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Can High-Conflict People Change?

  Can High Conflict People Change?   ©2019 Bill Eddy, LCSW, Esq.   This is an increasingly important question in many areas of modern life, including in love relationships, in the workplace and in legal disputes. Major decisions are often made by assuming that someone will or won’t change their negative behaviors. Yet there are many factors that influence the likelihood that a difficult person will change—or not. The three most important factors are: which type of high-conflict personality they have, how severe their behavior is, and what their environments reinforce.   5 Types of High Conflict People High conflict people (HCPs) tend to have a pattern of behavior that increases or keeps conflicts going, rather than calming or resolving them. They tend to have four key characteristics: preoccupation with blaming others (their Targets of Blame) lots of all-or-nothing thinking (and solutions) unmanaged emotions (which often throw them off-track) extreme behaviors (that 90% of people would never do) Once you see these four characteristics, there is a lot that you can anticipate: they rarely seek counseling, they vigorously defend their past behavior, and they escalate their attacks on those they blame (which often includes new Targets of Blame over time). In other words, they are locked into their high-conflict behavior patterns and resistant to change. They see all of their problems as caused by other people, so they are not motivated to change on their own. But a small percentage do change, with a combination of coercion (family, workplace and/or court) and good programs of change, as described in this article. The more severe the patterns of high conflict people, the more likely they are to also have a personality disorder. This is a mental health disorder that shows up primarily in interpersonal relationships. There are ten types of personality disorders in the Diagnostic Manual of Mental Health Professionals (DSM-5). Fundamentally, those with personality disorders have a narrower range of behavior than most people, with three traits that make them resistant to change, which is why they are called disorders: interpersonal dysfunction lack of self-reflection lack of behavior change Not all people with personality disorders are HCPs preoccupied with Targets of Blame. But five of the ten types of personality disorders are particularly prone to high-conflict behavior patterns: borderline, narcissistic, antisocial, paranoid, and histrionic. These five have different patterns of behavior, which make them have more or less potential to change. Overall, its harder to change one’s personality-based behavior than to recover from alcoholism or another addiction—which is never easy. Here are the five types of high-conflict personalities and their likelihood for behavior change.   Borderline HCPs High-conflict people who have traits of borderline personality disorder (BPD) usually have the following key patterns of repeated interpersonal behavior in addition to the above characteristics: wide mood swings (from loving or friendly, to intense blaming or hatred) sudden and intense anger (disproportionate; especially when they feel abandoned) seeing people as perfect or terrible (sometimes swinging back and forth about this) The good news is that therapies have been developed over the past twenty years or so which have had some good success for those with this disorder, if they are willing to get the therapy. Dialectical Behavior Therapy (DBT) focuses on teaching small skills in small steps, with a lot of repetition in a very supportive environment. This method ideally includes an individual therapist, plus a group therapy for learning, discussing and practicing these skills. Distress tolerance, better awareness of relationships, and learning proportional responses to interpersonal situations are among the skills learned. With weekly individual and group therapies, in two to five years many people have outgrown the diagnosis of borderline personality disorder. They may still have some traits, but have developed the ability to look at their own behavior and change their own behavior to have more successful relationships. DBT is one form of cognitive-behavioral therapy (CBT). Other approaches that various therapists use tend to be forms of CBT, with homework and specific self-help skills to learn: cognitive(changing the types of things that they tell themselves) and behavioral(practicing changing little behaviors step by step). Also important in any method of therapy with people with traits of BPD is having a therapist who can ride out the emotional storms of a BPD client’s anger, helping the client become self-aware and use new skills when they are upset like this, rather than getting angry back at the client or rejecting the client. Likewise, it’s important that any therapist with clients with BPD is good at setting limits and guiding the client by gently suggesting behavior change, rather than just providing support for the person as they are (which just reinforces their bad behavior). The implications for this with borderline HCPs in families, the workplace and legal disputes, is that the person may have the potential for change if they can be convinced of the need for ongoing counseling, such as DBT or other cognitive-behavioral skill-training types of therapy. Families can coerce their loved one to get this help by threatening to withdraw their support, as in an alcohol or drug intervention. Employers can threaten termination of employment if the person does not get some kind of help to change their behavior. Judges can order individuals with these disorders to go into treatment to stop certain behaviors, such as domestic violence treatment programs, drug or alcohol treatment programs, or other programs, as a motivation to change or else legal consequences will be imposed. There is hope for change for borderline HCPs if the person will stick with the program. The big question for borderline HCPs (and any HCPs) is whether they can take responsibility for their part in problems, rather than just blaming others.   Narcissistic HCPs HCPs with narcissistic personality disorder (NPD), or just traits but not the full disorder, generally have these characteristics: a drive to be seen as superior; to put others down to put themselves up demanding that others admire them and wanting them to be jealous of them a lack of empathy for

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7 Tips for Working with Clients with Borderline Personality Disorder

Clients with borderline personality disorder (BPD) suffer from constant “emotion dysregulation” (wide mood swings, sudden anger, unnecessary suspiciousness, inappropriately intense excitement, misplaced loving feelings, etc.), as the accompanying article by Shehrina Rooney describes. This is not something over which they have conscious control, unless they are learning to regulate their emotions in some form of therapy. In fact, such emotion dysregulation is at the heart of most of their problems in relationships, with romantic partners, family members and professionals. With this in mind, here are seven tips for those working with someone with BPD:

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typewriter with peace of paper with crisis typed on it

Is This Really a Crisis? People with Personality Disorders Often See Internal Crises as External Crises

Is This Really a Crisis? People with Personality Disorders Often See Internal Crises as External Crises ©2019 Bill Eddy LCSW, ESQ. As I wrote in my latest article in Psychology Today, people with personality disorders often see their own internal crises as external crises caused by someone else. Since I began working with clients with borderline and narcissistic personality disorders over thirty years ago, it has been clear that these individuals spend a great deal of time reacting to situations they perceive as crises that are really internal upsets projected onto others. In fact, one of the first things I learned to teach them was to regularly ask themselves: “Is this really a crisis?” This article briefly reviews some of what I have learned as a therapist and lawyer. Crisis-Prone Characteristics Personality disorders are characterized by the DSM-5 as including “significant distress or impairment in social, occupational, or other important areas of functioning.”1 This internal distress may be triggered by a wide variety of outside events or even the person’s own internal ruminations. In addition, this pattern is unchanging over time, as it “is inflexible and pervasive across a broad range of personal and social situations.”2 Lastly, what is important in this discussion is that this includes “ways of perceiving and interpreting self, other people, and events.”3 This is not all that the DSM-5 says about personality disorders, but the theme of misperceptions of crises is what will be discussed in this article. Targets of Blame Because of these misperceptions of other people, those with personality disorders often have what I call Targets of Blame, who they believe are responsible for causing their feelings of distress. I have seen this many times in legal disputes, when one person is convinced that another person (husband, wife, neighbor, co-worker, supervisor, or even a stranger) is out to harm them, when they really are not. This could be someone almost at random, but it is most commonly someone close to the person or in a position of power over the person. I have observed many people lose a legal case because it was based on such misperceptions about a fantasy Target of Blame. (This is not to say that people with personality disorders don’t also have valid claims some of the time.) Two brief examples help demonstrate this. Borderline Personality Example Many years ago, I represented a young woman in her divorce as her lawyer. She had numerous problems, including a drug addiction, an incident of violence against her soon-to-be ex-husband, a brief hospitalization for danger to self and others, and two young children who were the subject of a custody dispute. Fortunately, we were able to put together an excellent treatment team including a hospital psychiatrist, a clinical social worker as therapist, daily involvement in a 12-step program, and I was her lawyer with a background as a therapist. The team agreed that she had borderline personality disorder, as well as substance use disorder, and she became motivated for treatment—especially because the issue of care of her children depended on her sobriety and a significant improvement in her mental health. Since her case was active in family court, we needed to discuss strategy and her progress on a regular basis. One day she told me that a key part of her recovery (from substances and her personality disorder) was to ask herself these two questions every day: “Is this really a crisis?” And: “What is my part in this problem?” She realized that the incident of violence by her against her husband was an overreaction to fears that he was taking the children away from her forever, when he was really just driving away with them for his routine parenting time. It was not really a crisis, but she misperceived that it was and thereby created a real crisis for herself and everyone else around her. Over the next months and years, she stuck with her recovery from drugs and also her symptoms as someone with borderline personality disorder. She was a good example to me of someone who out-grew the diagnosis of borderline over the next few years. And the other good news is that she was able to become a much better parent and the custody battle in court turned into an out-of-court agreement for shared parenting which both parents handled quite well (he also was in recovery from a substance abuse problem). Narcissistic Personality Example In another case I worked on as a divorce lawyer, my client was a husband who was also a recovering alcoholic for about ten years before I met him. In his case, he was falsely accused of child sexual abuse of his young son by his soon-to-be ex-wife. (I have worked on many true cases of child sexual abuse, as well as many false cases—some honestly believed but false and others knowingly false to the extent of court sanctions being imposed. So I make no assumptions about each case.) After a thorough investigation determined that the accusations were completely untrue, it was not surprising that he was on the defensive and understandably angry. At first he wanted sole physical custody to punish her for her allegations, especially because she told the world about them, including people at his son’s preschool and their church. It became clear that she had a problem, possibly a personality disorder, which may have explained her misperceptions about him. For various reasons, the case eventually evolved into an shared physical custody plan, which endured for several years. They were both able to let go of blaming each other enough to co-parent successfully. But during his family court case he had regular crises or near-crises, which is understandable given the above facts.  At one point, he raised the issue of whether he had a narcissistic personality disorder. (He had read one of my books on this subject in divorce.) He was in therapy and he raised it with his therapist. He said they agreed that he may have had some traits, but not the disorder. I said that made sense to me. Soon after

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