Insight-oriented psychotherapy, which is the most common form of therapy, is tailor made for most of us neurotics.  Why?  Because it provides us with exactly what we need:  insight into the emotional roots of our dysfunctional behavior – emotional roots that are largely unconscious because of the degree to which we’ve repressed our feelings and blocked out of our conscious awareness the unresolved emotional conflicts of our past.  That’s why we tend to appreciate it so much when our counselors interpret the “dynamics” of our problems and shed a “new light” on our circumstances.  And because the ways we might have been trying to cope with our issues were inadequate and making us feel badly, we both need and value the help we inevitably derive from the whole therapeutic experience. But as I pointed out in the prior post (see: Insight, Neurosis, and Character Disturbance) whereas neurotics need and value insight in therapy, disordered characters are already keenly aware of their problematic attitudes and behaviors.  As I’ve said countless times in workshops in a little rhyming mantra:  they already see, they just disagree.  That is, disturbed characters harbor beliefs and attitudes which are at odds with pro-social norms.  So, wasting time in therapy trying to get them to “see” is unnecessary and pointless.  There simply isn’t anything anyone could possibly say or bring to their attention that they haven’t heard a thousand times before from a variety of sources and in a variety of circumstances (still it’s amazing how many therapists will spend inordinate time and energy trying to get the disturbed character to “see” the error of his or her ways). Disturbed characters need something entirely different from the therapy process.  But unfortunately, few therapists are equipped  to provide them what they really need.  That’s primarily because most therapists are still overly aligned with traditional perspectives and insight-oriented approaches.

Disturbed characters need something very different from therapy.  What they need is what I refer to in Character Disturbance as “corrective emotional, cognitive, and behavioral experience.”  Try to give them advice, and they’ll often retort: “I know, I know.”  This not only demonstrates how consciously aware they already are (at least intellectually) of their problems but also attests to the fact that they’re not bothered enough by their way of doing things to consider changing them, or they have been so successful getting their way by doing those things that they don’t have any motivation to change their ways (i.e. their habitual modus operandi).  So the prime therapy task is not getting them to “see” what they’re doing but to practice thinking differently about things and, most especially, doing things differently.   And this always occurs in the moment of benign but definite confrontation.  That’s when genuine change always happens:  in the here and now. Disturbed characters in therapy need to have someone artfully challenge their dysfunctional beliefs, destructive attitudes, and distorted ways of thinking, challenge their stereotypical behaviors and tactics, and invite them to try out some alternatives.  And, as in traditional therapy, fostering change can only take place within the context of a conducive relationship (whether it be a therapeutic relationship with a counselor or any other relationship).  The relationship must be devoid of negativity yet firmly focus on confronting, setting limits, and most especially, correcting thinking errors and maladaptive behavior patterns.  Corrective emotional, cognitive, and behavioral experience means the artful, consistent challenging of someone’s dysfunctional beliefs, destructive attitudes, and distorted ways of thinking, stymieing their typical attempts at manipulation and impression management, enforcing boundaries and limits on their behaviors, and structuring the terms of engagement in a manner that prompts them to try out alternative, more pro-social ways of relating. Then, it’s crucial to reinforce them for their willingness to try out new, more constructive ways of thinking about and doing things.

Naturally, there are some disturbed characters whose pathology is so great or so deeply ingrained that they’re truly non-amenable to therapy.  But those cases are actually quite rare.  As I’ve noted many times before, character disturbance exists along a continuum (see: Character Spectrum Disorders), with most disturbed characters falling somewhere along the spectrum where appropriate intervention can still be quite helpful.  And, as I’ve also noted in all my work, character disturbance is manifested in several different and unique ways, each needing to be dealt with differently.  Still, intervention is possible and potentially quite helpful.  But actually securing appropriate intervention is difficult because of the persisting dominance in the professional community of traditional orientations.  And what most people really mean when they (therapists and lay persons alike) say that there’s no real  hope for personality and character-impaired individuals is that they’ve tried traditional approaches only to have experienced the truly frustrating results.

When In Sheep’s Clothing first came out, there were hardly any professionals aligned with the cognitive-behavioral perspective.  So much of what I had to say at the time seemed radical and not everyone received it well.  In fact, many professionals from a wide variety of disciplines took issue with me and the few other writers willing to speak on personality issues on the whole notion of character disturbance, insisting that everyone with psychological problems must be coming from an insecure, fearful, and emotionally scarred and wounded place and that most of the problems some of us saw as personality or character issues were really caused by underlying yet undiagnosed or untreated clinical conditions like anxiety disorder or depression.  But time, research, and the testimonials of thousands have demonstrated the validity of the perspective I advanced then and continue to refine today.  And now that the developed world is experiencing an epidemic of character disturbance (Japan has become the latest country to publish a new edition of In Sheep’s Clothing and soon, Character Disturbance as well), the perspective is proving more appropriate and timely than ever.   Unfortunately, I still hear horror stories from folks who desperately sought help only to see their situations worsen.  For this reason, in my next post I’ll be presenting some firsthand accounts of therapy encounters that made a difference for folks in relationships with impaired characters.  The names will be changed and the circumstances altered to ensure anonymity, but you’ll be able to get the picture.  Hopefully, the examples I’ll share will give some hope to those of you still struggling to find the right kind of help to deal with a troubled relationship.  And I’ll be highlighting some of the key concepts I outline in both my books about the big differences that apply when engaging therapeutically with impaired characters as opposed to neurotics.