Character Disturbance, Neurosis, and Therapy

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 confrontingsetting 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.

13 thoughts on “Character Disturbance, Neurosis, and Therapy

  1. It is not only therapists but all of us who struggle with this. I still have a tendency — when I am being manipulated with a pseudo-apology, for example — to explain to the other. But the more I use the techniques you recommend, dr Simon, the more it becomes obvious they know what they are doing perfectly well.

    It is a hard habit to shake, nonetheless. It would help the most to see videos of these confrontations, or best, to live near someone who behaves the sane way around them. But stories are next best… they impart the feel of what we must learn.

    The other pitfall is my tendency to blame back — to get all self-righteous at the nefarious crap they pull. Which they know well to use against me. As you say, “devoid of negativity” is part of the skills we need to learn, and that one is particularly hard for a person outraged by the attacks on them. But learn it we must.

  2. By modeling this, will others in our presence tend to pick up on these skills? I am thinking of my children, who I so badly want to learn to see the character disturbance in the world around us and know how to deal effectively with it. I want them to be empowered and to be able to protect themselves. I know it’s hard to predict if they can gain this kind of understanding and objectivity about character if their parents model effective interactions, but what is your guess? BTW my real name is Linda, not Joan. I have posted before as Joan on this site at a time when I was concerned about the CD individual I deal with somehow knowing my business. I am no longer fearful of anyone knowing I frequent this amazing site.

    1. Modeling appropriate behavior is not only always the right thing to do but eventually does have payoffs with respect to others observing and learning. The observers might not learn or model back what we want them to and when we want them to, but they will learn, and in time, payoffs reliably come.

    1. No, they are not immune. But some disturbed characters typically have a radically different response to adverse circumstances than others do. This is one of the key issues I address in “Character Disturbance.” Also, we not only err but put ourselves in an a position of disadvantage when we assume that trauma lies at the root of most disturbed character behavior patterns.

      1. Didn’t mean to imply trauma would be at the root of malformed characters, who see anything short of self-advancing as loathsome submission. I have read Character Disturbance and I know it’s thinking patterns ingrained for a long time and reinforced that do it. What I meant: Are their undeterred ways of responding to adverse consequences(especially those related to their behavior) apt to make them less likely to experience psychological trauma? Naturally I’m not trying to advocate trying to try and traumatize or it would end up blowing up in our faces, so correcting that possible misinterpretion right off the bat.

        1. Thanks for the comments. And some very good points made here. With respect to the key question, however, “it depends.” That is, there are several personality types which tend to be more character disturbed than neurotic who appear to have a relatively high threshold for responding with great resilience to a catastrophic or otherwise intense event that might prove devastatingly traumatic for others. And with respect to the different response to adverse consequence, sometimes it’s a matter of being almost immune to the “trauma” of circumstances, whereas other times it’s more of a renewed determination to make the pain of a situation an even better reason to intensify and solidify a fist-fighting approach to dealing with and “conquering” the world.

  3. I’ve watched some videos of Cognitive behavioral therapy role-playing. In the ones I can find, they all appear to be interactions between therapist and a person who seems to be fairly neurotic. The vignettes in your books are great. But there’s nothing like a video! Would you consider doing some videos depicting effective interactions and interventions with a character disturbed person (actor I assume)? The best videos I’ve seen are those that have “bubble thoughts” coming from the therapist’s head naming some of the behaviors they are observing as the client talks…

    1. This is something I’ve strongly considered before and even started to do but other things got in the way. Thanks for raising the issue again. You’ve got me thinking about the possibilities.

  4. Dr Simon,

    The videos would be extremely helpful. Do you consult via phone? Would you consider online conferences that cover a topic with possible questions/answers.


    1. I would definitely consider online conferences on a particular subject (so submit any suggestions), and have a series of “webinars” planned to begin in the spring of 2013. I also do scope and time-limited consultations via phone and Skype. To inquire about these, contact me directly through my email address at

  5. Dr Simon

    I read both you books and find them extremely valuable. Todays´ tendency to label everybody with an unapropriate behaviour as beeing depressed dazzles me. To give you an extreme example recently in Portugal my home land a terrible murder happened : a mother set fire to her house with two children inside (hers) and disapeared…later she was found and show no signs of repent…and she is still labeled as beeing depressed or so the media said….

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