Understanding and Managing Clients Displaying Characterological Behaviors: Special Focus on Borderline and Narcissistic Personality Disorders Author: William Malone, MSW, LISW-S 5 CE Hours Copyright 2017 William Malone All Rights Reserved You can contact this author at bmalone12003@yahoo.com For technical assistance with this home study contact jheisel@heiselandassoc.com Frequently in a person s life they will encounter individuals that are hard to get along with. These individuals could be a family member, friend, co-worker or even a boss. Their behaviors cause us to question ourselves and our approach to them. We are hoping to find a strategy that makes interacting with them much easier. Yet, our attempts fall short and we are back at the drawing board scratching our heads wondering what we could do differently the next time we encounter them. I remember a case that left me questioning my abilities. A 35 year old male came to see me about some personal problems he was having. I conducted the first session as I always do, but this was not working. Any
question I asked this 35 year old he would become irritated at times respond sarcastically and become defensive. I ended the first session without much information and scratching my head and pondering what do I do next. The client did set up a second session. I was amazed he did given the limited success I had in the first interview. The second session started out just like the first. Any question I asked the 35 year old client only provoked him. I push ahead, digging in my bag of tricks to see if I could get around his defenses. Again, with very little success, I was frustrated and I was certain the client was frustrated also. However, he did reschedule a third session. I really did not know what was this client looking for and what changes if any he wanted to make. I made the third appointment rather reluctantly. I went back to the drawing board in my mind again. I knew that I did not want to have the same outcome as the first two sessions. I was tired of being frustrated and I wanted to be helpful to this client. I decided to give the problem back to the client, since it was his in the first place. When the third session started, I asked the client, What is a question I can ask you that won t provoke you, irritate you or cause you to take a defensive position? To my amazement the client stopped reacting, thought for a minute or two and then said, That is a very good question. I responded by saying, I am glad to hear that. Do you have an answer for me? We spent the rest of that session and several other sessions discussing that point. We actually got somewhere. I was pleased and so was the client to be able to move ahead in a positive direction. The point of this case example is to illustrate individuals come to us and they can be difficult and our usual manner of behavior does not work. However, if we try something different it can shift the balance; throw the other person off guard by opening the door for the possibility of change. Some of these difficult behaviors can be characterological meaning the behaviors are just part of their character. Others behaviors that are defined as difficult, unreasonable or challenging are part of a whole different classification called personality disorders. Personality disorders imply that difficult behaviors can be classified into disorder types and these behaviors go beyond being characterological. Having a personality disorder means those who are diagnosed with one were born without some basic skill or character. For instance, a person diagnosed with the narcissistic personality disorder is missing the empathy characteristic. In short, this skill is not in their tool box and the behaviors we see externally are a result of this missing skill. Given the work we do as helping professionals (which in this home study course refers to social workers, counselors, marriage and family therapists and psychologists) we encounter a variety of people resulting is seeing more individuals with characterological problems and personality disorders. It is hopeful that we see fewer people with these kinds of problems in our personal
life. This makes sense because we have a choice in our personal life about who we are going to hang out with. This is not true in other areas of our life like work or school. However, this does not mean we won t encounter people with characterological issues or even full-blown personality disorders. We can find these individuals anywhere, at the grocery, bank, mall, hardware store and even in church. The point here is people with problems exist everywhere and we would serve our self well to know: how to interact effectively with them, know how to disarm them and be able to keep our cool while we are interacting with them. The purpose of this home study course is to provide the reader with specific skills and techniques to employ when encountering a difficult, unreasonable, and challenging individual. The objectives of this home study course are to become aware and learn how to effectively interact with a person who has moderate to severe characterological problems or have more serious personality disorders like Narcissistic personality disorder (NPD) or Borderline personality disorder (BPD). The objectives of this home study course are also for the reader to: Recognize Characterological Behaviors before You Get Tangled Up Identify and utilize strategies that reduce the negative impact of these behaviors Learn how to stay out of other people s mud puddles. Harness the power of your own emotions and not react to the difficult people in your life learn how to stop playing the victim role and be in control of your responses to those difficult people you need to interact with. Learn how to look at characterological behaviors and Personality Disorders in a new healthier perspective. Distinguish the differences between characterological behaviors and personality disorders. Be able to recognize the different types of difficult, unreasonable and challenging people in your life. Be able to establish a behavior strategy or strategies on what to do when you need to interact with a difficult person. Learn to identify defensive, reactive language and respond to it proactively. Learn how to avoid letting characterological problems and personality disorders drain you day. Learn how emotions play a major role in how effective one is in dealing with difficult behaviors. Be able to list characteristic of borderline personality disorder. Be able to list characteristics of narcissistic personality disorder. Make a determination if you are working with a boss with NPD and know what to do if you are. Be able to list some treatment strategies for borderline and narcissistic personality disorders. In first part of the home study course, I will address characterological behavior and the second part of the course I will address personality disorders in general and then look specifically at borderline personality disorder (BPD) and narcissistic personality disorder as described in the DSM 5. If you remember only one thing from this material remember this. Other people s behavior is not our
responsibility, it is theirs. We must most definitely avoid personalizing others behavior even though they may be intentionally directing it at us. By taking their actions personally we are letting the other person have control over our lives. In a sense, we are the puppet and they are the puppet master. Not cool for us. This is no easy task because all humans are hard wired for a fight or flight response. This goes back to cave man days when the rule of thumb was if it is smaller than you then eat it. If it is larger than you run for your life. Given that we are hard wired for these responses, it is no wonder that reacting to someone else is so easy. If you attack me says the husband to his wife, I will come back at you twice as strong. The wife says, if you do it, it will be the last thing you do. Now the fight is on and will only stop when one or both parties come back to their rational mind and start negotiating and problem solving rather than fighting. Back in the caveman days it was the survival of the fittest, but today was more civilized and therefore more skilled at reasonable rather than using reactive behavior. The skills presented in this course will maximize our efforts to be civilized rather than caveman. So remember, other people s behavior is their responsibility not ours. Our job is to maintain a position of being civilized where we take nothing personal even though it may be directed that way. To be effective at interacting with challenging people and people with personality disorder we must maintain our sense of control of self, we must self-regulate, we must self-modulate and we must respond to others in a spirit of assertiveness. Our mission is being helpful, not worrying about the content of words, but focusing on the process. I have a saying I learned for a wise therapist a long, long time ago. She taught me to let crazy be crazy because we can t stop that. What we can do is to decide how to be most helpful to these individuals and focus on relationship building rather that winning the conflict. By always maintaining our cool, our sense of sensibility, our inner strength and recognizing we are no longer back in caveman days even though if might feel like we are, and we act in a manner that we can look in the mirror and be proud of what we see there. This is far better than seeing our reflection in the mirror covered with mud because we jumped into the mud puddle with a challenging and unreasonable person only to find we are acting like them and responding like them. When a passerby sees us in the mud puddle with this difficult person the passerby will find it hard to identify who the crazy one is. Distinguishing Between Difficult People and Personality Disorders Individuals can be viewed as difficult when they present a pattern of behavior over time that is hard to manage. This could be a person who is constantly at odds with others on a regular basis. Statements like I don t want to have to deal with John s behavior throughout this meeting, or Georgia is such a pain in the neck. Another characteristic of a difficult person is related to their myopic vision.
They can only see their side of the story and are unwilling to look beyond their point of view. In some ways this person believes I am right and everyone else is wrong. We can add domineering, rigid and critical to the list of characteristics for difficult and challenging individuals. Wanting his or her way is also prevalent in difficult individuals. In many ways they have not learned to play nicely and corporately with others. One way to know you are interacting with a difficult person can be seen in their inability to accept feedback and or criticism. With this type of person you can find that you constantly are hitting a brick wall with them and your feedback and criticism are falling on deaf ears. Difficult individual frequently create power struggles. Since it has to be their way anything that is different will be viewed as an attack and they must attack back to hold their ground. Working effectively for this type of individual is far less important than being right. Having their way is far better than doing tasks the right ways and of course they know what is best. The attitudes, behaviors, and actions of difficult individuals do not occur occasionally. Rather, the behaviors and attitudes occur constantly, regularly and frequently. These folks are not reasonable they are difficult. It is important to remember that difficult people are difficult on ongoing bases. An average worker may have a bad day, might be stubborn about an important issue, but this occurs seldom and infrequently. The truth of the matter is that most of us can have a bad day and may not play well with others on occasion. This behavior is the exception to the rule. Difficult individual s whether it is a client, spouse, coworker, supervisor or boss are difficult all the time. When we compare difficult people to people with personality disorders we find that folks with personality disorders,according to the Diagnostic and Statistical Manual of the American Psychiatric Association, Vol. 5, are persons who show and enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is unstable over time, and leads to distress and impairment. According to the UK s National Health Service (NHS) the following symptoms suggest a possible personality disorder. These include: consistent and unusual behaviors that make it difficult to relate to others, bouts of irregular, alarming or alternating activities, emotional instability paired with intense interpersonal relationships, dramatic overly emotional displays aimed at drawing attention, fear of relationships, and fear in life that justifies odd behavior, chronic avoidance, anxiousness or extreme shyness.