Treating Personality Disorders in Children and Adolescents

A Relational Approach

Efrain Bleiberg

September 17, 2001
ISBN 9781572306981
Price: $85.00
348 Pages
Size: 6" x 9"
February 10, 2004
ISBN 9781593850180
Price: $40.00
348 Pages
Size: 6" x 9"

This groundbreaking volume presents a framework for understanding personality disorders in children, distinguishing them from more frequently diagnosed problems, and delivering effective interventions. Efrain Bleiberg draws on extensive clinical experience and cutting-edge neurobiological research to illuminate how specific personality disorders develop when children—and caregivers—become trapped in rigid, maladaptive patterns of feeling, coping, and relating. Strategies are described for integrating individual psychotherapy, family treatment, and pharmacotherapy to provide meaningful help to this highly challenging population. With particular attention to building and maintaining a strong therapeutic alliance, the book includes case vignettes and transcripts that bring each stage of treatment to life.

Winner—Gradiva Award, National Association for the Advancement of Psychoanalysis

“A feast of ideas and possibilities....Any therapist who works with children with serious problems...will be enriched by reading it.”

Psychologist-Psychoanalyst APA Division 39 Newsletter

“This excellent book provides insight into the formation of personality disorders in children. It is useful for the clinician, providing techniques to use in therapy to help the child or adolescent develop meaningful relationships.”

Doody's Electronic Journal

“Bleiberg has produced a brilliant, comprehensive, and genuinely innovative work. Presenting an integrated framework for treatment of a complex population of young people, this book retains the most important aspects of the old while presenting exhilarating new perspectives and powerful technical innovations. It offers a rare combination of originality, breadth, conceptual coherence, and clinical wisdom. An immensely valuable and lasting contribution.”

—Peter Fonagy, PhD, FBA, University of London and The Menninger Clinic

“Drawing on the clinical wisdom of psychoanalysis, and blending it with current progress in developmental science, this book reminds us that personality can become disordered at a very early age, with devastating consequences. Treatment requires the skillful blending of a multiplicity of intervention approaches, centered on the therapeutic relationship. This book demonstrates—in the best Menninger tradition—how we can approach such problems effectively from a modern developmental perspective.”

—Hans Steiner, MD, Stanford University School of Medicine

“This rewarding text offers practical strategies for clinical work with children and adolescents imprisoned by severe personality disturbances. Bleiberg provides a unique synthesis and application of current thinking about development and interpersonal relationships, incorporating attachment research as well as exciting recent neurobiological findings. In doing so, he lays the foundations for psychotherapeutic and psychopharmacological interventions that can help young people achieve a more reflective and interpersonally rewarding way of living. The book is comprehensive in its discussion of the phases of treatment, and offers insightful perspectives on crucial countertransference issues. Bleiberg has made an important contribution to theory and practice. I highly recommend this book.”

—Daniel J. Siegel, MD, Department of Psychiatry, UCLA School of Medicine

Table of Contents

1. Introduction

2. Attachment and Reflective Function

3. Psychological Organization and the World of Mental Representations

4. Trauma, Vulnerability, and the Development of Severe Personality Disorders

5. Antisocial and Narcissistic Children and Adolescents

6. Histrionic and Borderline Children and Adolescents

7. Beginning Treatment: Creating a Secure Base and a Representational Mismatch

8. Early Stages of Treatment: Forming the Alliance and Enhancing Reflective Function

9. Middle and Late Stages of Treatment: Using Connection to Move toward Integration

10. Residential Treatment and the Continuum of Services

11. Pharmacological Treatment

About the Author

Efrain Bleiberg, MD, is currently Professor and Vice Chairman, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, and Director of the Department's Division of Child and Adolescent Psychiatry. He is also Medical Director of the Menninger Clinic's Professionals in Crisis program and Training and Supervising Psychoanalyst at the Houston-Galveston Institute of Psychoanalysis.


Clinical psychologists, psychiatrists, social workers, and other clinicians working with children and adolescents; researchers, students, and trainees in these fields.

Course Use

May serve as a text in graduate-level courses.