Enduring Difficulties

Although I do not use the term “personality disorder” in my own practice, it is a label that is in common usage. I prefer to refer to “enduring difficulties” rather than a disordered personality for two reasons.

Personality Disorders or Enduring Difficulties?

First of all, there is a great deal of prejudice associated with “personality disorders” that can result in unfair treatment of people with this label.

Secondly, in my clinical experience, each individual I have worked with within a particular diagnosis (for example, Borderline Personality Disorder) has a unique personality. This shines through the unhelpful coping styles that are common to people within the same personality disorder diagnosis, making me question how accurate it is to describe a disorder of the personality.

For some people, mental health difficulties are long-standing, and have their origins in adolescence, childhood or infancy.

Sometimes the difficulties arose many generations ago in the family of the person with enduring difficulties, and have been passed on through social learning, trauma, parenting styles and contagious emotions. Some people were not taught how to manage normal, human emotions, and how to feel safe and secure in relationships.

People who have suffered in this way may have developed a number of unhelpful and even self-destructive coping styles to handle difficult emotions. These coping styles sometimes provide temporary relief, but at other times make the situation worse. Some people even fantasise about ending it all, because they feel overwhelmed by their suffering.

People with these difficulties may notice patterns in their relationships and life circumstances that play out repetitively throughout adulthood. They may have difficulties starting or keeping friendships and romantic relationships, although they may desperately want close connections with other people.

Others have decided that maintaining distance from other people is the only safe way to exist.

Then there are people who find themselves being exploited in relationships, and feeling unsafe around the people closest to them.

Treating Enduring Difficulties

There are several effective, evidence-based therapies for treating enduring difficulties. The therapy that most suits a person’s situation will depend on that person’s goals for therapy, and their personal values and style. A skilled therapist will take a detailed history and discuss treatment options with the person before agreeing to a therapeutic plan.

A key to all successful therapy that is especially important in the case of enduring difficulties, is the quality of the relationship with the therapist. The individual must find someone they can trust and feel comfortable around, in order to take the plunge into the often challenging work of healing old wounds.

In some ways, a therapist is like a teacher – not all teachers are a good fit for all students, and it is important to seek out a therapist that you feel comfortable learning from. It can take some time to develop trust in a new relationship.

Once a good therapeutic relationship is established, the therapy should be tailored to the goals of the person seeking therapy.

Safety is always the first priority of therapy, since it is not possible to benefit from therapy unless you are around to experience those benefits. For this reason, addressing any risky coping strategies and developing safer ways to manage emotions, often makes up the first stage of therapy.

Once progress has been made towards ensuring your safety, other goals usually come into play:

  • Understanding and addressing the unhelpful belief structures and behaviour patterns that have developed over time is often extremely beneficial, and a Schema Therapy approach can be very helpful.

  • Traumatic experiences can be the root cause of the instability, and Trauma Focused Therapy will be the most useful approach.

  • Dissociation, or switching between different parts of the self, is a central difficulty, and therapy for Dissociation may be needed.

  • Learning skills that were not learned earlier in life, such as how to be effective in interpersonal relationships, how to be assertive, how to regulate emotions or tolerate extreme emotions, may be helpful, and a Dialectical Behaviour Therapy approach may be useful.

  • Learning how to parent one’s own children in a different way than one was parented oneself may be useful, and the Positive Parenting Programme may help.

If you suspect that enduring difficulties have been making life and relationships more difficult for you than most, I welcome you to make an appointment with me so that we can meet and discuss your needs and develop a strategy to help you connect with your goals.

References

Linehan, Marsha (1993). Cognitive-Behavioural Treatment of Borderline Personality Disorder. New York: Guildford Press.

National Institute of Mental Health in England (2003). Personality Disorder: no longer a diagnosis of exclusion. Retrieved August 15, 2014 from http://www.doh.gov.uk/nsf/mentalhealth

Rothschild, Babette (2001). The Body Remembers. London: WW Norton and Co.

Sanders, MR; Mazzucchelli TG & Studman (2009). Facilitator’s Manual for Group Stepping Stones Triple P for Families with a Child Who Has A Disability. Milton: Triple P International.

Young, Klosko and Weishart (2003). Schema Therapy. New York: Guildford Press.