How do you deal with avoidants?

[ShrunkenHeads]

Any interesting/noteworthy cases of AVPDers? How do you deal with them? Breakthroughs?

I've read that they can be particularly frustrating for therapists.

---

Members don't see this ad.

 

[Therapist4Chnge]

I have tried, but for some reason they seem to be avoiding their appointments.

*rim shot*

 

[nitemagi]

The usual to start -- SSRI (start low, aim high), teaching various relaxation techniques, then exposure/systematic desensitization. Add in some psychoeducation on how avoidance makes anxiety worse through progressive retreating and the anticipation of anxiety, and the way to deal with it is to face it.

 

[OldPsychDoc]

Read Motivational Interviewing.

The operative question is always going to be "Why are they there?" They're in your office--why? What do they want? Help them figure that out, and collaborate with them on a way to reach their goal.

 

[Fastball32]

Good discussion, but I agree that most avoidants will not seek testament for avoidance, rather if we see them in practice it would be for a different co-morbid condition.
Avoidants Personality Disorder is actually the most common personality disorder and one of the 5 proposed remaining personality disorders left in DSM-5.
I would speculate that most avoidants would eventually avoid the challenging therapeutic alliance.

 

[whopper]

I hate saying this because I very much don't like the idea of psychiatrists who don't know how to do psychotherapy and only push pills.

I refer them out for psychotherapy and give an SSRI.

What's going on is there's a shortage of psychiatrists, but not a shortage of psychotherapists where I'm at. I feel that ethically, I need to extend myself in terms of prescribing so that I can get more patients in. I can say in my own defense that I often-times don't believe patients need psychotropic medication or at the most they should not be the main focus of treatment. E.g. borderline PD, avoidant PD, and I tell patients this, and tell them the main focus should be psychotherapy. I also try to fit in some psychotherapy but IMHO it's not going to be as good as someone simply focusing on that without medications.

But I do agree with the above recommendations.