Understanding the Function and Effective Interventions for Cluster B Personality Disorder Symptoms
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Understanding the Function and Effective Interventions for Cluster B Personality Disorder Symptoms

Hi everybody and welcome to today’s
presentation on strengths based biopsychosocial approach to recovery
from personality disorders. Now a lot of times personality disorders kind of get
a bad rap because they are perceived to be intractable or untreatable, and in
this presentation I really want to look at some of the characteristics of
personality disorders in ways they can be modified. Will people always have
those behaviors available to them in the back of their head certainly but can we
help them develop new healthier behaviors I do believe so so over the
next 45 minutes or an hour we’re going to review the characteristics of cluster
B personality disorders and this is the cluster that’s characterized with
narcissistic antisocial borderline and histrionic Personality Disorder z’ will
explore the functions of the symptoms for people identify what may cause these
symptoms to develop explore what’s maintaining these symptoms that is
what’s the benefit because we know we don’t do things unless there’s the
benefit and explore the effects of these symptoms on significant others finally
we’ll identify interventions to help the person more effectively manage emotions
and relationships so your first step is really going to be to address the
emotional and/or behavioral disk control if someone is infringing upon the rights
of others hurting other people or hurting themselves they’re not going to
be able to engage in treatment right now we need to get that under control so the
first thing we need to identify is what are some of the vulnerabilities when you
feel more impulsive when you feel more emotional when you feel more scared what
types of things are going on that kind of prompt you to feel that way sometimes
it’s not getting enough sleep sometimes too much stress at home maybe it is
upcoming holidays everybody has different vulnerabilities but we need to
know what’s going to make you more likely to become emotional or act out
then we’ll identify what works to help the person self soothe when they have
experienced these situations in the past what have they done that has worked to
help them not hurt themselves or someone else then we’ll identify some helpful
distraction techniques things that they can do while they’re trying to figure
out what to do next we’ll take all this and put it together in a written safety
plan and I really want to emphasize written because if someone is in a very
emotional or wound-up state and they’re at risk of emotional or behavioral this
control or acting out they’re not thinking what was it that I talked about
with my therapist last week they’re just thinking they need the pain to stop so
you want to write the safety plan down so they can refer to it hopefully we can
help them develop enough self-awareness that they can stop pull out the safety
plan and go okay what do I need to do the next step is that when we start
identifying the salient symptoms their function and alternate ways to meet that
need like I said these behaviors have a purpose they’re serving a purpose for
the person and we need to figure out what that is so we can help them either
change the way they feel about the situation or change the situation in a
healthier way we need to find out what it looks like for different people
for example being dramatic being dramatic looks different for different
people some people may get loud and aggressive
some people may play the damsel in distress what does it look like for your
particular client then look at how the behavior is being maintained when they
do act out when they do engage in this behavior that’s theoretically
dysfunctional what are the rewards what do they get out of it because there’s
something and we can figure out different ways to meet that need or to
quell that need in the treatment process so we’re going to start out talking
about generalities there are four core features of personality disorders rigid
and extreme and distorted thinking patterns so in therapy when you are in
counseling 101 you learned about cognitions and cognitive
or shion’s and all that kind of stuff well take that and intensify it times 10
problematic emotional response patterns when people start to have these
distorted ways of thinking they get upset but since their thinking patterns
are so distorted times 10 then the emotional response seems to mirror that
and their emotional response seems to be excessive or times 10 when they’re that
upset when they’re that emotional when they’re that scared when they’re that
angry they need to make the pain stop which is where our impulses come in this
impulse control problem the person needs to make it stop and they’re going to
start probably sort of flailing to try to figure out how to make that stop
sometimes its self injurious sometimes it’s entering others sometimes it is
using addictions in order to numb the pain but this impulse control is
generally or this impulsive behavior is generally used to quell the fear and the
negative thoughts that are flooding this person’s mind when you behave that way
when everything is extreme when everything you think is times 10 when
your reactions are times 10 it can make it more difficult for people to be in
relationships with you when they see something happening and it’s a 1 on
their scale and you’re acting like it’s a 10 they can get very confused so we
understand that all of these kind of inter relate and as a matter of figuring
out where the person is motivated to start pulling the strings cluster B
which is what we’re going to talk about today is considered the dramatic
emotional and erratic cluster people in this cluster tend to have a whole lot
more difficulty managing their emotions managing their thought patterns and they
act out in a way to try to make the behavior stop whether that’s controlling
you or controlling themselves so borderline we’re going to go through
each of these and kind of talk about them a little bit if somebody has
borderline personality disorder traits and I emphasize traits because a lot of
us you know just about every has some personality traits that may fit
here now we’ve got to remember that when we’re diagnosing a personality disorder
this is a pervasive method of interacting with people that goes over
time and in multiple situations and causes clinically significant distress
or impairment in functioning okay so that being said even if your patient
does not meet the criteria for a borderline diagnosis a lot of these
traits we’re going to talk about are common among people so if it’s bothering
them if it’s causing them a problem let’s like let’s work on it
instead of saying well it doesn’t meet the criteria for a disorder so you know
you’ll be fine now let’s help them work on it before it
becomes a problem so borderline disparar is one of the acronyms that can be used
to help remember some of the characteristics for borderline
personality disorder one of the hallmark characteristics for not only borderline
but this whole category is disturbance of identity people with borderline
personality disorder don’t have a sense of self at all they don’t know who they
are they exist exclusively based on what they are to other people so they are a
spouse they are a daughter they are an employee they are something else
so when that threatens to go away they don’t have anything to replace it with
they can’t say well I’m a good person they’re like well if I’m not a mother
anymore what am i if my children move out and they don’t need me anymore then
my life is kind of over and we want to help them address those cognitive
distortions so this disturbance of identity lack of not only a self-esteem
but lack of self-concept they don’t know who they are what does it look like a
lot of times people with low self-concept or no self-concept will
tend to define themselves based on their roles based on what they do for other
people and based on what they think you want them to be they’re chameleons
a lot of times this develops because they grew up in households where it
wasn’t safe to have their own opinions it wasn’t safe to develop a personal
identity it was controlled by the addict the borderline the person with
depression whatever was going on in that household the child was not able to
develop a sense of self safely they had to be whatever they were expected to be
by other people what’s maintaining it now well if they
haven’t ever learned who they are or developed a sense of who they are then
you know they’ve got to know that they’re missing it before they can start
to develop it remember that personality disorders are
ego-syntonic that means the person doesn’t realize it’s not normal if you
want to use that word to feel this way one of the things we can help people
identify as they go through treatment is kind of what is underlying their
emotional reactions disturbance of identity will come up a lot with your
your cluster B characteristics emotionally all over the place people
who are empty inside who don’t know who they are it’s scary
it is terrifying to think that they may lose part of themself they are afraid of
being abandoned they are afraid of basically disappearing because they are
not somebody’s something so whenever they perceive the slightest hint of
disapproval criticism or rejection they respond with that times 10 and to use a
clinical term they freak the freak out it is just not even fathomable to expect
that they’ll be able to exist if they get rejected so then they start
frantically trying to hold on to somebody when this happens the
relationship becomes very tenuous because the person with borderline
personality traits may start to act out they start to get very angry
to try to bully or control the other person because they’re so afraid of
being abandoned the person in the relationship with the client or the
person with borderline traits doesn’t understand what’s going on it’s like why
are you getting all worked up over this it wasn’t a big deal
which creates a miscommunication the person in the relationship starts
feeling like they have to walk on eggshells because they don’t know what
is going to set off their significant other and they know that if they set
them off even with the slightest hint of anything that is not going to be an
irritation or you know a momentary sadness or whatever it’s going to be a
complete episode of rage or terror or crying or pleading it’s exhausting
they also know that when a person with borderline characteristics they have no
internal identity they fear being abandoned in order to keep you and this
is one of our sort of trademarks of BPD as opposed to other personality
disorders in this cluster when they’re afraid of being abandoned a lot of times
they will act out in self injurious ways in order to communicate partly to numb
their own internal pain and distress and everything that’s going on because
they’re focusing on managing the physical pain so they can’t focus on the
inter psychic pain but it also is a way of manipulating other people because
it’s either look what you made me do and if you would have just done what I asked
you to do I wouldn’t have had to hurt myself so this is your fault so I’m
going to use that guilt and I’m going to work on it they can also use it in a way
of saying I can’t take care of myself I need you here to take care of me
neither is really functional in an adult relationship paranoia or dissociation
again in this situation these people tend to be very hyper vigilant they are
aware of the slightest look that says I disapprove or the slightest
or the slightest action which tends to make them you know we call it hyper
vigilant sometimes it’s called paranoia because everything is perceived through
and abandonment lens so anytime you do anything it’s going to be taken
personally you can see some of these or hear some of these cognitive distortions
coming out now personalization all-or-nothing thinking abandonment they
are constantly waiting to be abandoned they don’t feel worthy of love because
they don’t even know who they are they don’t love themselves and they’ve never
probably been loved for who they are so there’s this fear of abandonment which
again if my role goes away if I’m not your girlfriend anymore I’m
not your wife anymore then part of me dies because I don’t have a me I exist
purely as a conglomeration of roles impulsive we talked about it earlier
when the thoughts are so extreme and so fast and so negative and the emotions
follow at a certain point a person has to make it stop it’s just it’s
overwhelming and it’s oppressive which often results in impulsive behaviors
just finally make it stop I can’t do it any more relationships are going to be
unstable even if somebody understands what’s going on it’s very difficult to
be in a relationship with somebody with borderline traits because they are so
all over the place cognitively and emotionally and there’s always this
worry that they’re going to hurt themselves you’ve got to keep your own
guilt in check so there are a lot of boundary issues with a person with
borderline personality disorder and a lot of guilt so people in relationships
with people who have borderline personality tend to be the type that
want to rescue if they stay in this relationship so then we need to look at
some of those boundary issues and what need the borderlines behaviors are
filling for the significant other feelings of emptiness well if you don’t
know who you are if you’ve never been loved
for who you are only appreciated for what you do I can see where you might
feel empty inside you might not have a feeling of satisfaction because you’re
always afraid you’re not going to be good enough and you’re always afraid
that you’re going to be abandoned which can lead to inappropriate rage remember
I said times 10 when most of us face a threat to our self-esteem to our person
to whatever the body sends out a fight-or-flight reaction and we either
hit the fear which says you need to get out of there or the fight which says you
need to conquer this you can do it it’s not worry and irritation for the person
with borderline it is always just overwhelming anxiety or rage again this
is exhausting not only for the people that are in relationships the
significant others of the person with borderline personality but for the
person with borderline personality imagine being in your own head or
there’s this constant fear this constant battle that’s constant not feeling good
enough and frequent bouts of rage at others for potentially abandoning you
because that’s terrifying and it yourself for not being good enough if
you can put yourself in their head you can kind of understand where these
behaviors might come from now the key is figuring out what to do with them
the first step and we’re going to talk about this towards the end of the
presentation is to help the person develop a stable sense of self who are
they apart from their roles who are they
distress tolerance and coping skills and develop a support system that
understands how they react and can help them navigate through the initial phase
of distress people with histrionic Personality Disorder HPD the the
mnemonic that you can use to remember this is praise
provocative or seductive behavior instead of the self injurious acting out
behavior that you see in borderline personality in histrionic personality
you see someone who is going to be overly sexual overtly sexual one example
you might think of is Jessica Rabbit from who framed Robert Roger Rabbit
she was overly sexual and she controlled people using her sexuality relationships
with the person with histrionic Personality are considered more intimate
than they actually are this person will meet you and within 30
minutes be telling you their deepest darkest secrets and you’re going to be
best as best as friends forever and ever normal relationships don’t develop that
quickly if you meet somebody who has this complete absence of boundaries and
just automatically clings on to you it’s a pretty good guess
that there are some histrionic traits there the person with histrionic
Personality Disorder also doesn’t have a good sense of self they have been
approved of or learned to manipulate people or whatever you want to say
through sexual and seductive behavior they don’t know who they are so they
look to others for external reinforcement to tell them that they’re
okay they want to be your best friend they need to be your best friend because
they need to be validated which leads to the attention-seeking they need to be
constantly reminded or reinforced that they are your best friend your bestest
friend and you’re not going anywhere they need to be the center of attention
and this can be very dramatic this can be very kind of over-the-top sometimes
because they need to be the center of attention it can be negative or positive
they can start a shouting match in the middle of the mall or they can be being
extremely seductive at a party whatever is going to get them the most attention
at the time they’re influenced easily by others or circumstances
just like the BPD and others in this cluster the person with HPD needs to be
validated externally because they don’t know who they are they don’t know what
they’re good at they don’t know what you know they don’t have a good sense of
self and they don’t have a good self-esteem so they are going to jump on
the popularity bandwagon whatever happens to be the most popular they’re
going to do which means other people may have difficulty trusting them if
circumstances change this person’s whims may change with the circumstances you
never know what this person is going to do from moment to moment it’s always
very dramatic and it’s always very grandiose they use a speech style to
impress that lacks detail and one of the best examples I can give of this is if
you’ve ever listened to a politician on the campaign trail they will make these
just glorious grandiose campaign promises but they never tell you how
they’re going to do it I’m going to reduce taxes well score that’s what we
want how are you going to do it Oh we’ll get to that later person people
with histrionic Personality Disorder do the same thing they will tell you that
they are going to start a company that they are going to do something huge and
impressive but they won’t have all the details worked out again you have some
emotional lability shallowness their emotions switch depending on what is
going to give them the most attention they can be sad they can be angry they
can be fearful their emotions are general generally not genuine they are a
production they are a facade that this person is putting on not because they
are intentionally trying to they’re going oh what’s going to get me the most
attention but because this has been reinforced in their life
they have learned to use emotional displays and dramatic displays in order
to divert attention from something that’s bad
or to get attention and be reinforced be taken care of be called by the people
that they care about now we’re going to switch gears a little bit because
antisocial and narcissistic are different in many many ways than
borderline and histrionic borderline and histrionic have no stable sense of self
and they’re desperate for external validation antisocial and narcissistic
don’t have exactly those same traits people with antisocial personality
disorder have difficulty conforming to the law they have difficulty respecting
others needs wants you know preferences they will steal from you just as soon as
they will look at you they are determined to satisfy their own needs
because they want to complete lack of empathy obligations are often ignored
unless it suits them there’s a reckless disregard for the safety of themselves
or others again they’re going to do what they want to do because it suits them at
the time and they don’t think about how it may impact other people they only
think about satisfying their own wants needs and desires immediately they have
an inability to feel remorse or empathy for other people they don’t feel bad
about what they do if they get caught and they seem to feel bad it’s probably
that they feel bad that they got caught not because they hurt somebody else they
tend to be deceitful lying and manipulative because that’s what how
they get what they want from other people they don’t plan with sufficient
time they don’t say okay I want to buy a car so I’m going to need to save up
money so let me develop a plan they say I want a car I’m going to go steal one
or I want a car you will let me borrow yours if not I will just take it from
you their temper tends to be irritable and aggressive this is a person who has
no regard for your feelings the only thing that keeps them in check is
getting their own wants needs and desires met immediately and if that
doesn’t happen they throw a temper tantrum very similar if you will to a
three or four year old in the middle of the cereal aisle wanting some super
sugary cereal and not getting their own way now I don’t expect a three or four
year old to plan and to conform to social norms and yada yada this is
something they have to learn a 34 year old on the other hand should know better
what are the benefits to this I think I’ve said them repeatedly this person
gets their needs met all the time and they don’t care whether other people
like them or not which is another key difference between histrionic borderline
and antisocial they are all about being their own best friend and making
themselves happy now a lot of times they also have an unstable self-concept
which is why they’ve put up these walls and said I don’t need anybody I can make
my own self happy thank you very much everybody I’ve ever trusted has let me
down everybody I’ve ever cared about has betrayed me so you know screw y’all I’m
going to do what I’m going to do for me because everybody else has always done
that to me at all or nothing thinking again and finally people with
narcissistic personality disorder think that they’re special and the mnemonic
special represents the characteristics of NPD they believe that they are unique
and this research has shown lately is not a way of covering up a lack of
self-esteem they truly believe that they are all that a bag of chips and a soda
to boot they’re preoccupied with and they use the term fantasies a lot in a
literature in this person’s mind is not a fantasy they’re preoccupied with
delusions if you will of unlimited success power brilliance beauty or ideal
they think they’re all that put yourself in the mind of somebody who is just the
best thing since sliced bread they feel entitled they feel entitled for you to
worship them they do need approval all the time similar to people with for
example histrionic personality who need to be the center of attention all the
time the person with narcissism needs to be revered all the time so they will
seek positions they will seek situations where people have to admire them they
are not above interpersonal exploitation if it gets them power if it gets them on
top if it gets them to be revered they’ll exploit anybody they will walk
all over them they tend to be arrogant and very self-important if you’ve had
someone with narcissism as a friend or as a client you’ll recognize some of
these because a lot of times you leave an interaction with them feeling bad
about yourself or wondering why you aren’t as successful the person with
narcissism really carries a cloud with them that they are the preeminent being
and they lack empathy they don’t really care how it makes you feel what’s most
important is how you make them feel and how you make them look a lot of people
with narcissistic personality disorder grew up in a family that communicated
these messages as a child they got the message it’s not about how you feel it’s
how you make us as the parents look so you will suck it up and you will do what
I tell you to and you will be the best at it or you will not be loved there are
some varying theories about how narcissistic personality disorder
develops and there’s a really good book called disarming the narcissist new
Harbinger publications that goes into great detail and it’s really well well
written if you want to take a look at that suffice it to say the person with
narcissism is not going to come into therapy
and say you know I’m having a real hard time getting along with other people and
I want to address some of my character defects they don’t think they have any
so this is a particularly challenging client to work with most of the time the
person with our sophistic traits or narcissistic personality disorder only
comes to counseling only comes to therapy because somebody has made them
they have given them an ultimatum you will go to counseling or I am going to
divorce you and take the kids or you will go to counseling or I’m going to
fire you so the person comes to counseling under duress and they will
present in the office like they are there’s nothing wrong with them they are
perfect and any hint of criticism or questioning that the therapist does will
be met with anger and condescension just be prepared for it because that’s how
they protect themselves because remember if they are not revered then they are
nothing and it’s very confusing to them if you don’t jump into their delusion so what do we do about it well let’s start
with the rigid extreme and distorted thinking patterns whether it’s
all-or-nothing thinking thinking that they have to be the best at everything
all the time or that you have to love them all the time or if you go away I’m
going to die these these extreme thought patterns tend to create a lot of
emotional turmoil so we need to start addressing those cognitive processing
therapy the challenging questions worksheet I love because it gives the
person multiple different avenues to challenge some of these beliefs that are
keeping them upset examine common cognitive distortions with them all or
nothing thinking if they start talking about something that made them mad made
them scared or you just wouldn’t believe what happened
keep an eye out for all-or-nothing thinking because generally it’s extreme
everybody always leaves nobody can be trusted in this case you know counsel
1:01 we’re going to start looking for exceptions the mental filter is viewing
the world through sort of colored glasses and it’s not usually not
rose-colored that we’re worried about if they perceive the world to be a scary
place then everything they see is going to reinforce that think about one time
when you got up and you’re getting ready for work and you were just in a bad mood
as you’re driving to work are you noticing the bunny that hops across the
road and the fact that it was a beautiful sunrise or are you noticing
the fact that you had to slam on brakes for that stupid rabbit and the Suns in
your eyes mental filters overgeneralization partly all-or-none
thinking but taking one instance maybe a bad relationship and saying all men are
untrustworthy or all women are untrustworthy or this will always happen
discounting the positive forgetting to focus on the things about themselves and
others that are good if my clients start talking about somebody and something
that was really really negative I say okay you know and we talk about it and I
hear their point of view but then I also ask them to find a couple of positive
things to say about it when I go home and the house is looks like a tornado
hit it it’s frustrating to me however the positive that means that my kids
were having a good time and that also means that my kids are there and having
a good time and I love my children you know
immensely so yeah is it irritating to go home and find the house looking like a
tornado hit it mm-hmm but there are positive things that I can
focus on – so it’s choosing which you focus on jumping to conclusions assuming
that just because somebody didn’t call you when they were supposed to but
they’re they’re leaving they hate you know it could be that they were stuck in
traffic or their phone died or their abilities iliyan different explanations
for the when I hear this type of cognitive
distortion I will stop my client and I will say okay that’s definitely possible
give me the facts to support it and then I want you to tell me two other possible
reasons this may have happened or this person may have acted this way let’s see
if we can look at some different perspectives once you bring in that idea
of reasonable doubt it starts to make the person think a little bit more and
helps them de-escalate some because it’s not of course this must be the answer
it’s like okay what are some possible reasons this might have happened now
true they may come back to the the worst possible answer but at least they’re
thinking about other options and eventually hopefully you can encourage
them to start thinking for their own sanity and their own health and wellness
what is the least offensive explanation for this well being careful obviously we
don’t want them to be taken advantage of and then emotional reasoning if I’m
afraid of something then it must be dangerous I’m terrified of bridges I
hate driving over bridges and there’s absolutely no logic to that at all and I
realize this so if I thought because I’m afraid to drive over bridges it must be
dangerous to drive over bridges that’s emotional Reid’s reasoning and I can
counter that by looking at facts and statistics and saying you know it’s
really not dangerous am i afraid yes so let’s look at the reasons why and you
know there are reasons why I was but bringing that to the forefront of
somebody’s mind to help them identify irrational conclusions then we want to
help them examine prior experiences which may be influencing perceptions of
current events so we can help clients challenge their schemas that’s a really
long way of saying if something happened 10 years ago with some other person and
they’re expecting every other person today to behave
that way is that realistic if something happened when they were a child that
made them feel helpless and unloved that sucks yeah but we got to deal with
that no doubt but when that same thing happens today what does that mean to
them as an adult as a person who’s able to rationalize things and provide
self-soothing is that the best way to react is that the best schema to have
and yet some people from your childhood are equally as dangerous in adulthood
but sometimes like being a bully or being bullied on the playground at
school may not be as salient today because you are an adult and likely that
same kind of bullying does not happen but if you expect it to happen then
you’re going to look for it and you’re going to look for signs and be hyper
vigilant so we want to examine prior experiences that provide negative
interpretations of today’s events rigid extreme and distorted thinking patterns
can also keep creeping back in we need to help people address faulty cognitions
that enable them to evaluate and act based on facts not feelings I talked
about that in a little a little while ago problematic emotional responses now
we’re down to feelings we talked about the thoughts let’s talk about the
feelings mindfulness to prevent vulnerabilities and become aware of
distress sooner if clients are mindful on a day-to-day basis they will realize
that there are certain things like not getting enough sleep or staying up too
late the night before or having to drive through really really heavy traffic
there are things that will put them on edge and make them more likely to
overreact or to act out or to engage in some of these dysfunctional behaviors we
also want them to become aware of distress sooner so when they feel
themselves starting to become excessively upset
they can stop it instead of letting it go all the way to a thousand they can
stop it maybe it you know seven fifty and then five
hundred we want people to be aware of themselves what are their physical
symptoms that they’re starting to get stressed what’s going on in their mind
when they’re starting to get stressed and then how do they deal with that
distress which brings us to distress tolerance skills
we can’t keep people from getting distressed it happens so my question is
when you get distressed how can you ride through it so you’re
not making decisions just based on wanting to make the distress go away
you’re making rational decisions that get you closer to where you want to be
for most people anywhere from a minute and a half to ten minutes is the time it
takes for them to kind of de-escalate enough or the Adrenaline’s not just
pumping all the way through and they can start to cognitively evaluate what’s
going on depending on your client some clients may want to start working on
dealing with their emotional responses because they feel like they’re always
angry or they’re always upset some clients may want to start dealing with
their cognitions first that is up to your client but you know what if they’re
able to calm down their emotions if they’re able to get control of their
feelings then they’re going to be better able to address the cognitive
distortions if they address the cognitive distortions first then they’re
probably not going to get so worked up so it doesn’t matter where you start
start where the client is willing to start impulse control problems if
they’re not in distress they’re much less likely to be impulsive so we want
to identify and address triggers that may contribute to someone being
impulsive having access to whatever it is and this is true with substances or
addictive behaviors but what triggers your impulsive behavior having them
define what their impulsive behaviors are it can be screaming it can be
throwing things be substances of abuse it can be going
out on a run it can be just getting in the car and driving what are your
impulsive behaviors and how can you address them let’s look at what they
mean like I said most of the time impulsive behaviors come from a need to
just make that distress stop so what distress tolerance skills do you
have what can you do instead that is less harmful or less counterproductive
how can you distract yourself sitting there and waiting for this flood of
anger to go away can feel like an eternity and trying to control it and
wait for it to go away can make it worse so how can you distract yourself what
can you do for that first minute and a half to 10 minutes until you can you
know think with a clear head and then what are your coping strategies coping
strategies are really either changing the situation because something’s amiss
and it needs to be changed or addressed or changing your reaction to it there
are some things that cannot be changed other people cannot be changed so you
can either choose to not engage with them which is changing the situation or
you can choose how you react to the situation maybe you have somebody who is
always going to find fault with something that you do family member
maybe it’s a family member that you have to see at every holiday so knowing that
that holiday is coming up is a vulnerability because the person is
probably going to start getting all fired up stressed out wondering what is
going to be criticized this time so you’ve got two options
one not go to the family function for the holiday which is often not an option
or to figure out how to deal with that for example just accepting that for
whatever reason this person has to find fault they’re going to find fault so
just expect it and let it roll off your back take what you need and leave the
rest if they find fault with something that
can be addressed that you think yeah you’re right you know I could work on
that great if they find fault with something that
you really don’t have any issue with then let it go that’s their issue that’s
on them not on you and then significant interpersonal problems another
behavioral issue if you’re impulsive if you are constantly looking for the
negative if you have all of these cognitive distortions that continue to
get you upset all of the time it’s going to be really difficult to stay in a
relationship with you so regardless of what the specific diagnosis or criteria
are helping people develop mindfulness and empathy to increase the awareness of
themself and others so they can become aware of when they are being emotional
when they are being sensitive when they are being hyper-vigilant but they can
also increase their awareness of how they impact others when they behave that
way develop a stable positive internal sense of self to reduce the need for
external validation if you can be okay for who you are then if somebody decides
to leave you don’t need to be on on guard all the time you don’t need to be
hyper vigilant you don’t need to be proving something you don’t need to be
the center of attention you’re comfortable in your own skin and that’s
all you need for a lot of clients when I say that they look at me like I’ve got
three heads because that’s just not something that they can even
conceptualize at the beginning and that’s okay you know I want to know
three months from now what are you hoping is going to be different along
with addressing these interpersonal issues and helping people develop
mindfulness we want to help them develop interpersonal skills we know that
personality disorders develop really early in life
and they’re not diagnosed until someone reaches adulthood but since they develop
early that means they probably were not able to develop healthy communication
skill and healthy boundaries they weren’t able
to develop the ability to see another person’s reaction and look for
possibilities they weren’t able to develop the ability to not see
everything as their fault they didn’t develop the ability to say I am sorry
you’re upset but that’s not my fault you know I’ll be here to support you but I
am NOT going to feel bad because you’re upset so developing those emotional
boundaries and allowing others to have feelings that are divergent from yours
are going to be key features in helping people develop a healthier way of
interacting so general tips personality disordered behaviors are ego-syntonic I
said that before I’ll say it again most of the time people were present in
treatment for something that is not a personality disorder it’s the result of
these behaviors they lost a relationship they lost their job they lost their
house they whatever the case may be I have never had somebody come into my
office and go I’m borderline help me figure that out I have had people
significant others bring them in and say she’s borderline fixer and my response
is usually you can’t do that she can fix herself but first we need to figure out
what’s going on before we even start putting labels on it and then it’s going
to be up to her to be able to figure out how to meet her needs as therapists we
can help people work backwards and identify what caused whatever the
presenting issue is so if the person comes because they just and ended a long
term relationship and they are clinically depressed what happened that
made the relationship end have you experienced this before have you had
other relationships end for similar reasons let’s look at some of these
common themes about why these relationships end a lot of times you
will hear from the towards some of these personality
disordered behaviors and you can start identifying them I am NOT going to tell
somebody well sounds like you’ve overreact all the time we’re going to
look at what happened and I’m going to let the client draw their own conclusion
about what’s going on with them for themselves because they’re in their own
head they know what’s an appropriate reaction and what’s an overreaction
we’ll do some cognitive distortion and cognitive disputing to help them figure
out if they are using some of those cognitive errors in order to help them
live a happier life so if we can figure out some common themes that generally
present in every relationship that’s what we can focus on in treatment how
can we make your relationships less conflictual well let’s look at what
causes the conflicts okay now how can we deal with that a person with personality
disorder traits will likely demonstrate these same traits and behaviors in
session so we need as therapists to compassionately identify and address
these relationships if you notice someone is trying to take over a session
and every time you say something they counter it you may ask you know if this
is because they feel the need to know everything that’s going on you may ask
what the benefit is or what they’re needing from you at this point in time
it’s going to depend on your client exactly how you address it but not
addressing it just reinforces it so it’s important to know how to deal with your
particular clients in a manner that is compassionate but firmly setting
boundaries cluster B disorders are characterized by a lack of a sense of
self difficulty forming authentic relationships and high levels of anxiety
and emotionality mainly because of a lack of sense of self and difficulty
forming relationships so they don’t have social support they don’t feel good
about themselves they don’t even know who they
are so they’re constantly worried about basically disappearing one of the first
goals of treatment is to identify what the behaviors are that are causing their
distress identify that function and help them start figuring out ways to deal
with it most personality disordered behaviors ego-syntonic help the patient
identify the behaviors they exhibit which may be problematic so you know if
they start acting in a way that you can see may cause conflict in relationships
outside of the therapy session you may want to point those out and say I’m
wondering how other people perceive it when you do this discuss in session what
triggers those behaviors what function the behavior served in the past you know
obviously you develop this for a reason everything we do is basically to help us
survive and exist and because it’s reinforced so where did this come from
what function it did it serve and then let’s figure out a different way to meet
that same need I’m not going to tell them that they’re pathological because I
don’t believe they’re pathological I believe that what they did was the best
thing that they could do given the tools that they had at that point in time and
I still believe that today it’s just they don’t have any new tools so therapy
and self-help books are the way for them to start getting those tools so they can
respond differently while it’s true the behaviors characteristic of personality
disorders cannot be completely erased you learn them you can’t just completely
unlearn them they can be sort of boxed up and stored in the mental archives
they need to have alternate behaviors to replace those if you’re not going to do
something you need to replace it with something else you can’t just not do
something the key here is the fact that personality disorders oppositional
defiant disorder any variety of issues and problems
can be treated but you can relapse or they can those behaviors can emerge
again if the current behaviors and current tools are not meeting the
person’s need in the same way you

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