full text of this book has been removed due to copyright
infringement as requested by Greenwood Publishing Group. 17/07/01
The author of the book Dr Martin Kantor has however generously agreed to write an overview of his book for use on this website, and that overview is reproduced below.
My sincere thanks to Dr Kantor and the acquisitions editor for psychology at Greenwood Publishing Group for their understanding and assistance. T.L. Jones 24/07/01
A GUIDE TO AVOIDANCE AND
AVOIDANT PERSONALITY DISORDER
Let us not
forget that the motives behind human actions are usually
complicated and various than we assume them to be in our subsequent explanations . . .
- Dostoyevsky, The Idiot
PART I DESCRIPTION AND DYNAMICS
1. Why Has Avoidant Personality Disorder Received so Little Attention?
2. The Literature
3. Descriptive Mental Status
4. Dynamics of Avoidance
5. Late APD
6. Preferential Avoidance
7. Avoidant People
8. Sociocultural Manifestations
PART II THE CONTRIBUTION OF
AVOIDANCE TO OTHER DISORDERS
9. Psychotic Spectrum Avoidance
10. Neurotic Spectrum Avoidance
11. Characterological Spectrum Avoidance
PART III THERAPY
12. Features of Avoidance Reduction
13. Establishing Goals
14. Specific Techniques of Avoidance Reduction
15. Therapeutic Errors
16. Direct Advice to the Avoidant
MARTIN KANTOR is a psychiatrist on the staff of the Department of Veterans Affairs Medical Center, East Orange, New Jersey. He is the author of The Human Dimension of Depression (Praeger, 1992), Diagnosis and Treatment of the Personality Disorders (1992), Problems and Solutions: A Guide to Psychotherapy for the Beginning Psychotherapist (Praeger, 1990), and Determining Mental Status: The "Physical Examination" of Psychiatry (1988).
OVERVIEW OF DISTANCING
BY MARTIN KANTOR ( July 2001 )
My book, Distancing, A Guide to Avoidance and Avoidant
Personality Disorder, is written not only for mental health
workers but also for the avoidant him- or herself who might find
some of the material in it useful for self-therapy. It has two
goals. The first is to provide a fresh, in-depth look at
avoidance and Avoidant Personality Disorder. (As I go on to
explain, people with Avoidant Personality Disorder are always
avoidant, but, since avoidance is an important characteristic of
a number of diverse behaviors, avoidants don't always have an
Avoidant Personality Disorder). The second is to evolve a
dedicated, eclectic, action-oriented therapeutic approach to the
avoidant patient and the patient with Avoidant Personality
Disorder. My therapeutic orientation derives from Lorna Smith
Benjamin's Reconstructive Learning therapy, where the therapist,
willing to do anything that works, uses a number of techniques
simultaneously or consecutively. The more active aspects of the
different therapeutic modalities are emphasized over the more
passive aspects. Therefore while understanding is important, to
get better avoidants have to do more than think; they have to do.
In chapter 1 I note that Avoidant Personality Disorder, or APD, is the stepchild or orphan of the personality disorders and suggest some reasons why this might be so. For one thing, avoidants, being inherently shy, tend to stay away from therapy and so are rarely observed by professionals. For another thing, APD can resemble and present clinically as another personality disorder, such as schizoid personality disorder.
In Chapter 2 I discuss the literature on avoidance and APD. There is a great deal written about the subject by authors ranging from Freud to Millon, but it tends to be missed because it isn't tagged. I present a review of the classic and self-help literature, both of which are loaded with good but unmarked descriptions of avoidance and APD. For example Kretschmer describes a sensitive type distinguished by a brooding, anxious, restricted and unconfident behavioral style, while Sheldon describes cerebrotonia which he defines as a tendency toward restraint, self-consciousness, introversion, social awkwardness, and a desire for solitude.
In Chapter 3 I present a descriptive Mental Status of avoidance and APD. I describe what avoidant people look like, how they speak, think, and behave, the kinds of moods they tend to have, the level of insight they achieve and present with, and their social judgment-a parameter which is often markedly affected by the avoidant process. In this section I begin my discussion of a little-recognized aspect of avoidance, something I emphasize throughout-the degree to which their hostility interferes with the ability to relate socially.
In Chapter 4 I focus on the dynamics of avoidance, that is, I discuss how avoidants got that way and what keeps them avoidant. I give a range of dynamics derived from different schools of thought since I believe that to understand avoidance and APD through and through we have to look at it from more than one perspective. Some people learn to be avoidant. Others become avoidant as their way of resolving inner psychological conflict.
In Chapter 5 I discuss late APD-what happens to a person who is avoidant for a long time, when the avoidance eventually seriously affects his or her life. This is essentially a description of what can happen to an avoidant or a person with APD who doesn't get help in time.
In Chapter 6 I introduce the concept of preferential avoidance. Not everyone wants to be very social. Some people just want to be left alone, and they shouldn't be labeled as ill because of that. However, it's important not to rationalize and excuse problem avoidance by calling it a solution.
In Chapter 7 I discuss the avoidant people found in every day life. I describe avoidant parents, workers, and bosses so that my readers can better identify avoidance and APD when it occurs in others around them.
In Chapter 8 I discuss the sociocultural manifestations of avoidance. There are avoidant societies as well as avoidant people, and some social problems like bigotry can have their origin in personal avoidance.
In Chapters 9-11 I discuss the contribution of avoidance to other disorders. Avoidance is a key dynamic in disorders ranging from schizophrenia to Antisocial Personality Disorder. It is certainly a main contributor to social phobia, which APD resembles very closely. However, many therapists, their patients, and laymen fail to appreciate the important contribution avoidance makes not only to their daily lives but also to their psychological problems. These chapters by focusing on the avoidant component of a wide range of behaviors can help therapists, their patients, and laymen differentiate APD from other similar, overlapping disorders. Many great therapeutic tragedies have occurred when this differentiation has not been made. For example treating a schizoid patient as if he or she has APD can be disastrous if the patient is pushed too far too fast and into dangerous territory that he or she cannot successfully handle.
Chapter 12 begins the therapy section of my book. The chapters that follow are the ones that are the most obviously helpful to people desiring to use the text for self-help. However I caution you not to try to get over a problem you don't understand. In my view understanding is very close to curing, so don't skip the preliminaries. In this chapter I describe what I call "avoidance reduction," a therapeutic technique I have developed by culling relevant parts of other therapies and stitching them together into a new gestalt, or whole, creating a therapeutic approach suitable for the avoidant person. This approach is dedicated to handling the causes, complications, and consequences of distancing using techniques derived from psychoanalysis, cognitive and behavior therapy, interpersonal therapy, and other therapies that might in any way be relevant to my therapeutic goals for avoidants.
In Chapter 13 I discuss establishing goals for the avoidant. Not every avoidant will want to get to the same place in life. Not every avoidant can get to the same place in life. Each avoidant person is different, and capable of more or less in the way of connecting. One-size goals do not fit all. Nonavoidance isn't always the end point; less avoidance may be all that is possible, and quite enough.
In Chapter 14 I describe a number of specific therapeutic techniques for avoidance reduction, such as exhortation, total push, learning, and understanding (developing insight). It takes skill to combine the different therapeutic approaches into a seamless workable therapeutic plan. This chapter offers useful suggestions on what might work. It is meaningful for therapists and avoidants alike, but it is no substitute for a book on how to actually do psychotherapy with an avoidant patient/client. In Chapter 16 I give the avoidant some direct advice. This is less a complete workbook on how to get over being avoidant (I am in the process of putting one of those together) than it is a compendium of a few good ideas that I hope will lead to improvement.
Chapter 15 describes therapeutic errors. Therapists I have known have made many mistakes in treating avoidance/APD and I describe some of these in the hope that they won't be repeated. This chapter is also adaptable for use by patients and laymen who want to know what not to do when trying to help themselves or other people in their lives.