'Personality Disorders': supporting people without stigma
I don't mind telling you I have mixed feelings about sharing my new qualification publicly. This year (2021) I trained with Evergreen and passed my exam in August to gain the qualification Certified Personality Disorder Treatment Provider. I trained with Gregory W. Lester, PhD who has trained more therapists in this than anyone else in the world, ever. He certainly speaks from a wealth of clinical experience and shares case examples of helping thousands of people move from lives which are a struggle, involve crime, constant stress and tragically, suicide to people who have satisfying relationships and can engage in their lives in meaningful ways without harm to themselves or others.
I don't like the terminology used when it comes to 'Personality Disorders' and have been resistant to the medical model for some time which can leave people feeling stigmatised and blamed or cause them to stop looking to understand themselves by explaining away their difficulties with a diagnosis. A diagnosis describes what is happening, it doesn't explain it. A person isn't acting or feeling a certain way because they have a personality disorder, the way they are acting or feeling can be labelled as a personality disorder. I am only in support of such a diagnosis if it serves to help a person deepen their understanding of themselves and develop in ways which improves their quality of life (and often that of their family and community). I recognise clients (and their families) who suffer because certain aspects of their personality are limited and other aspects are overly developed. This leads to a rigid, inflexible way of interacting and being in the world, often resulting in conflict with other people and society. Often people in this situation don't see how their actions lead to the conflict and see other people or society as the problem.
Gregory talks about why this is more widely recognised now than it was even a few decades ago. The demands of life were very different in the first half of the 20th century. Options were limited. Life choices were minimal. If you were rigid in how you relate to people it didn't necessarily cause you too many problems. You had your role in life, you interacted with a few people who knew your quirks and you did your job. As society has developed, we have been asked to become more and more flexible and interact with many more people. For people with fully rounded personalities they can adapt to suit the situation and draw on any of their traits to cooperate and get the best possible outcomes. If you have only one dominant trait you have no choice but to keep acting the same way regardless of how people respond, whether it gets you what you want or not, whether it bring happiness or causes suffering.
He describes a 'Normal Personality' as one that,
"1. Contains sufficiently diverse traits as to allow the individual to be flexible and adaptive and to adjust their responses in a way that allows them to achieve more positive than negative consequences given the changing needs, demands, and requirements of different situations in life.
2. Contains sufficient self-monitoring and self-corrective capacity to allow the individual to monitor themselves, correct themselves, and adjust their responses as needed in order to produce positive consequences."
And he describes a 'Personality' that is 'Disordered' as,
"1. Has only one trait, resulting in the individual “doing the same thing over and over” irrespective of the appropriateness of the behavior, the contingencies of the situation, or the negative consequences created.
2. Lacks self-monitoring and self-corrective capacity, resulting in the individual being unable to alter their responses for better consequences and being unable to realize that their own behavior is the cause of their distress."
So while I am not going to be giving out 'Personality Disorder' labels (unless this is specifically requested by the client), I have learnt a huge amount about how to diagnose and recognise each of the types of Personality Disorder, the very specific management and treatment models and how to offer a style of relational therapy that will help people create lives they want to live.