Mentally ill therapists

[ClinPsycMasters]

Have you ever come across a therapist, who, in your opinion, should not be practicing?

I have met a few therapists who had cluster B and C personality traits, perhaps severe enough to meet the criteria for a personality disorder. I've also read quite a few articles about seeming competent therapists who abused their patients (emotionally and sexually) for years.

How do these people complete their training? How do they gain admission? Are they that good in covering up the more extreme pieces of their personality? Is it that we are all vulnerable to all kinds of questionable behavior under the "right" circumstance? Is personality more fluid than I am assuming, meaning that personality traits can develop into a full blown personality disorder under stress?

Most recently a friend of mine told me about a therapist that we both knew for a short while, who was fired from his job, after the extent of his voyeuristic tendencies and his sadistic rage during his therapy sessions became public. Though we all felt he was a bit paternalistic and overly curious, nothing about him particularly jumped at us during the dozen times we met with him over lunch. It boggles the mind.

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[Manicsleep]

I guess the worst is when they use their 'power' to abuse.

A recent example is the psychologists in the Guantanamo case. Disgusting.

 

[rmbsstock]

0ut...

 

[ClinPsycMasters]

I guess the worst is when they use their 'power' to abuse.

A recent example is the psychologists in the Guantanamo case. Disgusting.

I agree. Reminds me of that infamous Milgram experiment. Not to say there was no individual psychopathology in Guantanamo case--and I simply don't know--but that even students of human behavior may be vulnerable to destructive social influence under the "right" circumstances.

 

[Buzzwordsoldier]

Thanks for starting this thread. When I was a noob my mentor went to great lengths to convince me 95% of the people working in the field of mental health are irremediably incompetent. I've since developed a slightly more generous guesstimate of perhaps 80%.

On a related note, for two years and across five hospitals I've met but one patient (yes, I used the word) who had ever worked as a mental health therapist. Care to guess which profession has been far and away the most well represented? One clue -- it's a healthcare profession...

 

[deleted176373]

I guess the worst is when they use their 'power' to abuse.

A recent example is the psychologists in the Guantanamo case. Disgusting.

Really? Outside of the major media accounts what do you know about what the psychologists at GITMO did? There is a lot more to the story than the NPR version of the story.

Now back to the issue of mentally ill therapists... Do you think that a therapist suffering from GAD should not be allowed to practice? Perhaps you should investigate the work of Barry Wolfe and decide whether he's capable of providing competent treatment of anxiety disorders. There are other examples of well known psychologists who have struggled past their own challenges only to have reputations as excellent clinicians, authors, and researchers.

I think that we should be careful before throwing stones, even at people who have personality disorders. I know of therapists who if you tested them would appear to have full blown cluster B personality traits yet they are good therapists, despite the PAI or MMPI suggesting that these people would be otherwise incapable of functioning effectively in society. People can and do manage to overcome their personality traits, and those that can leverage those traits into assets can do very well.

Mark

 

[ClinPsycMasters]

Really? Outside of the major media accounts what do you know about what the psychologists at GITMO did? There is a lot more to the story than the NPR version of the story.

Now back to the issue of mentally ill therapists... Do you think that a therapist suffering from GAD should not be allowed to practice? Perhaps you should investigate the work of Barry Wolfe and decide whether he's capable of providing competent treatment of anxiety disorders. There are other examples of well known psychologists who have struggled past their own challenges only to have reputations as excellent clinicians, authors, and researchers.

I think that we should be careful before throwing stones, even at people who have personality disorders. I know of therapists who if you tested them would appear to have full blown cluster B personality traits yet they are good therapists, despite the PAI or MMPI suggesting that these people would be otherwise incapable of functioning effectively in society. People can and do manage to overcome their personality traits, and those that can leverage those traits into assets can do very well.

Mark

By definition, people with serious mental illness, including Cluster B personality disorders would have severe enough symptoms that their work suffers, and more importantly their patients are negatively affected.

GAD, some depressive symptoms, that's nothing to worry about excessively--no pun intended. Anxiety and depression are the common cold of psychiatry. Heck, if you don't feel some anxiety and depression as a result of the stresses and hassles of living in a major city, economics, your training, dealing with patients and their suffering, you must be superman!

I started this thread to talk about those therapists who do let their mental illness affect their work with patients. I am curious why that happens. Do their colleagues notice that something is not quite right with them but keep silent? Do they work on their own? Do they develop these disorders after training? Are we all vulnerable to this? Does it depend on conscious/unconscious motivations (voyeurism, need for power, etc) for pursuing this line of work? Does it depend on environmental factors as opposed to personal factors?

By no means did I mean to suggest that anyone with a mental illness should not go into mental health. For instance, renowned clinical psychologist, Kay Redfield Jamison, has bipolar disorder. Personal experience of dealing with a mental illness may actually help one sympathize with the patient better.

However, the issue of abuse of power is very serious and sharing opinions, be based on personal experience, research papers, or simply speculations, may be helpful to all of us.

 

[psychmama]

edit - never mind

 

[kbean]

On a related note, for two years and across five hospitals I've met but one patient (yes, I used the word) who had ever worked as a mental health therapist. Care to guess which profession has been far and away the most well represented? One clue -- it's a healthcare profession...

I'm curious but don't have any particular guesses...

 

[TenaciousGirl]

By definition, people with serious mental illness, including Cluster B personality disorders would have severe enough symptoms that their work suffers, and more importantly their patients are negatively affected.

GAD, some depressive symptoms, that's nothing to worry about excessively--no pun intended. Anxiety and depression are the common cold of psychiatry. Heck, if you don't feel some anxiety and depression as a result of the stresses and hassles of living in a major city, economics, your training, dealing with patients and their suffering, you must be superman!

I started this thread to talk about those therapists who do let their mental illness affect their work with patients. I am curious why that happens. Do their colleagues notice that something is not quite right with them but keep silent? Do they work on their own? Do they develop these disorders after training? Are we all vulnerable to this? Does it depend on conscious/unconscious motivations (voyeurism, need for power, etc) for pursuing this line of work? Does it depend on environmental factors as opposed to personal factors?

By no means did I mean to suggest that anyone with a mental illness should not go into mental health. For instance, renowned clinical psychologist, Kay Redfield Jamison, has bipolar disorder. Personal experience of dealing with a mental illness may actually help one sympathize with the patient better.

However, the issue of abuse of power is very serious and sharing opinions, be based on personal experience, research papers, or simply speculations, may be helpful to all of us.

You bring up an interesting topic. I would like to add that it is possible for someone to have very strong traits of an axis II PD but be free from distress. In my opinion, distress is a huge factor in relation to the various areas of functioning. I don't have any research or evidence to back up what I'm about to say, it is purely my opinion. You asked why individuals with mental illness let it affect their work with patients, and are they aware of this when they go into the field, etc. etc. Truthfully I think some people have certain personality traits, needs, and desires, and those attributes attract them to our profession. This can be very positive or negative. I think that some people have awareness of these factors and others don't. Awareness is the key. Clinicians that have awareness are able to keep their own "stuff" in check in hopes that it doesn't interfere negatively with the work with the client. It should be no surprise, then, that individuals without this awareness of their own "stuff" have difficulty in preventing it from negatively impacting their work with others. So there really isn't a definitive answer to your question.

You mentioned if coworkers see these negative traits why they don't say something. I'm curious ... how would that conversation go? "Hey, Dr. X, I notice that you're quite narcissistic. Are you sure you aren't just looking for a constant need of admiration from your patient?" I have heard of supervisors calling out their supervisee on certain traits but I've never heard of a coworker doing this. Obviously if you see a coworker doing something unethical, you should approach him or her to resolve the issue and if it goes unresolved then further action is warranted.

Every profession seems to attract a certain demographic. So when people say the majority of people in psych are "crazy" it seems silly to me. Everyone encounters a "psychological issue" at some point in their lifetime. Whether it's depression, somatic complaints manifested by stress or anxiety, or axis II stuff ... no one is truly free from these problems.

As a side note, when I was in speech-language pathology, I was astonished at the articulation disorders, voice disorders, and pure lack of pragmatic skills/awareness of the faculty in my department. I thought it was odd but even in that field, people with speech and language "issues" were attracted to the profession.

 

[Therapist4Chnge]

Traits are one thing, full blown Sx's that impact one or more areas of daily functioning is a very different issue. I'm sure it happens, though it is tough to get through a typical doctoral program, so I'm not sure if most would be weeded out.

 

[ClinPsycMasters]

Traits are one thing, full blown Sx's that impact one or more areas of daily functioning is a very different issue. I'm sure it happens, though it is tough to get through a typical doctoral program, so I'm not sure if most would be weeded out.

Unless it's not a respectable program. Or that it's a research-intensive program and the therapist in question is as productive as Octomom.

The therapist I referred to in the first post was an excellent researcher and had his bachelor's in math before he switched to psych.

 

[Buzzwordsoldier]

I'm curious but don't have any particular guesses...

RN/NP -- with countless others reporting to work and managing the nursing grind thanks to their regularly prescribed psych meds.

As for mentally ill therapists, I would likely not refer anyone to a therapist whom I knew carried a psychiatric diagnosis. Understand -- to begin with, I'd be only somewhat more likely to refer people to therapists who endorse the concept of mental illness. This has made hospital work veeerrrrrry interesting...

Edit -- not to mention posting on these boards!!!

 

[Rapunzel]

Interesting topic, but I find the implication that mentally ill therapists abuse their patients offensive. It's too close to the assumptions the general public makes that schizophrenics commit violent crimes and other stuff like that. It's a fact that the prevalence of mental illnesses, specifically depression and anxiety, is higher among mental health professionals than in the general population.

The best therapist I have ever known has a history of being institutionalized and was told would never survive outside of a mental hospital. Now this therapist is quite well respected, successful, etc. This therapist sometimes makes statements about being the only sane psychologist out of all of their colleagues.

You might consider me to be a mentally ill therapist. I meet criteria in cluster B, cluster C, depression, anxiety, dissociative symptoms - the "complex PTSD" concept seems to sum it up better tnan any other single label. I'm highest functioning in my professional life, and don't always do so well in personal domains. My graduate GPA was just about 4.0 - I only ever got two A- grades, and those weren't my fault - or I guess maybe they are related to my weaknesses. I couldn't get my team members to follow through on a couple of group assignments, or to approach the tasks intelligently. Getting through school was not a challenge. Holding a job - well, I've never managed to stay at a job past 2 years so far. Hoping for a new record there soon. I do very well working with clients - not quite so well with supervisors. I'm just starting my career. A narcissistic professor (Clinical Psychologist - wrote his own textbook - shared vignettes that might have been entertaining to some students, but his clients would have been very hurt to hear how he presented them) made a broad statement about people who have issues of their own don't belong in this field, and believing him cost me 20 years of my life. I'm sure that professor would have considered himself completely normal, but he was not a very nice person and I am sure that the first therapist I described is a much more effective clinician.

My own therapy has been very important. However, about half of the therapists who treated me, I found out later, had at some point in their career had their licenses revoked for inappropriate sexual behavior with clients. I don't know if any of the ones with the ethics problems meet criteria for mental illnesses, but there were no signs of it that I could observe. What those 3 do all have in common is all were clinical psychologists, and all were spread very thin either with extremely heavy caseloads, travel demands, or both. Now that I think of it, all of them did engage in significant boundary crossings with me and probably all of their clients on a routine basis.

As for me, I've been assaulted by clients - I make a pretty good target sometimes as 'victim' - but would not consider myself at any higher risk than other clinicians (meaning ethical, healthy ones) to act abusively or unethically toward clients. That's not who I am.

 

[ClinPsycMasters]

You might consider me to be a mentally ill therapist. I meet criteria in cluster B, cluster C, depression, anxiety, dissociative symptoms - the "complex PTSD" concept seems to sum it up better tnan any other single label.

As for me, I've been assaulted by clients - I make a pretty good target sometimes as 'victim' - but would not consider myself at any higher risk than other clinicians (meaning ethical, healthy ones) to act abusively or unethically toward clients. That's not who I am.

First part: Are you exaggerating? Are you saying you have two personality disorders and PTSD? Or that you have certain traits belonging to those categories? If you really do meet the criteria for all these mental illnesses (and none is in remission), and still have done so well at school and as a therapist, then hats off to you! You're a great success story, the poster-boy for "wounded healer" type of therapist.

I was obviously making generalizations and did not say every single mentally ill therapist is likely to abuse patients. In fact I also pointed out in one of my posts that one of the questions I have is whether we are all vulnerable to boundary violation and abusing patients, that environmental factors may be just as important.

But mental illness and other "issues" do sometimes affect the work, which is why some schools encourage/require prospective therapists to undergo therapy themselves. The more disturbed individuals may be screened out during admission.

In addition, it may also depend on the kind of work you're going to do. The particular therapist I mentioned was a great researcher and was part of a research-intensive program. Other programs may differ. Also, psychodynamic psychotherapy is more taxing on therapist's psyche, imo. So is working with severely disturbed patients. I am speculating here, but it may also have to do with other issues that are going on in the therapist's life at that time (midlife crisis, divorce, financial issues, etc).

Second highlighted part: what do you mean?

 

[Rapunzel]

No, I'm not exaggerating, but there's a lot of overlap. All or any of the above diagnostic categories could apply, but essentially it all boils down to a central theme. "Complex PTSD" isn't a DSM diagnosis, but is a pretty good description or summary.

My grades in graduate school are a fact. My success as a therapist is really yet to be determined, as I'm just getting started. I get good feedback most of the time, and have been able to understand and connect with some clients in ways that most people don't seem to 'get' because sometimes drawing on my own experiences gives me some insight into what the client is going through - not that I can ever assume that what I felt is exactly the same as what they are feeling. I have had problems as a therapist too. When I was starting my first practicum, I was working with three clients who were all considered to be pretty easy cases - just some situational stuff they needed to work through. I had a severe depressive episode but thought I could keep going and function normally anyway, and that nobody would notice because I thought I could step out of myself and focus on them. All three of my clients asked to change therapists the same week. They sensed that I wasn't right and it made them insecure and nervous. When I'm not sure that I'm okay, I have to communicate with a supervisor and ask them to tell me if it's interfering with my work. I am much better than I used to be.

My interests have to do with trauma and emotional dysregulation. I use DBT, not exclusively but it is what I know best at this point. I'm always learning and adding new tools. I actually work best with the more severely disturbed or traumatized clients. I can connect with them, and I'm a lot less self-conscious than, say, when I'm aware that my client's GAF is higher than mine. Then I get nervous that they might notice, and that wouldn't be a good thing.

The part about being a target or victim - I'm vulnerable. It's like I was born with a sign on my forehead that says "hurt me." I have a sensitive nature, and was always the smallest kid in my age group and was a victim of bullying by peers, sexual abuse, and constant emotional neglect/invalidation by my family. My job, and my last several jobs also, is working with people with aggressive behavior problems. Currently it's youth in court-mandated residential treatment. They are the bullies. And I have been physically attacked though in other settings than where I work now - past jobs. It's not exactly my first choice of population, but it does fit my interests. Even bullies act the way that they do for some reason, and most of them have trauma in their lives too. And I'm not as vulnerable as I once was. I have the keys to the doors and combinations to the security system, and I've been a trainer for systems of physical restraint and crisis management. And very few of the boys I'm working with are interested in beating up a woman half their weight and twice their age, who listens to them.

 

[ClinPsycMasters]

Well, your story is very inspiring to me. I really commend you for your ambition and persistence. You come across as a sympathetic and caring person. I hope you do take good care of yourself because the type of work you're describing sounds quite challenging and draining.

I am glad you posted.

 

[rmbsstock]

First part: Are you exaggerating? Are you saying you have two personality disorders and PTSD? Or that you have certain traits belonging to those categories? If you really do meet the criteria for all these mental illnesses (and none is in remission), and still have done so well at school and as a therapist, then hats off to you! You're a great success story, the poster-boy for "wounded healer" type of therapist.

I used to have extensive discussions with my professors (2 of them) about the issue of the "wounded healer". Both always agreed that you cannot be a healer unless you heal yourself first. You can be wounded first, and get recovery first, then go out and heal others. But to be still wounded and even half healed, you will end up getting sick again and spreading your issues unto others.
I never believed them, till I worked for five years with Juvenile Detention youth. All of which are court mandated to be in my program. They came from Philly and Pittsburgh and all used to call themselves as gangsters from the hood like the Bloods and Crips.. I am 5"1, and my job was to pay the role of the "bad guy" in a Blue Print Program " MTFC Multidimentionsal Treatment Foster Care [check it out on the web). Anyway, I ran this program and I stood infront of gangsters and I played the role I needed to do, but I never ever let them know that I was a victim of Physical, verbal, and sexual abuse. I never made them sense that I am on three anti depressants, because I went to therapy for three years to be able to stand in their face and then be able to sit with them. You cannot heal others unless you are healed. You may need to take drugs for a long time, but these clients need you 100% . If you are still bleeding through out therapy, they are going to lose the most precious person in their life, you are their only support system!
You may always need to have a support system to you to keep you in check, and I have that because I need that for me. But, if I ever feel there is any place a client can come and see within me, or if their GAF is higher than mine, then, there is no need for me to be on the case, for the safety of both of us.
Their safety from a stand point, if I gave them a chance to assault me, then they will have another crime against them in court, and I did them wrong than helped them.

 

[deleted176373]

Traits are one thing, full blown Sx's that impact one or more areas of daily functioning is a very different issue. I'm sure it happens, though it is tough to get through a typical doctoral program, so I'm not sure if most would be weeded out.

Those with "PD's" who leverage those SX's into strengths can practice. Don't make me whip out my highly unusual test scores to support this, but if you took with Greene says about my MMPI code-type, you'd swear there is NO WAY that I would ever be able to practice. My PAI has a section that details that some of my scores are "unusual even in a clinical population (well above the skyline)" and "unlikely to be experiencing any success in his life." LOL.

I do find it amusing that some assume that personality disorders are always debilitating, it's not true, they can be debilitating but they can also be functional. Yes, I could meet the criteria for a PD and it would interfere with my ability to practice if I wasn't compensating adequately for it in other ways. Yes, I understand that I am an N=1, but the diagnosis of a PD isn't sufficient to eliminate someone from practice. You have to look at the whole picture... true, I have not been diagnosed with a PD, but only because I haven't spent enough time on the other side of the couch... not because I don't meet the criteria in a strict sense. These same PD'ish traits make it easier for me to empathize with personality traits that many struggle with and other therapists find difficult to relate to.

Mark

 

[Therapist4Chnge]

Those with "PD's" who leverage those SX's into strengths can practice. Don't make me whip out my highly unusual test scores to support this, but if you took with Greene says about my MMPI code-type, you'd swear there is NO WAY that I would ever be able to practice. My PAI has a section that details that some of my scores are "unusual even in a clinical population (well above the skyline)" and "unlikely to be experiencing any success in his life." LOL.

I agree actually. My point was that there is a large difference between traits and clinically impairing Sx's. I'm sure if I took a personality assessment it'd pop up some OCD and narcissistic personality traits, though not in a clinical range. Look no farther than Donald Trump or Oprah for what Narc. traits can do for a person.

 

[erg923]

hmmm...if i had to venture a guess, Id say markp is a raging psychopath....

Just kidding, obvioulsy...

 

[deleted176373]

hmmm...if i had to venture a guess, Id say markp is a raging psychopath....

Just kidding, obviously...

LOL, you're not too far off! LMAO. Much of my high score is related to my misspent youth.

 

[Therapist4Chnge]

LOL, you're not too far off! LMAO. Much of my high score is related to my misspent youth.

Who knew clogging and basket weaving would attract such nefarious people!

 

[erg923]

well then..im not too worried about the minor blemishes on my record (you know what im talking about) keeping me out of the service for military internships...

 

[ClinPsycMasters]

hmmm...if i had to venture a guess, Id say markp is a raging psychopath....

Just kidding, obvioulsy...

They wouldn't accept such a person in the military.

 

[ClinPsycMasters]

I do find it amusing that some assume that personality disorders are always debilitating, it's not true, they can be debilitating but they can also be functional. Yes, I could meet the criteria for a PD and it would interfere with my ability to practice if I wasn't compensating adequately for it in other ways.
Mark

I think personality disorders can be debilitating and are by definition maladaptive/dysfunctional across a broad range of situations. Of course that does not mean ALL situations. I do believe that having a personality disorder can put you and your patient at risk, given that therapy, specially psychodynamic psychotherapy and similar depth therapies can take you to uncharted territories in your own psyche. Of course a very self-aware person who has a good support system, communicates with caring colleagues, and/or sees a therapist might do just fine or even excel at work.

If I can digress a bit, I do have issues with defining mental illness based on "function." I have read the extensive literature on definition of mental illness but I can't think of a particularly better definition. Yet, defining mental illness based on function overvalues society's structure. For instance, if most jobs in a particular society at a particular historical time require a measure of insensitivity/mercilessness, and I am unable to adapt to such a role, then it is assumed that it is I and my personality that is dysfunctional. That is still a useful concept but to go further and call it a disorder, an illness, to medicalize it essentially, is presumptuous.

 

[PsychGraduate]

PD Axis II disorders can be extrmely troubling in a social context but several of them can be easily masked and even hidden for long periods of time. An extreme case example may be of a serial killer who has a wife, 2.5 kids, a successdul business and is the community leader. There are examples of this in case reports or you can find several in the news archives and these people function at high levels within society for 20 years or more at times. That is the extreme case, but another one is of the psychologist who works ethically with his or her clients and has good clinical outcomes but lies and manipulates without any guilt her friends, family and co-workers, but does not lose their respective job, is not accused of a major crime and lives a relatively normal life. Still rare, but it does happen. Then there are people who have BPD yet they get PhD's and in between attacks of the most severe symptoms work for a number of years, maybe not in clinical but perhaps in research psychology; not as rare as the first two scenarios.

Then there are those clinical psychologists who are way too arrogant and nacrcisstic to be allowed to practice but they do and they make considerable money doing so.

Now true cluster A's and cluster B's will filter out most from actually practicing and the aforementioned were extreme cases, however, no MMPI must be very carefully interpreted.

Generally the person with an axis II does not think there is anything wrong with them.

 

[TenaciousGirl]

PD Axis II disorders can be extrmely troubling in a social context but several of them can be easily masked and even hidden for long periods of time.

Yeah ... "closet narcissism" is a perfect example of this.


I said it before and I'll say it again... Whether or not someone has a PD isn't really the issue. The issue (among others) is: does the PD cause him or her distress? If someone meets the criteria for a PD but is not distressed in a clinical/extreme way, then that person probably wouldn't seek treatment or be very aware. I think this is the setup for a situation where PD traits can be a "benefit" to a person.

 

[Psy01]

I said it before and I'll say it again... Whether or not someone has a PD isn't really the issue. The issue (among others) is: does the PD cause him or her distress? If someone meets the criteria for a PD but is not distressed in a clinical/extreme way, then that person probably wouldn't seek treatment or be very aware. I think this is the setup for a situation where PD traits can be a "benefit" to a person.

It could also be a great problem to the person, even if they're unaware. For example, there is someone in my life who has a PD and they are totally oblivious to the problems it causes (with one big one being that is causes serious damage to their relationships). To them, everyone else has the problem.

 

[ClinPsycMasters]

It could also be a great problem to the person, even if they're unaware. For example, there is someone in my life who has a PD and they are totally oblivious to the problems it causes (with one big one being that is causes serious damage to their relationships). To them, everyone else has the problem.

Yes, exactly! Presumably a person with a personality disorder can still be a good therapist but only if they are really self-aware. If they do not believe that their narcissism or paranoia, for example, can affect the patient during therapy session, then their work suffers. For instance, a patient's hostility will be attributed to his own issues when in fact it is the therapist who is creating the effect.

 

[TenaciousGirl]

It could also be a great problem to the person, even if they're unaware. For example, there is someone in my life who has a PD and they are totally oblivious to the problems it causes (with one big one being that is causes serious damage to their relationships). To them, everyone else has the problem.

ah yes, but is it in fact a problem for them if they do not recognize it as such? Of course *we* see it as a problem, but what about the perspective of the client? I think one of the hardest things about working with PDs has to do with the element of insight and often times that is greatly lacking.

 

[ClinPsycMasters]

ah yes, but is it in fact a problem for them if they do not recognize it as such? Of course *we* see it as a problem, but what about the perspective of the client? I think one of the hardest things about working with PDs has to do with the element of insight and often times that is greatly lacking.

I'm a little confused. Are we still talking about therapists who have PD? In their case, they need to be self-aware because they may mistakenly attribute to the patient, feelings that have arisen during the session as a result of the interaction between patient's personality and that of their own. Self-awareness is of course also necessary with therapists who do not have PD. The ones with PD, however, need even greater awareness as they have bigger blind spots.

And if you are referring to patients with PD, well, not many of them come for therapy. If you are a cutthroat politician or businessman, you could worry less about your narcissistic or antisocial traits. They are in fact quite functional for you. Same goes with a narcissistic surgeon or paranoid spy. You only catch these people if they have a crisis. It's rare that they actually want to change. Some PDs are more functional in our society than others (e.g. avoidant personality disorder)

 

[TenaciousGirl]

I'm a little confused. Are we still talking about therapists who have PD? In their case, they need to be self-aware because they may mistakenly attribute to the patient, feelings that have arisen during the session as a result of the interaction between patient's personality and that of their own. Self-awareness is of course also necessary with therapists who do not have PD. The ones with PD, however, need even greater awareness as they have bigger blind spots.

And if you are referring to patients with PD, well, not many of them come for therapy. If you are a cutthroat politician or businessman, you could worry less about your narcissistic or antisocial traits. They are in fact quite functional for you. Same goes with a narcissistic surgeon or paranoid spy. You only catch these people if they have a crisis. It's rare that they actually want to change. Some PDs are more functional in our society than others (e.g. avoidant personality disorder)

right ... read my post earlier in this thread.

my point was that although we may see the problem or issue, the person (professional or client) may not. So, how do you approach working with someone that lacks this insight? The truth is, many people who lack insight will never gain it for one reason or another. Since one of the original elements in this thread is professionals with PDs ... how would you handle working with someone who has a PD and lacks insight?

 

[ClinPsycMasters]

First off, I would keep my expectations grounded in reality. Hence, I'm not expecting a 180 degree personality change, at least not in a few months. I think significant changes can happen and personality is not as rigid as one might imagine. Of course the person must want to change, at least a bit, either for himself or people he cares about. And I'll provide enough "his kind of evidence" not to mention encouragement that change in that direction is a good thing for him and others.

If I have a narcissistic client who is pissed with the staff at his workplace, thinking they're hindering his progress and not taking his big plans seriously, I try to provide different views, including speculating on what the staff might think and how they might feel. He may be right, at least partially. His narcissism may be based in the reality. His tremendous amount of energy, untamed enthusiasm, and superior intelligence have made him truly believe that he really is special. And he got top grades and has done fairly well at work as a manager. I'll try to change what is possible, and the rest I'll try to channel in an area where it can be "functional." I may encourage him to get involved in the community, to volunteer in a leadership role and that sort of thing.

p.s. this is purely hypothetical and it depends on the person and the particular type of therapy but I use it to illustrate that personality can be changed and what can't, can be shaped and directed to a domain where it can be more functional. Hopefully, he can also be more self-aware and insightful at the end of it all.

 

[TenaciousGirl]

First off, I would keep my expectations grounded in reality. Hence, I'm not expecting a 180 degree personality change, at least not in a few months. I think significant changes can happen and personality is not as rigid as one might imagine. Of course the person must want to change, at least a bit, either for himself or people he cares about. And I'll provide enough "his kind of evidence" not to mention encouragement that change in that direction is a good thing for him and others.

If I have a narcissistic client who is pissed with the staff at his workplace, thinking they're hindering his progress and not taking his big plans seriously, I try to provide different views, including speculating on what the staff might think and how they might feel. He may be right, at least partially. His narcissism may be based in the reality. His tremendous amount of energy, untamed enthusiasm, and superior intelligence have made him truly believe that he really is special. And he got top grades and has done fairly well at work as a manager. I'll try to change what is possible, and the rest I'll try to channel in an area where it can be "functional." I may encourage him to get involved in the community, to volunteer in a leadership role and that sort of thing.

p.s. this is purely hypothetical and it depends on the person and the particular type of therapy but I use it to illustrate that personality can be changed and what can't, can be shaped and directed to a domain where it can be more functional. Hopefully, he can also be more self-aware and insightful at the end of it all.

and what about a coworker, a fellow therapist who you suspect has a PD? (like what you mentioned at the very beginning of the thread) How would you handle being a part of a team with such a person? What could you do other than just deal with it?

 

[ClinPsycMasters]

and what about a coworker, a fellow therapist who you suspect has a PD? (like what you mentioned at the very beginning of the thread) How would you handle being a part of a team with such a person? What could you do other than just deal with it?

I'll bring it up to his attention. Most likely I won't have much info to go by. However, if he is irritating to me or anybody else on the team, I'm sure he'll hear about it. If he's abusive to his patients, it's my ethical obligation to inform the proper authorities. If it's a borderline case, as it usually is, we create a friendly enough environment to allow for constructive criticism at the team meeting so he'll hear everybody's concerns. This is all hypothetical of course and it depends on a lot of different factors, like what information we have to go by, what kind of working environment you have, and your own set of values.

The therapist I mentioned at the beginning of the thread was not strictly a coworker. We knew him--just barely--from school and had lunches together on and off with a bigger group of people and some old classmates.

Edit: just to be clear, I started this thread to get a discussion going. This is simply my opinion.

 

[deleted176373]

First off, I would keep my expectations grounded in reality. Hence, I'm not expecting a 180 degree personality change, at least not in a few months. I think significant changes can happen and personality is not as rigid as one might imagine. Of course the person must want to change, at least a bit, either for himself or people he cares about. And I'll provide enough "his kind of evidence" not to mention encouragement that change in that direction is a good thing for him and others.

I think you're slightly off the mark here, personalities really don't change. They are enduring, and this is why most therapists hate working with PD clients, especially borderlines. I love working with PD's and I DON'T expect them to change their personality, but I rather work with them to manage their personalities and seek to help them leverage their personality traits to become assets rather than liabilities. Perhaps this is a very unsophisticated approach, but it seems to work quite well in therapy and allows them to develop insight to their own behaviors and how they perceive and interpret the world around them.

I think that the whole "disorder" part of personality disorders is a mistake. It is an approach that makes the patient and the therapist believe that there is something inherently flawed in the patient when there is not. What is missing are the tools to deal with these traits and to prevent the traits from leading to poor decision making. Telling the patient that they are flawed allows them to further blame their "disorder" for their inability to control their life. People with PD's have as much ability to make the right decisions for themselves as they have had to make the wrong decisions, the only catch is that they need to be continually evaluating how their perception of events and circumstances may differ from so called "normal" people.

As noted before, these changes don't happen overnight, the nature of personality traits is that they result in practiced behavior patterns and other habits that can prove detrimental to the client. It often takes them a while to come around to doing things differently, but once they do they tend to make rapid progress in improving their lives. You certainly can't force them to change, they have to choose to change, but the underlying personality is stable. I think we may be getting to the same place with clients, but my assertion is that the underlying personality is still there. I think it's important to acknowledge to the client that first they are not "sick" and two that therapy won't change who they are but how they can more effectively approach events in their lives.

Just my 2 cents.

Mark

 

[justme08]

Curious, do you think PTSD or substance abuse can change a person's personality? I happen to share a similiar view regarding PD and them being the examples of people on extreme poles of personlity traits.

 

[deleted176373]

Curious, do you think PTSD or substance abuse can change a person's personality? I happen to share a similiar view regarding PD and them being the examples of people on extreme poles of personlity traits.

Not sure that I would say that about both, but certainly it is possible that both could amplify existing personality traits. I do believe that substance use can bring about changes in personality, as evidenced by people who use pharmacological interventions and react poorly to them, yet another substance for treatment of the same condition may not bring out these differences.

An example of this was a person who was being treated for ADHD with Straterra, collateral information indicated that this person was extremely irritable and easily provoked to anger. The person reported severe mood swings but focus was said to have improved. After switching to Vyvance, the mood swings disappeared and focus remained improved, collateral information suggested that the person was much happier and easy to get along with. Whether this was the amplification of the personality traits or the creation of traits is not something I am sure I could answer.

Mark

 

[ClinPsycMasters]

I think you're slightly off the mark here, personalities really don't change. They are enduring, and this is why most therapists hate working with PD clients, especially borderlines. I love working with PD's and I DON'T expect them to change their personality, but I rather work with them to manage their personalities and seek to help them leverage their personality traits to become assets rather than liabilities. Perhaps this is a very unsophisticated approach, but it seems to work quite well in therapy and allows them to develop insight to their own behaviors and how they perceive and interpret the world around them.

I think that the whole "disorder" part of personality disorders is a mistake. It is an approach that makes the patient and the therapist believe that there is something inherently flawed in the patient when there is not. What is missing are the tools to deal with these traits and to prevent the traits from leading to poor decision making. Telling the patient that they are flawed allows them to further blame their "disorder" for their inability to control their life. People with PD's have as much ability to make the right decisions for themselves as they have had to make the wrong decisions, the only catch is that they need to be continually evaluating how their perception of events and circumstances may differ from so called "normal" people.

As noted before, these changes don't happen overnight, the nature of personality traits is that they result in practiced behavior patterns and other habits that can prove detrimental to the client. It often takes them a while to come around to doing things differently, but once they do they tend to make rapid progress in improving their lives. You certainly can't force them to change, they have to choose to change, but the underlying personality is stable. I think we may be getting to the same place with clients, but my assertion is that the underlying personality is still there. I think it's important to acknowledge to the client that first they are not "sick" and two that therapy won't change who they are but how they can more effectively approach events in their lives.

Just my 2 cents.

Mark

Well, you see Mark, I come from a program where the director, an influential behaviorist, announced quite confidently to the small clinical class that "there is no such thing as personality." Whatever we call personality, he asserted, can be changed because it's nothing but an entrenched pattern of behaviors and as such subject to change.

I won't go that far for sure but I think temperaments are the only things that we can not change...ever! However, personality can be changed. I'm not saying that I can take someone with schizoid personality disorder and changed them into a person with histrionic personality disorder.

I am taking a depth psychology perspective here, assuming that given the person's temperament and the early environment, certain dynamics were created and that these dynamics can be redirected and reshaped--only to some extent.

That is not to say that this is easy or done in a short time. And it depends how entrenched these patterns truly are. It's much easier to do that with a 20 year old who still has identity issues and wants to change, than with a 70-year-old spy whose paranoid personality (disorder) is his identity to a large extent.

Also, as I said--perhaps in this thread?--I am a bit uncomfortable with how we are deciding on what is a disorder and what is not. Nowadays it's all about distress and dysfunction. From a purely functional perspective, we are giving the society and the environment too much credit in telling us who is disordered and who is not. In medicine, it's more clear-cut. If you're limping, that's dysfunction. In psychology, if you are narcissistic enough to think you're god's gift to APA, you can be a good leader!

 

[PsychGraduate]

I think you're slightly off the mark here, personalities really don't change. They are enduring, and this is why most therapists hate working with PD clients, especially borderlines. I love working with PD's and I DON'T expect them to change their personality, but I rather work with them to manage their personalities and seek to help them leverage their personality traits to become assets rather than liabilities. Perhaps this is a very unsophisticated approach, but it seems to work quite well in therapy and allows them to develop insight to their own behaviors and how they perceive and interpret the world around them.

I think that the whole "disorder" part of personality disorders is a mistake. It is an approach that makes the patient and the therapist believe that there is something inherently flawed in the patient when there is not. What is missing are the tools to deal with these traits and to prevent the traits from leading to poor decision making. Telling the patient that they are flawed allows them to further blame their "disorder" for their inability to control their life. People with PD's have as much ability to make the right decisions for themselves as they have had to make the wrong decisions, the only catch is that they need to be continually evaluating how their perception of events and circumstances may differ from so called "normal" people.

As noted before, these changes don't happen overnight, the nature of personality traits is that they result in practiced behavior patterns and other habits that can prove detrimental to the client. It often takes them a while to come around to doing things differently, but once they do they tend to make rapid progress in improving their lives. You certainly can't force them to change, they have to choose to change, but the underlying personality is stable. I think we may be getting to the same place with clients, but my assertion is that the underlying personality is still there. I think it's important to acknowledge to the client that first they are not "sick" and two that therapy won't change who they are but how they can more effectively approach events in their lives.

Just my 2 cents.

Mark

Hit the nail on the head

 

[deleted176373]

Well, you see Mark, I come from a program where the director, an influential behaviorist, announced quite confidently to the small clinical class that "there is no such thing as personality." Whatever we call personality, he asserted, can be changed because it's nothing but an entrenched pattern of behaviors and as such subject to change.

It's clear that we might believe a lot of the same stuff, we are just looking at it from different perspectives. I don't think that the behaviorists are all wrong here, just a different way of conceptualizing it.

I get the point he is trying to make though.

Mark

 

[ClinPsycMasters]

It's clear that we might believe a lot of the same stuff, we are just looking at it from different perspectives...

Mark

Agreed.

 

[stigmata]

In Colorado the licensing law requires us to report other providers who we feel are impaired and dangerous.

 

[ClinPsycMasters]

In Colorado the licensing law requires us to report other providers who we feel are impaired and dangerous.

Interesting. What sort of evidence would you need before you do so?

 

[stigmata]

It doesn't say, and the statute is not adhered to by any means. It is a bit scarey actually...