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WHEN ALARM BELLS SHOULD RING:
Recognizing Personality Disorders
By
Susan Schwartz Senstad, M.A., M.F.T., M.F.A.
What to do – but first, what NOT
to do
First, what you are not to do is to diagnose anyone (unless
you are trained to do so). It requires formal qualifications and
experience to do that. This article is intended only to
give you a sense for when you may be in the presence of certain
kinds of disturbance; it is in no way sufficient to equip you to
make the determination of whether that is so or not. I
do recommend, however, that you err in the direction of caution
if you have doubts about someone’s psychological health.
What, then, can you do if you sense that someone who comes to you
suffers from a Personality Disorder?
1. Study and consult:
Inform yourself well. At the end of this article, I have a list
of books and websites for lay people and professionals. These will
help you become better at recognizing when these kinds of disturbances
may be present. They will also help you tune your empathy.
I highly recommend, also, that you establish cooperation with a
supervising psychologist or psychiatrist with some expertise regarding
Personality Disorders with whom you can consult when you are in
doubt about someone’s health. This will not just increase
your safety and that of your clients/students, but will also help
to educate your instincts so you know you can trust them.
2. Screen for facilitation:
People with Personality Disorders ought not to be facilitated using
VD.
The Aware Ego process lies at the core of VD and it is precisely
that function that is damaged in people with these disorders. Strikingly
often, however, people suffering from Personality Disorders are
drawn to communications trainings and consciousness methods such
as Voice Dialogue instead of therapy. Some explanations for this
may be:
• Here, they may seek a way to fill their terrifying sense
of emptiness while still avoiding the prolonged, emotionally provocative
contact of deep psychotherapy.
• Here, they may seek a system, a reassuring self-help structure
they can lock into in order to soothe the frightening sense of internal
chaos – about which they are in denial and which they struggle
hard not to feel.
• Here, too, they often receive precisely what they do not
need: validation that they are ‘okay’! Many who choose
to become VD facilitators are invested in helping people feel better
about themselves and thus shy away from the uncomfortable task of
holding up the mirror that displays their disturbance. To
further shore up such people’s merely superficial ‘self-esteem’
instead of addressing their deep pain is to do the terrible disservice
of helping them maintain their disturbed reality untreated.
For such people, contact with a VD facilitator can serve as a golden
opportunity to be assisted in seeking the kind of help that they
really need.
3. Screen for training:
Under no circumstance should someone suffering from a Personality
Disorder be trained to facilitate other people’s consciousness
process!
Since there is neither a certification nor de-certification process
in place for Voice Dialogue facilitators, a special responsibility
falls upon any person who sets out to train VD facilitators to make
sure those they select as students are sufficiently healthy. It
can be a difficult economic decision to turn away a potential paying
student when trying to fill a course; it can be a painful duty to
tell a member of an on-going course that their participation now
appears inappropriate. Ethically, however, we serve our practice,
Voice Dialogue, our students and the disturbed person best by screening
carefully. (Also, a Personality Disordered group participant is
usually very disruptive to a group’s process.)
The fact that subtle psychological disturbance is often hard to
pick up on, even for trained clinicians, has implications for how
long and thorough a training process needs to be. Quick VD facilitator
trainings are not advisable; they need to last long enough for the
trainer to have time to become clear about the psychological health
of his/her trainees.
4. Teach:
In my opinion, education in recognizing pathology ought to be a
part of all VD facilitator trainings. If you as the trainer are
not a psychology professional capable of teaching about pathology,
you can invite in a guest teacher who is.
5. REFER the person you suspect may be disturbed to a
qualified professional:
Take your educated warning bells seriously, strengthen your own
personal boundaries and then try to help the person engage in psychotherapy
with a qualified professional. I say this knowing that the prognosis
for healing Personality Disorders is not very good. (During the
last fifteen years, a psychosocial treatment form called dialectical
behavior therapy (DBT) was developed specifically to treat Borderline
Personality Disorders and does look promising.)
Nor is referring a person with a Personality Disorder particularly
easy. Someone suffering from a Personality Disorder is unlikely
to seek psychotherapy for these reasons, among others:
• Denial is a central part of his problem, including denying
that he has a problem. According to him, the problem he has is that
people have a problem with him – which he sees as their problem.
• His limitations were shaped into a psychological structure
so early on that they are in harmony with how he experiences himself
(what is called ‘ego-syntonic’). He is comfortable with
them. Consequently, he is rarely motivated to change them.
• If he does agree to enter therapy, he is likely to sabotage
the process early in order to run away from how provocatively intimate
a genuine therapeutic relationship is. (Don’t think for a
moment, however, that this denial abolishes the pain he experiences.)
During my years in practice, some of my work included long-term,
intensive psychotherapy focused on providing ‘corrective experience
over time’ with, among others, people suffering from such
Personality Disorders as Borderline Personality Disorder. I know
from experience, therefore, that some people do get better –
IF they receive help to construct the missing structures where the
deficits lie.
6. KEEP DOING YOUR OWN PERSONAL CONSCIOUSNESS WORK:
Have someone facilitate you regularly. The clearer you are with
yourself, with your strengths and limitations, the better position
you are in to sort out your responses to other people and assess
their health.
People with milder forms of Personality Disorders are hard to catch
onto, even for trained professionals. Most of us who have trained
Voice Dialogue facilitators have experienced, or probably will experience,
that we’ve assumed one or another trainee to be far healthier
than he or she turned out to be in the long run. But, once you realize
your error, work hard to refer that person and ask him not to facilitate
others until he has received the help he needs.
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Table of Contents
Aims of this article
What is ‘normal’?
What is ‘abnormal’
Warning signs that a potential client/student
may suffer from a Personality Disorder
What to do – but first, what NOT to
do
Working with a client/student whose parent
and/or partner suffers from a Personality Disorder
Doing Bonding Pattern work with a client/student
with a Personality Disordered parent and/or partner
About the author
Appendix 1: References and Useful Books
& Websites
Appendix 2: DSM IV – Personality
Disorders
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