns by self-report or reports from significant others. The therapist collects data that suggest the presenting pattern has been in place for a significant amount of time—for example, "Oh, I have done that since I was a kid," or "He has always been that way."

2. The patient has had several attempts at therapy. The patient's history includes a number of therapists and/or long periods of therapy—for example, for example, "I've seen therapists going back to 1968."

3. Therapy is usually crisis oriented. The therapy process is oriented more to the crisis dujour than to development of specific problem solving-skills or a problem-solving pattern—for example, "I couldn't wait to get here. Listen to what's happened to me this week."

4. The patient is noncompliant with current or previous treatment regimen. The patient misses appointments, arrives late, or fails to do homework—for example, "Why should I have to do this? It is so much bull_t."

5. The patient has poor monitoring skills. He/she seems unable or reluctant to self-monitor and/or unable to monitor the reactions of others—for example, "I wasn't aware that they were upset. How was I supposed to know that?"

6. The patient seems to be unaware of the impact of his/her words and behaviors on others. The patient acts in a manner and/or says things that get him/ her into trouble—for example, "They overreacted. They shouldn't be that upset. I just commented on her family."

7. The patient's behavior is rigid and compulsive. The person maintains a pattern of behavior that appears impermeable to incoming data—for example, "This is how I have always done it."

8. The patient is resistant to change. The individual keeps using unsuccessful behaviors even after years of failure in their use—for example, "Why should I be the one that has to change?"

9. The patient is other-blaming. He/she blames others rather than assuming personal responsibility for his/her actions—for example, "If they were willing to allow me the slack to do it my way, then the problems would be over."

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