Directions Select two (2) of any Personality Disorders from the DSM-V-TR. After reading through the diagnostic criteria for each diagnosis, please respond to the questions below, then listen to a portion of a podcast about a person who experiences harm due to someone in her life with a personality disorder. Review the podcast portion and respond to the questions after the Prologue and Act One. Please include any references you use to answer the questions.

Select two (2) of any Personality Disorders from the DSM-V-TR. After reading through the diagnostic criteria for each of the diagnoses, please respond to the questions

1. What would be your primary treatment goals for someone experiencing these symptoms?

2. What personal barriers, thoughts, or concerns would you overcome to work with this patient effectively?

Patient #3  Prologue and Act One
: 

https://www.thisamericanlife.org/587/the-perils-of-intimacy

1. What therapeutic goals would you discuss with Rachel if she was your patient? 

2. What personal barriers, thoughts, or concerns would you overcome to work with Rachel effectively?

Therapeutic Goals for Treating Personality Disorders

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Personality Disorders: Treatment Goals and Therapeutic Challenges

Personality disorders (PDs) involve enduring patterns of behavior, cognition, and inner experience that deviate significantly from cultural expectations and lead to interpersonal difficulties, emotional distress, and functional impairment. For this assignment, two DSM-5-TR personality disorders are examined: Borderline Personality Disorder (BPD) and Narcissistic Personality Disorder (NPD). After reviewing diagnostic criteria, treatment goals and personal clinician barriers are explored. The second portion analyzes the podcast This American Life episode “The Perils of Intimacy,” focusing on Rachel, who experienced harm through her relationship with a person displaying pathological traits.

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1. Borderline Personality Disorder (BPD)

BPD is characterized by emotional instability, impulsive behaviors, unstable relationships, identity disturbance, and chronic fears of abandonment (APA, 2022).

Primary Treatment Goals

1. Increase emotional regulation skills.
   Dialectical Behavior Therapy (DBT) is foundational for helping patients reduce affective instability and impulsivity (Linehan, 2015).

2. Reduce self-harm and high-risk behaviors.
   Treatment focuses on crisis planning, safety monitoring, and skills to manage distress.

3. Improve interpersonal effectiveness.
   Patients benefit from learning skills that enhance communication, boundary-setting, and conflict resolution.

4. Strengthen identity coherence.
   Therapy helps patients understand their values, long-term goals, and internal experiences to build stable self-concepts.

Personal Barriers to Overcome as a Clinician

• Managing countertransference. BPD clients may evoke strong emotional reactions due to intense attachment needs or testing behaviors (Gabbard, 2020).

• Avoiding burnout. The clinician must maintain appropriate boundaries and self-care practices.

• Remaining stable during crises. The therapist must remain calm and structured even when the patient is dysregulated or frustrated.

• Reframing behaviors as symptoms, not attacks. Recognizing behavior as trauma-based prevents misinterpretation.

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2. Narcissistic Personality Disorder (NPD)

NPD involves grandiosity, need for admiration, and lack of empathy, along with vulnerability beneath the surface (APA, 2022).

Primary Treatment Goals

1. Increase insight into interpersonal behavior.
   Helping patients recognize the impact of their entitlement and lack of empathy is essential (Ronningstam, 2016).

2. Strengthen emotional tolerance and regulation.
   Many individuals with NPD struggle with shame, hypersensitivity to criticism, and identity instability.

3. Develop empathy and relational reciprocity.
   Therapy aims to expand the patient’s ability to understand others’ perspectives.

4. Reduce dependency on external validation.
   Building intrinsic self-worth helps reduce manipulative or attention-seeking behaviors.

Personal Barriers to Overcome as a Clinician

• Managing feelings of inadequacy or frustration.
  NPD patients may challenge the therapist’s credibility, triggering defensive reactions.

• Avoiding reinforcement of maladaptive patterns.
  Clinicians must not cater to unrealistic expectations or power struggles.

• Maintaining empathy without enabling.
  A balanced stance allows clinicians to hold patients accountable while validating emotions.

• Patience with slow progress.
  Insight develops gradually; expecting rapid change can lead to clinician discouragement.

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After listening to the Prologue and Act One, Rachel describes a relationship with a partner whose behaviors reflect patterns of manipulation, deceit, and emotional instability—traits commonly associated with personality pathology. Rachel experiences confusion, guilt, and trauma as she navigates a relationship marked by dishonesty and abuse. Her narrative highlights the emotional harm that can occur when someone is entangled with an individual who displays personality disorder traits.

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1. Therapeutic Goals for Working With Rachel

A. Restore Psychological Safety

Rachel’s experience includes betrayal, anxiety, and chronic self-doubt. Initial treatment should focus on:

• Establishing a consistently safe therapeutic environment

• Helping her identify signs of manipulation or coercive control

• Reducing hypervigilance and emotional distress

B. Process Trauma and Betrayal

Rachel’s psychological symptoms suggest trauma responses. Treatment may involve:

• Trauma-informed therapy

• Cognitive Processing Therapy (CPT) or EMDR for restructuring distorted beliefs

• Exploration of how manipulation impacted her sense of identity, trust, and boundaries

C. Strengthen Self-Worth and Autonomy

Victims of emotional exploitation frequently internalize blame. Goals include:

• Identifying cognitive distortions (“I should have known better”)

• Building self-compassion

• Enhancing decision-making confidence and assertiveness

D. Develop Healthy Relationship Patterns

Therapy should help Rachel:

• Recognize red flags in future relationships

• Strengthen emotional boundaries

• Understand attachment dynamics influencing her vulnerability to manipulation

E. Improve Social Support and Resource Connection

Rachel may benefit from:

• Peer support groups

• Psych-education on personality disorders

• Safety planning should emotional manipulation continue

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2. Personal Barriers, Thoughts, or Concerns to Overcome as a Clinician

A. Avoiding Overidentification

Rachel’s story may trigger strong protective instincts in the therapist. Clinicians must maintain boundaries and avoid emotional entanglement.

B. Managing Judgment Toward the Harmful Partner

It is natural to feel anger toward individuals who manipulate or harm others. Effective therapy requires:

• Focusing on Rachel’s healing rather than villainizing her partner

• Understanding the relational dynamics that contributed to the harm

C. Preventing Victim-Blaming

Clinicians must ensure:

• Rachel never feels judged for staying in a harmful relationship

• Therapy approaches emphasize empowerment rather than criticism

D. Remaining Patient With Trauma Processing

Recovery from emotional exploitation is nonlinear. Clinicians must respect Rachel’s pace.

E. Monitoring Personal Bias About Personality Disorders

Therapists must challenge internalized beliefs that individuals with PDs are “untreatable” or inherently dangerous. Compassionate, science-based understanding promotes better support for both victims and individuals diagnosed with PDs.

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Borderline and Narcissistic Personality Disorders present unique therapeutic challenges requiring patience, structure, empathy, and firm boundaries. When working with individuals harmed by someone with PD traits—such as Rachel—the clinician must focus on safety, trauma processing, empowerment, and the development of healthy relational patterns. Effective treatment involves not only structured therapeutic goals but also self-reflection, awareness of personal biases, and emotional regulation on the part of the clinician. By integrating trauma-informed approaches, evidence-based practices, and ethical self-monitoring, therapists can support both individuals living with personality disorders and those affected by their behaviors.

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American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.).

Bateman, A., & Fonagy, P. (2016). Mentalization-based treatment for personality disorders. Oxford University Press.

Beck, A. T., Davis, D. D., & Freeman, A. (2015). Cognitive therapy of personality disorders. Guilford Press.

Campbell, W. K., & Miller, J. D. (2011). The handbook of narcissism and narcissistic personality disorder. Wiley.

Gabbard, G. O. (2020). Psychodynamic psychiatry in clinical practice (6th ed.). American Psychiatric Publishing.

Herman, J. L. (2015). Trauma and recovery. Basic Books.

Kernberg, O. (2016). Personality disorders. Yale University Press.

Linehan, M. M. (2015). DBT® skills training manual (2nd ed.). Guilford Press.

Ronningstam, E. (2016). Identifying and understanding the narcissistic personality. Oxford University Press.

Young, J., Klosko, J., & Weishaar, M. (2003). Schema therapy: A practitioner’s guide. Guilford Press.