Questions and Answers
Question #23


Questions and Answers

Questions and Answers


Question # 23

Why do you not recommend insight-oriented, dynamic psychotherapy for adolescents or adults with NLD?

Dynamic psychotherapy that aims, among other things, to achieve insight for the client is very appropriate for most persons who are reasonably intelligent (including being capable of insight) and whose attempts at adaptation are being limited to a significant extent by various forms of intrapsychic conflict or "internalized" psychopathology. Once insight into the basis(es) for the conflict(s) is achieved, the process of synthesis/building up of the personality can begin. This process is often somewhat easier to prosecute with success than is the achievement of insight regarding the reasons for the initiation and development of the psychopathology.

The principal problem that adolescents and adults with NLD experience with this process is the achievement of insight. Because of their limitations in concept-formation and related skills, they often fail to achieve the required insight(s). Instead, they tend to "fall back" on their relatively well-developed verbal skills. For example, they tend to engage in very repetitive, monotonous verbal descriptions of their adaptive problems. (It may be of interest to note that it is this type of descriptions that often befuddle--end even annoy--persons with whom they deal in their everyday lives.)

Bottom line: They either continue in psychotherapy for many years, or are seen as "untreatable" and therapy is discontinued. In either case, insight is not achieved, and the psychotherapy is deemed a failure. For the vast majority of persons with NLD who participate in such therapy, the experience is a complete waste of time and economic resources. For many of these persons, the therapy can be shown to be counterproductive, especially when the time, effort, and resources expended could have been put to much better use in forms of therapy (e.g., some types of the cognitive-behavioural variety) that are much more likely to achieve positive results. As pointed out in Questions 21 and 22, the predominant needs for most persons with NLD are usually in the area of skills learning that will prepare them to deal with their problems in adaptation. Stressing the need for (unattainable) insight as an alternative to learning and practicing necessary skills is tantamount to the counterproductive spinning of one's (psychic) wheels.

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