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Rating: 
Summary: Dr Kantor does it again!
Review: I have been an avid fan of the work of Dr. Martin Kantor for quite some time now. This book, Distancing:Avoidant Personality Disorder is one of my favorites of all time, because it not only deals with the obvious factors surrounding the avoidant personality, but it also digs deeper into the more subtle, oft neglected aspects of this malady such as the formation of unstable relationships that are not necessarily due to shyness or fear of social situations, but rather may be simply byproducts of a fear of intimacy and commitment. Dr. Kantor is brilliant in his conversational style . He offers substance for the practicing therapist; help and hope for the patient; and support for the victims of those who suffer from Avoidant Personality Disorder, and who are distressed because they believe they must be doing something wrong. This book should be read by everyone--by those in the mental health profession, by those who suffer from the disorder to varying degrees, and by the rest of us who most likely either know someone, or have had someone in our lives at one time or another who made us miserable by their inability to get close. An indispensable book!
Rating: 
Summary: The problem with Kantor's book
Review: I personally was extremely dissatisfied with this book. I'm a Psychology major preparing to go to graduate school for my PhD in Clinical Psychology. Since personality disorders are my preferred area of research, I bought the book to get a better understanding of the disorder.
I found his description of those with AvPD to be condemning and denigrating. He often used blanket statements such as "'Grandiose narcissistic hypomanic avoidants are selfish people" and really did very little to empathize or even explain the behavior, just made character judgements and then attributed it to the disorder.
His vignettes,also, seemed to lack any real basis. He described behavior which, while unpleasant or problematic, would not warrant as severe a diagnosis as that of a personality disorder. Although I agree with him that the dsm criteria of personality disorders has some problems with it, he didn't convincingly tie in his conceptualization of the disorder with any research.
I thought that much of his book would be more applicable to dealing with an avoidant attachment style than an avoidant personality disorder and while some of his vignettes could be tied in with the disorder, he also included many relationship issues which, while problematic, could hardly be called pathological.
While I agree that the friends and loved ones of those with a personality disorder also need support and compassion, using the categorization of a personality disorder as a pejorative helps no one.
Rating:
Summary: The Misunderstood, Excrutiating APD
Review: Martin Kantor is a psychiatrist on the staff of the Department of Veterans Affairs Medical Center in East Orange, New Jersey, and has elsewhere written a summary of Distancing reproduced (and lightly edited) here:APD has to date been a misunderstood and neglected entity -- either entirely ignored or confused with another disorder, such as Social Phobia. The purpose of my revised Distancing is to broaden our dynamic understanding of APD, to describe, understand and treat all avoidants, not just those who are shy and social phobic, and to develop a new therapeutic approach to avoidance, one I call Avoidance Reduction. This is an eclectic method for treating avoidants composed of relevant techniques borrowed from psychoanalytic, cognitive behavioral, interpersonal, existential and supportive therapies. Many clinicians fail to recognize APD, instead diagnosing Social Phobia. Those who do recognize APD emphasize shyness and Social Phobia as its main features. However, these are not basic to all patients with APD. What is basic to APD is not shyness or Social Phobia but a severe and pervasive social and relationship anxiety displayed in a variety of ways. Therefore, there are not one but four subtypes of APD, each of which requires a different psychotherapeutic approach. Type I avoidants, the classic avoidants, are withdrawn. There are two subtypes of withdrawn avoidants. The first is the shy individual who cannot seem to tolerate, flinches in the face of, and pulls back from any form of social contact. The second suffers from a Social Phobia, which is a delimited pull back from a situation or event that symbolizes relationships, for example, from public speaking or eating in public. Though shy and social phobic avoidants are the main and virtually exclusive focus of today's scientific literature, these avoidants may not even be in a majority, but may represent only the tip of the avoidant iceberg. Types II and III avoidants, almost entirely ignored by the literature, also suffer from relationship anxiety -- but their relationship anxiety takes the form not of shyness or Social Phobia but of unstable relationships due to a fear of commitment. Type II avoidants shift from relationship to relationship afraid of closeness due to a fear of commitment ("mingle" avoidants such as the perpetual bachelor or femme fatale). They are therefore the opposite of withdrawn. These are hyperrelated individuals who can relate easily, widely and well but have difficulty sustaining the relationships they form. Theirs are unstable relationships, marked by a tendency to abandon relationships before they fully develop, especially when closeness threatens and commitment looms. Type III avoidants form lasting relationships only to disrupt them after months or years of apparent functionality. These are what I call the "seven year itch" avoidants who form what appear to be solid relationships -- only to tire of them after a shorter or longer period of time, then leave them with little warning. That is, they abandon their relationships after some time has passed, and they often do so suddenly and without warning. Type IV avoidants hide out in a codependent relationship with one person to avoid having healthy relationships with many people. They sink into one relationship to avoid all others. Some are dependent on their family. Others are dependent on a lover with whom they form a merger relationship that protects them from the anxiety associated with relationships outside of the primary relationship. These are all patients with APD. Their dynamics are remarkably similar. They all require Avoidance Reduction. However, the significant differences in the ways they manifest their avoidance require a different therapeutic emphasis in each case. For example, while exposure techniques may prove useful for Type I shy and social phobic avoidants, they will likely be ineffective for Type II avoidants with a commitment phobia, who are more likely to benefit from insight oriented and cognitive therapy. Effective treatment of APD requires a devoted approach dedicated to reversing the underlying relationship anxiety via Avoidance Reduction. It will be applicable to reduction of avoidance in all its forms. Avoidance Reduction should focus not only on fear of criticism (the official dynamic explanation of avoidance) but also on the equally important fears of flooding, depletion, and acceptance. Avoidants are not simply afraid of criticism and humiliation -- the only reason for avoidance currently identified in the official literature. They are also afraid of being flooded by feelings they cannot tolerate, and of being depleted should they express these feelings. Most importantly, they fear acceptance as much as they fear rejection because they fear losing their identity and personal freedom. In practice, Avoidance Reduction involves a pastiche of familiar psychotherapeutic approaches in use today, including psychodynamic, cognitive behavioral, interpersonal, and supportive approaches, selected elements of which are combined for a synergistic effect. My book is for psychotherapists who will be better able to identify, understand and manage APD from the detailed clinical descriptions, illustrative clinical vignettes (including those from real life) and thorough exploration of the psychodynamic, cognitive and interpersonal dynamics of the disorder. It is also for victims of avoidants who can learn to better manage the people in their lives who snub and otherwise neglect or exploit them. It is a self help manual for avoidants themselves, for individuals attempting to surmount their relationship anxiety and form close, satisfying, meaningful relationships with others without inordinate fear and regret.
Rating:
Summary: APD: Character or Personality Disorder?
Review: Martin Kantor is a psychiatrist on the staff of the Department of Veterans Affairs Medical Center in East Orange, New Jersey, and has elsewhere written the following summary of Distancing reproduced (and lightly edited) here:
~~~
APD has to date been a misunderstood and neglected entity -- either entirely ignored or confused with another disorder, such as Social Phobia. The purpose of my revised Distancing is to broaden our dynamic understanding of APD, to describe, understand and treat all avoidants, not just those who are shy and social phobic, and to develop a new therapeutic approach to avoidance, one I call Avoidance Reduction.
This is an eclectic method for treating avoidants composed of relevant techniques borrowed from psychoanalytic, cognitive behavioral, interpersonal, existential and supportive therapies. Many clinicians fail to recognize APD, instead diagnosing Social Phobia. Those who do recognize APD emphasize shyness and Social Phobia as its main features. However, these are not basic to all patients with APD. What is basic to APD is not shyness or Social Phobia but a severe and pervasive social and relationship anxiety displayed in a variety of ways. Therefore, there are not one but four subtypes of APD, each of which requires a different psychotherapeutic approach.
Type I avoidants, the classic avoidants, are withdrawn. There are two subtypes of withdrawn avoidants. The first is the shy individual who cannot seem to tolerate, flinches in the face of, and pulls back from any form of social contact. The second suffers from a Social Phobia, which is a delimited pull back from a situation or event that symbolizes relationships, for example, from public speaking or eating in public. Though shy and social phobic avoidants are the main and virtually exclusive focus of today's scientific literature, these avoidants may not even be in a majority, but may represent only the tip of the avoidant iceberg.
Types II and III avoidants, almost entirely ignored by the literature, also suffer from relationship anxiety -- but their relationship anxiety takes the form not of shyness or Social Phobia but of unstable relationships due to a fear of commitment. Type II avoidants shift from relationship to relationship afraid of closeness due to a fear of commitment ("mingle" avoidants such as the perpetual bachelor or femme fatale). They are therefore the opposite of withdrawn. These are hyperrelated individuals who can relate easily, widely and well but have difficulty sustaining the relationships they form. Theirs are unstable relationships, marked by a tendency to abandon relationships before they fully develop, especially when closeness threatens and commitment looms. Type III avoidants form lasting relationships only to disrupt them after months or years of apparent functionality. These are what I call the "seven year itch" avoidants who form what appear to be solid relationships -- only to tire of them after a shorter or longer period of time, then leave them with little warning. That is, they abandon their relationships after some time has passed, and they often do so suddenly and without warning.
Type IV avoidants hide out in a codependent relationship with one person to avoid having healthy relationships with many people. They sink into one relationship to avoid all others. Some are dependent on their family. Others are dependent on a lover with whom they form a merger relationship that protects them from the anxiety associated with relationships outside of the primary relationship.
These are all patients with APD. Their dynamics are remarkably similar. They all require Avoidance Reduction. However, the significant differences in the ways they manifest their avoidance require a different therapeutic emphasis in each case. For example, while exposure techniques may prove useful for Type I shy and social phobic avoidants, they will likely be ineffective for Type II avoidants with a commitment phobia, who are more likely to benefit from insight oriented and cognitive therapy. Effective treatment of APD requires a devoted approach dedicated to reversing the underlying relationship anxiety via Avoidance Reduction. It will be applicable to reduction of avoidance in all its forms.
Avoidance Reduction should focus not only on fear of criticism (the official dynamic explanation of avoidance) but also on the equally important fears of flooding, depletion, and acceptance. Avoidants are not simply afraid of criticism and humiliation -- the only reason for avoidance currently identified in the official literature. They are also afraid of being flooded by feelings they cannot tolerate, and of being depleted should they express these feelings. Most importantly, they fear acceptance as much as they fear rejection because they fear losing their identity and personal freedom.
In practice, Avoidance Reduction involves a pastiche of familiar psychotherapeutic approaches in use today, including psychodynamic, cognitive behavioral, interpersonal, and supportive approaches, selected elements of which are combined for a synergistic effect.
My book is for psychotherapists who will be better able to identify, understand and manage APD from the detailed clinical descriptions, illustrative clinical vignettes (including those from real life) and thorough exploration of the psychodynamic, cognitive and interpersonal dynamics of the disorder.
It is also for victims of avoidants who can learn to better manage the people in their lives who snub and otherwise neglect or exploit them.
It is a self help manual for avoidants themselves, for individuals attempting to surmount their relationship anxiety and form close, satisfying, meaningful relationships with others without inordinate fear and regret.
~~~
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