Context-Oriented Model Development in Psychotherapy Planning (‘COMEPP’): a useful adjunct to diagnosis and therapy of severe personality disorders


Melitta Fischer-Kern, Department of Psychoanalysis and Psychotherapy, University Hospital of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria.


Objective:  Pathogenous interpersonal (e.g. interfamilial) relationships and reference styles can compromise treatment efforts in severely disturbed (i.e. psychotic or borderline) patients. The integration of family- and individual-centred starting points may be useful in establishing interdisciplinary treatment concepts in these patients. Context-Oriented Model Development in Psychotherapy Planning (COMEPP) represents a diagnostic and therapy planning process, integrating both systemic and psychoanalytic conceptualizations.

Method:  COMEPP is exemplified by the case of a young man with psychotic personality disorder who had previously been unresponsive to pharmacological and psychological treatment.

Results:  After psycho-dynamical conflicts (i.e. primitive projective processes from the patient's mother to her son) had been elucidated during the COMEPP process, a sufficient treatment setting could be established.

Conclusion:  COMEPP provides a psychotherapeutical approach to treatment planning on case-specific premises and may serve as an adjunct to concomitant pharmacological and psychological treatment strategies in so-called ‘therapy refractory’ patients.