Why Treating Personality Disorders is a Challenge for Therapists?

The profession of psychotherapists is always challenging as it deals with unexpressed thoughts, feelings and emotions. However, therapists face more challenges while treating individuals with personality disorders.

Personality disorder is a mental health condition where a person’s overall patterns of behavior gets disrupted and generally lasts a life-time. When individuals have a disturbed pattern of childhood relationships, specially with their parents, they tend to develop maladaptive adjustment styles in their adult relationships. Consequently, this can pose challenges for therapists in accurately comprehending the client’s true nature and mental state.

Some therapists may choose not to work with clients who have personality disorders because the clients’ impulsive and risky behaviors may occasionally result in legal and other complications for the therapist.

CHALLENGES IN BUILDING TRUST AND RAPPORT WITH CLIENTS HAVING PERSONALITY DISORDER

• It can be challenging for therapists as they are just not symptoms, they are deep-seated patterns of behavior that has been internalized.
• There is limited scope for medication for individuals with personality disorder.
• It is difficult to build rapport with the patient.
• The manipulative nature of individuals might confuse the professionals.
• It is difficult to understand the predictability of their actions, as they have an unstable mood.
• There remains a possibility of the patient to impulsively engage in self-harm outside of the therapy session.
• Treatment is long-term and patients often resist the treatment thereby discontinuing sessions.
• There is a possible risk for the therapist to get dragged in legal cases due to their clients’ actions.

EXPLORING ALTERNATIVE APPROACHES FOR TREATING PERSONALITY DISORDERS

The common therapeutic approaches, exceptionally used to treat individuals with personality disorders are:

• Dialectical behavior therapy (DBT)
• Schema-focused therapy
• Mentalization-based therapy (MBT)
• Systems training for emotional predictability and problem-solving (STEPPS)

However, it is common in personality disorders that clients become resistant to the treatment. Depending on their personality type, they might resist their treatment in different ways. It is important for the therapist to deal with the resistance with caution and sensibility.

• Clients’ resistance can generate negative counter transference for the client. But, the therapist should remain calm, empathetic and help the client heal at their own pace.
• Understanding the reason for resistance and dealing with that area with care.
• Building a good rapport and framing sentences in a non-judgmental and acceptable way, can help to avoid resistance from the client.
• Showing genuine empathy and concern for the client is important to break the resistance.
• Whatever treatment procedure is followed, must be documented from time to time so that it can be referred by other professionals during emergency situation.
• It is always necessary to take help from colleagues and supervisors (without sharing details of the clients’ identity) when needed.

Individuals with certain types of personality disorders tend to be impulsive and therefore might pose a risk for self harm. During this kind of situation, if the therapist is informed, they should immediately assess the need for hospitalization. If the risk is less then the therapist may help the client deal with the situation in the following ways:

• Assuring them with the therapist’s emotional presence (if not physical) during the crisis.
• Validating the feelings of the client.
• Allowing them to vent out their emotions.
• Allowing them to cry if they want.
• Showing genuine care towards them.

SPECIALIZED TRAINING TO UNDERGO

• After completing Masters or MPhil degree in Clinical Psychology, the individual could opt for certain specialized trainings in DBT (Dialectical Behavior Therapy), CBT (Cognitive Behavior Therapy), REBT (Rational Emotive Behavior Therapy) as these are used for treating Personality Disorders.
• There are also certain International courses available online like Personality Disorder Certification Training (https://catalog.pesi.com/sales/bh_c_001287evg_advpersonalitydisorders_organic-89736)
• There are certain platforms (like cognivest, udemy etc.) that provide online training courses for Personality Disorders.

BUILDING THERAPIST RESILIENCE IN TREATING CLIENTS WITH PERSONALITY DISORDER

In most cases it has been observed that clients with personality disorder, tend to manipulate the therapist, become suspicious of them or get too attached to or avoidant from them. Therefore, they often try to resist the treatment. This initiates a negative counter-transference. To deal with it, the therapist must build resilience.

• The therapist needs to accept and acknowledge the feelings that the client is generating and address them in their therapy sessions.
• Involving the client in some activities to bring out their area of interest which in turn is validating for the therapist.
• Maintaining a clear boundary with the client and referring them if too much of distress is evoked.
• Referring clients with psychotic features, violent behavior and other significant cases to psychiatrists for additional medical support, if necessary.