Therapy for Personality Disorders

If you're navigating life with a personality disorder, you know what it's like to feel overwhelmed by emotions that seem uncontrollable or to struggle with relationships that are more turbulent than they should be.

Personality disorders can profoundly impact your life, affecting everything from your self-image to how you interact with others.

Recognising the challenges you face is the first step toward recovery. Therapy can provide essential tools and strategies to help you manage these challenges, enhancing your ability to lead a fulfilling life.

This guide will explore various therapeutic approaches specifically tailored to address the unique needs of individuals with personality disorders. By understanding these methods, you'll be better equipped to start a journey toward healing and improved mental health.

Table of Contents | Jump Ahead

Understanding Personality Disorders

Challenges in Therapy for Personality Disorders

Therapeutic Approaches

Next Steps: Finding and Preparing for Therapy for Personality Disorders

Self-Awareness and Skills Development

Addressing Stigma and Promoting Understanding

Key Takeaways

FAQ

Understanding Personality Disorders

Personality disorders are characterised by enduring patterns of behaviour, cognition, and inner experience that deviate significantly from a person's culture's expectations. These patterns are inflexible and pervasive across many contexts and lead to significant distress or impairment in social, occupational, or other important areas of functioning.

Common types of personality disorder include:

Borderline Personality Disorder

• What You Might Feel: Intense emotional fluctuations, a pattern of unstable relationships, and impulsive decisions that you may often regret later.
  
• Why Seek Treatment: Therapy, especially Dialectical Behaviour Therapy (DBT), can provide you with tools to manage intense emotions, build stable relationships, and cope with feelings of emptiness or fear of abandonment.

Narcissistic Personality Disorder

• What You Might Feel: You might feel a strong need for admiration and a sense that you deserve special treatment, coupled with difficulties empathising with others.
  
• Why Seek Treatment: Therapy can help you understand and improve your relationships, enhance empathy, and adjust expectations, contributing to more fulfilling personal and professional interactions.

Antisocial Personality Disorder

• What You Might Feel: Frequent conflicts with society, a disregard for others' rights, and perhaps a history of deceit or manipulation.
  
• Why Seek Treatment: Though you might be hesitant to seek therapy, it can be crucial in helping you reduce behaviours that could lead to more serious consequences and in helping you better understand and respect societal norms.

Avoidant Personality Disorder

• What You Might Feel: Extreme shyness and fear of rejection prevent you from engaging in social activities and forming close relationships despite a strong desire to connect with others.
  
• Why Seek Treatment: Therapy can help you overcome fears of rejection, improve your self-esteem, and form relationships, making social interactions less anxiety-inducing.

Obsessive Compulsive Personality Disorder

• What You Might Feel: A deep need to maintain order, perfection, and control over your environment and routines, which can interfere with your efficiency and flexibility.
  
• Why Seek Treatment: Therapy can help you loosen the reins of control and perfectionism, prioritise more effectively, and enjoy a more balanced life.

Sichiotypal Disorder

• What You Might Feel: You might often feel like you're on the outskirts of society, experiencing extreme discomfort in social situations, distorted thinking, and peculiar behaviours.
  
• Why Seek Treatment: Cognitive Behavioural Therapy (CBT) and other supportive therapies can help you address distorted perceptions, improve your social skills, and manage anxiety, reducing feelings of paranoia and isolation.

Dependant Personality Disorder

• What You Might Feel: A pervasive and excessive need to be taken care of, leading to submissive and clinging behaviour and fears of separation.
  
• Why Seek Treatment: Therapy can help you develop more healthy and independent relationships, increase your self-confidence, and learn to express your needs and opinions in a balanced way.

therapy for personality disorders aims to provide you with the skills to understand and change these deep-seated patterns, thereby improving your daily functioning and relationships.

The goal is to foster a better sense of self and greater stability in your emotions and interactions with others.

Challenges in Therapy for Personality Disorders

Therapy for personality disorders presents unique challenges for you and your therapist. Understanding these challenges can prepare you for what to expect and how to navigate the therapy process effectively.

Engagement Issues

• Trust and Rapport: If you have a personality disorder, you might find it particularly hard to trust others, including mental health professionals. Establishing a therapeutic relationship may take longer and require more patience and effort from you and your therapist.
  
• Consistency: Due to the nature of some personality disorders, you may struggle with consistency in attending sessions or adhering to treatment plans, which are critical for the success of the therapy.
  

Treatment Resistance

• Denial of Problems: You might minimise the extent of your issues or deny that your behaviours are problematic, which can make addressing these behaviours in therapy challenging.
  
• Fear of Change: Change can be especially frightening if you have long-standing patterns of behaviour that feel integral to your identity, even if they are maladaptive.
  

Emotional Regulation

• Intensity of Emotions: Many personality disorders involve intense emotional experiences. These can be overwhelming and may lead to significant distress during therapy sessions, where emotional issues are often brought to the forefront.
  
• Impulsive Reactions: Therapy can trigger strong reactions, and impulsivity can complicate the management of these reactions within the therapeutic setting.

These challenges require a thoughtful, tailored therapeutic approach that respects your pace and personal experience. Effective therapy for personality disorders often involves a combination of techniques designed to build trust, encourage engagement, and gradually introduce changes in thought and behaviour patterns.

Therapeutic Approaches

Effective treatment for personality disorders often involves a variety of therapeutic approaches, each addressing different aspects of these complex conditions:

Dialectical Behaviour Therapy (DBT)

• Focus: Originally developed for Borderline Personality Disorder, DBT helps you learn to manage emotional dysregulation and reduce self-harm behaviours through a skills-based approach.
  
• Techniques: DBT teaches mindfulness, emotional regulation, distress tolerance, and interpersonal effectiveness to help you deal with stressful situations more calmly and make healthier choices.

Cognitive Behavioural Therapy (CBT)

• Focus: CBT aims to identify and change negative thinking patterns and behaviours characteristic of personality disorders.
  
• Benefits: Understanding and restructuring these patterns can improve your interactions and reactions, leading to better social and personal functioning.

Schema Therapy

• Focus: This therapy is designed to help you break deeply ingrained negative life patterns or schemas, which often underlie personality disorders.
  
• Techniques: Through schema therapy, you explore unmet needs from childhood and learn healthier ways to fulfil them in adulthood.

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Transference-Focused Psychotherapy (TFP) and Mentalisation-Based Therapy (MBT)

• TFP Focus: This approach uses the relationship between you and your therapist to reveal and address the unconscious conflicts driving your symptoms.
  
• MBT Focus: Helps improve your ability to recognise and understand your and others' mental states, which can be particularly challenging for those with personality disorders.

Each of these therapies offers a pathway to understanding and managing the behaviours and thoughts associated with personality disorders. Choose the one that aligns most closely with your outlook.

Integrating Therapy into Recovery Plans

Creating a personalised recovery plan is essential for effectively managing personality disorders. This plan involves a combination of therapeutic approaches tailored to your specific needs and challenges, ensuring a holistic treatment process.

Personalised Treatment Plans

• Assessment and Tailoring: Your therapist will begin with a thorough assessment to understand the specific traits and behaviours associated with your personality disorder. Based on this assessment, they will tailor a treatment plan that may include one or more of the therapeutic approaches discussed earlier.
  
• Integrated Treatment: Often, the best outcomes are achieved by combining different types of therapy. For instance, you might engage in DBT to better manage emotions while simultaneously participating in TFP to explore deeper relational patterns and conflicts.
  

Holistic Approach

• Lifestyle Modifications: Therapy plans often include recommendations for lifestyle changes supporting recovery, such as improving sleep habits, increasing physical activity, and adopting a healthy diet.
  
• Medication Management: While therapy focuses on psychological and behavioural aspects, medications may be used to manage specific symptoms such as mood swings or depression, particularly in complex cases. However, therapy is the primary treatment for personality disorder.
  

Long-term Management

• Ongoing Support: Recovery from a personality disorder is a long-term process. Continuing therapy sessions, even after initial goals have been met, help maintain progress and address new challenges as they arise.
  
• Relapse Prevention: It is crucial to develop strategies to recognise and respond to potential relapse triggers. Your therapist will work with you to identify these triggers and create a plan to manage them effectively.
  

Support Systems

• Family and Friends: Involving your close social circle in recovery can provide essential support. Educational sessions for family and friends can help them better understand the disorder and teach them how to offer effective support.
  
• Community Resources: Engaging with community resources and support groups provides additional support layers, ensuring you don't have to face your recovery journey alone.

By addressing both the individual needs and social context, your treatment plan for a personality disorder can lead to more effective and sustainable recovery. It cannot only help you manage symptoms but also improve your overall quality of life, allowing you to engage more fully and achieve personal goals.

Next Steps: Finding and Preparing for Therapy for Personality Disorders

Therapy requires thoughtful preparation and consideration of the unique challenges you might face to address the specific needs associated with personality disorders effectively.

Finding the Right Therapist

• Look for Specialisation: Ensure the therapist has specific experience with personality disorders. Therapists trained in DBT, TFP, or schema therapy may be particularly adept at handling the complex challenges associated with these conditions.
  
• Initial Interactions: When contacting potential therapists, pay close attention to how they communicate with you. For someone with a personality disorder, the therapist must demonstrate understanding and patience from the outset.
  
• Trial Sessions: Consider starting with a trial session to see how you feel about the therapist's approach. People with personality disorders often have heightened sensitivity to relational dynamics, making the therapeutic relationship even more critical.

Preparing for Therapy

• Clarify Your Therapy Goals: Reflect on what you want to address in therapy. For example, if you have borderline personality disorder, you might focus on emotion regulation and relationship management. Clear goals can help the therapist tailor the sessions to your needs.
  
• Personal History Preparedness: Prepare a concise history of your mental health that includes any previous diagnoses, treatments, and your understanding of how your personality disorder affects your life. This will provide a solid foundation for initial discussions.
  
• Emotional Readiness: Therapy can be particularly challenging for those with personality disorders due to intense emotional experiences and deep-seated patterns. Mentally and emotionally, preparing yourself for this process is crucial. Consider starting with mindfulness or relaxation techniques to manage stress related to starting therapy.
  
• Logistical Planning: Arrange your schedule to consistently accommodate therapy sessions. People with personality disorders often struggle with changes and disruptions, so having a predictable routine can be helpful.

Expecting and Addressing Therapy Challenges

• Anticipate Transference: Understand that transference might occur when feelings unconsciously distort how you see others, e.g., the therapist. This is common in therapy, especially for those with personality disorders. Recognise that feelings of anger, mistrust, or idealisation towards your therapist might be reflections of your condition and not the therapist’s behaviour. Reassess the situation and make decisions once you feel calmer.
  
• Use Therapeutic Relationship as a Tool: Your interactions with your therapist can serve as a valuable real-time model for understanding and modifying your relational patterns. Discussing these dynamics openly in therapy can provide practical insights and strategies for change.
  
• Collaborative Problem Solving: When issues arise in therapy, view them as opportunities to practice resolving conflicts or misunderstandings. Collaborate with your therapist to differentiate between your perceptions influenced by personality disorder traits and the therapist’s actual intentions or actions.

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Building a Support System

• Involving Trusted Others: Sometimes, involving a trusted friend or family member in parts of your therapy might be helpful, especially when trying to discern therapy challenges versus your personality disorder manifestations. They can provide an outside perspective on your interactions with your therapist and help validate or challenge your perceptions.
  
• Consistent Check-ins: Regularly check in with yourself and, if applicable, with trusted others about your therapy experience. Reflect on what feels like genuine therapeutic missteps versus what may be projections or distortions from your personality disorder.

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Maintaining Open Communication

• Transparent Dialogue: Maintain open lines of communication with your therapist about how you perceive the therapy and the relationship. Honest discussions about your reactions and feelings can help clarify misunderstandings and adjust therapeutic approaches.
  
• Feedback Loop: Use a feedback loop where you and your therapist can share observations about the therapeutic process. This helps ensure that therapy adapts to your needs and addresses the relational dynamics characteristic of your personality disorder.

By acknowledging that your personality disorder patterns will likely surface in therapy and preparing to address these with your therapist and trusted individuals, you can create a more resilient and responsive therapeutic environment. This approach not only helps manage the personality disorder itself but also enhances your overall growth and therapy outcomes.

Self-Awareness and Skills Development

As you progress in therapy for personality disorders, developing a deeper level of self-awareness and practical skills can significantly improve your ability to manage symptoms and enhance your interactions both within and outside of therapy sessions.

Developing Self-Awareness

• Mindfulness Practices: Engage in mindfulness exercises that help you observe your thoughts and feelings without judgment. This can be particularly effective in increasing awareness of the moment-to-moment shifts in emotions and thoughts, which are common in personality disorders.
  
• Reflective Journaling: Keep a therapy journal to record your thoughts, feelings, and reactions after each session. This practice can help you identify patterns in your behaviour and emotional responses that need to be addressed in therapy.
  
• Self-Observation Exercises: Your therapist might guide you through specific exercises designed to enhance your self-monitoring skills. These can help you catch early signs of emotional dysregulation or interpersonal difficulties.

Skills Development

• Emotional Regulation Techniques: Learn and practice skills such as deep breathing, progressive muscle relaxation, or guided imagery to manage intense emotions. These techniques can be crucial in preventing overwhelming feelings from dictating your actions.
  
• Interpersonal Effectiveness Skills: DBT, for example, offers specific training in interpersonal effectiveness, which teaches you how to assert your needs and manage conflicts in relationships more constructively.
  
• Crisis Management Skills: Develop a set of strategies for a crisis, including who to contact, what coping mechanisms to employ, and how to express emotions safely. This preparation can be lifesaving during moments of intense psychological stress.

Sustaining Long-Term Recovery

Long-term management of personality disorders through therapy involves continuous effort and adaptation. Here's how you can sustain recovery and effectively manage your condition over time:

Ongoing Therapy and Support

• Continued Engagement in Therapy: Even as you progress significantly, continuing therapy can provide ongoing support and address new challenges or setbacks.
  
• Support Groups: Participate in support groups specifically for personality disorders, which can offer community understanding and additional coping strategies.
  
• Family and Relationship Therapy: Involve significant others in therapy sessions to improve relationship dynamics and enhance mutual understanding and support.

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Lifestyle Integration

• Routine Health Checks: Regular physical check-ups can help manage the stress physical health problems can place on mental health.
  
• Balanced Lifestyle: Incorporate regular physical activity, a healthy diet, and sufficient sleep into your routine, as these can significantly affect mood stability and overall mental health.

Continuous Learning and Adaptation

• Educational Workshops: Attend workshops and seminars on personality disorders to stay informed about new research and therapies.
  
• Adaptation of Strategies: As you grow and change, so should your coping strategies. Regularly reviewing and adjusting your strategies with your therapist ensures they remain effective.

You can maintain the gains you have made in therapy and manage your personality disorder effectively. Your journey may have its challenges, but a fulfilling and balanced life is attainable with the right tools and support.

Key Takeaways

• Diverse Therapeutic Approaches: A range of therapies, including DBT, CBT, TFP, MBT, and group therapies, provide robust tools for managing personality disorders. Each has its strengths and can be tailored to meet individual needs.
  
• Support Systems Are Crucial: Recovery is not a journey to be walked alone. Family, friends, healthcare providers, and peer support groups provide the necessary support and understanding.
  
• Stigma Reduction: Actively participating in initiatives to educate and inform others helps break down stigma barriers, allowing for a more inclusive and understanding society.
  
• Therapeutic Relationship is Key: The success of therapy often hinges on the strength of the relationship between you and your therapist. A trusting, open relationship enables more effective communication and therapeutic outcomes.
  
• Long-term Commitment: Managing personality disorders requires a long-term commitment to therapy, even beyond the resolution of acute symptoms, to maintain stability and continue personal growth.
  
• Customised Therapy Plans: Tailored treatment plans that cater to individual symptoms, triggers, and life circumstances are more effective. This customisation ensures that therapy addresses the specific aspects of the disorder that impact your life the most.
  
• Holistic Approaches Enhance Outcomes: Incorporating holistic approaches such as mindfulness, stress management, and lifestyle changes improves overall therapy outcomes and helps manage symptoms.
  
• Peer Support as a Resource: Engaging with peer support groups offers emotional support, reduces isolation, and provides practical advice from others who have experienced similar challenges.

FAQ

How can I tell if my therapy is effective, given my tendency to have fluctuating perceptions of progress?

Therapy effectiveness can be monitored through consistent, objective measures beyond feelings or perceptions. These might include improvements in specific behaviours, better management of emotional responses, and feedback from others about changes in interactions. Regular reviews with your therapist can also provide a structured way to assess progress.

Can personality disorders be cured, or will I always feel some symptoms?

Personality disorders are generally seen as long-term conditions, but many symptoms can be effectively managed with appropriate therapy. The focus is often on long-term management and symptom reduction, rather than a complete cure, to improve overall functioning and quality of life.

How long do I need to stay in therapy for my personality disorder?

The duration of therapy varies widely among individuals. Due to the chronic nature of personality disorders, therapy often requires a long-term commitment. Duration can depend on the specific type of disorder, the severity of symptoms, and personal life circumstances.

Is it normal to feel uncomfortable with my therapist or to have strong negative feelings towards them?

Yes, it’s quite common for individuals with personality disorders to experience intense feelings towards their therapist, including discomfort, mistrust, or even devaluation. These reactions can be part of transference, where feelings towards significant others are unconsciously transferred to the therapist. Addressing these feelings openly in therapy can be vital to the treatment process.

What should I do if I feel my therapist doesn’t understand me or if I feel belittled during sessions?

It’s important to communicate these feelings during your sessions. Given the complexity of personality disorders, it might sometimes be part of the disorder's symptomatology to perceive interactions negatively. Discussing these perceptions with your therapist can provide insights into your relational patterns and benefit therapy.

How can family members support me if they don’t fully understand what I’m going through?

Family members can be encouraged to participate in educational programs about personality disorders, which can help them better understand your experiences and challenges. Family therapy can also be an excellent tool for improving communication and understanding within the family dynamic.

What if I frequently feel like quitting therapy?

Feelings of wanting to quit therapy can be common, especially if therapy challenges deep-seated patterns or becomes emotionally uncomfortable. It's important to discuss these feelings in therapy as they can be integral to understanding and treating the underlying aspects of the personality disorder.

Additional Resources

https://www.mind.org.uk/information-support/types-of-mental-health-problems/personality-disorders/treatment/

https://www.healthline.com/health/personality-disorders

https://www.mayoclinic.org/diseases-conditions/personality-disorders/diagnosis-treatment/drc-20354468

https://mentalhealth-uk.org/help-and-information/conditions/personality-disorders/treatments/

https://www.camh.ca/en/professionals/treating-conditions-and-disorders/personality-disorders/personality-disorders---treatment/personality-disorders---psychotherapy

"In treating personality disorders, the goal is not to change the person but to help them understand and manage their patterns in a way that improves their quality of life and relationships." -Aaron T. Beck