Evolutionary Systems Therapy for Personality Pathology

Evolutionary Systems Therapy is a novel form of psychotherapy defined by three distinctive features: (i) the understanding of patient functioning is informed by the theory of evolution; (ii) the origin of both psychopathology and mental health is assumed to be relational; (iii) clinical practice is integrative, with a primary focus on interventions useful for navigating relational complexity. Findings on the clinical utility of this therapy are specific to personality pathology and are promising to date, although still limited to small sample sizes. This chapter presents the three levels of conceptualization used as well as the treatment structure. The case conceptualization aims to help the clinician distinguish a basic personality organization from a maladaptive structure emerging from persistent failures to adapt to social environments. Subsequently, the most prominent traits are explored, intersecting an ontogenetic and phylogenetic understanding of how these traits channel experience in a patient's interpersonal situations. To assist the clinician, three recurring interpersonal styles have been identified, corresponding to the three super-spectra commonly described in modern psychopathology. Finally, the intervention is organized into four modules that are not rigid compounds, but rather priority targets that guide the work both in a single session and throughout the course of therapy.