Goals
For
individuals with AvPD, the goal of treatment is to increase
self-esteem, increase confidence in interpersonal relationships,
and to de-sensitize their reaction to criticism (Sperry, 1995, p.
44). Treatment should be directed toward reinforcing a
self-concept of competency. These individuals can learn to
balance caution with action and to develop a tolerance for
failure (Dorr, Retzlaff, ed., 1995, pp. 196-197).
One must beware of the clinician that is overprotective of the
patient and holds up progress - this sustains the poor view of
self that the patient has come to treatment to remedy. The other
clinician to beware is the one who forces the patient to face new
situations prematurely, without proper preparation, and who then
criticizes the patient for not being "brave" enough.
Millon (Millon & Davis, 1996, pp. 281-282) believes that the
ultimate aim of therapeutic intervention is to counter the
tendency for individuals with AvPD to perpetuate a pattern of
social withdrawal, perceptual hypervigilance, and intentional
cognitive interference. He does note, however, that these
individuals often have a poor prognosis. Their habits and
attitudes are pervasive and ingrained, as with all the
personality disorder patterns. They are rarely in a supportive
environment that could assist them to change their behavior. They
are also inclined, in treatment, to reveal only that which will
not cause the service provider or other group members to think
ill of them.
As with all of the personality disorders, individuals with AvPD
cannot become their own personality and temperamental opposite.
While they may, in fact, fantasize about becoming an outgoing,
confident extrovert, the development of a more functional version
of their basic personality traits can lead to a substantial
improvement in the subjective experience of the quality of their
lives. Oldham (1990, pp. 173-182) suggests that the more
functional personality style of the avoidant personality disorder
is the "sensitive personality style." These individuals
are comfortable with the familiar, stay close to family and a
limited number of friends, care what others think about them, are
cautious and deliberate in dealing with others, and maintain a
courteous, polite interpersonal reserve. Within their own homes
and with friends, they are warm, giving, open and creative. The
implication is that these individuals can develop rewarding
relationships and live with interpersonal connectedness while not
pressuring themselves to be excessively outgoing. They do not
have to be extroverted to avoid isolation.
Accordingly, it is important that treatment goals address
realistic expectations for change, including confrontation of
fantasies that cannot be realized and should not be part of the
treatment plan.